PATHOGENETIC DIVERSITY OF THE IMMUNE DISTURBANCES IN PATIENTS WITH PULMONARY DRUG SUSCEPTIBLE AND DRUG RESISTANT TUBERCULOSIS

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Răspunsul imun la infecția cu M. tuberculosis constă în activarea resistenței imune mediate celular (RIC). Rezistența naturală (RN) și imunitatea umorală (IU) contribuie la menținerea îndelungată a rezistenței imune la o reinfecție și la reactivarea infecției latente. Scopul. Evaluarea diversității patogenetice a perturbărilor imune (PI) în sânge la pacienții cu tuberculoză pulmonară sensibilă (TB-S) și TB-MDR. Material și metode. Indicatorii RIC (CD3+), rezistenței naturale (numărul fagocitar) și IU (CD19+) au fost determinați la 36 persoane sănătoase (eșantionul control EC), 57 cazuri noi de TB-S (eșantionul de studiu 1-ES1) și 72 cazuri noi de TB-MDR (ES2). Analiza statistică s-a efectuat utilizând SPSS Statistics 23.0. Media s-a raportat la valoarea de referință a EC (%). Intervalul 1-33% de la valoarea de referința în EC a fost considerat gradul 1 al PI , 34-66% - gradul 2 PI, >66% - gradul 3 PI, de asemenea valoarea pozitivă-hiperfuncție imună (HFI) și negativă-deficiență (DI). Rezultate. Indicatorii RIC au demonstrat deficiența imunității celulare (DIC) la 41% pacienți din ES1, toți cu gradul 1 al DIC; în ES2 gradul 1 s-a stabilit la 82% și gradul 2 la 18%. În ES1 s-a stabilit DIC la 90% și deficiența IU (DIU) la 9%. În ES2 s-a determinat DIC la 90%, DIU la 10% și deficiența RN (DRN) la 23%. În ES1 gradul 1 al hiperactivității imune (HAI) s-a determinat la 43%, gradul 2 la 31% și gradul 3 la 26% cazuri. În ES2 gradul 1 al HAI s-a stabilit la 16%, gradul 2 la 36% și gradul 3 la 53% cazuri. Concluzii. Deficiențele RIC au fost mai frecvent stabilite la pacienții cu TB-MDR, fiind asociate cu o rată mai mare a DRN, DIU și un grad mai mare al HAI.Background. The immune response to M. tuberculosis infection consists mainly in the activation of the cell-mediated immune response (CIR). Natural resistance (NR) and humoral immunity (HI) contribute to a long-lasting immune resistance to reinfection and reactivation of latent infection. Objective of the study. Assessment of the pathogenic diversity of immune disorders (ID) in serum in patients with pulmonary susceptible tuberculosis (S-TB) and MDR-TB. Material and Methods. Indicators of CIR (CD3+), NR (phagocytic number), and HI (CD19 +) were determined in 36 healthy individuals (control group-CG), 57 new cases with S-TB (study group 1-SG1) and 72 new cases of MDR-TB (study group 2-SG2). The average was reported to the CG, which was the reference value, %. Range 1-33% of the reference value in CG considered the 1 st degree of ID, 34-66% - the 2 nd degree ID, >66% - the 3rd degree ID, as positive-immune overactivity (IOA) and negative-immune deficiency (ID). Results. Indices of CIR showed in the SG1 the cell-mediated immune deficiencies (CID) in 41% cases all of the 1 st degree ID, in the SG2- CID of the 1 st degree was in 82% and of 2nd degree CID - in 18% of cases. In the SG1 the CID was established in 91% and HI deficiencies (HID) – in 9%. In the SG2 the CID was in 90%, HID in 10% and NR deficiencies (NRD) in 23% of cases. SG1 the 1 st degree IOA was detected in 43%, 2 nd degree 31% and 3rd degree 26% cases. In SG2 the 1st degree IOA was established in 16%, 2 nd degree in 36% and 3rd degree in 53% of cases. Conclusion. The deficiencies of the CIR were more frequently, established in patients with MDR-TB, associated with a higher rate of NRD and HID and a higher degree of IOA

