Analysis of Multiple Infection in Ixodic Ticks <i>Dermacentor reticulatus</i> in a Combined Natural Focus of Vector-Borne Infections in the Tomsk Region

The aim of the study was to characterize mono- and mixed infection with causative agents of vector-borne infections in Dermacentor reticulatus ticks inhabiting one of the anthropourgic foci of the Tomsk Region. Materials and methods. D. reticulatus ticks were collected from vegetation “on the flag” in the forest park zones of the southern part of Tomsk in August and September, 2020–2021. To isolate nucleic acids from homogenates of mites and subsequent PCR diagnostics, kits of the RealBest series (“Vector-Best”, Novosibirsk) were used. 184 individual samples of nucleic acids were examined for the presence of molecular-genetic markers of tick-borne encephalitis virus (TBEV), pathogenic borrelia, babesia, rickettsia, anaplasma, and ehrlichia. Results and discussion. The spectrum of pathogens detected through PCR assay of ticks collected in one of the anthropurgic foci of the Tomsk Region in 2020 and 2021 includes TBEV, pathogenic borrelia, rickettsia, and babesia. The highest rate of D. reticulatus infection has been established in relation to candidate pathogens of tick-borne rickettsioses (Rickettsia sp.) and babesioses (Babesia sp.). The overall frequency of co-infection in D. reticulatus was 12.88 %. Seven different associations of pathogens infecting D. reticulatus have been identified. The majority (88.24 %) of the detected cases of mixed infection were rickettsia associations. Double infection has been registered in 94 % of the total number of mixed variants. Markers of four tick-borne infection pathogens simultaneously (Rickettsia species DNA, Babesia species DNA, Borrelia burgdorferi s.l. DNA and TBEV RNA) have been found in one sample. Changes in areal of the D. reticulatus against the background of an increase in their numbers, determines the need to analyze the epidemiological significance of the ticks of this species in combined foci of tick-borne infections, especially in the zone of sympatry with ixodic ticks of other species

Effects of diet on blood rheological indices, cytokine concentrations, and emergence of metabolic disorders in the persons with increased body mass index

Metabolic syndrome (MS) is a serious medical and social problem due to its high prevalence, lack of common approaches to diagnosis and treatment. Prevention of food dysadaptation reactions and the studies of control mechanisms of immune tolerance to food antigens is of special scientific interest, thus providing available anti-inflammatory tools for correcting increased permeability of the intestinal epithelium and vascular endothelium associated with development of MS. Nutritional dysadaptation occurs due to inappropriate diet being mediated by the geno-phenotypic characteristics of digestive enzymes and immune system which control the efficiency of food digestion.Immunological control of digestion, including dynamic maintenance of tolerance to food antigens, is carried out at two levels of immune system: innate response with functional involvement of microbiota, and adaptive response, represented by cellular and humoral mechanisms associated with molecular epitopes and critical mass of persistent food antigens which are present in immunologically competent areas of small intestine, due to changing permeability of intestinal barrier and transcytosis processes. Patients and methods: aiming for assessment of the diet contribution to the immuno-biochemical and rheological imbalance in people with increased body weight, 170 volunteers of both sexes aged 20-55 years were examined, depending on the body mass index: &gt; 27.0 kg/m2 (clinical group, n = 120), and those with BMI of &lt; 25.0 kg/m2 (control group, n = 50). We have revealed statistically significant increase of multiple parameters in the clinical group, i.e., concentration of IL-6, IL-17, cholesterol, glucose, glycosylated hemoglobin, insulin, indices of insulin resistance and atherogenicity. Increased levels of specific IgG antibodies to a number of food antigens were found in the subjects in the clinical group. In the course of our study, a statistically significant relationships was found between total numbers of platelets (p &lt; 0.05; r = 0.213), erythrocytes (p &lt; 0.05; r = -0.211), mean erythrocyte volume (MCV) (p &lt; 0, 05; r = 0.339), and the concentration of IgG to casein in the blood, as well as a correlation between the levels of sIgG to soybeans and the number of platelets (p &lt; 0.05; r = 0.231). At the same time, some associations were found between the established values of IgG to casein pAG, and the risk of developing atherogenic changes (atherogenicity index &gt; 3) being significant at OR = 2.68 (1.33-5.42), as well as between IgG values to casein pAG (OR = 8.9 (2.6-30.5)), to soybean pAG (OR = 5.6 (1.8-16.7)), to gluten pAG ((F = 0.00359. p &lt; 0.05), and increased body mass index.The results obtained were interpreted as a possible impairment of food tolerance for a number of food antigens in individuals with high body mass index, due to the revealed correlations between concentrations of IgG to food antigens, imbalance of pro-inflammatory cytokines, rheological and metabolic parameters. These data may be used as biomarkers suggesting higher risk of evolving metabolic syndrome

