[Prevention of the development of geriatric syndromes and acute functional deficiency in patients with frailty.]

One of the most difficult tasks in medical practice is pharmacotherapy in elderly and senile patients. The complexity of pharmacotherapy in elderly patients is due to age-related physiological changes, high frequency of multimorbidity. The age of patients no longer precludes surgical intervention, and surgical procedures are often performed on elderly patients with complex comorbidities. Over the past 15 years, the number of emergency hospitalizations has increased significantly worldwide.

[SARS-CoV-2-induced non-bacterial endomyocarditis with the development of acquired heart defects]. / SARS-CoV-2-indutsirovannyi nebakterial'nyi endomiokardit s razvitiem priobretennykh porokov serdtsa.

Patients with damage of the mitral, aortic and tricuspid valves and systolic myocardial dysfunction associated with previous SARS-CoV-2 infection are described. The diagnosis of acquired defect was established in 4 patients based on medical history, electrocardiography, echocardiography, magnetic resonance imaging of the heart, endomyocardial or intraoperative myocardial biopsy, and in one case, autopsy. The study of the myocardium included H&E, Van Gieson staining, immunohistochemical (IHC) study with antibodies to CD3, CD20, CD45, CD68, to the nucleocapsid and Spike proteins of SARS-CoV-2. Previous valve diseases (prolapse, bicuspid aortic valve) served as a background for the development of the defect in 2 patients. In all cases, IHC studies revealed coronavirus proteins, lymphocytic endocarditis and myocarditis, moderate fibrosis, and signs of connective tissue disorganization. High titers of anticardiac antibodies indicated an autoimmune mechanism for carditis. No signs of infective endocarditis or thromboembolic complications were identified in any case. In patients with an unclear nature of valvular heart defects, a previous new coronavirus infection should be identified and taken into account as a possible etiological factor. The simultaneous development of lymphocytic myocarditis significantly increases the risk of surgical intervention on the valves and requires an integrated approach to treatment.

[Thromboembolic mask of severe lymphocytic myopericarditis: possibilities of clinical and morphological diagnostics and complex treatment].

This report presents a clinical case of a 57-year-old female patient who was admitted for dyspnea, productive cough, reduced left ventricular (LV) systolic function, and who had previously undergone thoracocentesis for significant pleural effusion. This case is a unique combination of lymphocytic myocarditis and massive intracardiac and ileo-caval thrombosis. Morphological verification of the diagnosis, that was necessary prior to the administration of immunosuppressive therapy due to the prothrombogenic effect of glucocorticoids, provided a justification for a basis therapy for myocarditis, which significantly improved the patient's condition.

[Surgical intervention on the middle and upper segments of the bone portion of the nasal septum].

The vector analysis of computed tomograms of the nose and paranasal sinuses of 102 patients was carried out to study the spatial relationship between lamina cribrosa and the area of surgical intervention at the perpendicular plate of the ethmoid bone. Simultaneously, specific syntopic features of the middle and upper zones of the bony portion of the nasal septum were determined. The data obtained were used to develop the method for the sparing surgical intervention on the middle and upper levels of the bony portion of the nasal septum.

[Functional activity of specific antibodies in patients vaccinated against tick-borne encephalitis in relation to different virus strains].

The paper shows variability of the functional activity of the superficial structures of three Far Eastern strains of tick-borne encephalitis (TBE) virus used to study the immunogenicity of different vaccines. The avidity antibodies to the study TBE virus strains were not detected in all of the persons vaccinated with different TBE vaccines even in the year of immunization. Two years after a course of vaccination, immune response and antibody avidity were decreased in the vaccinees. The persons vaccinated with "eastern" vaccines were better protected against Sofjin-like strain P-73 that had led to a fatal outcome in a patient with TBE. Those vaccinated with "western" strain vaccines were found to have a higher affinity for antibodies to the strains P-202 and P-69 that caused inapparent TBE in the year of immunization and 2 years later. A group of persons vaccinated with both "western" and "eastern" vaccines in different periods showed rather high antibody avidities.

[Coding nucleotide sequences of tick-borne encephalitis virus strains isolated from human blood without clinical symptoms of infection].

Genomes of four tick-borne encephalitis virus strains, isolated from the blood of the individuals after tick bites and causing no clinical symptoms of infection, were characterized. Analysis of translated polypeptides revealed 21 amino acid positions typical of this group of strains and distinguishing them from the other tickborne encephalitis virus strains of Far Eastern subtype examined earlier. Only three mutations led to substantial amino acid changes, which probably could affect the infection process severity. It is suggested that two associated mutations, deletion of amino acid 111 in the capsid protein C and substitution (Ser1534 --> Phe) in the NS3 protein influence strictly coordinated polyprotein processing, disturbing correct arrangement of viral particles. This process can result in the development of defect viral particles, containing no RNA. Mutation (Ser917 --> Gly) in nonstructural protein NS1 results in the substitution of hydrophilic amino acid, specific to highly virulent strains, by the hydrophobic one. This could influence the effectiveness of viral replication complex, thereby affecting the infectivity of tick-borne encephalitis virus strains.

