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Aim. To investigate whether intravenous contrast-enhanced multislice spiral computed tomography (computed tomography) (MSCT) versus myocardial morphological examination can diagnose myocarditis and the non-inflammatory causes of dilated cardiomyopathy (DCM) and evaluate prognosis in patients with the latter. Subjects and methods. A study group consisted of 130 patients, including 95 men (46.8±11.9 years), with DCM (mean left ventricular (LV) end-diastolic dimension (EDD), 6.6±0.8 cm; mean LV ejection fraction (EF), 29.8±9.3%; NYHA functional class (FC) III (II; III)). All the patients underwent intravenous contrast-enhanced 320-slice CT of the heart; myocardial morphological examination was made in 48 patients (endomyocardial biopsy in 29 patients, intraoperative biopsy in 7, and autopsy in 9, and study of the explanted heart in 3). In addition, cardiotropic viral DNA in the blood and myocardium and the level of anticardiolipin antibodies were determined; echocardiography (in all the patients), scintigraphy (n = 45), magnetic resonance imaging (MRI) (n = 21), and coronary angiography (CG) (n = 46), and a genetic consultation were performed. A comparison group comprised 20 patients, including 14 men (69.3±9.2 years), with coronary atherosclerosis (40% or more stenoses) according to MSCT findings in the absence of criteria for DCM (mean LV EDD, 4.8±0.5 cm; mean LV EF, 59.4±4.6%). Results. Morphological/comprehensive examination showed that myocarditis as a cause of DCM was diagnosed in 76 (65%) patients; its concurrence with genetic cardiomyopathies was in 17 more patients (17%). MSCT of the heart revealed lower accumulation areas in 2 (1.5%) patients (type 1 based on the proposed rating scale), delayed myocardial contrast agent accumulation (DMCAA) in 81 (62.3%): subendocardial accumulation (type 2) in 8, intramyocardial accumulation in 4 (type 3), subepicardial accumulation in 52 (type 4), and transmural accumulation in 15 (type 5); DMCAA was not noted in 49 patients. DMCAA was not found in the comparison group. As compared with biopsy, the sensitivity, specificity, predictive value of positive and negative results of the tests in detecting active myocarditis for all the types of DMCAA were 77.4, 47.1, 72.7, and 53.3%, respectively; those for types 3-5 of DMCAA were 77.4, 52.9, 75.0, and 56.3%; those in detecting all the morphological types of myocarditis were 68.3, 28.6, 84.8, and 13.3%, and those for types 3-5 were 65.9, 28.6, 84.4, and 12.5%, respectively. Comparison of the data of MSCT and those of comprehensive examination in all the patients with DCM, the diagnostic significance in detecting myocarditis for all the types of DMCAA was 70.6, 67.9, 88.9 and 38.8%, respectively; that for DMCAA types 3-5 was 60.8, 67.9, 87.3, and 32.3%. In the study group, MSCT also identified the non-compacted myocardium (n = 31 (23.8%)), coronary atherosclerosis (n = 31 (23%)), which is confirmed by CG findings in 15 patients. The patients with DMCAA significantly more frequently showed a relationship with previous infection, acute onset, significantly higher NYHA FCs, end-diastolic and end-systolic LV volumes, and insignificantly lower LV EF. During a mean follow-up periods of 12 (6; 37.25) months, the overall mortality rate was 17.7% (23 deaths); the death + transplantation index was 20% (n = 26). All the types of DMCAA were found to be significantly related to prognosis: in the DMCAA group, the mortality rate was 21.5% versus 7.8% in the non-DMCAA group (odds ratio 3.22; 95% confidence interval, 1.02 to 10.21; p < 0.05). Conclusion. MSCT with the assessment of delayed contrast enhancement (and simultaneous CT coronary angiography) can be used for the non-invasive diagnosis of myocarditis in patients with DCM, including that in the presence of contraindications to MRI. DMCAA correlates with the presence of myocarditis, its activity, the degree of functional disorders, and prognosis.

Vulvovaginal candidiasis (VVC) frequently occur in women of childbearing age. 5-10% of these women experience recurrent vulvovaginal candidiasis (RVVC), which is characterized by at least 4 episodes of infection in 12 months. In addition to known risk factors such as antibiotics, diabetes, or pregnancy, host genetic variation and antifungal immune response play a substantial role in the pathogenesis of RVVC. The aim of this study was to identify a molecular-genetic factors of recurrence of VVC. Our results shows that single nucleotide polymorphisms (SNP) in cytokine genes such as IL4, IL1b and CCL2 were associated with recurrent vulvovaginal candidiasis and effect on susceptibility to disease.