Clinical and radiological aspects of limited forms of infiltrative pulmonary tuberculosis and slowly resolving pneumonia

IMSP Institutul Ftiziopneumologie „Chiril Draganiuc”, IP Universitatea de Stat de Medicină și Farmacie „Nicolae Testemiţanu”Algoritmul diagnosticului tuberculozei pulmonare este definit clar, însă sensibilitatea redusă a metodelor contemporane de laborator în formele limitate, condiționează dificultatea diagnosticului diferențial cu pneumonia, în special cu evoluție trenantă. A fost realizat un studiu de tip caz-control, prospectiv, selectiv, comparativ şi descriptiv pe un lot de 180 pacienți, divizați în 2 eșantioane: I -125 bolnavi de tuberculoză pulmonară infiltrativă cu extindere limitată și eșantionul II - 55 bolnavi de pneumonie comunitară trenantă. Rezultatele obținute au constatat predominarea manifestărilor de impregnare infecțioasă în eșantionul bolnavilor de pneumonie trenantă. Distrucțiile parenchimatoase și diseminația bronhogenă s-au identificat doar în eșantionul bolnavilor de tuberculoză pulmonară. Impactul comorbidităților și a vîrstei înaintate a fost mai impunător în eșantionul bolnavilor de pneumonie trenantă. La majoritatea pacienților a fost constatată o evoluție clinică și radiologică pozitivă sub acțiunea tratamentului etiotrop, însă resorbția considerabilă a infiltratului pulmonar a predominat la bolnavii de pneumonie trenantă.Despite of a clearly defined diagnostic algorithm of pulmonary tuberculosis, low sensibility of contemporary laboratory methods in limited forms of pulmonary tuberculosis contributes to a difficult differential diagnosis with community acquired pneumonia, especially with slowly resolving pneumonia. A case-control, prospective, selective, comparative and descriptive study was performed using a group of 180 patients, divided into two samples: I group - 125 cases with limited form of pulmonary infiltrative tuberculosis; II group - 55 cases with slowly resolving community-acquired pneumonia. The findings identified the prevalence of intoxication syndrome in the slowly resolving pneumonia sample. Lung destructions and bronchogenous dissemination was identified only in the tuberculosis sample. A higher impact of comorbidities and old age was more relevant in slowly resolving pneumonia sample. Clinical and radiological improvement was established in most patients of both groups, but the considerable resorbtion of lung infiltrates predominated in slowly resolving pneumonia sample

Diversitatea patogenetică a perturbărilor imune la pacienții cu tuberculoză pulmonară sensibilă și multidrog-rezistentă

