Neurotropic enteroviruses (Picornaviridae: Enterovirus): predominant types, basis of neurovirulence

Enteroviruses are one of the most common causative agents of infectious diseases of the central nervous system. They are characterized by genetic variability, the ability to infect a wide range of cells, including brain microglial cells and astrocytes, and persist in the central nervous system tissue, causing delayed and chronic diseases. The review presents data on the basis of neurovirulence of non-polio enteroviruses and the most common pathogens causing enteroviral neuroinfections.

Phylodynamic characteristics of reassortant DS-1-like G3P[8]-strains of rotavirus type A isolated in Nizhny Novgorod (Russia)

Since 2013, there has been an increase in reports of the spread of a double intergroup reassortant strain of rotavirus type A (RVA) with the genotype G3P[8] and other genes belonging to the second genogroup I2-R2-C2-M2-A2-N2-T2-E2-H2. In our study, we provide a molecular genetic characterization of rotaviruses with genotype G3P[8]-I2 isolated in Nizhny Novgorod. In our study, we used RT-PCR, Sanger sequencing, RNA-PAGE methods. Phylogenetic and phylodynamic analysis were performed using the Bayesian approach. According to our study, there was a significant increase in the proportion of G3P[8] from 15% during the period of 2020-2021 to 53% during the period of 2021-2022 in Nizhny Novgorod, Russia. Phylogenetic analysis based on the VP4 gene revealed that DS-1-like RVAs isolated in Nizhny Novgorod belong to different clusters of the P[8]-3.1 lineage, with a level of variation ranging from 1.1% to 1.3%. Based on the VP6 gene, the equine-like RVAs identified by us carry genetic variants belonging to three distinct clusters of the lineage I2-V, with a variation level ranging from 2.0% to 4.5%. These data indicate the genotypic diversity of circulating DS-1-like G3 RVAs. Phylogenetic analysis of the VP7 gene allowed us to assign the isolates identified in our study to the G3-1 lineage. We estimated that the circulation of the most recent common ancestor of the spreading strains dates back to 2002. Additionally, we determined the typical level of mutations in the VP7 gene, which amounted to 2.14*10-3 substitutions/per site/per year.

The use of Dapagliflozin in Acute Decompensated Heart Failure: Results of the Randomized Study

Aim      To determine the effect of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on kidney function in acute decompensated heart failure (ADHF).Material and methods  A controlled randomized study on the dapagliflozin treatment in ADHF was performed. Patients were randomized to a main group (standard therapy supplemented with dapagliflozin) or a control group (standard therapy for ADHF). The primary endpoint was the development of acute kidney injury (AKI). 200 patients were included (mean age, 74±12 years; 51% men). 31% of patients had type 2 diabetes mellitus (DM2). Mean left ventricular ejection fraction (LV EF) was 47±14 %; in 44.5% of patients, LV EF was less than 45%. Median concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) was 5225 [3120; 9743] pg / ml, glomerular filtration rate (GFR) was 51 [38; 64] ml / min / 1.73 m2.Results In-hospital mortality was 6.5%. Analysis of the dynamics of body weight loss showed significant differences (4200 [2925; 6300] g vs. 3000 [1113; 4850] g; p=0.011) in favor of the dapagliflozin group. The requirement for increasing the daily dose of furosemide and adding an another class diuretic (thiazide or acetazolamide) did not differ between the groups. However, median furosemide dose during the stay in the hospital was lower in the dapagliflozin group (80 [67; 120] mg vs. 102 [43; 120] mg; p=0.016). At 48 hours after randomization, GFR significantly decreased in the dapagliflozin group (-5.5 [-11; 3] ml/min/ 1.73 m2) compared to the control group (-0.3 [-4; 5] ml / min/1.73 m2, р=0.012). Despite this, GFR did not differ between the groups at discharge (51 [41; 66] ml/min/1.73 m2 and 49 [38; 67] ml/min/1.73 m2, respectively; p = 0.84). In the dapagliflozin group, frequency of AKI episodes was not increased compared to the control group (13 and 9.4%, respectively; p = 0.45).Conclusion      The dapagliflozin treatment in ADHF is associated with more pronounced body weight loss and lower average doses of loop diuretics during the period of stay in the hospital, with no associated clinically significant impairment of renal function.

Detection and full-genotype determination of rare and reassortant rotavirus A strains in Nizhny Novgorod in the European part of Russia

Reassortant DS-1-like rotavirus A strains have been shown to circulate widely in many countries around the world. In Russia, the prevalence of such strains remains unclear due to the preferred use of the traditional binary classification system. In this work, we obtained partial sequence data from all 11 genome segments and determined the full-genotype constellations of rare and reassortant rotaviruses circulating in Nizhny Novgorod in 2016-2019. DS-1-like G3P[8] and G8P[8] strains were found, reflecting the global trend. Most likely, these strains were introduced into the territory of Russia from other countries but subsequently underwent further evolutionary changes locally. G3P[8], G9P[8], and G12P[8] Wa-like strains of subgenotypic lineages that are unusual for the territory of Russia were also identified. Reassortant G2P[8], G4P[4], and G9P[4] strains with one Wa-like gene (VP4 or VP7) on a DS-1-like backbone were found, and these apparently had a local origin. Feline-like G3P[9] and G6P[9] strains were found to be phylogenetically close to BA222 isolated from a cat in Italy but carried some traces of reassortment with human strains from Russia and other countries. Thus, full-genotype determination of rotavirus A strains in Nizhny Novgorod has clarified some questions related to their origin and evolution.

On the nature of picobirnaviruses

The picobirnaviruses (Picobirnaviridae, Picobirnavirus, PBVs) are currently thought to be animal viruses, as they are usually found in animal stool samples. However, no animal model or cell culture for their propagation has yet been found. In 2018, a hypothetical assumption about PBVs belonging to prokaryotic viruses was put forward and experimentally substantiated. This hypothesis is based on the presence of Shine-Dalgarno sequences in the genome of all PBVs before three reading frames (ORF) at the ribosomal binding site, with which the prokaryotic genome is saturated, while in the eukaryotic genome such regions occur with low frequency. The genome saturation with the Shine-Dalgarno sequences, as well as the preservation of this saturation in the progeny, according to scientists, allows us to attribute PBVs to prokaryotic viruses. On the other hand, there is a possibility that PBVs belong to viruses of eukaryotic hosts - fungi or invertebrates, since PBV-like sequences similar to the genome of fungal viruses from the families of mitoviruses and partitiviruses have been identified. In this regard, the idea arose that, in terms of reproduction mode, PBVs resemble fungal viruses. The divergence of views on the true PBV host(s) has sparked discussions among scientists and required further research to elucidate their nature. The review highlights the results of the search for a PBV host. The reasons for the occurrence of atypical sequences among the PBV genome sequences that use an alternative mitochondrial code of lower eukaryotes (fungi and invertebrates) for the translation of viral RNA-dependent RNA polymerase (RdRp) instead of the standard genetic code are analyzed. The purpose of the review was to collect arguments in support of the hypothesis about the phage nature of PBVs and to find the most realistic explanation of the reasons for identifying non-standard genomic sequences for PBVs. Based on the hypothesis about the genealogical relationship of PBVs with RNA viruses from other families with similar segmented genomes, such as Reoviridae, Cystoviridae, Totiviridae and Partitiviridae, virologists support the assumption of a decisive role in the origin of atypical PBV-like reassortment strains between PBVs and viruses of the listed families. The collected arguments given in this review indicate a high probability of a phage nature of PBVs. The data presented in the review show that the belonging of PBV-like progeny to prokaryotic or eukaryotic viruses is determined not only by its genome saturation level with a prokaryotic motif, standard or mitochondrial genetic code. The primary structure of the gene encoding the viral capsid protein responsible for the presence or absence of specific proteolytic properties of the virus that determine its ability for independent horizontal transmission into new cells may also be a decisive factor.