[Biological and molecular genetic characteristics of a Far-Eastern tick-borne encephalitis virus population and its pathogenetic implication].

The authors have got an idea of the structure of the tick-borne encephalitis (TBE) virus population forming in the human body after tick bite in the south of the Far East. A hundred and forty-five antigen-positive samples were virologically studied in enzyme immunoassays. Human blood leukocytic virus isolation on the first day of tick suction testified to the capacity of the virus to adsorb and multiply just in the peripheral blood immunocompetent cells. The bulk (as high as 70%) of the TBE virus population was non-neuroinvasive strains, most of which could rapidly eliminate from man and albino mice. The neuroinvasive strains (as high as 30%) caused encephalitis in albino mice and different TBE forms (inapparent, feverish, focal). The sequences of 160 bp fragment of glycoprotein E gene of 24 strains have shown that they belong to one Far Eastern subtype of TVE virus.

[The avidicity index of specific IgG in the diagnosis of diseases caused by west Nile and tickborne encephalitis viruses].

The significant antigenic crossovers between West Nile virus (WNV) and tick-borne encephalitis virus (TBEV) make the immunological diagnosis of these diseases difficult. The avidicity index of virus-specific class G immunoglobulins (IgG) was used as a criterion for the differentiation of an immune response to WNV or TBEV in patients and convalescents. The panels of the sera sampled from patients with tick-borne encephalitis and convalescents in the Novosibirsk and Tomsk Regions and in the Primorye Territory and from those with West Nile fever and convalescents in the Volgograd Region. The determination of the avidicity index could establish that in the convalescents' sera, the avidicity index of virus-specific IgG was much higher than that in the patients' sera in the acute phase of infection. In relation to heteroantigen, the avidicity index and the positivity coefficient were substantially less than those in the reaction with homoantigen. The findings have indicated that the determination of the value of the avidicity index of virus-specific IgG and the positivity coefficient makes it possible to differentiate West Nile fever and tick-borne encephalitis with confidence on the basis of solid-phase enzyme immunoassay in determining virus-specific IgG in the sera of patients and convalescents in different regions of Russia.

[The genotyping of the West Nile virus in birds in the far eastern region of Russia in 2002-2004].

Samples from 20 species of trapped and dead birds were collected in the Far Eastern Region in 2002-2004 and were analyzed by the anti-WNV MAb-modified immunoenzyme assay for antigen detection and RT-PCR for viral RNA detection. Five positive samples from cinereous vultures (Aegypius monachus) and two positive samples from cattle egret (Bubulcus ibis) were found in both tests. The sequencing of the 322 bp fragments of protein E gene showed 99-99.67% homology with the strain WNV/LEIV-VlgOO-27924 of the WNV isolated in Volgograd, Russia, 2000. Additionally, five positive samples from birds (Pica pica, Corvus macrorhynchos, Larus crossirostris, Parus minor, Emberiza spodocephala) collected in autumn 2004 were found during screening with anti-WNV MAb-modified ELISA. These results confirm that the WNV is circulating in the Far Eastern Region of Russia and outbreaks of WN fever in humans may be possible. This demonstrates that the genotype 1a of the West Nile virus could spread in the southern regions of the Far East by migrating birds and introduction of the WNV into other southern regions of the Asian part of Russia are probably.

[Molecular typing of the tick-borne encephalitis virus isolated from patients with different-infection severities in the south of Russia's Far East]. / Molekuliarnoe tipirovanie shtammov virusa kleshchevogo éntsefalita, vydelennykh ot liudei s razlichnoi stepen'iu tiazhesti infektsii na territorii iuga Dal'nego Vostoka Rossii.

The thick-borne encephalitis virus (TBEV), which is widespread in the Eurasian continent, belongs to the Flaviviridae family, Flavirus genus, and comprises the Far Eastern, Siberian and West European subtypes. It was for the first time that the gene part of the E 24 strain envelope glycoprotein of TBEV, which caused infection in residents of the South of Russia's Far East, was analyzed. It was established that the TBEV Far-Eastern subtype causes different-severity disease cases ranging from the focal ones with the lethal outcome to latent infection forms. On the basis of the phylogenetic analysis, the Far-Eastern subtype was shared between 4 sub-clusters, 2 of which constitute a majority of the analyzed TBEV strains.