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Brucellosis is a widespread zoonotic illness with significant morbidity rates in Armenia. It causes a wide range of clinical consequences as it progresses, from mild ones that don't require changing the composition or length of an antibiotic prescription to fortunately uncommon, fatal situations involving the heart or central nervous system. According to the National Institutes of Health's Annual Statistical Records, the number of cases with Brucellosis that were initially diagnosed in Armenia was 309 in 2015, 362 in 2017, and 201 in 2018; simultaneously no data for 2016 has been provided. As Brucellosis is an endemic disease for Armenia, sometimes there can be co-infection of Brucellosis with other diseases. Management of such cases is difficult because of drug-drug interactions and hepatotoxicity of drags. The aim of the case report is to discuss the challenges of management of patient with Brucellosis and Viral Hepatitis C infection. A 59-year-old man was admitted to the hospital, Intensive Care Unit with gastrointestinal bleeding with a primary diagnosis of liver encephalopathy. Based on the clinical and laboratory findings, the patient was diagnosed with liver cirrhosis of mixed etiology (alcohol + Viral Hepatitis C), Child-Pugh C class (decompensated disease) Meld-Na22, splenomegaly, grade 3 ascites, stage 3 liver encephalopathy. 2 months after the first hospitalization the patient started to develop an increase in body temperature (up to 39C), pain in the spine, neuropathies and paresthesia. Patient was tested for Brucellosis, Wright-Hedelson (agglutination test) positive results (positive, 1:200 respectively), and positive serology results (high levels of IgG and IgM) confirmed diagnosis. Patient was treated based on international guidelines and drug-drug interaction information. [ABSTRACT FROM AUTHOR]

In the third decade of the XXI century, HIV infection and viral hepatitis C remain urgent problems of modern medicine. Only in the Russian Federation in 2023, more than 1.6 million HIV-infected people and about 2 million patients with chronic viral hepatitis C are registered. Patients with a combined course of these diseases are of particular concern. However, insufficient coverage of etiotropic therapy for patients with chronic viral hepatitis C due to its high cost leaves pathogenetic therapy as the only available method of treatment for many of them. Material and Methods. Clinical data of patients hospitalized in the day hospital of the state budgetary health care institution "Samara Regional Clinical Center for AIDS Prevention and Control" were used. Physical, virological, immunological, biochemical and general clinical methods, elastometry of liver tissue were used for examination of hospitalized patients. Statistical processing of the results was performed using the application program "Statgrarhics Plus for Windows". Pathogenetic therapy was carried out in a two-week course in accordance with the "Recommendations for the diagnosis and treatment of adult patients with hepatitis C" (2013) and included (along with protective regime and therapeutic nutrition) the use of detoxification and metabolic therapy. Antiretroviral therapy with 3–4 drugs was carried out in 68% of the patients. Results. It was shown that the prescribed course of pathogenetic therapy of chronic viral hepatitis C did not have the expected effectiveness in the majority of patients referred for treatment according to the dynamics of changes in the values of "liver tests", despite the fact that the "right subcostal syndrome" was eliminated in 75.7% of persons with stage 3 and 66.7% with stages 4A and 4B of HIV infection. Statistical studies of the relationship (linear, rank and canonical) did not reveal its presence between the results of the conducted treatment and the complex of initial clinical and clinicallaboratory data obtained during hospitalization of the examined persons. Discussion. The presence of cytolysis syndrome and "right subcostal syndrome" is not a valid criterion for referral to a two-week course of pathogenetic therapy of chronic viral hepatitis C in order to obtain a positive result in the majority of patients with stages 3, 4A and 4B of HIV infection. Other baseline data (virologic and immunologic indices, degree of liver tissue fibrosis, indices of general and biochemical blood analysis) had no reliable correlation with the results of treatment, which did not allow their use for predicting the effectiveness of the prescribed treatment. Antiretroviral therapy was not associated with the results of pathogenetic therapy of chronic viral hepatitis C according to the indicators of cytolysis syndrome and "right subcostal syndrome", despite the fact that most of the prescribed drugs had a hepatotoxic effect.

Objective: To describe the deaths recorded on death certificates mentioning hepatitis C among residents in the Federal District between 2006 and 2020. Methods: This descriptive epidemiological study used official, non-nominal databases of the Mortality Information System (Sistema de Informação sobre Mortalidade). Data analysis was performed with TabWin, Microsoft Excel, and Stata software, alongside population estimates from the Planning Company of the Federal District (Companhia de Planejamento do Distrito Federal). Trend analysis was conducted using Prais-Winsten linear regression. Results: Between 2006 and 2020, 487 deaths mentioning hepatitis C were recorded. Among these, 229 (47.0%) listed hepatitis C as the underlying cause, while 258 (53.0%) identified hepatitis C solely as an associated cause. The overall mortality rates for hepatitis C and the adjusted mortality rates (hepatitis C + hepatocellular carcinoma) showed stationary trends. Conclusion: Hepatitis C was underreported as the underlying cause of death. This underscores the need for professional training and a review of the criteria used to determine the underlying cause of mortality. [ABSTRACT FROM AUTHOR]

According to recent data, there are currently 170 to 200 million people infected with HCV worldwide, and the number of new cases annually is approximately 40,000. Thus, the overall prevalence of the pathogen in the world is about 1.8–3%. The dynamic monitoring of circulating viral variants in specific groups that reflect the situation in the wider population, including potential pathogen spread, is of high importance for predicting the epidemiologic situation. Pregnant women are such a group. The Republic of Guinea is one of the poorest countries in the world, in which medicine receives little finance from the state. Among other conditions, HCV infection is not monitored in the country. This work used blood plasma from pregnant women living in the Republic of Guinea and their partners (1810 and 481). ELISA diagnostic kits were used to detect serologic markers, and PCR diagnostic kits were used to detect molecular biologic markers. Sanger sequencing, followed by phylogenetic analysis, was used for genotyping. The present study shows that HCV antibodies were detected in 3.2% of the pregnant women examined and in 3.33% of their male partners. HCV RNA was detected in 0.5% of cases in women and in all anti-HCV-positive male partners (3.33%). HCV RNA was more common in the men than in the pregnant women (χ2 = 25.6, df 1, p < 0.0001, RR = 6.69 with 95% CI: 2.97–15.04). The HCV viral load was determined for all the RNA-HCV-positive samples. The HCV viral load exceeded 1000 IU/mL in all nine women and only in two cases in men. The HCV genes NS5A and NS5B and the NS3 gene fragment were sequenced for 11 samples. Subtype 2q was determined for three isolates and 2j for another three isolates. Another five isolates could not be confidently assigned a subtype because different results were obtained with different methods of analyzing the three viral regions. It can be assumed that these isolates belong to new viral subtypes or to recombinant forms between genotype 2 subtypes. No drug resistance mutations were identified, but a large number of natural polymorphisms in the analyzed genomic regions of the HCV isolates were shown. These results may serve as baseline data for the future planning of a nationwide estimate of the prevalence of bloodborne infections among pregnant women. [ABSTRACT FROM AUTHOR]

The aim of study – to identify predictors of unfavorable outcomes in patients with co-morbidities of multidrug-resistant tuberculosis (MDR-TB); HIV infection; and viral hepatitis C (HCV) to optimize care.Materials and Methods. A total of 132 patients with MDRTB/HIV/HCV triple infection were included in the study: 112 individuals with favorable outcomes and 20 patients with unfavorable outcomes. To assess predictors of unfavorable outcomes; odds ratios and 95% confidence intervals were calculated. 95% confidence interval were calculated; and a prognostic model was built using logistic regression.Results. Generalization tuberculosis process increased the chance of unfavorable outcome by 8.13 times (95% CI: 2.252 – 29.354; p

Background: NK cells phenotype and functional state in different genotypes of chronic viral hepatitis C (CVHC), depending on liver fibrosis severity, have not been sufficiently studied, which limits the possibilities for the development of pathology therapy. Methods: The CVHC diagnosis was based on the EASL recommendations (2018). Clinical examination with liver elastometry was performed in 297 patients with genotype 1 and in 231 patients with genotype 3 CVHC. The blood NK cells phenotype was determined by flow cytometry in 74 individuals with genotype 1 and in 69 individuals with genotype 3 CVHC. Results: The frequency of METAVIR liver fibrosis stages F3–F4 was 32.5% in individuals with genotype 3, and 20.5% in individuals with genotype 1 CVHC (p = 0.003). In patients with both genotype 1 and genotype 3 CVHC, a decrease in the total number of blood NK cells, CD56brightCD16+ NK cells and an increase in the proportion of CD56dimCD16+ NK cells, CD94+ and CD38 + CD73+ NK cells were registered in patients with fibrosis stage F3–F4 by METAVIR in comparison with persons with METAVIR fibrosis stage F0–F1. Conclusions: In patients with both genotype 1 and genotype 3 CVHC, an imbalance in the ratio between cytokine-producing and cytotoxic NK cells and an increase in the content of NK cells that express inhibitory molecules were determined in patients with severe liver fibrosis. [ABSTRACT FROM AUTHOR]