Enterovirus 71-Associated Infection in South Vietnam: Vaccination Is a Real Solution

Hand-foot-and-mouth disease (HFMD) is the most common enteroviral infection in South-East Asia. When evaluating the role of enterovirus 71 (EVA71) as an etiological agent of infectious disease in South Vietnam, we revealed a high proportion of EVA71 among identified species A enteroviruses found in 3542 samples from HFMD cases; 125 samples from cases of enteroviral meningitis; and 130 samples from acute flaccid paralysis (AFP) cases. These represent 50%, 54.8%, and 51.5%, respectively. According to molecular analysis, 90% of EVA71 were attributed to genotype C4 and 10% were attributed to genotype B5. The predominance of EVA71 circulation among the population proves the need to strengthen surveillance (with monitoring of enterovirus circulation for facilitation of HFMD outbreak prediction) and to increase the effectiveness of preventative measures by the implementation of vaccination against EVA71-associated infections. A phase III trial of a Taiwanese vaccine (EV71vac) in Taiwan and South Vietnam showed its safety, tolerability, and efficacy in children aged 2-71 months. This B4 genotype-based vaccine, which features cross-protection against B5 and C4 genotypes, and other existing EV71 vaccines can serve as a good approach to solving the HFMD problem, which is so important for Vietnam.

[Variability of genes encoding nonstructural proteins of rotavirus А (Reoviridae: Rotavirus: Rotavirus A) genotype G9P[8] during the period of dominance in the territory of Nizhny Novgorod (central part of Russia) (2011-2020)]

INTRODUCTION

In Russia, rotavirus A is the main cause of severe viral gastroenteritis in young children. The molecular features that allow a rotavirus of a particular genotype to gain an evolutionary advantage remain unclear, therefore, the study of the genetic diversity of rotaviruses based on genes encoding nonstructural proteins (NSPs) responsible for the reproduction of the virus in the cell is an urgent task.

OBJECTIVE

To study the genetic diversity of rotaviruses of genotype G9P[8], which dominated Nizhny Novgorod in 20112020, based on genes encoding nonstructural proteins.

MATERIALS AND METHODS

Rotavirus-positive samples were subjected to PCR-genotyping and sequencing of NSP1 NSP5 genes. Phylogenetic analysis was carried out in the MEGA X program.

RESULTS

In the period 20112020, G9P[8] rotaviruses with four variants of the NSP2 gene were co-circulating in Nizhny Novgorod. New alleles were noted in 2012 (N1-a-III), 2016 (N1-a-IV) and in 2019 (N1-a-II). The appearance of new variants of other genes occurred in 2014 (E1-3, NSP4), 2018 (T1-a3-III, NSP3) and in 2019 (A1-b-II, NSP1). NSP2 gene had the most variable amino acid sequence (16 substitutions), 2 to 7 substitutions were observed in NSP1, NSP3 and NSP4, NSP5 was conservative.

DISCUSSION

The results obtained are consistent with the literature data and indicate the participation of NSP genes in maintaining the heterogeneity of the rotavirus population.

CONCLUSION

Until 2018, the genetic diversity of rotaviruses in Nizhny Novgorod was determined by the circulation of strains carrying several alleles of the NSP2 gene and conservative genes NSP1, NSP3NSP5. By the end of the study period, new variants of the genotype G9P[8] were formed in the population, carrying previously unknown combinations of alleles of nonstructural genes.

An increase in prevalence of recombinant GII.3[P12] norovirus in sporadic acute diarrhea in children in Nizhny Novgorod, Russia, 2018-2021

Noroviruses are important etiological agents causing acute intestinal infection in humans. In the last decades, the most common norovirus genotype was GII.4 despite a significant genetic diversity among strains, while the active circulation of noroviruses with other genotypes was observed periodically. This study shows an increase in the detection rate of recombinant GII.3[P12] norovirus in Nizhny Novgorod, Russia, from 6.8% in 2018-2019 to 34.9% in 2020-2021. We performed a phylogenetic analysis based on the nucleotide sequences of noroviruses possessing this genotype obtained in this work, as well as presented in the GenBank database. It has been shown that the circulation of GII.3[P12] noroviruses in the study area was the result of several independent introductions, either directly from the Western Pacific region, or through the Asian part of Russia. The polyphyletic origin, the geographical expansion, and the growth of the epidemic significance of the recombinant GII.3[P12] noroviruses were noted.

[Detection SARS-CoV-2 (Coronaviridae: Coronavirinae: Betacoronavirus: Sarbecovirus) in children with acute intestinal infection in Nizhny Novgorod during 2020-2021]

INTRODUCTION

The novel coronavirus infection COVID-19 is a major public health problem worldwide. Several publications show the presence of gastrointestinal (GI) symptoms (nausea, vomiting, and diarrhea) in addition to respiratory disorders.The aim of this study was the monitoring of RNA of COVID-19 pathogen, coronavirus SARS-CoV-2 (Coronaviridae: Coronavirinae: Betacoronavirus; Sarbecovirus) in children hospitalized with acute intestinal infection (AII), with following molecular-genetic characterization of detected strains.

MATERIAL AND METHODS

Fecal samples of children with AII hospitalized in infectious hospital of Nizhny Novgorod (Russia) in the period from 01.07.2020 to 31.10.2021 were used as material for the study. Viral RNA detection was performed by real-time polymerase chain reaction (RT-PCR). The nucleotide sequence of S-protein gene fragment was determined by Sanger sequencing.

RESULTS AND DISCUSSION

SARS-CoV-2 genetic material was detected in 45 out of 2476 fecal samples. The maximum number of samples containing RNA of the virus occurred in November 2020 (detection rate of 12.2%). In 20.0% of cases, SARS-CoV-2 RNA was detected in combination with rota-, noro-, and adenoviruses. 28 nucleotide sequences of S-protein gene fragment complementary DNA (cDNA) were determined. Phylogenetic analysis showed that the studied SARS-CoV-2 strains belonged to two variants. Analysis of the S-protein amino acid sequence of the strains studied showed the absence of the N501Y mutation in the 2020 samples, which is a marker for variants with a high epidemic potential, called variants of concern (VOC) according to the World Health Organization (WHO) definition (lines Alpha B.1.1.7, Beta B.1.351, Gamma P.1). Delta line variant B.1.617.2 was identified in two samples isolated in September 2021.

CONCLUSION

The detection of SARS-CoV-2 RNA in the fecal samples of children with AII, suggesting that the fecal-oral mechanism of pathogen transmission may exist, determines the necessity to optimize its monitoring and to develop an algorithm of actions with patients with signs of AII under the conditions of a novel coronavirus infection pandemic.

Cases of Acute Flaccid Paralysis Associated with Coxsackievirus A2: Findings of a 20-Year Surveillance in the Russian Federation

Surveillance for acute flaccid paralysis syndrome (AFP) in children under 15 is the backbone of the Global Polio Eradication Initiative. Laboratory examination of stool samples from AFP cases allows the detection of, along with polioviruses, a variety of non-polio enteroviruses (NPEV). The etiological significance of these viruses in the occurrence of AFP cases has been definitively established only for enteroviruses A71 and D68. Enterovirus Coxsackie A2 (CVA2) is most often associated with vesicular pharyngitis and hand, foot and mouth disease. Among 7280 AFP cases registered in Russia over 20 years (2001–2020), CVA2 was isolated only from five cases. However, these included three children aged 3 to 4 years, without overt immune deficiency, immunized with 4–5 doses of poliovirus vaccine in accordance with the National Vaccination Schedule. The disease resulted in persistent residual paralysis. Clinical and laboratory data corresponded to poliomyelitis developing during poliovirus infection. These findings are compatible with CVA2 being the cause of AFP. Molecular analysis of CVA2 from these patients and a number of AFP cases in other countries did not reveal association with a specific phylogenetic group, suggesting that virus genetics is unlikely to explain the pathogenic profile. The overall results highlight the value of AFP surveillance not just for polio control but for studies of uncommon AFP agents.