Host immunity against Candida albicans is crucial in controlling C. albicans infection. The innate immunity is believed to be the first line of host defense, such as the direct killing of yeasts through phagocytosis by neutrophils and macrophages. In addition to innate immune cells, an adjunctive protective effect is played by cellular adaptive immunity represented by Th lymphocytes. The balance of various Th cell subpopulations plays a crucial role in regulating the prognosis of C. albicans infection. Yeasts cell recognition by pattern recognition receptors leads to proinflammatory cytokines synthesis, cause immune system activation and yeast cells killing. However it was demonstrated that C. albicans inhibits immune response which cause infection. Aim - studying vaginal microbiota and the local immune response in women with recurrent vulvovaginal candidiasis for improving the tactics of their management. Results. Our date demonstrates that vaginal disbiosis are risk factor for RVVC and leads to more active innate immune system response.

Background. Vulvovaginal infections are the most common, studied, and still causing many questions. It has been established that the disturbance of the ratio of the vaginal microbiota components does not always lead to a disorder since the development and outcome of the disorder largely depend on the state of the macroorganism, including the state of its immune system. To date, the only method for assessing the state of local immunity is smear microscopy with counting leukocytes. An alternative to leukocyte counting is the assessment of immunological parameters (e.g., the transcriptional profile of cytokine genes). An integrated approach to assessing the state of microbiocenosis (the ratio of lactobacilli and opportunistic pathogens) and local mucosal immunity, considering the individual genetic characteristics of patients and microorganisms, makes it possible to optimize treatment methods for vaginitis. One of the ways to increase the effectiveness of treatment and prevention of the recurrence of infectious and inflammatory diseases in gynecology is systemic enzyme therapy based on the complex effect of a specially selected combination of plant and animal origin enzymes on key physiological and pathophysiological processes in the body. Aim. To study the clinical effect and the effect of combined therapy with an antibiotic and a medicinal product, including a complex of enzymes of plant and animal origin (Wobenzym) on the state of the vaginal microbiota, the expression of cytokine genes, and the recurrence rate in patients with bacterial vulvovaginitis. Materials and methods. An open-label, single-center, prospective, comparative, randomized study enrolled 88 patients according to inclusion criteria. After randomization of patients into 2 groups, the main group received combination therapy (clindamycin vaginal cream 2% and Wobenzym), and patients of the comparison group received standard therapy only (clindamycin vaginal cream 2%). Short-term and long-term endpoints were defined. The primary endpoints included the assessment of symptoms, the change over time of the number of leukocytes in Gram-stained smears, and the recurrence rate; the secondary endpoints were the study of the change over time of the inflammation index, the results of the assessment of the state of the vaginal microbiota by real-time quantitative polymerase chain reaction using the Femoflor 16 reagent kit and a microbiological study. Results. When used in combination, Wobenzym potentiates the antibacterial properties of clindamycin, reduces the inflammation index, promotes the growth of the normal microbiota of the vagina (Lactobacillus spp.), prevents the growth of opportunistic microorganisms and, as a result, prevents the recurrence of vulvovaginitis. Conclusion. The results support the use of combination therapy (antibiotic + Wobenzym) to improve the effectiveness of therapy and maintain normocenosis.

An increasing number of hormonal contraceptives and their varying system effects on the body of a woman makes it necessary to personify their prescription and search for means of predicting their safety and tolerability. The article presents the research data and shows the various informative clinical predictors in the development of adverse reactions in the background. It was found that the most significant clinical predictors of occurrence of side effects and complications on the background of the use of the HC are the existence of gynecological diseases associated with menstrual cycles and poor portability of HC in history; an independent predictor of adverse effects on the background of the COC are chronic cholecystitis and dysfunction of the sphincter of Oddi; dynamics of lipid parameters, biochemical blood spectrum, as well as some parameters of hemostasis with the use of different variants of HC; genotype women polymorphic locus rs2414096 aromatase gene (CYP19A1) is a significant predictor of complications and side effects when using HC.

The article describes the history of development of the concept of primary prevention of congenital malformations of the fetus via periconceptional receiving of multivitamin preparations containing folic acid. The results of Hungarian studies on the use of multivitamins are also given below as well as the current understanding of the mechanism of the prophylactic action of folic acid from a position of pharmacogenetics. The data on the use of different biochemical forms of folate is presented as well.