Features of baseline and lipopolysaccharide-induced cytokine secretion in mononuclear leukocyte cultures from patients with the erythema migrans form of acute lyme borreliosis based on clinical parameters

Introduction. Features of cytokine production in mononuclear cell cultures from Lyme borreliosis patients based on clinical data remained poorly studied. The study aim was to estimate the patterns of baseline and lipopolysaccharide-induced cytokine-secretory activity of peripheral blood mononuclear leukocytes from patients with erythema migrans form of acute Lyme borreliosis based on clinical parameters. Materials and methods. Groups of 22 and 12 patients with the diagnoses of mild or moderate severity of monoinfection and co-infection with tick-borne encephalitis of Lyme borreliosis with erythema migrans were examined twice: on week 1 after disease onset and day 14. The control group included 17 healthy donors. Basal and lipopolysaccharide-induced IL-6, IL-10, and TNFα secretion levels were assessed in mononuclear leukocyte culture supernatants applying enzyme immunoassay. Statistical analysis was performed by using the Mann–Whitney U-test, Wilcoxon test, and Spearman’s rank correlation. Results. The group of moderate severity patients was clinically distinguished by severer fever and intoxication manifestations. At the disease onset, the basal TNFα, IL-6 and IL-10 secretion levels in the moderate severity patient cultures were significantly higher than in those of the other groups. After antibiotics treatment, the baseline TNFα and IL-10 levels tended to decrease. At the onset, lipopolysaccharide-induced cultures from the moderate severity patients showed significantly suppressed TNFα production and increased IL-10 secretion as compared to the other groups. Lipopolysaccharide-induced IL-6 secretion in the moderate vs. mild severity group supernatants was significantly lower. In dynamics, the induced TNFα levels in the moderate severity patients were increased to the magnitude exceeding that in the controls. Positive correlations between the IL-6 and TNFα basal levels and maximum body temperature or the C-reactive protein serum concentrations were revealed in the patients. Induced TNFα levels showed negative correlations with fever levels or with IL-10 secretion. Conclusions. It was demonstrated that basal TNFα, IL-6 and IL-10 secretion levels in the mononuclear cell cultures of acute Lyme borreliosis patients increased with the increasing disease severity. Suppression of lipopolysaccharide-induced TNFα production in the moderate severity patient cultures was presumably associated with the regulatory cytokine IL-10 effects

Development of score models for severe course risk assessment of febrile form of tick-borne encephalitis

Background. There is no current generally accepted classification and clinical approaches to assess the clinical course severity of tick-borne encephalitis.   The aim is to develop models for the quantitative severity scores of the febrile form of tick-borne encephalitis using the most informative predictors.   Materials and methods. In accordance with clinical criteria of the height and duration of fever, two groups of 9 and 30 patients (52.2 ± 4.3 and 49.5 ± 3.9 years old) with severe and non-severe febrile form of tick-borne encephalitis were formed. The study design was a retrospective case-control study. Statistical significance assessment of variables was carried out using the chi-square test. The odds ratios were also calculated. The development of logistic regression models was carried out using Statistica 12.0 modules.   Results. A questionnaire of febrile form of tick-borne encephalitis severity score was developed using the height of fever and 11 most informative clinical predictors including arthralgia, chills, sleep disturbance, dizziness, orbital pain, nausea, photophobia, myalgia, severe headache, vomiting and meningism. To predict the severe clinical course of febrile form of tick-borne encephalitis, two logistic regression models were developed with or without severity score assessment of fever syndrome (coefficients α and β were –12.13 and 0.94 and –5.78 and 0.75 for models 1 and 2, respectively). Models 1 and 2 demonstrated a high predicted probability for cut-off values equal to 14 and 9 points and excellent quality of prediction test (AUC are equal to 0.99 and 0.98, respectively).   Conclusions. The models of severity score demonstrated high predicted probabilities to predict severe clinical course of febrile form of tick-borne encephalitis, which can be used in clinical practice and for scientific purposes

Прогностическая значимость общеклинического анализа крови для ранней диагностики микст-инфекции безэритемной формы иксодового клещевого боррелиоза и клещевого энцефалита

