Scientific and practical peer-reviewed journal
Рецензируемый научно-практический журнал «Название журнала на русском» «Nazvanie zhurnala na russkom» зарегистрирован Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций 05 августа 2014 года (Свидетельство о регистрации ПИ № ФС 77-58913 — печатное издание и свидетельство, Эл № ФС 77-58914 — сетевое издание).
Тираж 1000 экземпляров, периодичность 4 выпуска в год.
Распространение – Российская Федерация, зарубежные страны.
Электронная версия журнала с мультимедийными приложениями доступна по адресу rpmj.ru.
Выходит при поддержке Министерства здравоохранения России и Федерального государственного бюджетного учреждения «Федеральный медицинский исследовательский центр имени П.А.Герцена» Министерства здравоохранения Российской Федерации.
Журнал «Исследования и практика в медицине» - профессиональное медицинское издание, в котором отражаются результаты новейших исследований в области медицинских наук, организации здравоохранения, фундаментальных и прикладных исследований.
В издании представлен уникальный клинический опыт как практических врачей, так и специалистов разных научных и клинических школ. Публикуются новости медицинского и фармацевтического сообществ, научно-практические статьи для целевой аудитории - врачей различных специальностей.
Журнал, в первую очередь, имеет практическую направленность и публикует статьи ведущих специалистов, освещающих актуальные проблемы клиники, диагностики и лечения широкого круга заболеваний, алгоритмы диагностики и терапии различных нозологий. В нем публикуются передовые и оригинальные статьи, краткие сообщения, заметки из практики, лекции и обзоры. Мы стремимся развивать принцип междисциплинарного подхода, делаем все возможное, чтобы наши читатели были в курсе современных достижений медицинской науки и практики, помогаем врачам в освоении современных принципов распознавания и лечения широкого спектра заболеваний.
Current issue
EPIDEMIOLOGY OF TUBERCULOSIS AND OTHER SOCIALLY SIGNIFICANT DISEASES
Background. There has been an improvement in the epidemiological situation of tuberculosis in children and adolescents in St. Petersburg. However, there are some unresolved problems
Methods.Annual statistical surveillance forms for tuberculosis in children for 10 years were analysed. Medical records of in-patients identified in 2021 and 2022 were studied; the characteristics of tuberculosis contacts and ways of identification of patients were given.
Results. Over the period 2013–2022, the incidence of tuberculosis in children 0-14 years decreased from 17.3 to 4.3 per 100,000, the incidence in adolescents 15-17 years – from 27.6 to 3.3 per 100,000. The course of tuberculosis was generally favourable, bacterial excretion in children was observed in 2.9% of cases, in adolescents in 29.8%. In 2022, the structure of clinical forms of tuberculosis deteriorated compared to 2021 due to a decrease in the share of tuberculosis of intrathoracic lymph nodes from 82.1% to 69.4%, and the emergence of cases of more severe course of the disease. In children who became ill in 2022, household tuberculosis contact with an adult relative was established in 38.9% of cases, half of them only after tuberculosis was diagnosed in the child.
Conclusion. Detection of household contact with tuberculosis patients remains a priority method of preventing the disease in children. It is advisable to organise a monitoring system of tuberculosis infection foci in St. Petersburg.
The study was carried out to identify factors affecting the life expectancy of patients with viral hepatitis in areas with low population density.
Methods. Medical records of 30 patients died from viral hepatitis B and/or C in Kamchatskiy kray were studied retrospectively. Life expectancy (LE) from disease detection to lethal outcome was assessed. R-statistics was used to identify factors associated with LE.
Results. The median life expectancy of these patients is associated with non-modifiable factors: gender (women – 9 years, men – 3 years) and type of virus (HBV – 13 years, HCV– 5 years, B+C coinfection – 3 years), as well as modifiable factors: alcohol consumption during treatment (for those who drank alcohol – 3 years, for those who did not drink – 9 years), antiviral therapy (for those who received treatment – 12 years, those who did not – 2 years).
