Relief-topography of anterior and posterior corneal surfaces in myopic patients in the long-term follow-up period after anterior radial keratotomy

Purpose. To analyze the topographical features of the relief of anterior and posterior corneal surfaces in patients with myopia in the long-term period after anterior r adial keratotomy (ARK).Material and methods. We examined 132 patients with age-related cataracts of varying degrees of density and a history of myopia with previously performed ARK. Mean age of patients was 59.67±6.09 (from 47 to 76). In the control group, 30 patients of the same age group with myopia were examined. A comprehensive examination was performed, including optical biometry, keratotopography on the Pentacam HR device with the determination of the elevation points of the anterior and posterior corneal surfaces.Results. The corneal profile differed from the correct spherical configuration in the control group. The average deviation of the profile of the anterior part of the cornea from the BFS was (–)1.41±5.10 μm, the posterior part was (–)5.12±12.25 μm (p=0.0001). The profile of the posterior corneal surface had a pronounced prolapse in the paracentral area with positive elevation values in the lower-outer segment. Negative values were found in the upper and lower sectors in the peripheral area and positive values were found in the inner and outer sectors. The corneal profile was deformed in patients after ARK. Negative elevation values in the central and paracentral area and positive elevation values in the peripheral segments corresponding to its protrusion were noted. At the same time, the relief of anterior and posterior surfaces of the cornea was not regular. Prolapse from the posterior surface of the cornea in the peripheral area was more pronounced than its anterior surface (p=0.0001).Conclusion. The relief of anterior and posterior corneal surfaces in patients of the control group differs in the degree and topography of elevation. In patients after ARK, obvious topographic deformities of the anterior and posterior corneal pr ofiles were detected

DETECTION OF TUBERCULOUS MYCOBACTERIA IN THE BLOOD OF PATIENTS WHEN SUSPECTING TUBERCULOUS SEPSIS

The increase in HIV patients manifesting clinical signs of sepsis requires up-to-date, rapid and reliable techniques for etiologic diagnostics.The analysis has included 53 publications related to various aspects of tuberculous bacteriemia, resources for its detection and their efficiency. According to the publications tuberculous mycobacteria in blood can be detected in HIV-positive patients with severe immune suppression (CD4: 17-18 cells/mcl) and presence of the following clinical and laboratory and X-ray signs: fever, severe anemia, paratracheal lymphoadenopathy, miliary dissemination. It is feasible to test the blood in order to detect tuberculous mycobacteria only in the very ill HIV positive patients in whom tuberculosis is suspected and it is impossible to collect sputum and there are no obvious signs of pulmonary lesions.The presence oftuberculous mycobacteria in blood isrelated to the high mortality level (up to 60%) and the immediate prescription of anti-tuberculosis therapy can reduce it. Antiretroviral therapy can reduce the chances of tuberculous sepsis development. Development and optimization of test systems for rapid detection of DNA of tuberculous mycobacteria in blood can be fairly promising for the diagnostics of the urgent tuberculosis

High prevalence of genotype B0/W148 of Mycobacterium tuberculosis among HIV-TB patients in Perm Krai and Irkutsk Region

Background. The population with HIV-infection plays significant role in ongoing tuberculosis pandemic. Immunosuppression due to HIV-infection is one of the causes of TB disseminated forms in this group of people. Having low immune status is also often associated with a polyclonal M. tuberculosis infection. Aim of the research: comparative assessment of epidemic genotypes of M. tuberculosis prevalence and mixed genotypes identification within HlV-TB co-infected patients in two Russian regions. Materials and methods. The DNAs of 78 clinical isolates from Irkutsk Region (IR) and 64 strains from Perm Krai (PK) have been genotyped by MIRU VNTR 24 and RD105/RD207. Strains were obtained from patients who did not have significant age and sex differences. In the PK age of the patients was 34.5 ± 0.9, in IR - 34.4 ± 1.5 years. The samples were obtained from 67.2 and 65.4 % of men, respectively. Result. The study of the M. tuberculosis indicates significant predominance of Beijing genotype strains in patients with TB-HIV of PK (92.2 %) compared to the IR (59.5 %) (х2 = 18.0; p < 0.01). The prevalence of MDR pathogens in TB-HIV patients exceeded 50 %. The mixed genotype detection in the PK and IR was high (14.1 and 12.7 % respectively). The level of virulent strains B0/W148 was 34.4 % in PK patients and 25.3 % in IR ones. Analysis of the results suggests the epidemic spread of MDR-TB in the immunocompromised individuals. Conclusions: The identified trends may indicate that Perm Kray have a process of active dissemination of transmissible strains of M. tuberculosis within HIV-infected population