Objective - to expand the conception of molecular and biochemical changes in genital prolapse (GP) based on the study of morphological and immunohistochemical features in connective tissue structures of the ligamentous apparatus of the pelvic floor and their dependence on genetic polymorphisms MMP/TIMP. Materials and methods. The study involved 178 women aged 35 to 65, 134 of them with GP relapses (after hysterectomy by vaginal access because of a total and partial uterus and vaginal walls prolapse). Patients were randomized into the following groups: 1 - with manifestations of undifferentiated connective tissue dysplasia - CTD (11.7 points on average; n=86); 2 - with no CTD signs (n=48). Control group 3 consisted of healthy women without any GP signs (among 15 patients abdominal hysterectomy was performed in connection with uterus hyperplastic processes); n=44. Used. Morphological method of studies, immunohistochemical (to assess tissue biopsies of sacrum-uterine and round uterine ligaments), the expression of matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs), genotyping by polymerase chain reaction of MMP/TIMP polymorphisms. Results. The morphological study of women’s ligamentous apparatus in cases with GP revealed significant fibrosis, coarser collagen septa among bundles of smooth muscle fibers and degenerative changes in individual smooth muscle cells. The group with GP and CTD features showed diffuse atrophy, hyaline or mucinous degeneration of smooth muscle tissue and evident edema of extracellular matrix in 65% of samples. Pathobiochemical disorders in cases of pelvic descencia were determined by an imbalance in collagen type I and III content, with the predominance of the latter, less durable; a decrease in elastin levels and its considerable fragmentation. The greatest expression of tissue degradation was observed among women with GP and CTD manifestations on account of increased MMP-1 and -2 levels; TIMP-1 content was lowest in the group. Associations with GP development have been established among women with CTD signs for genetic polymorphisms: rs3918242 СT gene MMP9 (0.54) (p=0.007; OR 3.2; 95% CI 1.3-7.6), rs17576 AG gene MMP9 (0.62 vs. 0.32, p=0.01; OR 2.9; 95% CI 1.2-7.0); rs3025058 5A6A gene MMP3 (0.52 vs. 0.45, p=0.009; OR 3.7; 95% CI 1.3-10.1); rs2285053 (rs2285052) CT gene MMP2 (0.44 vs. 0.27, p=0.007; OR 3.2; 95% CI 1.3-7.5). Statistical significance for the groups was preserved after the correction for multiple comparisons. Conclusion. The data obtained reveal pathogenetic aspects of genital prolapse - the prevalence of extracellular matrix degradation in a dysplastic morphogenesis. Genetic predictors of pelvic floor remodeling including the formation of its insolvency were established, allowing to extend the range of diagnostic possibilities of the disease progression at early stages or detection the risk of recurrence after surgical treatment. Personification of high-risk groups conducting provides for the exclusion or modification of all the factors predisposing to the development of the disease and performing timely treatment and preventive measures.

Aim. To identify gene polymorphisms (OPG, RANKL, VDR, SOST) and evaluate their relationship with bone mineral density (BMD) and fractures for further optimization of diagnosis and treatment of postmenopausal osteoporosis (PMO). Materials and methods. The study included 236 postmenopausal women living in Moscow and the Moscow region. The main group (I) consisted of 174 patients, aged 50 to 83 years, with BMD < - 2.5 SD for the T-score. The comparison group (II) consisted of 62 postmenopausal women with BMD within the normal range and the lack of previous fractures, aged 50 to 77 years. Molecular genetic analysis of polymorphisms of VDR (rs10735810, rs1544410), RANKL (rs9594738, rs9594759) and OPG (rs3102735, rs3102735 and rs4355801), SOST (rs1230399) was performed by polymerase chain reaction in all subjects with PMO and in the control group. Results. In the presence of the T allele of the gene RANKL (rs9594759 and rs9594738) risk of reduced BMD at L1-L4 was increased by 2 times. Women with genotype C/C gene polymorphism of OPG (rs3102735) the risk of fractures of the distal radius (PR) was increased by 17 times, regardless of BMD. Genotype G/G rs1544410 polymorphism of VDR gene in patients with PMO is associated with an increased risk of fractures of the distal radius by three times. In patients with PMO genotype C/C in gene SOST (rs1230399) only cause differences in body mass index. According to an autosomal recessive pattern, homozygous genotype C/C was significantly associated with obesity in the PMO. Conclusions. Polymorphisms of genes RANKL (rs9594759 and rs9594738), OPG (rs3102735) and VDR (rs1544410) are associated with the risk of fractures and PMO. Gene SOST (rs1230399) had no statistically significant effect on BMD and fracture risk.

Variability in the subfertile patient population excludes the possibility of a single approach to controlled ovarian stimulation. Genetic screening may allow an individual patient’s response to stimulation during controlled ovarian stimulation to be predicted based on genotype. The objective of the study was to analyze the specific features of folliculogenesis, oogenesis, and embryogenesis in patients in relation to single nucleotide polymorphisms in assisted reproductive technology.

