[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).