Tuberculosis, Lung Diseases, HIV Infection最新文献

{"title":"Modern Directions of Optimization of Empirical Antimicrobial Therapy of Community-Acquired Pneumonia (Review)","authors":"M. Khaitovych, D. Turchak, V. Ulishchenko, V.Yu. Rafalskyi","doi":"10.30978/tb2024-1-95","DOIUrl":"https://doi.org/10.30978/tb2024-1-95","url":null,"abstract":"Severe community-acquired pneumonia (CAP) remains a life-threatening disease, causing 78 % of infection-related deaths and is the most common cause of sepsis. Empirical antibiotic therapy is started before the results of bacteriological diagnosis are available. The diversity of pathogens often makes it difficult to choose a drug for etiotropic empirical therapy. Isolates of bacteria responsible for CAP sometimes show high resistance to several antibiotics, including cephalosporins and carbapenems. We analyzed scientific publications from the PubMed database for the last 5 years on the problem of empirical antimicrobial therapy of CAP. Currently, empirical therapy for pneumonia is determined by the site of infection (hospital or other settings), but may be conditioned by the presence of risk factors for multidrug-resistant pathogens, regardless of the site of infection. A rational approach to making decisions about prescribing broad-spectrum antibiotics is to use risk prediction models at the patient level. Recommendations for empirical therapy of CAP have been developed, taking into account individual risk factors for multidrug-resistant infection, and their use, according to the results of 30-day mortality, has proven to be more effective than the use of classification by site of pneumonia.Among the current directions of empirical antimicrobial therapy of CAP are use of drugs with a narrow spectrum of action based on the use of an algorithm for determining the risk of multidrug-resistant infection, as well as a procalcitonin test; use of an algorithm for choosing an alternative antimicrobial agent in case of a history of penicillin allergy; reduction of the total duration of antimicrobial therapy; widespread introduction of antimicrobial stewardship programs in the activities of not only hospitals but also primary care facilities.","PeriodicalId":292478,"journal":{"name":"Tuberculosis, Lung Diseases, HIV Infection","volume":"44 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140408611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Level of Serum Interleukin-10 Depending on the Demographic and General Clinical and Laboratory Characteristics of the Coronavirus Disease-19 in Hospitalized Patients","authors":"O. Bilokon, K. Lytvyn","doi":"10.30978/tb2024-1-21","DOIUrl":"https://doi.org/10.30978/tb2024-1-21","url":null,"abstract":"Objective — to determine the content of interleukin-10 in hospitalised patients with COVID-19 and its relationship with demographic and clinical and laboratory parameters in the acute phase of the disease.\u0000Materials and methods. 77 patients with coronavirus disease-19 aged from 29 to 87 years (average age — (59.3 ± 12.4) years) were studied, among whom there were men — 43 (55.8 %), women — 34 (44.2 % ). The examination was carried out the next day after hospitalization. On average, the period from the onset of the disease was (9.2 ± 3.5) days. It was established that the average level of IL-10 among patients with COVID-19 was 2.5 times higher than the similar indicator in relatively healthy individuals: Me — 10.7 (6.2; 50.5) pg/l against 4.3 (3 .8; 4.7) (p < 0.001). Statistical processing of the research results was carried out using the Statistica v. 6.1 application program package.\u0000Results and discussion. It was established that gender and age did not affect the level of IL-10 in the blood serum of hospitalized patients with COVID-19. A significant increase in the content of the specified cytokine was determined in patients with a severe course (rs = 0.242, p = 0.035) and a fatal outcome of the disease (rs = 0.270, p = 0.018), which indicates the pro-inflammatory activity of the specified cytokine. The IL-10 indicator increases in the presence of concomitant diseases in the anam­nesis (rs = 0.271, p = 0.018), among which the most significant is carditis (rs = 0.226, p = 0.049), and certain conditions, in particular coagulopathy, accompanied by an increase in fibrinogen (rs = 0.249, p = 0.030). There is a tendency to increase the level of IL-10 in diabetes (rs = 0.154, p = 0.183), hyper-AlAT-emia (rs = 0.193, p = 0.094). Among the clinical characteristics, there is a tendency to increase the level of IL-10 in patients with the presence of such respiratory symptoms as cough (rs = 0.169, p = 0.145), shortness of breath (rs = 0.195, p = 0.091), increased frequency of respiratory movements (rs = 0.189, p = 0.102), as well as a decrease in saturation (rs = – 0.268, p = 0.019), which indicate the development of respiratory failure and reflect the severity of the disease. A direct correlation with the quantitative indicator of blood pressure was determined (rs = 0.245, p = 0.033), especially in people who had no history of hypertension. A direct relationship between the levels of IL-10 and fibrinogen (rs = 0.268, p = 0.019) was revealed, which may have a marker value for early determination of the risk of developing thrombotic complica­tions. An inverse relationship was found with blood saturation indicators (rs = – 0.268, p = 0.019).\u0000Conclusions. In patients, the level of IL-10 at the beginning of coronavirus disease-19 increases in accordance with the increase in the level of IL-6, which indicates its possible pro-inflammatory effect in the pathogenesis of the acute phase of the disease. The increase in the level of IL-10, which is observed in patien","PeriodicalId":292478,"journal":{"name":"Tuberculosis, Lung Diseases, HIV Infection","volume":"19 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140411660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of CD4+ T-Lymphocytes on the Strength of Anti-Diphtheria Immunity in Adult People Living with HIV","authors":"H. Revenko","doi":"10.30978/tb2024-1-35","DOIUrl":"https://doi.org/10.30978/tb2024-1-35","url":null,"abstract":"Vaccination is an important tool for preventing infectious diseases. People living with HIV (PLHIV) are a vulnerable group because they are at greater risk of contracting or developing complications from vaccine-preventable infectious diseases. Diphtheria is the most striking example of such an infectious pathology.\u0000Objective — to determine the level of seroprotection against diphtheria and assess the impact of CD4+ T-lymphocyte levels on the intensity of anti¬diphtheria immunity in PLHIV.\u0000Materials and methods. 90 PLHIV were involved in the study, the average age was (40.1 ± 0.9) years. Anti-diphtheria antibody levels were determined by enzyme-linked immunoenzyme assay using the RIDASCREEN Diphtheria IgG diagnostic test system (R-Biopharm AG, Germany). The quantitative content of CD4+ T-lymphocytes was determined using the flow cytometry method using monoclonal antibodies. Statistical processing was performed using the Statistica v. 6.1 license program.\u0000Results and discussion. The study revealed that the median level of anti-diphtheria antibodies in PLHIV was 0.17 IU/ml (0.09—0.38 IU/ml). The proportion of PLHIV without protection against diphtheria was 93.3 % (n = 84). A significant positive correlation was observed between the nadir of CD4+ T-lymphocytes and the strength of anti-diphtheria immunity (rs = 0.49, p < 0.001). ROC analysis indicated that a nadir level of CD4+ T-lymphocytes below 126 cells/µl predicts a high risk of lacking immunity against diphtheria, with a test sensitivity of 81.5 %, specificity of 100 %, and diagnostic efficiency of 82.6 %.\u0000Conclusions. The serological anti-diphtheria status of PLHIV is considered critically low. Assessment of the nadir level of CD4+ T-lymphocytes proved to be informative for determining the risk of immunological vulnerability of PLHIV against diphtheria. Since the increase in the level of CD4+ T-lymphocytes against the background of antiretroviral therapy does not lead to «restoration» of specific immunity, such PLHIV will need a booster administration of diphtheria toxoid.","PeriodicalId":292478,"journal":{"name":"Tuberculosis, Lung Diseases, HIV Infection","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140414364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Study of the Effect of Specific Antibacterial Therapy on the Course of Tuberculous Spondylitis in an Experiment","authors":"H.H. Holka, V. Vesnin, V. Burlaka, A.O. Oliynyk, O.H. Fadeev, O.V. Hoptsii, E.Yu. Frolova–­Romaniuk","doi":"10.30978/tb2024-1-58","DOIUrl":"https://doi.org/10.30978/tb2024-1-58","url":null,"abstract":"Objective — to assess the impact of modern antibacterial therapy on the development of a specific destructive process in experimental tuberculous spondylitis in animals.