ВЫЯВЛЕНИЕ МИКОБАКТЕРИЙ ТУБЕРКУЛЕЗА В КРОВИ КАК МЕТОД ДИАГНОСТИКИ ГЕНЕРАЛ ИЗОВАННОГО ТУБЕРКУЛЕЗА У ПАЦИЕНТОВ С ВИЧ-ИНФЕКЦИЕЙ

Objective: To study the informative value of the detection of mycobacteria in blood with the cultural method in patients with suspected tuberculous sepsis and to determine the most significant clinical and laboratory criteria for testing. Materials and methods: The investigation to detect M.tuberculosis was fulfilled in 159 HIV-positive patients with suspected tuberculosis sepsis. Blood culture was completed with culture medium Myco/F Lytic Culture Vials and analyzer BACTEC 9050. Results: Mycobacteria were detected in blood of 19 patients (11,9% of all patients): in 18 patients the growth of М. tuberculosis complex was detected (25,3% of all patients with diagnosed tuberculosis) and in 1 patient it was Mycobacterium avium complex (0,6% of all patients). It was shown, that the probability of M.tuberculosis detection was especially associated with the severity of the disease, immunosupression (less than 100 cells/mkl), hemoglobin quantity less than 90 g/l (levels were determined through the seeking for the most significant cutoffs). It was not proofed, that meningoencephalitis develops more often in patients with proven bacteremia. There were no evident differences in detection frequency of mycobacteria in sputum between patients with tuberculous sepsis and without it.Цель: изучить информативность культурального исследования крови на МБТ у больных ВИЧ-инфекцией с подозрением на туберкулезной сепсис и определить наиболее значимые предтестовые клинико-лабораторные критерии. Материалы и методы: обследование для выявления микобактерий в крови выполнено 159 больным ВИЧинфекцией с подозрением на туберкулезный сепсис. Посев крови производили на среду Myco/F Lytic Culture Vials и помещали в гемоанализатор BACTEC 9050. Результаты: микобактериальная инфекция кровотока выявлена у 19 пациентов (11,9% от числа тестируемых): у 18 человек обнаружен рост М. tuberculosis complex (25,3% от числа больных туберкулезом) и у одного больного – Mycobacterium avium complex (0,6% от числа тестируемых). Выявлено, что вероятность бактериемии наиболее связана с тяжестью состояния пациента; иммуносупрессией менее 100 клеток/мкл; снижением уровня гемоглобина менее 90 г/л (уровни были определены посредством поиска наиболее значимых порогов). Не удалось доказать, что менингоэнцефалит чаще развивается у лиц с подтвержденной бактериемией. Достоверных различий по частоте выявления МБТ в мокроте у больных с туберкулезным сепсисом и без него выявить не удалось

Основные характеристики заболеваемости глаукомой в Иркутской области и их связь с организационно- методическими мероприятиями офтальмологической

