The course of COVID-19 in a multiple sclerosis: a case report.

The authors present the case of a prolonged course of COVID 19 disease in a 37-year-old patient with multiple sclerosis on anti-CD20 monoclonal antibodies immunotherapy. This publication presents a clinical case of the course of COVID-19 disease in a multiple sclerosis patient receiving ublituximab therapy. The use of disease-modifying anti-CD20 monoclonal antibody therapy was associated with a protracted wave-like course of COVID-19 with the addition of a bacterial infection. This publication illustrates the key mechanisms and approaches to the treatment of such a cohort of patients. The use of highly effective multiple sclerosis treatment methods may be associated with an increase in the incidence of COVID-19 and worsening of its course. Multiple sclerosis patients receiving anti-CD20 therapy are at particular risk of a wave-like course of COVID-19, caused by immunosuppression, creates a basis for bacterial and fungal coinfection.

Genotype Distribution and Characteristics of Chronic Hepatitis C Infection in Estonia, Latvia, Lithuania, and Ukraine: The RESPOND-C Study.

Background and objectives: Since 2013, highly effective direct-acting antiviral (DAA) treatment for chronic hepatitis C (CHC) has become available, with cure rates exceeding 95%. For the choice of optimal CHC treatment, an assessment of the hepatitis C virus (HCV) genotype (GT) and liver fibrosis stage is necessary. Information about the distribution of these parameters among CHC patients in Estonia, Latvia, and Lithuania (the Baltic states) and especially in Ukraine is scarce. This study was performed to obtain epidemiologic data regarding CHC GT and fibrosis stage distribution for better planning of resources and prioritization of patients for DAA drug treatment according to disease severity in high-income (the Baltic states) and lower-middle-income (Ukraine) countries. Materials and methods: The retrospective RESPOND-C study included 1451 CHC patients. Demographic and disease information was collected from medical charts for each patient. Results: The most common suspected mode of viral transmission was blood transfusions (17.8%), followed by intravenous substance use (15.7%); however, in 50.9% of patients, the exact mode of transmission was not clarified. In Ukraine (18.4%) and Estonia (26%), transmission by intravenous substance use was higher than in Lithuania (5%) and Latvia (5.3%). Distribution of HCV GT among patients with CHC was as follows: GT1-66.4%; GT3-28.1; and GT2-4.1%. The prevalence of GT1 was the highest in Latvia (84%) and the lowest in Ukraine (63%, p < 0.001). Liver fibrosis stages were distributed as follows: F0-12.2%, F1-26.3%, F2-23.5%, F3-17.1%, and F4-20.9%. Cirrhosis (F4) was more prevalent in Lithuanian patients (30.1%) than in Estonians (8.1%, p < 0.001). Conclusions: This study contributes to the knowledge of epidemiologic characteristics of HCV infection in the Baltic states and Ukraine. The data regarding the patterns of HCV GT and fibrosis stage distribution will be helpful for the development of national strategies to control HCV infection in the era of DAA therapy.

LUNG ULTRASOUND DURING COVID-19 PANDEMICS: WHY, HOW AND WHEN?

OBJECTIVE: The aim: To optimize diagnostic of pathological processes in lungs af f ected by COVID-19, dynamic monitoring and clinical decision making using lung ultrasound in limited resources settings. PATIENTS AND METHODS: Materials and methods: Between the onset of pandemics and January 2021, approximately 9000 patients have been treated for conf i rmed COVID-19 in the Olexandrivska Clinical Hospital. Assessment of all hospitalized patients included hematology, chemistries and proinf l ammatory cytokines - IL-6, CRP, procalcitonin, ferritin. Diagnosis was conf i rmed by PCR for SARS-CoV-2 RNA. Chest X-ray was performed in all hospitalized cases, while CT was available approximately in 30% of cases during hospital stay. Lung ultrasound was proactively utilized to assess the type and extent of lung damage and to monitor the progress of disease in patients hospitalized into the ICU and Infection Unit (n=135). Ultrasound fi ndings were recorded numerically based on scales. RESULTS: Results: In the setting of СOVID-19, bedside lung ultrasound has been promptly recognized as a tool to diagnose and monitor the nature and extent of lung injury. Lung ultrasound is a real time assessment, which helps determine the nature of a pathologic process af f ecting lungs. In this paper the accuracy of bedside LUS, chest X-ray and computer tomography are compared based on clinical cases, typical for COVID-19 lung ultrasound appearance is evaluated. Described in article data is collected in one of the biggest facility that deals with COVID-19. Chest X-ray was performed in all hospitalized cases, while CT was available approximately in 30% of cases during hospital stay. The cases presented in the paper indicate potential advantages to the use of ultrasound in limited resource healthcare settings, especially when the risk of transportation to CT outweighs the value of information obtained. CONCLUSION: Conclusions: Grading of ultrasonographic findings in the lungs was suf f i cient for both initial assessment with identif ication of high risk patients, and routine daily monitoring. Hence, lung ultrsound may be used to predict deterioration, stratify risks and make clinical decisions.

CLINICAL AND LABORATORY MARKERS OF DIGESTIVE SYSTEM DISEASES IN HIV-INFECTED PATIENTS FOR FAMILY MEDICINE PRACTICE.

