Репозиторий Университета

© 2020 The Authors Purpose: To present the problems and possibilities of diagnostic and treatment in a patient with resistant exudative-constrictive pericarditis. Methods: The male patient 31 y. was admitted to the clinic due to exudative pericarditis and arthritis of the left knee joint. His medical history periodic febrile fever with a cough, episodes of syncope and atrial fibrillation, treatment with antibiotics and corticosteroids with a temporary effect. Results: No data were received for systemic disease, hypothyroidism, tumors. With CT in both lungs, small areas of fibrosis and lymphadenopathy were identified. Pericardial sheets diffusely thickened. EchoCG shows one liter of pericardial fluid with fibrin. All tests for viruses and tuberculosis are negative. Thoracoscopy was performed. Morphological examination showed tuberculosis granulomas with caseous necrosis. The growth of mycobacteria of tuberculosis from sputum was obtained. Therapy included pyrazinamide, ethambutol, levofloxacin, prednisolone 20 mg / day. Ponce's disease regressed. Due to the increase of constriction, subtotal pericardectomy was performed. Conclusion: Tuberculosis is one of the real causes of pericarditis with massive effusion and an outcome in constriction. The negative results of all laboratory tests for tuberculosis do not exclude the diagnosis. It is necessary to use invasive morphological diagnosis, including thoracoscopic biopsy.

© 2020 The Authors Purpose: To present the problems and possibilities of diagnostic and treatment in a patient with resistant exudative-constrictive pericarditis. Methods: The male patient 31 y. was admitted to the clinic due to exudative pericarditis and arthritis of the left knee joint. His medical history periodic febrile fever with a cough, episodes of syncope and atrial fibrillation, treatment with antibiotics and corticosteroids with a temporary effect. Results: No data were received for systemic disease, hypothyroidism, tumors. With CT in both lungs, small areas of fibrosis and lymphadenopathy were identified. Pericardial sheets diffusely thickened. EchoCG shows one liter of pericardial fluid with fibrin. All tests for viruses and tuberculosis are negative. Thoracoscopy was performed. Morphological examination showed tuberculosis granulomas with caseous necrosis. The growth of mycobacteria of tuberculosis from sputum was obtained. Therapy included pyrazinamide, ethambutol, levofloxacin, prednisolone 20 mg / day. Ponce's disease regressed. Due to the increase of constriction, subtotal pericardectomy was performed. Conclusion: Tuberculosis is one of the real causes of pericarditis with massive effusion and an outcome in constriction. The negative results of all laboratory tests for tuberculosis do not exclude the diagnosis. It is necessary to use invasive morphological diagnosis, including thoracoscopic biopsy.

© 2019, MDPI AG. All rights reserved. Tuberculosis is known to be the biggest global health problem, causing the most deaths by a single infectious agent. Vaccine-development efforts are extremely important. This paper represents the results of the first-in-human trial of recombinant subunit tuberculosis vaccine GamTBvac in a Phase I study. GamTBvac is a new BCG booster candidate vaccine containing dextran-binding domain modified Ag85a and ESAT6-CFP10 MTB antigens and CpG ODN adjuvant, formulated with dextrans. Safety and immunogenicity of GamTBvac were estimated in an open-label clinical trial on 60 Mycobacterium tuberculosis uninfected (MTB-uninfected) volunteers previously-vaccinated with Bacillus Calmette—Guérin vaccine (BCG). The candidate vaccine had an acceptable safety profile and was well-tolerated. Three different vaccine doses with a double-immunization scheme were assessed for immunogenicity and induced a significant increase in IFN-γ in-house IGRA response and IgG ELISA analysis. Among them, the half dose vaccine group (containing DBD-ESAT6-CFP10, 12.5 μg; DBD-Ag85a, 12.5 μg; CpG (ODN 2216), 75 μg; DEAE-Dextran 500 kDa, 250 μg; and Dextran 500 kDa, 5 mg) provided high, early and stable in time immune response specific to both protein antigen fusions and is proposed for the further studies.

© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. Background We report the association of the FAST strategy (find cases actively, separate safely, and treat effectively) with reduction of hospital-based acquisition of multidrug-resistant tuberculosis in the Russian Federation. Methods We used preintervention and postintervention cohorts in 2 Russian hospitals to determine whether the FAST strategy was associated with a reduced odds of converting MDR tuberculosis within 12 months among patients with tuberculosis susceptible to isoniazid and rifampin at baseline. Results Sixty-three of 709 patients (8.9%) with isoniazid and rifampin-susceptible tuberculosis acquired MDR tuberculosis; 55 (12.2%) were in the early cohort, and 8 (3.1%) were in the FAST cohort. The FAST strategy was associated with a reduced odds (adjusted odds ratio, 0.16; 95% confidence interval,.07-.39) and 9.2% absolute reduction in the risk of MDR tuberculosis acquisition. Conclusion Use of the FAST strategy in 2 Russian hospitals was associated with significantly less MDR tuberculosis 12 months after implementation.

