Ukrainian Pulmonology Journal最新文献

{"title":"REFRACTORY PULMONARY SARCOIDOSIS: PERSPECTIVES FOR THE USE OF COMBINED THERAPY WITH METHOTREXATE AND HYDROXYCHLOROQUINE","authors":"V. Gavrysyuk, E. Merenkova, Y. Dziublyk, G. Gumeniuk, N. Morska, N. Pendalchuk, A. I. Iachnik","doi":"10.31215/2306-4927-2023-31-2-29-38","DOIUrl":"https://doi.org/10.31215/2306-4927-2023-31-2-29-38","url":null,"abstract":"Refractory sarcoidosis is a variant of sarcoidosis course when glucocorticosteroids (GCS) used in maintenance dose not less than 10 mg daily   (prednisolone equivalent) and methotrexate (MTX), including combined use,  are not effective enough to achieve clinical remission. Aim — to evaluate the feasibility of combination use of MTX and GCS in patients with refractory pulmonary sarcoidosis. Mаtеrials and methods. There were enrolled 7 patients with refractory sarcoidosis: 4 females, 3 males; age – from 32 to 62 years. In 1 patient the diagnosis of refractory sarcoidosis was jastified by low effectiveness of MTX monotherapy 15 mg weekly for not less than 3 months, prescribed due to  contraindications for use of GCS (history of manifest mental disturbance in response to short course of GCS, prescribed for other indication). In 5 patients the refractoriness was defined by low effectiveness of MTX, prescribed due to relative resistance to GCS (initial response to GCS followed by progression of the disease during dose tapering). In 1 patient there was a combination treatment failure (methylprednisolone 12 mg daily with MTX 15 mg weekly) used for at least 3 months. In addition to clinical evaluation all patients were examined using high resolution computed tomography (CT) of lungs using multi-slice CT scanner Aquilion TSX-101A (Toshiba). CT scans were assessed using criteria described by M. Veltkamp, J. C. Grutters (2014). Lung function was assessed using flow-volume curve analysis, whole bodypletysmography, and spirometry by means of spirometry system MasterScreen («Viasys Healthcare GmbН») equipped by appropriate modules. For patients, who failed to respond to MTX monotherapy, combination therapy MTX 10 mg weekly with hydroxychloroquine (HCQ) 200 mg daily was prescribed. For patients, failed to respond to MTX/GCS therapy, we recommended tapering GCS dose until complete discontinuation, followed by MTX/HC combination therapy in above mentioned doses. To assess treatment tolerance before the initiation of combination treatment, 2 weeks after initiation and later on, once per month a laboratory workup including total blood count and blood chemistry (WBC, PLT, creatinine, alanineaminotransferase (ALT)) was done. Additionally, before the start of combination therapy all patients underwent ophthalmological examination. Results are presented in form of clinical series case report. Considering limited number of cases, a level of statistical significance (p) of prior treatment and combination MTX and HCQ treatment was determined using Fisher’s exact test. Combination therapy with MTX (15 mg/week) with HCQ (200 mg daily) for at least 3 months was quite effective in 5 out of 7 patients with refractory pulmonary sarcoidosis (Fisher’s exact test was 0,011, р < 0,05)) with overall satisfactory tolerability of treatment. Serious adverse reactions resulted in discontinuation of combination therapy were observed in 2 cases. Those patients were switched on GCS therapy.","PeriodicalId":328937,"journal":{"name":"Ukrainian Pulmonology Journal","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123137494","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":"EFFECTIVENESS OF METHOTREXATE IN MANAGEMENT OF PULMONARY SARCOIDOSIS RELAPSESE","authors":"N. Vlasova","doi":"10.31215/2306-4927-2021-29-4-24-29","DOIUrl":"https://doi.org/10.31215/2306-4927-2021-29-4-24-29","url":null,"abstract":"EFFECTIVENESS OF METHOTREXATE IN MANAGEMENT OF PULMONARY SARCOIDOSIS RELAPSES N. A. Vlasova Abstract Relapses are one of most urgent problems of treatment in pulmonary sarcoidosis patients. There have been demonstrated the correlation between the rate of pulmonary sarcoidosis relapses and previous longterm glucocorticosteroid (GCS) therapy. This makes a feasibility of GCS administration in patients with relapsing disease doubtful. Literature data and author’s clinical experience considering lower incidence of sarcoidosis relapses after the use of immunosuppressive drugs such as methotrexate (MTX) were the rationale for this study. Aim: to study the efficacy of MTX in treatment of patients with