Objective: to analyse the consumption pattern of antiviral therapy (AVT) for chronic hepatitis C on the example of an infectious hospital.Material and methods. The study was based on data from 380 discharge summaries of an infectious diseases hospital for 2011–2019. The criterion of sampling was the established diagnosis of chronic hepatitis C. The first line therapy regimens were analyzed and compared; the calculations were based on direct treatment costs of the study sample. The pharmacoeconomic effectiveness of therapy was assessed by calculating the cost-effectiveness ratio (CER).Results. A retrospective analysis of patients’ sampling allowed to establish a general profile: a 40-year-old man with hepatitis C virus genotype 1 and a mild degree of liver fibrosis. A total of 18 international nonproprietary names (17 trade names) were used for AVT. The pattern of drugs prescribed correlated with the clinical guidelines for the studied period and allowed to distinguish the beginning of the transition from interferonbased regimens to direct-acting antivirals (DAAs). The change in the treatment paradigm was associated not only with increased efficacy in achieving a sustained virologic response, but also with minimization of side effects. The high frequency of prescribing interferon regimens as AVT was accompanied by low rates of achieving virus elimination (63.69%), high frequency of relapses (12.88%), as well as the lack of response to pharmacological correction (21.32%) and premature discontinuation of therapy due to adverse events (2.11%). A total of 142,450,414.91 rubles was spent on the first line pharmacotherapy in the study cohort during the study period. Costs per 1 patient with the diagnosis “chronic hepatitis C” and F0–F3 fibroses according to METAVIR were 372,847.07 rubles with achieving sustained virologic response without relapse in 66% of cases, costs per patient with F4 liver lesion were 398,464.73 rubles (45,16%, respectively).Conclusion. The findings allow us to note the transition from interferon-, nucleoside- and nucleotide-based drugs to DAAs, which can be associated with an increase in therapy effectiveness and proportion of cases with sustained virologic response achieved along with a decrease in the number of adverse events. The results of the study have practical implications for building a strategy for hepatitis C virus elimination in terms of choosing effective pharmacotherapy while reducing the economic burden.

According to recent data, there are currently 170 to 200 million people infected with HCV worldwide, and the number of new cases annually is approximately 40,000. Thus, the overall prevalence of the pathogen in the world is about 1.8–3%. The dynamic monitoring of circulating viral variants in specific groups that reflect the situation in the wider population, including potential pathogen spread, is of high importance for predicting the epidemiologic situation. Pregnant women are such a group. The Republic of Guinea is one of the poorest countries in the world, in which medicine receives little finance from the state. Among other conditions, HCV infection is not monitored in the country. This work used blood plasma from pregnant women living in the Republic of Guinea and their partners (1810 and 481). ELISA diagnostic kits were used to detect serologic markers, and PCR diagnostic kits were used to detect molecular biologic markers. Sanger sequencing, followed by phylogenetic analysis, was used for genotyping. The present study shows that HCV antibodies were detected in 3.2% of the pregnant women examined and in 3.33% of their male partners. HCV RNA was detected in 0.5% of cases in women and in all anti-HCV-positive male partners (3.33%). HCV RNA was more common in the men than in the pregnant women (χ2 = 25.6, df 1, p < 0.0001, RR = 6.69 with 95% CI: 2.97–15.04). The HCV viral load was determined for all the RNA-HCV-positive samples. The HCV viral load exceeded 1000 IU/mL in all nine women and only in two cases in men. The HCV genes NS5A and NS5B and the NS3 gene fragment were sequenced for 11 samples. Subtype 2q was determined for three isolates and 2j for another three isolates. Another five isolates could not be confidently assigned a subtype because different results were obtained with different methods of analyzing the three viral regions. It can be assumed that these isolates belong to new viral subtypes or to recombinant forms between genotype 2 subtypes. No drug resistance mutations were identified, but a large number of natural polymorphisms in the analyzed genomic regions of the HCV isolates were shown. These results may serve as baseline data for the future planning of a nationwide estimate of the prevalence of bloodborne infections among pregnant women.

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The World Health Organization (WHO) aims to reduce HCV mortality, but estimates are difficult to obtain. We aimed to identify electronic health records of individuals with HCV infection, and assess mortality and morbidity. We applied electronic phenotyping strategies on routinely collected data from patients hospitalized at a tertiary referral hospital in Switzerland between 2009 and 2017. Individuals with HCV infection were identified using International Classification of Disease (ICD)‐10 codes, prescribed medications and laboratory results (antibody, PCR, antigen or genotype test). Controls were selected using propensity score methods (matching by age, sex, intravenous drug use, alcohol abuse and HIV co‐infection). Main outcomes were in‐hospital mortality and attributable mortality (in HCV cases and study population). The non‐matched dataset included records from 165,972 individuals (287,255 hospital stays). Electronic phenotyping identified 2285 stays with evidence of HCV infection (1677 individuals). Propensity score matching yielded 6855 stays (2285 with HCV, 4570 controls). In‐hospital mortality was higher in HCV cases (RR 2.10, 95%CI 1.64 to 2.70). Among those infected, 52.5% of the deaths were attributable to HCV (95%CI 38.9 to 63.1). When cases were matched, the fraction of deaths attributable to HCV was 26.9% (HCV prevalence: 33%), whilst in the non‐matched dataset, it was 0.92% (HCV prevalence: 0.8%). In this study, HCV infection was strongly associated with increased mortality. Our methodology may be used to monitor the efforts towards meeting the WHO elimination targets and underline the importance of electronic cohorts as a basis for national longitudinal surveillance. [ABSTRACT FROM AUTHOR]

Aim: To assess the current epidemiological situation and establish the dominant clinical profile of patients with chronic hepatitis C, taking into account the stage of the disease and the molecular genetic characteristics of the virus in the Republic of Tyva. Materials and methods: Based on the annual reports of the dispensary observation office of the Infectious Hospital of the Republic of Tyva, an electronic database was developed using the licensed Office Excel 2016 program, which included results on the health status of patients, clinical, laboratory and instrumental data, including molecular biological data with the determination of HCV genotypes. The analysis of the data of the state statistical reporting of infectious morbidity in the Russian Federation (form №2 “Information on infectious and parasitic diseases”) was carried out. Analytical tables developed by specialists of the Scientific and Methodological Center of the Saint-Petersburg Pasteur Institute for the period 2012-2022. The data of the Reference Center for Monitoring Viral Hepatitis of the Federal State Budgetary Institution “Central Research Institute of Epidemiology” of Rospotrebnadzor were used. Results. Over the past two years, the decrease in incidence in the Republic of Tyva is likely due to a decrease in the number of examinations, a decrease in patients seeking outpatient care, and insufficient screening in the context of the COVID-19 pandemic. Clinical, laboratory and instrumental examination of patients with HCV revealed the predominance of HCV-infected genotype 1 (49.4%), with F0-F2 fibrosis in 79% of cases. The clinical profile of typical patients with chronic hepatitis C was established; whose share in the total structure of the examined was 38.4%. Conclusion: There is a tendency to reduce the incidence of chronic hepatitis C in the Republic of Tyva. Based on the clinical information base, the most typical characteristics of chronic hepatitis C patients living in the Republic of Tyva have been established.

Objective·To explore the influencing factors of bacterial infection in decompensated stage of hepatitis C cirrhosis, and establish a risk prediction model of nomogram.Methods·A total of 574 patients with decompensated hepatitis C cirrhosis were retrospectively collected from The Third People′s Hospital of Kunming between January 2020 and December 2021, and divided into non-infected and infected groups according to whether bacterial infection occurred. The general information, complications, and laboratory indicators were collected. The variables were screened by univariate analysis, and least absolute shrinkage and selection operator (LASSO) regression, and the nomogram model were constructed and verified by multivariate Logistic regression analysis of influencing factors. The decision curve and clinical impact curve (CIC) were used to evaluate the clinical application value of the model.Results·Bacterial infections occurred in 28.4% (163/574) of the patients, with a total of 191 sites, mainly including spontaneous bacterial peritonitis (86/191) and pulmonary bacterial infections (79/191). Totally 78 strains of pathogens were isolated and cultured, mainly including Klebsiella pneumoniae (15/78) and Escherichia coli (15/78). Multivariate Logistic regression analysis showed that age ≥60 years [odds ratio (OR)=2.054, 95% confidence interval (CI) 1.104‒3.822, P=0.023], female (OR=1.701, 95%CI 1.112‒2.602, P=0.014), ascites (OR=2.386, 95%CI 1.601‒3.557, P=0.000), history of invasive procedures in the last two weeks (OR=2.605, 95%CI 1.368‒4.960, P=0.004), and hospitalization time≥2 weeks (OR=1.629, 95%CI 1.098‒2.416, P=0.015) were independent risk factors for bacterial infection in decompensated hepatitis C cirrhosis patients, while infusing human serum albumin (OR=0.324, 95%CI 0.194‒0.542, P=0.000) and high level of total cholesterol (OR=0.675, 95%CI 0.549‒0.830, P=0.000) were protective factors. The nomogram model was constructed with the above seven influencing factors. Receiver operator characteristic (ROC) curve analysis showed that the area under the curve (AUC) was 0.736 and the sensitivity was 80.4%; and the specificity was 65.1%. Hosmer-lemeshow test showed that the model had a good degree of fit (χ2=9.030, P=0.340). The bootstrap method was used for internal repeated sampling for 1 000 times, the average absolute error was 0.010, the calibration curve and the ideal curve were basically fitted, and the predicted values were in good agreement with the actual values. The decision curve showed that the nomogram model had certain clinical practicability in the high risk threshold range (0.040‒0.715). CIC showed that the nomogram model can be used to forecast the high-risk population in different levels.Conclusion·The nomogram risk prediction model constructed in this study has good predictability, consistency and clinical practicability, and can provide evidence for clinicians to preliminary judge the risk of bacterial infection in patients with decompensated hepatitis C cirrhosis.

