Chest X-ray as an alternative method of making a preliminary diagnosis in patients with susceptible or drug-resistant pulmonary tuberculosis.

Background: Making a preliminary diagnosis using X-ray methods for the study of resistant and resistant tuberculosis (TB) will help to make a preliminary diagnosis and determine further tactics for the treatment of TB, even with limited resources for microbiological diagnosis of drug resistance of TB. The present study was aimed at identifying chest X-ray differences between susceptible and resistant TB. Methods: A prospective cohort study of data from all consecutive patients with culture-confirmed pulmonary TB admitted during the year to the Kharkiv TB Dispensary No. 1 in Kharkiv, Ukraine. Results: One hundred and sixty-eight patients with lung TB were examined. Patients were divided into two groups: 1st patients with pulmonary TB with resistance of Mycobacterium tuberculosis (MTB) to at least isoniazid and rifampicin (resistant TB) and 2nd pulmonary TB with preserved susceptibility of MTB to anti-TB drugs (susceptible-TB). Patients of 1st group often had lesions in two lobes of the lungs 31.1% and one lung 43.3% versus 15.4% and 2.6% of patients with susceptible TB (P < 0.001). In addition, more than 3 cavities in the lungs 45.5% were significantly more often observed in patients with resistant TB versus 7.9%-the 2nd group (P < 0.001). Smaller cavities were observed in patients with susceptible TB up to 1.99 cm 74% versus 35.2% in 1st group (P < 0.001). We did not observe any significant radiological features depending on the right or left lung, as well as the lobar localization of the TB process. Conclusions: For resistant forms of TB, radiologically, a more widespread TB process in the lungs with the presence of a larger number of cavities and their larger size against a background of a more pronounced clinical picture and mycobacterium excretion than with susceptible TB is characteristic.

Effectiveness of inhaled hypertonic saline application for sputum induction to improve Mycobacterium tuberculosis identification in patients with pulmonary tuberculosis.

BACKGROUND: This study assessed the effectiveness and diagnostic significance of hypertonic saline sputum induction for improving Mycobacterium tuberculosis (MTB) detection. METHODS: A prospective, randomized, open, two-arm, comparative study on MTB identification effectiveness when using inhaled sodium chloride hypertonic solution was performed in patients diagnosed with pulmonary tuberculosis (TB). Patients were randomly assigned into two groups: group 1 (inhalation group) included patients who inhaled a 7% sodium chloride solution upon admission to the hospital, and group 2 (control group) coughed up their sputum as usual. For both groups, specimens were tested by bacterioscopic, bacteriological, and molecular genetic methods. Diagnostic chest radiography was performed for all participants. RESULTS: In this study, 644 patients (mean age 42.2 years; 151 women, 23.4%) were randomly divided into two groups. Low-quality sputum samples were observed in 7.4% of patients from the inhalation group and 28.8% in the control group (p < 0.001). Acid-fast bacilli (AFB) smear was positive in 65.1% of patients from the inhalation group and 51.3% of controls (p = 0.002). A similar statistically significant situation was observed when culture methods (93.9% inhalation group and 81.9% control group, p < 0.001) and molecular genetic tests (92.2% inhalation group and 79.4% control group, p < 0.001) were used. Thus, active pulmonary TB was not verified microbiologically in 6.1% of patients from the inhalation group and in 18.1% of controls (p < 0.001). CONCLUSIONS: Hypertonic saline sputum induction improves the quality of collected samples. This method may be appropriate to increase the rate of MTB detection in sputum using microscopic, bacteriological, and molecular genetic methods for diagnosing TB on the day of specimen collection. Hypertonic saline sputum induction is suitable for middle- and low-income countries with limited resources and causes no severe adverse effects in TB patients.

Treatment effectiveness and outcome in patients with a relapse and newly diagnosed multidrug-resistant pulmonary tuberculosis.

Aim To investigate the treatment effectiveness and outcome in patients with pulmonary tuberculosis relapse and newly diagnosed multidrug resistant pulmonary tuberculosis (MDR-TB). Methods A total of 240 pulmonary MDR-TB patients, including 114 ones with tuberculosis relapse and 126 cases of newly diagnosed pulmonary tuberculosis, were examined. Effectiveness of the basic antimycobacterial therapy course was evaluated based on the time to normalization of tuberculosis clinical manifestation, sputum culture and acid-fast bacilli stain conversion, cavity closure, disappearance of infiltrative and focal changes in the pulmonary tissue. Treatment outcomes were evaluated as cured, treatment completed, treatment failed, died and lost to follow-up according to the World Health Organization guidelines. Results When assessing the treatment effectiveness in patients with MDR-TB, a worse clinical and chest radiograph dynamics was observed in tuberculosis relapse against the background of high parameters of treatment failure (18.4 %) and low cured (34.2 %) compared with newly diagnosed pulmonary tuberculosis (7.1% and 58.7 %, respectively) (p=0.008 and p<0.001, respectively). Conclusion Standard treatment effectiveness in patients with newly diagnosed MDR-TB manifested by faster improvement and stabilization of health, earlier sputum culture and smear conversion, higher frequency of cavity closure and achievement of certain clinical and radiographic improvement against the background of fewer cases of treatment failure and a higher number of cured patients compared with MDR-TB relapse.

The Caspian Sea region: environmental change.

Ecosystems in the Caspian Sea region have been heavily modified by anthropogenic activities, mainly as a result of changes in the water flow and degradation of the water quality in the ecosystems. Changes in the regional environment have influenced regional economies, particularly obvious in the impacts on fish stocks. Using the methodology developed in the GIWA project, experts in the region carried out an assessment of the most important transboundary issues in shared waters in the region. This report focuses on the root causes for the most important drivers of environmental change in the region: habitat and community modification.