Vol 84, No 11 (2012)

The data on natural course of chronic viral hepatitis C infection (HCV) and the efficacy of antiviral treatment depending on virus genotype are summarized in the article. The significance of virus genotype in progression of liver febrosis and liver steatosis is discussed. It is pointed out that chronic HCV infection caused by genotype 3 is characterized by a more aggressive clinical course of disease and less favorable prognosis. Optimal approaches to the management of patients with genotype 3 of chronic HCV infection as well as perspectives of antiviral therapy in this group of patients are discussed in the article.

Aim. To reveal the predictors of inefficiency of combination treatment in patients with infiltrative pulmonary tuberculosis (IPT). Subjects and methods. One hundred and three patients with new-onset IPT underwent a complex clinical, radiological, laboratory and psychological examination before treatment. The findings were compared with the results of combination treatment for IPT within a year after the initiation of therapy. Results. The standard treatment regimens was ascertained to cause no clinical recovery in 6.8% of the patients who were characterized by the baseline excretion of M. tuberculosis and sputum in 100% of cases, by the highest X-ray and clinical manifestations of IPT with simultaneously evolving leukocytosis, increased erythrocyte sedimentation rate (ESR), elevated serum ceruloplasmin and enzyme markers of cholestasis, depressive fatigability, weight loss, and a worsening quality of life because of pain. Discriminant analysis yielded an algorithm for predicting the inefficiency of standard treatment for IPT, which was based on the integrative evaluation of thoracic pain, ESR, circulating ceruloplasmin levels, γ-glutamyl transpeptidase and alkaline phosphatase activities in the serum. Conclusion. It has been demonstrated that the inefficiency of IPT therapy may be predicted from the data of a complex clinical, hematological, and biochemical examination of patients before therapy.

Aim. To evaluate the clinical and morphological variants of kidney abnormalities in HIV-infected patients. Subjects and methods. Thirty HIV-infected patients (60% men and 40% women) aged 26 to 54 years (mean age 31.6±4.7 years) who had undergone diagnostic needle renal biopsy were examined. The indication for the biopsy was nephrotic syndrome (NS) (isolated or concurrent acute nephritic syndrome) and/or decreased renal function. The morphological study of biopsy specimens included light microscopy and immunofluorescence assay. Results. In the examined HIV-infected patients, the histological variants of kidney abnormalities presented with immune complex glomerulonephritis (ICGN) in 26 cases and with focal segmental glomerulosclerosis (FSGS) in 4 cases. The clinical manifestations of ICGN were as follows: NS (61.5%), acute nephritic syndrome (in more than one third of the patients) concurrent with hematuria, as well as mainly grades 2-3 arterial hypertension (AH) (12/14) and renal dysfunction. Immune complex glomerulopathies were marked by polymorphism in the renal morphological pattern with fluorescence during immunofluorescence microscopy in most cases of virtually all classes of immunoglobulins (IgA, IgM, IgG) and complement system fragments (С3, С1q). FSGS was clinically characterized by NS concurrent with AH, hematuria. The morphological subtypes of FSGS were exhibited by apical, perihilar, and nonspecific variants in 1, 1, and 2 cases, respectively. By the time the signs of renal dysfunction appeared, the HIV-infected patients with glomerulopathy were found to have a high viral load (HIV RNA >100 000 copies/ml) and low CD4 lymphocyte levels (≤200 in 1 µl). Conclusion. In our study, the morphological pattern of chronic glomerulonephritis showed a preponderance of immune complex nephropathies with the clinical manifestations of acute nephritic syndrome and/or NS concurrent with hematuria. High viremia and depressed immune system may be risk factors for nephropathy.