the relapses of pulmonary sarcoidosis. Material and methods. We examined 12 patients (5 males and 7 females, 36-54 years of age) with relapses of pulmonary sarcoidosis, revealed within 12 months after successful completion of main course of methylprednisolone (MP) therapy (clinical cure). MTX was prescribed in dose of 15 mg/week under monthly control of white blood cells and platelets count and alanine aminotransferase (ALT) serum level. Therapy has been stopped after the complete cure, confirmed by lung computed tomography (CT). The primary endpoint was the long-term outcomes of MTX use – the rate of repeated relapses during 12 months follow-up period following MTX discontinuation. The control group was comprised of 33 patients (males 14, females 19, 30-58 years of age) with relapses of pulmonary sarcoidosis after completion of GCS therapy, treated with MP at initial dose of 24 mg/day. Therapy has been stopped after the complete cure, confirmed by lung CT. The long-term outcomes were assessed at 6 and 12 months of follow-up. Additionally, incidence of adverse reactions was compared between groups. Exact Fisher’s test was used to determine the differences between studied variables. Results. No significant differences were found in rate of adverse reactions between study groups (16,7 % in МТХ vs 21,2 % in MP group). At the same time the rate of repeated relapses was lower in MTX than in MP group (25 % vs 57,6 %, respectively, p=0,01993). Conclusion. Use of MTX 15 mg/week in patients with relapses of pulmonary sarcoidosis was associated with less frequent repeated relapses in comparison with conventional use of MP at starting dose 24 mg/day. Key words: pulmonary sarcoidosis, relapse, methotrexate, methylprednisolone.","PeriodicalId":328937,"journal":{"name":"Ukrainian Pulmonology Journal","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116794645","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":"EFFECT OF COMBINATION OF TIOTROPIUM/ OLODATEROL ON PULMONARY FUNCTION IN PATIENTS WITH COPD IN THE REAL CLINICAL PRACTICE","authors":"Y. Mostovoy, K. Dmytriiev, N. Slepchenko","doi":"10.31215/2306-4927-2021-29-3-28-30","DOIUrl":"https://doi.org/10.31215/2306-4927-2021-29-3-28-30","url":null,"abstract":"EFFECT OF COMBINATION OF TIOTROPIUM/OLODATEROL ON PULMONARY FUNCTION IN PATIENTS WITH COPD IN THE REAL CLINICAL PRACTICE Y. M. Mostovoy, K. D. Dmytriiev, N. S. Slepchenko Abstract Aim — to evaluate the effect of combination therapy with tiotropium/olodaterol on pulmonary function in real clinical practice. Materials and methods. 100 patients with the diagnosis of COPD were included into the study (mean age was 64,09±1,94 years, 66 men and 34 women). Smokers — 68 %, mean smoking duration (24,44 ± 4,84) packyears. Average COPD duration was 9,35±2,42 years. All patients underwent spirometry at screening, 4-6 weeks and at 1 year after inclusion. FEV1, FVC, FEV1/FVC, FEF25, FEF50, FEF75, PEF, MMEF75/85, FEF75/85 were calculated. Results. There was statistically significant improvement in FEV1 and FVC values between visits 1 and 3 (p < 0,05). At visit 3 there was a statistically significant difference in FEV1 and FVC values when compared with same values at visit 1 after the inhalation of salbutamol, demonstrating better bronchodilation effect of tiotropium/olodaterol. Absolute increase of FEV1 between visits 1 and 3 was 221,31±34,9 ml; FVC — 411,01±66,08 ml. There was statistically significant increase of FEF75, MMEF75/25, FEF75/85 between visits 1 and 3 (p < 0,05). There was statistically significant increase of FEF75 at visits 2 and 3 in comparison with postBD FEF75 at visit, confirming better bronchodilation effect of tiotropium/olodaterol combination of at the level of small bronchi when compared with salbutamol (p < 0,05). Conclusions. Tiotropium/olodaterol combination showed good effect on pulmonary function in patients with COPD in real clinical settings. This combination demonstrated better bronchodilation than salbutamol, especially at the level of small bronchi. Key words: COPD, tiotropium/olodaterol, spirometry. Ukr. Pulmonol. J. 2020;29(3):28–30.","PeriodicalId":328937,"journal":{"name":"Ukrainian Pulmonology Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128511005","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":"PULMONARY ADVERSE REACTIONS OF CARDIOVASCULAR DRUGS","authors":"Y. Mostovoy, T. Danilevych","doi":"10.31215/2306-4927-2022-30-1-15-24","DOIUrl":"https://doi.org/10.31215/2306-4927-2022-30-1-15-24","url":null,"abstract":"PULMONARY