Oxidative stress and inflammation biomarkers in pulmonary tuberculosis

Background: Tuberculosis outcome and clinical features of the infection are influenced by the degree of the multiplication of mycobacterias, host’s defense mechanisms and the organism’s capacity to fight through the antioxidant mechanisms against the aggression of the oxidative stress. The aim of the study was to assess the oxidative stress and inflammatory biomarkers in pulmonary tuberculosis. Material and methods: A prospective study, which included 46 patients with pulmonary tuberculosis and 36 healthy persons determined according to the clinical and biochemical criteria, was performed. The oxidative stress was assessed through the level of the advanced oxidation protein products, advanced glycation end-products, fibrinogen, amino acid catabolic products, activity of N-acetyl-β-D-glucosaminidase. The determination of the total antioxidant activity of plasma was performed through ABTS and CUPRAC methods. IL-8 and TNF-α were assessed using analysis kits of BOSTER (USA) producer. Results: Was established high level of the oxidative stress following the assessment of the concentration of the advanced oxidation protein products, advanced glycation end-products, fibrinogen, N-acetyl-β-D-glucosaminidase, urea and creatinine. High concentration of amino acid catabolic products was attributed to the nephrotoxic properties of the medication. Was identified high level of the plasma total antioxidant activity and antioxidant compounds. Cytokines concentration IL-8 and TNF-α was several times higher than in the control group and they were assessed as specific biomarkers. Conclusions: High level of the protein peroxidation, advanced glycation end-products, fibrinogen, protein catabolism compounds, pro-inflammatory cytokines – IL-8 and TNF-α confirmed the boosting of the oxidative stress. The elevated total antioxidant activity and antioxidant proteins demonstrated the organism’s capacity to redress the oxidative aggression

Level of cytokines in patients with pulmonary drug susceptible and resistant tuberculosis

Department of Pneumophthisiology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Cytokines are the regulators of the immune response in tuberculosis: TNF-alpha and CXCL8 (IL-8) are involved in the granuloma formation, IL-10 inhibits the inflammation; some chemokines increase the liver production of the acute phase proteins (APPs). The aim of the research was to assess the serum level of IL-8, TNF-alpha, IL-10, C-reactive protein (CRP), ceruloplasmin and fibrinogen in patients with drug-sensitive and multidrug resistant tuberculosis (MDR-TB). Material and methods: A prospective case-control study, which included 51 patients, distributed in 2 groups: the 1st study group (N=24 new cases with drug-sensitive TB) and the 2nd study group (N=27 new cases with MDR-TB) according to sex and age were compared with the control group (N=36 healthy individuals). Results: Serum concentration of IL-8 was elevated up to 13 times, TNF-alpha up to 4 times and IL-10 up to 2 times in study groups, compared with the reference value of the control group. Fibrinogen concentration was elevated up to 2 times in study groups compared with the control group and CRP up to 3 times compared with conventional value. Ceruloplasmin was statistically higher in the drug-sensitive TB and mildly elevated in MDR-TB group. Conclusions: Proinflammatory biomarkers are more elevated than the anti-inflammatory response, without differences among groups regarding drug sensitivenes

Clinical evolution of patients with post-COVID syndrome

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Riscul apariției sindromului post-COVID (SPC) este determinat de severitatea infecției cu SARS-CoV2 și de statutul comorbid al pacientului. Se manifestă printr-o stare de astenie agravată de o activitate fizică minoră, tulburări de miros și gust, asociat cu tuse cronică. Scopul studiului. Evaluarea caracteristicelor generale și a particularităților clinico-evolutive ale pacienților cu sindromul post-COVID. Material și metode. S-a efectuat o cercetare prospectivă, care a inclus 69 pacienți diagnosticați cu sindromul post-COVID în perioada a 2022 în mun. Chișinău. Rezultate. particularități generale: raport bărbați/femei = 4/1, raport vârstă 45+/3 luni la 24(38%) pacienți. Clinic s-a manifestat prin astenie la toți, febră -28(44%), tuse seacă - 50 (79%), dispnee - 42 (67%), dureri toracice -28(44%), labilitate emoțională la 12(17%) și paraclinic VSH crescut-23 (36%), PCR crescută-42 (61%), LDH crescut-28 (44%) și radiologic îngroșarea desului peribronhovascular la 34 (49%). Anosmie și ageuzie nu s-a stabilit. Concluzie. Caracteristice pacienților cu SPC au fost sexul masculin, vârsta peste 45 de ani, cu reședința urbană, și condiții predispozante (comorbidități, obezitate). Particularitățile clinico-evolutive au fost astenia, tusea cu evoluție insidioasă, PCR crescut și îngroșarea desenului peribronhovascular la examenul radiologic.Introduction. The risk of post-COVID syndrome (PCS) is determined by the severity of SARS-CoV2 infection and the patient’s comorbid state. It is recognized by asthenia worsened by minor physical activity, disturbances of smell and taste, accompanied by a chronic cough. The aim of the study was to assess the general characteristics and the clinical peculiarities of patients with the post-COVID syndrome. Material and methods. A prospective research, which included 69 patients diagnosed with post-COVID syndrome in the period of 2022 in the Chisinau, was conducted. Results. General characteristics: male/female = 4/1, age ratio 45+/3 months in 24 (38%) patients. Clinically was established asthenia in all, fever - 28 (44%), dry cough -50 (79%), dyspnea – 42 (67%), chest pain - 28 (44%), emotional lability in 12 (17%) and paraclinical elevated ESR - 23 (36%), elevated CRP – 42 (61%), elevated LDH - 28 (44%) and radiologically - peribronchovascular thickening in 34 (49%) patients. Anosmia and ageusia was not established. Conclusion. Male sex, age over 45, with urban residence, and predisposing conditions (comorbidities, obesity) were patients characteristic with SPC. The clinical-evolutionary features were asthenia, cough with insidious evolution, increased CRP and thickening of the peribronchovascular pattern on radiological examination