Background. The immune response to M. tuberculosis infection consists mainly in the activation of the cell-mediated immune response (CIR). Natural resistance (NR) and humoral immunity (HI) contribute to a long-lasting immune resistance to reinfection and reactivation of latent infection. Objective of the study. Assessment of the pathogenic diversity of immune disorders (ID) in serum in patients with pulmonary susceptible tuberculosis (S-TB) and MDR-TB. Material and Methods. Indicators of CIR (CD3+), NR (phagocytic number), and HI (CD19 +) were determined in 36 healthy individuals (control group-CG), 57 new cases with S-TB (study group 1-SG1) and 72 new cases of MDR-TB (study group 2-SG2). The average was reported to the CG, which was the reference value, %. Range 1-33% of the reference value in CG considered the 1st degree of ID, 34-66% - the 2nd degree ID, >66% - the 3rd degree ID, as positive-immune overactivity (IOA) and negative-immune deficiency (ID). Results. Indices of CIR showed in the SG1 the cell-mediated immune deficiencies (CID) in 41% cases all of the 1st degree ID, in the SG2- CID of the 1st degree was in 82% and of 2nd degree CID - in 18% of cases. In the SG1 the CID was established in 91% and HI deficiencies (HID) – in 9%. In the SG2 the CID was in 90%, HID in 10% and NR deficiencies (NRD) in 23% of cases. SG1 the 1st degree IOA was detected in 43%, 2nd degree 31% and 3rd degree 26% cases. In SG2 the 1st degree IOA was established in 16%, 2nd degree in 36% and 3rd degree in 53% of cases. Conclusion. The deficiencies of the CIR were more frequently, established in patients with MDR-TB, associated with a higher rate of NRD and HID and a higher degree of IOA.Introducere. Răspunsul imun la infecția cu M. tuberculosis constă în activarea resistenței imune mediate celular (RIC). Rezistența naturală (RN) și imunitatea umorală (IU) contribuie la menținerea îndelungată a rezistenței imune la o reinfecție și la reactivarea infecției latente. Scopul. Evaluarea diversității patogenetice a perturbărilor imune (PI) în sânge la pacienții cu tuberculoză pulmonară sensibilă (TB-S) și TB-MDR. Material și metode. Indicatorii RIC (CD3+), rezistenței naturale (numărul fagocitar) și IU (CD19+) au fost determinați la 36 persoane sănătoase (eșantionul control - EC), 57 cazuri noi de TB-S (eșantionul de studiu 1-ES1) și 72 cazuri noi de TB-MDR (ES2). Analiza statistică s-a efectuat utilizând SPSS Statistics 23.0. Media s-a raportat la valoarea de referință a EC (%). Intervalul 1-33% de la valoarea de referința în EC a fost considerat gradul 1 al PI , 34-66% - gradul 2 PI, >66% - gradul 3 PI, de asemenea valoarea pozitivă-hiperfuncție imună (HFI) și negativă-deficiență (DI). Rezultate. Indicatorii RIC au demonstrat deficiența imunității celulare (DIC) la 41% pacienți din ES1, toți cu gradul 1 al DIC; în ES2 gradul 1 s-a stabilit la 82% și gradul 2 la 18%. În ES1 s-a stabilit DIC la 90% și deficiența IU (DIU) la 9%. În ES2 s-a determinat DIC la 90%, DIU la 10% și deficiența RN (DRN) la 23%. În ES1 gradul 1 al hiperactivității imune (HAI) s-a determinat la 43%, gradul 2 la 31% și gradul 3 la 26% cazuri. În ES2 gradul 1 al HAI s-a stabilit la 16%, gradul 2 la 36% și gradul 3 la 53% cazuri. Concluzii. Deficiențele RIC au fost mai frecvent stabilite la pacienții cu TB-MDR, fiind asociate cu o rată mai mare a DRN, DIU și un grad mai mare al HAI

