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Risks of recurrence in people with pulmonary tuberculosis 肺结核患者复发的风险
Pub Date : 2023-09-29 DOI: 10.32902/2663-0338-2023-3-24-30
I.O. Novozhylova, I.V. Bushura
OBJECTIVE. To assess the risk of relapse in patients with pulmonary tuberculosis (PTB). MATERIALS AND METHODS. 569 people with relapsed PTB (RPTB) were selected from the TB register (e-TB manager programme): 300 with a first case treatment outcome of “completed treatment” and 269 “cured”. The groups were compared according to the course and outcome of treatment of RPTB, clinical characteristics of the first case, medical and social risk factors, and all patients with RPTB were compared with the group of newly diagnosed PTB (NDPTB). Mathematical and conventional statistical methods were used to analyse. RESULTS AND DISCUSSIONS. It was found that patients with RPTB are a difficult group because more than 1⁄2 of them have lung destruction, 3⁄4 isolate mycobacterium tuberculosis (MBT), and more than 1⁄2 have resistance to antimycobacterial drugs (AMBD). In 73.6 % of them, medical and social risk factors were noted that may have caused or contributed to TB relapse and negatively affected the results of treatment. These factors include: severe comorbidities in 53.7 %, alcohol and drug abuse in 34.9 %, HIV infection in 30.5 %, and others (homelessness, release from prison, contact with a TB patient, unemployment, smoking, etc.); 62.1 % of patients had ≥2 risk factors at the same time. We consider the effectiveness of treatment of this category of patients to be insufficient, as the outcome of the main course of treatment was unsatisfactory in more than half of them (48.5 % of unsuccessfully treated, 4.7 % interrupted treatment, 8.3 % died), and taking into account repeated courses, the rate of effective treatment in some of them was only 65.6 %. There was no significant difference (neither in clinical characteristics nor in medical and social risk factors) between the groups of patients “cured” or “completed treatment” as a result of treatment of the first case of TB, but it was found that only 23.2 % of patients with RPTB were found to be resistant to AMBD at the first case of the disease, and 50.0 % of them had it, with multidrug resistance (MDR) in half of them. It has been statistically proven that patients with RPTB are more likely to have the following symptoms than patients with NDPTB: lung destruction (43.2±3.2 vs. 20.4±4.0 %, p<0.05), sputum isolation of MBT (38.1±3.3 vs. 24.9±3.9 %, p<0.05), multi- and poly-resistance of MBT to AMBD (30.2±8.1 vs. 9.5±4.3 %, p<0.05), various medical and social risks (73.6±2.2 vs. 44.5±3.4 %, p<0.05), including alcohol abuse (21.3±3.7 vs. 8.7±4.3 %, p<0.05 %), unemployment (51.1±2.9 vs. 21.9±4.0 %, p<0.05), concomitant diseases (39.5±3.3 vs. 8.5±4.3 %, p<0.05), HIV infection (22.5±4.0 vs. 4.9±4.4 %, p<0.05) and others – lack of a fixed place of residence, release from prison, contact with a TB patient, lack of permanent employment, smoking, etc. (64.3±2.5 vs. 8.3±4.3 %, p<0.05), as well as ≥2 risk factors at the same time (45.7±3.1 vs. 20.0±4.0 %, p<0.05), which confirms the role of
目标。评估肺结核(PTB)患者复发的风险。 材料和方法。从结核病登记册(e-TB管理人员规划)中选择了569名复发性肺结核(RPTB)患者:300例首次治疗结果为“完全治疗”,269例“治愈”。比较两组患者的肺结核病程、转归、首发病例的临床特征、医学及社会危险因素,并将所有肺结核患者与新诊断肺结核(NDPTB)组进行比较。采用数学和常规统计方法进行分析。 结果和讨论。结果发现,1 / 2以上的RPTB患者存在肺破坏,3 / 4的患者存在分离结核分枝杆菌(MBT), 1 / 2以上的患者存在抗结核药物耐药(AMBD),因此RPTB患者是一个困难的群体。其中73.6%的人指出,医疗和社会风险因素可能导致或促成结核病复发,并对治疗结果产生负面影响。这些因素包括:严重合并症占53.7%,酒精和药物滥用占34.9%,艾滋病毒感染占30.5%,以及其他因素(无家可归、出狱、接触结核病患者、失业、吸烟等);62.1%的患者同时存在≥2个危险因素。 我们认为这类患者的治疗效果不足,因为其中一半以上的患者主疗程的疗效不理想(48.5%的患者治疗失败,4.7%的患者中断治疗,8.3%的患者死亡),考虑到重复疗程,其中一些患者的有效治疗率仅为65.6%。由于第一例结核病的治疗而“治愈”或“完成治疗”的患者组之间没有显着差异(无论是临床特征还是医学和社会危险因素),但发现只有23.2%的RPTB患者在第一例疾病时发现对AMBD耐药,其中50.0%的患者患有该病,其中一半具有多药耐药(MDR)。经统计证实,RPTB患者比NDPTB患者更容易出现以下症状:肺损害(43.2±3.2 vs. 20.4±4.0%,p<0.05),痰液分离MBT(38.1±3.3 vs. 24.9±3.9%,p<0.05), MBT对AMBD的多重和多重耐药性(30.2±8.1 vs. 9.5±4.3%,p<0.05),各种医疗和社会风险(73.6±2.2 vs. 44.5±3.4%,p<0.05),包括酗酒(21.3±3.7 vs. 8.7±4.3%,p<0.05),失业(51.1±2.9 vs. 21.9±4.0%,p<0.05),伴随疾病(39.5±3.3 vs. 8.5±4.3%,p<0.05), HIV感染(22.5±4.0 vs. 4.9±4.4%,p<0.05),(p #x0D; 0.05)和其他-无固定住所、出狱、接触结核病患者、无固定工作、吸烟等(64.3±2.5比8.3±4.3 %,p #x0D; 0.05),以及同时存在≥2个危险因素(45.7±3.1比20.0±4.0%,p #x0D; 0.05),证实了上述因素在结核病患者复发的可能危险因素中的作用。结论。由于不利的耐结核结核病程、医疗和社会风险因素,如失业、严重合并症、酗酒、艾滋病毒感染和其他一些因素(属于无固定住所的人、从监狱释放、与结核病患者接触)可能导致(或促成)耐结核结核,并随后对治疗结果产生负面影响,因此应将具有这些因素的患者视为发生耐结核结核的特别危险人群。因此,应对高危人群进行筛查和监测。 鉴于在首例肺结核病例中检测到耐多药结核病是肺结核最危险的危险因素,有必要对所有肺结核患者进行耐多药结核病的检测,并对危险人群中的这些人进行随访,尽管他们的治疗结果很好。晚期发现RPTB(3 / 4)表明初级保健在结核病控制方面存在组织缺陷,主要是在形成风险群体并与他们合作方面,并要求在考虑战时新现实和挑战的情况下实施预防措施。