Aim. To evaluate the impact of a learning program on quality of life indicators in patients with prosthetic heart valves (PHV).Subjects and methods. One hundred and twenty-two patients with PHV were examined. A study group consisted of 72 patients who were trained at PHV school; a control group comprised 50 untrained patients. The comparison groups were matched for age, gender, education level, the underlying disease that had been a cause of heart disease, and the type of PHV. The SF-36 questionnaire assessing quality of life was used to evaluate the effectiveness of the learning program. Results. At baseline, before cardiac surgery, the patients with PHV showed low physical and mental health indicators in both groups. At 6-month follow-up, the physical health component was increased by 23.8% in the control group and by 27.4% in the study group trained by the learning program (p<0.05). Analysis of the scores of each scale of the questionnaire yielded significant results in both groups after 6 months of cardiac surgery (p<0.05), which showed better quality of life. The comparison groups had significant differences only in the scores of the mental health component. Thus, following 6 months the mental health component was 24.1% higher in the learning program group than in the control one (p<0.05). Conclusion. The learning program for patients with PHV, which is based on the principle of continuity of the in- and outpatient management, contributes to better quality of life mainly due to an improvement in the mental health component.

Aim. To identify and determine the mechanisms of an association between arterial hypertension (AH) and proatherogenic systemic metabolic disturbances in hypertensive disease (HD), as well as the possibility of eliminating these disturbances by antihypertensive therapy. Subjects and methods. Fifty-four patients with HD and 64 persons randomly selected from an unorganized urban population were examined. Systolic and diastolic blood pressure (BP), insulin sensitivity, the most important metabolic parameters of lipids, lipoproteins, and glucose, the degree of systemic inflammation and oxidative stress, and the rate of lipoprotein proatherogenic and immunogenic modification were determined. Results. All the patients with HD were found to have a regular concurrence of AH with systemic inflammation and activated free-radical reactions, metabolic abnormalities, such as atherogenic dyslipidemia, insulin resistance, atherogenic and immunogenic modified lipoproteins. Antihypertensive treatment failed to eliminate metabolic disturbances even when BP control was fully restored. Conclusion. AH and systemic metabolic disturbances in HD have a common pathogenetic basis and the treatment of hypertensive patients should provide the normalization of not only BP, but also inflammatory and oxidative status and systemic metabolism.

The paper gives concise data on the efficacy of entecavir in the treatment of chronic hepatitis B caused by its resistant virus strain and describes a relevant clinical case.

The paper describes a case of diffuse large B-cell lymphoma detected in a patient 13 months after sinus histiocytosis with massive lymphadenopathy (SHML) or Rosai-Dorfman disease (RDD) being diagnosed together with active hepatitis B virus infection. Analysis of their observations of patients with sinus histiocytosis and the data available in the literature allowed the authors to identify a few tens of cases with SHML associated with lymphomas. This case and previously described ones in the literature on the association of RDD and lymphomas may suggest with a high degree of probability that patients diagnosed as having RDD in evident lymphadenopathy and the non-typical clinical course of RDD may develop blood cancer.

The review considers the chemical structure, pharmacodynamics and pharmacokinetics of telaprevir, a new direct-acting antiviral agent, used to treat patients with chronic hepatitis C (CHC). The given data on Phase II and III clinical trials enable the authors to state the high efficacy of the drug in patients infected with hepatitis C virus type 1. The paper also provides data on the resistance of telaprevir and its drug interaction and denotes the place of the drug in the current antiviral treatment of patients with CHC.

Asthenia serves as a symptom of many both organic and mental diseases. 16-64% of patients with this diagnosis visit a polyclinic therapist. Asthenia is an obligate symptom of a number of mental illnesses, including stress-related neurotic disorders, and somatoform disorders (panic attacks, generalized anxiety disorders, somatoform autonomic disorders, adjustment disorders), as well as nonpsychotic petit mal depressions. Patients with these disorders generally see therapists or general practitioners, rather than psychiatrists. The paper reflects the classification, differential diagnosis, and treatment of asthenia. A clinical case is described; its therapy is warranted.

The lecture is dedicated to the idea of a role of psychosomatic disorders in the occurrence and development of asthma, on the diagnosis and treatment of the neuropsychic type of its course, and on possibilities for psychotherapeutic correction.