Screening for tuberculosis of patients with HIV-infection. New possibilities

Background. Tuberculosis associated with HIV infection is becoming almost a new disease, where not only new approaches to treatment are being formed, but there is also a need to improve the quality and search for new means of early diagnosis of tuberculosis infection.The aim. To evaluate the diagnostic performance of the T-SPOT.TB test for the detection of latent tuberculosis infection and clinical forms of tuberculosis in patients with HIV infection.Materials and methods. 396 patients registered at the AIDS Center for more than a year were examined. Everyone underwent standard examinations for pulmonary tuberculosis using sputum bacterioscopy techniques with Ziehl – Neelsen staining; a molecular genetic method based on hybridization technology – HAIN-GenoType MTBDRplus; crops on liquid media in the automated BACTEC MGIT 960 system and on Löwenstein–Jensen dense medium. T-SPOT.TB was conducted as a screening for everyone. With positive T-SPOT.TB results, negative results of the MBT search, absence of specific changes on the X-ray a conclusion was made about latent tuberculosis infection. Statistical data processing was carried out using the software package Statistica 10 (StatSoft Inc., USA).Results. According to the results of a comprehensive examination, tuberculosis was diagnosed in 174 patients, verified using various methods of searching for Mycobacterium tuberculosis in 116 patients (66.6 %). Infiltrative (63.8 %) and disseminated (24.7 %) tuberculosis were more often diagnosed. Latent tuberculosis infection was diagnosed in 52 patients, 170 HIV-infected patients have no data for tuberculosis at this stage.Conclusions. T-SPOT.TB can be used in the diagnostic complex of monitoring patients with HIV infections – as a screening method to detect latent tuberculosis, for preventive chemotherapy

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

Characteristics of local immunity in infants

The state of immunity of infant depends on the nature of nutrition. To assess the state of local immune protection in infants, non-invasive methods are used. Infants fed with breast milk have additional protection against respiratory, intestinal, and urinal infections, as they receive sIgA with mother's milkСостояние иммунитета детей первого года жизни зависит от характера питания. Чтобы оценить состояние местной иммунной защиты у детей грудного возраста используют неинвазивные методы. Дети, вскармливаемые грудным молоком, имеют дополнительную защиту от возбудителей респираторных, кишечных и уринарных инфекций, так как получают sIgA с материнским молоко

Healthcare delivery for HIV-positive people with tuberculosis in Europe

Background In a 2013 survey, we reported distinct discrepancies in delivery of tuberculosis (TB) and HIV services in eastern Europe (EE) vs. western Europe (WE). Objectives To verify the differences in TB and HIV services in EE vs. WE. Methods Twenty-three sites completed a survey in 2018 (EE, 14; WE, nine; 88% response rate). Results were compared across as well as within the two regions. When possible, results were compared with the 2013 survey. Results Delivery of healthcare was significantly less integrated in EE: provision of TB and HIV services at one site (36% in EE vs. 89% in WE; P = 0.034), and continued TB follow-up in one location (42% vs. 100%; P = 0.007). Although access to TB diagnostics, standard TB and HIV drugs was generally good, fewer sites in EE reported unlimited access to rifabutin/multi-drug-resistant TB (MDR-TB) drugs, HIV integrase inhibitors and opioid substitution therapy (OST). Compared with 2013, routine usage of GeneXpert was more common in EE in 2018 (54% vs. 92%; P = 0.073), as was access to moxifloxacin (46% vs. 91%; P = 0.033), linezolid (31% vs. 64%; P = 0.217), and bedaquiline (0% vs. 25%; P = 0.217). Integration of TB and HIV services (46% vs. 39%; P = 1.000) and provision of OST to patients with opioid dependency (54% vs. 46%; P = 0.695) remained unchanged. Conclusion Delivery of TB and HIV healthcare, including integration of TB and HIV care and access to MDR-TB drugs, still differs between WE and EE, as well as between individual EE sites

Risk factors and clinical diagnostic of pylorostenosis in chilldren

The article presents an analysis of retrospective studies of children operated on for pyloric stenosis. The influence of adverse factors in the formation of the antenatal period pathology of the upper gastrointestinal tract. Determine the cause of late diagnosis of pyloric stenosis.В статье представлен анализ ретроспективного исследования детей, прооперированных по поводу пилоростеноза. Установлено влияние неблагоприятных факторов антенатального периода на формирования патологии верхних отделов пищеварительного тракта. Определены причины поздней диагностики пилоростеноза