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引用次数: 0
Evaluation of the effectiveness of immunomodulator BI-V in the complex therapy of children and adolescents with multiple drug-resistant pulmonary tuberculosis 免疫调节剂BI-V在儿童和青少年多重耐药肺结核综合治疗中的疗效评价
Pub Date : 2023-09-29 DOI: 10.32902/2663-0338-2023-3-31-35
O.I. Sakhelashvili-Bil, I.L. Platonova
BACKGROUND. The feasibility of combining antimycobacterial therapy (AMBT) with bedaquiline (Bdq) and delamanid (Dlm) with non-specific immunomodulator BI-V in children and adolescents with multidrug-resistant and rifampicin-resistant pulmonary tuberculosis (MDR/Rif-TBP) needs to be studied. OBJECTIVE. To find out the effectiveness of the use of complex AMBT with Bdq and Dlm with non-specific immunomodulator BI-V in children and adolescents with MDR/Rif-TBP. MATERIALS AND METHODS. Children and adolescents with MDR/Rif-TBP at the initial stage of AMBT were given BI-V (BIVEL, Slovenia) as a non-specific immunomodulator. The patients were divided into two groups: 1st – 20 patients who received Bdq + Dlm + levofloxacin (Lfx) + linezolid (Lzd) + clofazimine (Cfz); 2nd ‒ 28 patients whose complex treatment included BI-V (Вdq + Dlm + Lfx + Lzd + Cfz + BI-V). BI-V was prescribed from the age of 3 years at 5 ml suspension once a day during 24 days RESULTS. The use of BI-V against the background of individualized regimens of AMBT in children and adolescents with MDR/Rif-TBP increased the effectiveness of treatment, contributed to the disappearance of symptoms of intoxication, the resolution of infiltration foci and the healing of decay cavities in system of immune protection, which contributed to the shortening of the inpatient stage of treatment, while maintaining a high therapeutic effectiveness (“cured” ‒ 92.8 %) and the formation of small residual changes in the lungs in the majority (89.3 %). CONCLUSIONS. When using combined complex AMBT with Bdq, Dlm and BI-V, high therapeutic efficiency was observed in most patients (92.8 %).
背景。bedaquiline (Bdq)和delamanid (Dlm)联合非特异性免疫调节剂BI-V治疗儿童和青少年多药耐药和利福平耐药肺结核(MDR/Rif-TBP)的可行性有待研究。目标。探讨AMBT联合Bdq和Dlm联合非特异性免疫调节剂BI-V治疗儿童和青少年MDR/Rif-TBP的疗效。材料和方法。在AMBT初始阶段患有MDR/Rif-TBP的儿童和青少年被给予BI-V (BIVEL,斯洛文尼亚)作为非特异性免疫调节剂。患者分为两组:1 ~ 20例患者接受Bdq + Dlm +左氧氟沙星(Lfx) +利奈唑胺(Lzd) +氯法齐明(Cfz)治疗;2 - 28例BI-V综合治疗(Вdq + Dlm + Lfx + Lzd + Cfz + BI-V)。从3岁开始使用BI-V, 5 ml混悬液,每天1次,持续24天;结果。在MDR/Rif-TBP儿童和青少年AMBT个体化方案的背景下使用BI-V,提高了治疗的有效性,有助于中毒症状的消失,浸润灶的溶解和免疫保护系统腐烂腔的愈合,从而有助于缩短住院治疗期。同时保持较高的治疗效果(“治愈”- 92.8%),大多数(89.3%)在肺部形成小的残余变化。结论。复方AMBT与Bdq、Dlm、BI-V联合使用时,大多数患者的疗效较高(92.8%)。
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引用次数: 0
New and little-known possibilities of edaravone in the treatment of cerebral stroke and extracranial pathology 依达拉奉治疗脑卒中和颅外病理的新的和鲜为人知的可能性
Pub Date : 2023-09-29 DOI: 10.32902/2663-0338-2023-3-36-42
O.A. Halushko
BACKGROUND. Edaravone is a free radical scavenger and inhibits lipid peroxidation and thus reduces oxidative damage to brain cells and other organs. Edaravone is mainly known as an effective agent in the treatment of ischemic stroke and amyotrophic lateral sclerosis. OBJECTIVE. To investigate the little-known possibilities of edaravone when it is used in clinical practice. MATERIALS AND METHODS. To solve the task, a search and analysis of full-text articles was conducted in the PubMed, Web of Science, Google Scholar, and Scopus databases. The search was conducted using the key word “edaravone” and included English-language and Ukrainian-language publications over the past 5 years (from April 2018 to April 2023). RESULTS. A total of 518 publications were identified and analyzed. Edaravone has been found to improve the clinical course and may be useful in the treatment of central nervous system diseases, depression, post-traumatic stress disorder, cognitive dysfunction, oncological and infectious diseases (in particular, coronavirus disease), many poisonings, etc. All this dictates the need for further clinical studies to explore new and unexpected possibilities of edaravone.