Conclusion. Measures to provide antiviral treatment and to prevent alcohol use for patients with viral hepatitis C should be prioritized in areas with low population densities.
TUBERCULOSIS PREVENTION
Aim. To evaluate the safety and effectiveness of preventive treatment of latent tuberculosis infection in people living in social welfare homes due to mental pathology.
Methods. 121 patients with latent infection living in social welfare homes were included in prospective study, 79 men and 42 women aged 25–90 years. The choice of preventive therapy regimen was made according comorbidities and the risk of interactions between antituberculosis drugs and psychopharmacotherapy. The incidence of adverse reactions, the dynamics of skin tests results and tuberculosis morbidity during two years of follow-up were evaluated.
Results. 119 patients received preventive treatment: isoniazid for 6 months (n = 47) or isoniazid and pyrazinamide for 3 months (n = 72). The incidence of adverse reactions was 5.9% (95% CI 2.4–10.8%), 10.6% in the isoniazid group, 2.8% in the isoniazid plus pyrazinamide group (p > 0.05). In the first year of follow-up, skin test reactions decreased in 62.4% of patients and became negative in 9.9%; in the second year − in 40.1% and 1.9%, respectively; the number of persons with hyperergic reactions decreased 3.4 times. No cases of active tuberculosis were detected.
Conclusion. In patients with latent tuberculosis infection living in social welfare homes due to mental pathology, preventive therapy with isoniazid (6 months) or isoniazid and pyrazinamide (3 months) is advisable.
Aim. To assess the state of vital organs in patients with severe autoimmune pathology before starting preventive therapy of tuberculosis infection.
Methods. Medical records, clinical and laboratory examination results were analysed in 38 patients with severe autoimmune diseases receiving long-term immunosuppressive therapy, which are referred to the TB dispensary to exclude tuberculosis infection. The frequency and severity of comorbid pathology, haematological and biochemical blood parameters before the start of preventive therapy of tuberculosis were assessed.
Results. indications for preventive therapy were determined in 37 (97.4%) patients: residual post-tuberculosis changes were detected in 7 (18.4%), latent tuberculosis infection in 30 (78.9%). A high frequency of significant concomitant pathology (on average 4.63 comorbidities per patient) with predominance of gastrointestinal (54.1%), visual (54.1%) and musculoskeletal (75.7%) diseases was revealed, which required individualisation of preventive therapy schemes and correction of drug doses. After a single 3-month course of preventive therapy, 27% of patients did not experience fading of the skin test with a recombinant tuberculosis allergen; 32.4% of patients still had hyperergic results.
Conclusion. Preventive therapy of tuberculosis infection in patients with severe autoimmune pathology requires a personalized approach with individual selection of regimens and doses of drugs used, careful clinical and laboratory monitoring, followed by long-term follow-up and assessment of the need for repeated preventive courses.
DIAGNOSIS OF TUBERCULOSIS
Due to the widespread drug resistance of M. tuberculosis (MTB), it is necessary to assess the possibility of using drugs with antimycobacterial activity previously used in other pathologies, e.g. clofazimine, in anti-tuberculosis chemotherapy regimens.
The aim was to determine the phenotypic sensitivity to clofazimine of clinical strains of MTB with different spectrum of drug resistance.
Methods. Clofazimine sensitivity was studied for 75 MTB clinical strains by serial microdilutions in Middlebrook 7H9 liquid medium (50 were drug-susceptible, 25 have MDR and pre-XDR), with estimation of MIC50, MIC90 and epidemiologic cut-off value of MIC (ECOFF).
Results. The growth of most MTB strains (76%) was suppressed by clofazimine concentrations ranging from 0.06 to 0.125 μg/ml. The growth of 50% (MIC50) and 90% (MIC90) of drug-sensitive strains was inhibited by clofazimine concentrations of 0.125 and 0.25 μg/ml, respectively, while the growth of drug-resistant strains was inhibited by 0.125 and 0.5 μg/ml, respectively. The ECOFF value was 0.25 μg/ml.