Течение деструктивного туберкулеза у детей

The aim of the study was to evaluate the outcome of pulmonary tuberculosis with lung destruction in children.Material and methods: a retrospective, selective, analytical research was performed, which included 43 children withtuberculosis. Results: the most frequently affected were girls 25 (58.1%) and the age group between 15 and 18 years 34(79.1%) cases.. Every second child was in tuberculous contact, 41.9% were actively detected and passively 22 (52.4%)cases, even if all patients were symptomatic. Infiltrative tuberculosis predominated, in equally proportion was extendedand limited, in most patients with unilateral localization, and with dissemination. Microscopic positive were 20 (46.5%)cases, GeneXpert MTB / Rif positive 30 (69.8%) cases, including resistant in 9 (20.9%) cases. Therapeutic success wasregistered in 30 (69.8%) cases, 2 (4.7%) cases were lost to follow-up, continued treatment with TB RR/MDR 11 (25.6%)children. Conclusions: destructive pulmonary tuberculosis evolves with unsatisfactory therapeutic results, due to theassociation with epidemiological risk factors, passive detection, extensive localization and bronchogenic dissemination.Scopul studiului a constat în evaluarea evoluției tuberculozei cu destrucție a țesutului pulmonar la copii. Material șimetode: s-a efectuat o cercetare retrospectivă, selectivă, analitică, care a inclus 43 copii cazuri noi cu tuberculoză pulmonară distructivă. Rezultate: au fost cel mai frecvent afectate fetele 25 (58,1%) și grupul de vârstă între 15 și 18 ani 34(79,1%) cazuri. Fiecare al doilea copil a fost din contact tuberculos, 18 (41,9%) au fost depistați activ, iar 22 (52,4%)pasiv, deși toți pacienții au fost simptomatici. Tuberculoza infiltrativă a predominat, în egală proporție extinsă și limitată,majoritatea cu localizare unilaterală, cu diseminație. Baciliferi au fost 20 (46,5%) cazuri, GeneXpert MTB/Rifampicinăpozitivi 30 (69,8%) cazuri, inclusiv rezistent la 9 (20,9%) cazuri. Succesul terapeutic s-a înregistart la 30 (69,8%) cazuri,au fost pieduți din supraveghere 2 (4,7%) cazuri, au continuat tratamentul cu regimul pentru TB RR/MDR 11 (25,6%)copii. Concluzii: tuberculoza pulmonară distructivă evoluează cu rezultate terapeutice nesatisfăcătoare, datorită asocieriicu factorii de risc epidemiologici, depistării pasive, localizării extinse și diseminației bronhogene.Цель исследования была оценить эволюцию туберкулеза легких с легочной деструкцией у детей. Материали методы: проведено ретроспективное, выборочное, аналитическое исследование, в котором участвовали 43 ребенка с туберкулезом. Результаты: чаще всего заболевали туберкулезом девочки 25 (58,1%) и возрастная группаот 15 до 18 лет 34 (79,1%) детей. Каждый второй ребенок находился в контакте с больным туберкулезом, активнобыли выявлены 41,9% и пассивно – 22 (52,4%) случая. Преобладал инфильтративный туберкулез, у большинствапациентов с односторонней локализацией и с диссеминацией. Положительными по микроскопии были 20 (46,5%)случаев, положительными по GeneXpert MTB / Rif - 30 (69,8%) случаев, в том числе резистентными в 9 (20,9%)случаях. Терапевтический успех был зарегистрирован в 30 (69,8%) случаях, 2 (4,7%) случая были потеряны изнаблюдения, продолжили лечение 11 (25,6%) детей с МЛУ ТБ. Выводы: деструктивный туберкулез легких развивается с неудовлетворительными терапевтическими результатами, что обусловлено эпидемиологическими факторами риска, пассивным выявлением, обширной локализации и бронхогенным распространением

Provocările și rezultatul tratamentului antituberculos video-asistat la pacienții cu tuberculoza pulmonară