In recent years, some new evidence on the role of Malassezia in late-onset sepsis in immunocompromised patients have been published, but there are still very few studies with special focus on newborns.The prevalence of Malassezia-associated conditions in 3519 newborn patients of general and surgical neonatal intensive care units (NICU) was assessed. All patients underwent pharyngeal and rectal swab screening for Malassezia spp. Identification of Malassezia spp. was carried out with the use of an adapted nutrient media, microscopic assessment of yeast cell morphology, and real-time PCR analysis.Malassezia furfur-induced invasive mycoses (IM) were developed 2.5 times more often in very low birth weight (VLBW) M. furfur-positive newborns, than in neonates with birth weight ≥1500 g, and affecting 15.8 % of VLBW infants. Funguria occurred 16 times more often in VLBW babies, but fungemia incidence was similar for both weight categories. Gastrointestinal (GI) colonization was found in 94.6 % of Malassezia-positive population, and in 8 % of all studied neonates. Among IM patients, death rate was 6.5 %. The specific pathogen was highly detectable by a combination of real-time PCR and an adapted nutrient media. Colonization with M. furfur in newborns was associated with low gestational age, VLBW, and long stay in NICU.The findings emphasize the need to monitor colonization and infection with M. furfur in neonates, staying in ICU for more than two weeks and to improve current diagnostic approaches by using real-time PCR and an adapted nutrient media for M. furfur isolation.

Цель: Изучить эффективность золедроновой кислоты в терапии постменопаузального остеопороза (ПМО) с учетом полиморфизма гена фарнезилдифосфат-синтетазы (FDPS). Методы исследования: клинический, определение биохимических маркеров костного метаболизма (БМКР) - электрохемилюминесцентным методом («Хоффманн-Ла Рош ЛТД», Швейцария). Измерение МПК проводили с помощью двухэнергетической рентгеновской абсорбциометрии позвонков поясничной области (L1-L4) и шейки бедренной кости (Neck left, Neck total left). Молекулярно-генетический (определение однонуклеотидного полиморфизма гена FDPS (rs2297480) - методом «примыкающих проб» с анализом кривых плавления (ЗАО «НПФ ДНК-Технология, Россия)). Результаты. Обследовано 225 женщин с постменопаузальным остеопорозом. Средний возраст составил 59 (5466) лет. Средняя продолжительность периода постменопаузы 7 (2-13) лет. ИМТ=27,2(23,6-29,05) кг/м2. Распределение аллелей (АА:АС:СС) составило 55,1(n=144):39,5(n=103):5, 4(n=14). Базальные уровни биохимических маркеров костного ремоделирования (БМКР) соответствовали периоду постменопаузы и статистически значимо не различались в зависимости от генотипа FDPS. Средние показатели МПК в поясничном отделе позвоночника и/или шейке бедра соответствовали остеопорозу. Всем пациенткам проводили терапию золедроновой кислотой (zol) в дозе 5 мг в виде внутривенной инфузии 1 раз в 12 месяцев в течение 2 лет. Дополнительно все пациенты получали кальций 1000 мг/сут и витамин Д3 800МЕ/сут. Реакция БМКР на инфузию zol различалась в зависимости от генотипа FDPS. Через 6 месяцев после 1-ой инфузии достоверно более выраженное снижение B-Crosslaps 92 (91-93)% отмечено у пациентов с С/С генотипом (p=0,056), по сравнению с 82% у носителей аллеля А (p=0.07). Через 9 месяцев после инфузии B-Crosslaps у носителей аллеля А повышались до 75%, остеокальцина - 44,4% от исходного. Тогда как у носителей генотипа C/C как B-Crosslaps - (87%), так и osteocalcine -(53,6%) оставались по-прежнему низкими (р=0,056). К 12 месяцу после инфузии уровни B-Crosslaps и osteocalcin у носителей аллеля A повышались и соответствовали премено-паузальным значениям, тогда как у носителей С/С генотипа оставались в пределах ниже нижней границы нормы для пременопаузы. У пациентов с СС генотипом на фоне выраженного снижения БМКР после 2ой инфузии золедроновой кислоты произошло снижение МПК на 5,6%. Выводы. Различная реакция на терапию золедроновой кислотой у пациенток с ПМО связана с полиморфизмом гена FDPS (rs2297480). Для пациентов с генотипом С/С характерно «гиперторможение» костного обмена в ответ на терапию золедроновой кислотой, что возможно, было причиной отрицательной динамики МПК в поясничном отделе позвоночника на втором году терапии золедроновой кислотой.

