Features of the course of manifest forms of acute hepatitis C

Aim. To identify clinical, epidemiological and laboratory-instrumental features of acute hepatitis C at the present stage according to the infectious hospital data. Methods. The study included 111 patients with acute hepatitis C aged from 18 to 79 years who were hospitalized in Republican Clinical Infectious Diseases Hospital named after A.F. Agafonov in 2011 - I quarter of 2017. Acute hepatitis C was diagnosed in accordance with the guidelines of the Ministry of Health of the Russian Federation. Results. In the study group, females aged 21 to 40 years, non-working, predominantly living in Kazan with medical transmission of infection (34 %) prevailed. The disease was mild and moderately severe (71 %). The icteric form was observed in 94 % of patients, in 3.6 % - with a cholestatic component. When comparing laboratory parameters, markers of cytolysis and cholestasis differed significantly in patients depending on the severity (p<0.001). Changes in the gallbladder walls (an ultrasound marker of cholestasis) were revealed in 21.4 % of patients. On specific examination, the viral RNA was detected in 100 % of patients. Analysis of serological markers revealed predominance of antibodies to core and NS3 proteins, M class antibodies were detected only in half of the patients. Specific antibodies were absent (“dark diagnostic window”) in 3 % of patients with mild and 6 % of moderate form of the disease. Conclusion. The feature of the course of acute viral hepatitis C was the predominance of moderate forms (71 %) with medical transmission of infection. Icteric forms of acute viral hepatitis C were diagnosed in 94 % of patients (in 3.6 % cases with the development of cholestatic component). PCR is a mandatory method of specific diagnosis of acute viral hepatitis C, and in case of a “dark diagnostic window” becomes the leading method

Эпидемиологическая характеристика папилломавирусной инфекции аногенитальной локализации в Республике Татарстан

Due to the high prevalence of anogenital warts, their significant economic and psychosocial burden, the lack of routine vaccination against papillomavirus infection, monitoring of the epidemiological situation for one of the common forms of papillomavirus infection – anogenital warts is relevant.The aim is to assess the epidemiological situation of anogenital warts in Tatarstan Republic for 2011–2020.Materials and methods. The study design is an observational descriptive epidemiological study. A retrospective epidemiological analysis of the incidence of anogenital warts in Tatarstan Republic for 2011–2020 was carried out. The analysis of long-term dynamics of incidence of the population as a whole and in age and sex groups is carried out. The structure of the incidence of anogenital warts was assessed. Intensive (per 100,000) and extensive morbidity rates (%) were calculated.Results. There is a decrease in the incidence of anogenital warts in Republic Tatarstan from 123,80/0000 in 2011 to 68,80/0000 in 2020. The dynamics of the incidence of anogenital warts among the female and male population had a unidirectional character – a decrease in the incidence. A comparison of incidence levels showed that the incidence of women was higher than that of men (80,40/0000 versus 55,80/0000, respectively, in 2020). The greatest incidence of anogenital warts was observed in the 18–29 age group during the observation period. The average annual incidence of anogenital warts in women aged 18–29 was 535,60/0000, in men of the same age group – 233,00/0000.Conclusion. Despite the decrease in the incidence of anogenital warts in Tatarstan Republic as a whole and in certain age and gender groups, high levels of incidence among people aged 18-29 years remain. The data obtained from the results of a retrospective analysis of the incidence of anogenital warts indicate the need to introduce routine vaccination against HPV infection, which will prevent large treatment costs, and will have a positive impact on public health indicators.В силу высокой распространенности аногенитальных бородавок, их существенного экономического и психосоциального бремени, отсутствия плановой вакцинации против папилломавирусной инфекции представляется актуальным проведение мониторинга эпидемиологической ситуации за одной из распространенных форм папилломавирусной инфекции – аногенитальными бородавками.Цель: установить закономерности проявлений эпидемического процесса аногенитальных бородавок в Республике Татарстан за период с 2011 по 2020 г.Материалы и методы. Дизайн исследования – обсервационное описательное эпидемиологическое исследование. Проведен ретроспективный эпидемиологический анализ заболеваемости аногенитальными бородавками в Республике Татарстан за 2011–2020 гг. Проведен анализ многолетней динамики заболеваемости населения в целом и в возрастных и половых группах. Проведена оценка структуры заболеваемости аногенитальными бородавками. Рассчитаны интенсивные (на 100 000) и экстенсивные показатели заболеваемости (%).Результаты. Отмечается снижение заболеваемости аногенитальными бородавками в Республике Татарстан с 123,80/0000 в 2011 г. до 68,80/0000 в 2020 г. Динамика годовых показателей заболеваемости аногенитальными бородавками среди женского и мужского населения имела однонаправленный характер – снижение заболеваемости. При сравнении интенсивных показателей заболеваемость женщин была выше заболеваемости мужчин (80,40/0000 против 55,8 0/0000 соответственно, по данным 2020 г.). Наибольшие показатели заболеваемости аногенитальными бородавками отмечаются в группе 18–29 лет в течение всего периода наблюдения. Среднемноголетний показатель заболеваемости аногенитальными бородавками женщин 18–29 лет составил 535,60/0000, мужчин той же возрастной группы – 233,00/0000.Заключение. Несмотря на снижение заболеваемости аногенитальными бородавками, в Республике Татарстан в целом и в отдельных половозрастных группах сохраняются высокие показатели заболеваемости среди лиц 18–29 лет. Данные, полученные по результатам ретроспективного анализа заболеваемости аногенитальными бородавками, свидетельствуют о необходимости внедрения плановой вакцинации против ВПЧ-инфекции (четырехвалентной вакциной), что предотвратит не только большие затраты на лечение, но и окажет положительное влияние на показатели общественного здоровья