Is this atherosclerosis in patients with HIV? Data received by OCT

Background

Chronic infection by HIV evolves with a vascular inflammatory action causing endothelial dysfunction. The action of the virus as well as the side effects of antiretroviral drugs contributes to the progression of cardiovascular diseases. The study aimed to characterise the changes of the structure of the coronary wall and the thickening of the intima by Optical Coherence Tomography in HIV-infected patients with or without symptoms of coronary heart disease.

Methods

Fifty-two HIV-infected individuals had a mean age of 49.8±11.4 years. There were 75% men, diabetes 30,8%, hypertension 30,8%, smokers 34,62% and 7,7% with cholesterol levels ≥99 mg/dl. Control group included 120 non-HIV-infected controls with coronary heart disease. All the participants from HIV-group receive ART, 100% of participants had plasma HIV RNA <20 copies/mL and 78,85% of them have symptoms of coronary artery disease.

Results

The average diffuse homogeneous thickening of the intima in patients with HIV was 0.67±0.24 mm, and 0.34±0.18 mm in control group, with normal values not exceeding 0.05 mm. There was impaired three-layer structure of coronary wall in 90,4% (47 of 52) HIV-infected participants and in 60% of control group, atherosclerotic plaque had only 34,62% of HIV group. All HIV-infected patients receive ART more than 5 years.

Conclusion

The coronary angiography and OCT demonstratedthat the inflammatory process resulting from HIV-infection or HAART may be relevant in the changes of coronary arteries in HIV-positive patients. The changes are predominantly represented by thickening of the intima, impaired three-layer structure of arterial wall and accelerating atherosclerosis.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Russian National Research Medical University named after N.I. PirogovCentral Clinical Hospital of Russian Academy of Science, Moscow, Russia

[Molecular monitoring of the rotavirus (Reoviridae: Sedoreovirinae: Rotavirus: Rotavirus A) strains circulating in Nizhny Novgorod (2012-2020): detection of the strains with the new genetic features]

INTRODUCTION

The pentavalent rotavirus vaccine has been registered in Russia, however, the vaccination coverage remains low, and an annual increase in the incidence of rotavirus infection is unavoidable. In this regard, molecular monitoring of rotaviruses in order to search for new variants possessing epidemic potential is an urgent task.

MATERIAL AND METHODS

PCR genotyping and VP4 and VP7 genes sequencing were used to characterize rotaviruses circulating in Nizhny Novgorod in 2012-2020. The phylogenetic analysis of the strains was carried out using the BEAST software package.

RESULTS

The spectrum included 17 genotypes with predominance of G9P[8] (37,4%). Detected in this study genotypes G1P[4], G1P[9], G2P[8], G4P[4], G4P[6], G8P[8], and G9P[4] were not previously identified in Nizhny Novgorod. The circulation of DS-1-like strains possessing genotypes G1P[8], G3P[8], G8P[8], or G9P[8] and a short RNA pattern had been shown. Rotaviruses of the common genotypes were genetically heterogeneous and belonged to different phylogenetic lineages and/or sublineages (P[4]-IV-a; P[4]-IV-b; P[8]-3.1; P[8]-3.3; P[8]-3.4 and P[8]-3.6; G1-I; G1-II; G2-IVa-1; G2-IVa-3; G3-1; G3-3; G4-I-c; G9-III; G9-VI).

DISCUSSION

These results extend the available data on the genotypic structure of rotavirus populations in Russia and show the genetic diversity of viral strains. G3P[8] DS-1-like viruses were representatives of the G3-1 lineage, new for the territory of Russia, and had the largest number of amino acid substitutions in the VP7 antigenic epitopes.

CONCLUSION

The emergence and spread of strains with new genetic features may allow rotavirus to overcome the immunological pressure formed by natural and vaccine-induced immunity, and maintain or increase the incidence of rotavirus infection.

[Phylodynamic characteristics of the Russian population of rotavirus А (Reoviridae: Sedoreovirinae: Rotavirus) based on the VP6 gene]

INTRODUCTION

Rotavirus A is one of the leading causes of acute gastroenteritis in children in the first years of life. Rotavirus infection is currently classified as a preventable infection. The most abundant rotavirion protein is VP6.

MATERIAL AND METHODS

Phylogenetic analysis and calculation of phylodynamic characteristics were carried out for 262 nucleotide sequences of the VP6 gene of rotavirus species A, isolated in Russia, using the BEAST v.1.10.4 software package. The derivation and analysis of amino acid sequences was performed using the MEGAX program.

RESULTS

This study provides phylodynamic characteristics of the rotaviruses in Russia based on the sequences coding VP6 protein. Bayesian analysis showed the circulation of rotaviruses of three sublineages of genotype I1 and three sublineages of genotype I2 in Russia. The level of accumulation of mutations was established, which turned out to be similar for genotypes I1 and I2 and amounted to 7.732E-4 and 1.008E-3 nucleotides/site/year, respectively. The effective population sizes based on nucleotide sequences of the VP6 I1 and I2 genotypes are relatively stable while after the 2000s there is a tendency of its decreasing. Comparative analysis of the amino acid sequences in the region of the intracellular neutralization sites A (231-260 aa) and B (265-292 aa) made it possible to reveal a mutation in position V252I in a proportion of Russian strains of genotype I1 some strains of genotypes I1 and I2 had mutation I281V. These substitutions were not associated with any sublineages to which the strains belong. The analysis of three T-cell epitopes revealed four amino acid differences (in aa positions 305, 315, 342, 348) that were associated with the first or second genogroup.

CONCLUSION

Based on the phylodynamic characteristics and amino acid composition of antigenic determinants, it was concluded that the VP6 protein is highly stable and could potentially be a good model for development of a rotavirus vaccine.

Picobirnaviruses: prevalence, genetic diversity, detection methods

This article presents a general overview of the prevalence, genetic diversity and detection methods of picobirnaviruses (PBVs), which are small, non-enveloped icosahedral viruses with a segmented double-stranded RNA genome consisting of two segments taxonomically related to the genus Picobirnavirus of the family Picobirnaviridae. This review of scientific papers published in 1988-2019 provides data on the PBV distribution in the nature and a broad host range. PBV infection is characterized as opportunistic, the lack of understanding of the etiological role of PBVs in diarrhea is emphasized, since these viruses are detected both in symptomatic and asymptomatic cases. The concept of PBV infection as a chronic disease caused by a long-lasting persistence of the virus in the host is considered. Such factors as stress syndrome, physiological conditions, immune status and host age at the time of primary PBV infection influence the virus detection rate in humans and animals. The possible zoonotic nature of human PBV infection is noted due to the capacity for interspecies PBV transmission acquired during evolution as a result of the reassortment of the genome segments of different viruses infecting the same host. Data providing evidence that PBVs belong to eukaryotes and a challenging hypothesis stating that PBVs are bacterial viruses are presented. The need to intensify work on PBV detection because of their wide distribution, despite the complexity due to the lack of the cultivation system, is emphasized. Two strategies of RT-PCR as main PBV detection methods are considered. The genomes of individual representatives of the genus isolated from different hosts are characterized. Emphasis is placed on the feasibility of developing primers with broader specificity for expanding the range of identifiable representatives of the genus PBV due to a huge variety of their genotypes. The importance of effective monitoring of PBV prevalence for studying the zoonotic and anthroponotic potential using metagenomic analysis is highlighted, and so is the possibility of using PBV as a marker for environmental monitoring.

