[The new possibilities in serologic diagnostic of Ixodes mite-borne borreliosis using ImmunoChip].

The new kit of reagents in format of the immunochip "ImmunoChip Borreliosis" for multiplex serologic analysis of mite-borne borreliosis demonstrated high diagnostic sensitivity and specificity. The percentage of detection of specific immunoglobulins was higher in "ImmunoChip Borreliosis" as compared with screening results in immune enzyme analysis. The high correlation between results of testing in immunochip and data of immune blotting is demonstrated to.

[Functional changes in the organ of vision and locomotor apparatus in adolescents from the Central Administrative District of Moscow].

The Russian Federation and Moscow also show a global tendency for dysfunctions of the locomotor apparatus (LMA) and the organ of vision (OV) to increase. Eight hundred and two adolescents from the Central Administrative District of Moscow were found to have involvements of LMA (35.4%) and OV (22.5%). There were more common abnormal posture (12.9%), spinal axis changes (11.7%), talpes (12.5%), and myopia (17.8%). The follow-ups made from 1997 to 2002 revealed an increase in the number of adolescents with functional changes (D2) with a decrease in that of apparently healthy adolescents (D1). The changes were prevalent in children born in 1986 onward. Examination of the interaction of LMA and OV as the uniform visual motor system revealed sexual dimorphism suggesting that the girls were more susceptible to these changes, which should be considered while developing a adifferential approach to teaching schoolchildren during pubertal period. Schoolchildren's health status should be systematically considered by a wide circle of specialists to estimate the maximum number of parameters in order to determine the reasons resulting in a steady-state tendency for ODA and OV dysfunctions to progress.

[The health status of 15-18-year-old schoolchildren in Moscow].

Analysis of the health status of about 3 thousand 15-year-old schoolchildren from the Central Administrative District of Moscow, made during annual prophylactic medical examinations during 1994 to 2003, revealed a clear tendency for diminished functional capacities in schoolchildren. There was a less than 30% reduction in the number of apparently healthy adolescents with a rise in the proportion of persons with dysfunctions of the locomotor apparatus (LMA) (24.7%), organ of vision (OV) (21.9%), and gastrointestinal tract (19.2%). Over time there was an increase in the frequency of changes in LMA, OV, and immune system. The revealed correlation and the similarity of the time course of changes during different years of observation between LMA and OV lesions in the examined schoolchildren assume the etiopathogenetic and embryogenetic commonness of their involvement due to the structural and functional unity with connective tissue elements. A functional relationship was assumed to be between OV and LMA, which was due to the visual motor functional system. In-depth studies are required to elucidate reasons for the revealed tendencies.

[Multicentre study of comparative efficacy of meropenem and combined regimens for empirical antibacterial therapy of severe nosocomial infections: results of clinical and pharmacoeconomic analysis].

Adequacy and effectiveness of empirical antibacterial therapy of severe nosocomial infections with meropenem vs. combined regimens of antibacterial therapy were investigated and the ratio of the cost and effectiveness of the compared regimens was evaluated. A prospective, randomized, open, comparative study of two initiative regimens of empirical antibacterial therapy of severe nosocomial infections was performed: meropenem in a daily dose of 1.5-3 g and the standard regimen with the use of betalactams and fluoroquinolones in combination with aminoglycosides and/or metronidazole. Patients with recorded diagnosis of nosocomial pneumonia (including the ventilator-associated one) or abdominal infection with the signs of severe sepsis and severity of APACHE II > 14 were enrolled. The patients were stratified into 2 groups subject to the disease severity, i.e. APACHE II 15-20 and APACHE II 21-25. One hundred thirty five out of 166 patients with recorded nosocomial infection were included into the final estimate of the therapy adequacy and effectiveness (Protocol Analysis): 62 patients were treated with meropenem and in the treatment of 73 patients the standard antibacterial therapy was used. In the group of the patients treated with meropenem there were stated significantly higher clinical effectiveness (recovery in 80.6% of the patients vs. the control of 46.6%, p < 0.01) and pathogen eradication (89.6 and 48.1% respectively, p < 0.01). The difference in the clinical and bacteriological effectiveness of meropenem and the standard therapy was more evident in the subgroups of more severe patients (APACHE > 20). With the use of meropenem the probability of recovery from nosocomial infection was significantly higher (RR 1.73-1.94, p < 0.001) vs. the control. Meropenem provided significantly higher eradication of the pathogens: P. aeruginosa (88 and 40% respectively, p = 0.007), E. coli (100 and 46.7%, p = 0.003), Acinetobacter spp. (90.9 and 40%, p = 0.02). The antibacterial therapy with the use of meropenem was assessed as adequate in 51 out of 56 patients (91.1%), that was 3 times as frequent as with the use of the standard antibacterial therapy (33.9%). The cost-effectiveness coefficient with the use of meropenem was 2.2 times lower vs. the control. Therefore, the empirical therapy of severe nosocomial infections with meropenem proved to be more adequate and from the economic viewpoint more advantageous vs. the standard combined regimens of antibacterial therapy, that was evident from significantly higher clinical and bacteriological efficacy of the treatment and decrease of the terms of the patients hospitalization in intensive care units (on the average by 5 days).

