Bulletin of RSMU

ISSN Print 2500–1094 ISSN Online 2542–1204

Bulletin of RSMU

BIOMEDICAL JOURNAL OF PIROGOV UNIVERSITY (MOSCOW, RUSSIA)

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Kovtun AS, Alekseeva MG, Averina OV, Danilenko VN

Antibiotic resistance is one of the biggest threats to modern medicine. Response to antimicrobial treatment is seriously disrupted by aminoglycoside phosphotransferases (Aph) — enzymes produced by bacteria. The aph genes were annotated in many bacterial species, including commensals of the gut microbiota that can transfer these genes to clinically important strains. For this study we prepared a catalog of 21 aph genes. The in silico analysis of 11 intestinal microbiomes of healthy Russians revealed the presence of 3 cataloged aph genes in 7 microbiota samples, namely aph(3'')-Ib, aph(3')-IIIa and aph(2'')-Ia. The most frequent was the aph(3')-IIIa gene detected in 6 metagenomes. Of note, this gene was first discovered in Enterococcus faecalis, but in this study we observed it in sequences typical for commensal Ruminococcus obeum and opportunistic Enterococcus faecium, Roseburia hominis, Streptococcus pyogenes and Staphylococcus epidermidis. Similarly, aph(2'')-Ia originally present in E. faecalis was detected in a sequence typical for Clostridium difficile. Our findings are consistent with the reports on the strong association between the geographical origin of the individual and frequency of aph genes. We suggest that clinical examination should include antibiotic sensitivity tests run not only on the causative agent, but also on the gut microbiota, for a better treatment outcome.

Received: 2017-03-29

Published online: 2017-05-29

DOI: 10.24075/brsmu.2017-02-02

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VIEWS 6019

Chaplin AV, Rebrikov DV, Boldyreva MN

The symbiotic relationship with the microbial flora inhabiting our bodies plays an immense role in maintaining our vitality. The microbiota protects us from pathogens, hardwires our immunity, and engages in the production of essential micronutrient components. The human microbiota encompasses several thousands of fungi, eubacteria, archaea and viruses, with eubacterial cells alone totaling over 10 trillion and outnumbering our body cells 100 to 1. Next generation sequencing has allowed researchers to comprehensively assess the diversity of microbial species in the human microbiota and to estimate their proportions with stunning accuracy. This has led to a breakthrough in our understanding of associations between human health and the microbiota. This review focuses on the current state of research on key microbial communities inhabiting the human body: those of the gastrointestinal and genitourinary systems. Less studied microbial communities colonizing the nose, nasopharynx, auditory canal, eye, and skin, as well as some others, are not included in the review.

Received: 2017-04-16

Published online: 2017-05-27

DOI: 10.24075/brsmu.2017-02-01

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VIEWS 6105

Aniskevich AS, Halfin RA

In this work we identify 16 key indicators to evaluate the performance of healthcare research organizations. These indicators comprehensively characterize such aspects of performance as research output and relevance, human resource development, integration into the international scientific community, distribution of scientific knowledge, promotion of the prestige of science, and resource provision. Below, we review the existing classification of medical research institutions and their key features. We present the results of the comprehensive performance evaluation of healthcare research organizations. We demonstrate the significance of the proposed indicators that accurately reflect the output and relevance of scientific research and stress that indicators currently used for performance evaluation are insufficient. We also emphasize the need for a systemic approach to personnel capacity assessment and confirm the importance of additional evaluation criteria that amount to 37.5 % of all key indicators.

Received: 2017-02-10

Published online: 2017-03-14

DOI: 10.24075/brsmu.2017-01-10

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VIEWS 5554

Belous AS, Shevelev AB, Trubnikova EV, Biryukova YuK, Mishina ES, Loyko EA, Lebedeva AA, Zakharchenko NS

Management of purulent wounds is a problem that requires particular attention: wounds are a common injury type for which suppurative complications are frequent, mortality rates are high and antimicrobial therapy may be ineffective due to the presence of drug-resistant bacteria in the wound. In this work we have studied the effectiveness of wound treatment with the leaf extract of transgenic Kalanchoe pinnata modified to produce antimicrobial peptide cecropin P1. Purulent wounds infected with Staphylococcus aureus were modeled in Wistar rats. Four groups of animals were formed, with 10 animals in each group. In all groups, the wounds were cleansed with 3 % hydrogen peroxide solution once a day; all groups except the controls received additional treatment. Group 2 received 10 % cefazolin solution, group 3 received kalanchoe juice, group 4 received the juice of cecropin P1-producing kalanchoe. Histologic stains of biopsy samples were performed after rats were sacrificed by anesthetic overdose on days 3, 10 and 14 after treatment onset. On day 3, wound dynamics was the same in all groups. On day 10 exudate was still observed in the controls; in group two exudation was almost finished and regeneration was about to begin; in groups 3 and 4 the wound defect was filled with granulation tissue. In spite of epidermal repair along the wound edges in groups 2 and 3, there still was some sloughing and granulation tissue was less mature than in group 4. We recommend conducting more extensive clinical research of the leaf extract of cecropin P1-containing transgenic Kalanchoe pinnata.