Copyright © 2018, Georg Thieme Verlag KG. All rights reserved. Thoracoplasty was invented for removing cavities between thoracic wall and remnant lung or mediastinum. It was initially used in cases of tuberculosis or unspecific infections, while currently it is used mainly for space problems after lobectomy/pneumonectomy. This article presents an overview of the historical and current techniques of this surgical procedure. Nowadays, thoracoplasty is rarely performed due to the low incidence of diseases for which this method is necessary. Therefore, this method has even been discredited. Furthermore, certain technical aspects of the thoracoplasty are not very well known because of the infrequent application of this procedure. Unfortunately, a look into the literature of thoracoplasty is not always usefull due to the biased views of advocates of different techniques such as Schede's thoracoplasty, Heller's Jalousie-Plastik, Alexander's extramusculoperiosteal thoracoplasty, Bjork's osteoplastic thoracoplasty, etc. Not to forget, there has always been a lack of research on the relevance and on the several techniques of thoracoplasty. The point is precise indication and correct execution of thoracoplasty as a final therapeutic option, which allows a safe and definitive solution of the space problem even in complex cases, without creating serious functional and cosmetic impairment for the patient. The main types of thoracoplasty are described in this article. Although the core principle of this operation remains unchanged, modern techniques are often cosmetically more considerable and less destructive, compared with techniques that were used in the past.

© The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. OBJECTIVES: Surgical interventional has been key in the treatment of tuberculosis (TB) for a long time. Its importance diminished after the emergence of chemotherapy. However, the spread of rapid multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB has led us to return to surgery to treat TB. Today, every second patient in Russia with destructive TB has either MDR or XDR TB, which is the reason for the low efficacy of conservative treatment. In 2015, treatment with drugs resulted in clinical recovery in only 29.8% of new cases of destructive TB acid-fast bacilli (AFB)+. METHODS: The author's data from 1999 to 2016 have been analysed. The author performed 5599 surgeries on patients with pulmonary TB aged from 1 to 87 years (mean age 34.6 years). The most common reasons for surgical treatment were fibrotic cavitary and cavitary pulmonary TB, tuberculoma with destruction, tuberculous pleural empyema, caseous pneumonia and intrathoracic lymph nodes. The strategy of early collapse therapy and the use of surgery to treat TB was proposed in the Penza region of Russia; the results were analysed to estimate the long-term outcomes of treatment. RESULTS: In 5599 surgeries, the full clinical effect was achieved in 93% of operated patients with MDR TB, in 92.1% of those with XDR TB and in 98% of patients without MDR or XDR resistance. According to the data from the Penza region, 3 years after surgery, 93.9% (149 of 159 cases) of the operated patients exhibited clinical recovery. CONCLUSIONS: Taking into account the data from the World Health Organization on the insufficient level of therapeutic success in the treatment of MDR and XDR pulmonary TB, surgical treatment is necessary in regions with a high frequency of drug-resistant cases.

Despite a steady tendency of decreasing of indices of morbidity of tuberculosis of population of the Chechen Republic, the problems related to early diagnosis of tuberculosis and organization of specialized medical care of patients continue to be unresolved. The questionnaire survey of administrators of anti-tuberculosis medical organizations of the Chechen Republic was carried out with the purpose of establishing difficulties in medical care support of patients with tuberculosis and determining main directions of their overcoming. The results of study demonstrated that main problems are asocial behavior of patients, inadequate staffing of institutions with medical and paramedical personnel, absence of proper relationship with other medical organizations, inadequate level of financing. The administrators indicated as main directions of solving problems increasing of remuneration of labor of medical personnel of anti-tuberculosis medical organizations, development of social defense of patients, physicians and population, alteration of actual normative legal base according to modern social economic conditions, enhancement of preventive direction of work, optimization of manning table and standards of work load of physicians and also development of tactics of treatment and re-organization of dispensary observation of patients with tuberculosis.

Prevalence, risk factors of primary pancreatic tuberculosis, clinical symptoms and data of instrumental and laboratory diagnosis are reviewed in the article. The authors emphasized the peculiarities of differential diagnosis with pancreatic malignancies and advisability of the most informative methods - endoscopy and fine-needle aspiration procedure.