Aim. To study possibility of nosological diagnosis in patients with dilated cardiomyopathy (DCMP) with use of myocardial biopsy. Material and methods. The trial enrolled 62 patients (23 females) with DCMP syndrome (end diastolic left ventricular size > 5.5 cm, ejection fraction < 55%). Mean age of the patients was 46.0±12.8 years. The examination included diagnosis of viral infections (Herpes virus, parvovirus B19), measurement of anticardial antibodies titer, 99Tc-MIBI single photon emission computed tomography of the myocardium, multislice computed tomography, MRT of the heart, coronarography, morphological study of the myocardium (n = 20) with application of polymerase chain reaction (PCR) for H.simplex viruses of types 1, 2 and 6, herpes zoster, Epstein-Barr, cytomegalovirus, parvovirus B-19, adenoviruses. The control group (20 operated patients with valvular heart disease and coronary heart disease) was examined for viral genome in the blood and myocardium. Results. Complex examination of DCMP patients showed the following distribution by nosological entuities: myocarditis (n = 41, 66.1%) including virus-positive (n = 14), primary DCMP (n = 16, 25.9%) including with non-compact myocarditis (NCM) in 3, with debute at delivery of the child - in 3. Arrhythmogenic right ventricular dysplasia combined with viral myocarditis (n = 2), genetic myopathy (n = 1) and Takayasu disease (n = 1) combined with NCM, isolated NCM (n = 1) were diagnosed in the rest cases. Morphological investigation of the myocardium was made in 20 patients: diagnosis of myocarditis and primary DCMP were made in 70% (including in 2 patients with CHD) and 20%. Detection of viral genome was 20 and 15% in the study and control group, respectively, in the myocardium - in 57.9 (test for parvovirus B19 was not made in 26%) and 65.0% (complete diagnosis).All the virus-positive patients with DCMP were diagnosed to have signs of active/borderline myocarditis. Diagnostic criteria and poor prognosis factors were defined. Conclusion. The nosological diagnosis of DCMP was made in all the examinees basing on the complex of clinical, case history and device evidence. The diagnosis was morphologically verified in 33.9% patients. Treatment approaches are developed.

The influence of dysbioticvaginal disturbanses on the results of treatment by IVF is stillremainsunclear. Thebacterial vaginosis takes the leading position in the structure of female genital tract infection diseases. Despite of numerous studies which were conducted in this area of investigation, the influence of bacterial vaginosis on treatment in IVF program and ET and also on the subsequent carrying of pregnancy is bad understood till now.

The aim of the study was to improve approaches to the use of Rh0(D) immune globulin in pregnant women with Rh-negative blood by introducing noninvasive method of determination of fetal rhesus blood factor by mother’s blood into curation program of pregnancy at risk of RBC sensitization. The accuracy of noninvasive method of rhesus genotyping in 204 pregnant women with Rh negative blood in 14-27 weeks of pregnancy was 99.0%. The determination of fetal rhesus allows personify implementation of immunological prophylaxis in Rh negative pregnant women.

Conclusion. 1. There were no significant differences in the occurrence frequency of allele and genotypes of C1444 locus of CRP gene in patient with osteoporosis. 2. It was founded that T allele and TT genotype of C1846T locus of CRP gene were more common in women with osteoporosis. 3. The determination of gene CRP polymorphism gives a responsibility to realize individual prognosis and to take preventive measures. Цель исследования. Определить полиморфизмы генов OPG, RANKL, VDR, SOST и оценить их взаимосвязь с минеральной плотностью кости (МПК) и переломами для последующей оптимизации диагностики и лечения постменопаузального остеопороза. Материал и методы. В исследование вошли 236 женщин в постменопаузе, проживающих в Москве и Московской области. Основную группу составили 174 пациентки, в возрасте от 50 до 83 лет, с показателями минеральной плотности кости (МПК) < - 2,5 SD по Т-критерию. Группу сравнения составили 62 женщины в постменопаузе с показателями МПК в пределах нормальных значений и отсутствием переломов в анамнезе, в возрасте от 50 до 77 лет. В нашем исследовании всем испытуемым с постменопаузальным остеопорозом и группы контроля с помощью полимеразной цепной реакции проводили молекулярногенетическое проводили с определением полиморфизмов генов VDR(rs10735810, rs1544410), RANKL (rs9594738, rs9594759) и OPG (rs3102735, rs3102735 и rs4355801), SOST (rs1230399). Результаты. При наличии Т аллелей гена RANKL по полиморфизмам rs9594759 и rs9594738 риск снижения МПК в поясничном отделе позвоночника увеличивается в 2 раза. У женщин с гомозиготным генотипом С/С по полиморфизму rs3102735 гена OPG риск развития переломов дистального отдела лучевой кости повышается в 17 раз вне зависимости от показателей МПК. Наличие генотипа G/G по полиморфизму rs1544410 гена VDR у пациенток с постменопаузальным остеопорозом ассоциировано с повышением риска переломов дистального отдела лучевой кости в 3 раза. У пациенток с ПМО гомозиготный генотип С/С по полиморфизму rs1230399 гена SOST обуславливают только различия в индексе массы тела. Заключение. Полиморфизмы генов RANKL (rs9594759 и rs9594738), OPG (rs 3102735) и гена VDR(rs1544410) ассоциированы с риском развития постменопаузального остеопороза и переломов. Ген SOST(rs1230399) не оказывает статистически значимого влияния на МПК и риск переломов.

