Vol 10, No 4 (2020)

The investigation included people of 9 age groups: less than 1 year, 1-9, 10-14, 15-19, 20-29, 30-39, 40-49, 50-59, and more than 60years old. Serological markers for HBV and HCV were identified using ELISA. HCV RNA and virus genotype were determined in the anti-HCV positive samples. Results. The detection rate of HBsAg averaged 0.4% (95% CI: 0.11-1.01%) and that of anti-HBs was 17.1% (95% CI: 14.97-19.53%). No HBV and HCV co-infection cases were identified. The detection rate of anti-HCV averaged 2.9% (95% CI: 2.07-4.17%), the prevalence of current HCV infection confirmed by viral RNA detection was 1.8% (95% CI: 1.14-2.82%). The proportion of individuals with current infection among those positive for anti-HCV was 61.3%. The prevalence of current HCV infection in the adult population (aged 20 to 50 years) of the Kaliningrad Region was 3.1% (95% CI: 1.9-5.0%), which was significantly higher than that in the children and adolescents aged less than 19 years (p < 0.05). The most common HCV genotypes were 1a (21%), 1b (37%), and 3a (32%). Conclusion. The Kaliningrad Region is characterized by a high prevalence of HCV infection in the general population with relatively rare cases of HBV infection. The individuals over 19 years of age are at increased risk for HCV infection and should be included in screening programs. The region shows a high HCV genotypic diversity; genotypes 1a, 1b, and 3a are most common. This distinguishes to a large extent the Kaliningrad Region from all other Russian regions, where genotype 1a is rare.

Objective. To investigate self-assessments of emotional state and behavioral strategies to reduce stress related to coronavirus infection (COVID-19) in HIV-infected patients and healthcare workers. Subjects and methods. A questionnaire survey covered 192 respondents: 67 healthcare workers in Moscow (Group 1), 79 HIV-infected patients (Group 2), and 46 respondents in the comparison group (Group 3). Results. When assessing the risks for COVID-19 infection, the respondents in Group 1 more commonly reported an increased infection risk (34.32%). When answering a question indicator, the respondents in Group 2 more often chose the option of the same risk as most people ( 72.15%). This group was noted to have also the largest share of risk denial (18.98%). 78.26% of the respondents in the comparison group considered the risk of getting coronavirus infection to be the same as the majority of people. The median self-assessment of emotional state in relation to coronavirus among the respondents in Group 2 (9.0 [5.0; 8.0] points) was statistically significantly higher than that in Group 1 (6.0 [5.0; 8.0]points; p < 0.001) and in Group 3 (6.0 [5.0; 8.0] points;p <0.001). When describing behavioral strategies aimed at reducing anxiety in relation to COVID-19, the group of strategies aimed at maintaining mental ecology was most representative: 26, 36, and 35% in Groups 1, 2, 3, respectively. These were respiratory exercises, meditation, reading, and hobbies in Group 1; meditation, going to the cottage, listening to music, respiratory exercises, and reading in Group 2; reading, going to the cottage, and meditation in Group 3. The avoidance strategies («I try not to think about it», «I do not think about it») were presented in 16, 9 and 9%, respectively. The stress in relation to COVID-19 was reduced, by drinking alcohol, eating, and smoking cigarettes, by survey participants in Groups 1 and 3 (9 and 6%, respectively). Conclusion. Correction of the detected def iciencies required comprehensive measures: the development of consistent measures aimed at studying the needs of various target groups during the COVID-19 epidemic, at increasing their commitment towards maintaining health and supporting the most adaptive behavioral strategies.

