Medical workers of health care institutions as a risk group for chemo-resistant tuberculosis: analysis of incidence, a clinical case.

The purpose of our study was to analyze the prevalence of morbidity of medical workers of health care institutions and anti-tuberculosis institutions, as well as the analysis of resistance of mycobacterium tuberculosis strains among medical personal of health facilities in the Dnipropetrovsk region. Retrospective analysis for 2015 - 2017 of electronic database of the patients register (TB-manager), outpatient cards and case histories of patients which underwent treatment in pulmonary-tuberculosis and surgical departments of CI «DnepropetrovskRegional Clinical Treatment and Prophylactic Association "Phthisiology"» DRC» was conducted . The incidence of tuberculosis among medical workers in health care institutions of Ukraine remains at a fairly high, stable level (426 cases of tuberculosis in 2016, 389 cases in 2017) on the background of the decrease in the incidence among the general population (59.5 people per 100 thousand population in 2014 and 51.9 per 100 thousand population in 2017 ). In Ukraine among tuberculosis patients – medical workers,  the overwhelming majority are workers of establishments of the general medical network (GMN) - 351 people, while in anti-tuberculosis institutions (ATI) in 2017, 38 cases of tuberculosis were registered. The article presents the clinical case of multidrug-resistant tuberculosis (MDR) in staff member of the pathoanatomical bureau, one of the medical institutions of the city Dnipro

Medical workers of health care institutions as a risk group for chemo-resistant tuberculosis: analysis of incidence, a clinical case.

The purpose of our study was to analyze the prevalence of morbidity of medical workers of health care institutions and anti-tuberculosis institutions, as well as the analysis of resistance of mycobacterium tuberculosis strains among medical personal of health facilities in the Dnipropetrovsk region. Retrospective analysis for 2015 - 2017 of electronic database of the patients register (TB-manager), outpatient cards and case histories of patients which underwent treatment in pulmonary-tuberculosis and surgical departments of CI «DnepropetrovskRegional Clinical Treatment and Prophylactic Association "Phthisiology"» DRC» was conducted . The incidence of tuberculosis among medical workers in health care institutions of Ukraine remains at a fairly high, stable level (426 cases of tuberculosis in 2016, 389 cases in 2017) on the background of the decrease in the incidence among the general population (59.5 people per 100 thousand population in 2014 and 51.9 per 100 thousand population in 2017 ). In Ukraine among tuberculosis patients – medical workers,  the overwhelming majority are workers of establishments of the general medical network (GMN) - 351 people, while in anti-tuberculosis institutions (ATI) in 2017, 38 cases of tuberculosis were registered. The article presents the clinical case of multidrug-resistant tuberculosis (MDR) in staff member of the pathoanatomical bureau, one of the medical institutions of the city Dnipro

The ATLAS Transition Radiation Tracker (TRT) proportional drift tube: design and performance

A straw proportional counter is the basic element of the ATLAS Transition Radiation Tracker (TRT). Its detailed properties as well as the main properties of a few TRT operating gas mixtures are described. Particular attention is paid to straw tube performance in high radiation conditions and to its operational stability

The ATLAS TRT electronics

The ATLAS inner detector consists of three sub-systems: the pixel detector spanning the radius range 4cm-20cm, the semiconductor tracker at radii from 30 to 52 cm, and the transition radiation tracker (TRT), tracking from 56 to 107 cm. The TRT provides a combination of continuous tracking with many projective measurements based on individual drift tubes (or straws) and of electron identification based on transition radiation from fibres or foils interleaved between the straws themselves. This paper describes the on and off detector electronics for the TRT as well as the TRT portion of the data acquisition (DAQ) system

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Результати хірургічного лікування хворих з двобічним деструктивним туберкульозом легень

