Objective was to conduct a comparative analysis of routine clinical and laboratory parameters in two groups of patients with chronic viral hepatitis C (CHC) depending on the presence or absence of hepatic steatosis.Methods and materials. The observational retrospective cross-sectional study included 411 patients with CHC, of which 43.80 % were those with hepatic steatosis. The studied parameters were routine clinical and laboratory parameters, the viral genotype, as well as formalized results of a liver biopsy and ultrasound examination of the abdominal organs. To assess the differences between the two groups, the following were calculated: Pearson’s test, two-tailed Fisher’s test, Wilcoxon rank sum test, Spearman’s correlation coefficient, and partial correlation coefficient.Results. It was found that CHC patients with hepatic steatosis were older and had a higher body mass index (BMI) than patients without hepatic steatosis (p<0.01). Among patients with hepatic steatosis, the 3a genotype of the virus (p<0.001) and advanced stages of liver fibrosis (p<0.01) were more often detected, higher concentrations of hepatic transaminase (p£0.001) and iron (p<0 .01) in blood serum were observed, as well as higher liver (p<0.001) and pancreas (p<0.001) sizes on ultrasound than among patients without hepatic steatosis.Conclusion. Age, BMI, viral genotype, stage of liver fibrosis, ALT, AST, GGT, and iron levels, as well as liver and pancreas size are potential predictors of the presence of hepatic steatosis in CHC patients.

The review article is devoted to the problem of lipid metabolism disorders in the liver in patients with chronic hepatitis B and chronic hepatitis C. The results of modern biological, epidemiological and clinical studies aimed at studying the causes and mechanisms of the formation of liver steatosis and steatohepatitis, their prevalence and influence on the course of infectious pathology are presented. Particular attention is paid to the generalization and systematization of the currently available data on the mechanisms of lipid metabolism disorders in the liver, mediated by the molecular structures of hepatitis B and C viruses. In conclusion, the need for timely diagnosis and treatment of pathological conditions caused by the development of lipid metabolism disorders in the liver is substantiated in order to increase the quality of medical care for patients with chronic hepatitis B and C.

Objective: to analyze the epidemiological and clinical features of acute respiratory infections occurring during the St. Petersburg 2017–2018 and 2018–2019 epidemic seasons.Materials and methods: the study included 457 patients, treated in St. Petersburg clinics from 2017–2019, displaying symptoms of acute respiratory infection (ARI), including evaluation of their clinical histories. Pathogen types were determined by polymerase chain reaction (PCR). Data analysis was carried out using mathematical statistics methods using the Statistica 10 software package (StatSoft Inc.).Results: in this study, we examined the epidemiological and clinical features of acute respiratory infections in St. Petersburg occurring during two epidemic seasons, 2017–2018 and 2018–2019. The 2017–2018 season was characterized by a prevalence of infections caused by influenza B viruses and influenza A subtype H3N2 viruses. In the 2018–2019 season, there was a greater number of acute respiratory viral infections (ARVIs) and infections caused by influenza A subtype H1N1pdm; influenza B virus was detected only in isolated cases. In the 2017–2018 sore throats and muscle aches were a characteristic symptom of influenza A H1N1pdm infections, of bacterial infections – only sore throats. It was shown that throat pain and vasodilation of the scleral and soft palate vessels were significantly more frequent in the 2017–2018 season, compared to the 2018–2019 season. Cough and redness of the posterior pharyngeal wall were hallmark signs of ARVIs in the 2018–2019 season.Conclusion: according to the data, each epidemic season is characterized not only by its own type-specific acute respiratory infection frequencies, but also by different clinical manifestation frequencies. For global monitoring, treatment effectiveness evaluation, and refined study of acute respiratory infection clinical features, it is advisable to use approaches which incorporate accurate, specific, and rapid molecular biological methods capable of identifying a broad range of pathogens.