\u0000Materials and methods. The experiments were conducted on 40 sexually mature guinea pigs (age over 6 months) with an average weight of 350—500 grams. Tuberculous spondylitis was induced using a proprietary method (Patent No. 112423 (UA) Ukraine).All experimental animals were divided into 4 equal groups. Groups 1—3 (main groups) received an injection of 0.5 ml of M. tuberculosis suspension (0.1 mg of dry weight in 1 ml) into the body of the vertebra, according to the specified method. Group 4 served as the control, receiving an injection of sterile physiological solution (0.9 % NaCl, 0.5 ml) into the vertebra.Specific first-line antibacterial drugs (ABDs) consisting of isoniazid, streptomycin, and rifampicin were administered to Group 1, which consisted of 10 guinea pigs. Group 2, also comprising 10 guinea pigs, received specific second-line ABDs, including amikacin, rifabutin and ofloxacin. Groups 3 and 4, each consisting of 10 guinea pigs, received no treatment.\u0000Results and discussion. The morphological analysis revealed the presence of an active tuberculosis process in the vertebral bodies and paravertebral tissues of animals subjected to tuberculosis simulation, regardless of whether they received specific first-line ABD treatment or not. Notably, the severity of destructive changes in affected vertebrae was similar between untreated animals and those treated with first-line ABDs.Animals modeled for tuberculosis and treated with specific second-line ABDs exhibited a suppression of the pathological process. This was evidenced by the formation of immature bone and connective tissue to varying degrees, along with the presence of a delineating zone separating the inflammatory focus from healthy tissue in the early stages of the disease (one month).Conclusions. Based on the histological examination of the vertebral bodies, it was established that the animals treated with specific first-line ABD showed clear morphological features of tuberculous inflammation. In animals treated with specific second-line ABD, inhibition of the pathological process.This study showed that the implementation of modern intensive specific antibacterial therapy in experimental conditions allows to achieve the delimitation of the destructive process in the relatively early stages of the disease development (4—5 weeks).The obtained new knowledge about the pathomorphological features of the course of TS against the background of carrying out specific antibacterial therapy allows radical surgical interventions on the musculoskeletal system without the risk of generalization of the tuberculosis process at an earlier time (compared with the generally accepted ones).","PeriodicalId":292478,"journal":{"name":"Tuberculosis, Lung Diseases, HIV Infection","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140414895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human-Beta-Defensin-1, Ferritin, Interleukin-6 and their Relationship with Clinical and Laboratory Parameters of the Severity of the Tuberculosis Process","authors":"O. S. Shevchenko, L. Todoriko, R. Shevchenko, S. Matvyeyeva, Е. Tudor, I. A. Ovcharenko, O. Shvets, O. Pohorielova","doi":"10.30978/tb2024-1-15","DOIUrl":"https://doi.org/10.30978/tb2024-1-15","url":null,"abstract":"Establishing relationships between clinical and laboratory parameters, such as general patient’s state, parameters of complete blood count and blood biochemistry and markers of the course of tuberculosis in the future can be used to predict the severity of dysfunction of various organs and tissues in patients with tuberculosis and in particular in patients who receive anti-tuberculosis treatment.\u0000Objective — to investigate the relationship between biochemical markers, namely Human-beta-defensin-1, ferritin and interleukin-6, and clinical and laboratory indicators of the severity of the tuberculosis process.\u0000Materials and methods. 