Introduction. Inverse acne (IA) is a chronic inflammatory skin disease that is more common in women, especially during puberty and menopause. It is believed that the first link of the pathogenetic mechanism is hyperkeratinization of the follicular cavity, followed by follicular occlusion, followed by expansion and rupture, and the presence of bacterial agents in the focus leads to the development of a local inflammatory reaction. Many concomitant diseases and triggers have been identified, including bacterial flora, which can significantly complicate the course of IA, lead to the chronization of the disease and a poor response to therapy. Early diagnosis of IA leads to the timely appointment of treatment. The diagnosis of IA is based on clinical features, and depending on the stage of severity according to Hurley, it is very important to choose the appropriate treatment. Case presentation. The authors present a clinical case of IA complicated by actinomycosis and viral hepatitis C. Conclusion. Actinomycosis is currently a rare diagnosis, especially in developed countries. In clinical practice, the diagnosis of actinomycosis can be difficult due to the nonspecific clinical and pathological features of the pathogen, its inherent difficulties in in vitro cultivation and complex histological characteristics. However, given the growing number of immunocompromised patients worldwide (for example, HIV-infected or hepatitis C patients) and numerous reports of infection with actinomycetes in these conditions, actinomycosis should be considered as a possible opportunistic infection.

The purpose of the study: to give a comprehensive characteristic (clinical-immunological, psychosocial, psychopathological) of women with HIV / viral hepatitis C (HCV) co-infection, to determine the presence of structural and functional changes in the brain using neuroradiological research methods. Material: The main study group consisted of 200 women with HIV / HCV co-infection and 200 women diagnosed with HIV infection without HCV. The criteria for inclusion in the study were: age from 18 to 45 years; the presence of a confirmed HIV / HCV co-infection or HCV monoinfection; the absence of the use of psychoactive substances (except alcohol) during 6 months prior to the study; non-pregnant. Methods: clinical; socio-demographic; laboratory; instrumental. In the future 36 women were selected from the main and comparison groups by the method of paired comparisons, identical to each other in age, at the initial stages of HIV infection, with a CD4 lymphocyte count of over 350 cells/µl; taking antiretroviral therapy for no more than 12 months; not receiving HCV antiviral therapy; without concomitant diseases; not using any substances during 6 months before the study. The studies of the structure and metabolism of the central nervous system were performedthem: magnetic resonance imaging (MRI) and positron emission tomography / computed tomography (PET / CT) with fluorodeoxyglucose (FDG). Results: Women with HIV / HCV, unlike women with HIV monoinfection, are more predisposed to the development of psychopathological conditions with a significant frequency of asthenic and anxiety disorders against the background of mild and moderate cognitive impairment, which is probably due to both the presence of concomitant HCV and the use of substances in the past. Patients with HIV / HCV revealed neuroradiological features in the form of vascular and HIV-encephalopathic changes, a high incidence of glucose hypometabolism. The relationship between the localization of signs of glucose hypometabolism and the identified anxiety, cognitive and insomniac disorders has been determined. The algorithm of examination and management of patients with HIV infection and HCV is proposed.

Abstract Introduction To monitor Sweden’s progress towards the WHO goal of eliminating viral hepatitis, we estimated the prevalence, notification rate, and liver-related morbidity and mortality for diagnosed hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in 2015 and 2018. Methods We identified cases of hepatitis B and C within the National System for Notifiable Diseases and obtained data on treatment and whether the case was deceased or not. We calculated prevalence, notification rates per 100,000, and proportion of newly diagnosed cases of hepatitis with liver disease at the time of diagnosis, and proportion of all deceased cases who died from liver disease. We calculated Poisson 95% confidence intervals (CIs) around the notification rates and Wilson 95% CIs around prevalence and mortality estimates. Results In 2015 and 2018, the prevalence of diagnosed HBV infections was 0.20% [95% CI: 0.19–0.20] and 0.21% [0.20–0.21]. Notification rates per 100,000 for HBV infections were 13.02 [12.32–13.76] and 7.71 [7.18–8.27]. HBV liver-related morbidity was 2.65% [1.90–3.68] and 2.16% [1.35–3.43]. HBV liver-related mortality was 20.00% [14.81–26.44] and 17.95% [13.20–23.94]. In 2015 and 2018, the prevalence of diagnosed HCV-infections was 0.24% [0.24–0.25] and 0.18% [0.18–0.19]. Notification rates per 100,000 for HCV infections were 15.92 [15.14–16.73] and 13.05 [12.36–13.77]. HCV liver–related morbidity was 8.14% [6.89–9.60] and 3.90% [2.99–5.08]. HCV liver–related mortality was 27.08% [24.54–29.77] and 26.90% [24.12–29.88]. Conclusions All indicators decreased or remained stable between 2015 and 2018, indicating progress in the elimination of viral hepatitis, especially for HCV infection.

The article presents modern ideas about the impact of viral hepatitis C on the course of pregnancy, the severity of maternal disease associated with it: methods of delivery and possible vertical transmission. Epidemiological data on the prevalence in the world and the Russian Federation, risk factors for perinatal HCV transmission, and the course of pregnancy in women infected with HCV are shown. The search for the necessary literary sources was carried out in the databases Scopus, PubMed, MedLine, The Cochrane Library, RSCI.

The mechanisms of hepatocellular carcinoma (HCC) formation still remain poorly understood. There are certain genetic features associated with the development of HCC. Objectives. To establish genetic peculiarities connected with interleukin stimulation and associated with the development of hepatocellular carcinoma in patients with viral hepatitis C (HCV). Material and methods. Genetic features of patients with liver diseases were determined by comparative analysis of gene expression in liver tissues based on the sequencing results available in open databases in 72 patients with hepatocellular carcinoma due to hepatitis C and 24 patients without any liver damage. Results. In patients with HCC-HCV, there is an increased expression of 4330 (7.93%) genes and a reduced expression of 693 (1.27%) genes compared with healthy individuals. Among the signaling pathways associated with the activity of interleukins (IL), as well as in patients with HCC-HCV, the largest number of genes is involved in the signaling pathway of interleukin-11, IL-1, IL-4 and IL-13, IL-10. Conclusions. An increased production of pro-inflammatory cytokines IL-1, 4, 6, 8, 13, that predominantly provide for overexpression of genes associated with the JAK/STAT signaling pathway has been established. At the same time, the production of anti-inflammatory cytokines, such as IL-10, 11, ensuring cell growth and proliferation, angiogenesis, and regulation of apoptosis processes is observed.

Introduction. There is a discussion about which genotype of viral hepatitis C (HCV) is the most aggressive. Some authors consider that the 1st genotype is the most aggressive, others define the 3rd HCV genotype as a factor that determines the high activity of the pathological process. The solution of this issue is important for optimizing the tactics of patient management.Aim. To compare the clinical and laboratory characteristics and the incidence of liver fibrosis in patients with chronic viral hepatitis C of the first and third genotypes.Materials and methods. 297 patients with genotype 1 of HCV and 231 patients with genotype 3 of HCV were examined. The diagnosis of chronic viral hepatitis C was established according to the recommendations of the European Association for the Study of the Liver (2016, 2018). Liver fibrosis was studied by shear wave transient elastometry with METAVIR score.Results and discussion. The frequency of elevated ALT in the blood prevailed in patients with HCV genotype 3 compared with persons with HCV genotype 1 (90.5% vs. 82.8%, p = 0.02). ALT levels above 3 norms were registered in 29.0% of patients with genotype 3 and in 16.8% patients with HCV genotype 1 (p = 0.001). The frequency of liver fibrosis F2 according to METAVIR was 11.8% in patients with genotype 1 and 21.2% in patients with genotype 3 of HCV (p = 0.005); the frequency of liver fibrosis F3–F4 according to METAVIR was 20.5% in patients with genotype 1 and 32.5% in patients with genotype 3 of HCV (p = 0.003). The combination of high viral load and high inflammatory activity, which was associated with liver fibrosis F3–F4 according to METAVIR in both compared groups, was determined in 16.9% of patients with genotype 3 and only in 10.4% of patients with genotype 1 of HCV (p = 0.04).Conclusion. The obtained data allow us to consider that in the surveyed population the course of chronic viral hepatitis C with genotype 3 is clearly more aggressive than in persons with genotype 1 of HCV.

