X-ray diagnostics of tuberculosis in the screening of patients with HIV infection

Background. The main method of screening of patients with HIV infection to detect pulmonary tuberculosis is X-ray diagnostics. A comparative assessment of changes in lung tissue in different methods of X-ray diagnostics and at different levels of CD4+ cells seems relevant.The aim of the study. To compare plain radiography and computed tomography of the lungs as screening methods for detecting tuberculosis in patients with HIV infection at various stages of immunosuppression.Materials and methods. 396  patients with HIV registered at the AIDS Center were  examined using plain lung radiography (PLR) and computed tomography (CT). To search for mycobacterium tuberculosis, we used bacterioscopy of a smear with Ziehl – Neelsen staining; HAIN-GenoType MTBDRplus technique; inoculation of BACTEC MGIT 960 liquid media; inoculation of Löwenstein – Jensen dense medium. Statistical processing of numerical material was carried out using the Statistica 5.5 program with a significance level p ≤ 0.05; Pearson χ2 criterion was used for the analysis of qualitative featuresResults. When comparing the results of PLR and CT, the differences were found. When  using PLR, the focal lung lesions were described more often (χ2  =  40.79; p = 0.00001), according to CT data, they turned out to be fibrosis (χ2 = 2.33; p = 0.1269). When comparing the PLR and CT data, the differences were obtained in the description of pulmonary fibrosis (χ2 = 20.78; p = 0.00001), focal lung lesions (χ2 = 40.79; p = 0.00001), dissemination (χ2 = 9.16; p=0.0025).Conclusion. When screening HIV-infected patients (at the standard of using plain radiography twice a year) it should be taken into account that CT provides more precise differentiation of focal lung lesions and pulmonary fibrosis, earlier detection of dissemination syndrome and ground-glass, especially at severe immunodeficiency with a decrease in CD4+ T lymphocytes down to 200 cells and less. Timely appointment of CT study will improve the effectiveness of tuberculosis detection at the stage of screening in AIDS centers

Features of Hematological and Hemostasiological Parameters in Coronavirus Infection COVID-19 and Community-Acquired Pneumonia

Against the background of priority attention paid to the COVID-19 pandemic, there are also cases of community-acquired pneumonia of a different genesis. Identification of the features of lung lesions in such diseases is relevant during the spread of seasonal respiratory infections. The comparative study of the dynamics of hematological and hemostasiological parameters of blood in patients with pneumonia of various origins is of interest in terms of searching for predictors of the prognosis of the diseases development.Aim. To compare the features of clinical symptoms, hematological and hemostasiological parameters in patients with pneumonia caused by COVID-19 and in patients with community-acquired pneumonia.Materials and methods. During cross-sectional study two groups were formed: group 1 consisted of 92 patients diagnosed with moderate community-acquired pneumonia caused by COVID-19 infection; group 2 included 40 patients diagnosed with moderate community-acquired bilateral polysegmental pneumonia.Results. It was found that patients with COVID-19 had an older age (69 vs 39.3 years), a lower body temperature at admission (37.5 vs 38.85 °C), a lower percentage of reduced oxygen saturation (less than 89 % in 5.4 % of cases vs 10 % of cases). In most cases, the average values of some hematological parameters in patients with COVID-19 did not go beyond the reference range. Leukopenia (below 4 × 109 cells/l) and lymphopenia (below 1.1 × 109 cells/l) were observed in 26 % and 38 % of cases respectively; thrombocytopenia (less than 100 × 109 cells/l) – in 12.2 % of cases; hyperfibrinogenemia (more than 4 g/l) – in 65.3 % of cases. A direct correlation was found between platelet levels and leukocytes (R = 0.53; p < 0.001) and lymphocytes (R = 0.29; p = 0.06). Compared with the patients of the group 2,on average, patients with COVID-19 had significantly lower levels of leukocytes and lymphocytes (2.5 times each; p < 0.001) and an increased level of fibrinogen (by 45 %; p < 0.001).Conclusion. In patients with pneumonia caused by COVID-19, we revealed the particular features of clinical symptoms, hematological and hemostasiological blood parameters compared to community-acquired nonspecific pneumonia

Features of peripheral blood cellular immunity parameters in patients with lung damage up to 30 % in COVID-19