背景。依达拉奉是一种自由基清除剂,可抑制脂质过氧化,从而减少对脑细胞和其他器官的氧化损伤。依达拉奉主要被认为是治疗缺血性中风和肌萎缩侧索硬化症的有效药物。目标。探讨依达拉奉在临床应用时鲜为人知的可能性。 材料和方法。为了解决这个问题,在PubMed、Web of Science、Google Scholar和Scopus数据库中对全文文章进行了搜索和分析。搜索使用关键词“依达拉奉”进行,包括过去5年(2018年4月至2023年4月)的英语和乌克兰语出版物。结果。共鉴定和分析了518份出版物。依达拉奉已被发现可改善临床病程,并可用于治疗中枢神经系统疾病、抑郁症、创伤后应激障碍、认知功能障碍、肿瘤和传染病(特别是冠状病毒病)、许多中毒等。所有这些都表明需要进一步的临床研究来探索依达拉奉新的和意想不到的可能性。
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引用次数: 0
Severe community-acquired pneumonia: principles of diagnostics and intensive therapy 严重社区获得性肺炎:诊断原则和强化治疗
Pub Date : 2023-09-29 DOI: 10.32902/2663-0338-2023-3-7-15
V.I. Chernii
BACKGROUND. Pneumonia is an important medical and social problem due to its high prevalence, high rates of disability and mortality, and significant economic losses due to this disease. In Ukraine in 2017, the incidence of pneumonia among adults was 384.0 cases per 100,000 population, and the mortality rate was 11.7 per 100,000 population, i. e. more than 3 % of those who had pneumonia died. Community-acquired pneumonia (CAP) is the leading cause of morbidity and mortality from pneumonia among all age groups worldwide: 3-4 million people suffer from CAP with high morbidity and mortality. OBJECTIVE. To analyze the pathogenesis, diagnosis, and treatment of severe CAP from the modern literature data to optimize the treatment of this group of patients. MATERIALS AND METHODS. Bibliosemantic, comparative, and system analysis methods were used. The proposed recommendations are based on the analysis of modern literature, the results of randomized studies, and meta-analyses devoted to the investigation of the problem of diagnosis and management of severe CAP. RESULTS AND DISCUSSION. The problems of pathogenesis, diagnosis, and treatment of severe CAP were analyzed using modern literature data to optimize the treatment of this group of patients. CAP can be caused by various pathogens, such as Streptococcus pneumoniae, Haemophilus influenzae, atypical bacteria (eg, Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella species), and viruses. It is quite difficult to establish the etiology of pneumonia even with the use of modern microbiological technologies, therefore, in many countries of the world, a classification is used that takes into account the conditions of the occurrence of the disease, the features of the infection of the lung tissue, as well as the immune reactivity of the patient’s organism. This classification makes it possible to predict the probable causative agent of the disease with a fairly high degree of probability. The diagnosis of CAP is considered established in the presence of radiologically confirmed focal infiltration of lung tissue and at least two of the following clinical signs: acute onset of the disease with a body temperature >38 °C, cough with sputum, physical signs (muffled or dull percussion sound, weakened and/or harsh bronchial breathing, a focus of sonorous small vesicular rales and/or crepitations), leukocytosis (>10×109 /L), and/or shift to rod nuclear cells (>10 % of them). The severity of CAP is assessed clinically, as well as using the criteria given in the scales to determine the need for the patient to be hospitalized or admitted to the intensive care unit (ICU). Patients with CAP requiring mechanical ventilation or with septic shock should be admitted to the ICU. CONCLUSIONS. Severe CAP is associated with high morbidity and mortality, and although there are European and non-European guidelines for CAP, there are no specific guidelines for severe CAP. These international guideli
背景。肺炎是一个重要的医疗和社会问题,因为它的高患病率、高致残率和死亡率,以及由这种疾病造成的重大经济损失。2017年,乌克兰成人肺炎发病率为每10万人384.0例,死亡率为每10万人11.7例,即超过3%的肺炎患者死亡。社区获得性肺炎(CAP)是全世界所有年龄组肺炎发病率和死亡率的主要原因:300万至400万人患有CAP,发病率和死亡率很高。目标。从现代文献资料中分析重症CAP的发病机制、诊断及治疗,以优化该组患者的治疗。 材料和方法。采用文献语义学、比较法和系统分析法。所提出的建议是基于对现代文献的分析,随机研究的结果,以及对严重CAP的诊断和管理问题的荟萃分析。 结果和讨论。利用现代文献资料分析重症CAP的发病机制、诊断及治疗问题,优化该组患者的治疗方案。CAP可由多种病原体引起,如肺炎链球菌、流感嗜血杆菌、非典型细菌(如肺炎衣原体、肺炎支原体、军团菌)和病毒。即使使用现代微生物学技术,也很难确定肺炎的病因,因此,在世界上许多国家,采用的分类考虑到疾病发生的条件、肺组织感染的特征以及患者机体的免疫反应性。这种分类使得以相当高的概率预测疾病的可能病原体成为可能。若有影像学证实的肺组织局灶性浸润,且至少有以下两种临床体征,则可诊断为CAP:急性起病,体温38℃,咳嗽伴痰,体征(低沉或沉闷的叩击声,支气管呼吸减弱和/或刺耳,有清晰的小水疱声和/或心音),白细胞增多(10×109 /L),和/或向棒状核细胞转移(占10%)。临床评估CAP的严重程度,并使用量表中给出的标准来确定患者是否需要住院或入住重症监护病房(ICU)。需要机械通气或感染性休克的CAP患者应入住ICU。 结论。严重的CAP与高发病率和死亡率相关,尽管有欧洲和非欧洲的CAP指南,但没有针对严重CAP的具体指南。这些来自ERS、ESICM、ESCMID和ALAT的国际指南根据GRADE方法为严重CAP的诊断、经验性治疗和抗生素治疗提供了循证临床建议。此外,还确定了现有的知识差距,并为未来的研究提供了建议。
{"title":"Severe community-acquired pneumonia: principles of diagnostics and intensive therapy","authors":"V.I. Chernii","doi":"10.32902/2663-0338-2023-3-7-15","DOIUrl":"https://doi.org/10.32902/2663-0338-2023-3-7-15","url":null,"abstract":"BACKGROUND. Pneumonia is an important medical and social problem due to its high prevalence, high rates of disability and mortality, and significant economic losses due to this disease. In Ukraine in 2017, the incidence of pneumonia among adults was 384.0 cases per 100,000 population, and the mortality rate was 11.7 per 100,000 population, i. e. more than 3 % of those who had pneumonia died. Community-acquired pneumonia (CAP) is the leading cause of morbidity and mortality from pneumonia among all age groups worldwide: 3-4 million people suffer from CAP with high morbidity and mortality.