Tuberculoza în contextul migrației economice

Background. Migration has a major impact on public health worldwide. Objective of the study. Evaluation of the medical and social conditions that contributed to the tuberculosis of migrants. Material and Methods. A selective, descriptive and retrospective study was performed in which 70 migrant workers were included, hospitalized in the clinical subdivisions of PHI Clinical Municipal Hospital of Ftisiopneumology in 2018 Results. Distributing patients according to sex were found the predominance of men with 46 (65.71%) compared to 24 (34.28%) women. Active tuberculosis is more common in patients with the following risk factors: domicile in the urban area, absence of established place of residence, absence of insurance policy, unemployed. Microbiologically positive was every third, and every fifth was diagnosed with MDR-TB. By examining symptomatic patients, every second patient and only every fifth was detected by examining groups at increased risk of disease. Therapeutic success was established in every second case, every fifth died and every fourth patient was lost to follow-up. Conclusion. the negative impact of migration on the evolution of tuberculosis can be found by the high rate of deaths and treatment interruptions which increases the risk of developing drugresistant tuberculosis. Introducere. Migraţia conferă un impact major asupra sănătăţii publice la nivel mondial. Scopul lucrării. Evaluarea condiţiilor medico-sociale care au contribuit la îmbolnăvirea de tuberculoză a migranţilor. Material și Metode. S-a efectuat un studiu de tip selectiv, descriptiv şi retrospective, în care au fost incluși 70 de lucrători migranţi, internați în subdiviziunile clinice ale IMSP Spitalul Clinic Municipal de Ftiziopneumologie în anul 2018. Rezultate. Repartizând pacienţii în dependenţă de sex am constatat predominarea bărbaților cu 46 (65,71%) faţă de 24 (34,28%) femei. Tuberculoza activă se întâlnește mai frecvent la pacienții cu următorii factori de risc: domiciliu urban, absenţa locului de trai stabilt, neasigurare, şomeri. Microbiologic pozitiv a fost fiecare al treilea, iar fiecare al cincilea a fost diagnosticat cu TB-MDR. La examinarea pacienţilor, simptomatici au fost fiecare al doilea pacient şi doar fiecare al cincilea prin examinarea grupurilor cu risc sporit de îmbolnăvire. Succesul terapeutic sa stabilit la fiecare al doilea caz, decedat fiecare al cincilea şi a fost pierdut din supraveghere fiecare al patrulea. Concluzii. Impactul negativ al migrației asupra evoluției tuberculozei poate fi constatat prin rata înaltă a deceselor și întreruperea tratamentului ce crește riscul dezvoltării tuberculozei drogrezistente

Determinants of loss to follow-up and tuberculosis patients' awareness

Background: The highest rate of patients with the low disease outcome is represented by the lost to follow-up and died cases. The aim of the study wasto assess the major determinants of low tuberculosis treatment outcome. Material and methods: A retrospective selective, descriptive, case-control study targeting social, demographic, economic and epidemiological peculiarities,case-management, radiological aspects and microbiological characteristics of 437 patients with pulmonary tuberculosis with different outcomes: curedand lost to follow-up was performed. Patients’ awareness was established by performing a pre-designed schedule containing open-ended and close-endedquestions, reflecting knowledge about disease. There were interviewed 151 patients treated after a previous lost to follow-up. Results: It was established that the major risk factors for loss to follow-up were: the history of detention, migration, patients with MDR-TB, patient’saddressing to the hospital, previous history of treatment and social vulnerability. Most of the patients were aware about the disease through the healthpersonnel and were satisfied with the received knowledge. The proportion of those who were informed through the mass media was high. They knewthat tuberculosis is curable with a complete treatment; however, every tenth considered that two-three months are sufficient. Conclusions: Raising awareness among patients with high risks about the compliance and the duration of the treatment, emphasizing that the treatmentis free of charge and will not be started after a previous drop up will improve disease outcome