Increasing detection of rotavirus G2P[4] strains in Nizhny Novgorod, Russia, between 2016 and 2019

Rotavirus infection is one of the leading causes of acute gastroenteritis in children in their first years of life. We studied the genotypic diversity of rotavirus A (RVA) strains in Nizhny Novgorod, Russia, during the period 2016-19. In total, 4714 samples of faeces from children admitted to the Nizhny Novgorod Hospital for Infectious Diseases with acute gastroenteritis were examined. The share of rotavirus-positive samples was 31.5% in 2016-17. It decreased to 21.6% in 2018-19. In Nizhny Novgorod, all six global types of RVA were detected (G1P[8], G2P[4], G3P[8], G4P[8], G9P[8] and G12P[8]), as well as sporadic samples with genotypes G9P[4], G3P[9], G9P[9], G8P[8], G2P[8], G4P[4], G3P[9]. The fraction of strains with genotype G2P[4] gradually increased from 5.9% in 2016-17 to 39.1% in 2018-19. Simultaneously, the proportion of G9P[8] strains decreased from 63.2% to 27.7% in the same period. Phylogenetic analysis showed that rotaviruses with the G2P[4] genotype carried ubiquitous alleles of the VP7 and VP4 genes during the period of their prevalence: G2-IVa-1 and G2-IVa-3; P[4]-IVa and P[4]-IVb. As rotavirus vaccination is not widely used in the region because it is not included in the national vaccination calendar in Russia so far, the increase in the number of G2P[4] RVA is likely due to natural strain fluctuations.

Genotype constellations of the rotavirus A strains circulating in Nizhny Novgorod, Russia, 2017-2018

Currently, the full-genome-based classification is widely used to investigate rotavirus A (RVA) strains found in different countries around the world. However, the information on the full genotypes of rotaviruses circulating in Russia is limited. Using partial sequencing, this study determined the full genotype constellations of 15 RVA strains in total commonly detected in Nizhny Novgorod (European part of Russia) in 2017-2018, three from each of the following genotypes G1P[8], G4P[8], and G9P[8] and six from G2P[4]. There were two intergenogroup mono-reassortants possessing an identical genotype constellation of G4-P[8]-I1-R1-C1-M1-A1-N1-T1-E2-H1 with the DS-1-like NSP4 gene of probably local origin. A variety of subgenotype lineages and their combinations of Wa-like rotaviruses and genetic heterogeneity among G9P[8] and G1P[8] strains were shown on the basis of phylogenetic analysis of each gene. Moreover, two distinct co-circulating variants that differed in all 11 genome segments were found among DS-1-like rotaviruses.

[Identification of rotavirus I- and E-genotypes by multiplex PCR method.]

INTRODUCTION

In recent years the presence of reassortant rotavirus strains is increasingly mentioned in the world due to the application of the full-genome based classification system. Information on the circulation of such strains in the territory of Russia is limited. The aim of this work was the development of the approach for determination of genotypes of segments encoding VP6 (I) and NSP4 (E) to reveal reassortant strains.

MATERIAL AND METHODS

Rotavirus-positive samples were studied by means of nucleotide sequencing and multiplex PCR. Phylogenetic analysis was conducted using the Bayesian approach.

RESULTS

Three alleles of the VP6 gene (I1-1, I2-IV, I2-VII) and seven alleles of the NSP4 gene (E1-I, E1-III, E2-VI, E2-VII, E2-X, E2-XII, E3) were detected on the base of nucleotide sequences of Nizhny Novgorod rotaviruses. Taking into account these results, the oligonucleotide primers specific to genotypes I1, I2, I3 and E1, E2, E3 were designed. Optimal conditions for multiplex PCR were chosen. The method was tested using the strains collected in Nizhny Novgorod in 2018. The diversity of I and E genotypes was determined and various combinations with G and P genotypes were identified.

DISCUSSION

G9-P[8]-I1-E1 rotaviruses were predominant (32.7 %) and G2-P[4]-I2-E2 rotaviruses were in second place (29.1 %). Strains with genotypes G4-P[8]-I1-E2, G3-P[8]-I2-E2 and G2-P[4]-I2-E1 were detected sporadically. They had genes of two rotavirus genogroups, so can be considered to be reassortant.

CONCLUSION

The proposed approach is a useful tool for the characterization of rotaviruses in the conditions of the beginning of vaccination against rotavirus infection in Russia.

Case of thrombosis of the portal vein and its branches in a patient seropositive for Borrelia antigens

Borreliosis after sucking ticks is an acute problem in the world. People do not go to doctors after that often, which leads to the development of various complications. Thrombosis of veins of various localization can be one of them. Thrombosis of the portal vein represents a significant problem too with high morbidity and mortality. The risk factors for splanchnic vein thrombosis include infections, but its relationship with borreliosis has not been studied. А 34-year-old man with chronic helicobacter-associated gastritis and gallstones was hospitalized due to development during the last 11 days of epigastric pain and fever to 38.7 °C after a picnic at the forest without a registered tick bite. The blood leukocytes were increased to 11.2*109/l, lymphocytes 70%, C-reactive protein 34.6 mg/l, procalcitonin 0.195 ng/ml. The multispiral computed tomography of the abdominal cavity revealed thrombosis of portal, lienalis and superior mesenteric veins. D-dimer was 1.98 mcg/ml, antithrombin III 75%. JACK2V617F, oncological, rheumatic, thrombophilia markers, blood and urine cultures were negative. A high concentration of anti-Borrelia burgdorferi IgM 62.2 U/ml and its increasing to 190 U/ml in dynamics was revealed at the immunofluorescence assay. Anti-Borrelia IgM to OspA, p31 and OspC, p25 were detected at the immunoblotting assay. Anticoagulation, doxycycline, detoxification therapy reduced pain and normalized temperature and inflammation markers. Vein thrombosis was not detected at the control tomography after 2 weeks. Despite that the combination of thrombosis and borreliosis is rare, it is necessary to screen for Borrelia antigens in patients with splanchnic vein thrombosis and fever.

Case of thrombosis of the portal vein and its branches in a patient seropositive for Borrelia antigens

Borreliosis after sucking ticks is an acute problem in the world. People do not go to doctors after that often, which leads to the development of various complications. Thrombosis of veins of various localization can be one of them. Thrombosis of the portal vein represents a significant problem too with high morbidity and mortality. The risk factors for splanchnic vein thrombosis include infections, but its relationship with borreliosis has not been studied. А 34-year-old man with chronic helicobacter-associated gastritis and gallstones was hospitalized due to development during the last 11 days of epigastric pain and fever to 38.7 °C after a picnic at the forest without a registered tick bite. The blood leukocytes were increased to 11.2*109/l, lymphocytes 70%, C-reactive protein 34.6 mg/l, procalcitonin 0.195 ng/ml. The multispiral computed tomography of the abdominal cavity revealed thrombosis of portal, lienalis and superior mesenteric veins. D-dimer was 1.98 mcg/ml, antithrombin III 75%. JACK2V617F, oncological, rheumatic, thrombophilia markers, blood and urine cultures were negative. A high concentration of anti-Borrelia burgdorferi IgM 62.2 U/ml and its increasing to 190 U/ml in dynamics was revealed at the immunofluorescence assay. Anti-Borrelia IgM to OspA, p31 and OspC, p25 were detected at the immunoblotting assay. Anticoagulation, doxycycline, detoxification therapy reduced pain and normalized temperature and inflammation markers. Vein thrombosis was not detected at the control tomography after 2 weeks. Despite that the combination of thrombosis and borreliosis is rare, it is necessary to screen for Borrelia antigens in patients with splanchnic vein thrombosis and fever.

