Molecular genetic tests GeneXpert MTB/RIF and Xpert MTB/RIF (Ultra) in the diagnosis of tuberculosis (review of literature).

In recent tuberculosis years is the main cause of morbidity and death among patients with HIV infection. Modern diagnostics of tuberculosis includes mass screening of the population: digital fluorography from the age of 15 and immunodiagnostics in children and adolescents. Detection of mycobacterium tuberculosis by microscopy occurs in forms of tuberculosis with the decay of lung tissue. Such patients represent a high epidemic risk. To improve the verification of diagnosis in the practice of a phthisiologist, molecular genetic methods for the search for mycobacteria are increasingly used, based on the identification of specific fragments of the DNA chain in the diagnostic material. The most widely used method is the polymerase chain reaction (PCR), which is based on directed DNA amplification. The latest innovation is fully automated systems using cartridge technology GeneXpert. The advantages of GeneXpert are high sensitivity, speed (result in 2 hours), real-time PCR detection, exclusion of sample contamination. The technique of cartridge technology is constantly being improved, various cartridges are used on its platform, which not only detect M. tuberculosis, but also determine the sensitivity to anti-tuberculosis drugs - rifampicin (MTB / RIF cartridge) or several anti-TB drugs (MTB / XDR). Cartridges have been developed that are able to detect Mycobacterium tuberculosis (MBT) at an even lower concentration in the test material - MTB / RIF (Ultra). GeneXpert technology can be used to diagnose extrapulmonary tuberculosis by examining various biological materials, which are more effective in detecting tuberculosis in children and adolescents, in HIV-positive individuals.

Comparative Informativity of Computing Methods of Insulin Resistance Assessment.

We conducted a comparative study of the calculated indices of insulin resistance HOMA-R, Caro, FGIR, and QUICKI in 29 healthy volunteers (mean age 26.21±0.93 years) with normal body mass index (23.34±0.55 kg/m2). Among the used methods for insulin resistance assessment, QUICKI is the only method that has characteristics required for the diagnostic criterium: low variability coefficient, 100% reproducibility, and minimum coefficient of variation.

Comparative study of the serum hepcidin level of patients with pneumonia in COVID-19 and Pneumocystis pneumonia.

In the context of a pandemic caused by the SARS-CoV-2 virus, for a patient with respiratory symptoms and bilateral lung damage, COVID-19 becomes the first disease in the differential diagnostic search. Pneumonia in COVID-19 shares many characteristics with Pneumocystis pneumonia. One of the possible markers of the severe course of COVID-19 is hepcidin, a peptide hormone that negatively regulates iron metabolism. There are no data on the value of hepcidin in Pneumocystis pneumonia in the published scientific literature. The purpose of this study is to conduct a comparative analysis of hepcidin in the blood serum of patients with pneumonia in COVID-19 and Pneumocystis pneumonia to clarify their pathogenetic features. A case-control observational study was conducted, including 68 patients with pneumonia in COVID-19 and 44 patients with HIV infection and Pneumocystis pneumonia (PCP/HIV). Determination of hepcidin was carried out by ELISA using the ELISA Kit for Hepcidin. Statistical data processing was carried out using the MedCalc 19.2.6 software. Results. Comparative analysis of serum hepcidin levels in the study groups showed that hepcidin is statistically significantly higher in PCP/HIV than in COVID-19 - the median value is 22 times higher (p <0.0001). When examining the ROC curve for hepcidin, it was found that this biomarker has a high diagnostic potential and indicates a higher probability of COVID-19 than PCP/HIV at values ≤768.044 pg / ml. In the context of the COVID-19 pandemic, it is necessary to remember about other diseases that manifest themselves with a similar clinical and radiological picture. COVID-19 and PCP/HIV share many similarities; the peptide hormone hepcidin has shown itself as a potential differential diagnostic marker between them, and therefore the need for further studies of hepcidin is justified, taking into account the severity of the course of COVID-19, the presence of comorbidities and in a comparative aspect with pathologies that «mimic¼ under COVID-19.

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.

Hematological indicators for lung damage caused by COVID-19 infection.