Периферическая ритмическая магнитная стимуляция при нейрогенных расстройствах мочеиспускания: обзор литературы и результаты клинического исследования

Urinary disorders caused by peripheral nervous system injury are characterized by weakness of neural control of lower urinary tract. Clinical and urodynamic examination demonstrate detrusor-hyporeflexia and its reduced contractility. Magnetic stimulation influences autonomic and somatic nerves innervating pelvic organs but the mechanism of action is still unclear. This paper presents literature review on diagnostics and treatment of neurogenic urinary disorders by using magnetic stimulation and the results of our investigational study. 7 patients with neurogenic urinary retention were included in a prospective study of peripheral repetitive magnetic stimulation. Prolonged clinical improvement during the follow-up of 3 months was observed in all patients.Расстройства мочеиспускания, обусловленные повреждением периферической нервной системы, характеризуются ослаблением активной иннервации нижних мочевых путей. Клинико-уродинамическая картина соответствует гипорефлекторному мочевому пузырю, при котором наблюдается нарушение сократительной активности детрузора. Магнитная стимуляция оказывает воздействие на вегетативные и соматические нервные волокна, участвующие в иннервации органов малого таза, однако в настоящее время механизм действия остается неизученным. В статье представлены обзор данных литературы, касающейся диагностики и лечения нейрогенных расстройств мочеиспускания с помощью магнитной стимуляции, а также результаты собственного клинического исследования. Были выполнены обследование и наблюдение 7 пациентов с нейрогенной задержкой мочеиспускания вследствие поражения периферической нервной системы. Больным проводили процедуры периферической ритмической магнитной стимуляции ежедневно, на курс 10 сеансов. У всех пациентов наблюдался клинический результат в течение 3 мес. 

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

Pilot assessment of students’ mastering outpatient department physician communication skills during the COVID-19 pandemic

The results of an anonymous Google forms survey of the USMU faculty of medicine and prevention 6th year students are discussed. The survey was dedicated to the assessment by the final year students the possibilities of mastering practical skills of a primary care physician during practical training in outpatient departments during the pandemic of coronavirus infection, as well as students’ suggestions for organizing practical training.В статье рассмотрены результаты анкетирования с помощью гугл-опросника студентов 6-го курса лечебно-профилактического факультета УГМУ по оценке возможностей освоения практических навыков врача в ходе практической подготовки в поликлиниках в период пандемии коронавирусной инфекции, а также предложения студентов по организации практической подготовки

Диагностика туберкулеза легких в условиях пульмонологического отделения стационара

A clinical case of 23-year old female with pulmonary tuberculosis is described in this article. The patient was admitted to a hospital with preliminary diagnosis of community-acquired pneumonia and negative TB test. Differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia is often difficult and could be more difficult in patients with co-existing specific (Mycobacterium tuberculosis) and non-specific infection in the lungs.Дифференциальная диагностика туберкулеза легких (ТЛ) и пневмонии является сложной проблемой на этапе первичного обследования пациента в терапевтической практике. Представлен клинический случай диагностики ТЛ у 23-летней женщины при поступлении в стационар терапевтического профиля с диагнозом внебольничная пневмония при наличии отрицательных специфических тестов на ТЛ. Диагностика также может быть затруднена при наличии сочетанной специфической (микобактерии туберкулеза) и неспецифической инфекции в зоне воспалительного поражения легких

Nutrition status and development of infants and children of early age

The article presents the results of a complex estimation of health of 150 children and infants. In the study some children were identified abnormalities in nutritional status: the presence of alimentary-dependent conditions, a deficiency of one or more macro - and microelements in the urine (iodine, zinc, magnesium, iron, molybdenum, calcium). At most of children iodine deficiency of different degree of expressiveness is revealed. Correlation interrelations between the level of microcells and existence of deviations in a state of health of children are defined.В статье представлены результаты комплексной оценки здоровья 150 детей грудного и раннего возраста. В ходе исследования у части детей были выявлены отклонения в нутритивном статусе: наличие алиментарно-зависимых состояний, дефицит одного и более макро- и микроэлементов в моче (йода, цинка, магния, железа, молибдена, кальция). У большинства детей выявлен йодный дефицит разной степени выраженности. Найдены определенные корреляционные взаимосвязи между уровнем микроэлементов и наличием отклонений в состоянии здоровья детей