100 patients diagnosed with pulmonary tuberculosis were included in the study. After receiving 60 doses of anti-tuberculosis treatment, the patients were retrospectively divided into 2 groups. Group 1 (n = 77) consisted of patients in whom sputum conversion was observed after 60 doses of treatment, determined by sputum microscopy. Group 2 (n = 23) comprised patients in whom bacterial secretion was maintained after 60 doses of treatment, as detected by microscopy. In addition to the routine studies provided for the monitoring of patients with tuberculosis by the current orders of the Ministry of Health of Ukraine, the levels of Human-beta-defensin-1, ferritin and interleukin-6 (IL-6) in the fasting blood were additionally measured by ELISA at the beginning of treatment and after 60 days. Statistical data processing was carried out using the Statistica 8.0 software environment.\u0000Results. A comparison of the investigated parameters between groups at the beginning of treatment showed significantly higher values of Human-beta-defensin-1 (Group 1 — (18.97 ± 2.42) pg/ml, Group 2 — (55.02 ± ± 15.69) pg/ml), ferritin (Group 1 — (94.86 ± 6.02) ng/ml, Group 2 — (141.61 ± 24.66) ng/ml) and IL-6 (Group 1 — (80.33 ± 5.03) pg/ml, Group 2 — (110.13 ± 10.35) pg/ml) in patients with positive sputum micros­copy after 60 doses of treatment, p < 0.05. All studied markers demonstrated a reliable positive relationship with the massiveness of bacterial excretion, a conditional indicator of the severity of clinical symptoms and signs, ESR and urea level, as well as reliable negative correlations with creatinine level. In addition, patients with a lower body mass index were found to have higher levels of Human-beta-defensin-1 and ferritin. Higher levels of Human-beta-defensin-1 and ferritin are associated with lower hemoglobin levels (Human-beta-defensin-1 was also negatively correlated with erythrocyte count). An increase in the leukocytes level is accompanied by a significant increase in the level of Human-beta-defensin-1 and IL-6. Additionally, a significant negative correlation was found between the level of glucose and ferritin, as well as between the level of bilirubin and ferritin and IL-6.\u0000Conclusions. The determined significantly higher levels of Human-beta-defensin-1, ferritin and interleukin-6 in patients in whom sputum microscopy was p","PeriodicalId":292478,"journal":{"name":"Tuberculosis, Lung Diseases, HIV Infection","volume":"1982 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140416785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modern Features of the Epidemiological Situation of Tuberculosis in Ukraine (Review)","authors":"Yu.M. Valetskyi, V.O. Nychyporuk, R.O. Valetska","doi":"10.30978/tb2024-1-103","DOIUrl":"https://doi.org/10.30978/tb2024-1-103","url":null,"abstract":"Objective — to study the epidemiological situation of tuberculosis in Ukraine from 2018 to 2022. \u0000Materials and methods. This research utilised a comprehensive source base including official statistical data from the State Statistics Service and the Ministry of Health of Ukraine, scholarly articles from both international and domestic researchers, materials from periodicals and international conferences and internet resources. Additionally, the insights and analyses were enriched by involving six experts and organisers from the phthisiatric service. These experts were instrumental in interpreting statistical data and identifying causal relationships within the dynamics of the epidemiological indicators.\u0000Results and discussion. From 2018 to 2022, the incidence of tuberculosis (TB), including its recur­rences, in Ukraine decreased by 27.3 %. During this timeframe, TB incidence among children aged 0—14 years fell by 16.9 %, and among adolescents aged 15—17 years, it dropped significantly by 45.8 %. Despite these overall reductions, a notable increase in TB incidence was observed across the Ukrainian population by approximately 3.5 % and specifically among children aged 0—14 years by 25.4 % in 2021, compared to 2020. The Odesa Oblast reported the highest morbidity rate across all Ukrainian regions over this five-year period, although it experienced a 36.0 % reduction from 2018 to 2022. Importantly, the prevalence of all forms of active TB across the Ukrainian population decreased by 40.7 % from 2018 to 2022. This decline was also reflected among children aged 0—14 and 15—17 years, with decreases of 34.1 and 