Цель. Оценка эффективности, безопасности, переносимости, а также определение оптимальной дозы препарата риамиловир у пациентов с диагнозом «острая респираторная вирусная инфекция» (ОРВИ). Материалы и методы. В исследование включены 270 пациентов с неосложненным течением ОРВИ легкой и средней тяжести заболевания (с лабораторно подтвержденным методом полимеразной цепной реакции наличием антигенов ОРВИ, отсутствием антигенов вирусов гриппа). Пациенты включались в исследование после подписания информированного согласия. Больные рандомизированы в 3 группы в соотношении 1:1:1 по 90 человек в каждую. Завершили исследование в соответствии с протоколом 267 пациентов. В исследовании участвовали лица с диагнозом ОРВИ. Результаты. Подтверждены эффективность, безопасность и хорошая переносимость препарата риамиловир. Нежелательных лекарственных реакций, связанных, по мнению врача, с приемом препарата и повлекших прекращение приема препарата, в данном исследовании не отмечалось. Заключение. В результате клинического исследования показана эффективность обеих схем лечения ОРВИ препаратом риамиловир. Различий в эффективности и безопасности предлагаемых схем терапии не выявлено. Рекомендовано практическое использование обеих схем лечения. Однако, по мнению авторов, прием препарата 3 раза в день значительно удобнее для пациентов, повышает качество жизни и приверженность терапии.

AIM Evaluation of efficacy, safety, tolerability, and determination of the optimal dose of riamilovir in patients diagnosed with acute respiratory viral infection (ARVI). MATERIALS AND METHODS The study included 270 patients with uncomplicated ARVI of mild and moderate severity (with a laboratory-confirmed PCR method for the presence of ARVI antigens, absence of influenza virus antigens). Patients were included in the study after signing an informed consent. Patients were randomized into 3 groups in a 1:1:1 ratio of 90 patients in each group. Completed the study in accordance with the Protocol: 267 patients. The study involved patients diagnosed with ARVI. RESULTS Confirmed the efficacy, safety and tolerability of the drug riamilovir. Adverse drug reactions associated, in the opinion of the doctor, with taking the drug and resulting in discontinuation of the drug, were not noted in this study. CONCLUSION As a result of clinical study, the effectiveness of both ARVI treatment regimens with drug riamilovir has been shown. There were no differences in the effectiveness and safety of the proposed treatment regimens. Practical use of both treatment regimens is recommended. However, according to the authors, taking the drug 3 times a day is much more convenient for patients, improves the quality of life and adherence to therapy.

Extrahepatic manifestations occur in more than half of patients with chronic hepatitis C virus infection and may be no less dangerous to the health and life of the patient than the isolated pathology of the liver. Chronic hepatitis C virus infection is often accompanied by the formation of neurocognitive disorders, clinically manifested by general weakness, fatigue and the inability to maindoi tain concentration for a long time. Every fifth patient with chronic hepatitis C develops depression. The development of type 2 diabetes among patients with chronic hepatitis C virus infection is observed 1.7 times more often than among non-infected individuals. Mixed cryoglobulinemia is observed in at least 30% of patients, however, the clinical manifestations of this pathology develop only in 4.9% of cases, of which 69–89% of skin lesions, 19–44% of distal sensory and sensorimotor polyneuropathy, 30% of membranoproliferative glomerulonephritis, 28% of joint damage. Among patients with chronic hepatitis C virus infection, higher prevalence than among non-infected individuals is observed, the prevalence rates of such nosologies as lymphoma from cells of the marginal zone are 2.47 times, diffuse large cell B cell lymphoma – 2.24 times, hypothyroidism – 3.1 time. Significantly more rarely encountered extrahepatic manifestations of chronic hepatitis C virus infection are skin lesions that are not associated with the development of cryoglobulinemic vasculitis: acquired late skin porphyria, necrolytic acral erythema and lichen planus. The question of the pathogenetic relationship of chronic hepatitis C virus infection with cardiovascular pathology remains open.