During the pandemic of a new coronavirus infection one of the most serious complications is pneumonia. When entering a specialized pulmonology Department, the presence of pneumonia is confirmed by computed tomography (CT), the etiology is confirmed by the detection of SARS-CoV-2 RNA by PCR, the article analyzes the indicators of blood analysis when patients are admitted to the hospital. All admitted patients were divided into 2 groups. Group 1 of the study - with a new coronavirus infection Covid-19, confirmed by the detection of PCR-RNA SARS-CoV-2 (n=27). Group 2 consisted of 65 patients (70.7%) with lung tissue damage characteristic of Covid-19 according to CT, who had a negative analysis of PCR-RNA SARS-CoV-2. Statistically significant deviations were shown in a decrease in the percentage and absolute content of lymphocytes, monocytes and platelets, and an increase in neutrophils. The comparative analysis in the groups with positive and negative PCR analysis for the detection of SARS-CoV-2 RNA showed no statistically significant differences. It can be assumed that with the similarity of clinical manifestations and CT-data, a negative result of PCR-RNA SARS-CoV-2 can be diagnosed as «lung damage caused by COVID-19 infection¼.

[Surgical treatment of pulmonary tuberculosis]. / Khirurgicheskoe lechenie bol'nykh tuberkulezom legkikh v XXI veke.

The main surgical approaches to the treatment of pulmonary tuberculosis were developed and introduced into surgical practice in the 60s of the last century. However, epidemiological changes and new medical technologies justify advisability of further improvement of surgical management of pulmonary tuberculosis. Computed tomography with 3D-nodeling and preoperative planning are valuable to analyze spread of pathological process and visualize pulmonary structures for improvement of surgical treatment.

[Iron metabolism and indicators reflecting its changes in pulmonary tuberculosis (literature review).]

Iron is an essential element for human and bacteria, including mycobacterium tuberculosis. Over review includesthe literature on the problem of iron metabolism in patients with tuberculosis and with comorbid pathology HIV infection and tuberculosis. The literature was searched for when writing this review using the RSCI, CyberLeninka, Scopus, Web of Science, MedLine, PubMed databases using the following keywords: iron, ferritin, hepsidin, lactoferrin, tuberculosis, pneumonia, HIV infection. Iron compounds are involved in many redox reactions: oxygen transport, cellular respiration, the trichloroacetic acid cycle, DNA biosynthesis, and others. The ratio of intracellular and extracellular iron in the body is regulated by the low molecular weight hormone hepcidin, the mechanism of action of which is to block the function of ferroportin, an exporter of iron from cells, which leads to the accumulation of the intracellular iron pool and the prevention of the toxic effect of free iron. The role of iron in the interaction of the human body with ferro-dependent bacteria has been established. Iron is necessary for the growth and development of bacterial cells, and the methods for its production from the host are different. Information on the effect of iron metabolism on pulmonary tuberculosis is scarce and contradictory: some authors have identified a decrease in hemoglobin and transferrin in combination with elevated levels of ferritin in patients with tuberculosis; according to other sources, hyperferritinemia in tuberculosis cannot be predictive, but is a marker inflammation. At the same time, there are studies that indicate a significant increase in ferritin in patients with disseminated tuberculosis relative to other clinical forms. Currently, the incidence of tuberculosis in patients with HIV infection is increasing, while diagnostic tests are not very informative. The search for diagnostic markers in terms of iron metabolism may open up new possibilities for the diagnosis of pulmonary tuberculosis.

Discoordination of Autonomic Support of Functions in the Pathogenesis Gastroesophageal Reflux Disease.

A cross-sectional study performed on a continuous sample of 32 patients (mean age 46.36±3.31 years) with gastroesophageal reflux disease and excess body weight showed that the disturbance of sympathetic/parasympathetic relationships, disruption of segmental and compensatory increase in the suprasegmental mechanisms of autonomic regulation determines the course of gastroesophageal reflux disease in these patients.

[The Modern Characteristics and Trends of Tuberculosis Epidemiology in Samara].

The article presents the results of investigation of features of dynamics of main demographic indices characterizing epidemic condition with tuberculosis in Samara during last decade. The gender age, social and clinical structures of patients spotted for the first time.

Specific Features of Gastroesophageal Reflux Disease in Patients with Overweight (Basis for Personalized Treatment).

А cross-sectional study was performed on a continuous sample of patients (N=52) with the gastroesophageal reflux disease. Specific features of this disease in patients with overweight were revealed. Regurgitation predominated in the structure of complaints. Fibrogastroduodenoscopy revealed endoscopically negative form of the diseases in 38% of cases. According to 24-h pH monitoring results, alkaline reflux pH>7 took more than 25% time in supine position at high DeMeester score, which limits the usage of aggressive acid-lowering therapy.