The assessment of different tuberculosis-related features in Moldova regions

Department of Pneumophthisiology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Tuberculosis represents a social-related disease and for identifying the priority interventions for reducing its impact must be identified the main disparity features of patients. Material and methods: Global Competitiveness Report and Report of the National Centre for Health Management were used. The clinical study was retrospective, randomized, selective, and included 263 new pulmonary TB cases registered in three different Moldovan regions: Chisinau (center), Balti (north) and Cahul (south). Results: Attributable risk identified that in Chisinau compared to Balti predominated patients in economical vulnerable state, without health insurance, GeneXpert MTB/ Rifampicin sensible and those who successfuly finished the treatment. In Balti compared to Chisinau predominated chronic alcohol abusers, co-morbid patients, severe pulmonary tuberculosis, direct addressing to the hospital, patients infected with GeneXpert MTB/Rifampicin resistant strains of Mycobacteria. The major differences between Chisinau and Cahul groups, with predominance in Chisinau were homeless, co-morbid patients and those who successfully finished the treatment course. In Cahul predominated patients with rural residence, direct addressed to the regional hospital and severe forms of tuberculosis. Comparing the Balti and Cahul groups was established the predominance in Cahul of patients with rural residence, in economically vulnerable state and patient’s detection by general practitioner. In Balti predominated co-morbid patients, alcohol abusers, patients with severe forms of tuberculosis. Conclusions: Reduction of health care inequality will be achieved through social assistance of vulnerable groups and improvement of the general public life

Особенности борьбы с туберкулезом и человеческие ресурсы

Universitatea de Stat de Medicină şi Farmacie Nicolae TestemiţanuTuberculosis control is a priority for the health system of the Republic of Moldova. In 2016, the National Tuberculosis Control Program was adopted, according to the objectives of the worldwide implemented End TB strategy. The evaluation of the Program’s performance indicators established a positive dynamics; however the rate of patients with severe forms and low incidence of drug-resistant patients established barriers for the early detection, low activity in high risk groups and insuffi cient use of new diagnostic methods. The high rate of therapeutic success was conditioned by the exclusion of the drug-resistant tuberculosis cohort, and the reduced mortality was endangered by the number of patients diagnosed after death. The proportion of the TB-HIV varied according to the regions, the maximum being in the north of the country. The large number of hospital beds associated with long-term hospitalization conditioned a fi nancial burden and high risk of nosocomial infection transmission. The precarious mechanism of tuberculosis patient centered care was established an impediment for ensuring an optimal therapeutic efficacy.Борьба с туберкулезом является одним из приоритетов здравоохранения страны. В 2016 году была утверждена Национальная Программа по борьбе с туберкулезом, которая внедрила цели. Стратегии End TB. Оценка основных показателей эффективности Программы выявила положительную динамику, однако высокий процент больных с тяжелым течением туберкулеза и значительная доля пациентов с лекарственной устойчивостью демонстрируют наличие препятствий в обследование групп риска и недостаточное использование новых методов диагностики. Высокий показатель успешности лечения был обусловлен исключением больных с лекарственной устойчивостью, а снижение смертности включало большое число пациентов с диагнозом, установленным после смерти. Доля ТБ-ВИЧ варьировала в зависимости от регионов, самый высокий уровень выявлен на севере страны. Большое число больничных коек, связанных с длительной госпитализацией, обусловливает высокие финансовые затраты и риск внутрибольничной инфекции. Несовершенный подход к пациенту с туберкулезом является препятствием в обеспечении оптимальной терапевтической эффективности