Non-invasive diagnostic tests for Helicobacter pylori infection

BACKGROUND: Helicobacter pylori (H pylori) infection has been implicated in a number of malignancies and non-malignant conditions including peptic ulcers, non-ulcer dyspepsia, recurrent peptic ulcer bleeding, unexplained iron deficiency anaemia, idiopathic thrombocytopaenia purpura, and colorectal adenomas. The confirmatory diagnosis of H pylori is by endoscopic biopsy, followed by histopathological examination using haemotoxylin and eosin (H & E) stain or special stains such as Giemsa stain and Warthin-Starry stain. Special stains are more accurate than H & E stain. There is significant uncertainty about the diagnostic accuracy of non-invasive tests for diagnosis of H pylori. OBJECTIVES: To compare the diagnostic accuracy of urea breath test, serology, and stool antigen test, used alone or in combination, for diagnosis of H pylori infection in symptomatic and asymptomatic people, so that eradication therapy for H pylori can be started. SEARCH METHODS: We searched MEDLINE, Embase, the Science Citation Index and the National Institute for Health Research Health Technology Assessment Database on 4 March 2016. We screened references in the included studies to identify additional studies. We also conducted citation searches of relevant studies, most recently on 4 December 2016. We did not restrict studies by language or publication status, or whether data were collected prospectively or retrospectively. SELECTION CRITERIA: We included diagnostic accuracy studies that evaluated at least one of the index tests (urea breath test using isotopes such as13C or14C, serology and stool antigen test) against the reference standard (histopathological examination using H & E stain, special stains or immunohistochemical stain) in people suspected of having H pylori infection. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the references to identify relevant studies and independently extracted data. We assessed the methodological quality of studies using the QUADAS-2 tool. We performed meta-analysis by using the hierarchical summary receiver operating characteristic (HSROC) model to estimate and compare SROC curves. Where appropriate, we used bivariate or univariate logistic regression models to estimate summary sensitivities and specificities. MAIN RESULTS: We included 101 studies involving 11,003 participants, of which 5839 participants (53.1%) had H pylori infection. The prevalence of H pylori infection in the studies ranged from 15.2% to 94.7%, with a median prevalence of 53.7% (interquartile range 42.0% to 66.5%). Most of the studies (57%) included participants with dyspepsia and 53 studies excluded participants who recently had proton pump inhibitors or antibiotics.There was at least an unclear risk of bias or unclear applicability concern for each study.Of the 101 studies, 15 compared the accuracy of two index tests and two studies compared the accuracy of three index tests. Thirty-four studies (4242 participants) evaluated serology; 29 studies (2988 participants) evaluated stool antigen test; 34 studies (3139 participants) evaluated urea breath test-13C; 21 studies (1810 participants) evaluated urea breath test-14C; and two studies (127 participants) evaluated urea breath test but did not report the isotope used. The thresholds used to define test positivity and the staining techniques used for histopathological examination (reference standard) varied between studies. Due to