Role of JAK/STAT3 Signaling in Functional Stimulation of Mesenchymal Progenitor Cells by Fibroblast Growth Factor.

JAK/STAT signaling pathway was examined during functional stimulation of mesenchymal progenitor cells with fibroblast growth factor. The differences were observed in the realizations of the proliferation-differentiation potential of CFU-fibroblasts under blockade of JAKs or during selective inactivation of STAT3. The study revealed stimulating influences of JAKs and STAT3 on mitotic activity of progenitor cells and individual roles of these proteins in the control of their maturation. Blockade of JAKs diminished the level of fibroblast colony formation and the score of actively proliferating CFU-fibroblasts at the background increase of the differentiation rate of progenitor cells. In contrast, STAT3 inhibitor resulted in a coordinated decrease of all examined parameters.

Particular Role of JAK/STAT3 Signaling in Functional Control of Mesenchymal Progenitor Cells.

The role of JAK/STAT3-mediated signaling pathway in the realization of the growth potential of mesenchymal precursor cells was examined in vitro. The stimulating role of JAKs and STAT3 towards proliferating activity of progenitor cells and their different role in the regulation of differentiation of the progenitor elements were demonstrated. Inhibitors of JAKs and STAT3 reduced the yield of fibroblast CFU and their mitotic activity. Blockade of JAKs accelerated and selective inactivation of STAT3 decelerated differentiation of progenitor cells.

Extension of the Metabolic Syndrome Cluster.

In a one-stage cross-sectional study, a continuous sample of 102 patients (mean age 47.81±0.63 years) with metabolic syndrome was examined. It was found that autonomic dysfunction determines specific features of arterial hypertension in this group of patients, it causes cardiac autonomic neuropathy and underlies the mechanisms of lower urinary tract symptoms development.

Abacavir usage patterns and hypersensitivity reactions in the EuroSIDA cohort.

OBJECTIVES: Five to eight per cent of HIV-positive individuals initiating abacavir (ABC) experience potentially fatal hypersensitivity reactions (HSRs). We sought to describe the proportion of individuals initiating ABC and to describe the incidence and factors associated with HSR among those prescribed ABC. METHODS: We calculated the proportion of EuroSIDA individuals receiving ABC-based combination antiretroviral therapy (cART) among those receiving cART after 1 January 2009. Poisson regression was used to identify demographic, and current clinical and laboratory factors associated with ABC utilization and discontinuation. RESULTS: Between 2009 and 2016, of 10 076 individuals receiving cART, 3472 (34%) had ever received ABC-based cART. Temporal trends of ABC utilization were also heterogeneous, with 28% using ABC in 2009, dropping to 26% in 2010 and increasing to 31% in 2016, and varied across regions and over time. Poisson models showed lower ABC utilization in older individuals, and in those with higher CD4 cell counts, higher cART lines, and prior AIDS. Higher ABC utilization was associated with higher HIV RNA and poor renal function, and was more common in Central-East and Eastern Europe and lowest during 2014. During 779 person-years of follow-up (PYFU) in 2139 individuals starting ABC after 1 January 2009, 113 discontinued ABC within 6 weeks of initiation for any reason [incidence rate (IR) 14.5 (95% confidence interval (CI) 12.1, 17.5) per 100 PYFU], 13 because of reported HSR [IR 0.3 (95% CI 0.1, 1.0) per 100 PYFU] and 35 because of reported HSR/any toxicity [IR 4.5 (95% CI 3.2, 6.3) per 100 PYFU]. There were no factors significantly associated with ABC discontinuation because of reported HSR/any toxicity. CONCLUSIONS: ABC remains commonly used across Europe and the incidence of discontinuation because of reported HSR was low in our study population.

Pathogenetic Mechanisms of Outbreak and Development of Cardiac Autonomic Neuropathy in Patients with Metabolic Syndrome.

A cross-sectional study of universe sample of patients (N=135; mean age -49.7±0.8 years) with metabolic syndrome yielded the incidence of cardiac autonomic neuropathy of 37.5%. The pathogenetic peculiarities were revealed for the onset and development of this neuropathy. At the early stages, the progress of cardiac autonomic neuropathy closely correlated with elevation of blood glucose, while endothelial dysfunction progressing at the later period against the background of persistent hyperglycemia is viewed as an extra factor contributing to the development of this disease.

