Мониторинг кардиотоксического действия бедаквилина у детей старшего возраста и подростков с множественной и широкой лекарственной устойчивостью возбудителя

The objective: to evaluate expanded monitoring of cardiovascular disorders in older children and adolescents with multiple drug resistant tuberculosis receiving bedaquiline (Bq) as a part of anti-tuberculosis therapy.Subjects and Methods: A cohort retrospective-prospective study (2015-2021) was conducted, which included 36 patients aged 13-17 years old who received Bq. The prospective part included 19 patients (Main Group), they underwent extended monitoring (EM) of cardiotoxic reactions; this extended monitoring program was developed in Central Tuberculosis Research Institute. The retrospective part included 17 patients (Control Group), in whom cardiotoxic reactions were assessed using standard monitoring recommended by the Russian Society of Phthisiologists at that time. The relationship between the studied risk factor (monitoring by standard ECG) and the outcome (Bq discontinuation) was assessed using the Pearson χ2 test.Results. Prolongation of the QTc interval > 0.440 ms was noted in 17.6% of cases in Control Group and it was regarded as a cardiotoxic effect of Bq, the drug was discontinued. In Main Group, prolongation was noted in 47.3% of cases which was considered a functional disorder of the cardiovascular system according to EM, the drug was not discontinued, χ2 = 3.896; p = 0.049. EM can be used in older children and adolescents with multiple drug resistant respiratory tuberculosis, which will make it possible to safely include Bq to chemotherapy regimens.Цель исследования: оценить расширенный мониторинг сердечно-сосудистых нарушений у детей старшего возраста и подростков, больных туберкулезом с МЛУ МБТ, получающих бедаквилин (Bq) в составе противотуберкулезной терапии.Материалы и методы: проведено когортное ретроспективно-проспективное исследование (2015-2021 гг.), в которое включены 36 пациентов 13-17 лет, получавшие Bq. В проспективную часть вошли 19 пациентов (основная группа), им проводился расширенный мониторинг (РМ) кардиотоксических реакций, разработанный на базе ФГБНУ «ЦНИИТ»; в  ретроспективную часть включены 17 пациентов (контрольная группа), у которых кардиотоксические реакции оценивались с помощью стандартного мониторинга, рекомендованного РОФ в тот период времени. Взаимосвязь между изучаемым фактором риска (проведение мониторинга по стандартной ЭКГ) и исходом (отмена Bq) оценивали с помощью критерия χ2 Пирсона.Результаты исследования. Удлинение интервала QTс > 0,440 мс отмечено в 17,6% случаев в контрольной группе и расценено, как кардиотоксическое действие Bq, препарат был отменен. В основной группе удлинение отмечено в 47,3% случаев, расценено с помощью РМ как функциональное нарушение со стороны сердечно-сосудистой системы, препарат был не отменен χ2 = 3,896; р = 0,049. РМ может быть использован у детей старшего возраста и подростков, больных туберкулёзом органов дыхания с МЛУ МБТ, что позволит безопасно включать Bq в режимы химиотерапии

Memory and Brain in Food-Storing Birds: Space Oddities or Adaptive Specializations?

Scatterhoarding birds that cache food items have become an important model system for the study of spatial memory and its correlates in the brain. In particular, it has been suggested that through adaptive specialization, species that cache food have better spatial memory and a relatively larger hippocampus than their non-caching relatives. Critics of this approach, dubbed neuroecology, maintain that neither of these hypotheses has been confirmed. Here, we review the evidence pertaining to a correlation between food-storing capability and the relative volume of the hippocampus. Hippocampal volume has been related to food-storing behaviour in comparisons between species, within species, or within individuals, but the evidence is not consistent. There are several possible reasons for this inconsistency, including: (1) food-hoarding birds may not always use memory for retrieval, (2) there may be systematic differences between data from North American and Eurasian species that affect the analysis, and (3) sample sizes have in many cases been too small. In addition, both the independent variable (degree of food-hoarding specialization) and the dependent variable (relative volume of the hippocampus) are not clearly and consistently defined. Alternatively, it is possible that the neuroecological hypothesis is false. Systematic empirical research is necessary to determine whether or not food-storing birds have evolved adaptive specializations in brain and cognition