Introduction: Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic inflammatory skin disease that is more common in women, especially during puberty and menopause. It is believed that the initial pathogenetic mechanism is hyperkeratinization of the follicular cavity, followed by follicular occlusion, expansion, and rupture. Ultimately, the presence of bacterial agents in the focus leads to a local inflammatory reaction. Many concomitant diseases and triggers have been identified, including bacterial flora, which can significantly complicate the course of HS, leading to disease chronicity and a poor response to therapy. Early diagnosis of HS leads to timely treatment; the diagnosis is based on clinical features. The appropriate treatment must be chosen depending on the stage of severity. Case Presentation: We present a case of HS complicated by actinomycosis and viral hepatitis C. Actinomycosis is a rare diagnosis, especially in developed countries. In clinical practice, the diagnosis of actinomycosis can be difficult due to the pathogen's nonspecific clinical and pathological features, inherent difficulties in vitro cultivation, and complex histological characteristics. Conclusion: Given the growing number of immunocompromised patients worldwide (for example, HIVinfected or hepatitis C patients) and the numerous reports of infection with actinomycetes in these conditions, actinomycosis should be considered as a possible opportunistic infection. Identifying and eliminating concomitant bacterial flora can significantly increase the chances of successful and effective therapy of HS. [ABSTRACT FROM AUTHOR]

The article describes the clinical observation of Kaposi sarcoma associated with HIV in a patient with disseminated pulmonary tuberculosis, viral hepatitis B and C. Kaposi sarcoma is a multifocal systemic tumor of endothelial origin with characteristic pathohistological signs associated with the human herpes virus type 8 (HHV-8). There are 4 clinical variants of Kaposi sarcoma: classical, endemic, epidemic, AIDS-associated, and immunosuppressive. The Kaposi sarcoma variant in HIV infection is characterized by rapid progression of the pathological process and multifocal dissemination. Clinical observation. Patient S., 41 years old, was admitted to the Surgut clinical tuberculosis dispensary with complaints of rashes on the skin of the entire body. The first elements of the rash appeared about two months ago. Objectively: the pathological skin process was widespread. Numerous bluish-red spots from 2 to 5 cm in diameter with a smooth surface, lenticular and numular papules, nodes up to 3 cm in diameter of a reddish-brown color with a purple hue, dense elastic consistency were diffusely localized on the skin of the face, trunk, and limbs. The diagnosis of Kaposi sarcoma associated with HIV was made based on clinical and anamnestic data and the results of additional research methods. Specific anti-tuberculosis and antiviral therapies were used in the treatment. Despite the treatment, the patient died as a result of decompensation of the main process. The described observation illustrates the complexity of managing patients with combined infectious pathology. Taking into account immunosuppression, disseminated pulmonary tuberculosis, the appointment of systemic cytotoxic therapy is difficult due to the risk of progression of Mycobacterium infection. The complexity of managing patients with Kaposi's epidemic sarcoma is also due to the high probability of multi-organ lesions and the high potential for dissemination of the process.

The problem of viral hepatitis (VH) today is an acute problem for the world healthcare system. Along with the COVID-19 pandemic, the VH pandemic claims up to 1.5 million lives annually. Since 2016, the Russian Federation has launched a WHO program aimed at combating VH. One of the first steps on the path of global elimination is getting rid of the virus in the small groups, among which micro-elimination in the child population is one of the promising areas.This review is devoted to the current state of the problem of VH in children in the Russian Federation today. The success of vaccine prevention (against viral hepatitis A and B) made it possible to achieve results in the form of a significant decrease in the incidence of children, minimizing the risk of perinatal infection. However, in recent years, there has been a progressive decline in vaccination coverage. This is mainly due to the growing popularity of anti-vaccination lobbies, a decrease in the awareness of patients and health workers about the need for timely vaccination, as well as the introduction of restrictive measures to prevent a new coronavirus infection. The emergence of mutant, "vaccine-eluting" strains, which are also resistant to available antiviral drugs, is another serious problem on the way to eliminating viral HBV. In the field of treating children with HBV, the possibilities are extremely limited, only 2 drugs are available, one of which (tenofovir alafenamide) is available only from the age of 12. Registration of direct antiviral drugs for the treatment of adolescents with chronic hepatitis C has made it possible to bring closer the goal of microelimination of the virus in children. However, the high cost of drugs poses a challenge for the state to introduce long-term benefit programs to ensure the availability of treatment. In addition, at the moment, the treatment of young children in our country remains a prospect for the future.Thus, despite significant advances in the strategy for the elimination of viral hepatitis, a number of problems remain relevant and present significant difficulties in achieving the global goal.

Introduction: To monitor Sweden's progress towards the WHO goal of eliminating viral hepatitis, we estimated the prevalence, notification rate, and liver-related morbidity and mortality for diagnosed hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in 2015 and 2018. Methods: We identified cases of hepatitis B and C within the National System for Notifiable Diseases and obtained data on treatment and whether the case was deceased or not. We calculated prevalence, notification rates per 100,000, and proportion of newly diagnosed cases of hepatitis with liver disease at the time of diagnosis, and proportion of all deceased cases who died from liver disease. We calculated Poisson 95% confidence intervals (CIs) around the notification rates and Wilson 95% CIs around prevalence and mortality estimates. Results: In 2015 and 2018, the prevalence of diagnosed HBV infections was 0.20% [95% CI: 0.19–0.20] and 0.21% [0.20–0.21]. Notification rates per 100,000 for HBV infections were 13.02 [12.32–13.76] and 7.71 [7.18–8.27]. HBV liver-related morbidity was 2.65% [1.90–3.68] and 2.16% [1.35–3.43]. HBV liver-related mortality was 20.00% [14.81–26.44] and 17.95% [13.20–23.94]. In 2015 and 2018, the prevalence of diagnosed HCV-infections was 0.24% [0.24–0.25] and 0.18% [0.18–0.19]. Notification rates per 100,000 for HCV infections were 15.92 [15.14–16.73] and 13.05 [12.36–13.77]. HCV liver–related morbidity was 8.14% [6.89–9.60] and 3.90% [2.99–5.08]. HCV liver–related mortality was 27.08% [24.54–29.77] and 26.90% [24.12–29.88]. Conclusions: All indicators decreased or remained stable between 2015 and 2018, indicating progress in the elimination of viral hepatitis, especially for HCV infection. [ABSTRACT FROM AUTHOR]

Introduction: The patients with chronic renal failure in hemodialysis treatment constitute an important risk group to acquire the infection for the viral hepatitis C. Objective: To characterize carriers of the viral hepatitis C in hemodialysis treatment according to clinical epidemiological and endoscopic variables. Methods: An observational, descriptive, retrospective and longitudinal investigation of 63 patients with chronic renal failure, in hemodialysis treatment, carriers of the viral hepatitis C was carried out, who were assisted in the Gastroenterology Service of Dr. Juan Bruno Zayas Teaching General Hospital in Santiago de Cuba from January, 2015 to September, 2019. Results: In the investigation there was a prevalence of the male sex, the 31-60 age group, besides hypertension and the diabetes mellitus as personal history. The risk factors of more incidence were injections and frequent transfusions. Conclusions: There was a significant correlation between the time in hemodialysis and the time of diagnosis of the viral hepatitis C; however, the viral replication stayed low. [ABSTRACT FROM AUTHOR]