Objective: to improve surgical treatment efficiency in patients with limited bilateral destructive pulmonary tuberculosis.Materials and methods. The outcomes of 80 simultaneous bilateral lung resections in patients with limited destructive tuberculosis were evaluated depending upon the types of surgical access which were as follows: video-assisted thoracic surgery (VATS) resection (28 patients), transsternal access (25), and routine thoracotomy (27 cases).Results and conclusions. When performing simultaneous bilateral VATS resection, intraoperative blood loss decreased by 1.8 times as compared with the routine thoracotomy and 1.5 times as compared with the sternotomy. The risk of postoperative complications after VATS resection decreased by 1.6 times. The use of bilateral VATS resection may significantly reduce the surgical injury in comparison with traditional approaches, better visualise resection area due to the optical magnification and perform a more radical resection of a tuberculous lesion with meticulous haemo- and aerostasis, reduce lung tissue deformation.Цель: повышение эффективности хирургического лечения больных с ограниченным двусторонним деструктивным туберкулезом легких.Материалы и методы. Оценены результаты 80 одновременных двусторонних резекций легких у больных с ограниченным деструктивным туберкулезом в зависимости от типа хирургического доступа: VATS-резекция (28 больных), трансстернальный доступ (25), рутинная торакотомия (27).Результаты и выводы. При выполнении одновременной двусторонней VATS-резекции интраоперационная кровопотеря уменьшилась в 1,8 раза по сравнению с рутинной торакотомией и в 1,5 раза по сравнению со стернотомией. Риск послеоперационных осложнений после VATS-резекции снизился в 1,6 раза. Применение двусторонней VATS-резекции позволяет значительно снизить травматичность оперативного вмешательства посравнению с традиционными способами, лучше визуализировать зону резекции за счет оптического увеличения и выполнить более радикальную резекцию туберкулезного очага с тщательным гемо- и аэростазом, уменьшить деформацию легочной ткани.Мета: підвищення ефективності хірургічного лікування хворих з обмеженим двостороннім деструктивним туберкульозом легень.Матеріали і методи. Оцінено результати 80 одночасних двосторонніх резекцій легень у хворих з обмеженим деструктивним туберкульозом залежно від типу хірургічного доступу: VATS-резекція (28 хворих), трансстернальний доступ (25), рутинна торакотомія (27).Результати та висновки. При виконанні одночасної двосторонньої VATS-резекції інтраопераційна крововтрата зменшилася в 1,8 разу порівняно з рутиною торакотомією і в 1,5 разу порівняно зі стернотомією. Ризик післяопераційних ускладнень після VATS-резекції знизився у 1,6 разу. Використання двосторонньої VATS-резекції дозволяє значно знизити травматичність оперативного втручання порівняно з традиційними способами, краще візуалізувати зону резекції за рахунок оптичного збільшення і виконати більш радикальну резекцію туберкульозного вогнища з ретельним гемо- та аеростазом, зменшити деформацію легеневої тканини

Histomorphological features of combined forms of tuberculosis and lung cancer.

The were studied pathological features of combined forms of tuberculosis and non-small cell lung cancer in 72 patients who underwent radical surgical resection interventionsfrom transsternal access with mediastinal lymph node dissection, with predominanceof pneumonectomy - 63.9%. There were identified three main categories of pathological changes: cancer on the background of post-tuberculosis changes, cancer in tuberculoma, cancer in the wall of the active cavity. Post-tuberculosis changes were presented by dense centers, fibrosis, cirrhosis areas, sanitized cavities with histological predominance of coarse fiber connective tissue with giant cellgranulomas, with areas characterized by the appearance of the lung tissue with atypical proliferation and metaplasia of bronchopulmonary epithelium, which is a precancerous condition. This malignant tumor process was presented mainly by adenocarcinomas and squamous cell cancer and differred by polymorphic macro- and microscopic picture. Cancer intuberculoma and fibrous wall cavity differed by pronounced activity of tuberculosis process in the form of lymphohistiocytic infiltration, foci of caseous necrosis and presence of expressed granulation layer of Pirogov-Langhans’cells. The basic morphological causes of carcinogenesis due to secondary changes of lung tissue in patients with tuberculosis were determined. The features of metastasis of malignant tumors on the background of specific tuberculous and post-tuberculosis changes in regional lymph nodes and the interrelation between the frequency of metastatic lesions with severity of tuberculosis and post-tuberculosis changes in them were studied; this has clinical significance in the surgical treatment of patients with concomitant forms of tuberculosis and lung cancer