Influenza is a common respiratory infection caused by viruses of types A, B and C. Characteristic of influenza infection is the development of intoxication and damage to the epithelium of the mucous membrane of the upper respiratory tract, often the trachea. Complications of influenza occur in 10–15% of patients. Most often it is pneumonia, bacterial focal infections (sinusitis, otitis, urinary and biliary tract infections), activation of chronic infections (tuberculosis, rheumatism). In influenza infection, as in the treatment of any infectious disease, the greatest importance belongs to etiotropic therapy. The world health organization recommends the use of neuraminidase inhibitors for etiotropic treatment of influenza. Currently, 2 neuraminidase inhibitors are used in the Russian Federation - oseltamivir and zanamivir. Both of these drugs are included in the clinical guidelines approved by the Ministry of health of Russia. In the Russian pharmaceutical market, oseltamivir is represented including the domestic drug Nomides in several dosages of 75 mg, 45 mg, 30 mg, which allows it to be used in children from 3 years. Etiotropic drugs should be prescribed as early as possible from the moment of clinical manifestation of the disease, optimally - in the first 48 hours from the onset of the disease, without waiting for laboratory verification of the diagnosis. The advantages of etiotropic therapy are reducing the risk of complications, shortening the period of fever and other symptoms. It is equally important to reduce the incidence of secondary complications requiring antibiotics and hospitalizations due to influenza. Etiotropic drugs for influenza therapy, including nomides, are used to prevent influenza infection. It should be noted that chemoprophylaxis does not replace vaccination against influenza, but is an auxiliary method of preventing the disease.

Aim. To evaluate the informativeness indicators of the new diagnostic method «ФП Тест» version 1.0 to determine the moderate/severe degree of hepatitis activity in patients with chronic HCV infection.Materials and methods. The study included 304 patients with chronic HCV infection. 184 patients were randomly selected into the training sample, 120 patients into the test sample. As a standard method for diagnosing hepatitis activity, a puncture biopsy of the liver was performed in all patients with the calculation of the histological activity index according to the Knodell scale. Minimal/mild degree of hepatitis activity (HAI 0–8 score) was detected in 46,38% of patients, moderate/severe hepatitis activity (HAI 9–18 score) in 53,62% of patients.Results. The accuracy of the method «ФП Тест» version 1.0 for the diagnosis of moderate/severe hepatitis activity was 79,17%, sensitivity — 78,46%, specificity — 80,00%. The values of the area under the ROC — curve for classifying patients depending on the presence or absence of moderate/severe hepatitis activity were: «ФП Тест» version 1.0 (AUC=0,84, cut-off value=0,52), determination of ALT level (AUC=0,74, cut-off value=61,40 U/L), determination of AST level (AUC=0,76, cut-off value=39,00 U/L).Conclusion. The new diagnostic method «ФП Тест» is a simple, affordable and informative test to determine the moderate/severe degree of hepatitis activity in patients with chronic HCV infection.

Introduction. In the context of a high load on all links in the structure of providing medical care to patients with COVID-19, solving the issue of effective triage of patients seems to be extremely urgent. The duration of inpatient treatment is one of the most objective and unambiguously interpreted indicators that can be used to indirectly assess the severity of the patient’s condition.Objective. Develop a machine learning model to predict the duration of inpatient care for patients with COVID-19 based on routine clinical indicators assessed at the prehospital stage.Materials and methods. A total of 564 patients were examined with diagnoses: U07.1 COVID-19, virus identified (n = 367) and U07.2 COVID-19, virus not identified (n = 197). The study included 270 patients, of whom in 50.37% of patients the duration of inpatient treatment did not exceed 7 days, in 49.63% of patients the duration of inpatient treatment was more than 10 days. Eleven clinical parameters were chosen as the most important predictors for predicting the duration of inpatient treatment: age, height and weight of the patient, SpO2 level, body temperature, body mass index, pulse rate, number of days from the onset of illness, respiratory rate, systolic and diastolic arterial pressure.Results. The accuracy of our machine learning model for predicting the duration of inpatient treatment more than 10 days was 83.75% (95% CI: 73.82–91.05%), sensitivity — 82.50%, specificity — 85.00%. AUC = 0.86.Conclusion. The method developed by us based on machine learning is characterized by high accuracy in predicting the duration of inpatient treatment of patients with COVID-19, which makes it possible to consider it as a promising new tool to support medical decisions on further tactics of patient management and to resolve the issue of the need for hospitalization.

