Tuberculosis and malnutrition: The European perspective.

Tuberculosis (TB) is a leading infectious cause of death worldwide, despite ongoing efforts to limit its incidence and mortality. Although the European Region has made gains in TB incidence and mortality, it now contends with increasing numbers of multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB). Malnutrition is a major contributor to the burden of TB and may also be directly caused or enhanced by the onset of TB. The presence of malnutrition may worsen TB and MDR/RR-TB related treatment outcomes and contribute to growing TB drug-resistance. Preventing and treating all forms of malnutrition is an important tool to limit the spread of TB worldwide and improve TB outcomes and treatment efficacy. We carried out a scoping review of the existing evidence that addresses malnutrition in the context of TB. Our review found malnutrition increased the risk of developing TB in high-burden settings and increased the likelihood of developing unfavorable treatment outcomes, including treatment failure, loss to follow-up, and death. The potential impact of nutritional care and improved nutritional status on patient prognosis was more difficult to evaluate due to heterogeneity of patient populations, treatment protocols, and treatment durations and goals. High-quality trials that consider malnutrition as a major risk factor and relevant treatment target when designing effective strategies to limit TB spread and mortality are needed to inform evidence-based practice. In TB patients, we suggest that widespread and regular nutritional screening, assessment, and counselling, has the potential to increase effectiveness of TB management strategies and improve patient quality of life, overall outcomes, and survival.

[Current prerequisites for a molecular genetic classification of endometrial cancer]. / Sovremennye predposylki dlia molekuliarno-geneticheskoi klassifikatsii raka éndometriia.

The review analyzes current investigators' data on the introduction of an additional endometrial cancer classification based on the results of molecular and genetic studies. This necessity is dictated by clinical observations, according to which the genetic profile of the tumors may not correspond to their morphological structure, which considerably changes patient management tactics. The existing dualistic model of carcinogenesis makes it possible to identify and describe the characteristic molecular features of the tumors in terms of their histological structure. The review also analyzes the concept of 4 new endometrial cancer subgroups: ultramutated, hypermutated, copy-number low, and copy-number high (serous-like). It gives the results of investigations of the molecular and genetic characteristics of each subgroup. Particular attention is paid to the role of POLE gene mutations in the ultramutated subgroup. Different theories justifying a good prognosis in these patients are considered. The molecular characteristics of endometrial cancer versus tumors of other organs are compared. The potential benefits of introducing the new classification, which allow one to change approaches to stratifying the risk for this disease, are presented.