RESUMO
The study of the clinical and laboratory dynamics after an intensive phase of treatment in patients with firstly diagnosed pulmonary tuberculosis (FDTB) with alcohol consumption, and the development of a method for predicting the effectiveness of treatment. Examined 109 men with FDTB aged 20 to 50 years. Depending on the level of alcohol consumption, 3 groups of patients were formed. Patients of each group divided into two subgroups depending on the treatment regimen. The highest response to antioxidant therapy had indicators of phagocytic and enzymatic activity of neutrophils and endogenous intoxication. The dynamics of a decrease in all indicators of oxidative stress in groups 1 and 2 was higher in patients who additionally received antioxidants. The positive effects of group 3 was less. The models of prediction the positive dynamics level in the treatment of patients depending on the scheme therapy received have been developed. Predictors of treatment efficacy for patients with FDTB and alcohol intake with standard therapy are baseline alcohol consumption level, phagocytic index, and blood lymphocyte count. When prescribing antioxidants to a standard therapy regimen - initial level of alcohol consumption and phagocytic number. The degree of alcohol consumption is a common determinant of treatment effectiveness, regardless of treatment regimen.
Assuntos
Tuberculose Pulmonar , Adulto , Consumo de Bebidas Alcoólicas , Antioxidantes/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo , Resultado do Tratamento , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Adulto JovemRESUMO
The Ukraine ranks among the top 20 countries with the highest number of multidrug-resistant (MDR) and extensively drug resistant (XDR) Mycobacterium tuberculosis cases in the world. However, little is known of the genetic diversity, i.e., resistance signatures, in clinical isolates from this region. We analyzed seven of most prevalent MDR/XDR antibiotic resistance-conferring genes from clinical isolates (n = 75) collected from geographically diverse Ukrainian oblasts and the southern Crimean peninsula. Genomic analysis revealed that 6 (8%) were sensitive, 3 (4%) were resistant to at least one antibiotic but were not MDR, 40 (53%) were MDR, and 26 (35%) were XDR. The majority of isolates (81%) were of the Beijing-like lineage. This is the first study to use next-generation sequencing (NGS) of clinical isolates from the Ukraine to characterize mutations in genes conferring M. tuberculosis drug resistance. Several isolates harbored drug resistance signatures that have not been observed in other countries with high-burden tuberculosis. Most notably, the absence of inhA gene promoter mutations, a diversity of mutation types in the rpoB resistance-determining region, and detection of heteroresistance provide a broader understanding of MDR/XDR from this area of the world.