&#x0D; OBJECTIVE. To analyze the pathogenesis, diagnosis, and treatment of severe CAP from the modern literature data to optimize the treatment of this group of patients.&#x0D; MATERIALS AND METHODS. Bibliosemantic, comparative, and system analysis methods were used. The proposed recommendations are based on the analysis of modern literature, the results of randomized studies, and meta-analyses devoted to the investigation of the problem of diagnosis and management of severe CAP.&#x0D; RESULTS AND DISCUSSION. The problems of pathogenesis, diagnosis, and treatment of severe CAP were analyzed using modern literature data to optimize the treatment of this group of patients. CAP can be caused by various pathogens, such as Streptococcus pneumoniae, Haemophilus influenzae, atypical bacteria (eg, Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella species), and viruses. It is quite difficult to establish the etiology of pneumonia even with the use of modern microbiological technologies, therefore, in many countries of the world, a classification is used that takes into account the conditions of the occurrence of the disease, the features of the infection of the lung tissue, as well as the immune reactivity of the patient’s organism. This classification makes it possible to predict the probable causative agent of the disease with a fairly high degree of probability. The diagnosis of CAP is considered established in the presence of radiologically confirmed focal infiltration of lung tissue and at least two of the following clinical signs: acute onset of the disease with a body temperature &gt;38 °C, cough with sputum, physical signs (muffled or dull percussion sound, weakened and/or harsh bronchial breathing, a focus of sonorous small vesicular rales and/or crepitations), leukocytosis (&gt;10×109 /L), and/or shift to rod nuclear cells (&gt;10 % of them). The severity of CAP is assessed clinically, as well as using the criteria given in the scales to determine the need for the patient to be hospitalized or admitted to the intensive care unit (ICU). Patients with CAP requiring mechanical ventilation or with septic shock should be admitted to the ICU.&#x0D; CONCLUSIONS. Severe CAP is associated with high morbidity and mortality, and although there are European and non-European guidelines for CAP, there are no specific guidelines for severe CAP. These international guideli","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135243159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endocrine side effects of immunotherapeutic drugs 免疫治疗药物的内分泌副作用
Pub Date : 2023-09-29 DOI: 10.32902/2663-0338-2023-3-43-48
O.S. Orlyk, A.V. Garnytska
BACKGROUND. Immunotherapy is an innovative approach to treatment that is changing the paradigm in oncology and is achieving significant results in the fight against malignant tumors including leukemia, melanoma, lung cancer, kidney cancer and many others. This treatment uses the power of the body’s immune system to fight cancer cells. Immunotherapy can lead to long-term remission or even complete disappearance of tumors in patients with certain types of cancer. The success of therapy depends on many factors, including the type of cancer and individual patient characteristics. As with any treatment, patients with immunotherapy may experience side effects. As a result of treatment with pembrolizumab (and other immunotherapeutic drugs), patients may develop endocrine disorders. The most common endocrine side effects include thyroiditis (which can lead to hyper- or hypothyroidism), inflammation of the parathyroid glands, hypophysitis, and diabetes mellitus. OBJECTIVE. Based on the literature data, to investigate the possible side effects of immunotherapeutic drugs on the endocrine system. MATERIALS AND METHODS. Object: endocrine complications due to immunotherapy. Research method: review of literary sources. RESULTS. Among the manifestations of the endocrine system, the most common are thyroid dysfunction and diabetes mellitus. It is important to monitor the levels of thyroid-stimulating hormone (TSH), free T4, blood glucose and glycated hemoglobin for timely detection of endocrine pathology, prevention of unwanted complications and improvement of patients’ quality of life. CONCLUSIONS. Immunotherapy is vital for cancer patients. Given the possible development of various side effects, including those from the endocrine system, patients should monitor the main indicators of the thyroid gland (TSH, free T4) and carbohydrate metabolism (blood glucose, glycated hemoglobin) both before starting immunotherapy and during treatment. Patients with pre-existing endocrine disorders require more careful monitoring. It is possible that such patients, in the process of immunotherapy, may require correction of hypoglycemic drugs: speaking of diabetes mellitus, a possible option may be a dose correction of tableted antidiabetic drugs, a change in the therapy regimen or insulin therapy; in diseases of the thyroid gland, the doctor may suggest dose adjustment of thyroid drugs, ultrasound diagnostics and/or fine-needle aspiration biopsy of thyroid nodules.
