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.

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.

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.

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.