© 2018 Media Sphera Publishing Group.All Rights Reserved. The goal is to present the possibilities of diagnosis verification, the features of the clinical picture of tuberculous pericarditis in the therapeutic clinic and the results of its treatment. Materials and methods. The paper presents clinical observation and a general analysis of 10 cases of tuberculous pericarditis in patients aged 31-79 (mean age 58.0 ± 15.1 years), 6 women and 4 men. Diagnostic puncture pericardium was performed on two patients, pleural puncture - on three Thoracoscopic biopsy of hilar lymph nodes and lung (n=1), pleura (n=1), supraclavicular lymph node biopsy (n=1). Dyskin test was carried out, as well as sputum examination, multispiral computed tomography, oncological search. Results. A 31-year-old patient with a massive effusion in the pericardial cavity, pleural lesion, arthritis of the left knee joint, whose results of the pericardial effusion and sputum were not diagnosed, tuberculosis was detected only with thoracoscopic biopsy of the lung and intrathoracic lymph nodes; the treatment via prednisolone and subtotal pericardectomy was performed. Among 10 patients with MSCT of the lung, changes were noted in general, but in only one case they were highly specific. Diaskin test is positive in 70%. In the study of punctata, bronchoalveolar flushing, Koch bacteria were not detected; at sputum in microscopy and biological sample BC was detected in two patients. The lymphocytic character of effusion in the pericardium / pleura is noted in 4 out of 5 cases. At a biopsy of lymphonoduses and a lung at 2 patients the picture of a granulomatous inflammation with a caseous necrosis. Pericarditis was predominantly large (from 2 cm and more) effusion, signs of constriction were noted in 50% of patients. Conclusion. Tuberculosis is one of the frequent causes of pericarditis in the Moscow therapeutic clinic. The most lymphocytic effusion with fibrin and the development of constriction. The negative results of all laboratory tests for tuberculosis do not exclude a diagnosis, It is necessary to use invasive morphological diagnostics, including thoracoscopic biopsy.

© 2018 Medical Education. All rights reserved. Clinical signs and course of pulmonary disease of Fedor M. Dostoevskiy (1821 - 1881) has been analyzed in the article on the basis of memoirs of contemporaries and physicians who followed the writer up to the end of his life. Diagnostic hypotheses of the disease and the cause of death have been discussed.

© 2018 Media Sphera Publishing Group.All Rights Reserved. In the modern clinic of internal diseases, the specific gravity of the infectious pathology, manifested by various clinical syndromes, is increasing. Infectious pathology is represented by diseases of the respiratory system, heart disease (infective endocarditis, cardioimplant infections, viral myocarditis), infectious arthropathies, extrahepatic manifestations of viral hepatitis, cytopenic syndromes, various manifestations of sepsis and some other conditions.In most cases, the diagnosis and management of such patients is the responsibility of the internist, who must be able to suspect the infection and carry out its verification. In the process of diagnostic search and management of patients, close interaction of the internist with a clinical microbiologist, clinical pharmacologist and other related specialists is necessary.

© 2018 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved. The development of mesenteric lymphadenitis is typical for patients with HIV infection at the stage of secondary diseases. The purpose of our study is to decipher the etiology of lymphadenitis in patients with HIV infection at the stage of secondary diseases. The analysis of disease histories of 113 HIV infection patients at the stage of secondary diseases with the use of statistical processing was carried out. The article presents examples that characterize the polymorphism of clinical variants of the development of mesadenitis in HIV-infected patients with stage 4B, which has developed as a result of the influence of various etiological factors.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. The purpose of this clinical observation was to demonstrate an interesting and obvi-ous case of discrepancies in the clinical and radiological and morphological pat-terns of intrathoracic lymph nodes tuberculosis. Correct diagnosis is the key to a correct choice of further treatment of this patient, therefore, it is necessary to keep in mind possible variations and difficulties in establishing the stage of intrathoracic lymph nodes tuberculosis.

© 2018 Russian Electronic Journal of Radiology. All Rights Reserved. Purpose. This case describes the role of radiology diagnostic methods in patients with congenital right transposition of the aortic arch. Due to the underestimation of radiology data, congenital right transposition of the aortic arch was not detected before surgery, which led to the selection of inadequate surgical access and technical difficulties that were successfully overcome.

© 2018 Russian Electronic Journal of Radiology.All Rights Reserved. Purpose. To show the difficulty of diagnosis and treatment of atypical course of tuberculous empyema, when the process was complicated by tuberculosis of the chest, destruction of the diaphragm and penetration into the liver. Results. After chest MSCT scan, tuberculosis was suspected. The patient successfully underwent surgery: Pleurectomy with chest wandering abscess excision, resection of the VII rib and abdominal wandering abscess excision combined with the diaphragm and liver resection. The postoperative period was uncomplicated. During examination 4 years after surgery the patient was in a satisfactory condition, has ability to work, was transferred to group III dispensary tuberculosis registration. Discussion. Diagnosis and treatment of pleural empyema in some cases is difficult and, sometimes, requires differentiation from the oncological process. We have not found cases of tuberculous empyema spread of in the abdominal cavity with penetration into the liver in the literature. Conclusion. MSCT scan allowed to timely diagnose the atypical course of tuberculous empyema.

