Peculiarities of the Inflammatory Process in the Reproductive Organs of C57Bl/6 Female Mice with Experimental Tuberculosis.

Intravenous infection of C57Bl/6 female mice with M. tuberculosis H37Rv led to involvement of the lungs and dissemination of the tuberculous infection to the abdominal and pelvic organs. M. tuberculosis were detected in the lungs and spleen in 14, 35, and 90 days and in the uterine horns in 90 days after infection. Morphological analysis of organs showed successive development of exudative necrotic tuberculosis of the lungs, acute and chronic nonspecific inflammation in the reproductive organs (vagina, uterus, and uterine horns). The inflammatory process in the reproductive organs was associated with the development of anaerobic dysbiosis, that was most pronounced in 35 days after infection. Antituberculous therapy was followed by reduction of M. tuberculosis count in the lungs and spleen in 60 and 90 days after infection, eliminatation of M. tuberculosis in the uterine horns, arrest of nonspecific inflammation in female reproductive organs, recovery of the balance between aerobic and anaerobic microflora, and development of candidiasis of the urogenital mucosa.

[A difficult case of the differential diagnosis of focal infiltrative lung changes in phthisiatric practice].

Errors occur rather commonly in the differential diagnosis of respiratory diseases accompanied by X-ray lung tissue changes as foci and infiltration. Infiltrative and disseminated pulmonary tuberculosis, lung cancer, and pneumonia constitute a high proportion among the detected concurrent lung diseases. The rate of diagnostic discordance for these lung abnormalities accounts for more than 30%; and the diagnosis period for an infiltrative lung process lasts 2­3 weeks in 20% of cases and above 1­3 months in 80%. In particular, clinicians are faced with great difficulties in diagnosing aspiration pneumonia; this is due to that its X-ray manifestations are not purely specific and they are characterized by the parenchymal (alveolar) infiltration of lung tissue with a varying extent of lung inflammation. This paper describes a clinical case of a patient with salivary gland adenocarcinoma and focal infiltrative lung changes. Diagnostic difficulties have emerged in establishing the genesis of the changes in the lung.

Performance of Cepheid ® Xpert MTB/RIF ® and TB-Biochip ® MDR in two regions of Russia with a high prevalence of drug-resistant tuberculosis.

The purpose of this study was to assess the performance of Cepheid® Xpert MTB/RIF® ("Xpert") and TB-Biochip® MDR ("TB-Biochip"). Sputum specimens from adults with presumptive tuberculosis (TB) were homogenized and split for: (1) direct Xpert and microscopy, and (2) concentration for Xpert, microscopy, culture [Lowenstein-Jensen (LJ) solid media and Mycobacteria Growth Indicator Tube® (MGIT)], indirect drug susceptibility testing (DST) using the absolute concentration method and MGIT, and TB-Biochip. In total, 109 of 238 (45.8 %) specimens were culture-positive for Mycobacterium tuberculosis complex (MTBC), and, of these, 67 isolates were rifampicin resistant (RIF-R) by phenotypic DST and 64/67 (95.5 %) were isoniazid resistant (INH-R). Compared to culture of the same specimen, a single direct Xpert was more sensitive for detecting MTBC [95.3 %, 95 % confidence interval (CI), 90.0-98.3 %] than direct (59.6 %, 95 % CI, 50.2-68.5 %) or concentrated smear (85.3 %, 95 % CI, 77.7-91.1 %) or LJ culture (80.8 %, 95 % CI, 72.4-87.5 %); the specificity was 86.0 % (95 % CI, 78.9-91.3 %). Compared with MGIT DST, Xpert correctly identified 98.2 % (95 % CI, 91.5-99.9 %) of RIF-R and 95.5 % (95 % CI, 85.8-99.2 %) of RIF-susceptible (RIF-S) specimens. In a subset of 104 specimens, the sensitivity of TB-Biochip for MTBC detection compared to culture was 97.3 % (95 % CI, 91.0-99.5 %); the specificity was 78.1 % (95 % CI, 61.5-89.9 %). TB-Biochip correctly identified 100 % (95 % CI, 94.2-100 %) of RIF-R, 94.7 % (95 % CI, 76.7-99.7 %) of RIF-S, 98.2 % (95 % CI, 91.4-99.9 %) of INH-R, and 78.6 % (95 % CI, 52.1-94.2 %) of INH-S specimens compared to MGIT DST. Xpert and Biochip were similar in accuracy for detecting MTBC and RIF resistance compared to conventional culture methods.

