Features of clinical manifestations and diagnosis of comorbidity of disseminated pulmonary tuberculosis, coronavirus, pneumocystis and pneumococcal pneumonia in patients with late stages of HIV infection with immunodeficiency

Aim. To study the features of clinical manifestations and diagnosis of comorbidity of disseminated pulmonary tuberculosis, coronavirus, pneumocystis and pneumococcal pneumonia in patients with late stages of HIV infection with immunodeficiency. Materials and methods. The prospective study included 120 newly identified patients with disseminated pulmonary tuberculosis with Mycobacterium tuberculosis, stage IVB of HIV infection, in the phase of progression and in the absence of antiretroviral therapy, aged 2953 years, who were randomized into 1A and 2A main groups and 1B and 2B comparison groups. Group 1A included 29 patients with comorbidity and pneumocystis pneumonia and group 2A 31 patients with comorbidity of disseminated pulmonary tuberculosis, coronovirus pneumococcal pneumonia, and group 1B and 2B comprised 29 and 31 similar patients, but without coronovirus pneumonia. To diagnose coronavirus pneumonia, PCR of SARS-CoV-2 RNA was used in smears from the nasopharynx and oropharynx, in sputum or in endotracheal aspirate. To detect Pneumocystis jirovecii, the causative agent of pneumocystis pneumonia, a microscopic examination of diagnostic material from the respiratory tract with RomanovskyGiemse and GrokottGmri coloration was carried out, and to detect Streptococcus pneumoniae, the causative agent of pneumococcal pneumonia, the diagnostic material was seeded on special nutrient media with determination of the drug resistance of the resulting culture to broad-spectrum antibiotics. Statistical data processing was carried out using the Microsoft Office Excel 2019 program with the calculation of the average in the group and the standard error of the average, confidence interval. Results. The comorbidity of disseminated pulmonary tuberculosis, coronavirus, pneumocystis and pneumococcal pneumonia in patients in the late stages of HIV infection, in the phase of progression and in the absence of antiretroviral therapy was characterized by severe immunodeficiency, generalization of tuberculosis with multiple extrapulmonary lesions and severe pneumonia. This determines the similarity of clinical manifestations and respiratory symptoms, and also makes it difficult to visualize computed tomographic changes consisting of a complex simultaneous combination of four pathological syndromes: dissemination, pleural pathology, increased pulmonary pattern and adenopathy. Simultaneous layering of several pathologies with the same type of clinical manifestations and computed tomographic changes requires a comprehensive etiological diagnosis of specific diseases to prescribe timely comprehensive treatment and reduce the lethality of this heavy contingent of patients. Conclusion. Patients with disseminated pulmonary tuberculosis and HIV infection who are registered in the office of tuberculosis care for HIV-infected in the tuberculosis dispensary represent a high risk group of COVID-19 infection and the development of coronavirus pneumonia, and with severe immunodeficiency, pneumocystis and pneumococcal pneumonia, should be regularly subjected to preventive studies for timely detection of COVID-19, coronavirus, pneumocystis and pneumococcal pneumonia for the purpose of their emergency isolation and timely treatment

Ultrasound of Acute Appendicitis in the Admission Room of a Multidisciplinary Surgical Hospital

Ultrasound (US) for diagnosing acute appendicitis (AA) and its complications in the admission room may be used as a primary diagnostic method in urgent patients. A total of 180 adult patients underwent US for suspected appendicitis; these results showed high possibilities in pathology screening and differential diagnosis from similar clinical diseases. The accuracy of US in detecting AA with obvious clinical findings and typical position is 100%, but in retrocecal and retroperitoneal forms, it decreases to 84%. With our algorithm of the right iliac and localized pain regions, US scanning optimizes the screening of patients with suspected AA presented in the admission room

The Imaging of Legg-Calve-Perthes Disease

Diagnosis of hip joint pathology remains a serious problem in childhood and adolescence. A wide range of pathologies—including dysplastic, dystrophic, inflammatory, oncological and post-traumatic diseases of the musculoskeletal system—leads to the advancement of imaging methods and techniques. Legg-Calve-Perthes disease (LCPD) is a common cause of hip pain in children that may be initially clinically and radiographically difficult to diagnose Radiography of the pelvis in two views (anteroposterior and Lauenstein) is the main method of diagnosing aseptic necrosis. Destructive changes of the femoral head and neck of the femur are clearly determined. However, the presence of X-ray negative patterns at the first stage of the disease and the impossibility of visualizing all the anatomical structures induce us to improve the diagnostic algorithm of this difficult pathological process