ADVERSE REACTIONS OF CARDIOVASCULAR DRUGS Y. M. Mostovoy, T. D. Danilevych Abstract Diagnosis and treatment of chronic obstructive pulmonary disease, bronchial asthma, pneumonia, idiopathic pulmonary fibrosis is an actual problem in medicine and pulmonology. These diseases are quite often combined with common diseases of the cardiovascular system, in particular, coronary artery disease, hypertension, and heart failure. The supervision of such patients is a difficult problem for the physicians. This review focuses on published data regarding the use of common drugs for the treatment of the cardiovascular diseases, such as angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, antiplatelet agents, statins, antiarrhythmic drugs, etc. Special emphasis has been made on pulmonary adverse reaction of these medications. Key words: amiodarone, angiotensin-converting enzyme inhibitors, beta-blockers, acetylsalicylic acid, statins, pulmonary adverse reactions.","PeriodicalId":328937,"journal":{"name":"Ukrainian Pulmonology Journal","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125594428","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":"EVOLUTION OF GINA GUIDELINES. PRACTICAL ASPECTS OF ASTHMA MANAGEMENT THROUGH THE PRISM OF CLINICAL TRIALS","authors":"S. Zaikov, F. T. Bogomolov, G. Gumeniuk","doi":"10.31215/2306-4927-2022-30-1-6-14","DOIUrl":"https://doi.org/10.31215/2306-4927-2022-30-1-6-14","url":null,"abstract":"EVOLUTION OF GINA GUIDELINES. PRACTICAL ASPECTS OF ASTHMA MANAGEMENT THROUGH THE PRISM OF CLINICAL TRIALS S. V. Zaikov, F. T. Bogomolov, G. L. Gumeniuk Abstract Through the 28 years lifetime of GINA (Global Initiative for Asthma) recommendations, there’s been a shift in the paradigm of asthma management. GINA is a Global Strategy of treatment and prophylaxis of asthma, established by National Heart, Lung and Blood Institute in collaboration with National Institute of Health and World Health Organization in 1993. First published in 1995 GINA report has become a widespread consensus, which made a basis for clinical recommendations on asthma worldwide. One can define three major periods in evolution of GINA. The first period covered 1994–2004 years since GINA originated and first edition published until experts have recognized the advantage of inhaled rout of asthma drugs administration. It was proved that in many patients the main goal was establishing asthma control, while combination of inhaled corticosteroid with long-acting beta agonist (ICS/LABA) was a preferred option in moderate persistent asthma. In this period it was recommended to chose an approach to managent of asthma, based on scientific evidence, rather then expert’s opinion. In this regard, a second period (2005–2014 years) should be considered outstanding, due to the change in perception of major goals of asthma management, considering exclusively data from numerous studies. Such concepts as patient-medical personnel partnership, patient’s education, guided self-control and goals of treatment have been introduced. GINA recommends to use asthma control as a major approach to treatment instead of severity of disease. Personalized treatment should be aimed on exacerbation risk reduction. Steps 3-5 of treatment algorithm were modified to include ISC-formoterol for maintenance therapy and relief of symptoms (MART-therapy). Third period of GINA started after SYGMA 1 and 2 studies results became available. It was demonstrated that on-demand symptom-relief use of anti-inflammatory therapy with ICS/formoterol combination was highly effective in mild asthma patients. Use of this combination as rescue medication decreased the risk of exacerbation in comparison with short-acting beta agonist (SABA) and may be used in any variant of asthma. Since GINA 2019 edition SABA became not the only one available option even for the mildest forms of asthma. Eventually, in 2021 the culmination of GINA evolution occurred: major algorithm of asthma management has been divided in two tracks: preferred (Track 1) therapy with ICS/formoterol and alternative (track 2) therapy with SABA as rescue medication. The authors of this article review in details the periods of GINA evolution, resulted in dividing asthma management into two tracks, which provide personalized treatment strategy considering all patient’s needs and characteristics such as fast relief of symptoms, decreased risk of exacerbation and establishing ","PeriodicalId":328937,"journal":{"name":"Ukrainian Pulmonology