背景。免疫疗法是一种创新的治疗方法,正在改变肿瘤学的范式,并在对抗恶性肿瘤(包括白血病、黑色素瘤、肺癌、肾癌和许多其他肿瘤)方面取得了重大成果。这种疗法利用人体免疫系统的力量来对抗癌细胞。免疫疗法可以导致某些类型癌症患者的肿瘤长期缓解甚至完全消失。治疗的成功取决于许多因素,包括癌症的类型和患者的个体特征。与任何治疗一样,免疫疗法的患者可能会出现副作用。由于使用派姆单抗(和其他免疫治疗药物)治疗,患者可能会出现内分泌紊乱。最常见的内分泌副作用包括甲状腺炎(可导致甲状腺功能亢进或减退)、甲状旁腺炎症、垂体炎和糖尿病。目标。结合文献资料,探讨免疫治疗药物对内分泌系统可能产生的副作用。 材料和方法。目的:探讨免疫治疗引起的内分泌并发症。研究方法:文献资料综述。 结果。在内分泌系统的表现中,最常见的是甲状腺功能障碍和糖尿病。监测促甲状腺激素(TSH)、游离T4、血糖及糖化血红蛋白水平,对及时发现内分泌病理,预防不良并发症,提高患者生活质量具有重要意义。 结论。免疫疗法对癌症患者至关重要。考虑到可能出现的各种副作用,包括内分泌系统的副作用,患者应在开始免疫治疗前和治疗过程中监测甲状腺(TSH,游离T4)和碳水化合物代谢(血糖,糖化血红蛋白)的主要指标。已有内分泌失调的患者需要更仔细的监测。这类患者在免疫治疗过程中可能需要纠正降糖药:说到糖尿病,一种可能的选择可能是调整片剂降糖药的剂量,改变治疗方案或胰岛素治疗;对于甲状腺疾病,医生可能建议调整甲状腺药物的剂量,超声诊断和/或甲状腺结节细针穿刺活检。
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引用次数: 0
Features of the course of pulmonary tuberculosis against the background of coronavirus infection according to computed tomography of the chest organs 胸部器官ct对冠状病毒感染背景下肺结核病程特征的探讨
Pub Date : 2023-09-29 DOI: 10.32902/2663-0338-2023-3-16-23
М.І. Lynnyk, V.І. Іgnatieva, G.L. Gumeniuk, V.А. Svyatnenko, V.Ye. Ivashchenko, О.P. Chobotar, М.G. Palivoda
BACKGROUND. Quarantine measures regarding the coronavirus disease (COVID-19) pandemic, initiated in early 2020, and subsequently large-scale hostilities in Ukraine, led to a decrease in the detection of tuberculosis (TB) patients and an increase in mortality from this disease. Particular attention needs to be paid to the peculiarities of the course of pulmonary TB against the background of a coronavirus infection, which may be due to both the features of the impact of SARS-CoV-2 and the features of the immunological status of patients with pulmonary TB with preserved sensitivity to antimycobacterial drugs (DSTB) and with drug resistance. OBJECTIVE. To investigate the dynamics of the course of pathological changes in the lungs in patients with pulmonary TB against the background of coronavirus infection by analyzing the data of computed tomography (CT) of the chest organs. MATERIALS AND METHODS. Establishing the diagnosis and treatment of pulmonary TB were carried out in accordance with the Order of the Ministry of Health of Ukraine No. 530. The diagnosis of COVID-19 was established in patients who were treated for pulmonary TB in accordance with the current protocols for the treatment of the coronavirus infection. All patients underwent dynamic CT of the chest organs was performed on the Aquilion TSX-101A scanner (Toshiba, Japan). RESULTS AND DISCUSSION. Clinical, laboratory and X-ray data of patients with pulmonary TB and COVID-19 were analyzed in dynamics. It has been established that with timely diagnosis and adequate treatment of DSTB of the lungs, viral pneumonia (COVID-19) does not complicate the course of the TB process. The period of the course of COVID-19 is characterized by the continuation of the positive dynamics of the TB process. In patients with TB with multiple drug resistance, viral pneumonia (COVID-19) does not cause serious complications, but the period of the course of COVID-19 is characterized by the absence of positive dynamics of the TB process. With untreated pulmonary TB on the background of viral pneumonia (COVID-19), the disease can become severe and end in death. CONCLUSIONS. CT of the chest organs in patients with pulmonary TB against the background of COVID-19 is highly informative in monitoring the pathological process, detecting complications and evaluating the effectiveness of treatment.
背景。2020年初针对冠状病毒病(COVID-19)大流行采取的隔离措施,以及随后在乌克兰发生的大规模敌对行动,导致结核病患者检出率下降,该病死亡率上升。需要特别注意的是,在冠状病毒感染的背景下,肺结核病程的特殊性,这可能是由于SARS-CoV-2的影响特点和肺结核患者对抗结核药物(DSTB)保持敏感性和耐药的免疫状态的特点。目标。通过分析肺部器官CT资料,探讨冠状病毒感染背景下肺结核患者肺部病理变化的动态变化。 材料和方法。根据乌克兰卫生部第530号命令,建立了肺结核的诊断和治疗。根据目前治疗冠状病毒感染的方案,在接受肺结核治疗的患者中诊断为COVID-19。所有患者均在Aquilion TSX-101A扫描仪(Toshiba, Japan)上进行胸部器官动态CT扫描。结果和讨论。对肺结核合并新冠肺炎患者的临床、实验室和x线资料进行动态分析。已经确定,通过及时诊断和适当治疗肺部的DSTB,病毒性肺炎(COVID-19)不会使结核病过程复杂化。2019冠状病毒病期间的特点是结核病进程的积极动态继续存在。在多重耐药结核病患者中,病毒性肺炎(COVID-19)不会引起严重并发症,但COVID-19病程期间的特点是缺乏结核病过程的积极动态。在病毒性肺炎(COVID-19)的背景下,未经治疗的肺结核可能会变得严重并最终导致死亡。结论。新冠肺炎背景下肺结核患者胸部脏器CT对监测病理过程、发现并发症、评价治疗效果具有很高的信息价值。
{"title":"Features of the course of pulmonary tuberculosis against the background of coronavirus infection according to computed tomography of the chest organs","authors":"М.І. Lynnyk, V.І. Іgnatieva, G.L. Gumeniuk, V.А. Svyatnenko, V.Ye. Ivashchenko, О.P. Chobotar, М.G. Palivoda","doi":"10.32902/2663-0338-2023-3-16-23","DOIUrl":"https://doi.org/10.32902/2663-0338-2023-3-16-23","url":null,"abstract":"BACKGROUND. Quarantine measures regarding the coronavirus disease (COVID-19) pandemic, initiated in early 2020, and subsequently large-scale hostilities in Ukraine, led to a decrease in the detection of tuberculosis (TB) patients and an increase in mortality from this disease. Particular attention needs to be paid to the peculiarities of the course of pulmonary TB against the background of a coronavirus infection, which may be due to both the features of the impact of SARS-CoV-2 and the features of the immunological status of patients with pulmonary TB with preserved sensitivity to antimycobacterial drugs (DSTB) and with drug resistance.