Objective. Identification of laboratory parameters that are used in routine practice and can serve as diagnostic and prognostic criteria for the development of sepsis and its outcomes in patients with purulent-inflammatory diseases of soft tissues.Materials and methods. The study included 48 patients with purulent-inflammatory diseases of soft tissues. Recorded the occurrence of such clinical events as the development of sepsis or septic shock, intensive therapy, death or recovery and discharge from the hospital. For the diagnosis of sepsis, a SOFA (Sepsis-related organ failure assessment score) ³ 2 points was used. Patients were divided into subgroups according to the number of points according to the SOFA scale, intensive care and depending on the outcome of the disease: Subgroup 1 – 26 patients with sepsis (SOFA ³ 2 points) and 22 patients with systemic inflammatory response syndrome (SIRS) and SOFA <2 points; 2nd subgroup – 12 people who underwent intensive therapy and 36 people without it; 3rd subgroup – 7 patients with a fatal outcome and 41 patients with a favorable outcome.Results. In patients with sepsis, albumin concentration was 24,07 g / l in median versus 34,65 g / l in the control group of patients with SOFA <2 points (p <0,01); glucose -7,82 mmol / l and 5,15 mmol / l (p <0,01); sodium concentration of 133 mmol / li 139 mmol / l (p <0,01). The values of the international normalized ratio (INR) amounted to a median of 1,29 and 1,04 (p <0,01); activated partial thromboplastin time -36,20 seconds and 31,50 seconds (p <0,01). In the subgroup of patients for whom intensive therapy was required, the concentration of albumin was 22,34 g / l by median versus 30,10 g / l (p <0,01); urea – 15,50 mmol / l versus 6,00 mmol / l (p <0,05), glucose – 9,61 mmol / l against 5,80 mmol / l (p <0,05), lactate dehydrogenase-644,00 U / l and 426,00 U / l (p <0,05); INR – 1,35 against 1,05 (p <0,05). The aver-age total protein concentration is 47,80 g / l versus 57,90 g / l (p <0,01). The average albumin is 22,34 g / l versus 28,50 g / l (p <0,05). The glucose concentration among patients with a fatal outcome was 12,00 mmol / l in median versus 5,95 mmol / l (p <0,01); urea – 23,22 mmol / l versus 6,00 mmol / l (p <0,01). The incidence of lethal disease was statistically significantly higher in patients with a total protein level of less than 52 g / l 5,96 times (RR = 5,96, 95% CI 1,32 – 26,89), glucose more than 11 mmol / l – 7,00 times (OR = 7,00, 95% CI 1,25 – 39,15), urea more than 20 mmol / l – 7,05 times (RR = 7,05, 95% CI 2,00 – 24,85).Conclusion. Routine laboratory indicators as the level of total protein, albumin, glucose, sodium and urea, as well as indicators of the blood coagulation system (INR and APTT), can serve as diagnostic and prognostic criteria for the development of sepsis and its outcomes in patients with purulentinflammatory diseases. soft tissue.

Extrahepatic manifestations occur in more than half of patients with chronic hepatitis C virus infection and may be no less dangerous to the health and life of the patient than the isolated pathology of the liver. Chronic hepatitis C virus infection is often accompanied by the formation of neurocognitive disorders, clinically manifested by general weakness, fatigue and the inability to maindoi tain concentration for a long time. Every fifth patient with chronic hepatitis C develops depression. The development of type 2 diabetes among patients with chronic hepatitis C virus infection is observed 1.7 times more often than among non-infected individuals. Mixed cryoglobulinemia is observed in at least 30% of patients, however, the clinical manifestations of this pathology develop only in 4.9% of cases, of which 69–89% of skin lesions, 19–44% of distal sensory and sensorimotor polyneuropathy, 30% of membranoproliferative glomerulonephritis, 28% of joint damage. Among patients with chronic hepatitis C virus infection, higher prevalence than among non-infected individuals is observed, the prevalence rates of such nosologies as lymphoma from cells of the marginal zone are 2.47 times, diffuse large cell B cell lymphoma – 2.24 times, hypothyroidism – 3.1 time. Significantly more rarely encountered extrahepatic manifestations of chronic hepatitis C virus infection are skin lesions that are not associated with the development of cryoglobulinemic vasculitis: acquired late skin porphyria, necrolytic acral erythema and lichen planus. The question of the pathogenetic relationship of chronic hepatitis C virus infection with cardiovascular pathology remains open.