Objective: is to develop a model for early diagnosis of mixed infection of the non-erythema migrans form of Lyme borreliosis and tick-borne encephalitis using the assessment of the complete blood count and the blood leukocyte indices of patients in the first week of the disease.Materials and methods. The retrospective clinical study involved Group 1 of 27 patients with the mixed infection of the non-erythema migrans form of Lyme borreliosis and the febrile form of tick-borne encephalitis and Group 2 of 29 patients with the monoinfection of the non-erythema migrans form of Lyme borreliosis, who were hospitalized no later than in the 7th day of the disease. The average age of patients in Groups 1 and 2 was 50.6±3.4 and 49.9±2.3. We analyzed 14 parameters of the complete blood count as well as calculated the leukocyte intoxication index and the body resistance index. Statistical significance assessment was carried out using the chi-square test and ROC analysis. Logistic regression model was developed using STATISTICA 12.0 modules.Results. The levels of the band and polymorphonuclear neutrophils (&lt;0,001 и p=0,002) and the leukocyte intoxication index (p&lt;0,001) were significantly higher and the levels of the body resistance index (p&lt;0.001), lymphocytes (p&lt;0.001) and platelets (p=0.004) were lower in Group 1 than in Group 2. Informative predictors of mixed infection included the body resistance index (AUC=0.77), leukocyte intoxication index (AUC=0.75), the band and polymorphonuclear neutrophils (AUC=0.74), lymphocytes (AUC=0.77), and platelets (AUC=0.70). Logistic regression model has a “very good” predictive value (AUC=0.85) and include two parameters: body resistance index and platelets (×109/L).Conclusion. The developed model has a “very good” predictive value for early diagnosis of the mixed infection of the non-erythema migrans form of Lyme borreliosis and tickborne encephalitis before laboratory diagnosis confirmation. Цель: разработка модели ранней диагностики микст-инфекции безэритемной формы иксодового клещевого боррелиоза и клещевого энцефалита на основе изучения информативности предикторов общеклинического анализа крови и лейкоцитарных индексов у больных в первую неделю заболевания.Материалы и методы. В ретроспективное клиническое исследование было включено 27 пациентов с микстинфекцией безэритемной формы ранней локализованной стадии иксодового клещевого боррелиоза и лихорадочной формы клещевого энцефалита (группа 1) и 29 больных моноинфекцией безэритемной формы иксодового клещевого боррелиоза (группа 2), госпитализированных не позднее 7-го дня заболевания. Средний возраст больных в группах 1 и 2 был 50,6±3,4 и 49,9±2,3 лет. Проанализированы 14 показателей общеклинического анализа крови и рассчитаны лейкоцитарный индекс интоксикации по Я.Я. Кальф-Калифу и индекс резистентности организма. Для статистического анализа применяли критерий «хи-квадрат» и ROC-анализ. Разработка моделей логистической регрессии проводились с помощью модулей STATISTICA 12.0.Результаты. Больные в группе 1 по сравнению с группой 2 имели существенно более высокие уровни таких показателей, как палочкоядерные и сегментоядерные нейтрофилы (p&lt;0,001 и p=0,002) и лейкоцитарный индекс интоксикации (p&lt;0,001) при одновременном значительном снижении уровней индекса резистентности организма (p&lt;0,001), лимфоцитов (p&lt;0,001) и тромбоцитов (p=0,004). Предикторами микст-инфекции, имеющими «хороший» прогноз, были индекс резистентности организма (AUC=0,77), лейкоцитарный индекс интоксикации (AUC=0,75), палочкоядерные и сегментоядерные нейтрофилы (AUC=0,74), лимфоциты (AUC=0,77) и тромбоциты (AUC=0,70). Для ранней диагностики микст-инфекции была построена модель логистической регрессии, имеющая «очень хорошую» прогностическую значимость (AUC=0,85), которая включала две переменные: индекс резистентности организма и тромбоциты (×109 /л).Заключение. Разработанная модель позволяет с высокой вероятностью прогнозировать микст-инфекцию безэритемной формы иксодового клещевого боррелиоза и клещевого энцефалита до лабораторной верификации диагноза

Complex analysis of information technologies integration and adoption into medical organizations

Nowadays Information Technologies (IT) are taking more and more stable position in the process of work organization in various companies, and particularly among medical organizations. Present-day scientific society has already begun to research the topic of IT integration particularities into the Health organizations. Current article is focused on this issue. Our team has planned and provided a systematic review to understand which barriers can appear in different medical centers during implementation of the innovative IT into working process. The review has been fulfilled according to the designed protocol based on the actual recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. In the course of the workflow we have explored 2050 articles complied with the requirements. As a result, 23 key publications have been chosen and analyzed in detail. After considering the list of issues and barriers associated with the IT Implementation into hospitals and medical centers have been highlighted and described. We have classified them to notional clusters depending on the reasons of their appearance as well. In addition our team has defined the list of practical recommendations following which the result of the IT integration will be improved, but the risk of a negative outcome in the future can be eliminated