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Introduction. Viral hepatitis (HV) by its socio-economic significance occupies one of the leading places in human infectious pathology, therefore, the development of fundamentally new methods of prevention, diagnosis and treatment, as well as the creation of new antiviral drugs remain relevant. An antiviral herbal drug "Flakozid" has been created in VILAR, which is presented in a dosage form – 0,1 g tablets for oral administration.Аim. To analyze the experimental and clinical efficacy and safety of flakozid therapy in viral hepatitis.Materials and methods. Experimental study of the effect of flakozid on viral hepatitis A (HAV). The AGMK cell culture (BS-C-1 line) and the hepatitis A virus strain HM 175 adapted to it were used in the work. The studies were conducted in two series of experiments using different concentrations of the drug, which was introduced into cultures simultaneously with the infection of HAV. Experimental study of the effect of flakozid on viral hepatitis C (HCV). In the present experiments, a virus-containing culture fluid collected from infected cultures of chicken embryo fibroblasts containing 7,0 lg TCD50/ml of infectious HCV (genotype 1b) was used. The cytotoxic, viricidal and antiviral activity of flakozid was studied using transplanted cultures of pig embryo kidney cells (SPEV) obtained from the collection of cell lines of the D. I. Ivanovsky Research institute of virology of the Ministry of Health of the Russian Federation. In the experiments, a one-day monolayer of cells grown in 96-well plastic culture panels was used. ID50 – the concentration of the drug "Flacozid", which inhibits the development of the virus in the monolayer by 50 %, and CD50 – its minimum concentration, which causes cytotoxic destruction of 50 % of the cells of the monolayer, as well as the CTI – chemotherapeutic index, calculated as the ratio of CD50 to ID50, were determined. A well – known domestic antiviral agent, "Ribavirin", was used as a comparison drug. Clinical studies of flakozid in viral hepatitis A. The results of clinical studies of the antiviral drug "Flakozid" (0,1 g tablets) were analyzed in 258 patients with viral hepatitis A. "Flakozid" was prescribed to patients with a moderate course of the disease, 0,1 g 3 times a day for 20 days against the background of basic therapy: diet, alkaline drinking, Enterodes®. The therapeutic effect was assessed by clinical (weakness, decreased appetite, nausea, vomiting) and biochemical parameters (the level of direct bilirubin, transaminase activity), as well as by the severity of hepatolienal syndrome. Clinical studies of flakozid in viral hepatitis В. The results of clinical studies of the antiviral drug "Flakozid"(0,1 g tablets) were analyzed in 410 patients with acute viral hepatitis B, which was regarded as moderate. "Flakozid" was prescribed against the background of basic therapy: diet and detoxification therapy: 5 % glucose solution, 5 % ascorbic acid solution, "Hemodesi", at a daily dose of 0,3–0,8 g for up to 38 days. The comparison group received the same basic therapy without flakozid. The dynamics of clinical symptoms (general weakness, headache, sleep disorders, dizziness, nausea, vomiting, impaired appetite, itchy skin, pain in the right hypochondrium, jaundice, etc.), data from laboratory examination methods were evaluated, markers of hepatitis B – HBeAg and Australian antigen (HBsAg) were determined every 10 days and indicators of cellular immunity before the appointment and after 21 days of treatment; the absolute number of lymphocytes, the total number of T-lymphocytes, as well as theophylline-resistant and theophylline-sensitive cells.Results and discussion. The results of experimental studies revealed the antiviral effect of flakozid against the hepatitis A virus, confirmed during clinical studies in adult patients. Treatment with flakozid in patients with viral hepatitis A against the background of basic therapy at a daily dose of 0,3 g for 20 days led to a significant reduction in the symptoms of intoxication, a reduction in the jaundice period, normalization of the size of the liver and spleen. Treatment with flakozid as part of complex therapy of patients with acute viral hepatitis B (AHVB) of moderate severity in daily doses of 0,3–0,8 g for 38 days showed its high effectiveness, contributing to a faster disappearance of clinical symptoms of the disease (improvement of the general condition of patients, reduction of the severity and disappearance of clinical symptoms of intoxication, reducing of the jaundice period), normalization of biochemical parameters (reducing the level of bilirubin and transaminase activity), as well as elimination of HBsAg from the blood, stimulation of cellular immunity. "Flakozid" was well tolerated, did not cause allergic reactions. Based on the results of clinical studies, "Flakozid" is approved for medical use as an antiviral agent (registration number 90/248/7). The high antiviral activity of flakozid against the hepatitis C virus in cell cultures was established. In terms of the severity of the therapeutic effect, "Flakozid" was not inferior to ribavirin, and in terms of CTI it was noticeably superior.Conclusion. Treatment with flakozid in patients with viral hepatitis A and B showed its high efficiency, contributed to a faster disappearance of clinical symptoms of the disease, normalization of biochemical parameters, elimination of HCV from the blood, good tolerability. "Flakozid" is recommended in clinical practice in the complex treatment of hepatitis A and B. In vitro experiments have established a high antiviral activity of flakozid against the hepatitis C virus, which justifies the possibility of conducting clinical studies of the drug in patients with the viral hepatitis C.

Objective – before and after the treatment to determine the functional state of the liver, serum levels of enzymes and biochemical indices in syphilis patients with viral hepatites B and C. The results of the study are based on the data from a comprehensive examination of 35 patients with syphilis alone and 127 patients with syphilis co-infected with viral hepatites B and C before and after treatment. Test methods: hepatology, rheogeopathography, enzyme content and biochemical parameters determined in the serum. According to the results of radionuclide hepatology it has been established that disorders of the functional capacity of the liver already occur in the early stages of the disease. The most significant disorders have been in the patients with the prescription of infection for more than 12 months and in the patients co-infected with viral hepatites B and C. A disorder of pigment metabolism and increased activity of trans­aminases have been revealed in early latent syphilis. In co-infection with viral hepatites B and C an increase in total bilirubin, Lactate dehydrogenase, Alanine transaminase, Aspartate aminotransferase and albumin has been revealed. Dysproteinemia has been revealed in patients with early latent syphilis co-infected with hepatitis C. Patients with early latent syphilis treated with immunomodulators tend to normalize these indices. In patients with syphilis a disorder of the functional state of the liver have been revealed already at an early stage of the disease. The most pronounced disorder of biochemical parameters and activity of liver enzymes are observed in syphilis patients with viral hepatites B and C, as well as in patients with early latent syphilis only with the prescription of the infection for more than 12 months; in such a case it is advisable to use drugs affecting the immune system.

Objectives: The aim of this study was to evaluate the efficacy and safety of sofosbuvir/ledipasvir ± ribavirin in Malagasy patients with hepatitis C virus genotypes 1 and 2, in real conditions. Patients and methods: This was a retrospective monocentric clinical study, carried out over a period of 3 years from March 1, 2017 to February 28, 2020, in a hospital hepato-gastroenterology department. Results: In total, 26 patients (M/F: 11/15) with hepatitis C virus genotype 1 (n = 13) or genotype 2 (n = 13), were treated with sofosbuvir/ledipasvir without (n = 21) or with (n = 5) ribavirin for 12 weeks. The mean age was 61.38 ± 7.09 years. Seventeen patients (65.4%) had cirrhosis. The overall sustained virological response was 96.2% (95% CI = 80.4–99.9%). There was no significant difference between the sustained virological responses of genotypes 1 and 2 (92.3% vs 100%; p = 0.31) or those of cirrhotic or non-cirrhotic patients (94.1% vs 100%; p = 0.46). A relapse was observed in one patient (5.9%) — cirrhotic and genotype 1b — under sofosbuvir/ledipasvir with ribavirin. Seven patients (26.9%) experienced mild adverse reactions, including asthenia (57.1%) and insomnia (42.9%). Conclusion: Treatment with sofosbuvir/ledipasvir ± ribavirin for infection with hepatitis C virus genotype 1 has been shown to be safe and effective, even in the presence of cirrhosis. The sofosbuvir/ledipasvir combination is a good option for genotype 2 non-cirrhotic patients.

An imbalance between oxidative stress and antioxidative defence mediates a variety of diseases pathogenesis. The present study aims to assess the possible outcome of supplementation of oral vitamin-C (VC), an antioxidant, in Viral Hepatitis C (HCV) treatment as an adjuvant therapy. 200 HCV-patients were selected, 100 were given Vitamin-C (1000 mg/day) along with anti HCV treatment (sofosbuvir plus daclatasvir) while the other 100 took only anti-HCV treatment for 4weeks. The serum ascorbic acid (Vitamin-C) levels and functions of the liver were tested before and after the VC supplementation. HCV patients with relatively low serum ascorbic acid showed significant improvement after the intake of vitamin C. After 4 weeks of treatment, AST, ALP, albumin, and total, direct and indirect bilirubin were improved significantly in the VC group; whereas only ALT and indirect bilirubin were improved in both groups when associated with the control subjects. Comparing the two treatment groups at 4weeks; more effective and significant improvement was observed in ALT (p<0.01), AST (p<0.001), direct (p<0.01) and indirect bilirubin (p<0.001), total proteins (p<0.001) and albumin (p<0.05) in patients with VC supplementation on anti-viral treatment compared to only anti-viral treatment group. Thus, VC supplementation improves the antiviral therapy outcome by bestowing a beneficial effect in minimizing liver damage in HCV cases. [ABSTRACT FROM AUTHOR]