OBJECTIVE: The aim: To identify clinical and laboratory signs of digestive system disease in HIV-infected patients for helping family physicians. PATIENTS AND METHODS: Materials and methods: Research was conducted at five regional HIV / AIDS centers in Ukraine during 2017-2019. Randomly selected 342 adult HIV-infected patients were divided into two groups, with concomitant digestive system diseases and without concomitant digestive system disease. Statistical analysis was performed using the software package EZR 1.41 (Saitama Medical Center, Jichi Medical University, Japan). RESULTS: Results: The incidence of digestive system disease in patients with HIV clinical stages II, III and IV was significantly higher than in patients with HIV clinical stage I. Gastrointestinal disease was also significantly associated with the incidence of tuberculosis, candidiasis, kidney disease and HIV encephalopathy. Incidence of asthenic-vegetative and dyspeptic syndromes, weight loss, anemia and leukopenia, elevated liver enzymes, low CD4 counts and detectable viral load levels in patients on antiretroviral therapy were significantly more common in HIV-infected patients with gastrointestinal pathologies. HIV patients with digestive system disease significantly more often had changes to their therapy regiment, interruptions in treatment and more often experienced side effects. CONCLUSION: Conclusions: Digestive system disease becomes more common with the progression of HIV infection. Comorbidity of HIV infection and digestive system disease is characterized by changes in general clinical, biochemical and immunological blood parameters and patients with digestive system comorbidities more often have a poor virological response to antiretroviral therapy.

INTENSIFICATION OF ANTIVIRAL THERAPY OF CHRONIC HEPATITIS B BY MEANS OF INTRADERMAL IMMUNIZATION WITH AUTOLEUKOCYTES.

OBJECTIVE: The aim: Was a trial of intradermal immunization with native autoleukocytes as a curative vaccine. PATIENTS AND METHODS: Materials and methods: Thus, 3-shot series vaccination by means of intradermal injection of autoleukocytes with 30 - 40 days interval was conducted for patients who, in spite of continuous (at least 2 years) therapy with nucleotide analogue, experienced HBV DNA reproduction. For this procedure, 80 - 100 ml of a patient's heparinized venous blood was being precipitated at the temperature 37оС for 120 - 140 minutes, after blood plasma was being centrifuged at 450g for 8 minutes. The precipitate was resuspended in 1 - 1.5 ml of blood serum and injected intradermally in the region of the back. RESULTS: Results: Viral load decreased in all patients even after single immunization; it was possible to achieve a negative result by ultrasensitive PCR method in 23.33% of patients in the group of patients who did not respond adequately to antiviral therapy. CONCLUSION: Conclusions: In patients with chronic hepatitis B, intradermal immunization with autoleukocytes has a significant impact on intensity of virus replication. It is confirmed by a considerable reduction of DNA HBV amount in patients, in whom antiviral therapy was stopped before immunization.

A Managerial Approach towards Modeling the Different Strains of the COVID-19 Virus Based on the Spatial GeoCity Model.

This study proposes a modification of the GeoCity model previously developed by the authors, detailing the age structure of the population, personal schedule on weekdays and working days, and individual health characteristics of the agents. This made it possible to build a more realistic model of the functioning of the city and its residents. The developed model made it possible to simulate the spread of three types of strain of the COVID-19 virus, and to analyze the adequacy of this model in the case of unhindered spread of the virus among city residents. Calculations based on the proposed model show that SARS-CoV 2 spreads mainly from contacts in workplaces and transport, and schoolchildren and preschool children are the recipients, not the initiators of the epidemic. The simulations showed that fluctuations in the dynamics of various indicators of the spread of SARS-CoV 2 were associated with the difference in the daily schedule on weekdays and weekends. The results of the calculations showed that the daily schedules of people strongly influence the spread of SARS-CoV 2. Under assumptions of the model, the results show that for the more contagious "rapid" strains of SARS-CoV 2 (omicron), immunocompetent people become a significant source of infection. For the less contagious "slow strains" (alpha) of SARS-CoV 2, the most active source of infection is immunocompromised individuals (pregnant women). The more contagious, or "fast" strain of the SARS-CoV 2 virus (omicron), spreads faster in public transport. For less contagious, or "slow" strains of the virus (alpha), the greatest infection occurs due to work and educational contacts.

Consensus on management of hepatitis C virus infection in resource-limited Ukraine and Commonwealth of Independent States regions.

Globally, 69.6 million individuals were infected with hepatitis C virus (HCV) infection in 2016. Of the six major HCV genotypes (GT), the most predominant one is GT1, worldwide. The prevalence of HCV in Central Asia, which includes most of the Commonwealth of Independent States (CIS), has been estimated to be 5.8% of the total global burden. The predominant genotype in the CIS and Ukraine regions has been reported to be GT1, followed by GT3. Inadequate HCV epidemiological data, multiple socio-economic barriers, and the lack of region-specific guidelines have impeded the optimal management of HCV infection in this region. In this regard, a panel of regional experts in the field of hepatology convened to discuss and provide recommendations on the diagnosis, treatment, and pre-, on-, and posttreatment assessment of chronic HCV infection and to ensure the optimal use of cost-effective antiviral regimens in the region. A comprehensive evaluation of the literature along with expert recommendations for the management of GT1-GT6 HCV infection with the antiviral agents available in the region has been provided in this review. This consensus document will help guide clinical decision-making during the management of HCV infection, further optimizing treatment outcomes in these regions.