49.7 %, respectively. Statistically, the highest morbidity rate among healthcare institution employees in Ukraine was observed in 2018, reaching 6.0 per 10,000 employees. \u0000Conclusions. Since 2020, a concerning trend has emerged in Ukraine with an increase in the incidence of tuberculosis by almost 3.5 %, and a sharp rise of 25.4 % among children aged 0—14 years in 2021, reversing the previously declining trend. This uptick is likely influenced by the COVID-19 pandemic. Despite this, there was a notable decrease in the prevalence of all forms of active TB across Ukraine's entire population by 40.7 % from 2018 to 2022. The highest morbidity rate among healthcare workers was observed in 2018, at 6.0 per 10,000 workers. A significant concern remains TB's impact on the working-age population, leading to permanent disability. However, the rate of primary disability due to TB among the adult and working-age population showed a decrease in 2022 by 11.4 and 3.9 %, respectively. The underdiagnosis of TB, potentially exacerbated by the COVID-19 pandemic and the ongoing conflict, poses a significant challenge to controlling the disease.","PeriodicalId":292478,"journal":{"name":"Tuberculosis, Lung Diseases, HIV Infection","volume":"6 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140408474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Potential of Repeated Application of β-Glucans in Patients with Chronic Obstructive Pulmonary Disease and the Comparative Effectiveness of Subsequent Treatment Courses","authors":"I. Hospodarskyy, L. Hryshchuk, T.V. Boyko","doi":"10.30978/tb2024-1-28","DOIUrl":"https://doi.org/10.30978/tb2024-1-28","url":null,"abstract":"Objective — to assess the effectiveness and safety of repeated courses of the β-glucans in patients with chronic obstructive pulmonary disease (COPD).\u0000Materials and methods. A total of 58 COPD patients with 2 to 4 clinical exacerbations in the previous year were examined and randomized into two groups. The severity of the course, the frequency of exacerbations, the stratification of symptoms and the measurement of external breathing parameters were carried out following the GOLD (Global Initiative for Chronic Obstructive Lung Disease) recommen­dations. Also, all patients recorded the need for antibiotics during the calendar year. Indicators of cellular immunity were determined by differentiation clusters on venous blood cells using a Beckman-Coulter flow cytometry.Patients of the 1st group (22 patients) received tiotropium and standard treatment for exacerbations, according to the COPD treatment protocol. At the beginning of the observation, 20 people in the 2nd group also received Imunsil D3 (Nutrimed, Ukraine) 1 capsule 2 times a day for 1 month. 16 patients from the 2nd group were reapplied beta-glucans for 1 month after a 1 year gap. These patients entered the 3rd group.\u0000Results and discussion. In contrast, the appointment of β-glucan ensured an increase in the number of cells with natural killer activity (p < 0.05) and cells of the monocyte-macrophage series (CD14+, p < 0.05), and also contributed to the restoration of the immunoregulatory index (p < 0.05). In the case of repeated use of the drug β-glucan for 1 month, the increase in the number of cells with the activity of natural killers (p < 0.05) and cells of the monocyte-macrophage series (CD14+, p < 0.05), as well as the CD4+/CD8+ index was more pronounced than even in patients of the 2nd group (p < 0.05).According to the CAT (COPD Assessment Test) questionnaire, in the 1st (control) group, there was also a tendency to aggravation — worsening of the severity indicator in 5 patients. At the same time, in patients treated with β-glucans, the CAT index worsened in only 1 patient. In the case of repeated use of β-glucans after 1-year gap (group 3), the CAT index did not deteriorate in any of the patients.The most important result of using immunostimulating therapy was a decrease in the frequency of exacerbations from 2.6 ± 0.5 during the previous year to 1.8 ± 0.4 after a one-month course of treatment with the drug β-glucan (p > 0.05). Repeated use of beta-glucan significantly reduced the number of exacerbations — up to 1.2 ± 0.2 times during the year (p < 0.05).The need to use antibiotics in patients treated with β-glucan decreased from 2.3 ± 0.3 to 1.1 ± 0.2 (p < 0.05) courses of antibiotic therapy per year. With repeated use of β-glucan after 1-year gap, the need for antibiotics decreased to 0.8 ± 0.2 courses per year.