Relevance. Acute respiratory infections (ARI) are a serious health problem not only because of the high frequency of their occurrence, but also because of the economic damage they cause both in the form of direct costs (the cost of diagnosis and treatment) and indirect costs (disability, reduced labor productivity, etc.). Pregnant women and children under 5 years of age are included in the group of patients with risk factors for complications of influenza and other ARI, therefore, an analysis of the etiological structure of ARI and influenza in obstetric hospitals is an urgent task. In recent years, there has been an urgent need to create a national complex diagnostic test system based on molecular genetic methods for detecting infectious agents that cause ARI. Aims. The aim of the study is to analyze the etiological structure of ARI and influenza in patients with clinical symptoms and to develop and implement a new test system for rapid screening and diagnosis of infections that cause ARI. Materials & methods. When studying the etiological structure of ARI and influenza, cultural studies of the nasal and pharyngeal mucosa were carried out, followed by identification of microorganisms using MALDI-TOF mass spectrometry and molecular genetic study (real-time PCR) using an experimental test panel containing primers that allow detecting the following viruses: influenza A, B viruses, parainfluenza viruses of the 1st, 2nd, 3rd and 4th types, coronaviruses OS43, HKU1, NL63, E229, respiratory syncytial virus, metapneumovirus, rhinovirus and adenovirus, as well as bacterial pathogens of ARI: Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus pyogenes, Moraxella catarrhalis, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa. The test system was developed using the following methods: real-time PCR, a combination of reverse transcription and real-time PCR (RT-PCR) and the next generation sequencing (NGS) method. Results. The etiological structure of ARI and influenza was analyzed in patients with clinical manifestations (cough, tickling/sore throat/hyperemia of the mucous membrane of the palate and the back wall of the pharynx, shortness of breath/difficulty breathing, acute runny nose/nasal congestion). The species spectrum of bacterial and viral pathogens was revealed. A new test system based on PCR, real-time RT-PCR and NGS has been created for complex diagnostics of both viral and bacterial pathogens of ARI, consisting of three separate components: the main test system «ARI», which detects the main viral and bacterial pathogens of ARI, and two additional sets of reagents: «Oseltamivir resistance» and «Oseltamivir/ Zanamivir resistance». Conclusions. The new test system can be used to detect and differentiate nucleic acids of pathogens of ARI of humans. The test system seems to us promising for further use. As a result of the analysis of the etiological structure of acute respiratory infections and influenza, attention is drawn to a significantly smaller variety of identified pathogens in 2020 and a much more pronounced dominance of rhinovirus infection compared to our previous study in 2019.

Aim: the study was aimed to develop a reagent kit for the real-time RT-PCR diagnostics of virus causing COVID-19.Materials and Methods. Three target sites were chosen in the genome SARS-CoV-2. The testing included 220 samples, 48 artificially created positive samples (made from patients’ biomaterial) and 172 clinical samples (scrapes from nasal and pharyngeal cavities, bronchoalveolar lavage, expectoration, endotracheal/nasopharyngeal aspirate, feces, post-mortem material), obtained from two medical centers. Preliminary, the obtained biomaterial was analyzed with a reagent kit of comparison. The evaluation was performed with a confidential interval CI 95%. The calculation of CI for the sensitivity and specificity was made based on the distribution of χ2.Results. The authors developed a technology of novel coronavirus infection (COVID-19) real-time RT-PCR diagnostics for the application in practical healthcare and proposed the variants of testing at all the stages (preanalytical, analytical, and post-analytical, including automated results processing). The proposed reagent kit meets the requirements of the World Health Organization and the Ministry of Healthcare of the Russian Federation. The study results demonstrated high sensitivity and specificity. The sensitivity was 100% (95% CI) 95.6–100%; the specificity was 100% (95% CI) 96.7–100%.Conclusion. The proposed reagent kit was registered in the RF as a medical product; the registration certificate No. RZN 2020/9948 dated 01.04.2020. The application of the reagent kit in network laboratories will provide patients with access to testing for the virus causing COVID-19 and contribute to quick differential diagnostics, improvement of pandemic control, and accurate statistics on the spread of the virus.