Socket Preservation During Preimplantation Period: Effi cacy of Osteoplastic Material Application Using Cone Beam Computed Tomography

Aim. To analyse the effi ciency of osteoplastic material application in order to reduce the resorption level after tooth extraction in the preimplantation period according to the data of cone beam computed tomography.Materials and methods. The study involved 80 patients who were divided into 4 equal groups depending on the preservation material used. The fi rst group was treated with Cerabone (Botiss, Germany) xenomaterial based on natural bovine bone. Plasma enriched with PRGF growth factors obtained by the BTI Endoret (Spain) technology was used for the patients of the second group. The third group consisted of patients who underwent a socket preservation of the extracted tooth with a powdered autologous dentin matrix (ADM) obtained from their own tooth. In the fourth group, bone-plastic material based on hydroxyapatite with Collapan-L lincomycin hydrochloride (Intermedapatit, Russia) was used to prevent socket resorption. All patients had a cone beam computed tomography of the maxillofacial region before the extraction and 3 months after the preservation in order to evaluate the level of bone resorption. After the installation of dental implants, a comparative assessment of the bone resorption level in the vertical and horizontal directions before tooth extraction and in the preimplantation period was carried out.Results. The smallest level of vertical bone resorption after socket preservation was observed in group 1 (Cerabone) and group 3 (ADM). The median value of the socket resorption level in group 1 was 0.7 mm (8.54 %) in the vertical direction and 0.5 mm (9.45 %) in horizontal measurement as compared to the level of bone tissue before tooth extraction. Similar indicators were observed in the group using an autologous dentin matrix. The vertical decrease in the socket bone tissue was 0.61 mm (7.75 %), horizontal — 0.51 mm (6.2 %). The level of bone resorption was signifi cantly higher using two other materials.Conclusions. The use of three-dimensional radiation research methods allows a comprehensive assessment of the bone tissue volume to be carried out, which in turn determines the choice of the dental implant size, the need for further bone-plastic surgery to increase the width/height of the alveolar ridge. The use of cone beam computed tomography showed that the most optimal results can be obtained by introducing Cerabone material into the socket of the extracted tooth, as well as using the innovative method of preservation with the patient’s own powdered tooth (ADM)

Magnetic resonance imaging of the temporomandibular joint: An integrative approach

BACKGROUND: According to various data, orofacial diseases occur in the population in 20%85% of cases. The most common cause of maxillofacial pain unrelated to the dental system is temporomandibular joint (TMJ) dysfunction, which is defined as a disruption of the anatomical relationship during natural movements. Magnetic resonance imaging (MRI) is the method of choice for diagnosing joint pathology. AIM: MRI with static, pseudodynamic, and dynamic protocols were optimized for targeted diagnosis of TMJ dysfunction. METHODS: Classical examination of the TMJ is performed in a closed and open mouth position. However, the images obtained do not reflect the location of the intra-articular disc at all stages of mandibular motion. RESULTS: After a static examination in two oral positions, pseudodynamic sagittal T1 weighted imaging (WI) scans were obtained. The patient was asked to divide the movements from full closure to full mouth opening into five steps. The examination was conducted with the MRI operator and the patient acting together. The scans assessed the position and shape of the meniscus at five stages of mandibular movements. The performed program is leading in the assessment of the disc shape changes at each stage of the mouth opening. Wide coverage of the studied area allows to visualize both articular relations of internal structures and surrounding soft tissues, including contraction of the lateral wing muscle and superficial and deep parts of the masseter muscle. The final stage was a dynamic T2 WI scan performed by the patient individually. The obtained series of images represents sequential movements of the condyle, maximally approximating the natural mouth opening. The pulse sequence helps to assess the amplitude of motion of the mandibular condyle and hypermobility, which can be difficult when performing static images with standard mouth expanders. CONCLUSIONS: An optimized dynamic and pseudodynamic TMJ study protocol is an essential part of the precise diagnosis of TMJ dysfunction and allows for differential diagnosis between muscle spasm and intra-articular disc adhesion and reliable visualization of intra-articular relationships during mouth opening