PURPOSE: Russian glaucoma epidemiological studies are scattered and not always objective, since they are based on the outcomes of the annual reports provided by the primary care ophthalmologists. Taking into account the significant staff shortages, these data may not fully reflect the true epidemiological situation. A similar situation exists in the studied region, which defined the purpose of the present work: to identify the key epidemiological characteristics in long-term morbidity of glaucoma in Irkutsk region to improve the system of clinical examination. METHODS: 300.000 medical records of patients referred to the Irkutsk branch of Sv. Fyodorov Eye Microsurgery Institute between 1992 and 2013 diagnosed with glaucoma were processed. Epidemiological evaluation of the data was based on the analysis of primary morbidity with a further characteristic of the disease stages. The results of the study were processed using conventional parametric and nonparametric statistical analysis. The obtained absolute values were transferred to intensive parameters using the following formula: A/Bx1000=intensive index, where A is the number of patients with newly diagnosed glaucoma, B - the number of patients referred to the Irkutsk branch of Sv. Fyodorov Eye Microsurgery Institute during a one year period. Due to the fact that 80% of glaucoma patients living in the Irkutsk region undergo the primary examination in the Irkutsk branch of Sv. Fyodorov Eye Microsurgery Institute of Russian Ministry of Health, the data were extrapolated to the epidemiological situation in the entire region. RESULTS: The incidence of glaucoma increased from 45.2 to 140.6 per 1,000 patients. We noted an increasing detection rate of preclinical stages of glaucoma. At the same time, the detection rate of advanced stages of glaucoma remained stable. Four periods during which the incidence increase exceeded the expected results were identified. These periods correspond to widespread application of new diagnostic technologies and realization of additional organizational arrangements in this area. CONCLUSION: The results of the study allowed estimating the epidemiological situation on glaucoma and identifying the main regularities of its development. This information can be used in predicting the major trends in the prevalence of glaucoma for better preventive healthcare management decisions.ЦЕЛЬ. Эпидемиологические исследования глаукомы в России носят разрозненный и не всегда объективный характер, так как основываются на итоговых годовых отчётах, предоставляемых специалистами-офтальмологами первичного звена, однако с учетом значительного кадрового дефицита эти данные не могут полностью отражать истинную эпидемиологическую обстановку. Аналогичная ситуация сложилась и в изучаемом регионе, что и определило цель настоящей работы - выявление основных эпидемиологических характеристик в многолетней заболеваемости глаукомой в Иркутской области для совершенствования системы диспансеризации. МЕТОДЫ. Обработано 300 тысяч медицинских карт пациентов, обратившихся в Иркутский филиал ФГБУ МНТК «МГ» с диагнозом глаукома за период с 1992 по 2013 гг. Эпидемиологическая оценка полученных данных основывалась на анализе первичной заболеваемости с дальнейшей ее характеристикой по стадиям заболевания. Результаты исследования обработаны с использованием общепринятых параметрических и непараметрических критериев статистического анализа. Полученные абсолютные значения были переведены в интенсивные показатели по следующей формуле: А/Вх1000=интенсивный показатель, где: А - количество пациентов с впервые установленным диагнозом «глаукома», В - количество всех пациентов, обратившихся в ИФ МНТК «МГ» за год. В связи с тем, что 80% больных глаукомой, проживающих в Иркутской области, проходят первичное углубленное обследование в Иркутском филиале ФГБУ «МНТК «Микрохирургия глаза» им. акад. С.Н. Федорова» Минздрава России (ИФ МНТК «МГ»), полученные данные были экстраполированы на эпидемиологическую ситуацию во всем регионе. РЕЗУЛЬТАТЫ. Выявлен рост заболеваемости глаукомой с 45,2 до 140,6 на 1000 обследованных. Отмечено увеличение выявляемости этого заболевания в доклинических стадиях. В то же время остается стабильным показатель выявления глаукомы в далекозашедших стадиях. Определены четыре периода, в которых рост заболеваемости значительно превышает прогнозируемые результаты. Эти периоды по времени соответствуют широкому внедрению на рассматриваемой территории новых диагностических технологий и проведению дополнительных организационных мероприятий. ЗАКЛЮЧЕНИЕ. Результаты проведенного исследования позволили оценить эпидемиологическую обстановку по глаукоме и выявить основные закономерности ее развития, что может быть использовано в прогнозировании основных тенденций распространенности глаукомы для принятия управленческих решений с целью профилактики заболеваемости