Phylogenetic comparison of the VP7, VP4, VP6, and NSP4 genes of rotaviruses isolated from children in Nizhny Novgorod, Russia, 2015-2016, with cogent genes of the Rotarix and RotaTeq vaccine strains

Group A rotaviruses (RVA) are one of the leading causes of gastroenteritis in young children worldwide. The introduction of universal mass vaccination around the world has contributed to a reduction in hospitalizations and outpatient visits associated with rotavirus infection. Continued surveillance of RVA strains is needed to determine long-term effects of vaccine introduction. In the present work, we carried out the analysis of the genotypic diversity of RVA strains isolated in Nizhny Novgorod (Russia) during the 2015-2016 epidemic season. Also we conducted a comparative analysis of the amino acid sequences of T-cell epitopes of wild-type and vaccine (RotaTeq and Rotarix) strains. In total, 1461 samples were examined. RVAs were detected in 30.4% of cases. Rotaviruses with genotype G9P[8] (40.5%) dominated in the 2015-16 epidemic season. Additionally, RVAs with the following genotypes were detected: G4P[8] (25.4%), G1P[8] (13%), G2P[4] (3.2%). Rotaviruses with genotypes G3P[9], G6P[9], and G1P[9] totaled 3%. The number of partially typed and untyped RVA samples was 66 (14.9%). The findings of a RVA of G6P[9] genotype in Russia were an original observation. Our analysis of VP6 and NSP4 T-cell epitopes showed highly conserved amino acid sequences. The found differences seem not to be caused by the immune pressure but were rather related to the genotypic affiliations of the proteins. Vaccination against rotavirus infection is not included in the national vaccination schedule in Russia. Monitoring of the genotypic and antigenic diversity of contemporary RVA will allow providing a comparative analysis of wild-type strains in areas with and without vaccine campaign.

Predominance of new G9P[8] rotaviruses closely related to Turkish strains in Nizhny Novgorod (Russia)

Genotype G9P[8] rotaviruses are rare in the territory of Russia. They were found in Nizhny Novgorod only in 2011-2012 for the first time, when their proportion was 25.9%. During the next two seasons, G9P[8] strains were detected in only 1.8% of cases. Their proportion substantially increased again in 2014, and they became predominant in the city by 2016. Phylogenetic analysis on the basis of gene VP7 nucleotide sequences showed that this increase was accompanied by the emergence of new strains in the population. These isolates were related to Turkish strains, but not to Russian ones detected earlier.

Detection and molecular characterization of reassortant DS-1-like G1P [8] strains of rotavirus A

Group A rotaviruses (RVA) are the main cause of viral gastroenteritis in children worldwide. In this study we provide the molecular characteristics of reassortant DS-1-like G1P[8] RVA strains detected in Russia for the first time. Previously, such reassortant strains were detected in Japan and Thailand. The G1P[8] RVAs with DS-1-like short electropherotype RNA-PAGE were isolated from children hospitalised with an acute gastroenteritis during the 2013-2014 period. The DS-1-like G1P[8] strains accounted for 2.6% of all RVA strains detected continuously throughout the season. A phylogenetic analysis was made on the basis of the established nucleotide sequences of genes VP7, VP8* (VP4), VP6 and NSP4. The Nizhny Novgorod strains belong to G1-I and G1-II alleles of VP7 gene and to P[8]-3 allele of VP4. According to their VP6 sequences, two Russian samples clustered with the reassortant strains isolated in Japan, Thailand and Australia and two other strains were phylogenetically close to the typical G2P[4] DS-1-like RVA. Nucleotide sequences of G1P[8] strains that belong to NSP4 gene form a separate cluster from G3P[8] DS-1-like rotaviruses detected in Thailand and Australia. The RVA alleles included in Rotarix and RotaTeq vaccine strains were clustered separately from the studied reassortant RVAs. On the grounds of phylogenetic analysis we assume a polyphyletic origin of reassortants between Wa- and DS-1-like strains. Mutation rates evaluated by Bayesian inference in clusters with reassortant RVA strains were 1.004Е-3 (VP7), 1.227E-3 (VP4), 3.909E-4 (VP6), and 4.014Е-4 (NSP4). Analysis of tMRCA showed relatively contemporary origin of alleles DS-1-like G1P[8] rotaviruses: VP7 - 1998 (G1-I) and 1981 (G1-II), VP4 - 1998, VP6 - 1994, NSP4 - 1979.

[GASTROINTESTINAL COMPLICATIONS OF ANTICOAGULANT THERAPY IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION]

Non-valvular atrial fibrillation is the most common cardiac source of emboli and cardioembolic stroke. Anticoagulants are recommended for preventing stroke in patients with non-valvular atrial fibrillation. Warfarin reduces the risk of stroke in patients with AF by approximately two-thirds. Several novel anticoagulants that can overcome the limitations of warfarin have been introduced in the market or are under development. The NOACs are at least as effective as warfarin for stroke prevention in AF. Bleeding complications, including gastrointestinal bleeding, are common complication of anticoagulant treatment. The NOACs therapy are associated with an increased risk of major gastrointestinal bleeding compared with warfarin, and dabigatran is associated with an increased risk of non-bleeding upper GI symptoms such as dyspepsia and heartburn. This review provides information on the safety and risks of using NOACs, methods of treatment of gastrointestinal complications events in patients with non-valvular atrial fibrillation.

[Group enterovirus infection due to coxsackievirus A16 in Northwestern Russia]

AIM

Study features of epidemic process and etiology of oral cavity and limb enterovirus exanthema group diseases in a number of territories of Northwestern Russia.

MATERIALS AND METHODS

Isolation and identification of non-poliomyelitis enteroviruses from material of patients was carried out according to WHO recommendations. Phenotyping and phylogenetic analysis of enteroviruses was carried out.

RESULTS

In 3 territories of Northwestern Russia oral cavity and limb enterovirus group diseases were registered. Children aged less than 14 years, predominately aged less than 3 years, were shown to be involved in the epidemic process. Coxsackie A16 enteroviruses from 27 samples of patients were isolated in cell cultures and identified by using specific sera. Coxsackie A16 enteroviruses from 16 samples were identified by using partial sequencing of VP1 genome area. Phylogenetic analysis has shown that the identified Coxsackie A16 viruses distributed among 2 phylogenetic groups.

CONCLUSION

Coxsackie A16 enteroviruses that had never been detected in the region previously were established to be the etiologic factor of oral cavity and limb enterovirus exanthema group disease in the 3 territories of Northwestern Russia. The data obtained give evidence on the necessity of epidemiologic and virological control for enterovirus infection with the aim of obtaining novel information on the circulation of non-poliomyelitis enteroviruses in the population and the establishment of development patterns for epidemic process of this infection.

[Epidemic variants of norovirus genotype GII.4 in Nizhny Novgorod in 2006 - 2012]

AIM

Genotyping of noroviruses that had circulated in the territory of Nizhny Novgorod during 6 epidemic seasons (2006 - 2012), detection of dominating genovariants and analysis of their change.

MATERIALS AND METHODS

Feces samples from children hospitalized in an intestinal infection department of one of the infectious disease hospitals of Nizhny Novgorod served as material for the study. Noroviruses were detected by reverse transcription polymerase chain reaction. Genotypes and gene variants were determined by analysis of nucleotide sequences of viral genome regions coding capsid protein and RNA-dependent RNA-polymerase.