Received: 2017-02-05

Published online: 2017-03-13

DOI: 10.24075/brsmu.2017-01-09

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VIEWS 5792

Eremeeva ZhG, Fazylov VH

Individuals carrying occult (latent) hepatitis B pose epidemiological threat. Testing donated blood donors for surface antigen HBsAg (hepatitis B virus, HBV) only does not allow to assume the blood safe from the point of view of infections, which can result in post-transfusion transmission of infection. Lack of confidence here is due to the fact that the virus is present in the body even when HBsAg is negative. The study analyzes data of 61,155 blood donors of the Republican Blood Center (Kazan), collected in 2010–2014. The tests applied were those aimed at detecting HBsAg, anti-HBc-total, anti-HBc IgM (enzyme immunoassay), and determining DNA of the virus in the blood by polymerase chain reaction in "real time". It was found that donors with occult hepatitis B are identified each year, but their numbers decrease gradually. To prevent the spread of the virus it is recommended to add the anti-HBc-total test to the standard set of diagnostic tests.

Received: 2017-02-01

Published online: 2017-03-13

DOI: 10.24075/brsmu.2017-01-08

Comments 0

VIEWS 5821

Oleynik AF, Fazylov VH, Beshimov AT

Antiretroviral therapy (ART) for HIV-positive patients allowed labeling the disease a therapeutically controlled one. The main goal of ART is to prolong patient's life and preserve its quality. This is accomplished through viral load reduction (decrease of the number of HIV-RNA copies in blood plasma), which leads to the growing numbers of CD4<sup>+</sup>-T-lymphocytes. However, ART can be ineffective. In 2010–1014, we conducted an observational cohort retro/prospective study aimed at learning how often ART can be ineffective from immunological (II), virological (VI) and clinical points of view. The study was carried out at the premises of the Republic Center of AIDS and Infectious Diseases (Kazan, Russia). The study included 341 adult HIV-positive patients subjected to ART at 3rd and 4th stages of disease's development, with the treatment virologically efficient at least during the first year. The observation period was 1 to 3 years. ART was considered II (immunologically inefficient) when the number of CD4<sup>+</sup> increased for less than 50 cells/mcl through the year with HIV completely suppressed. VI (virological inefficiency) of ART was registered if the number of HIV RNA copies was above the definition threshold after 6 months of treatment. ART was II in 14.0–15.9 % of cases after a year of treatment and in 22 % of cases after three years. It was noted that subsequent restoration of an adequate number of T-lymphocytes CD4<sup>+</sup> required they overcame the threshold of 100 cells/mcl within the 1st year of treatment. Virologically, ART was effective for 92.7 % for patients. Most (80 %) cases of VI of ART were results of patients' lax attitude towards treatment. Clinically, ART helped 91 % of patients; this result largely depended on the number participants for whom ART was II. II of ART is a risk factor, the risk being progression of the disease with active ART in the background and death of the HIV-positive individual. II of ART makes the risk of clinical progression of HIV 6.232 times higher (95 % CI 3.106–12.51).

Received: 2017-01-31

Published online: 2017-03-13

DOI: 10.24075/brsmu.2017-01-07

Comments 0

VIEWS 6522

Chernyavskaya OA

Increasing HIV prevalence among women and growing numbers of HIV-positive patients who choose to become pregnant prompt a discussion of management strategies applied to such patients. In this work we analyze a case of a pregnant HIV-positive woman with marked immunodeficiency who started seeking medical advice only after she had developed severe life-threatening secondary conditions. We look at the progression of comorbidities that led to the death of the patient and her baby and evaluate the chosen treatment plan. We also propose recommendations for the management of patients with similar pathologies that include psychological care, vigilance against possible atypical progression of a comorbidity, such as tuberculosis, and extensive diagnostic evaluation.

Received: 2017-02-04

Published online: 2017-03-13

DOI: 10.24075/brsmu.2017-01-06

Comments 0

VIEWS 6282

Shur KV, Maslov DA, Bekker OB, Danilenko VN

Antibiotic selection pressure, genetic polymorphism as well as diversity of the immune status of the host and other selection factors continuously prompt Mycobacterium tuberculosis, the tuberculosis causative agent, to evolve. Significant or insignificant mutations shape new (sub)lineages of the pathogen whose evolution can be understood only through analyzing and monitoring its genotypic diversity and properties of its lineages. In our study we used a set of 46 M. tuberculosis clinical isolates from Moscow region. The samples were typed using the standard 24-loci MIRU-VNTR technique. Beijing family isolates were shown to prevail in the collection (60.9 %), as well as Beijing-B0/W148 subtype (60.7 % of total Beijing type samples); most of them (88,2 %) were multidrug-resistant resistant. The applied technique allowed us to detect one case of a mixed-strain infection.

Received: 2017-02-01

Published online: 2017-03-13

DOI: 10.24075/brsmu.2017-01-05

Comments 0

VIEWS 6165