Effectiveness of Lifestyle Modification in Corrections of States Associated with Metabolic Syndrome.

In a 3-month study, 30 obese patients were assigned to lifestyle modification therapy, which is the major component of all modern strategies correcting the metabolic syndrome. The 3-month course of non-pharmacological therapy significantly diminished the major index evaluating the state of these patients, i.e., the risk of cardiovascular disasters. This therapy positively affected all the states associated with metabolic syndrome: arterial BP attained the targets in 53% patients together with normalization of their nocturnal arterial BP dipping status; the lipid panel and carbohydrate metabolic indices normalized in 46 and 44% patients, respectively; hepatic steatosis moderated in 56% patients; and the disturbances in hemostasis were annihilated in 67% patients.

Cardiac Autonomic Drive during Arterial Hypertension and Metabolic Disturbances.

ANS support of the cardiac work was assessed with analysis of heart rate variability in representative samples of patients with arterial hypertension and metabolic disturbances manifested by overweight, classes I-II obesity, compromised glucose tolerance, and type II diabetes. Initially enhanced sympathetic effects on the heart rate demonstrated no further increase during the orthostatic test in contrast to suprasegmentary influences enhanced by this test. The pronouncedness of revealed peculiarities in ANS drive to the heart correlated with metabolic disturbances, and these peculiarities attained maximum in patients with type II diabetes.

Global Tests in Evaluation of the Function of Pro-and Anticoagulant Systems: Present and Future.

Comparative analysis of the effectiveness of global tests for evaluation of the blood coagulation systems demonstrated the possibility of obtaining express data on hemostasis stages I-II and III when working with native substrate (whole blood). Changes in viscous characteristics of the whole blood recorded ex vivo during hemocoagulation allowed us to propose the concept of permanency of fibrinogenesis as the obligatory in vivo process determining the hemostatic potential, an integral characteristic of the hemocoagulation cycle providing sufficient blood fluidity and limiting extravasation of blood components under conditions of permeability disturbances and damage to the vascular wall.

[Treatment motivation in patients with chronic cardiorenal syndrome].

AIM: To study treatment motivation in patients with chronic heart failure (CHF) and in those with CHF concurrent with chronic kidney disease (CKD). SUBJECTS AND METHODS: A total of 203 patients (130 men and 73 women; mean age, 61.8±9.6 years) with CHF diagnosed and assessed in accordance with the National Guidelines of the All-Russian Research Society of Cardiology and the Heart Failure Society for the diagnosis and treatment of CHF (third edition, 2009) were examined. CKD was diagnosed according to the 2012 National Guidelines of the Research Nephrology Society of Russia. A group of patients with chronic cardiorenal syndrome (CRS) included those with CHF and CKD with a glomerular filtration rate (GFR) of <60 ml/min/1.73 m2. The clinical course of CHF, personality profile, and motivation for non-drug and drug treatments were assessed in patients with chronic CRS. RESULTS: CFR was 67.7±17.2 ml/min/1.73 m2; chronic CRS was observed in 89 (44%) patients. Psychological functioning assessment showed that the patients with chronic CRS as compared with those with CHF without CKD had high anxiety and maladaptive disease attitudes. CHF treatment motivation (compliance with lifestyle modification and medication) was proved inadequate and detected only in 31 (15.3%) patients with CHF regardless of the presence of CKD. The specific features of psychological functioning, which affected treatment motivation, were seen in patients with chronic CRS: those who were lowly motivated had a euphoric attitude towards their disease (p=0.03); those who were satisfactorily motivated showed an emotive accentuation of character (p=0.002). CONCLUSION: The presence of CKD aggravates the clinical course of CHF and negatively affects the psychological functioning of patients with CHF. The patients with chronic CRS are characterized by a low level of motivation for both drug and non-drug treatments, which should be taken into account when managing this cohort of patients.

[Comparative analysis of incidence and prevalence of cardiovascular diseases among military personnel and seafarers serving on the bank].

The study presents retrospective analysis of navy soldiers' cardiovascular diseases, which most often cause the growth in labor force, loss rates and navy soldiers' dismissal and mortality rates, and, therefore, are one of the most pressing problems of the military medical services. Comparative assessment conducted between emergence and pervasiveness of these diseases in navy with those of land-based soldiers. Analysis of correlation between morbidity rates and length of service in navy is also included.