Background. The stability of human organism for different kind of infection, including SARS-CoV-2 is significantly defined by the immune system. The mechanisms of the cellular immunity to the SARS-CoV-2 are not exactly defined and are under study. The aim. To study the features of cell immunity parameters in patients with lung damage up to 30 % in COVID-19. Material and methods. 73 people were examined during the 2020–2021 pandemic. The study group consisted of 31 patients with lung damage up to 30 % with COVID-19, the comparison group consisted of 42 people not infected with SARS-CoV-2. A complete clinical blood count was carried out using a Medonic M20 hematological analyzer (Boule Medical, Sweden), the level of lymphocyte subpopulations was determined using a FACS Calibur cytometer (BD, USA) and FITC- and phycoerythrin-labeled monoclonal antibodies (Sorbent, Russia). Differences were considered statistically significant at p < 0.05. Results. Patients with COVID-19 with lung damage according to computed tomography (CT) ≤ 30 % before the treatment had a restructuring in the ratio of lymphocyte subpopulations in 67.7 % of cases. Lymphopenia (< 1.1 × 109 cells/l) was detected in 34.4 % of patients: a decrease in the absolute count of CD3+ lymphocytes by 30.8 %, CD3+CD4+ – by 35 %, CD3+CD8+ – by 6.7 % (p < 0.05), CD16+CD56+ natural killer (NK) cells – by 29.4 % (p = 0.009). The level of CD95+ lymphocytes in COVID-19 is 3.2 times higher than in healthy individuals. Elevated levels of HLA-DR+- (> 20 %) and CD3+ HLADR+ lymphocytes (> 6 %) are recorded in 60 % and 86.7 % of patients, respectively. Elevated levels of CD19+ B lymphocytes (> 17 %) in COVID-19 are 2.6 times more common than in healthy individuals. Correlation dependences of the count of NK cells with a wide range of T lymphocyte subpopulations were revealed. Conclusion. Cellular immunity indicators in COVID-19 have a number of features that can serve as predictors of the progression of the severity of the disease

Heuristic Models of Two-Fermion Relativistic Systems with Field-Type Interaction

We use the chain of simple heuristic expedients to obtain perturbative and exactly solvable relativistic spectra for a family of two-fermionic bound systems with Coulomb-like interaction. In the case of electromagnetic interaction the spectrum coincides up to the second order in a coupling constant with that following from the quantum electrodynamics. Discrepancy occurs only for S-states which is the well-known difficulty in the bound-state problem. The confinement interaction is considered too. PACS number(s): 03.65.Pm, 03.65.Ge, 12.39.PnComment: 16 pages, LaTeX 2.0

Значение социальных факторов при летальных исходах у пациентов с сочетанием туберкулеза и ВИЧ-инфекции

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Иммунодиагностика туберкулезной инфекции in vitro в решении вопроса о назначении превентивной химиотерапии

For the immunodiagnosis of tuberculosis infection, in addition to standard skin tests (Mantoux test with 2 TU PPD-L and Diaskintest), in vitro tests are currently used, one of which is the T-spot.TB test.Purpose of research. Evaluate the T-SPOT test as a method of early detection of tuberculosis infection in children and adolescents and its role as an additional method in solving the problem of the need for chemoprophylaxis.Materials and methods. The analysis of the results of T-SPOT.TB in 794 children aged 2 to 17 years inclusive in the period from 2016 to 2019 was carried out. Two groups were allocated: 1 group (n = 596) — children who underwent T-SPOT.TB as the main methodology; Group 2 — 198 children with positive skin test results for a recombinant tuberculosis allergen after screening. The results of T-SPOT.TB were evaluated taking into account the data of previous immunodiagnostics and associated pathology.Results. It is established that T-SPOT.TB. can be used as an independent method in case of rejection of skin tests. The level of latent tuberculosis infection is higher among children with concomitant pathology according to the results of T-SPOT.TB twice.Conclusion. T-SPOT.TB can be an alternative method for diagnosing tuberculosis infection during screening. In children with concomitant pathology of the T-SPOT.TB can serve as the leading method of tuberculosis immunodiagnosis. A positive T-SPOT.TB can serve as an additional method for deciding on the appointment of preventive chemotherapy.Для иммунодиагностики туберкулезной инфекции, помимо стандартных кожных тестов (проба Манту с 2 ТЕ ППД-Л и Диаскин-тест) в настоящее время применяют тесты invitro, одним из которых является тест T-SPOT.TB.Цель исследования: оценить тест T-SPOT.TB как метод раннего выявления туберкулезной инфекции у детей и подростков и его роль как дополнительного метода в решении вопроса о необходимости химиопрофилактики.Материалы и методы. Проведен анализ результатов T-SPOT.TB у 794 детей в возрасте от 2 до 17 лет включительно в период с 2016 по 2019 гг. Выделено 2 группы: 1 группа (n = 596) — дети, которым Т-SPOT.TB проводилась как основная методика; 2 группа — 198 детей с положительными результатами кожных проб на аллерген туберкулезный рекомбинантный после скрининга. Оценивались результаты Т-SPOT.TB с учетом данных предшествующей иммунодиагностики и сопутствующей патологии.Результаты. Установлено, что Т-SPOT.TB. может применяться как самостоятельный метод в случае отказа от кожных проб. Уровень латентной туберкулезной инфекции выше среди детей с сопутствующей патологией по результатам Т-SPOT.TB в два раза. Заключение. T-SPOT.TB может быть альтернативным методом диагностики туберкулезной инфекции при скрининге. У детей с сопутствующей патологией T-SPOT.TB может служить ведущим методом иммунодиагностики туберкулеза. Положительный T-SPOT.TB может служить дополнительным методом для принятия решения назначения превентивной химиотерапии