&#x0D; OBJECTIVE. To investigate the dynamics of the course of pathological changes in the lungs in patients with pulmonary TB against the background of coronavirus infection by analyzing the data of computed tomography (CT) of the chest organs.&#x0D; MATERIALS AND METHODS. Establishing the diagnosis and treatment of pulmonary TB were carried out in accordance with the Order of the Ministry of Health of Ukraine No. 530. The diagnosis of COVID-19 was established in patients who were treated for pulmonary TB in accordance with the current protocols for the treatment of the coronavirus infection. All patients underwent dynamic CT of the chest organs was performed on the Aquilion TSX-101A scanner (Toshiba, Japan).&#x0D; RESULTS AND DISCUSSION. Clinical, laboratory and X-ray data of patients with pulmonary TB and COVID-19 were analyzed in dynamics. It has been established that with timely diagnosis and adequate treatment of DSTB of the lungs, viral pneumonia (COVID-19) does not complicate the course of the TB process. The period of the course of COVID-19 is characterized by the continuation of the positive dynamics of the TB process. In patients with TB with multiple drug resistance, viral pneumonia (COVID-19) does not cause serious complications, but the period of the course of COVID-19 is characterized by the absence of positive dynamics of the TB process. With untreated pulmonary TB on the background of viral pneumonia (COVID-19), the disease can become severe and end in death.&#x0D; CONCLUSIONS. CT of the chest organs in patients with pulmonary TB against the background of COVID-19 is highly informative in monitoring the pathological process, detecting complications and evaluating the effectiveness of treatment.","PeriodicalId":13681,"journal":{"name":"Infusion & Chemotherapy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135199881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The role of comorbidity in the development of Long-COVID 合并症在Long-COVID发展中的作用
Pub Date : 2023-03-29 DOI: 10.32902/2663-0338-2023-1-20-24
T.V. Chernii, V.I. Chernii, D.A. Fokina
BACKGROUND. Post-COVID syndrome is a set of conditions that occur in patients after a coronavirus infection. To date, there remains great interest in identifying the relationships between the influence of concomitant diseases on the course of SARS-CoV-2 infection and the selection of a justified treatment regimen from the point of view of the pathogenesis of the formation of long-term consequences of the disease. OBJECTIVE. To investigate the role of comorbidity in the development of Long-COVID, to study and analyze the results of treatment with a combination of Xavron, Tivorel and Xylate in patients with asthenic manifestations of Long-COVID. MATERIALS AND METHODS. A clinical and neurological examination of 50 patients aged 47 to 76 years with a diagnosis of chronic cerebral ischemia and an asthenic syndrome that persisted for more than 3 months after a confirmed SARS-CoV-2 infection was carried out. All patients were treated according to a clinical protocol approved by the MOH of Ukraine. In addition to the main treatment, 20 patients received a 10-day course of infusions of a combination of the drugs Xavron in a dose of 30 mg No. 10, Tivorel 100.0 No. 5 and Xylate 200.0 No. 5 every other day. Efficacy was assessed before treatment, on the 5th and 10th day of treatment using the MMSE, DASS-21, FAS and MOND scales. RESULTS AND DISCUSSION. A stable positive relationship was found between the number of CIRS-G comorbidity scores and the MOND score. A positive correlation coefficient between comorbidity and asthenic syndrome, assessed on the FAS scale, was also expressed – 0.699 (p<0.001). A somewhat weaker negative relationship was found between anxiety and the number of points on the CIRS-G scale – -0.474 (p=0.035). Assessment of depression and stress on the DASS-21 scale did not show a reliably significant correlation effect. After treatment, the severity of neurological symptoms, assessed by the MOND scale, decreased from 5.6±1.6 to 2.8±1 (p<0.01). Depression and anxiety scores on the DASS-21 scale decreased moderately from 4.9±3.6 to 2.8±1.5 (p<0.01) and from 6.3±2.3 to 4.3±1.5 (p<0.01), respectively. A more significant regression was observed on the stress scale – from 10.3±3.1 to 7.5±1.9 (p<0.01). The difference in the severity of fatigue from 28.8±4.1 to 20±1.2 was especially noticeable (p<0.01). CONCLUSIONS. Asthenic syndrome, which is prevalent in the Long-COVID, directly depends on the background of chronic diseases. The combination of Xavron, Tivorel and Xylate is pathogenetically justified and safe in the treatment of patients with Long-COVID. The use of this combination leads to a reduction of asthenic syndrome, which, in turn, has a positive effect on the reduction of cognitive manifestations of Long-COVID in the form of “brain fog”.