Aлгоритм оценки риска неудачного лечения туберкулеза легких

Catedra Pneumoftiziologie, IP USMF Nicolae TestemiţanuSummary. R Moldova reports the highest incidence of tuberculosis (114,3/100.000) in European Regions, the lowest treatment success rate (52,3%) and the highest treatment failure rate (2009-6,2%, 2010-19,6%, 2011- 3,6%). Using, a study group of 201 new pulmonary TB cases with treatment failure and a control group of 105 new pulmonary TB cases cured, were evaluated risk factors for antituberculosis treatment failure and was performed an algorithm of risk estimation of treatment failure.Резюме. Р. Молдова подтверждает самый высокий уровень заболеваемости туберкулезом (114,3/100.000), самый низкий уровень эффективности результата лечения (52,3%) и самый высокий уровень неудачного лечения туберкулеза легких (2009 – 6,2%, 2010 – 19,6%, 2011 – 3,6%) в Европейском Регионе. Были изучены причины неудачного лечения туберкулеза легких как факторов риска у основной группы, составленной из 201 нововыявленных больных с неудачным лечением и соответственно у контрольной группы, составленной из 105 нововыявленных больных с удачным лечением. Был составлен алгоритм оценки риска неудачного лечения для использования пневмофтизиатрами

Risk factors segregation of tuberculosis patients: retrospective, cohort study

Catedra de pneumoftiziologie, Universitatea de Stat de Medicină și Farmacie ”Nicolae Testemiţanu”, Chișinău, Republica MoldovaRezumat Introducere. Tuberculoza reprezintă o boală infecţioasă asociată determinanţilor sociali ai sănătăţii, ale căror neluare în consideraţie conduce la deficienţe în controlul maladiei. Material și metode. A fost realizat un studiul retrospectiv, de tip cohortă, care a inclus 668 de cazuri, înregistrate în municipiul Chișinău în perioada anului 2015. Criteriile de includere au constituit: vârsta peste 15 ani, diagnostic de ,,tuberculoză şi consimţământ informat semnat. Rezultate. Segregarea pacienţilor conform particularităţilor sociale și economice a stabilit următoarele grupuri cu risc sporit de îmbolnăvire: social (absenţa poliţei de asigurare, şomajul, condiţiile de de trai precare), biologici (vârsta cu risc ftiziogenic, statutul comorbid, deprinderi habituale cu risc morbid) și alte grupuri minore (contacţi, migranţi, persoane cu istoric de detenţie). Factorii de risc au contribuit la depistarea tardivă a fiecărui al doilea bolnav. Rata mică a succesului terapeutic este asociată cu o rată înaltă a deceselor. Concluzii. Stratificarea pacienţilor în funcţie de grupul de risc permite asigurarea unei abordări individualizate, centrate pe pacient.Abstract Introduction. Tuberculosis is an infectious disease associated to the health determinants and their lack of approach contributes to the failure of disease control. Material and methods. A retrospective, cohort type study was performed using 668 patients registered in Chisinau during 2015. Including criteria were: age more than 15 years old, patient diagnosed with tuberculosis and the signed informed consent. Results. Patients segregation according to the social and economic features established several risk groups: social (lack of health insurance, unemployment and poor living conditions), biologic (high risk phtysiogenic age, comorbid state, harmful habits with morbid risk) and other minor groups (contacts with infected people, migrants, individuals with history of detention). Risk factors contributed to the late detection of every second patient. Low treatment success rate was associated with a high rates of death. Conclusions. The patients stratification according to the risk proportion permits the establishment of the patient-centered care and application of an individualized approach

Tuberculosis evolution and treatment outcome in drug addicted patients

Background: Drug injection is considered an important issue for the public health of the Republic of Moldova. In the RM the intravenous drug users (IVDU) are the key population for HIV infection, B and C hepatitis, TB and sexual transmitted diseases. The aim of the study was to assess the tuberculosis evolution and treatment outcome in intravenous drug addicted patients. Material and methods: A retrospective selective, descriptive study targeting socioeconomic, demographic, economic and epidemiological peculiarities, case-management, diagnosis of radiological aspects and microbiological characteristics of 233 patients with pulmonary tuberculosis registered in Chisinau city from 2012 to 2016 among them 48 IVDU was performed. The results were compared with a sample of 34 IVDU. Results: Men were predisposed for drug addiction and the age is younger in addicts with tuberculosis. Socioeconomic vulnerability is extended in the selected groups; however, the poverty deepness was more important in addicted patients with tuberculosis. Close contact with a sick patient predominated in addicts with tuberculosis, but nobody assessed the contact in addicts without tuberculosis. Associated diseases predominated in addicts with or without tuberculosis, more frequently were: HIV infected individuals, viral hepatitis and neurological disorders. Conclusions: Risk factors for tuberculosis in drug addicts were: unemployment and associated lack of health insurance, patient’s homeless state, middle adulthood and the immune suppressive condition – HIV infection. Major disease-related characteristic in IVDU patients was the presence of severe destructive forms of tuberculosis and "loss to follow-up" as outcome