© 2018 Bulletin of Siberian Medicine. All rights reserved. The aim of the investigation was to determine the characteristics of the immune response regulation for pulmonary tuberculosis (TB) and to analyze the role of regulatory T cells in the immunopathogenesis of TB with eosinophilia in the blood, depending on the clinical form of the disease and sensitivity of Micobacterium tuberculosis to anti-TB drugs. Materials and methods. 157 patients who were initially diagnosed with infiltrative and disseminated TB were examined. The material of the study was venous blood and culture of mononuclear leukocytes isolated from venous blood. The content of interleukin (IL) 4, IL-10 and transforming factor beta (TGFβ) in culture suspensions of mononuclear leukocytes in vitro and IL-5 in the blood was determined by enzyme-linked immunosorbent assay (ELISA) test. The expression of surface molecules CD4, CD20, CD25 and intracellular transcription factor Foxp3 by lymphocytes of the blood was evaluated by flow cytometry. The obtained results were analyzed by statistical methods. Results. It is shown that excessive generation of regulatory T cells in patients with TB is associated with eosinophilia of the blood and imbalance of immune response regulation mechanisms. In TB with eosinophilia, an increase in the number of Foxp3-positive regulatory T cells in the blood is combined with in vitro hypersecretion of anti-inflammatory cytokines TGFβ, IL-10, IL-4 and an increase in the content of CD20+ B lymphocytes and IL-5 in the blood. These changes are most pronounced in the disseminated form of TB in combination with drug resistance. Conclusion. Characteristics of immunoregulation at TB with blood eosinophilia are associated with activation of immunosuppression mechanisms and polarization of immune response towards Th2-dependent pathway.

© 2018, Springer Science+Business Media, LLC, part of Springer Nature. Culture of mouse macrophages (RAW 264.7 ATCC strain) in wells of a 6-well plate was infected with M. tuberculosis in proportion of 15 mycobacteria per one macrophage and then treated with a lytic strain of mycobacteriophage D29. Antibacterial efficacy of mycobacteriophages was studied using D29 phage (activity 108 plaque-forming units/ml) previously purified by ion exchange chromatography. After single and double 24-h treatment, the lysed cultures of macrophages were inoculated onto Middlebrook 7H10 agar medium. The number of mycobacterial colonies in control and test wells (at least 3 wells in each group) was 300.178±12.500 and 36.0±5.4, respectively (p<0.01).

© 2018 Russian Electronic Journal of Radiology.All right reserved. Purpose: Demonstration of various radiological methods possibilities in diagnosis, evaluation of the lung resection volume, planning of thoracoplasty and efficacy monitoring of the surgical treatment of destructive pulmonary multi-drug resistant (MDR) tuberculosis (TB). Results: Plain chest film revealed a widespread pulmonary tuberculosis inflammation. With CT application, the nature and prevalence of pulmonary parenchymal involvement was clarified, indications and volume of complex surgical intervention were determined, and surgical treatment efficacy was controlled. Digital tomosynthesis application determined the state of the lung tissue after resection and the volume of the planned postponed thoracoplasty. Discussion: Taking into account the incidence of pulmonary tuberculosis in our country, the similarity of its clinical and radiological picture with a number of other pathological processes, as well as the polymorphism of alterations, it is necessary to know the pathomorphological, clinical and radiological manifestations of this disorder. A reliable assessment of the respiratory organs state according to the radiography data has objective limits due to the presence of a cumulative effect and other factors. So, CT is the priority method in diagnosis, evaluation of lung resection volume, planning of thoracoplasty, and monitoring of surgical treatment efficacy. Due to layer-by-layer visualization, the method of digital tomosynthesis makes it possible to obtain additional information, in comparison with radiographic data, in pulmonary parenchyma state assessment at pre- and postoperative stages, which indicates the prospects of its application in solving this tasks. Conclusion: Due to modern radiological methods in the study of respiratory organs TB, the question of the expediency of surgical treatment or refusal in favor of conservative therapy is solved, which is of particular relevance in patients with MDR TB. Accurate determination of lung resection and thoracoplasty volume significantly reduces the risk of postoperative complications, which contributes to improving the quality of life of the patient. A correct control of respiratory TB surgical treatment efficacy with CT application allows estimating the state of the zone of interest, and timely reveal the relapse of a specific process.

© 2017 New Terra Publishing House. All rights reserved. The article presents a comprehensive description of tuberculous infection nidi, where children were exposed to this infection and developed multiple drug resistant tuberculosis. It was found out that the risk to develop MDR TB in children was also related to exposure to a TB case with undetected resistance to rifampicin, which was to be taken into account when prescribing the chemotherapy regimen. When prescribing preventive treatment to children exposed to MDR tuberculosis one should consider the potential risks and benefits.