背景。后冠状病毒综合征是冠状病毒感染后患者出现的一系列症状。迄今为止,从疾病形成长期后果的发病机制的角度出发,人们仍然非常有兴趣确定伴随疾病对SARS-CoV-2感染过程的影响与选择合理的治疗方案之间的关系。目标。探讨合并症在Long-COVID发展中的作用,研究和分析Xavron、替佛瑞尔和木酸酯联合治疗Long-COVID虚弱表现患者的效果。 材料和方法。对50例年龄在47岁至76岁之间,诊断为慢性脑缺血并在确诊的SARS-CoV-2感染后持续3个多月的衰弱综合征的患者进行临床和神经学检查。所有患者均按照乌克兰卫生部批准的临床方案进行治疗。除主要治疗外,20名患者接受了为期10天的药物联合输注,剂量为30 mg No. 10,每隔一天输注一次替佛瑞尔100.0 No. 5和Xylate 200.0 No. 5。治疗前、治疗第5、10天分别采用MMSE、DASS-21、FAS、MOND量表评估疗效。结果和讨论。CIRS-G合并症评分与MOND评分呈稳定正相关。FAS量表评估的共病与衰弱综合征之间的正相关系数也为- 0.699 (p<0.001)。焦虑与CIRS-G量表得分之间存在较弱的负相关关系- -0.474 (p=0.035)。抑郁和压力在das -21量表上的评估没有显示出可靠的显著相关效应。治疗后,经MOND量表评估的神经症状严重程度从5.6±1.6降至2.8±1 (p<0.01)。抑郁和焦虑在DASS-21量表上分别从4.9±3.6分降至2.8±1.5分(p<0.01)和从6.3±2.3分降至4.3±1.5分(p<0.01)。在应力量表上观察到更显著的回归-从10.3±3.1到7.5±1.9 (p<0.01)。疲劳程度从28.8±4.1到20±1.2的差异尤为显著(p<0.01)。结论。在长冠人群中普遍存在的虚弱综合征与慢性病背景直接相关。Xavron、Tivorel和Xylate联合治疗Long-COVID患者在病理学上是合理和安全的。使用这种组合可以减少虚弱综合征,这反过来又对减少长冠状病毒以“脑雾”形式出现的认知表现产生积极影响。
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引用次数: 0
The role of vitamin D deficiency in antituberculous protection 维生素D缺乏在抗结核保护中的作用
Pub Date : 2021-12-27 DOI: 10.32902/2663-0338-2021-4-38-44
L. Todoriko, Ya.I. Toderika, O. Shevchenko, O. Pidverbetska, O.Ya. Pidverbetskyi
BACKGROUND. The main task of modern phthysiology is a comprehensive search for ways to optimize the etiotropic and the pathogenetic treatment of tuberculosis (TB). The search for improved treatment in addition to etiotropic antimicrobial therapy lies in the plane of improving pathogenetic therapy. Analysis of the available scientific sources suggests that the efficacy of TB treatment can be improved by adding vitamin D to the pathogenetic treatment, as vitamin D metabolites support the innate immune response to Mycobacterium tuberculosis. OBJECTIVE. To determine the role of vitamin D in the immunopathogenesis of the inflammatory response in pulmonary TB and to assess the prospects of its impact on improving the effectiveness of treatment by analyzing information from available scientific sources on this topic. MATERIALS AND METHODS. The study was performed for the period December 2020 – August 2021. The search was conducted by Keywords: pulmonary tuberculosis, vitamin D, mechanism of action, pathogenesis, treatment. Access to various full-text and abstract databases was used as the main source of research. RESULTS AND DISCUSSION. A large number of studies conducted so far prove the link between vitamin D deficiency and the occurrence of pulmonary TB. Vitamin D receptors have been found to be present on various surfaces of immune cells, including T and B cells, indicating that they need vitamin D to perform cellular functions. Vitamin D has been shown to increase the phagocytic activity of macrophages, and that monocytes incubated with cholecalciferol (vitamin D3) metabolites induce anti-TB activity. A number of studies have shown that vitamin D increases the body’s production of the antimicrobial/antimycobacterial peptide LL-37, a member of the cathelicidin petelide family. Therefore, the narrowly analyzed analysis according to the literature suggests that in the conditions of full vitamin D status of the human body the course of TB will be favorable, and in case of vitamin D deficiency – which is primarily associated with genetic polymorphisms, the course of TB may be unfavorable. CONCLUSIONS. Vitamin D functionates as one of the activators of macrophages and plays a role in the immune defense of the human body against mycobacterial TB. The inclusion of vitamin D in the program of complex treatment of TB infection is promising, as it enhances the production of antimicrobial/antimycobacterial peptide LL-37. It can be used as one of the components of TB prevention in children.