Journal","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134278450","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":"POST-COVID-19 INTERSTITIAL LUNG DISEASE AS A MANIFESTATION OF THE POST-COVID-19 SYNDROME","authors":"O. К. Yakovenkо, Y. Dziublyk, О. G. Khanin, L. Romaniv, L. M. Dzhumaniuk, E. Khodosh","doi":"10.31215/2306-4927-2023-31-2-39-43","DOIUrl":"https://doi.org/10.31215/2306-4927-2023-31-2-39-43","url":null,"abstract":"The aim was to study the clinical features of post-COVID-19 interstitial lung disease (ILD) and to determine the prospects for the use of the antifibrotic drug nintedanib in patients with moderate and severe COVID-19. Material and methods. A prospective cohort study was conducted in 266 patients (≥ 18 years old) with moderate and severe COVID-19 who were hospitalized and discharged after treatment at the Volyn Regional Clinical Hospital between September and November 2021. The study design included telephone contact with patients one year after hospital discharge to collect the complaints and history data related to postCovid syndrome. The patients with persistent respiratory symptoms were invited for an examination. A questionnaire, assessment of objective status, laboratory and functional tests were performed. The study included a group of patients (n = 25) with post-COVID-19 interstitial lung disease as a sequela of severe coronavirus infection. In all cases, interstitial pneumonia with a radiological pattern of chronic organizing pneumonia was established by computer tomography. All patients with post-COVID-19 ILD received glucocorticosteroid (GC) therapy with methylprednisolone 16 mg/day for 3–6 months with a gradual dose reduction until complete withdrawal. In addition, 9 patients with postCOVID-19 ILD received off-label antifibrotic therapy with the nintedanib 300 mg daily for 3 months. Statistical analysis was performed by means of SPSS Statistics 26 using the binomial test, the asymptotic T-test for the probability of success in two independent Bernoulli trial schemes, and the non-parametric Kolmogorov-Smirnov, Mann-Whitney U, and median tests. Results and discussion. In 9.4 % (n = 25) of patients post-COVID-19 ILD was diagnosed: 76 % (n = 19) — COVID-19 associated ILD; 16 % (n = 4) — systemic connective tissue disease (SCTD) triggered by COVID-19; 8% (n = 2) misdiagnosed pre-COVID-19 ILD. Radiological pattern of fibrosis-like lesions was established in 64% (n = 16); true fibrotic radiological pattern of pulmonary fibrosis (PF) — in 36 % (SCTD — 4 cases, other ILD — 2 cases). It was found that CPAP respiratory support did not significantly correlated with the presence of a radiological pattern of PF (p = 0.774) and the progression of postCOVID-19 ILD (p = 0.146). No significant correlation was found between the presence of a radiological pattern of PF and the gender of patients (p = 1.000 and p = 0.146, respectively) or age (p = 0.881 or p = 0.885). Despite the presence of autoimmune markers in number of cases and the diagnosis of SCTD, there was no correlation between PF pattern and SCTD ILD (p = 0.146 and p = 1.000). The use of nintedanib (n = 9) for 3 months in the remote period of severe COVID-19 disease did not changed the radiological pattern of PF (p = 1.000) and the progression of post-COVID-19 ILD (p = 0.180), same as the blood oxygen saturation post 6-minute walking test (p = 0.411 according to the median test and p = 0.329 acc","PeriodicalId":328937,"journal":{"name":"Ukrainian Pulmonology Journal","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132670796","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":"PREDICTING THE RISK OF LOCAL TUBERCULOSIS IN CHILDREN WITH LATENT TUBERCULOSIS INFECTION","authors":"O. Bilogortseva, Y. Dotsenko, O. Sivachenko, L. Arefyeva, V. V. Gorbenko, V. A. Ovsyanitskaya","doi":"10.31215/2306-4927-2021-29-4-5-9","DOIUrl":"https://doi.org/10.31215/2306-4927-2021-29-4-5-9","url":null,"abstract":"O. I. Bilogortseva, Y. I. Dotsenko, O. Y. Sivachenko, L. V. Arefyeva, V. V. Gorbenko, V. A. Ovsyanitskaya Abstract Children with LTBI represent a large risk group for reactivation of the tuberculosis process at any time. The available diagnostic methods do not answer the question regarding the risk of local TB formation in them. Aim: to present a model for predicting the risk of developing localized tuberculosis (TB) in children with latent tuberculosis infection (LTBI). Materials and methods: 275 children with LTBI and 116 children with newly diagnosed TB