Viral hepatitis affects hundreds of millions of people worldwide, the most dangerous of which are hepatitis B and C. The aim of our study was to study the prevalence and incidence of HC in the world and in Ukraine, as well as approaches in pharmacotherapy of HC to further identify effective measures to eliminate HC and improve pharmaceutical supply to patients in HC in Ukraine. The materials of the study were WHO statistical reports, national country reports, national recommendations for pharmacotherapy, the analysis of which was carried out by methods of generalization of information, analytical, comparative method. Results of the research. According to the WHO segmentation, the most frequent cases of HC are found in the populations of the Nordic-Mediterranean region (15 million cases) and the European region (12 million cases). Four countries in the world account for more than 40 % of all people infected with HC, two of which are in the Nordic-Mediterranean region (Pakistan - 7.2 and Egypt - 5.6 million people, respectively). The incidence of HC in Western Europe is up to 0.5 %, while in Northern Europe it is up to 3.3 %. Currently, the highest number of first-time HC infections in 2019 was registered among the populations of Ireland, the United Kingdom and Finland. The lowest incidence rates were found in Romania, Italy and Greece. It has been established that males aged 20-45 years prevail among those infected with HC. It was found that the prevalence of HC in Ukraine in 2015 was 3 %, according to 2020 - 5 %, with the annual number of newly recorded cases of HC increases by at least 7 %. According to the gender distribution, the ratio is on average 1.3 patients among men to 1 patient among women. An analysis of international guidelines for the pharmacotherapy of HC has shown that their latest revisions contain new direct-acting antiviral drugs, namely combinations of drugs such as glecaprevir/pibrentasvir and sofosbuvir/velpatasvir. The standard of HC treatment in Ukraine, approved in January 2021, is more in line with the recommendations of the WHO (2018), AASLD (2019) and EASL (2020) than the 2016 treatment protocol. Conclusions. The annual rate of HC infection in the world remains very high and is estimated at 1.5 million people. Regular revision and updating of standards of HC treatment with the latest direct-acting antiviral drugs, annual increase in the number of people in the world and in Ukraine who receive timely diagnosis of HCV and its full treatment are effective steps to achieve the goal of eliminating viral hepatitis. [ABSTRACT FROM AUTHOR]

The new American Association for the Study of Liver Diseases and Infectious Diseases Society of America recommendations for the management of hepatitis C patients are analyzed. To screen for viral hepatitis C, it is recommended that antibodies to the hepatitis C virus and RNA be detected in individuals with increased risk of infection. Patients with an increased risk of infection include people who inject narcotic drugs; patients with prolonged hemodialysis; health workers after contact with the blood or mucous membranes of a patient with viral hepatitis C; persons who received blood transfusions or blood components before 1987. In most patients, non-invasive tests can be used to diagnose liver fibrosis, which include physical examination, determination of serum fibrosis markers, including the FIB-4 index, ultrasound or computed tomography of the liver and liver elastography. The introduction of direct antiviral drug regimens significantly facilitated the treatment of viral hepatitis C and significantly increased the frequency of response to antiviral treatment. The development of combined pathogenetic regimens with a relatively short duration of treatment has become an important step in the management of patients with viral hepatitis C. New American recommendations suggest the use of pangenotypic regimens in patients with viral hepatitis C without fibrosis or with compensated liver cirrhosis: glecaprevir (300 mg)/pibrentasvir (120 mg) 3 pills per day within 8 weeks or the combination of sofosbuvir (400 mg)/velpatasvir (100 mg) 1 pill per day for 12 weeks with the expected response to therapy in 95–100% of patients. Review authors note a number of rational aspects of the new American recommendations, but consider that experienced and qualified specialists should treat patients with chronic viral hepatitis C in Russia.

Objective: to study effectiveness of remaxol inclusion in pathogenetic therapy scheme for patients with pulmonary tuberculosis and HIV infection in combination with Chronic hepatitis C against the background of alcohol- and drug-related liver damage. Material and methods: 132 case histories of patients with pulmonary tuberculosis and HIV infection, occurring against the background of liver pathology of various origins, were analyzed. Depending on its type and treatment regimen, the patients were divided into the following groups and subgroups: the main group (received Remaxol in the therapy scheme - 400 ml intravenously 1 time per day for 10 days) and control (without maintenance therapy). The first group included patients with concomitant drug-related liver damage, the second - with chronic hepatitis C, the third - with alcohol-related liver damage, and the fourth - with chronic hepatitis C and chronic alcohol intoxication. All patients were examined over time - before the start of the therapy and within 2 weeks after it began: in addition to general blood test, the level of total bilirubin and alanine aminotransferase was studied. Results: The inclusion of Remaxol in the treatment regimen of patients contributed to more rapid relief of dyspeptic disorders and pain, as well as decrease in cytolysis rates. Conclusion: The use of hepatoprotector Remaxol in complex treatment of patients with pulmonary tuberculosis and HIV infection with concomitant chronic hepatitis C on the background of alcohol- and drug-related liver damage contributes to improvement of the functional state of liver and, as a result, increases the effectiveness of treatment.

Objectives: In some eastern European countries, serious challenges exist to meet the HIV‐, tuberculosis (TB)‐ and hepatitis‐related target of the United Nations Sustainable Development Goals. Some of the highest incidence rates for HIV and the highest proportion of multi‐drug‐resistant (MDR) tuberculosis worldwide are found in the region. The purpose of this article is to review the challenges and important next steps to improve healthcare for people living with TB, HIV and hepatitis C (HCV) in eastern Europe. Methods: References for this narrative review were identified through systematic searches of PubMed using pre‐idientified key word for articles published in English from January 2000 to August 2020. After screening of titles and abstracts 37 articles were identified as relevant for this review. Thirty‐eight further articles and sources were identified through searches in the authors' personal files and in Google Scholar. Results: Up to 50% of HIV/MDR‐TB‐coinfected individuals in the region die within 2 years of treatment initiation. Antiretroviral therapy (ART) coverage for people living with HIV (PLHIV) and the proportion virological suppressed are far below the UNAIDS 90% targets. In theory, access to various diagnostic tests and treatment of drug‐resistant TB exists, but real‐life data point towards inadequate testing and treatment. New treatments could provide elimination of viral HCV in high‐risk populations but few countries have national programmes. Conclusion: Some eastern European countries face serious challenges to achieve the sustainable development goal‐related target of 3.3 by 2030, among others, to end the epidemics of AIDS and tuberculosis. Better integration of healthcare systems, standardization of health care, unrestricted substitution therapy for all people who inject drugs, widespread access to drug susceptibility testing, affordable medicines and a sufficiently sized, well‐trained health workforce could address some of those challenges. [ABSTRACT FROM AUTHOR]

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Background and Objectives: Viral hepatitis C infection is an important public health concern worldwide because it is one of the major global causes of death and morbidity. The early identification of infected people, together with the provision of proper treatment, are the key strate-gies used in preventing HCV infection. However, data regarding the epidemiological patterns of hepatitis C in Lithuania are limited. The aim of this research was to evaluate trends in acute HCV cases registered via the national surveillance system in Lithuania during 2005–2018. Mate-rials and Methods: Incidence rates were calculated for data, stratified by gender, age group (0–24, 25–54, 55–74, and 75+), place of residence (urban or rural), and the Lithuanian county where the case was recorded. The crude incidence rate of hepatitis C was defined as the number of new in-fections per 100,000 people during a one-year time period. A linear regression was applied to evaluate IR trends during the period of 2005–2018. Results: From 2005 to 2018, 572 cases of acute hepatitis C were registered, and the incidence rate ranged from 2.03 cases per 100,000 people in 2005 to 0.55 in 2016. A statistically significant decreasing trend in the incidence rate was found during the study period (p < 0.0001). Almost 63% of the acute HCV infections recorded via the national surveillance system were in individuals aged from 25 to 54 years. Conclusions: Being male, aged between 25 and 34 years, and living in the city might be important factors for under-standing the epidemiological patterns of HCV in Lithuania. Although the number of HCV cases recorded in Lithuania is decreasing, our country has one of the highest IRs compared to other European countries. This shows that a new approach to hepatitis C virus screening strategies is needed. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C is a disease with significant global impact. According to the World Health Organization there are 71 million people chronically infected with the hepatitis C virus. About 399.000 people die each year, mostly from cirrhosis and hepatocarcinoma. GT 1 and 3 are the most common causes of infection. Chronic HCV infection is accompanied by extrahepatic manifestations reported in up to 75% of patients, rapid development of hepatic fibrosis and accelerated time to cirrhosis and increased risk for liver failure, HCC and liver-related mortality. HCV therapy is one of the interventions necessary to reduce global burden of disease. Because of their high virological efficacy, ease of use, safety and tolerability, IFN-free, ribavirin-free, DAA-based regimens must be used in HCV-infected patients without cirrhosis or with compensated cirrhosis, including: treatment-naive patients: never been treated for their HCV infection, treatment-experienced patients: previously treated with PEG-IFNa + RBV. From pangenotypic drugs or drug combinations for treatment HCV in Europe are recommended: sofosbuvir/velpatasvir, sofosbuvir/velpatasvir/voxilaprevir and glecaprevir/pibrentasvir. Genotype-specific drugs sofosbuvir/ledipasvir, ombitasvir/paritaprevir/ritonavir, or grazoprevir /elbasvir are recommended for (GT 1, 4, 5 and 6). Conclusions: The new direct-acting antiviral treatment regimens can be given to most patients with chronic hepatitis C virus infection, including those with liver cirrhosis, they have shown high efficacy, achieving sustained virologic response in over 90% of patients. DAA are well tolerated and have minimal side effects that do not require treatment discontinuation.