\u0000Conclusions. The appointment of β-glucan ensured an increase in the number of cells with the activity of natural killers and cells of the monocyte-macrophage pool. Also, ","PeriodicalId":292478,"journal":{"name":"Tuberculosis, Lung Diseases, HIV Infection","volume":"76 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140411381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 and Myasthenia Gravis Exacerbation in an Elderly Patient: a Case Report","authors":"I. Kaidashev, A. V. Lavrenko, Y. Avramenko, L.P. Ozarchuk","doi":"10.30978/tb-2023-4-65","DOIUrl":"https://doi.org/10.30978/tb-2023-4-65","url":null,"abstract":"Treatment of COVID-19 in elderly patients with myasthenia gravis (MG), an autoimmune disease characterized by increased dynamic muscle weakness, is associated with a number of challenges, such as chronic immunosuppression, exacerbation of MG, and polymorbidity.We present the case of an elderly patient with generalized seropositive MG who contracted COVID-19. Aggravating factors are the patient’s age, the duration of myasthenia gravis, COVID-19, and comorbidity (chronic coronary heart disease, diffuse cardiosclerosis, atrial fibrillation, NYHA class I heart failure, hyper­tension). The patient had a favorable outcome despite the exacerbation. The patient required intravenous injections of immunoglobulin (1 mg/kg) for 2 days, non-invasive ventilatory support, and treatment of respira­tory and urogenital nosocomial infections (Pseudomonas aeruginosa and Klebsiella oxytoca).COVID-19 led to exacerbation of MG, progression of muscle weakness, development of respiratory failure, and hypoxia in an elderly patient. Intravenous immunoglobulin is a possible effective medication in the treatment of this comorbid pathology.During the COVID-19 pandemic patients with MG may be at greater risk of worse outcomes than healthy individuals due to an immunodeficient state associated with immunotherapy and possible respiratory and bulbar muscle weakness. The examination of patients with MG and a COVID-19 may reveal new pathogenetic patterns and change the therapeutic strategy.Knowledge of the essence of the disease, the main links of its pathogenesis, the spectrum of modern therapeutic agents, and algorithms for their use allow us to improve the quality of medical care for patients with MG. The implementation of a comprehensive multidisciplinary approach in the treatment of these patients allows us to significantly reduce the mortality rate, prolong the life of patients, and improve its quality.","PeriodicalId":292478,"journal":{"name":"Tuberculosis, Lung Diseases, HIV Infection","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139202577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Video-Thoracic Surgical Treatment of TB-Empyema for Pleuro-Pulmonary Tuberculosis","authors":"Y. Koshak","doi":"10.30978/tb2023-4-24","DOIUrl":"https://doi.org/10.30978/tb2023-4-24","url":null,"abstract":"According to WHO, the emergence of purulent diseases with superinfection is observed due to the formation of resistance of microorganisms, mixed specific and nonspecific flora to the main anti-tuberculosis drugs. The rational choice of diagnosis and surgical intervention significantly reduces the formation of suppuration resistance for pleura-pulmonary tuberculosis. Objective — to improve the surgical treatment of pleural tuberculosis empyema due to minimally invasive diagnostics and video-assisted thoracic resections. Materials and methods. A retrospective analysis was conducted on our own studies involving 685 cases of patients with stage I—III pleuro-pulmonary complications of tuberculosis empyema. This included a review of minimally invasive video-surgical diagnostics and operations conducted over the past decade. The treated patients were divided into two groups: Group 1, consisting of 351 patients (51.25 %), underwent operations using minimally invasive technologies (video-thoracoscopy (VTS), video-assisted surgical resection (VATS)); Group 2, comprising 334 patients (48.75 %), underwent open wide thoracotomy. In Group 1, 301 patients had acute pleural TB-empyema and 50 had