were examined. After ranking 57 clinical signs and risk factors, the most significant of them were identified and their diagnostic coefficients (DC) were determined. The essence of the model is to calculate DCs with further calculation of their sum, based on the numerical value of which it is possible to predict a low and high risk of developing a local form of TB in children with LTBI. Results: The effectiveness of the prognosis model was confirmed by the results of observation of 228 children with LTBI. Using this model, it is possible to predict the low and high risk of developing localized TB in children with LTBI. The values of the diagnostic coefficients can independently predict the course of LTBI in a child. Conclusions: The use of the proposed prognosis model increases the accuracy of predicting the risk of developing a local form of tuberculosis in children with latent tuberculosis infection by 29.4%, compared with the Mantoux test, and to determine the contingents that need additional examination, preventive treatment and dynamic observation by a pediatric phthisiatrician in order to prevent the progression of LTBI into active tuberculosis. In conditions of quarantine and limited access of patients to medical services, the proposed model for predicting the risk of developing localized TB in children with LTBI can serve as an additional tool in the practice of a pediatric phthisiatrician. Key words: children, latent tuberculosis infection, predicting the risk","PeriodicalId":328937,"journal":{"name":"Ukrainian Pulmonology Journal","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127233425","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":"HOT TUB LUNG","authors":"Y. Dziublyk","doi":"10.31215/2306-4927-2022-30-1-25-29","DOIUrl":"https://doi.org/10.31215/2306-4927-2022-30-1-25-29","url":null,"abstract":"HOT TUB LUNG Y. O. Dziublyk Abstract This review deals with current approaches to etiology, pathogenesis, clinical features and diagnostics of hot tub lung. The aim of the report is to extend the knowledge of practicing physicians in the area of interstitial lung diseases considering possible role of environmental exposures. Hot tub lung is a granulomatous lung disease, resulted in hyperreactive response of immune system to airborne exposure with nontuberculous mycobacteria (NTM). ATS diagnostic criteria for hot tub lung include the sub-acute onset of respiratory symptoms associated with hot tub exposure, positive mycobacterial cultures from respiratory and water samples, and characteristic radiographic findings. Treatment of this condition rests on avoidance of exposure with bacterial antigens and a trial of corticosteroid therapy. Better understanding of this pathology would help physician with sometimes difficult differential diagnosis of interstitial lung diseases. Key words: hot tub lung, nontuberculous mycobacteria, hypersensitivity pneumonitis. Ukr. Pulmonol. J. 2022;30(1):25–29.","PeriodicalId":328937,"journal":{"name":"Ukrainian Pulmonology Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129039441","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":"RESULTS OF HISTOLOGICAL EXAMINATION OF POST-OPERATIVE SPECIMENS WITH DETERMINATION OF DEGREE OF MORPHOLOGICAL ACTIVITY OF TUBERCULOSIS AND CLINICAL PRESENTATION OF TUBERCULOSIS PATIENTS AFTER VATS RESECTION AND VATS PLEUROECTOMY WITH DECORTICATION OF LUNG","authors":"M. Opanasenko, I. Liskina, V. Lysenko, L. Zagaba, O. Tereshkovich, B. Konik, L. Levanda, S. M. Shalagai, M. I. Kalinichenko, M. Shamrai","doi":"10.31215/2306-4927-2022-30-4-28-33","DOIUrl":"https://doi.org/10.31215/2306-4927-2022-30-4-28-33","url":null,"abstract":"RESULTS OF HISTOLOGICAL EXAMINATION OF POST-OPERATIVE SPECIMENS WITH DETERMINATION OF DEGREE OF MORPHOLOGICAL ACTIVITY OF TUBERCULOSIS AND CLINICAL PRESENTATION OF TUBERCULOSIS PATIENTS AFTER VATS RESECTION AND VATS PLEUROECTOMY WITH DECORTICATION OF LUNG M. S. Opanasenko, I. V. Liskina, V. I. Lysenko, L. M. Zagaba, O. V. Tereshkovich, B. M. Konik, L. I. Levanda, S. M. Shalagai, M. I. Kalinichenko, M. U. Shamrai Abstract Patients with pulmonary tuberculomas of different histological structure, as well as pulmonary fibrous-cavernous tuberculosis (FCT) are subject to surgical treatment. These phase-forms require careful morphological examination, which provides an objective determination of the degree of activity of a specific inflammatory process. Materials and methods. 