reflect different magnitude of HBV-specific immune response. Characterization of T cell profiles is relevant to the improved understanding of chronic HBV infection and the design of antiviral therapy. The aim of the present study is to determine the absolute CD4 counts in different phases of CHB infection. METHODS: 106 hepatitis B patients were included in the study. All CHB patients fulfilled the following criteria: positive HBsAg for at least 6 months, no other concomitant causes of liver disease (hepatitis A, E and C, HIV infection and alcohol consumption of more than 60 g/day, autoimmune hepatitis and metabolic liver disease). None of the patients were drug user or exposed to hepatotoxins. Liver function tests, blood urea and creatinine, Haemoglobin%, total leucocyte and lymphocyte counts, platelet count and INR were measured for all patients. CD4 counts were determined by flow cytometry. HIV antibody and HBV markers (HBsAg, HBsAb, HBeAg, HBeAb, HBcAb, and anti-HBcAb IgM) were detected by enzyme-linked immunosorbent assay. Serum HBV DNA load was assessed by quantitative real-time polymerase chain reaction. RESULTS: Absolute CD4 count and CD4% were normal in acute hepatitis B and 'immune tolerant' CHB. But CD4 declines from 'immune reactive' to 'HBeAg-negative' CHB. Average CD4 counts were below 500/lL in these two phases -351.12 + 33.23 and 237.0 + 118.27 respectively. CD4 counts were below 350/lL in 72.72% and below 200/lL in 27.27% in these two phases. Such low levels of CD4 count are not proportionate to the total lymphocyte counts in these two phases. Absolute CD4 count rises to moderate level in 'inactive HBV carrier state' (754.4 + 174.87) and 'treatment-experienced' patients (734.5 + 204.57). Similarly CD4% were low in 'immune reactive' to 'HBeAg-negative' (<25%) in contrast to 'immune tolerant' and 'inactive HBV carrier state' (>35%) CHB. CONCLUSIONS: CD4 count gradually declines with progressive liver damage in 'immune reactive' and 'HBeAg-negative' CHB and it may be implicated in the design of the antiviral therapy. Interferon may be unsuitable for CHB with very low CD4 counts (<250/lL). Sequential therapy comprising oral anti viral followed by Peg-Interferon might be theoretically appropriate approach in this group of patients. On the other hand, those with higher CD4 are appropriate for Peg-Interferon first followed by oral anti viral.

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Objectives: The objective of this research is to provide an overview of the regulatory process of drug delivery in social networks and the impact on healthcare in Russia. This analysis was carried out to evaluate the availability and reliability of innovation methods (drug delivery by social networks) in Russian healthcare. MethOds: Studies were retrieved from relevant regulatory authorities' databases (Roszdravnadzor, AIS Roszdavnadzor and Ministry of Health of the Russian Federation web portals), using relevant search strategies. Included studies were primarily conducted in various healthcare settings in Russia. The search methodology employed was in line with AIS guidelines. The search language was limited to Russian. Results: In total, 50 records were included in the qualitative synthesis of this review. The governance, process and implementation of drug market access have been analyzed in detail. The successful implementation of drugs delivery was primarily used in cities. Further use included identification of knowledge dissemination of drugs delivery by networks in villages and small cities. Challenges are related to the interim nature of legislation. In addition there is a lack of transparency and electronic databases. Detailed analyses of the findings from studies are still ongoing. cOnclusiOns: Preliminary analysis shows that limited evidence exists on the impact of innovatiom methods on healthcare in Russia. In Russia drugs delivery by social network access is straightforward if there is proof of authorization to sell a product and licenses. It also highlights the disparity in the awareness among people regarding the utility of drug delivery by social networks. For a country with divergent health systems and a huge rural population, the use drug delivery by social networks may be very impactful in improving healthcare. However, this system has disadvantages in terms of safeguarding patient safety. Lack of transparency, incomplete regulations are challenges faced by Russia.

Neurosurgical treatment for psychiatric disorders features a long and controversial history. This article explores a ‘spectrum of psychosurgery,’ describing how old-fashioned and controversial prefrontal lobotomy gradually evolved into modern day, mainstream scientific deep brain stimulation (DBS). We focus on the rise, fall and possible re-emergence of psychosurgery as a therapeutic intervention today.We journey through historic indiscriminate use of prefrontal lobotomy, which evoked stern criticism from both public and professionals, through to the development of modern day DBS - performed for patients suffering from severe, treatment resistant symptoms of obsessive-compulsive disorder (OCD), epilepsy and movement disorders.We hope this article will provide a basis for understanding the availability of existing treatment options and potential future opportunities, whilst simultaneously challenging any public/professional preconceptions of psychosurgery, which may indirectly be obstructing patient care.Additionally, we carried out a qualitative survey displayed in WordCloud Format, capturing the intellection of 38 mental health professionals working for North West Boroughs NHS Healthcare Foundation Trust, on ‘psychosurgery,’ ‘prefrontal lobotomy’ and ‘DBS’, which may well reflect wider public opinion.In summary, the article provides a brief, yet comprehensive overview of the controversial history of psychosurgery, present-day practice, and future trends of neurosurgery for psychiatric disorders.