sparse data for each threshold reported, it was not possible to identify the best threshold for each test.Using data from 99 studies in an indirect test comparison, there was statistical evidence of a difference in diagnostic accuracy between urea breath test-13C, urea breath test-14C, serology and stool antigen test (P = 0.024). The diagnostic odds ratios for urea breath test-13C, urea breath test-14C, serology, and stool antigen test were 153 (95% confidence interval (CI) 73.7 to 316), 105 (95% CI 74.0 to 150), 47.4 (95% CI 25.5 to 88.1) and 45.1 (95% CI 24.2 to 84.1). The sensitivity (95% CI) estimated at a fixed specificity of 0.90 (median from studies across the four tests), was 0.94 (95% CI 0.89 to 0.97) for urea breath test-13C, 0.92 (95% CI 0.89 to 0.94) for urea breath test-14C, 0.84 (95% CI 0.74 to 0.91) for serology, and 0.83 (95% CI 0.73 to 0.90) for stool antigen test. This implies that on average, given a specificity of 0.90 and prevalence of 53.7% (median specificity and prevalence in the studies), out of 1000 people tested for H pylori infection, there will be 46 false positives (people without H pylori infection who will be diagnosed as having H pylori infection). In this hypothetical cohort, urea breath test-13C, urea breath test-14C, serology, and stool antigen test will give 30 (95% CI 15 to 58), 42 (95% CI 30 to 58), 86 (95% CI 50 to 140), and 89 (95% CI 52 to 146) false negatives respectively (people with H pylori infection for whom the diagnosis of H pylori will be missed).Direct comparisons were based on few head-to-head studies. The ratios of diagnostic odds ratios (DORs) were 0.68 (95% CI 0.12 to 3.70; P = 0.56) for urea breath test-13C versus serology (seven studies), and 0.88 (95% CI 0.14 to 5.56; P = 0.84) for urea breath test-13C versus stool antigen test (seven studies). The 95% CIs of these estimates overlap with those of the ratios of DORs from the indirect comparison. Data were limited or unavailable for meta-analysis of other direct comparisons. AUTHORS' CONCLUSIONS: In people without a history of gastrectomy and those who have not recently had antibiotics or proton ,pump inhibitors, urea breath tests had high diagnostic accuracy while serology and stool antigen tests were less accurate for diagnosis of Helicobacter pylori infection.This is based on an indirect test comparison (with potential for bias due to confounding), as evidence from direct comparisons was limited or unavailable. The thresholds used for these tests were highly variable and we were unable to identify specific thresholds that might be useful in clinical practice.We need further comparative studies of high methodological quality to obtain more reliable evidence of relative accuracy between the tests. Such studies should be conducted prospectively in a representative spectrum of participants and clearly reported to ensure low risk of bias. Most importantly, studies should prespecify and clearly report thresholds used, and should avoid inappropriate exclusions

ACTIVITY MONITORING OF A NTIBODIES TO HIV-1 STRUCTURAL PROTEINS IN A BSENCE OF ANTIRETROVIRAL TREATMENT AND IN THE COURSE OF THERAPY

Abstract. In HIV-infected patients, the process of antibody production to certain HIV-I structural proteins proceeds in differential manner, depending on the antigen localization. Upon progression of the disease, an increased ratio of antibodies to env surface glycoproteins is found, along with decreased percentage of antibodies to gag gene proteins