Objective. To provide evidence for the necessity and safety of using favipiravir for the treatment of adult patients with non-severe forms of COVID-19. Subjects and methods. Of the 168 study participants, 163 received at least one dose of the test drug or the comparator: 108 patients received etiotropic therapy with favipiravir (experimental group), 55 were treated with umifenovir or hydroxychloroquine (comparison group). The endpoints of the study were time to clinical improvement according to the WHO Ordinal Scale of Clinical Improvement, time to viral elimination and presence or absence of adverse events (AEs), directly caused by the applied drugs, as well as AEs severity. Results. AEs were reported in both groups. A short-term increase in the level of hepatic transaminases was most often observed in overall population. In the experimental group, the most common AE was hyperuricemia, which is an expected reaction that is managed by medication discontinuing and causes no long-term consequences. At the same time, higher rate of virus elimination was recorded in the favipiravir group: in 71.4% of participants in the experimental group vs. 57.1% in the comparison group (on Day 3 and in 81.2% vs. 67.9% on Day 5, respectively. Clinical improvement occurred 4 days earlier in the experimental group (p = 0.005). Conclusion. The use of etiotropic therapy for the treatment of COVID-19 at its early stages and in case of non-severe forms of the disease is reasonable, necessary, and reduces the risk of complications. The choice of favipiravir as an initial treatment is based on the fact that its use resulted in earlier elimination of SARS-CoV-2 virus and much earlier onset of clinical improvement (by 4 days) according to the WHO Ordinal Scale of Clinical Improvement, when compared to umifenovir or hydroxychloroquine. Evaluation of the safety profile of favipiravir revealed no serious AEs associated with its use. However, when prescribing the drug, it should be remembered that favipiravir is contraindicated for pregnant women due to its teratogenic effects on the fetus. In addition, both men and women should apply the additional contraceptive methods during the period of drug use and for the following 3 months.

Objective. To develop a model that predicts a response to therapy for chronic hepatitis C (CHC) in children and adolescents. Subjects and methods. The investigation enrolled 116 children and adolescents aged 3 to 18 years with CHC who had not previously received etiotropic therapy. The patients were randomly divided into 2 groups of 58 people each. All the children were examined using general clinical, biochemical, immunological, and instrumental studies, which could reveal the most significant prognostic indicators. Results. Two antiviral therapy options (standard and differentiated) for CHC were compared. Evaluation of the efficiency of differentiated therapy allowed the most significant indicators to be selected to create a mathematical model. Multivariate regression analysis made it possible to prepare a mathematical model covering the main signs of the disease for the assessment and prediction of a response to therapy. After 48 weeks, a complete virological response was achieved in 30 (51.7%) patients in the standard therapy group and in 47 (81.0%) in the differentiated therapy group. Conclusion. The choice of a CHC therapy regimen, which is based on the prediction of a response, by using the multivariate regression analysis, and on the mathematical modeling of the most significant immunological and biochemical parameters is clinically reasonable and justified, since it increases the number of patients who have achieved a complete virological response.

Patients with severe fibrosis and cirrhosis of the liver are a vulnerable group that is at an increased risk for infection with COVID-19 and hads its severe course due to the development of a systemic immunodeficiency state. The paper describes a case of severe COVID-19 infection associated with liver cirrhosis (Child-Pugh class B) in a 52-year-old female patient with a fatal outcome. The main causes of death were respiratory complications, as well as sudden deterioration in liver function, which led to end-stage disease.

Chronic HBV infection is a dynamic process that reflects the interaction between HBV replication and the host immune response. The data available in the literature show that in chronic hepatitis B, it is precisely the quantitative composition and functions of innate immune cells which have a pronounced effect on the virus. A deep insight into the immunopathogenetic mechanisms caused by individual antigenic HBV components that cause both chronic hepatitis B and its adverse outcomes will serve as the basis for using prognostically significant methods for immunodiagnosis, as well as for effective treatment and prevention of the disease.

Toxoplasmosis is a common parasitic disease in humans and animals, which is caused by the protozoan Toxoplasma gondii. About one-third of the world’s population is infected with Toxoplasma. It used to be that toxoplasmosis was asymptomatic in healthy people. However, there is more and more evidence that latent toxoplasmosis alters human behavior and affects the development of neuropsychiatric and neurodegenerative diseases, including schizophrenia. The paper considers the facts proving the impact of Toxoplasma invasion on the development of schizophrenia: there is a higher rate of Toxoplasma infection in schizophrenic patients than in the local population; the appearance of clinical schizophrenia symptoms in T. gondii-infected patients; an antiprotozoal effect of some antipsychotic drugs; an association of latent toxoplasmosis with treatment-resistant schizophrenia. It also discusses possible mechanisms by which T. gondii may affect the development of schizophrenia when applied to the classical hypotheses of this disease and the prospects for studying the association.

The paper is dedicated to the anniversary of Tamara Aleksandrovna Nikolaeva (1910-1991), one of the organizers of the State Sanitary and Epidemiological Service; Chief Medical Officer of the RSFSR and the USSR, Deputy Minister of Health of the USSR; and the First Director of the Central Institute of Epidemiology, USSR Ministry of Health. Her professional, creative and social activities in medicine are reflected.