Причина смерти – коморбидность ВИЧ-инфекции и туберкулеза

The aim. The purpose of this study was to analyze causes of deaths of hospitalised HIV infected patients with tuberculosis.Methods. Medical reports of patients with tuberculosis who died in a specialized hospital of Samara city in 2013 were analyzed using the total sampling method.Results. Ninety per cent of deaths in hospitalised HIV infected TB patients were caused by end stage AIDS with the high proportion (82%) of miliary tuberculosis, involvement of multiple organs (53%) and drug dependence (88%).Conclusion. Improving interaction of TB specialists and experts on HIV infec tion is needed to improve statistic analysis of morbidity of and mortality from tuberculosis and to reduce mortality from these comorbid diseases.По числу инфицированных вирусом иммунодефицита человека (ВИЧ) Самарская область является неблагоприятным регионом. Среди впервые выявленных больных туберкулезом неуклонно возрастает доля ВИЧ инфицированных. Цель. Оценка ситуации по умершим ВИЧ инфицированным больным туберкулезом, поступившим на стационарное лечение, и изучение причин их смерти. Материалы и методы. Проведен анализ историй болезни умерших в ГБУЗ "Самарский областной клинический противотуберкулезный диспансер им. Н.В.Постникова" за 2013 г.Результаты. Показано, что у ВИЧ инфицированных больных туберкулезом в ≤ 90 % случаев причиной летальных исходов в стационаре является терминальная стадия ВИЧ (синдром приобретенного иммунодефицита) с выраженным преобладанием диссеминированного туберкулезного процесса (82 %), множественным поражением органов и систем (≤ 53 %) и наркотической зависимостью (88 %).Заключение. Для исключения исчезновения туберкулезного процесса из поля зрения статистики и снижения потери от консолидированной активности 2 опасных возбудителей необходимо оптимизировать взаимодействие специалистов по борьбе с туберкулезом и ВИЧ инфекцией

ПУТИ ОПТИМИЗАЦИИ ВЫЯВЛЕНИЯ ТУБЕРКУЛЕЗА В ПУЛЬМОНОЛОГИЧЕСКОМ ОТДЕЛЕНИИ

The objective: to optimize detection of tuberculosis in a pulmonology unit.Subjects and methods. In a pulmonology unit, patients suspected of having tuberculosis had a minimum number of diagnostic tests: a skin test with tuberculous recombinant allergen, three consecutive Ziel-Nelson microscopies of sputum and fluids of bronchoalveolar lavage, and in the laboratory of TB services they performed GeneXpert MTB/RIF, Bactec MGIT. Results of the diagnostics were analyzed in 70 patients with etiologic confirmation of diagnosis.Results. A targeted inquiry and taking the patient's history were informative in 4% of cases, skin test with TRA – in 27.1%, GeneXpert MTB/RIF – в in 100%, and Bactec MGIT – in 97.1%. Introduction of express diagnostic methods to a pulmonology unit reduced the average number of bed-days from admission to diagnostics of tuberculosis and transfer to a TB in-patient unit down to 9.80 ± 4.72 days. Molecular genetic methods can be recommended for introduction to general medical services as a diagnostic minimum when examining patients with a high risk of tuberculosis.Цель: оптимизировать выявление туберкулеза в пульмонологическом отделении.Материалы и методы. В пульмонологическом отделении пациентам с подозрением на туберкулез проводили диагностический минимум: ставили пробу с аллергеном туберкулезным рекомбинантным, проводили анализ мокроты (трехкратно) и жидкости бронхоальвеолярного лаважа (БАЛЖ) методами микроскопии по Цилю – Нильсону, в лаборатории противотуберкулезной службы диагностический материал исследовали с помощью GeneXpert MTB/RIF, Bactec MGIT. Проанализировали результаты диагностического процесса у 70 больных с этиологически подтвержденным диагнозом.Результаты. Целенаправленный опрос, сбор анамнеза были информативными в 4%, проба с АТР – в 27,1%, GeneXpert MTB/RIF – в 100%, Bactec MGIT – в 97,1%. Внедрение ускоренных методов диагностики в пульмонологическом отделении сокращает средний койко-день от поступления до установления диагноза туберкулеза и перевода в противотуберкулезный стационар до 9,80 ± 4,72 дня. Молекулярно-генетический метод можно рекомендовать в общую лечебную сеть как диагностический минимум при обследовании пациентов с высоким риском подозрения на туберкулез

Probing Anomalous Quartic Couplings in e-gamma and gamma-gamma Colliders

We analyze the potential of the e+e- Linear Colliders, operating in the e-gamma and gamma-gamma modes, to probe anomalous quartic vector--boson interactions through the multiple production of W's and Z's. We examine all $SU(2)_L \otimes U(1)_Y$ chiral operators of order p^4 that lead to new four--gauge--boson interactions but do not alter trilinear vertices. We show that the e-gamma and gamma-gamma modes are able not only to establish the existence of a strongly interacting symmetry breaking sector but also to probe for anomalous quartic couplings of the order of 10^{-2} at 90% CL. Moreover, the information gathered in the e-gamma mode can be used to reduced the ambiguities of the e+e- mode.Comment: Revtex, 18 pages, 6 figure