Background and objectiveResistance in the sexually transmitted bacterium Mycoplasma genitalium to all recommended therapeutic antimicrobials have rapidly emerged. However, to date, internationally reported resistance surveillance data for M. genitalium strains circulating in Eastern Europe are entirely lacking. The aim of this study was to estimate the prevalence of macrolide and fluoroquinolone resistance-associated mutations in M. genitalium in four cities in Russia and one in Estonia, 2013–2016.Materials and methodsConsecutive urogenital samples found positive for M. genitalium during diagnostic testing were retrospectively analyzed for resistance-associated mutations in the 23S rRNA and parC genes using pyrosequencing and conventional Sanger sequencing, respectively.ResultsIn total, 867 M. genitalium positive samples from 2013–2016 were analyzed. Macrolide resistance-associated mutations were detected in 4.6% of the samples from Russia (0.7–6.8% in different cities) and in 10% of the samples from Estonia. The mutations A2059G and A2058G were highly predominating in both Russia and Estonia, accounting together for 90.9% of the cases positive for nucleotide substitutions in the 23S rRNA gene. The rates of possible fluoroquinolone resistance-associated mutations were 6.2% in Russia (2.5–7.6% in different cities) and 5% in Estonia. The mutations S83I and S83N were the most frequent ones in Russia (24.4% each), whereas D87N highly predominated in Estonia (83.3% of all fluoroquinolone resistance-associated mutations). Approximately 1% of the samples in both countries harbored both macrolide and possible fluoroquinolone resistance-associated mutations, with A2058G and S83I being the most frequent combination (37.5%).ConclusionsThe prevalence of macrolide and fluoroquinolone resistance-associated mutations in M. genitalium was 4.6% and 6.2%, respectively, in Russia, and 10% and 5%, respectively, in Estonia. Despite the relatively low rates of macrolide and fluoroquinolone resistance in these countries, antimicrobial resistance surveillance and testing for resistance-associated mutations in M. genitalium positive cases would be valuable.

The existing model of financial support of medical assistance for clinical-statistical groups (CSGs) in 2018 provides for the reimbursement for hospital stay expenses by the compulsory medical insurance fund in patients claiming the need for genetically engineered biological products (GiBP) during their stay in a day-care or 24-hour inpatient facility. The payment is made to CSG no. 121 in a day care and to CSG no. 316 in a 24-hour inpatient facility. The heterogeneity of the expenses for therapy with GiBP necessitates further division of the Federal CSGs into subgroups located in the constituent parts of the Russian Federation. This process has been initiated in some parts of the country, and it is seen as a way of regional adaptation of the Federal Medical insurance model. The proposed subdivision of the Federal CSGs allows for setting the tariffs reflecting the real expenses incurred by a local medical organization due to the therapeutic use of GiBP. The models of such specific CSGs proposed by RF subjects (after an expert evaluation) can be taken as a basis for updating the Federal CSG model, taking into account the differences in the costs of different drug therapy regimens.

The infant roseola, viral pemphigus, papular-hemorrhagic rash as a form of gloves and socks syndrome, and one-sided laterothoracic exanthema can be referred to the rare types of infectious rash in the pediatrician’s practice. These diseases, despite certain signs peculiar to everyone, are often not diagnosed during the initial admission to a pediatrician. The study describes the characteristics of each type of rash, the course of the disease, and discusses possible errors in the primary diagnosis of rare infectious rashes.

Objective. In this study, we examined the prevalence of macrolide-resistant M. genitalium in two Russian cities, Smolensk and Tula, between 2013 and 2017. Materials and Methods. DNA’s samples were isolated from urethral and cervicovaginal swabs using primary screening and tested for macrolide resistance-associated mutations by real-time PCR. This technology makes it possible to identify any nucleotide substitutions in the 23S rRNA M. genitalium gene at positions 2058, 2059, 2611 M. genitalium by melting curve analysis after the amplification. Results. According to the study in two cities (Smolensk and Tula) macrolide resistance-associated mutations were found in 3, 65% of isolates (21⁄574). The A2058G transition 23S rRNA MGE was the most common mutation that is associated with macrolide resistance: 5⁄12 (41.6%) – Smolensk, 8⁄9 (88.8%) – Tula. Rare substitutions have been reported at position A2058T 23S rRNA MGE and at position C2611T23S rRNA MGE. All received data is published at the AntiMicrobial Resistance Map (AMRmap) (http://AMRmap.com). Conclusions. According to our study, the frequency of macrolide-resistance mutations in M. genitalium was not more than 4% in two cities of Central Russia during 2013–2017. Despite the relatively low rates of resistance of M. genitalium to macrolides in Smolensk and Tula, our data emphasize the need for epidemiological surveillance of resistance in this pathogen.

The article represents the results of a prospective analysis of 28 patients with severe plaque psoriasis and advanced psoriatic arthritis with insufficient response to previous systemic therapy, treated with certolizumab pegol at the Tula Regional Clinical Dermatovenerologic Dispensary in years 2017–2019. Certolizumab pegol demonstrated high and sustained efficacy in improving skin disease and manifestations of psoriatic arthritis. Safety profile of certolizumab pegol was consistent with the therapeutic class.