chronic cases. Among the patients in Group 2, acute pleural TB empyema was observed in 284 cases and chronic TB empyema in 50 cases. Results and discussion. According to our data, only VTS is a highly informative method for detecting tuberculosis, pleural TB-empyema in the 1st, 2nd and 3rd stages of its development. Minimally invasive technologies have advantages over open thoracotomies and significantly reduce intraoperative bleeding, the number of posto­perative complications and mortality from surgical treatment. The analysis of our own researches proves that video­thoracoscopic interventions (VTS, VATS) in tuberculous suppurations have some disadvantages, namely: the inability to palpably assess the condition of altered structures within the pleural cavity, the technical complexity involved in performing marginal resection of a bronchial fistula. All this requires further development of high-tech surgical techniques in our country. In a comparative analysis of the frequen­cy and nature of complications during surgery, we found that, overall, in the main group, they occurred 2.1 times less frequently than in the comparison group (p < 0.05). Conclusions. To improve surgical treatment of pleural tuberculosis empyema through minimally invasive diagnostics and video-assisted thoracic resections (VATS). The greatest diagnostic difficulties were encountered in patients with localization of pleural TB empyema in the area of active tuberculous and metatuberculous changes. In 48.7 % of patients, the pleural TB empyema is diagnosed at a late stage of the purulent process.","PeriodicalId":292478,"journal":{"name":"Tuberculosis, Lung Diseases, HIV Infection","volume":"249 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139203202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of The Diagnosis Peculiarities of Familial Tuberculosis","authors":"I. Duzhyi, N.M. Kyrychenko, V. Hlynenko","doi":"10.30978/tb-2023-4-49","DOIUrl":"https://doi.org/10.30978/tb-2023-4-49","url":null,"abstract":"Objective — to compare the diagnostic features of individuals with family tuberculosis within the context of reorganizing the tuberculosis control service. Materials and methods. The study involved the analysis of diagnostic results and management of 406 patients within a cluster of family tuberculosis. Among them, 207 patients were identified as the source of tuberculosis (comparison group), and 199 were contacts who contracted the disease from individuals in the comparison group. Patients in the comparison group were examined by family doctors, while contacts were evaluated by phthisiologists. Results and discussion. Patients in the comparison group served as carriers of pulmonary tuberculosis in 201 (97.1 %) cases and extrapulmonary tuberculosis in 6 (2.9 %) cases. Concurrent illnesses were detected in 114 (55.1 %) individuals. Upon consulting family doctors within the first 5 days of examination, the diagnosis was not established in the comparison group. However, within 20 days, it was verified in 164 (79.2 %) patients. In the main group, pulmonary forms of the disease were observed in 173 (86.9 %) patients, while extrapulmonary forms were present in 26 (13.1 %). Diagnosis was established within 5 days in 94 (47.2 %) individuals and within 10 days in 77 (37.7 %). Overall, within the first 10 days, pulmonary diagnosis was verified in 173 (86.3 %) patients in the main group, as opposed to 18 (8.7 %) in the comparison group, representing a 9.9-fold difference (p < 0.001). Conclusions. Given that 114 patients in the comparison group had concurrent illnesses over many years, their tuberculosis manifestation was treated as «known» to the patient and the attending physi­cian, leading to a delay in diagnosing pulmonary tuberculosis by more than 20 days. Patients in the main group sought medical attention by reporting contact with tuberculosis patients, resulting in consultations with phthisiologists and, consequently, a 9.9-fold faster verification of pulmonary tuberculosis. Screening of individuals suspected of tuberculosis should be promptly conducted by phthisiologists.","PeriodicalId":292478,"journal":{"name":"Tuberculosis, Lung Diseases, HIV Infection","volume":"233 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139205073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}