Background. The video-assisted treatment (VAT) in patients with pulmonary tuberculosis (TBP) involves monitoring of the administration of the anti-tuberculosis drugs by a trained medical worker using an electronic device. Objective of the study. To identify the barriers in implementation of VAT in patients with PTB and to evaluate the therapeutic outcomes. Material and Methods. A prospective case-control study which included 114 patients with PTB treated VA, distributed in the study group 1 (SG1) – 26 cases treated using the complete VA regimen and the study group 2 (SG2) – 88 cases treated VA only in the continuation phase in the period 2019-2022 in Chisinau was conducted. Statistical analysis was performed by SPSS Statistics 23.0 software, using Fisher exact test, Odds Ratio (OR) and Confidence Interval (CI). Results. Distribution according to sex: men/women rate = 1.4 in SG1 vs 2,7 in SG2, and age between 18 and 44 years 15 (58%) vs. 61 (69%) cases, respectively. Detected by symptomatic screening were 8 (31%) vs. 42 (48%), including 24 (92%) new cases vs. 82 (93%) and 2 (8%) vs. 6 (7%) relapses, respectively. The established risk factors were: socially vulnerable status, OR = 2.7 (CI95: 1.6-2.9); low level of education, OR = 2.5 (CI95: 1.8-3.4); vagrancy, OR = 9.2 (CI95: 2.6-12.4); migration, OR = 3.5 (CI95: 2.4- 4.2); comorbid state, OR = 1.9 (CI95: 2.4-4.2). Therapeutic success was established in 24 (92%) vs. 78 (89%) cases, died one (2%) patient in SG1 and one (1.3%) continued the treatment in SG1 vs. 10 (11%) in SG2. Conclusion. Barriers in implementation of VAT identified in patients with PTB were: social risk factors, migration and comorbidities. The rate of therapeutic success was high and similar in both groups.Introducere. Tratamentul videoasistat (TVA) pentru tuberculoză pulmonară (TBP) constă în supravegherea administrării medicamentelor anti-tuberculoase de către un lucrător medical instruit utilizând un dispozitiv electronic. Scopul lucrării. Identificarea barierelor în implementarea TVA la pacienții cu TBP și evaluarea rezultatului terapeutic. Material și Metode. A fost efectuat un studiu prospectiv de tip caz-control care a inclus 114 pacienți cu TBP tratați VA, distribuiți în eșantionul de studiu 1 (ES1)-26 cazuri tratate cu regim complet VA și eșantionul de studiu 2 (ES2)-88 cazuri tratate VA doar în faza de continuare în perioada 2019-2022 în Chișinău. Analiza statistică a rezultatelor s-a efectuat utilizând SPSS Statistics 23.0, cu aplicarea testului exact Fisher, Odds Ratio (OR), intervalul de încredere (IÎ). Rezultate. Distribuția pe sex: bărbați/femei = 1,4 în ES1 vs. 2,7 în ES2 și pe vârstă 18-44 ani 15 (58%) vs. 61 (69%) cazuri, respectiv. Depistați prin screeningul simptomaticilor au fost 8 (31%) în ES1 vs. 42 (48%) în ES2, inclusiv 24 (92%) cazuri noi vs. 82 (93%) și recidivă 2 (8%) vs 6 (7%). Factorii de risc stabiliți: statutul social-vulnerabil, OR = 2,7 (ÎI95: 1,6-2,9); nivelul redus de școlarizare, OR = 2,5 (ÎI95: 1,8-3,4); vagabondajul, OR = 9,2 (ÎI95: 2,6-12,4); migrația, OR = 3,5 (ÎI95: 2,4-4,2); statutul comorbid, OR = 1,9 (ÎI95: 2,4-4,2). S-a stabilit succesul terapeutic în 24 (92%) vs. 78 (89%) cazuri, a decedat 1 (2%) pacient în ES1 și continuă 1 (1,3%) în ES1 vs. 10 (11%) în ES2. Concluzii. Barierele în implementarea TVA identificate la pacienții cu TBP au fost: factorii de risc sociali, migrația și statutul comorbid. Rata succesului terapeutic a fost mare și similară în ambele eșantioane