In the Russian Federation, the number of new cases of influenzaand SARS each year reaches 30 million people, and the annual total economic damage is estimated at 40 billion rubles, accounting for about 80% of the damage from all infectious diseases. Today, one of the main priorities of confronting the consequences of the annual epidemics of influenza is the development and introduction into clinical practice of new drugs with proven effectiveness and safety, the use of which is economically feasible.Objective. Conduct a clinical and economic analysis of two alternative regimens for treating influenza patients using the modern drug Triasavirin® and the known Tamiflu® neuraminidase inhibitor.Materials and methods. The study included 127 patients with a laboratory confirmed diagnosis of «influenza». All patients were divided into two groups. The main group consisted of 82 patients who received Triazavirin® 1 capsule (250 mg) 3 times a day for 5 days. The comparison group consisted of 45 patients who received Tamiflu® 1 capsule (75 mg) 2 times a day for 5 days. To conduct a clinical and economic evaluation of two alternative treatment regimens, cost-effectiveness factors were calculated, such as the ratio of the cost of therapy to the indicator of its effectiveness. The analyzed events were: (1) recovery by the 5th day from the start of treatment; (2) temperature normalization by the 5th day from the start of treatment; (3) no symptoms of intoxication (headache, myalgia, pain / rei in the eyeballs) by the 5th day from the start of treatment; (4) absence of catarrhal manifestations (pain / sore throat, cough) to the 10th day from the beginning of treatment.Results. The use of the drug Triazavirin® for treatment of influenza patients in comparison with the inhibitor of neuraminidase with Tamiflu® is economically viable, both with respect to the timing of recovery (cost-effectiveness ratio: 935,57 rubles / unit vs 1859,39 rubles / unit) and normalization of temperature body (cost- effectiveness ratio: 869,53 rubles / unit vs. 2014,33 rubles / unit), and with respect to the duration of intoxication (cost-effectiveness ratio: 859,42 rubles / unit vs. 1473,90 rub ./unit) and catarrhal (coefficient of expenditure e ciency: 869,53 rubles / unit against 1611,47 rubles / unit) syndromes.Conclusion. Triazavirin® is a new effective antiviral agent for the treatment of influenza. The use of Triazavirin® in the treatment of patients with influenza is economically viable, due to significant budget savings both in terms of the cost of treatment, and the reduction in concomitant therapy and the reduction in the period of temporary disability of working patients.

In the Russian Federation, the number of new cases of influenza and SARS each year reaches 30 million people, and the annual total economic damage is estimated at 40 billion rubles, accounting for about 80% of the damage from all infectious diseases. Today, one of the main priorities of confronting the consequences of the annual epidemics of influenza is the development and introduction into clinical practice of new drugs with proven effectiveness and safety, the use of which is economically feasible. Objective. Conduct a clinical and economic analysis of two alternative regimens for treating influenza patients using the modern drug Triasavirin® and the known Tamiflu® neuraminidase inhibitor. Materials and methods. The study included 127 patients with a laboratory confirmed diagnosis of «influenza». All patients were divided into two groups. The main group consisted of 82 patients who received Triazavirin® 1 capsule (250 mg) 3 times a day for 5 days. The comparison group consisted of 45 patients who received Tamiflu® 1 capsule (75 mg) 2 times a day for 5 days. To conduct a clinical and economic evaluation of two alternative treatment regimens, cost-effectiveness factors were calculated, such as the ratio of the cost of therapy to the indicator of its effectiveness. The analyzed events were: (1) recovery by the 5th day from the start of treatment; (2) temperature normalization by the 5th day from the start of treatment; (3) no symptoms of intoxication (headache, myalgia, pain / rei in the eyeballs) by the 5th day from the start of treatment; (4) absence of catarrhal manifestations (pain / sore throat, cough) to the 10th day from the beginning of treatment. Results. The use of the drug Triazavirin® for treatment of influenza patients in comparison with the inhibitor of neuraminidase with Tamiflu® is economically viable, both with respect to the timing of recovery (cost-effectiveness ratio: 935,57 rubles / unit vs 1859,39 rubles / unit) and normalization of temperature body (cost- effectiveness ratio: 869,53 rubles / unit vs. 2014,33 rubles / unit), and with respect to the duration of intoxication (cost-effectiveness ratio: 859,42 rubles / unit vs. 1473,90 rub ./unit) and catarrhal (coefficient of expenditure e ciency: 869,53 rubles / unit against 1611,47 rubles / unit) syndromes. Conclusion. Triazavirin® is a new effective antiviral agent for the treatment of influenza. The use of Triazavirin® in the treatment of patients with influenza is economically viable, due to significant budget savings both in terms of the cost of treatment, and the reduction in concomitant therapy and the reduction in the period of temporary disability of working patients.