[Optimisation of diagnostics and differential diagnostics disseminated pulmonary tuberculosis].

One of the reasons of dramatic situation with tuberculosis in Russia is untimely diagnostics of tuberculosis. The aim of the study was to identify the causes of diagnostic mistakes when we deal with disseminated pulmonary tuberculosis at current stage and to modernize the diagnostic process. The analysis of the diagnostic activity of the consultative diagnostic center of Central Tuberculosis Research Institute of Russian Academy Medical Sciences for 2011 was performed with special attention on the results of the survey of 505 patients with pulmonary dissemination. The frequency of discrepancies of disseminated pulmonary tuberculosis diagnostics was 96.1%. Based on the studies carried out the main causes diagnostic mistakes in patients with disseminated pulmonary tuberculosis were determined. New directions of improving of tuberculosis diagnostics were developed: overall high-technology examination of patient, adherence to the diagnostic procedure, developed by consultative diagnostic center of Central Tuberculosis Research Institute (CTRI), timely performing fiber-optic bronchoscopy with complex biopsy and diagnostic surgery procedures, further training of primary health care doctors. Implementation of proposed activities will significantly (by 3-5 times) reduce the time for diagnostics of respiratory system disease.

[Digital X-ray study in the monitoring of collapse therapy in patients with destructive pulmonary tuberculosis].

Digital versus analogue X-ray studies in identifying different X-ray symptoms are analyzed; their accuracy, sensitivity, and radiation load on a patient were established. The costs of consumables used at digital and analogue X-ray studies have been calculated. An algorithm for monitoring artificial pneumothorax and pneumoperitoneum has been proposed for patients with destructive pulmonary tuberculosis. A procedure has been developed to determine a commissural process in the pleural cavity by digital X-ray study and X-ray computed tomography. The findings are indicative of the expediency and medicoeconomic effectiveness of digital X-ray study used in the monitoring collapse therapy in patients with destructive pulmonary tuberculosis.

[Differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia].

The purpose of this investigation was to enhance the efficiency of differential diagnosis of pneumonia and pulmonary tuberculosis. A hundred and fifty-nine adult patients were examined. These included 78 patients with pulmonary tuberculosis and 81 with community-acquired p neumonia. The clinical features of infiltrative pulmonary tuberculosis (n = 48) and mild community-acquired pneumonia (n = 51) were compared. The course of caseous pneumonia (n = 30) was compared with that of moderate and severe community-acquired pneumonia (n = 30). Significant differences in the manifestations of the intoxication and bronchopulmonary syndrome were not found in patients with community-acquired pneumonia and infiltrative pulmonary tuberculosis. Physical studies showed that in patients with community-acquired pneumonia, moist rale (54.9%) and crepitation (11.8%) were prevalent, but in those with infiltrative tuberculosis rale was absent in 60.4% of cases and the pattern of respiration was unchanged in 79.2%. Chest X-ray studies indicated that in patients with community-acquired pneumonia, lower lobar inflammatory changes were predominant in 62.8% of cases whereas in those with infiltrative pulmonary tuberculosis the process was mainly bilateral (43.8%) with the presence of destructive changes (83.3%) and bronchogenic dissemination (66.7%). In patients with caseous pneumonia, the intoxication syndrome was more significant than in those with severe community-acquired pneumonia. Chest X-ray studies demonstrated that in patients with caseous pneumonia, specific changes were bilateral with the involvement of 2 lobes or more, with destruction and bronchogenic dissemination while in those with community-acquired pneumonia, the pulmonary processes were predominantly bilateral (76.6%) at the lower lobar site (36.7%).

[Pathomorphological features of pulmonary tuberculosis at different stages of HIV infection: autopsy data].

