[MOLECULAR-BIOLOGICAL MARKERS OF HEPATITIS B IN PATIENTS WITH LIVER FIBROSIS/CIRRHOSIS IN UZBEKISTAN].

AIM: Evaluate prevalence of genetic variants of hepatitis B, viruses in population of various regions of Uzbekistan with hepatitis of various genesis and different severity levels of liver fibrosis and cirrhosis. MATERIALS AND METHODS: Blood plasma and liverbiopsy from 39 patients with different severity levels of liver fibrosis and cirrhosis served as study material. Genotyping based on direct sequencing of Pre-S1/Pre-S2/S HBV DNAregion was applied. RESULTS: Hepatitis B virus was detected in 32 samples ofthe 39 provided, frequency of occurrence - 82%, respectively. Phylogenetic analysis has shown, that only genotype D was detected among the examined,patients, hepatitis B virus subtype D1 predominated (84.38%) compared with D2 (3.12%) and.D3 (12.5%) subtypes. CONCLUSION: Large-scale sequencing of HBV in, Central Asia will allow to evaluate routes of transmission and time of evolutionary separation or virus isolates. Understanding the epidemiology of the infectious process is important for development of programs for prophylaxis and therapy of the infection.

[HBV COVALENTLY CLOSED CIRCULAR DNA AS A MARKER OF PREVALENCE OF OCCULT HEPATITIS B IN PATIENTS WITH HBV, HDVAND HCV INFECTION IN UZBEKISTAN].

AIM: Evaluate significance of covalently closed circular DNA of hepatitis B virus as a marker for detection of occult viral hepatitis B in Uzbekistan population with hepatitis of various genesis. MATERIALS AND METHODS: Blood plasma and liver biopsy from 39 patients with different severity levels of liver fibrosis and cirrhosis served as study material. HBV covalently closed circular DNA detection was carried out according to Pollicino T et al. (2004). RESULTS: Covalently closed circu- lar DNA of hepatitis B virus was detected in 82% of samples, including in 54.5% of patients with chronic viral hepatitis C (CVHC) and in 100% of patients with hepatitis of unknown etiology. Quantitative evaluation of content of covalently closed circular DNA of hepatitis B virus in liver tissue in patients with CVHB has shown an average of 2.5 copies of HBV genome as ccc DNA per cell, in patients with CVHB + D an average of 0.7 copies/cell, in patients with co-infection by HCV and HBV - 0.5 copies/cell, in patients with CVHC an average of 0.12 copies/cell, and in patients with cryptogenic hepatitis - 0.2 copies/cell. CONCLUSION: Detection of HBV DNA is a complex problem for effective laboratory diagnostics of hepatitis. Detection of HBV ccc DNA as a marker of occult hepatitis B in patients with CVHC and patients with hepatitis of unclear etiol- ogy is an. important factor for diagnostics, selection of adequate therapy, prognosis of disease outcome and prevention of development of severe liver diseases.

[Etiology of infectious diseases in pregnant women with symptoms of fever and lung syndrome].

31 samples of blood serum of pregnant women with acute respiratory virus infection and pneumonia symptoms who had been administered into hospital were analyzed. Antibacterial and antifungal treatment was ineffective. Autumn-winter-spring seasonality was detected. In connection with above-mentioned, an attempt was made to find out the etiology of a disease using viroloy methods. Primers of hantaviruses, Crimea-and-Congo hemorrhage fever, coronaviruses, SARS, Leptospirosis and virus hepatitis. Genome of B hepatitis virus was discovered in 3 samples, C--in one sample, G--in four samples. The test for other primers was negative. It was shown that in case of serious clinical course only abortion can save mother's life. It is necessary to find out aetiology of the disease, primers and other pathogenic organisms of virus infections.

The disease burden of hepatitis B in Uzbekistan.

OBJECTIVE: To describe the burden of hepatitis B illness in Uzbekistan by means of model-based estimates. METHODS: A mathematical simulation model was developed to mimic the disease evolution of hepatitis B and calculate the size and age of specific HBV patient groups, defined according to the severity of their illness. RESULTS: The calculations indicate that of 678000 neonates in Uzbekistan, 159185 (235 per 1000) would incur an HBV infection at some time during their lives. About 55095 persons (81 per 1000) would become chronic carriers of hepatitis B and 6307 persons (9.3 per 1000) are expected to die due to hepatitis B before they would die from another cause. In the overall population, we calculated that about 3074 Uzbeki die each year from the consequences of hepatitis B. Only 3.2% of these premature HBV-deaths are due to acute hepatitis B, whereas 96.8% are due to chronic hepatitis B. It was calculated that 2.1% of all deaths (or 1 in 47 deaths), and nearly 25% of deaths (or one in four deaths) between 30 and 40 years of age in Uzbekistan are due to hepatitis B. Vaccination seems easily defensible on the basis of rudimentary but very conservative cost-effectiveness calculations ($84 per carrier prevented; $735 per death prevented and $22 per life-year gained). CONCLUSION: Hepatitis B represents a huge health problem in Uzbekistan, especially in young adults. The potential for prevention by vaccination seems very high, but demands a long-term vision if chronic hepatitis, in particular, is to be reduced. Routine hepatitis B vaccination was found to be a relatively cost-effective intervention in Uzbekistan.