RESULTS

During examination of 6589 children with an acute intestinal infection between July 2006 and June 2012 noroviruses were detected in 17.55% of cases. Nucleotide sequences of capsid and/or polymerase gene regions were determined for 114 norovirus isolates. Genotyping has shown that noroviruses of 8 various genotypes had circulated in the territory of Nizhny Novgorod--GII.1, GII.2, GII.3, GII.4, GII.6, GII.7, GII. 12, GII.13 with the domination of GII.4 noroviruses for the whole observation period. A dynamic of change of epidemic variants of genotype GII.4 noroviruses that had been accompanied by an increase of frequency of detection of norovirus in children hospitalized with acute intestinal infection similar to global was established. A short-term circulation of GII.4 2006b-NN 2008 norovirus subvariant in spring of 2008 and spread of genotype GII.12 norovirus during 2009, 2010 epidemic season were also shown.

CONCLUSION

The data obtained give evidence to the necessity of norovirus circulation monitoring with the aim of early detection of novel virus variants that may determine an increase of norovirus infection morbidity.

[Modern notions about the role of taurine in the central nervous system]

Literature data concerning modern notions about the role of taurine in the central nervous system are analyzed. Mechanisms of the neuroprotective activity of taurine are described. Evidence showing the effects of taurine as neurotransmitter, neuromodulator, antioxidant, etc. is provided.

[Prevalence, features of circulation, and diversity of human parechoviruses in Nizhny Novgorod]

A total of 5230 specimens from children with gastroenteritis collected in Nizhny Novgorod in 2006-2010 were screened for human parechoviruses (HPeV). HPeV were observed every year with mean frequency of 6.16%. The majority of HpeV (65.83%) was detected in children younger than 3 years. The typing of 71 detected HPeV with the use of partial sequencing of the VP3-VP1 region revealed the presence of HPeV1 (91.55%), HpeV6 (5.63%), HPeV3 (3.08%), HPeV4 (1.54%). HPeV1B was predominant among HPeV1, HPeV1A was identified rarely. Six stains of HPEV1 formed separate phylogenetic cluster, had sequence gomology with HPEV1A or HPeV1B not more than 88% and could be characterized as members of a separate genotype HPeV1.

[Molecular-genetic characteristic of astroviruses circulating in Nizhny Novgorod]

AIM

Genotyping ofastroviruses isolated from children with acute enteric infection (AEI) on the territory of Nizhny Novgorod in 2006 - 2011.

MATERIALS AND METHODS

Samples of feces from children hospitalized in intestine infection department of a Nizhny Novgorod infectious diseases hospitals served as study material. Astroviruses were detected by reverse transcription polymerase chain reaction method. Astrovirus genotypes were determined based on phylogenetic analysis of nucleotide sequence of genome fragment coding capsid protein.

RESULTS

During examination of 5759 children with AEI from July 2006 to June 2011 astroviruses were detected in 2.6% of cases, and in 2010 - 2011 the frequency of astrovirus detection (5.19%) was significantly higher than in the previous epidemic seasons and the average based on the whole observation period. Genotyping of the detected astroviruses showed that genotype 1, 2, 3, 4, 5 astroviruses circulated on the territory of Nizhny Novgorod with predomination ofgenotype 1. Genotype 1 astroviruses are presented by genetic lineages 1a, 1b, 1d with predomination of lineage la. From the start of 2010 all the detected isolates from genetic lineage la belonged to a single new sublineage - 1a-2010. The second by quantity of detected isolates were genotype 5 astroviruses identified for the first time in Nizhny Novgorod in July 2010. Genotype 2, 3 and 4 astroviruses were detected in isolated cases.

CONCLUSION

Activation of astrovirus circulation in the population of Nizhny Novgorod that was shown by a significant increase of frequency of their detection in children with AEI in 2010 - 2011 epidemic season with the highest probability was caused by appearance of genotype 5 astroviruses, that had not previously been detected in this territory and other territories of Russian Federation.

[Molecular genetic echovirus 9 variants identified in patients with aseptic meningitis in Russia in 2007-2009]

In 2009 echovirus 9 caused a higher seasonal incidence of enterovirus infection (EVI) and its several outbreaks in a number of regions of Russia. Analysis of the partial VP1 coding region differentiated 4 phylogenetic lineages of echoviruses 9 variants identified in patients with aseptic meningitis and EVI in 2007-2009. One variant of echovirus 9 was most commonly encountered in 2009. Echoviruses 9 identified in different areas, which had a high (98.2-100%) homology of nucleotide sequences of the partial VP1 coding region, varied in the amino acid sequences within the B-C loop.

[Subacute infectious endocarditis of unusual etiology: peculiarities of diagnostics and treatment]

Infectious endocarditis (IE) is an inflammatory disease of cardiac valves and endocardium of different origin. Subacute IE is a specific form of sepsis associated with the presence of the site of infection in the heart responsible for recurrent septicemia, embolism, and progressive changes in the immune system leading to nephritis, vasculitis, synovitis, and polyserositis. This form develops in response to a low-virulent pathogen (e.g.fungi) or as a result of inefficient antibacterial therapy. A patient is described presenting with fibrous body, aortic and mitral valve infection by the alga Prototheca wickerhamii associated with primary (myeloperoxidase) immunodeficiency. Recent data on diagnostics and treatment of subacute IE are presented.

[Detection of parvovirus B19 markers in blood samples of donors]

AIM

To assess detection rate of parvovirus B19 markers in population of donors in one of the regions of Russian Federation.

MATERIALS AND METHODS

Screening of blood samples from 1000 donors for parvovirus B19 DNA was performed by real-time polymerase chain reaction. Levels of specific antibodies to parvovirus B19 were measured by quantitative enzyme immunoassay (R-Biopharm AG, Germany).

RESULTS

Parvovirus B19 DNA was detected in 10 samples (1%) with viral load ranging from 1.0 x 10(3) to 1.0 x 10(6) genome equivalents per 1 ml. All DNA-positive samples contained IgG, and one sample contained IgM also. IgG were detected in 29.7% of DNA-negative samples. In these samples specific IgM were not detected. Mean level of IgG in DNA-negative and DNA-positive groups was 27.52 IU/ml [95% CI (19.6 -35.4) IU/ml] and 107.30 IU/ml [95% CI (55.7 - 158.9) IU/ml] respectively. Level of IgG in DNA-negative group was significantly lower than in the DNA-positive (p < 0.0001).

CONCLUSION

Results of the study provide new and important information for making rational decision about screening of donors' blood for parvovirus B19 markers.

[Genetic diversity of human caliciviruses detected in schoolchildren with gastroenteritis in Nizhni Novgorod]

A total of 2312 children admitted to the Nizhni Novgorod infectious disease hospitals for diagnosed acute gastroenteritis were examined using the RT-PCR. The detection rate of human caliciviruses was found to be 6.5% (range 1.2 to 11.2%). The population of calicivuruses presented with noroviruses genogroups I (16%) and II (81%), and sapoviruses (3%). Noroviruses genogroup II included genotypes GII.2 and GII.4 with a preponderance of the variant CII.4-2006b. The detected sapoviruses were clustered with sapoviruses GI.1, GI.2, and GII.1 by phylogenetic analysis.

[Aseptic meningitis season caused by enteroviruses in 2007: molecular-epidemiological aspects]

AIM

Analysis of manifestation of epidemic process of aseptic meningitis and causes of its activation using molecular genetic methods.