Pregnant women are at high risk for the adverse course of respiratory diseases, among which the influenza is the one of the leading infections, of ten finishing tragically for most pregnant and her offspring. Due to the disproportionately high morbidity, mortality and adverse outcomes of pregnancy after influenza virus infection, pregnant females are classified as a priority group for vaccination. Immunization with inactivated influenza vaccine is one of the most important strategy to prevent both of influenza infection, its severe complications, and mitigating of the effects of the epidemic of influenza. There was accumulated sufficient evidence demonstrating that the vaccine promotes the diminution of clinical manifestations of influenza infection in pregnant women, as well, has a positive effect on the health of the newborns due to the active transport of maternal antibodies. In the review there are presented data on the safety, high immunogenicity and clinical efficacy of vaccination against influenza as for pregnant women as well for infants.

Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever is severe acute infectious diseases accompanied by the development of severe systemic inflammatory response followed by the addition of disseminated intravascular coagulation and multiple organ failure. Since 1976 in Africa regularly observed disease outbreaks among humans caused by different types of Ebola virus. Modern epidemic in West Africa began in Guinea in February 2014 and is still going on, coming out of the country and distributed in Liberia, Sierra Leone and Nigeria. According to the World Health Organization (WHO) on December 14, 2014 recorded 18,603 cases of them confirmed EVD 11807, fatal 6915. From July 2014 to currently registered sporadic cases EVD among health care workers caring for patients, as well as among tourists returning from countries affected by the epidemic is already outside of West Africa. Due to the limited use of specific antiviral therapy with special attention to the management ofpatients with EVD should be paid to the intensive and timely pathogenetic therapy. Today, the only way to reduce morbidity and mortality among people from EVD is awareness on the risk factors of infection and the use ofpersonal protective measures.

Interferon-gamma (IFN-y) is a pleiotropic lymphokine that have multiple effects on the growth and differentiation of various types of cells associated with innate immunity. IFN-y induces differentiation ofmyeloid cells, stimulates the expression of major histocompatibility complex (MHC) class II and class I antigens, it is a potent activator of macrophages which destroy antigenic molecules penetrating the cell. IFN-y is widely used for the treatment of infectious diseases, cancer, autoimmune and allergic diseases. Studies conducted in Research Institute ofInfluenza indicate that drugs IFN-y can be successfully usedfor prevention of influenza and acute respiratory infection (ARI) during the rise of incidence, as well as for the treatment - the first few days/ hours of the onset. The concomitant use of drugs as IFN-a and IFN-y on influenza and ARI can greatly improve the prophylactic and therapeutic efficacy.

Acute respiratory diseases (ARD) are the most common in the structure of all infectious diseases. High antigenic variation of influenza viruses, adenoviruses and rhinoviruses slows down the process of creation of universal vaccines and leads to high incidence of developing resistance to direct-acting antiviral agents. Therefore, in the treatment and prevention of ARVI, it is reasonable to take medicines which activate the mechanisms of nonspecific immune response thus increasing the overall resistance of the organism. IFN-γ is a pluripotent cytokine with a strong etiotropic (antiviral) action and a potent immunomodulator. IFN-γ can be recommended for the prevention and treatment of influenza and ARVI during the peak of disease or in the first days/ hours of the disease onset. Concomitant use of IFN-α and IFN-γ against influenza and ARVI can significantly increase both prophylactic and therapeutic efficacy.