Abstract Background The epidemiology and risk factors for hepatitis C virus (HCV) infection in Rwanda are not well known; however, this information is crucial to shaping the country’s public health approach to hepatitis C control. Methods A HCV screening campaign was conducted in the general population in 24 districts previously identified to have a high HCV disease burden. At the time of sample collection, sociodemographic information and self-reported risk factors were collected. Bivariate and multivariate logistic regressions were conducted to assess risk factors independently associated with hepatitis C antibodies (HCVAb) seroprevalence. Results Out of a total of 326,263 individuals screened for HCVAb, 22,183 (6.8%) were positive. In multivariate analysis, risk factors identified as statistically associated with HCVAb Seroprevalence include history of traditional operation or scarification (OR = 1.09, 95% CI: 1.05–1.14), presence of viral hepatitis in the family (OR = 1.27, 95% CI: 1.15–1.40), widowed or separated/divorced (OR = 1.36, 95% CI: 1.26–1.47), Southern province (OR = 1.98, 95% CI: 1.88–2.08) and aged 65 years and older (OR = 4.86, 95% CI: 4.62–5.11). Ubudehe category 3 (OR = 0.97, 95% CI: 0.93–1.01) and participants using RAMA (Health insurances for employees of public and private sectors) insurance (OR = 0.76, 95% CI: 0.70–0.85) had lower odds of HCV seroprevalence. Conclusions Our findings provide important information for Rwanda’s strategy on prevention and case-finding. Future prevention interventions should aim to reduce transmission through targeted messaging around traditional healing practices and case-finding targeting individuals with a history of exposure or advanced age.

The new direct-acting antiviral agents (DAA) have revolutionised the treatment of patients with chronic hepatitis C virus (HCV) infection. With the development of new potent DAA and the approval of different DAA combinations, cure rates of HCV infection of >90% are achievable for almost all HCV genotypes and stages of liver disease. Currently available DAA target different steps in the HCV replication cycle, in particular the NS3/4A protease, the NS5B polymerase, and the NS5A replication complex. Treatment duration varies between 8 and 24 weeks depending on the stage of fibrosis, prior treatment, HCV viral load, and HCV genotype. Ribavirin is required only for some treatment regimens and may be particularly beneficial in patients with cirrhosis. Conclusion: With the new, almost side effect-free DAA treatment options chronic HCV infection became a curable disease

ABSTRACT Infectious agents cause serious diseases in humans worldwide and are responsible for the high rate of morbidity and mortality. The prevalence and epidemiology of infectious disease (HCV) in the hospital visited patients referred by the physicians through the initial findings and their associated risk factors were studied in Swat. The data of 174 infected patients were collected during the period of 2015 to 2017 from two clinical laboratories of Tehsil Matta Swat. Inform consent form was taken before blood collection. After taking informed consent blood samples were collected and ICT test was performed and then ICT positive cases were conform through PCR. A total of 174 ICT positive samples [106 male and 68 females] were included in this study. Age was considered from 10 to 72 years. Of the 174 ICT strip positive, 99 [63 males, 36 females] were confirmed through PCR. The prevalence rate was recorded 56.89%. I.V/I.M injection was recorded in 100% of the individuals. Visits to the barber shop was reported in (58%) of the individuals, married individuals were (81.0), surgical operation was reported in (44.8%), sharing toothbrush was observed in (29.9%), piercing was reported in (39.7%), family history was reported in (26.4%), dental treatment was observed in (21.8%), jaundice were (13.2%) and tattooing was (1.7%). Blood transfusion, surgical operations, Jaundice, family history and dental treatment were found significant risk factors for acquiring HCV infection. It was concluded that proper implementation of precautionary measures should be needed to control the spread of HCV in far near future.

Viral hepatitis is a major health problem. Despite preventive efficacy with hepatitis B vaccine and therapeutic efficacy with nucleosi(ti)de analogs against B hepatitis or new direct acting anti-virals against C hepatitis, number of cases remain undiagnosed. In case of B hepatitis (positive HBsAg) or C hepatitis (positive HCV RNA) in a member of the couple, the use of assisted reproductive therapy (ART) is always dictated by the cause of infertility and there is currently not enough evidence to recommend one technique (IUI/IVF/ICSI) over another in patients infected with hepatitis. Overall, the data from the literature regarding the impact of B or C hepatitis on fertility and ART outcomes are controversial. The results are mainly reassuring and live birth rates are not different from couples without hepatitis and the risk of transmission remains very low. It has been reported that the positivity of HCV RNA in gametes cannot be excluded, which encourages to reinforce the washing procedure in a laboratory agreed for the viral risk. Providing a successful vaccination course, the risk of HBV horizontal transmission seems to be eliminated. Finally, it is important to inform the couple that ART procedure does not prevent mother to child transmission in case of maternal infection with hepatitis B or C. [ABSTRACT FROM AUTHOR]

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Viral C hepatitis affects 3% of the globe population and associates multiple haematological abnormalities such as anemia and neutropenia, which may increase during antiviral treatment. That’s why we considered it necessary to evaluate the haematological manifestations found before and during the antiviral therapy in patients with viral hepatitis C, by performing a retrospective and prospective study, during 2009-2017, of 62 children with viral hepatitis C, admitted in Clinic II Pediatrics, St. Mary's Hospital, Iasi.

From all group of infectious pathology viral hepatitises, from which the most priority are the parenteral hepatitises B and С, are essential for health of mankind, also the Irkutsk region isn’t an exception. The aim of the study: to assess an epidemiological situation in sharp and chronic forms of the viral hepatitises B and С in the territory of the Irkutsk region for the long-term period. Materials and methods. The retrospective analysis of an epidemiological situation on viral hepatitises B and C in Russia, Siberian Federal District and in the Irkutsk region for 2008–2016 is carried out. Results. The expressed decrease in incidence of acute viral hepatitis B is noted, at a chronic form of this disease rates of decrease had less expressed character that can be connected with carrying out by mass vaccinal prevention. The carried-out ranged distribution of territories for all forms of viral hepatitis B and viral hepatitis C in the Irkutsk region has allowed to reveal territories of risk. Conclusion. Parenteral viral hepatitises (sharp and chronic forms) are widespread in the territory of the Irkutsk region. From 43 administrative territories of the area, 24 belong to unsuccessful on incidences from which five are to territories of high epidemiological risk: cities of Irkutsk, Angarsk and Ust-Ilimsk and also Katangsky and Shelekhovsky districts.

Актуальність. Останніми роками зросла увага до інфекційного агента, вплив якого може призвести до розвитку запального процесу в підшлунковій залозі. Значне поширення вірусного гепатиту С серед населення, різноманітність його позапечінкових проявів обумовлюють актуальність проблеми. Недостатність розробки питань первинної й вторинної профілактики хронічного панкреатиту мотивує до глибшого вивчення механізму його розвитку на тлі вірусного гепатиту С. Мета: вивчити клінічний перебіг хронічного панкреатиту у хворих із супутнім вірусним гепатитом С. Матеріали та методи. Обстежено 57 хворих на хронічний панкреатит із супутнім вірусним гепатитом С. Групу порівняння становили 20 осіб, хворих на хронічний панкреатит. Для встановлення клінічного діагнозу хронічного панкреатиту й вірусного гепатиту С усі хворі були обстежені згідно з протоколами, затвердженими наказами МОЗ України № 638 від 10.09.2014 і № 729 від 18.07.2016. Діагноз хронічного панкреатиту й вірусного гепатиту С верифікували на підставі даних анамнезу захворювання, клінічних проявів і результатів досліджень. Загальноклінічні й біохімічні обстеження проводили хворим на хронічний панкреатит у фазі загострення й нестійкої ремісії, хворим із вірусним гепатитом С — у фазі стійкої ремісії. Результати. У клінічному перебігу хронічного панкреатиту із супутнім вірусним гепатитом С провідне місце посідали больовий, диспептичний синдроми й порушення випорожнення, що були більш вираженими, ніж у групі порівняння (вірогідна відмінність від показників II групи, p < 0,05). У хворих на хронічний панкреатит із супутнім вірусним гепатитом С виявили анемію легкого ступеня, зниження рівня загального білка в крові, гіпербілірубінемію, гіперхолестеринемію, підвищення рівня ферментів аланінамінотрансферази й аспартатамінотрансферази, підвищення рівнів амілази крові й діастази сечі (вірогідна відмінність стосовно II групи, p < 0,05). У хворих на хронічний панкреатит із супутнім вірусним гепатитом С показник копрограми становив (5,20 ± 0,82) бала, а у хворих на хронічний панкреатит — (3,10 ± 0,32) бала (виявлено значно гірші показники, більш виражений запальний синдром і дисбактеріоз). У двох досліджуваних групах переважала стеаторея II типу. Глибина структурних змін у підшлунковій залозі за даними ультразвукового дослідження в групі хворих на хронічний панкреатит із супутнім вірусним гепатитом С становила (2,56 ± 1,10) бала, що відповідає процесу середнього ступеня тяжкості. У контрольній групі ступінь ураження становив (1,90 ± 0,60) бала. Висновки. На підставі оцінки даних дослідження встановлено негативний вплив супутнього вірусного гепатиту С на перебіг хронічного панкреатиту.