Aim. To study the efficacy and safety of mycophenolate mofetil (MM) in combination with corticosteroids in the treatment of lymphocytic myocarditis in comparison with a standard combination of corticosteroids and azathioprine.Material and methods. The study included 46 patients aged 18 years and older with severe and moderate lymphocytic myocarditis (men, 34; women 12; mean age, 53,5±13,0 years). The diagnosis was verified using endomyocardial biopsy. Symptom duration averaged 9,5 [4; 20.25] months. All patients had class 3 [2,75; 3] heart failure (HF). The main group included 29 patients who received MM 2 g/day, including six patients — instead of azathioprine, which was canceled due to cytopenia (n=3) or insufficient effect (n=3). The comparison group included 17 patients who received azathioprine 150 [100; 150] mg/day. Patients of both groups also received methylprednisolone at a starting dose of 24 [24; 32] and 24 [24; 24] mg/day and standard HF therapy. In 7/2 patients, the parvovirus B19 genome was detected in the myocardium. In all cases, an increase in anticardiac antibody titers was evidence of immune activity. The average follow-up period was 24 [12; 54] months (at least 6 months).Results. The groups were completely comparable in age, initial characteristics and standard drug therapy. In both groups, a comparable significant increase in the ejection fraction (EF) was noted as follows: from 31,2±7,6 to 44,7±8,3% and from 29±9,1 to 46±11,9% (p

Aim. To study the role of contrast-enhanced multispiral computed tomography (MSCT) of the heart in diagnostics of myocarditis in patients with the syndrome of dilation cardiomyopathy (DCMP) comparing to morphological investigation of myocardium.Material and methods. Into the main group of study, 127 patients included (92 males, 46,9±11,8 y.o.) with DCMP syndrome (mean end diastolic size (EDS) of the left ventricle (LV) 6,6±0,8 cm, mean ejection fraction (EF) 29,7±9,5%, 3 [2; 3] FC by NYHA). All underwent 320-slice MSCT of the heart with i.v. contrast, 50 underwent morphological investigation of myocardium (endomyocardial byopsy in 30, intraoperational in 7, autopsy in 9, explanted heart study in 4). Also, viral infection markers were studied, as the level of anticardiac antibodies, EchoCG (all patients), scintigraphy (n=42), magnete-resonance tomography (MRI) (n=21), coronary arteriography (CAG, n=48). Comparison group included 18 patients (12 males, 69,2±8,5 y.o.) with coronary atherosclerosis (stenosis form 40%) by MSCT and absence of DCMP criteria (mean EDS LV 4,7±0,5 cm, mean EF LV 59,3±4,9%, 0 [0; 2] FC by NYHA).Results. By the data from complex investigation, myocarditis as the main cause of DCMP syndrome was diagnosed in 79 (62,2%) patients of the main group, its comorbidity with genetic cardiomyopathies — in 19 else (15%). In MSCT of the heart the areas of lower accumulation were found in 4 patients from main group (3,1%, type 1 by the proposed evaluation score), delayed accumulation of the contrast in myocardium — in 72 (56,7%) patients: in 12 subendocardial (type 2), in 4 intramyocardial (type 3), in 44 subepicardial (type 4), in 12 transmural (type 5); in 51 patient there was no delayed accumulation. Sensitivity and specificity of all types of delayed accumulation in diagnostics of myocarditis were 63,3% and 78,7%, positive and negative predictive value 86,1% and 50,7%, subepicardial and transmural types — 49,0%, 83,0%, 85,7%, 43,8%, respectively. While comparing the data of MSCT directly with morphological study of myocardium, diagnostic significance of all types of delayed accumulation in myocarditis revealing was 66,7%, 84,6%, 87,5%, 61,1%, subepicardial and transmural types — 52,4%, 92,3%, 91,7%, 54,5%, respectively.By MSCT in the main group also the non-compaction myocardium was found (n=29, 22,8%), coronary atherosclerosis (n=33, 26,0%), confirmed by CAG in 16 patients. Presence/absence of delayed accumulation by our proposed score correlated with 1) diagnostical signs: duration of illness (r=-0,185, p

Objective. Identification and analysis of risk factors for stress urinary incontinence in women, assessing the relationship of stress urinary incontinence and undifferentiated connective tissue dysplasia. Subjects and methods. The study group included 85 women with a confirmed diagnosis of stress urinary incontinence, in the control group - 105 women without disease, comparable to the main features of the study group. We used clinical-anamnestic method of investigation, questioning (ICIQ-SF), a comprehensive urodynamic study. Evaluation of genital prolapse was conducted to quantity the classification of pelvic organ prolaps (POP-Q), assessment of severity of the connective tissue dysplasia was carried out on a scale of severity of the clinical criteria for connective tissue dysplasia, modified by Buyanova and Smolnova. Results. We established elevated risk of stress urinary incontinence in women with a BMI value of 30 kg/m 2, RR = 2,45 (95% Cl 1,21-4,94, p