背景。现代生理学的主要任务是全面探索优化结核病的病因和致病治疗方法。除致因性抗菌药物治疗外,寻找改进的治疗方法是在改进病原学治疗的平面上。对现有科学资料的分析表明,由于维生素D代谢物支持对结核分枝杆菌的先天免疫反应,在致病性治疗中加入维生素D可以提高结核病治疗的疗效。目标。通过分析现有的有关这一主题的科学资料,确定维生素D在肺结核炎症反应的免疫发病机制中的作用,并评估其对提高治疗有效性的影响前景。材料和方法。该研究在2020年12月至2021年8月期间进行。关键词:肺结核,维生素D,作用机制,发病机理,治疗。获取各种全文和摘要数据库是研究的主要来源。结果和讨论。迄今为止进行的大量研究证明了维生素D缺乏与肺结核的发生之间的联系。维生素D受体被发现存在于免疫细胞的各种表面,包括T细胞和B细胞,这表明它们需要维生素D来发挥细胞功能。维生素D已被证明可增加巨噬细胞的吞噬活性,并且与胆钙化醇(维生素D3)代谢物孵育的单核细胞可诱导抗结核活性。许多研究表明,维生素D可以增加人体产生抗菌/抗细菌肽LL-37,这是抗菌肽家族的一员。因此,根据文献的狭义分析表明,在人体维生素D充足的情况下,结核病的病程将是有利的,而在维生素D缺乏的情况下,结核病的病程可能是不利的,而维生素D缺乏主要与遗传多态性有关。结论。维生素D作为巨噬细胞的激活剂之一,在人体对结核分枝杆菌的免疫防御中发挥作用。将维生素D纳入结核病感染的综合治疗方案是有希望的,因为它能促进抗菌/抗真菌肽LL-37的产生。它可以作为儿童结核病预防的组成部分之一。
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引用次数: 1
Risks of using pre-event time scale and ordinal scale measurements in COVID-19 clinical trials 在COVID-19临床试验中使用事件前时间尺度和顺序尺度测量的风险
Pub Date : 2021-12-27 DOI: 10.32902/2663-0338-2021-4-32-37
M.V. Yashchenko
BACKGROUND. The article shows the results of literature search and analysis of endpoints of interventional clinical trials of phase III-IV of the treatment of hospitalized patients with coronavirus disease (COVID-19) and of its prevention. MATERIALS AND METHODS. Among 102 trials found, ordinal scales were used in 60 trials, time-to-event outcome measures were used in 54 trials, both scales – in 49 trials. Time-to-event endpoints were related to hospitalization/intensive care unit term, discontinuation of oxygen therapy, and clinical improvement standardized on ordinal scales. At the same time, the early discontinuation of oxygen therapy and the early discharge create risks to the biometric measurement. RESULTS AND DISCUSSION. Statistical calculations showed the association of the number of new COVID-19 hospital admissions per day with the percentage of free beds, but not only with the number of new coronavirus infection cases in general, the number of deaths and the number of people recovering from COVID-19 per day in different regions of Ukraine. These results may indicate that resource-dependence and organizational aspects affect the hospitalization of patients with COVID-19. CONCLUSIONS. Therefore, to ensure that the discharge or discontinuation of oxygen therapy was due solely to a positive clinical outcome, data on changes of number of beds, access to oxygen supplies as well as data relevant to determination of the desired clinical outcome (body temperature, oxygen saturation, severity of symptoms, etc.) should be collected. It is recommended to collect biomarker data after discharge, if possible.
背景。本文显示了对新冠肺炎(COVID-19)住院患者治疗和预防的III-IV期介入临床试验终点的文献检索和分析结果。材料和方法。在发现的102项试验中,60项试验使用了顺序量表,54项试验使用了事件发生时间结果测量,49项试验使用了两种量表。时间到事件终点与住院/重症监护病房期限、停止氧疗和临床改善相关。同时,早期停止氧疗和早期出院对生物特征测量产生风险。结果和讨论。统计计算显示,在乌克兰不同地区,每天新增COVID-19住院人数与免费床位百分比相关,但不仅与一般新冠病毒感染病例数、死亡人数和每天从COVID-19中康复的人数相关。这些结果可能表明资源依赖和组织方面影响COVID-19患者的住院治疗。结论。因此,为了确保出院或停止氧疗完全是由于临床结果阳性,应收集床位数量变化、供氧情况以及与确定预期临床结果(体温、血氧饱和度、症状严重程度等)相关的数据。如果可能,建议在出院后收集生物标志物数据。
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引用次数: 0
Inhaled antiseptics and inhaled antiviral non-prescription drugs in the prevention of ARVI, in particular COVID-19: an epidemiological study 吸入消毒剂和吸入抗病毒非处方药预防ARVI,特别是COVID-19:一项流行病学研究
Pub Date : 2021-12-27 DOI: 10.32902/2663-0338-2021-4-5-15
Y. Feshchenko, M. Gumeniuk, М. Lynnyk, O. Dziublyk, M. Kuzhko, О. Tereshkovych, O. Khmel, I. Panashchuk, M.V. Yashchenko, Оleksiy S. Denysov, Т.А. Sprynsian
BACKGROUND. The article presents the results of a continuous, cross-sectional, non-interventional, multicenter retrospective epidemiological study, which included cases of 3443 participants. Questionnaires and rapid test for antibodies to SARS-CoV-2 were used to collect data. OBJECTIVE. To determine the relationship between the systematic use of additional drugs for the prevention of COVID-19, including inhaled antiseptics and inhaled antiviral drugs, separately and in combination with other drugs, and the risk of developing of coronavirus disease (COVID-19). RESULTS AND DISCUSSION. 396 participants (11.8 %) took inhaled antiseptics in any period since March 2020, and 410 participants (12.2 %) took inhaled antivirals. A statistically significant protective relationship between episode of COVID-19 when taking inhaled antiseptics and inhaled antiviral drugs (risk ratio 0.901; 95 % confidence interval 0.856-0.948) was determined. CONCLUSIONS. The use of inhaled antiseptics and inhaled antiviral drugs as additional methods of prevention of COVID-19 has shown a statistically significant effect not only on reducing the risk of COVID-19, but different combinations of inhaled antiseptics or inhaled antiviral drugs with other drug groups as additional methods of preventing COVID-19 had a statistically significant protective relationship with the episode of the disease, with the severity of COVID-19 and with the need for hospitalization.
背景。本文介绍了一项连续、横断面、非介入、多中心回顾性流行病学研究的结果,其中包括3443名参与者的病例。采用问卷调查和SARS-CoV-2抗体快速检测方法收集数据。目标。确定系统使用额外的预防COVID-19药物,包括吸入性防腐剂和吸入性抗病毒药物,单独或与其他药物合用,与发生冠状病毒病(COVID-19)的风险之间的关系。结果和讨论。自2020年3月以来的任何时期,396名参与者(11.8%)吸入了防腐剂,410名参与者(12.2%)吸入了抗病毒药物。吸入消毒剂和吸入抗病毒药物时发生COVID-19的保护关系有统计学意义(风险比0.901;95%置信区间0.856 ~ 0.948)。结论。使用吸入性防腐剂和吸入性抗病毒药物作为新冠肺炎的附加预防方法,不仅在降低新冠肺炎风险方面具有统计学意义,而且不同组合使用吸入性防腐剂或吸入性抗病毒药物作为附加预防方法与疾病发作、新冠肺炎严重程度和住院需要具有统计学意义的保护关系。
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引用次数: 0
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Infusion & Chemotherapy
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