Biomedical subjects
T M Ignatova
Publications and source records attributed to T M Ignatova.
[Efficacy of lamivudine in HBeAg-negative chronic hepatitis B].
The necessity of the search for new drugs to treat chronic hepatitis B (CHB) is explained by the necessity to prevent hepatic cirrhosis (HC) and hepatocellular carcinoma. Treatment of HBeAg-negative CHB rests on the same principles as of HBeAg-positive one. Efficacy of nucleoside analogue lamivudin is well studied in HBeAg-positive CHB. The aim of this study was to evaluate lamivudine efficacy in therapy of HBeAg-negative CHB. Lamivudine (epivir--150 mg/day or zeffix--100 mg/day) was given for 1 year to 10 patients (5 males, 5 females, mean age 49.5 +/- 13.5). Their blood serum contained no HBeAg but contained HBeAb and HBVDNA. Chronic hepatitis was verified morphologically in 9 patients of whom 2 had HC and 2 developing HC. Moderate activity of the disease was in 4 patients, low--in 5. All the patients had a high ALT level (150 +/- 140 U/l, 60-528 U/l, high normal value 40 U/l). ALT and HBV DNA in the serum were examined by polymerase chain reaction in the course of treatment and for 6 months after its end. To the end of the treatment a complete response (absence of HBVDNA and normalization of ALT) was achieved in 8 (80%) patients. 5 (63%) of them 2-4 months after the end of the treatment had the exacerbation with appearance of HBVDNA in the serum and elevation of ALT level. A persistent response (6 months after lamivudin treatment) was in 3 (30%) patients, in 2 of them HBsAg was not detected. Lamivudin therapy is effective in HBeAg-negative CHB. In this study a high baseline level of ALT was the factor predisposing to a lasting response to treatment.
[Nephrolithiasis as an initial clinical manifestation of Wilson-Konovalov disease].
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[Chronic liver diseases in pregnancy].
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[Risk factors of progression in cryoglobulinemic glomerulonephritis associated with hepatitis C virus].
The article reviews literature and original data on renal affections associated with mixed cryoglobulinemia (MCG), discuss etiology, clinical and morphological features of renal damage, variants of the clinical course and prognosis. Among 50 patients with mixed MCG selected by the presence of cryoglobulinemia (> 100 mg/dl) and in 75% with markers of hepatitis c virus infection, renal lesion was found in 14(28%). 7 of them had moderate urinary syndrome, 4 had nephrotic syndrome and 3--acute nephritic syndrome with subsequent rapid progression. 5 patients had cryoglobulinemic mesangiocapillary glomerulonephritis. A clinical case is reported illustrating complications and difficulties of treatment of cryoglobulinemic glomerulonephritis.
[Mesangiocapillary glomerulonephritis].
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[Primary biliary cirrhosis and CREST syndrome: a rare classical combination (literature review and case report)].
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[Cryoglobulinemic nephritis associated with chronic HCV infection].
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[Myocarditis, polymyositis and Raynaud's syndrome in female patient with chronic hepatitis C].
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[Extrahepatic manifestations of chronic hepatitis C].
AIM: To study incidence, special features and mechanisms underlying onset of extrahepatic lesions in HCV-infection. MATERIALS AND METHODS: Extrahepatic symptoms of chronic hepatitis C and its outcome--hepatic cirrhosis were studied in 157 patients. HCV-infection was confirmed by ELISA II and polymerase chain reaction (detection in the serum of anti-HCV and HCVRNA, respectively). Morphological studies of the liver were made in 134 patients, of other organs and tissues--in 20 patients. Immunological tests were made in 124 patients. Thyroid hormones, antibodies to thyroglobuline were measured with radioimmunoassay in 74 patients. RESULTS: Extrahepatic manifestations were found in 70(44.6%) patients with chronic hepatitis C (more frequently in hepatic cirrhosis), for the most part in women and in long-lasting disease. 54(43.5%) women had cryoglobulinemia, 27 of them showed it clinically. Patients with cryoglobulinemia and free of it exhibited varying frequency cutaneous vasculitis, Raynaud's syndrome, affection of the muscles and joints, nodular periartheritis, lesions of the lungs, myocarditis, autoimmune thyroiditis, Sjogren's syndrome, lichen ruber planus, porphyria cutanea tarda, immune cytopenia, autoimmune hemolytic anemia, hypoplastic anemia, monoclonal immunoglobulinopathy, B-cell lymphoma. Of high frequency were activity of rheumatic factor (66.9%), hypocomplementemia (31.8%), antinuclear antibodies (9.8%) and other immunological disorders. CONCLUSION: Some extrahepatic lesions in HCV-infection are detailed: frequent mixed cryoglobulinemia and associated vasculitides of different sites, malignant lymphoproliferative diseases, more frequent than in HBV-infection involvement of the thyroid and salivary glands, some skin lesions.
[Visceral manifestations of Wilson-Konovalov disease (analysis of 22 cases)].