Part I (Diagnostics), was published in the journal “Rational Pharmacotherapy in Cardiology” 2014;10(1):62-72Aim. To develop a comprehensive clinical and morphological approach to the nosological diagnosis and treatment of "idiopathic" arrhythmias (IA) and the syndrome of dilated cardiomyopathy (DCM).Material and methods. Patients (n=320) with IA (n=190; 117 women, age 45.3±14.8 years) and DCM (n=130, 41 women, age 46.9±12.5 years) were included in the main group. 51 people (patients with ischemic heart disease; heart valve disease, hypertrophic cardiomyopathy, who underwent open-heart surgery; healthy volunteers) were included in the control group. Along with the standard tests evaluation of the level of anti-heart antibodies (185 patients with IA and 122 with DCM), viral serology (166 and 122), multispiral computed tomography (42 and 88), cardiac magnetic resonance imaging (41 and 22), coronary angiography (19 and 54), myocardial biopsy/autopsy (19/0 and 33/9) were performed.Results. According to morphological study infectious-immune myocarditis was found in 78.9% patients with IA and 66.7% patients with DCM, arrhythmogenic right ventricular dysplasia in 5.3% and 4.8% of patients, respectively. Other genetic cardiomyopathies, including combination with myocarditis were revealed in other patients. The frequency of the viral genome detection in the myocardium in IA, DCM and the control group was 17.6%, 66.7% and 77.1%, respectively. However in the control group the incidence of myocarditis and anti-heart antibodies titers were significantly lower than in the main group, where a strong correlation between myocarditis and anti-heart antibodies titers was found. The algorithm of noninvasive nosological diagnostics was developed; it allowed to verify diagnosis in 95% of IA patients and 89% DCM patientsThe basic therapy (antiviral drugs, corticosteroids, hydroxychloroquine, azathioprine) was performed in some patients with myocarditis. Improving of the antiarrhythmic effect of treatment in patients with IA, a significant increase in ejection fraction, a reducing of the size of the heart chambers and of pulmonary artery pressure in patients with DCM, a reducing of the need in surgical treatment (including in the virus-positive patients) occurred as results of treatment.Conclusion. Nosological cause of IA and DCM syndrome can be diagnosed in most patients by using an integrated clinical and morphological approach. This allows managing effective etiotropic and pathogenetic treatment.

PAim. To develop a comprehensive clinical and morphological approach to the nosological diagnosis and treatment of "idiopathic" arrhythmias (IA) and the syndrome of dilated cardiomyopathy (DCM).Material and methods. Patients (n=320) with IA (n=190; 117 women, age 45.3±14.8 years) and DCM (n=130, 41 women, age 46.9±12.5 years) were included in the main group. 51 people (patients with ischemic heart disease; heart valve disease, hypertrophic cardiomyopathy, who underwent open-heart surgery; healthy volunteers) were included in the control group. Along with the standard tests evaluation of the level of anti-heart antibodies (185 patients with IA and 122 with DCM), viral serology (166 and 122), multispiral computed tomography (42 and 88), cardiac magnetic resonance imaging (41 and 22), coronary angiography (19 and 54), myocardial biopsy/autopsy (19/0 and 33/9) were performed.Results. According to morphological study infectious-immune myocarditis was found in 78.9% of IA and 66.7% of DCM-patients, arrhythmogenic right ventricular dysplasia in 5.3% and 4.8% of patients, respectively. Other genetic cardiomyopathies, including combination with myocarditis were revealed in other patients. The frequency of the viral genome detection in the myocardium in IA, DCM and the control group was 17.6%, 66.7% and 77.1%, respectively. However in the control group the incidence of myocarditis and anti-heart antibodies titers were significantly lower, while in the main group a strong correlation between myocarditis and anti-heart antibodies titers was found. The algorithm of noninvasive nosological diagnostics was developed; it allowed to verify diagnosis in 95% of IA patients and 89% DCM patients.Conclusion. Nosological cause of IA and DCM syndrome can be diagnosed in most patients by using an integrated clinical and morphological approach.

Adhesion of the labia minora is one of the most complicated diseases in girls at the age beginning with infancy. The occurrence of this condition in population is 0,6–3% of girls. It mainly can be found at the age of from 3 months to 6 years, the age from 12 to 23 months is the peak of disease prevalence. The relapse rate varies from 14 to 39%. During last decade the prevalence of disease has been reported to rise significantly. However there is lack of uniform guidelines of children with this condition management both in Russia and abroad. In this article the problem of management of infant girls with adhesions of the labia minora is highlighted, the advantages and disadvantages of various treatment options are discussed.