DETECTION OF MYCOBACTERIUM TUBERCULOSIS IN BLOOD FOR DIAGNOSIS OF GENERALISED TUBERCULOSIS IN HIV-POSITIVE PATIENTS

Objective: To study the informative value of the detection of mycobacteria in blood with the cultural method in patients with suspected tuberculous sepsis and to determine the most significant clinical and laboratory criteria for testing. Materials and methods: The investigation to detect M.tuberculosis was fulfilled in 159 HIV-positive patients with suspected tuberculosis sepsis. Blood culture was completed with culture medium Myco/F Lytic Culture Vials and analyzer BACTEC 9050. Results: Mycobacteria were detected in blood of 19 patients (11,9% of all patients): in 18 patients the growth of М. tuberculosis complex was detected (25,3% of all patients with diagnosed tuberculosis) and in 1 patient it was Mycobacterium avium complex (0,6% of all patients). It was shown, that the probability of M.tuberculosis detection was especially associated with the severity of the disease, immunosupression (less than 100 cells/mkl), hemoglobin quantity less than 90 g/l (levels were determined through the seeking for the most significant cutoffs). It was not proofed, that meningoencephalitis develops more often in patients with proven bacteremia. There were no evident differences in detection frequency of mycobacteria in sputum between patients with tuberculous sepsis and without it

ВЛИЯНИЕ ОГРАНИЧЕНИЯ ПОСЕЩАЕМОСТИ ПАЦИЕНТОВ С ВИЧ-ИНФЕКЦИЕЙ, СОЧЕТАННОЙ С ТУБЕРКУЛЕЗОМ, ПОЛИКЛИНИКИ ЦЕНТРА СПИД НА ЧАСТОТУ КОНТАМИНАЦИИ МИКОБАКТЕРИЯМИ БОЛЬНИЧНОЙ СРЕДЫ УЧРЕЖДЕНИЯ

The attendance of patients with HIV infection, combined with tuberculosis, of different medical organizations was studied before and after limiting service of patients with co-infection in the AIDS center polyclinic. 163 flushes from the hospital environment of the AIDS centre polyclinic were studied by polymerase chain reaction for the presence of tuberculosis mycobacteria DNA. It was established that a decrease in the number of visits to a specialized polyclinic by the patients with HIV infection combined with tuberculosis was accompanied by a decrease in the degree of hospital facility environment contamination by tuberculosis mycobacteria.Изучена посещаемость пациентов с ВИЧ-инфекцией, сочетанной с туберкулезом, разных медицинских организаций до и после ограничения обслуживания больных с коинфекцией в поликлинике Центра СПИД. Методом полимеразной цепной реакции на наличие ДНК микобактерий туберкулеза исследовано 163 смыва с объектов больничной среды поликлиники Центра СПИД. Установлено, что уменьшение количества посещений специализированной поликлиники больными с ВИЧ-инфекцией, сочетанной с туберкулезом, сопровождалось снижением степени контаминации больничной среды учреждения микобактериями туберкулеза.</p

New variant of PRDM16 gene nucleotide sequence in a family with various phenotypic manifestations of the non-compacted myocardium

The article presents the examination of three generations of a family with diagnosed left ventricular noncompaction (LVNC) and various phenotypic manifestations of the disease (isolated, hypertrophic and dilated type of LVNC). As a result of a molecular genetics tests, a previously undescribed single nucleotide deletion in the PRDM16 gene was revealed in all family members with the LVNC phenotype, leading to a frameshift mutation in exon 9 and the formation of a premature termination codon. This gene encodes a transcription factor responsible for after-birth suppressing the expression of genes involved in prenatal and postnatal development. Despite the presence of previous studies showing the relationship of the PRDM16 gene with LVNC development, currently there are insufficient data to prove the pathogenicity of the identified variant. However, the segregation of the symptomatic variant in three generations supports the association of the identified variant with LVNC. With the accumulation of information about changes in PRDM16 in patients with cardiomyopathies, it is possible to change the status of this gene and clarify its contribution to primary heart diseases