CHALLENGES AND OUTCOMES OF VIDEOASSISTED TREATMENT IN PATIENTS WITH PULMONARY TUBERCULOSIS

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Tratamentul videoasistat (TVA) pentru tuberculoză pulmonară (TBP) constă în supravegherea administrării medicamentelor anti-tuberculoase de către un lucrător medical instruit utilizând un dispozitiv electronic. Scopul lucrării. Identificarea barierelor în implementarea TVA la pacienții cu TBP și evaluarea rezultatului terapeutic. Material și Metode. A fost efectuat un studiu prospectiv de tip caz-control care a inclus 114 pacienți cu TBP tratați VA, distribuiți în eșantionul de studiu 1 (ES1)-26 cazuri tratate cu regim complet VA și eșantionul de studiu 2 (ES2)-88 cazuri tratate VA doar în faza de continuare în perioada 2019-2022 în Chișinău. Analiza statistică a rezultatelor s-a efectuat utilizând SPSS Statistics 23.0, cu aplicarea testului exact Fisher, Odds Ratio (OR), intervalul de încredere (IÎ). Rezultate. Distribuția pe sex: bărbați/femei = 1,4 în ES1 vs. 2,7 în ES2 și pe vârstă 18-44 ani 15 (58%) vs. 61 (69%) cazuri, respectiv. Depistați prin screeningul simptomaticilor au fost 8 (31%) în ES1 vs. 42 (48%) în ES2, inclusiv 24 (92%) cazuri noi vs. 82 (93%) și recidivă 2 (8%) vs 6 (7%). Factorii de risc stabiliți: statutul social-vulnerabil, OR = 2,7 (ÎI95: 1,6-2,9); nivelul redus de școlarizare, OR = 2,5 (ÎI95: 1,8-3,4); vagabondajul, OR = 9,2 (ÎI95: 2,6-12,4); migrația, OR = 3,5 (ÎI95: 2,4-4,2); statutul comorbid, OR = 1,9 (ÎI95: 2,4-4,2). S-a stabilit succesul terapeutic în 24 (92%) vs. 78 (89%) cazuri, a decedat 1 (2%) pacient în ES1 și continuă 1 (1,3%) în ES1 vs. 10 (11%) în ES2. Concluzii. Barierele în implementarea TVA identificate la pacienții cu TBP au fost: factorii de risc sociali, migrația și statutul comorbid. Rata succesului terapeutic a fost mare și similară în ambele eșantioane.Background. The video-assisted treatment (VAT) in patients with pulmonary tuberculosis (TBP) involves monitoring of the administration of the anti-tuberculosis drugs by a trained medical worker using an electronic device. Objective of the study. To identify the barriers in implementation of VAT in patients with PTB and to evaluate the therapeutic outcomes. Material and Methods. A prospective case-control study which included 114 patients with PTB treated VA, distributed in the study group 1 (SG1) – 26 cases treated using the complete VA regimen and the study group 2 (SG2) – 88 cases treated VA only in the continuation phase in the period 2019-2022 in Chisinau was conducted. Statistical analysis was performed by SPSS Statistics 23.0 software, using Fisher exact test, Odds Ratio (OR) and Confidence Interval (CI). Results. Distribution according to sex: men/women rate = 1.4 in SG1 vs 2,7 in SG2, and age between 18 and 44 years 15 (58%) vs. 61 (69%) cases, respectively. Detected by symptomatic screening were 8 (31%) vs. 42 (48%), including 24 (92%) new cases vs. 82 (93%) and 2 (8%) vs. 6 (7%) relapses, respectively. The established risk factors were: socially vulnerable status, OR = 2.7 (CI95: 1.6-2.9); low level of education, OR = 2.5 (CI95: 1.8-3.4); vagrancy, OR = 9.2 (CI95: 2.6-12.4); migration, OR = 3.5 (CI95: 2.44.2); comorbid state, OR = 1.9 (CI95: 2.4-4.2). Therapeutic success was established in 24 (92%) vs. 78 (89%) cases, died one (2%) patient in SG1 and one (1.3%) continued the treatment in SG1 vs. 10 (11%) in SG2. Conclusion. Barriers in implementation of VAT identified in patients with PTB were: social risk factors, migration and comorbidities. The rate of therapeutic success was high and similar in both groups

The predictive factors for positive molecular-genetic assay in patients with pulmonary tuberculosis from chisinau city

Background: One of the most important tuberculosis control action is the early detection, especially of multidrug-resistant tuberculosis. Cultural methods remain the golden standard for pulmonary tuberculosis diagnosis. The microscopic identification of acid-fast-bacilli in sputum is still a worldwide used method for TB detection. The low sensibility of conventional microscopic methods endangers the actual epidemiological situation. Starting with 2012, the genetic-molecular technology – Xpert MTB/RIF Assay - was implemented in the Republic of Moldova. The assessment of initial experience of Xpert MTB/RIF Assay is compulsory for improving the early case detection. The aim of the study is the assessment of extrinsic factors predictable in positive Xpert MTB/RIF patients. Material and methods: A retrospective, selective, descriptive and case-control study was performed. There were enrolled 361 new pulmonary tuberculosis patients, diagnosed and hospitalized in the Muncipal Clinical Hospital of Phthysiopneumology of Chisinau in the period of 01.01.2014 - 01.01.2015. The patients were disributed into 2 groups: I - 174 patients with positive Xpert MTB/RIF Assay result; II - 187 patients with negative Xpert MTB/RIF Assay result. Investigations were performed according to the National Clinical Protocol – 123 Tuberculosis in adults. results: The male gender was predominating above the female gender in both groups: 67,8% vs 32,2% in the 1st group and 55,6% vs 44,4% in the 2nd group. According to the economical status, disadvantaged patients were predominating in the 1st group (71,3%), as compared with the 2nd group (50.8%), with the degree of concludence, p<0,001. The hystory of household TB contact was predominating in the 1st group – 17,2% vs 9,1% in the 2nd group, (p<0.05). Conclusions: The implementation of Xpert MTB/RIF Assay improves the early TB detection and the prompt initiation of an adequate treatment regimen, according to the susceptibility testing results

