[Prognostic factors in patients with hematological malignancies and concomitant chronic hepatitis C].

The study evaluated the impact of HCV infection on the prognosis in patients with hematological malignancies. A total of 96 patients with anti-HCV antibodies were enrolled, with the age of 37.8 (3.0-81.0) years old, 39.6% had non-Hodgkin's lymphoma. Chronic hepatitis C (CHC) was diagnosed in 46.9% patients prior to malignancy development, in 38.5% patients simultaneously with malignancy, and in 14.6% patients during malignancy treatment. Clinical and biochemical signs of HCH were mild in most of the patients, minimal liver fibrosis (F0-1 by METAVIR system) was discovered in 47.3% patients, severe fibrosis or cirrhosis (F3-4) was diagnosed in 40% of participants. Only 20 (20.8%) of patients received antiviral therapy against HCV prior to enrollment. Regression analysis demonstrated that age >55 years old, late onset of antiviral therapy, and poor nutritional status were significant predictors of death from hematological malignancy. Survey conducted among physicians of hematological oncology hospitals in Saint-Petersburg revealed gaps in knowledge on presentation and risks of HCV infection, as well as on opportunities of modern antiviral therapy.

[Disorders of carbohydrate-lipid metabolism and galectin-3 level as factors of liver fibrosis progression in chronic hepatitis C].

AIM: To assess the effect of metabolic disorders and galectin-3 levels on the progression of liver fibrosis in chronic hepatitis C. MATERIALS AND METHODS: 106 patients with HCV without decompensated liver cirrhosis were examined. EXCLUSION CRITERIA: age younger than 20 and older than 65 years, diabetes, coronary heart disease, hypertension, alcoholism, drug addiction. Laboratory examination (biochemical blood test, enzyme immunoassay (ELISA) with determination of HCV-Ab antibodies, viral load) was supplemented with liver elastometry (Fibroscan) with fibrosis assessment (kPa, METAVIR scale). The body mass index of Quetelet (kg/m2), the presence of abdominal obesity, insulin resistance were evaluated. Serum levels of insulin and galectin-3 were determined by ELISA. RESULTS: In 45% of patients, an increase in ITM was revealed, in 44% abdominal obesity, in 62% insulin resistance. In 75% abdominal obesity was determined in patients with liver fibrosis F3F4. Insulin resistance was found more often in patients with fibrosis F01 56.7%. Significant correlations between the level of galectin-3 and the degree of liver fibrosis (in kPa) [r=0,206, p=0,034], as well as the stage of liver fibrosis (on the METAVIR scale) [r=0,247, p=0,01] were obtained. The level of galectin-3 in liver cirrhosis was 6.32 (4.57; 9.64) ng/ml, which is significantly higher than in F0 3.96 (1.45; 5.30) ng/ml (p=0.002) and F1 3.85 (2.20; 5.83) ng/ml (p=0.002). By calculating the specificity and sensitivity of isolated for F4 stage of liver fibrosis (ROC-curve, the level of galectin-3 is 5.21 ng/ml), the level of specificity of 74.7%, sensitivity of 74% was established. CONCLUSION: We found a significant relationship between the disturbances of carbohydrate-lipid metabolism and liver fibrosis, the level of galectin-3 and fibrosis stage of the liver. The prognostic value of increasing the level of galectin-3 for predicting the cirrhotic stage of liver fibrosis is substantiated.

[Markers of endothelial dysfunction (VCAM-1 and vWF) in chronic hepatitis C].

