As public health systems are being modernized across the world, conventional medicine is undergoing a serious transformation and new medical models are emerging based on personalized, predictive, participatory, precision, mobile, and digital approaches. So far, there is no consensus in the literature and the medical community about the goals, objectives and applications of these models, particularly precision medicine, which is sometimes perceived as merely a fancier term for personalized medicine. The role of laboratory diagnostics in precision medicine is also a matter of intense debate. This review analyzes the currently available information about precision medicine and gives examples of how 5P approaches can be used in clinical practice.
Results Of the 156 specimens, 83 N. gonorrhoeae strains were tested for antimicrobial susceptibilities to 18 agents. The prevalence of β-lactamase producing strains and chromosomally-mediated resistant strains were 7.2% and 16.5%, respectively. Against cepharosporins, one strain was resistant to cefixime with MIC 0.5 μg/ml. There was not resistant strain to ceftriaxone, but the 7 strains (8.4%) had MIC 0.125 μg/ml. The MIC of fluoroquinolones to all strains showed a bimodal distribution. The values of MIC90 of ciprofloxacin and levofloxacin were 16 and 8 μg/ml, respectively. Sitafloxacin, one of fluoroquinolones had strong activity to N. gonorrhoeae strains and the value of MIC90 was 0.25 μg/ml. The MIC of azithromycin in 2 strains was 2 μg/ml, but no high-level resistance to macrolides was detected. Conclusion The first national surveillance for antimicrobial susceptibilities of N. gonorrhoeae was performed. Fluoroquinolone-resistance N. gonorrhoeae strains were spread in Japan. The resistant rate of azithromycin resistant was 2.4%. Introduction Recent data have raised questions over the efficacy of azithromycin 1g for the treatment of chlamydia infection. In order to measure effective absorption, we developed a protocol to quantify the concentration of azithromycin using liquid chromatography and tandem mass spectrometry (LC-MS/MS) in self-collected high-vaginal swabs. Methods Ten healthy women were asked to self-collect a highvaginal swab (baseline) prior to taking a 1g dose of azithromycin. A blood sample was collected four hours later to determine plasma concentrations of azithromycin. Participants then self-collected a high vaginal swab each day for a further 9 days. All swabs were preserved in 1ml of 100% Methanol and stored at -80°C prior to analysis. One ml of chloroform containing 10mg/ml of Leucine enkephalin as an internal standard was added to extract azithromycin. Azithromycin concentrations were calculated using a validated LC-MS/MS method. Data were normalised to the internal standard and to membrane lipid concentrations, measured in the same samples using LC-MS/MS. Results Azithromycin was detected at varying concentrations in all 10 women in all post-treatment samples. The highest average normalised azithromycin concentration of 953ng/ml (range = 267-2200ng/ml, standard error of mean (sem) = 181ng/ml) was detected on day 2 post-treatment. The lowest average azithromycin concentration was 164ng/ml (range = 51-387ng/ml, sem = 42ng/ml), 9 days post-treatment. The average concentration of azithromycin detected in blood samples was 339ng/ml (range = 107-628ng/ml, sem = 57ng/ml). In 9/10 women azithromycin concentrations remained above 64ng/ml, the hypothesised mean inhibitory concentration (MIC) of azithromycin for chlamydia, for the entire 9 days. Conclusion We have validated a method for detecting the azithromycin concentration in self-collected high-vaginal samples using LC-MS/MS. Azithromycin concentrations remained above the Post-treatment Detection of azithromycin in high-
The review addresses issues related to genetic predisposition and resistance to infectious diseases. Genetic factors largely determine the susceptibility of the body to various diseases, including infectious ones. A genetic predisposition to tuberculosis, salmonellosis, viral hepatitis, tick-borne encephalitis, Lyme disease, HIV and others is shown. Knowledge of molecular genetic biomarkers is necessary for identifying risk groups, conducting predictive measures, in particular vaccination. The main influence is given to the genes of the main histocompatibility complex; the role of mitochondrial DNA in susceptibility to HIV infection is shown.
Metabolic syndrome is a complex of metabolic, hormonal and clinical disorders that are risk factors for the development of cardiovascular diseases, which are based on insulin resistance and compensatory hyperinsulinemia. The main mechanisms of the effects of chronic hyperinsulinemia on blood pressure are given, and the main symptoms and manifestations of the metabolic syndrome are given. The most common variant of dyslipidemia in the metabolic syndrome is the lipid triad.
Laboratory technologies, which are the basis of personalized medicine, are considered. The main focus is on genetic methods for identifying genetic polymorphisms that determine a predisposition to multifactorial diseases. Description of application of personalized medicine approaches in clinical practice on the example of oncology, endocrinology and other branches of medicine is given.
The review discusses issues related to genetic predisposition and resistance to tuberculosis. Genetic factors largely determine susceptibility to various diseases, including infections. The main focus is on the genes of the major histocompatibility complex and toll-like receptors. A number of genetic polymorphisms responsible for resistance and predisposition to tuberculosis and related clinical consequences are considered. Knowledge of molecular genetic biomarkers is necessary to identify risk groups and carry out predictive measures.
В рамках модернизации системы здравоохранения в настоящее время происходит изменение старых и становление новых направлений современной медицины: персонализированной, предиктивной, превентивной, партисипативной, прецизионной, мобильной и цифровой. Вместе с тем, в научной литературе и медицинском сообществе имеются различные мнения о целях, области применения и задачах указанных направлений здравоохранения и роли в них лабораторной диагностики. Прежде всего это относится к прецизионной медицине, которая воспринимается только как более современное название персонализированной медицины. В обзоре проанализирована и обобщена имеющаяся на сегодняшний день информация и представлены примеры применения подходов медицины 5П в клинической практике.
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