Clinical presentation, risk factors and outcomes of tuberculosis in military recruits

Department of Pneumophthisiology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Tuberculosis represents the major threat for the health protection in the military forces. The aim of this retrospective and descriptive study was the evaluation of risk factors, clinical presentation and treatment outcomes of tuberculosis in military recruits. Material and methods: 51 military recruits with tuberculosis diagnosed during 01.01.2010-31.12.2015 in Chisinau military quarters and managed in the Hospital of Pneumophtysiology were assessed. Results: Most of military recruits aged 18-22, were residents of the rural localities, graduated incomplete general school or lyceum and were economically vulnerable. One half of the group consisted of active smokers and every tenth patient abused alcohol. Every fourth patient had tuberculosis in childhood and every tenth had family contact with a tuberculosis-affected person. Disease’s insidious onset was established in one half of the group and the acute onset in every fourth patient. Every tenth patient was diagnosed with tuberculosis within the first 6 months after the enrollment. Only one half of the groups were symptomatic patients, who complained of cough, asthenia and loss of weight. Pulmonary infiltrative tuberculosis predominated among recruits. Extensive infiltrates and involvement of both lungs were identified in a lower proportion. The high rate of successful treatment outcome was endangered by the high rate of lost to follow-up patients, demonstrating poor evaluation and follow-up after the discharging from the hospital. Conclusions: The epidemiological studies among military recruits are limited. The high rate of young, economically vulnerable men with risk factors demonstrates their priority for active screening. Treatment outcomes must be improved by the implementation of the adequate follow-up after hospital discharging

Challenges and outcomes of video-assisted treatment in patients with pulmonary tuberculosis

Introduction. According to the updated national policy, the patients with tuberculosis may benefit from the following treatment options: 1. Community or home-based DOT when the treatment is delivered in the community close to the patients home or work. 2. DOT administered by specialized healthcare providers in hospitals or specialized services. 3. Video-assisted treatment (VAT). VAT in patients with pulmonary tuberculosis (TBP) involves monitoring of the administration of the anti-tuberculosis drugs by a trained medical worker using an electronic device. Purpose. To identify the barriers in implementation of VAT in patients with PTB and to evaluate the therapeutic outcomes. Material and methods. A prospective case-control study which included 114 patients with PTB treated VA, distributed in the study group 1 (SG1) 26 cases treated using the complete VA regimen and the study group 2 (SG2) 88 cases treated VA only in the continuation phase in the period 2019-2022 in Chisinau was conducted. Statistical analysis was performed by SPSS Statistics 23.0 software, using Fisher exact test, Odds Ratio (OR) and Confidence Interval (CI). Results. Distribution according to sex: men/women rate=1,4 in SG1 vs 2,7 in SG2, and age between 18 and 44 years 15 (58%) vs. 61 (69%) cases, respectively. Detected by symptomatic screening were 8 (31%) vs. 42 (48%), including 24 (92%) new cases vs. 82 (93%) and 2 (8%) vs. 6 (7%) relapses, respectively. The established risk factors were: socially vulnerable status, OR=2.7 (CI95: 1.6-2.9); low level of education, OR=2.5 (CI95: 1.8-3.4); vagrancy, OR=9.2 (CI95: 2.6-12.4); migration, OR=3.5 (CI95: 2.4-4.2); comorbid state, OR=1.9 (CI95: 2.4-4.2). Therapeutic success was established in 24 (92%) vs. 78 (89%) cases, died 1 (2%) patient in SG1 and 1 (1.3%) continued the treatment in SG1 vs. 10 (11%) in SG2. Conclusions. Barriers in implementation of VAT identified in patients with PTB were: social risk factors, migration and comorbidities. The rate of therapeutic success was high and similar in both groups