Background: Hepatitis C virus (HCV) infection is an important cause of liver disease. The correlation between hepatic steatosis and HCV treatment results is unclear. Majority of studies showed that hepatic steatosis decreases efficacy of treatment while some showed no correlation. Noninvasive modalities (transient elastrography; TE) have recently largely supplanted liver biopsy, which may limit recognition of steatosis. The controlled attenuation parameter (CAP) from TE is a parameter to identify hepatic steatosis. Objective: To determine the correlation between hepatic steatosis and sustained virological response (SVR). Materials and Methods: The retrospective study analyzed data from HCV infected patients in the hepatitis clinic of Hatyai Hospital between 2014 and 2017. All patients were measured for CAP before treatment. The correlation between hepatic steatosis and SVR was analyzed. Results: Seventy four HCV infected patients participated in the present study. Twenty five percent of participants were hepatic steatosis (n = 15). SVR was 80% in hepatic steatosis group and 71.2% in group without hepatic steatosis (p = 0.50). Other factors showed no significant except significant fibrosis. Conclusion: There was no relationship between hepatic steatosis and HCV treatment outcome. [ABSTRACT FROM AUTHOR]

The association between hepatitis virus infection and Parkinson's disease remains controversial. To determine whether hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are associated with an increased risk of Parkinson's disease in Korean aged ≥40 years, we completed a population‐based prospective study including patients without infections and those with HBV, HCV and HBV/HCV infections from 2005 to 2015. We used the International Classification of Diseases 10th Revision to identify Parkinson's disease (G20) and chronic hepatitis C virus (B18.2) and chronic hepatitis B virus infections (B18.0 or B18.1). To identify Parkinson's disease risk, competing risk analysis adjusted for age, sex, comorbidities and death was performed. Overall, 1 010 317 patients (358 052, noninfection; 488 990, hepatitis B; 144 459 hepatitis C; and 18 680 hepatitis B/C) were included. The incidence density of Parkinson's disease per 10 000 person‐years was highest in the hepatitis C group (8.0), followed by the hepatitis B/C (6.8) and hepatitis B (5.0) groups. Hypertension, ischaemic heart disease, epilepsy, stroke and depressive disorder increased the hazard of Parkinson's disease in all groups. The adjusted hazard ratios were 1.25 (95% confidence interval: 1.17‐1.35), 1.39 (95% confidence interval: 1.27‐1.52) and 1.46 (95% confidence interval: 1.14‐1.85) in the HBV, HCV, and HBV/HCV groups, respectively. Our findings suggest that adult patient of 40 years and older with HBV and HCV infections should be monitored for signs of Parkinson's disease so that early intervention and accurate treatment can be provided for minimizing the development and consequences of Parkinson's disease. [ABSTRACT FROM AUTHOR]

• NEAT1 and TUG1 levels were significantly lower in HCV and HCC patients. • Only TUG1 was significantly lower in the serum of HCC group compared to HCV group. • A model of AFP, p53 and TUG1 could efficiently predict HCC in HCV patients. • A model of AFP, TUG1 and NEAT1 discriminated between HCC cases and healthy controls. The present study investigated the serum detectability and the diagnostic implications of long non-coding RNAs; nuclear enriched abundant transcript 1 (NEAT1) and taurine upregulated gene 1 (TUG1) in viral hepatitis C (HCV) and HCV-associated hepatocellular carcinoma (HCC). The study included twenty healthy controls, forty non-malignant HCV patients and forty HCV-associated HCC patients. The study assessed liver function tests, the antioxidant status, serum alpha fetoprotein, p53, NEAT1 and TUG1. Diminished serum expression of NEAT1 and TUG1 was observed in HCV and HCV-associated HCC and was closely associated with deregulated liver function and elevated AFP levels. A model of NEAT1, TUG1 and AFP accurately differentiated between HCC patients and healthy controls with sensitivity greater than that of AFP alone. Additionally, the diagnostic performance of a model of TUG1, p53 and AFP was superior to that of each marker alone for predicting HCC in HCV patients. Significant alterations in the serum expression of NEAT1 and TUG1 in HCV and HCV-associated HCC patients were recorded. We propose NEAT1 and TUG1 as non-invasive, cost-effective and complementary biomarkers that improve the diagnostic characteristics of AFP. [ABSTRACT FROM AUTHOR]

Prior to the introduction of screening in the early 1990s, infection with hepatitis C virus (HCV) by blood donors was of great importance in forming the global reservoir of infection. Currently, donor status under this criterion is necessarily determined and the use of donated blood by a person with proven serological markers for the biopathogen is not allowed. The purpose of this article is to discuss the literature on the epidemiological link between blood transfusion and HCV infection and to examine the dynamics of the spread of this agent among blood donors on our terms. Results: The occurrence of posttransfusion HCV in countries currently exercising reliable control of blood donation has been reduced exclusively to casuistics and is due solely to cases found in the earliest stage of infection - in the diagnostic window. During the analyzed period, single cases of donors with HCV antibodies were recorded at both centers annually. Men represent a larger relative share than positive donors. The 25-30 age group also represents a greater relative share of positive donors. In addition, the data suggest that there is a tendency to decrease the relative share of positive donors over time. However, observations regarding gender, age group and trends over time should be considered with caution as they may be due to demographic characteristics and possible changes in the demographic characteristics of donors as a whole (for which data are not available). [ABSTRACT FROM AUTHOR]

Background and Objectives: Viral hepatitis C infection is an important public health concern worldwide because it is one of the major global causes of death and morbidity. The early identifi-cation of infected people, together with the provision of proper treatment, are the key strategies used in preventing HCV infection. However, data regarding the epidemiological patterns of hep-atitis C in Lithuania are limited. The aim of this research was to evaluate trends in acute HCV cases registered via the national surveillance system in Lithuania during 2005–2018. Materials and Methods: Incidence rates were calculated for data, stratified by gender, age group (0–24, 25–54, 55–74, and 75+), place of residence (urban or rural), and the Lithuanian county where the case was recorded. The crude incidence rate of hepatitis C was defined as the number of new infec-tions per 100,000 people during a one-year time period. A linear regression was applied to evalu-ate IR trends during the period of 2005–2018. Results: From 2005 to 2018, 572 cases of acute hepa-titis C were registered, and the incidence rate ranged from 2.03 cases per 100,000 people in 2005 to 0.55 in 2016. A statistically significant decreasing trend in the incidence rate was found during the study period (p < 0.0001). Almost 63% of the acute HCV infections recorded via the national surveillance system were in individuals aged from 25 to 54 years. Conclusions: Being male, aged between 25 and 34 years, and living in the city might be important factors for understanding the epidemiological patterns of HCV in Lithuania. Although the number of HCV cases recorded in Lithuania is decreasing, our country has one of the highest IRs compared to other European countries. This shows that a new approach to hepatitis C virus screening strategies is needed.

Aim. Study clinical outcomes in patients with, chronic hepatitis C depending on genotype of hepatitis C virus (HCV) and IL28B gene polymorphism. Materials and methods. 592 individuals were examined, 75 of those had HCV RNAgenotypes determined by PCR. Genotyping of single nucleotide polymorphisms (SNP) - rs 12979860 (C/T) and rs8099917 (T/G) in IL28B gene was carried out by real-time PCR. Results. HCV RNA was detected in 72 examined residents of Yakutia. HCV lb genotype was determined in 74.2% of cases, 3a - in 11.4%, la and 2 - 5.7% each. Frequency of polymorph variant rsl2979860 CC was 72.2%, CT - 27.8%, rs8099917 TT - 61.1%, TG - 23.2%. Conclusion. Combination of HCV lb with polymorphic variants of IL28B gene rs.l.2979860 CC and rs8099917 CT showed a less aggressive course of the disease. On the other hand, HCV infection of individuals with genotype 3a and polymorphism rsl2979860 CC or rs809917 TT of IL28B gene showed a more severe clinical presentation. The presence of polymorph variants rs8099917 T/G and rs 12979860 C/T showed more severe clinical outcomes of HCV infection (viral load up to 19035212 copies, cirrhosis with ascite, hepatocarcinoma).

Objective: Study of the prevalence of the viral hepatitis C and viral hepatitis B in the territory of Saratov City and Saratov Region, analysis of the revealed cases and discussion of laboratory diagnostics issues. Methods: Statistical and reporting forms were used in the CJSC «Doctor Paramonov’s Clinic» in Saratov City, immunoenzyme method of testing blood serum which identify antibodies and antigens, and statistical analysis. Results: Analysis of the received data shows the increasing number of persons, who tested for viral hepatitis C and B. A tendency of annual increase of infected among tested persons are observed. Prolonged absence of rich clinical presentation complicates the process of actual diagnose arrangements. Conclusion: Results of the research dictate the need of a wide examination of patients, which will provide a high detectability, timely treated patients with hepatitis C and B, will assist the reduction of prevalence of these kind of viruses.