UNLABELLED: AIM. To estimate the blood levels of endothelial factors (soluble vascular adhesion molecule 1 (sVCAM-1) and von Willebrand factor (vWF:Ag)) in relation to the magnitude of the biochemical, histological, and virological characteristics of chronic hepatitis C (CHC). SUBJECTS AND METHODS: The investigation enrolled 69 patients with asymptomatic CHC. The mean age of the examined was 33.6 +/- 7.8 years. Laboratory examination included a standard set of clinical and biochemical parameters for chronic hepatitides. The stage of hepatic fibrosis (HF) and the degree of histological activity were determined by the METAVIR scale based on histological examination of liver biopsy specimens, by using the calculated FibroTest (BioPredictive, France) and indirect ultrasonic liver elastometric assay (Fibroscan). The serum content of sVCAM-1 and vWF:Ag were measured by ELISA. RESULTS: Elevated sVCAM-1 and/or vWF:Ag levels were found in 33.3% of the patients with CHC. There was a significantly higher increase in blood sVCAM-1 levels in patients with cytolytic syndrome than in those with normal alanine aminotransferase activity. Particularly high sVCAM-1 levels (more than twice higher) were recorded in the CHC patients with severe HF (F3-F4) than in those with milder HF (F0-F2) (1966.98 (1299.79, 3451.73) and 975.98 (888.94, 1226.13) ng/ml (p < 0.001). There were higher blood levels of vWF:Ag in the patients with severe HF (F3-F4) than in those with early-stage HF (FO-F2)--1.61 (1.29; 1.81) and 1.31 (1.15, 1.45) U/ml; p < 0.05). CONCLUSION: In the patients with HCH, the found elevated blood sVCAM-1 and vWF:Ag levels related to the biochemical activity of hepatitis and, to a greater extent, with the degree of HF can judge the implication of endothelial dysfunction in the pathogenesis of chronic HCV infection.

[Hepatoprotective activity of remaxol in patients with chronic hepatic disorders].

This milticentre randomized clinical study of the efficiency of remaxol infusion solution (hepatoprotective medicine for chronic liver dysfunction) included 494 patients with chronic hepatitis B and C. 294 of them staying in 7 clinics were given remaxol and 200 ones received placebo. Randomization was achieved by the envelope method. A detailed description of clinical and laboratory characteristics of the diseases is presented. Effects of remaxol vs placebo on the functional activity of affected liver are discussed. Results of laboratory and clinical analysis indicate that mechanism of remaxol action is based on hepatoprotective, antioxidative, and anticholestatic activities of the drug.

Co-morbidity of infectious and addictive diseases in St. Petersburg and the Leningrad Region, Russia.

The Russian health care system is organized around specific diseases, with relatively little focus on integration across specialties to address co-morbidities. This organizational structure presents new challenges in the context of the recent epidemics of injection drug use (IDU) and HIV. This paper uses existing and new data to examine the prevalence of reported new cases of drug dependence (heroin) and HIV over time as well as associations between drug dependence and alcoholism, hepatitis B and C, and tuberculosis in the City of St. Petersburg and the Leningrad region. We found a sharp rise in reported cases of IDU beginning in 1991 and continuing until 2002/2003, followed by a sharp rise in newly reported cases of HIV. These rises were followed by a drop in new cases of HIV and drug addiction in 2002/2003 and a drop in the proportion of HIV-positive individuals with IDU as a risk factor. Infection with hepatitis B and C were common, especially among injection drug users (38 and 85%, respectively), but also in alcoholics (7 and 14%). Tuberculosis was more common in alcoholics (53%) than in persons with alcoholism and drug dependence (10%), or with drug dependence alone (4%). Though these data have many limitations, they clearly demonstrate that drug dependence and/or alcoholism, HIV, hepatitis, and tuberculosis frequently co-occur in St. Petersburg and the Leningrad Region. Prevention and treatment services across medical specialties should be integrated to address the wide range of issues that are associated with these co-morbidities.

[The assessment of the course of an infectious process by the membrane status of the peripheral blood lymphocytes]. / Otsenka techeniia infektsionnogo protsessa po sostoianiiu membran limfotsitov perifericheskoi krovi.

Lipid peroxidation in lymphocyte membranes is studied in patients with acute viral hepatitis B and B + C and in chronic alcoholics with Flexner's dysentery and with uneventful premorbid history. The intensity of lipid peroxidation in lymphocytes was increased, corresponding to the severity and period of infection. The premorbid background and therapy influenced the lymphocyte membrane status, which can serve as an integral indicator of immunological reactivity of the organism.

