The aim : to highlight the importance of considering hemophagocytic lymphohistiocytosis in patients with jaundice of unclear origin and systemic inflammatory manifestations after coronavirus infection. Key points . A 64-y.o. patient was admitted to the hospital with jaundice, pruritus, fatigue, weight loss. The complaints occurred 2 weeks after discharge from the hospital for treatment of patients with coronavirus infection. Laboratory tests revealed signs of hepatic insufficiency, markers of cholestasis and inflammation persisted in time. Upon instrumental examination no signs of hepatosplenomegaly, biliary tree changes, intra- and extrahepatic obstruction were found. S. aureus was identified in blood cultures, CT scan of the facial skull bones showcased the focus of infection in the area of the roots of teeth 2.4 and 2.5. Therefore, antibiotics were prescribed. Subsequently, the patient's condition was complicated by the development of two episodes of acute respiratory distress syndrome, which occurred during the withdrawal of glucocorticosteroid therapy. Liver biopsy was performed, morphological study revealed signs of “vanishing bile duct” syndrome, excessive activation of macrophages and hemosiderosis of sinusoidal cells. Identified lesions can be found in hemophagocytic lymphohistiocytosis (HLH), a life-threatening complication of coronavirus infection. Glucocorticosteroids therapy, transfusions of human immunoglobulin, albumin, and parenteral nutrition have led to patient's condition improvement. Conclusion . COVID-19 provokes the development of secondary HLH 10 times more often than other respiratory viral infections. The possibility of hemophagocytic syndrome development should be considered, including cases of overlap syndrome with sepsis, in patients with unresolved jaundice, hyperferritinemia after coronavirus infection. Routinely used scales and criteria for diagnosis of HLH (H-score, HLH 2004) in such cases lacks sensitivity, therefore, careful analysis of clinical picture and exclusion of other causes of jaundice are required.

Aim. A review to highlight the bile acids importance as steroid mediators of nervous system activity and show the nervous system involvement in cholesterol metabolism and bile acids production.Key points. Presence of bile acid membrane and nuclear receptors and their activation role in mediating manifold metabolic processes have been established in various organs and tissues. Bile acid transporters are discovered in CNS. The animal brain under physiological conditions was found to contain about 20 bile acid types of likely innate origin suggested by their high contents; the bile acids spectrum in CNS differs significantly from blood plasma. Clinical and experimental works are conclusive about the CNS bile acids influence on mitochondrial membrane, their antioxidative role and, probably, steroid-mediator involvement in indirect regulation of memory, attention, motor functions and appetite.Conclusion. Bile acids act as pleiotropic signalling molecules affecting various tissues. The presence in CNS of various bile acid synthesis-related receptors and enzymes indicates their value in brain functioning and warrants research into their metabolism.

The natural history of liver cirrhosis (LC) is characterized by two stages: compensated and decompensated. Current clinical and laboratory prognostic models, such as Child-Pugh and MELD scales, do not take into account immune dysregulation, as well as it potential impact on the LC decompensation and the survival. Neutrophil to lymphocyte ratio (NLR) is simple and affordable parameter, representing the imbalance of two distinct immune pathways.Aim:to evaluate relationship between NLR level, mortality and SIRS development in patients with DC.Materials and methods.In this retrospective study 36 patients with DC which were hospitalized in Hepatology Department of V.H. Vasilenko clinic of propaedeutics and internal diseases, gastroenterology and hepatology, Sechenov University from January 2009 to December 2017 were enrolled. Correlation analysis, univariate and multivariable analysis were provided to find factors statistically significantly associated with lethal outcome and SIRS. The optimal cut-off levels for the NLR associated with adverse outcome were determined.Results.AIn multivariable analysis, NLR > 4 (p < 0,001) was statistically significantly associated with lethal outcome in patients with DC during hospitalization (OR: 1.57, [95 % CI 1.125–2.209], p = 0.008). Sensitivity and specificity of this cut-off is 100 % and 79.17 %, respectively. NLR > 4.8 was associated with SIRS development during hospitalization (OR: 1.484, [95 % CI 1.103–1.997], p = 0.009) with 100 % sensitivity and 90 % specificity.Conclusions.NLR is an independent risk factor of lethal outcome and SIRS development in patients with decompensated liver cirrhosis.