[Use of fluoroquinolones in rheumatology]. / Primenenie ftorkhinolonov v revmatologii.

The efficacy and tolerance of 3 fluoroquinolones (ciprofloxacin, pefloxacin, lomefloxacin) were studied in 157 patients with rheumatic diseases concurrent with infection-induced abnormalities. Infection cure was achieved in 123 (78.6%) patients, as evidenced by clinical, microbiological, and serological studies. The tolerance of fluoroquinolones was regarded as good, satisfactory, and poor in 114 (72.6%), 37 (23.6%), and 6 (3.8%) patients, respectively. All representative drugs of the fluoroquinolones series produced typical adverse reactions. The authors consider it expedient to make further clinical studies to test the optimal treatment regimens and to expand indications for the use of fluoroquinolones in this group of patients.

[Articular lesions in Ixodes tick-borne borreliosis (Lyme disease)]. / Porazhenie sustavov pri iksodovykh kleshchevykh borreliozakh (laimskoi bolezni).

Articular lesions in 157 patients infected with ixodes tick-borne borreliosis (ITB) in a central Russia's region set on, on the average, in 4 months after tick attack; they were associated with systemic signs of an early disseminated infection and set on less seldom in a late period. The most often encountered systemic signs were as follows: secondary erythema (32% of patients), neurological syndrome (13%), cardio-vascular lesions (22%), ocular lesions (13%) and hepatic lesions (8%). The articular syndrome manifested itself through arthralgia (53 patients) and arthritis (104 patients), which set on quite often in the tick-attack area. There was a peculiarity typical of articular lesions, which made it possible to distinguish them from other rheumatic disease. A dynamic follow-up revealed different clinical variations of Lyme's arthritis and peculiarities of the genetic profile, i.e. a higher prevalence of HLA A2, HLA-B15 and HLA-DR4 as well as of haplo-types HLA A2-B15 and HLAB15-DR4. The articular lesions were associated with an intensive specific humoral immune response. The instrumental examination methods, i.e. ultrasonography of joints as well as scintigraphy of bones and joints, did not reveal any qualitative differences between arthralgia and arthritis, which is indicative of a common nature different-intensity manifestations of arthropathy in thick-borne borreliosis.

[Antibodies to Yersinia enterocolitica and Proteus mirabilis in blood sera of rheumatoid arthritis patients]. / Antitela k Yersinia enterocolitica i Proteus mirabilis v syvorotkakh bol'nykh revmatoidnym artritom.

Data on specific antibodies to the bacterial antigens of Yersinia enterocolitica (serovars 03, 09) and Proteus mirabilis in rheumatoid arthritis (RA) patients are presented. According to the data of some researchers, these organisms play some role in the pathogenesis of RA. The highest level of IgG antibodies to Y. enterocolitica antigens of both serovars was noted. The activity of specific IgG antibodies to serovar 03 was higher than that to serovar 09. In the sera of RA patients with P. mirabilis antgens the activity of IgM antibodies was higher.

[Methods for the instrumental diagnosis and verification of Lyme arthritis]. / Metody instrumental'noi diagnostiki i verifikatsii Laim-artrita.