MATERIALS AND METHODS

Samples of feces and CSF, nasopharyngeal swabs from 296 patients with aseptic meningitis (AM), as well as 240 samples of drinking water and 6 samples of lake water were studied. Epidemiologic analysis, isolation of enteroviruses in Hep-2 and RD cell cultures, RT-PCR, partial sequencing of 5'NTR and genome region coding VP1 were performed.

RESULTS

Marked rise of AM caused by enteroviruses in Nizhny Novgorod during 2001 - 2007 was demonstrated. From August to October 2007, enteroviruses were detected in 93.8% of patients with AM (22.5 per thousand). Seasonal rise of incidence was determined by 9 serotypes of enteroviruses: E30 - 26 cases (53.1%), E7 - 7 (14.3%), E18 - 5 (10.3%), E13 - 3 (6.1%), E9 - 2 (4.0%), CB5 - 3 (6.1%),CA1 - 1 (2.0%), CA9 - 1 (2.0%), CA13 - 1 (2.0%). Serotype E30, represented by two subtypes, dominated. Dominating subtype E30-N1 was closely related with E30 strains isolated in 1994 - 2001 in Europe. Subtype E30-N2 was genetically related with Asian strains isolated in 2000 - 2006. RNA of E7, E9, E13, E18, CB5 viruses and dominating subtype E30-N1 were detected in nasopharyngeal swabs from patients with AM, which can explain rapid and wide spread of these viruses in susceptible population by aspiration route of transmission.

CONCLUSION

Increased incidence of AM in Nizhny Novgorod in 2007 was caused by variant of E30 virus, which was genetically related with strains isolated in European countries in 1997.

[Nucleotide sequence analysis of the NSP4 gene from group A rotaviruses isolated in Nizhni Novgorod]

The complete nucleotide sequences of the NSP4 gene from Russian isolates of Group A rotaviruses with different G[P] types obtained in Nizhni Novgorod have been first ascertained. They belong to their affiliation to three NSP4 (A, B, and C) of the 5 known genotypes. Eleven strains had NSP4 genotype. Phylogenetic analysis based on the complete nucleotide sequences of the NSP4 gene revealed the sequence homology of G1P[8] viruses with the strains circulating in Scandinavia and that of the G3 type viruses with the strains from South-Eastern Asia. The rotavirus strains G1, G3, G4, and P[8] demonstrated the homology with porcine rotavirus strains, while the strains G3P[6], G3P[9], and G2P[4] did the homology with bovine rotavirus strains. There was an unusual strain of human rotaviruses G3P[9] genetically related to feline rotaviruses.

[Indication and identification of Lactobacillus spp. with the use of polymerase chain reaction]

AIM

The aim of the work is the development of laboratory test for indication and identification of Lactobacillus spp. by the polymerase chain reaction.

MATERIALS AND METHODS

The work is developed on the base of the GenBank/EMBL data about genetic sequences of the Lactobacillus spp. The sequences of DNA were studied with the help of the ClustalW program. The strains of the Lactobacillus spp., which are the object of the research, have been registered in Russian collection of industrial microorganisms.

RESULTS

The laboratory test of nested-PCR for indication and identification L. plantarum, L. fermentum, L. acidophilus, L. delbrueckii, L. casei, L. rhamnosus was performed. The specificity of the nested-PCR was correlated with the control analyses of monoculture Lactobacillus spp. and commercial products.

CONCLUSION

The new developed laboratory nested-PCR test may be use in control system of milk foods enriched by probiotic microorganisms.

[G[P] type profiles of group A human rotavirus and their distribution in Nizhni Novgorod and Dzerzhinsk in 1997-2005]

RT-PCR was used to determine G (VP7) and P (VP4) genotypes of group A rotavirus found in 2454 children with diarrhea in 1997-2005. Eight G[P] combinations, including G1-4 serotypes and P[4, 6, 8, 9] genotypes, were identified. The P[8] genotype was presented by the subtypes P[8]-1 and P[8]-2. In 1997-2005, the spectrum and distribution of G[P] types were as follows: G1P[8]-1 (10%), G1P[8]-2 (67%), G1P[6] (3%), G2P[4] (9%), G3P[8]-2 (5%), G3P[6] (1%), G3P[9] (1%), G4P[8]-2 (3%), G9 (0%), G?P[?] (1%). Five G[P] types of rotavirus were identified in the 2004-2005 season. The G2P[4] type was prevalent (37%), the GI P[8]-2 type was detected in 25% of cases; G3P[8]-2 in 22%; G4P[8]-2 in 12%; G3P in 2%), G[?]P[?] in 2%. The P[8]-1 subgemotype was not found. The spectrum of the G1P[8] types of rotavirus and their distribution should be taken into account while developing a vaccine prophylaxis program against rotavirus gastroenteritis in Russia.

[Ischemic heart disease in patients with schizophrenia (clinico-epidemiological study)]

We carried out a multicenter controlled study of case histories of patients with schizophrenia and acute myocardial infarction (AMI) or postinfarction cardiosclerosis (PIC) from cardiological (n=44), psychosomatic (n=19) and psychiatric (n=23) hospitals was. In hospital mortality, ischemic heart disease (IHD) risk factors, peculiarities of IHD course, antipsychotic therapy were analyzed. Elevation of in hospital mortality related to PIC and its complications was revealed in somatopsychiatric (21% vs 1.26%; p<0.05) and psychiatric (29% vs 1.26%; p<0.05) hospitals. Hypercholesterolemia, excess weight in patients with schizophrenia were met more rarely (36, 32, 9, 21%, 16, 0% vs 61, 45%, respectively; p<0.05) while diabetes mellitus (5, 5, 9% vs 15%, respectively; p>0.05), arterial hypertension (89, 84, 45% vs 77%, respectively; p>0.05) - with same frequency as in comparison group. Patients with schizophrenia do not differ from persons not suffering from this psychiatric disease by proportion of patients with AMI (39, 47, 49% vs 43%; p>0.05) and PIC (73, 74, 61% vs 73%; p>0.05). Probability of effect of inadequate body weight and psychotherapy with phenothiazine derivatives and antiparkinsonian cholinolytic medications on elevation of mortality of patients with IHD and schizophrenia is discussed.

[Comparison of the efficacy and safety of electrical cardioversion and pharmacological cardioversion with nibentan in patients with persisting atrial fibrillation and flutter]

The aim of the study was to compare the efficacy and safety of pharmacological cardioversion (PC) by nibentan, a class III antiarrhythmic agent, and electrical cardioversion (EC) in patients with persisting atrial fibrillation (AFib) and atrial flutter (AFI) receiving basic antiarrhythmic therapy. Ninety-seven patients with persisting AFib and AFI were included in the trial (45 patients constituted PC group, and 52 constituted EC group). Both groups were comparable according to basic demographic and clinical parameters as well as antiarrhythmic therapy being applied. The results of the study showed that the efficacy of PC did not differ from that of EC (86.7% and 92.3% respectively, p = 0.282). the frequency of arrhythmogenic effect did not differ between the groups either (p = 0.46). One case of non-stable ventricular tachycardia was registered in the PC group. The most significant adverse effect was bradicardia, which was registered more often in the PC group than in EC group (26.7% and 3.8%, respectively, p = 0.001). In conclusion, the efficacy and safety of PC with nibentan in patients with persisting AFib/AFI is comparable with those of EC.