[Intensity of the peroxidation of membrane lipids and metabolism of lymphocytes in viral hepatitis patients]. / Intensivnost' perekisnogo okisleniia lipidov membran i metabolizm limfotsitov u bol'nykh virusnymi gepatitami.

Patients with acute viral hepatitis B were found to have an increase in the processes of peroxidization of lymphocyte membrane lipids and in the activity of superoxide dismutase, an antioxidant enzyme, depending on the period of the disease and its severity. Patients with a severe form of the disease were found to have specific features of the intracellular metabolism of lymphocytes in comparison with patients having moderate forms of the disease. To a lesser degree, the characteristics of lymphocytes in hepatitis cases depended of the etiology of the disease, caused by hepatitis virus B, C or the combination of both. The properties of lymphocytes were found to reflect the immune reactiveness of the body and could be used for evaluating the severity of the disease, prognostication and the achievement of convalescence.

[Characteristics of viral hepatitis in addicts with consideration of lymphocyte membrane condition]. / Kharakteristika virusnykh gepatitiov u narkomanov s uchetom sostoianiiamembran limfotsitov.

AIM: To study changes in the condition of lymphocyte membranes of patients with acute viral hepatitis B (AVHB) in narcotic addicts. MATERIALS AND METHODS: 136 patients with AVHB have been examined for endogenic intoxication (plasma levels of middle-size molecular peptides, urine levels of red cells). 74% of the examinees had practiced parenteral injections of opium substitutes. Measurements were made of lymphocyte levels of malonic dialdehyde and superoxide dismutase activity characterizing free radical lipid peroxidation, enzymes of the main metabolic cycles. RESULTS: AVHB addicts often display antibodies to hepatitis C virus, high indices of endogenic intoxication. CONCLUSION: Viral hepatitis was associated with enhanced intensity of lymphocyte membrane lipid peroxidation correlating with the disease severity and duration irrespective of concomitant drug addiction. Early convalescence in drug addicts ran with persisting metabolic disturbances in the immunocompetent cells. This is a pathogenetic sign of the disease transformation to the chronic form.

[The significance of lipid peroxidation in the pathogenesis of leptospirosis and its complications]. / Znachenie perekisnogo okisleniia lipidov v patogeneze leptospiroza i ego oslozhnenii.

Lipid peroxidation (LPO) and antioxidant plasma activity were evaluated in 39 patients with leptospiral jaundice. At the height of the disease LPO proceeded more actively, being the highest in cases of severe complications. Early in the disease course general antioxidant activity of plasma was inhibited significantly more noticeably in complicated versus uncomplicated leptospirosis. This confirms pathogenetic implication of membrane LPO in leptospirosis. The approaches to prognostication of the disease course and completeness of the response are proposed.

[The biochemical aspects of the pathogenesis of viral hepatitides]. / Biokhimicheskie aspekty patogeneza virusnykh gepatitov.

502 patients with acute viral hepatitis B were examined for blood levels of hydrocortisone and insulin, blood proteolytic systems, proteinase inhibitors, acute phase proteins. Most of the biochemical reactions promoted compensation and adaptation processes inhibiting the disease progression. In severe and progressive hepatitides biochemical mechanisms of adaptation are impaired. This entails pathogenetic implications.

[The importance of the antioxidant protection systems of the blood in adaptation to the infectious process in viral hepatitis B]. / Znachenie sistem antioksidantnoi zashchity krovi v adaptatsii k infektsionnomu protsessu pri virusnom gepatite B.

The components of the blood antioxidant systems (superoxide dismutase, catalase, ceruloplasmin, glutathione system) take a direct part in the molecular mechanisms of the body adaptation under conditions of viral hepatitis infection. The peculiarity of the mechanisms by which lipid peroxidation is regulated in different grades of hepatitis is of a role in the disease pathogenesis and underlies the prediction of the course of hepatitis.