Twenty-two patients with Wilson-Konovalov disease (WKD) had not only hepatic but also visceral symptoms: renal affection, cutaneous vasculitis, arthralgias, endocrine disorders, etc. In 8 of these 22 patients extrahepatic symptoms appeared 10 years before hepatic signs. The latter were distinguished by the frequency of edematic-ascitic syndrome, hemolytic episodes, hemorrhagic syndrome; low activity of serum aminotransferase. Initial neurological symptoms were registered in 6 patients only. 12 patients benefited from copper-eliminating therapy. 4 patients had advanced process which caused death. To detect WKD early, special diagnostic tests should be conducted in all subjects under 45 with hepatic symptoms or WKD-specific visceral manifestations. Examination of the patients' sibs is also desirable.
[Chronic viral diseases of the liver and pregnancy].
Sixty patients with chronic active hepatitis and liver cirrhosis of viral etiology had in the course of the disease a total of 130 pregnancies, that eventuated in labor in 62 (48%), in spontaneous abortions in 13 (10%), and in artificial abortions in 55 (42%) cases. The incidence of preterm labor was 18%, of late gestosis 46%; early detachment of a normally positioned placenta occurred in 2 women, and 3 women suffered an abnormal blood loss. Cesarean sections were carried out in 9% of cases. Perinatal mortality has made up 64.5%. Two babies died within the first months of life of congenital cerebral paralysis. The pregnancy and its outcome did not result in 78% of cases in deterioration of the patients' health status and did not influence the disease development. The authors discuss the policy of management of patients with chronic active hepatitis and liver cirrhosis of a viral origin in pregnancy and labor.
[Detection of hepatitis B virus DNA using local nucleic acid amplification (polymerase chain reaction) in fixed tissues in chronic viral liver diseases].
PCR is a highly sensitive, convenient and rapid method for detection of viral DNA in fixed tissue samples which allows one to analyse the material from the pathology files, mainly biopsies. PCR in a fixed material requires larger amounts of DNA-polymerase and longer duration of every stage of thermo-cycles compared to PCR in the purified DNA samples.
[Chronic active hepatitis and pregnancy].
In the course of chronic active hepatitis (CAH) 61 patients (CAH of virus etiology in 75% and of obscure etiology in 25%) had 211 pregnancies which terminated in delivery in 80 (38%) cases, spontaneous abortions in 12 (6%) cases, and medical abortions in 119 (56%) cases. In most cases there was successful termination of pregnancies without deterioration resulting from liver disease including patients treated adequately with immunosuppressive drugs. CAH exacerbations associated with pregnancies and their outcomes were noted in 23 (38%) cases. They were more frequent and more severe in patients with liver cirrhosis (LC) unrecognized by the time of pregnancy. There were no mothers' deaths. CAH made a negative effect on the course and outcomes of pregnancies: the frequency of premature delivery was 9%, that of cesarean-5%, perinatal mortality-75%. Of 74 infants born alive 2 died within the first months after birth as a result of congenital liver cirrhosis, a double kidney was detected in one infant, the rest of the infants were healthy. Problems of therapeutic tactics in CAH patients after onset of pregnancy are discussed.
[Extrahepatic manifestations of chronic viral liver diseases].
The study of large groups of patients with chronic liver diseases of viral etiology (including those induced by HBV and HCV) has revealed extrahepatic manifestations which by their mechanisms formed 2 groups. The first group represents disorders related to delayed hypersensitivity in combination with immunocomplex reactions (lesions of the joints, skeletal muscles, lungs, myocardium, etc). The second group includes disorders of primarily immunocomplex genesis (vasculitis): skin vasculitis, Raynaud's syndrome, nodular periiarteritis, mixed cryoglobulinemia, etc.). Special group represents diseases of blood: immune cytopenias, monoclonal immunoglobulinopathy, malignant lymphoproliferative diseases. These findings and literature data on extrahepatic replication of HBV and HCV validate the diagnosis of "chronic generalized HBV or HCV infection" with listing of all manifestations of these infections.
[Pathogenesis of chronic hepatitis C].
Recent investigations revealed a specific interaction of virus with the host immune system. HCV is able to escape and modify the host's immune response, notably the rate of production and specificity of rheumatoid factor--the basis for mixed cryoglobulins and various non-organospecific and some organ-specific autoantibodies. Further studies are required to decode the mechanisms of virus-host immune system interaction for substantiating the treatment and prevention of HCV infection.
[Viral hepatitis C].
This review is indicative of a considerable progress in the study of viral hepatitis C: HCV biology (its structural and antigenic analysis, genotype heterogenicity and genome mutation, mechanisms of replication), serological diagnosis, epidemiology, pathogenesis and clinico-morphological characteristics of liver involvement, systemic manifestations as well as carcinogenesis in HCV contamination. There exist data in favour of HCV role in a wide spectrum of pathology in parallel to what was earlier established in relation to HCV.
[The incidence of detecting HB viral infection in the families of patients with kidney diseases].
A total of 33 families were surveyed with a view to determine the presence of viral hepatitis B markers in persons with diagnosed renal diseases. In all patients markers of hepatitis B virus infection (HBsAg, anti-HBs antibodies, anti-HBc total and IgM antibodies) were determined in the enzyme immunoassay. Those families in which examinees with renal pathology were found to have markers of hepatitis B virus infection exhibited a high level of contamination with hepatitis B virus. A high proportion of examinees with viral hepatitis B was established in the families where mothers were found to have markers of hepatitis B virus infection. These facts indicate that everyday contacts play an important role in the transmission of the virus. The study points out that in the family foci of hepatitis B virus infection non-manifest or slightly manifest forms of this infection are mainly registered.