[The clinical features of the course of coronary artery disease in patients with schizophrenia]

Thirty-nine patients suffering from coronary artery disease (CAD) and schizophrenia (main group) and 32 mentally healthy CAD patients (control group) were included in the study. Cardiological examination including complaint and anamnesis analysis, ECG, EchoCG, stress-EchoCG with dobutamine, 24-hour Holter ECG monitoring was performed; coronaroangiography was carried out in 15 patients. Acute circulatory insufficiency, early post-infarction stenocardia, and chronic left ventricular aneurism were found to be more frequent in patients with schizophrenia vs. controls. Certain differences in CAD risk factors between the groups were revealed. Hyperlipidemia and type 2 diabetes were found in 14 (36%) and 1 (3%) patients in the main group vs. 20 (62%) and 6 (19%) patients in the control group (p = 0.03; p = 0.04), respectively. Glucose intolerance was found in no schizophrenia patients, while it was revealed in 5 (16%) controls (p = 0.02). Patients with schizophrenia sought medical aid later than controls. The number of main group patients who sought medical aid during the first hour, the first 4 hours, the first 4 to 12 hours, or the first 12 to 24 hours was 2 (3%), 3 (5%), 16 (27%), and 38 (64%), respectively; in the control groups these numbers were 12 (30%), 21 (54%), 3 (8%), and 3 (8%), respectively (p < 0.001, p < 0.001, p = 0.02, p < 0.001, respectively).

[HIV-associated cardiomyopathy]

Dilated cardiomyopathy (DCMP) is a non-coronary heart disease, which leads to the severe degenerative changes and destruction of cardiomyocytes, heart chamber dilatation, systolic and diastolic myocardial dysfunction, steady heart failure progression, disability, and high mortality. HIV is considered to be one of the possible causes of DCMP. Heart involvement in AIDS influences prognosis by lowering survival rate. The number of HIV-infected patients grows in our country; thus, the number of patients with various AIDS manifestations is going to grow, too. In this article the authors adduce the observation of DCMP development in a HIV-infected patient.

[Effectiveness and safety of clopidogrel bisulfate in complex therapy of patients with acute coronary syndrome with ST segment elevation]

Efficacy of clopidogrel in acute myocardial infarction (AMI) was studied only in two trials. However efficacy and safety of loading dose of this drug and its long-term effectiveness were not studied in these trials.

AIM

To assess effects of clopidogrel loading dose and long term therapy in addition to standard treatment on death, re-infarction, recurrence of angina and bleedings rate in patients with ST segment elevation acute coronary syndrome.

METHODS

Patients (n=107) with AMI who met the criteria for thrombolytic therapy (TLT) were assigned randomly into either clopidogrel group A (n=51) or conventional therapy group B (n=56). Group A received loading dose of clopidogrel (300 mg) in addition to conventional therapy (TLT, aspirin, statin, ACE inhibitor and beta-blocker). Group B received only conventional therapy. The follow-up was 6 months after inclusion during which patients in group A continued to receive clopidogrel (75 mg/day after Day 2 of the study). Primary endpoint included death, re-infarction, recurrence of angina and bleedings. In addition, changes of ST segment after TLT and local contractility were assessed.

RESULTS

During 30 days of follow-up rates of primary endpoint were 2.0 and 41.1% in groups A and B, respectively (p=0.003). Subgroup analyses showed that this difference depended on the rate of angina recurrence (2.4 and 36.1% in groups A and B, respectively, p=0.002). These differences were maintained during all follow-up period. Odds ratios for clopidogrel were 0.235 for primary endpoint (95% CI 0.104-0.528, p=0.0003), 0.078 for angina recurrence (95% CI 0.022-0.279, p=0,0001). No significant differences were obtained for mortality, re-infarction and bleeding rate. TLT in group A was more effective. ST depression 90 min after TLT was 86.23+/-4.38 and 61.00+/-6.97% (p=0.010), reperfusion arrhythmia rate - 72.6+/-3.27 and 33.9+/-2.78% (p=0.005) in groups A and B, respectively.

CONCLUSION

The use of clopidogrel in addition to standard therapy for AMI is safe and effective. Long-term clopidogrel treatment decreases angina recurrence rate.

[Optimization of RT-PCR for the identification of VP4 gene of group A rotaviruses and evaluation of its diagnostic efficiency]

A method is suggested for the detection of the human rotavirus VP4 gene by RT-PCR. The method is universal for all [P] types of group A rotavirus in clinical samples. As against RNA electrophoresis and ELISA, it provides for a more accurate detection of rotaviruses by 18.8 and 26.5%, respectively. It was established by RT-PCR in February, 2002, in Nizhny Novgorod, that rotaviruses were responsible for 67% of acute gastroenteritis in hospitalized children.

[Trimetazidine in correction of chronic heart failure in patients with ischemic heart disease]

Twenty patients with NYHA class II-IV heart failure and ejection fraction below 40% received standard therapy (control period) or standard therapy plus open trimetazidine (20 mg t.i.d.) for 3 months in a cross-over design. Therapy with trimetazidine was associated with attenuation of clinical signs of heart failure (average NYHA class 2.90-/+0.10, 2.27-/+0.20 and 2.88-/+0.13, p<0.05, at baseline, after trimetazidine and control period, respectively), improvement of results of 6-minute walk test (average distance 321-/+19, 375-/+20 m, p<0.02, and 303-/+17 m at baseline, after trimetazidine and control period, respectively), increase of left ventricular ejection fraction (from 34.1-/+2.0 to 38.1-/+1.8%, p<0.05) and improvement of quality of life. Thus in patients with heart failure addition of trimetazidine to standard therapy for 3 months produced positive effect on clinical and hemodynamic status, exercise tolerance and quality of life.

[Detection of picobirnaviruses by electrophoresis of RNA in polyacrylamide gel]

Double-segment profiles typical of picobirnavirus (PBV) were detected (during 1994-2001) in nucleic acids extracted from feces of children (3 cases) and calf (1 case) with diarrhea by using the method of electrophoresis. The human genomic PBV segments migrated in the polyacrylamide gel (PAAG) as dsRNA segments sized 1.7 and 2.4 kbp for small and large segments, respectively; the similar calf sizes were 1.5 and 2.6 kbp. PBVs were detected in various places of the Nizhny Novgorod Region and at different time periods. It was for the first time that the PBV circulation was proven to be present in Russia's territory. However, their association with diarrhea was not reliably established, and the pathogenic PBV potential needs further investigations.

[Balloon coronary angioplasty in macrofocal myocardial infarction survivors]

Long-term results of delayed balloon coronary angioplasty (DBCA) in myocardial infarction (MI) survivors were studied by the following end points: general and cardiac lethality, repeated MI, renewal of anginal attacks, life-threatening arrhythmia, symptoms of circulatory deficiency, rate of hospitalization during 5 years of follow-up. 57 patients who had undergone DBCA 3 weeks--6 months after MI were analyzed retrospectively. Overall and cardiac lethality was 8.8%. For 5 years of follow-up renewal of angina was seen in 70.1% patients, repeated MI developed in 10.5%, life-threatening arrhythmia and conductivity disorders were revealed in 5.3%, chronic cardiac failure--in 22.8% patients. DBCA in survivors of macrofocal MI in combination with current drug therapy to improves significantly long-term prognosis and reduces twice 5-year lethality after Q-wave MI.

[Assessment of a developed "nested" variant of polymerase chain reaction for detecting enteroviruses in patients]

The RT-PCR assay for the detection of all human enteroviruses was used to analyze fecal samples, cerebrospinal fluid (CSF), respiratory tract swabs, and sera from 204 patients with symptoms of viral infection. Enteroviruses were detected in 31.37% of cases. The proposed method analyzes every type of clinical samples. The relative detection rate of enteroviruses in different samples was 70.64% in feces, 10.4% in SCF, 17.24% in swabs, and 21.14% in the sera. The use of serum in addition to other testing samples increased the rate of enterovirus detection at 18.25%. Developing techniques may be used for the diagnosis of acute enterovirus infections with different clinical manifestations.