[Immunological indices of viral hepatitis patients and the prognosis for the time periods of aspartate and alanine transaminase normalization]. / Immunologicheskie pokazateli u bol'nykh virusnym gepatitom i prognozirovanie srokov normalizatsii asparaginovykh i alaninovykh transaminaz.

The work presents the results of the correlation analysis and the regression equation between the number of T-lymphocytes, the levels of IgA, IgM, IgG and the dynamics of the fall of the alanine and asparagine transaminase levels; the work also presents the results of the leukocyte migration inhibition test and the data on the duration of the presence of asparagine transaminase and alanine transaminase in the blood. The relationship between the normalization of enzymatic samples from the liver and the immune status in patients with viral hepatitis A and B is shown.

[The relationship of antibody formation in immunization against typhoid fever to the acetylation phenotype]. / Sviaz' antiteloobrazovaniia pri immunizatsii protiv briushnogo tifa s fenotipom atsetilirovaniia.

The study of the dynamics of specific antibody formation in response to immunization against typhoid fever with adsorbed chemical vaccine T in its relationship to the phenotype of acetylation has yielded results characterizing a considerable variability of immune response simultaneously with the definite type of modification of parameter A.

[The relation of the acetylation phenotype to the predisposition to typhoid fever and its clinical course]. / Sviaz' fenotipa atsetilirovaniia s predraspolozhennost'iu k briushnomu tifu i ego klinicheskim techeniem.

Altogether 33 typhoid fever convalescents and 36 contacts of a control group were examined during an epidemic outbreak. In one year 17 former patients and 65 controls (persons who had been at the center of the outbreak but contracted no disease) were examined. Norsulfazole was used as a model agent to study an acetylation phenotype. Unimodal distribution of a degree of norsulfazole distribution was noted in the convalescents, bimodal distribution in the controls and patients examined in one year. Persons with a rapid type of acetylation were more predisposed to typhoid fever, and intoxication in them was more noticeable.

[The status of the monooxygenase enzyme system of the liver in Salmonella infection in rats]. / Sostoianie monooksigenaznoi fermentnoi sistemy pecheni pri sal'monelleznoi infektsii u krys.

Content and activity of microsomal cytochromes P450 and b5, amidopyrine N-demethylase, aniline hydroxylase, NADPH cytochrome c reductase were studied in liver tissue of rats with salmonelliasis. Distinct inhibition of the liver monooxygenase enzymatic system was detected during the acute period of the disease; its normalization was complete within the reconvalescence period. Endotoxinemia appears to be mainly responsible for alterations in the microsomal enzymes activity observed.

[A monooxygenase enzymatic system and cortisol in the serum of pregnant women with viral hepatitis]. / Monooksigenzanaia fermentnaia sistema i kortizol v syvorotke krovi beremennykh, bol'nykh virusnym gepatitom.

Specific features of the mono-oxygenase enzyme system functioning and blood serum cortisol level were studied in viral hepatitis patients in the second half of pregnancy. The more pronounced disorders of this system occur in a severe course of hepatitis. The level of cortisol and antipyrine clearance were in correlation which was changed depending on the form and severity of the disease course.

[Detection of antibodies to HIV virus in saliva by express-tests in Uzbekistan]. / Opredelenie antitel k virusu immunodefitsita cheloveka v sliune s pomoshch'iu ékspress-testa v Uzbekistane.

Saliva tests, when used in screening for antibodies to HIV virus (anti-HIV), makes testing safer, easy-to-fulfill (even outside clinic) and acceptable for a majority of examinees. The main quality parameters of express-test for the detection of anti-HIV in saliva were evaluated for the purpose of using the related approach in the HIV epidemiological supervision. Saliva samples and sera of 81 HIV-infected patients and of 99 presumably non-infected persons were investigated by the "OraQuick" express-test. The data obtained were compared with the results of ELISA-based serum testing. The sensitivity of "OraQuick" made 95% and its specificity was 100%. The test is appropriate for epidemiological investigations and HIV epidemiological supervision but it cannot be recommended for the blood transfusion service.

Rotavirus disease in Uzbekistan: cost-effectiveness of a new vaccine.

We evaluated the cost-effectiveness of rotavirus vaccination in Uzbekistan from the healthcare system and societal perspectives. Disease burden was estimated using national statistics on hospitalizations and deaths, and international estimates of under-five mortality. Without vaccination, the risk for rotavirus hospitalization by age 5 is 10 per 1000 children. Rotavirus hospitalizations cost US$ 406,000 annually, of which US$ 360,000 (89%) is for medical expenses and US$ 46,000 (11%) is for non-medical and indirect costs. Rotavirus mortality rate at 0.7 per 1000 derived from national data was three-fold lower than the same rate calculated from international estimates of under-five mortality. Rotavirus vaccination could reduce hospitalizations and deaths by 91% and avert US$ 370,000 in hospitalization costs alone. Vaccination would be cost-effective with vaccine prices in a range of US$ 2-25 per child. However, the cost-effectiveness is greatly influenced by mortality, vaccine price and vaccine efficacy.