165 patients were examined: 130 (78,8 %) patients with different forms of tuberculosis and 35 (21,2 %) patients with tuberculosis of pleura. Morphological determination of the degree of activity of specific inflammation was performed according to the developed classification using hematoxylin and eosin staining. Specific lung lesions were detected in 130 (78.8 ± 3.2)% of cases, pleural TB was histologically detected in 35 (21.2%). Results and discussion. Most VATS resections were performed on tuberculosis - 98 (75.4%), 19 (14.6%) cases were operated on with FCT, 11 (8.5%) patients had post-tuberculosis changes. 2 (1.5%) patients underwent surgery for infiltrative tuberculosis. The following degree of morphological activity of tuberculous inflammation was established in the resection samples: high - 28 (21.5%), moderate - 42 (32.3%) and low - 60 (46.2%) cases. The degrees of morphological activity of the operative material and clinical symptoms were compared: low activity was found in 60 (46.2%) patients, 14 (10.8%) of them had typical symptoms of TB; measurable activity was found in 42 (32.4%), of which 21 (16.2%) patients had a clinical picture of TB; 28 (21.5%) patients had high activity, 22 (78.6%) of them showed symptoms, and in 8 (36.4%) patients of this subgroup the sputum was positive for Mycobacteria. These data do not demonstrate clear correlation, but suggest a a significant difference between groups. Chronic TB pleurisy was detected in 18 (51.4%) cases. It was characterized by the growth of coarse fibrous connective tissue with the presence of epithelioid-cell granulomas, and typical clinical and radiological symptoms. Conclusions. Determining the morphological degree of activity of specific inflammation allows to prescribe additional courses of anti-TB therapy. Low activity - 60 observations (46.2%), moderate degree - 42 cases (32.3%), high morphological degree - 28 (21.5%) cases. Different types of tuberculoma show different degrees of morphological activity. A significant difference was found between the presence of the clinical picture of TB in morphologically high and low levels of specific inflammatory activity. In tuberculosis of pleura patients with subacute or c","PeriodicalId":328937,"journal":{"name":"Ukrainian Pulmonology Journal","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126627150","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":"RECOMMENDATION ON USE OF METHOTREXATE IN SARCOIDOSIS PATIENTS (WASOG, 2013) AND THE BACKGROUND FOR ITS UPDATE","authors":"І. O. Merenkova, N. Vlasova","doi":"10.31215/2306-4927-2021-29-3-53-57","DOIUrl":"https://doi.org/10.31215/2306-4927-2021-29-3-53-57","url":null,"abstract":"RECOMMENDATION ON USE OF METHOTREXATE IN SARCOIDOSIS PATIENTS (WASOG, 2013) AND THE BACKGROUND FOR ITS UPDATE І. O. Merenkova, N. A. Vlasova Abstract In 2013 the experts of World Association of Sarcoidosis and Other Granulomatous disorders (WASOG) have published the recommendations on use of methotrexate (MTX) in sarcoidosis patients. Considering the fact that by the moment of publishing of the recommendations, there were data presented from only one small (n=24) randomized trial (Baughman R. P. et al., 2000) and limited data from observational studies, the recommendations were mainly based on case series reports and sarcoidosis experts’ opinion, collected from appropriate survey. Since that time several trials on efficacy and safety of MTX, including large retrospective studies (Fang C., et al., 2019; Vizel A. A. et al., 2020; Baughman R. P. et al., 2020) have been accomplished. Current statement of WASOG has considered these new data. Upon review of recommendations the authors concluded that based on rich body research data on short and long-term outcomes of MTX use in pulmonary sarcoidosis, published during last 8 years, MTX may be prescribed as first line medication in patients with newly diagnosed pulmonary sarcoidosis. A safety profile of MTX allows to use it at initial dose of 15 mg/week. The concomitant administration of folic acid should be limited by cases of MTX intolerance, until new research data on this matter become available. In authors’ opinion, recommendations # 4-10, in connection with MTX safety, are up-to-date and should not be revised. Key words: pulmonary sarcoidosis, methotrexate, recommendations of WASOG-2013. Ukr. Pulmonol. J. 2021;29(3):53–57.","PeriodicalId":328937,"journal":{"name":"Ukrainian Pulmonology Journal","volume":"393 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122996502","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}