The case histories, autopsy protocols, and histological specimens from 11 patients who had died from HIV-associated tuberculosis and 15 patients died from progressive disseminated tuberculosis and caseous pneumonia in the absence of HIV infection (a control group). In all the study patients, the morphology of the lung and peripheral and intrathoracic lymph nodes was examined at the early (2B) and late (4B-5) stages of HV infection (Groups 1 and 2, respectively). Group 1 patients had died from caseous pneumonia. Their morphology of tuberculosis differed little from that in the control group. Group 2 was marked by a predominance of disseminated tuberculosis with extensive exudative necrotic lesions in the lung, lymph nodes, and other organs in the presence of reduced lymphoid tissue and in the absence of a limited epitheloid cell reaction.

[X-ray features of disseminated pulmonary tuberculosis at late stages of HIV infection].

The paper analyzes the results of a study of X-ray features of disseminated pulmonary tuberculosis in HIV infection on the basis of a retrospective analysis of the case histories of 65 HIV-infected patients with disseminated pulmonary tuberculosis and 60 patients with disseminated tuberculosis without HIV infection, who have been followed up in the Krasnodar Territory. X-ray changes characteristic for patients with disseminated tuberculosis in HIV infection and their difference from those with disseminated tuberculosis without HIV infection have been ascertained, which assists in timely establishing the diagnosis of tuberculosis in HIV infection.

[Antimycobacterial activity of a dry birch bark extract on a model of experimental pulmonary tuberculosis].

The study deals with the evaluation of antimycobacterial activity of betulinol, a dry birch bark extract (BBE), on a model of infection caused by Mycobacterium tuberculosis (MBT). It has established the inhibitory action of betulinol on the in vitro and in vivo growth of MBT and its positive effect on reparative processes in the lung, liver, and spleen of tuberculosis-infected mice.

[Efficacy of long-term enalapril use in combined therapy of chronic pulmonary heart]. / Otsenka éffektivnosti dlitel'nogo primeneniia énalaprila v kompleksnoi terapii khronicheskogo legochnogo serdtsa.

86 patients with chronic obstructive pulmonary diseases (COPD) and tuberculosis in combination with COPD complicated by chronic pulmonary heart (CPH) received a 18-month continuous treatment with enalapril (enap, D. Reddis Laboratories). It was found that the addition of enap, an inhibitor of ACE, to combined therapy of CPH patients is pathogenetic as it results in lowering of blood pressure in pulmonary artery, remodeling of hypertrophic right ventricle of the heart and decline of left ventricular dysfunction, in improvement of functional state of the lungs, in arrest of progression of cardiac failure. Long-term administration of the drug induced no serious side effects and is well tolerated.

[Impaired free radical oxidation and structural-functional state of erythrocytes in chronic respiratory insufficiency and a method of their correction]. / Narusheniia svobodnoradikal'nogo okisleniia i strukturno-funktsional'nogo sostoianiia éritrotsitov pri khronicheskoi dykhatel'noi nedostatochnosti i sposob ikh korrektsii.

To examine erythrocytic structural and functional changes and lipid peroxidation impairments, which are caused by respiratory failure, and to study whether small-volume extracorporeal blood membrane gas exchange (SVEBMGE) can correct these disorders, a clinical and experimental studies were undertaken to examine 15 patients with tuberculosis complicated by Degree III respiratory failure. Respiratory failure was found to activate lipid peroxidation which was accompanied by lower blood antioxidative activity and correlated with the structural and functional changes of red blood cells and their population composition. The application of SVEBMGE to correct experimental hypoxemia in Degree III respiratory failure complicating pulmonary tuberculosis was demonstrated to normalize the population composition of red blood cells showed the substituting and antioxidant-stimulating effect of oxygen, by contributing to a reduction in the rate of free radical oxidation.

[Low-flow membrane blood gas exchange in the treatment of chronic respiratory insufficiency]. / Malopotochnyi membrannyi gazoobmen krovi v lechenii khronicheskoi dykhatel'noi nedostatochnosti.

The results of experimental and clinical studies provide evidence that the developed method for treating chronic respiratory failure, i.e. low-flow extracorporeal membranous blood gas exchange, is a pathogenetic method for the management of respiratory failure. Its action is effected through improvement of the organism's oxygen regiment, partial CO2 elimination, improvement of hemodynamic and hemorheological parameters, prevention of damage to lung ultrastructure induced by respiratory failure.