We used instrumental methods to characterise Lyme arthropathy in 79 patients with joint involvement and history of Lyme borreliosis. All of them had arthralgia and 45 of them also had arthritis. Radiological examination has established subchondral bone sclerosis in sacroiliac joints in 68% and sacroiliitis in 29% of the examinees. Scintigraphy revealed polyarticular lesions in many cases. Ultrasound investigation has found inflammation and edema of periarticular tissues in the knee, shoulders and hips. The level of antibodies against the causative agent Borrelia (in EIA) was significantly higher in patients with marked signs of inflammation in ultrasound examination. Thus, the combined methods of examination in the diagnosis of Lyme arthritis provide the most complete information.

[The humoral immunological response of patients with Lyme disease]. / Immunologicheskii gumoral'nyi otvet u bol'nykh laimskoi bolezn'iu.

Indirect immunofluorescence (II), enzyme-labelled antibodies (ELA), immune blotting (IB) were used for serological evaluation of 74 patients with Lyme disease living in the North-West and Central regions of Russia. Both acute and chronic borreliosis can be seropositive or seronegative. As shown by II and ELA, these patients had a moderate humoral response, high titers of the specific antibodies being a rare finding. The range of anti-Borrelia antibodies (ABA) identified by IB is limited and, as a rule, includes antibodies to no more than 5 proteins of Borrelia burgdorferi. The highest ABA levels were associated with locomotor lesions and were significantly greater of the above levels in patients with migrating erythema. Informative value of II and ELA in Lyme's disease diagnosis according to this study is equal because ELA is more sensitive, while II is more specific. They are both of little help in atypical borreliosis presentation. Most available of other adequate serological tests is IB.

[The clinical instrumental characteristics of the locomotor involvement in patients who have had Lyme disease]. / Kliniko-instrumental'naia kharakteristika porazheniia oporno-dvigatel'nogo apparata u bol'nykh, perenesshikh laimskuiu bolezn'.

Locomotor system has been studied in 24 patients with a history of Lyme's disease. All of them had arthralgia, 11 had relapsing arthritis, chronic arthritis occurred in 6 examinees. Arthritis presented as recurrent asymmetric mono-oligoarthritis affecting primarily joints of the lower limbs. Periarticular disorders were detected in 12 patients. Serologically, 18 of 24 patients had elevated titers of antibodies to Borrelia burgdorferi in indirect immunofluorescence test. Scintigraphy revealed polyarticular lesions in many cases, ultrasound investigation of the joints confirmed inflammatory nature of the pathological changes. It is inferred that combined methods of examination in diagnosis of Lyme's arthritis (titers to antibodies to Borrelia burgdorferi, ultrasound investigations, scintigraphy of the joints) provide most complete information.

[Analysis of lipid plasma spectrum and basic parameters of red cell membranes in patients with metabolic syndrome and ischemic heart disease]. / Analiz lipidnogo spektra plazmy i osnovnykh parametrov kletochnykh membran éritrotsitov u bol'nykh s metabolicheskim sindromom i ishemicheskoi bolezn'iu.

Specific features of lipid plasma spectrum and principal parameters of red cell membranes are characterized in patients with metabolic syndrome (MS) and chronic stable ischemic heart disease (IHD). 109 patients with metabolic syndrome (diabetes mellitus type 2, arterial hypertension, abdominal obesity and dyslipidemia) were divided into 2 groups: with and without IHD. MS patients with IHD had marked defects of lipid metabolism with hypercholesterolemia, high levels of triglycerides, LDLP cholesterol, low level of HDLP cholesterol. Lipid plasma spectrum in MS patients with IHD vs those without coronary atherosclerosis was characterized by a significantly lower level of apo A1. In red cell membranes these patients had lower fractions of esterified cholesterol combined with high intensity of lipid peroxidation.

[Conditions for the development of myopia in schoolchildren]. / Ob usloviiakh formirovaniia shkol'noi blizorukosti.

School myopia is a most common health problem in schoolchildren, in adolescents in particular. School myopia resulted from connective tissue failure of the whole organism. Some data, such as the association of school myopia with the HLA system confirm this idea. New investigations in this direction will assist in concretizing the real cause of this type of myopia. The interaction between the lighting conditions and the development of refraction is also of interest.