Conclusion. Clofazimine even in low concentrations inhibits the growth of MTB clinical strains regardless of sensitivity to other antimycobacterial drugs. The obtained data serve as an additional basis for the use of clofazimine in the complex treatment of tuberculosis, including MDR and XDR pathogens.
TUBERCULOSIS TREATMENT
Aim. To evaluate the effect of antituberculosis therapy with simvastatin and methyluracil on systemic inflammation syndrome and homeostatic balance of the organism in patients with pulmonary tuberculosis and COPD.
Methods. 90 patients with newly diagnosed pulmonary tuberculosis (TB) and COPD were included; group 1 52 patients received only antituberculosis therapy (group 1), 38 patients received antituberculosis therapy in combination of simvastatin and methyluracil (group 2). The dynamics of functional cardiorespiratory parameters, indicators of systemic inflammation and lipid spectrum, type of adaptive reactions, efficiency of tuberculosis and COPD treatment were evaluated.
Results. Patients with comorbidity of tuberculosis and COPD have high frequency of widespread lung lesions and destructions, bacterial excretion, functional cardiorespiratory disorders on the background of systemic inflammation, endothelial dysfunction, dyslipidemia, pathological types of adaptive reactions. Duriing treatment in the 2nd group the decrease of systemic inflammation and endothelial dysfunction indices, lipid spectrum normalization (76,4% vs. 53,4% in the 1st group, p=0,001), appearance of harmonious types of adaptive reactions, more rare formation of large residual changes (26,3% vs. 65,4%, p=0,003), reduction of COPD clinical manifestations with decreased risk of exacerbations (63,2% vs. 13,5%, p=0,04) were noted more often.
Conclusion. Inclusion of simvastatin and methyluracil in the complex treatment of patients with tuberculosis combined with COPD contributes to the reduction of systemic inflammatory response, recovery of adaptive reactions, improvement of disease course and increase of therapy efficiency.
LITERATURE REVIEW
The literature review is devoted to the characteristics of methods for diagnosing latent tuberculosis infection (LTBI) in various epidemiological and clinical situations. For many years, the tuberculin skin test (TST) has been used for these purposes. In the last decade, tests for assessing the production of interferon-γ (IFN-γ) with M. tuberculosis-specific antigens (ESAT6-CFP10) have become widespread. Recommendations for using these tests (and their combinations) are described. Currently, new skin tests (using the same antigens) have also been developed, which are used in practice (mainly in Russia). New in vitro tests have also been developed to determine other (except IFN-γ) interleukins, surface markers of T-lymphocytes, and microRNAs. Detection of an immune response against latent stage-specific M. tuberculosis (dormant) antigens should be optimal. Corresponding tests have been developed but have not yet found wide practical application.
КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ
Pneumatosis intestinalis is a rare clinical condition characterised by the presence of extraluminal air accumulations in the intestinal wall.
We present a clinical case of pneumatosis intestinalis in a 35-year-old female patient with HIV/TB coinfection, symptoms of acute intestinal obstruction and the presence of free gas in the abdominal cavity according to non-contrasted multispiral computed tomography (CT). According to the results of additional examination (abdominal CT with oral and intravenous bolus contrasting) it was possible to exclude life-threatening conditions (acute intestinal obstruction, bowel perforation, mesenteric thrombosis), to confirm the presence of pneumatosis intestinalis and to avoid unjustified surgical intervention.
This clinical observation shows that detection of «free gas» symptom in the abdominal cavity on plain abdominal radiographs does not have 100% specificity in relation to acute surgical pathology, in some cases requiring the use of more accurate methods of investigation, including abdominal CT with oral and bolus intravenous contrasting.
ABSTRACTS OF THE XI ANNUAL CONFERENCE OF MOSCOW PHTHISIOLOGISTS «ANTITUBERCULAR DISPENSARY – THE MISSION OF THE XXI CENTURY»
ISSN 2413-0354 (Online)