Antituberculosis Chemotherapy Research Articles

Consistent Application of Physiotherapy Methods in the Treatment of Patients with Pulmonary Tuberculosis: A Clinical Case

Introduction. One of the problems of domestic phthisiology is the low effectiveness of treatment, which, along with anti-tuberculosis chemotherapy, uses pathogenetic methods, including physiotherapy procedures. The use of several physical factors in the treatment of pulmonary tuberculosis shows great therapeutic effectiveness. However, there are not enough works highlighting the combined effects of physical factors in tuberculosis of the respiratory system, applied in successive courses, taking into account the phase of a specific process and the mechanisms of therapeutic effects of physical methods.The purpose of the study — is to demonstrate the effectiveness of consistent application of physiotherapy methods in the treatment of patients with pulmonary tuberculosis.Materials and methods. The materials of the study were the medical records of the inpatient and the results of a comprehensive examination.Results and discussion. The presented clinical example demonstrates the effectiveness of consistent application of physiotherapy procedures in the complex treatment of a patient with infiltrative pulmonary tuberculosis. After 1 month from the start of treatment, accelerated positive clinical dynamics was noted, cessation of bacterial excretion, partial resorption of infiltrative changes in the lungs, by 2 months — closure of the decay cavities, after 4 months the patient was discharged with minimal radiological changes to continue treatment on an outpatient basis.Conclusion. Consistent application of physical factors can be one of the effective methods of improving the effectiveness of treatment of pulmonary tuberculosis, as demonstrated by the presented clinical examples. Further research is needed to substantiate the effectiveness of the proposed methodology.

Influence of preoperative antituberculosis chemotherapy duration on perioperative complications in patients treated with epididymectomy for epididymal tuberculosis.

We aimed to investigate the influence of preoperative antituberculosis chemotherapy duration on perioperative epididymectomy complications in patients with epididymal tuberculosis (ETB). This retrospective study examined patients with ETB between January 1, 2013, and March 31, 2023, who underwent unilateral epididymectomy at our hospital. We selected preoperative antituberculosis chemotherapy duration of 2, 4, and 8 weeks as the cutoffs for this study, to explore whether there are differences in the incidence of intraoperative and 30-day postoperative complications among the patients with different preoperative antituberculosis chemotherapy durations. Intraoperative complications were graded according to the Satava classification, and 30-day postoperative complications were defined according to the Clavien-Dindo classification. The study groups were compared using the unpaired t-test, Wilcoxon rank-sum test, Pearson's chi-square test, or Fisher's exact test, as appropriate. Overall, 155 patients were included. Statistical analysis revealed that there were no significant differences in the incidence of intraoperative and 30-day postoperative complications between patients with shorter preoperative antituberculosis chemotherapy duration and those with longer preoperative antituberculosis chemotherapy duration. In patients with ETB, preoperative antituberculosis chemotherapy duration did not significantly affect the incidence of perioperative complications after epididymectomy.

Integrated Approach in the Treatment of a Patient with Tuberculosis of the Lungs and Tracheobronchial Tree

Introduction. According to the World Health Organization data for 2021, there is an increase in the incidence of tuberculosis (TB) worldwide. There is also an unfavorable growth trend in drug-resistant TB. One of the complications of the tuberculosis process is tuberculosis of the tracheobronchial tree, which has tended to grow in recent years. Many studiesindicate the incidence of bronchial tuberculosis from 10 to 40 %, taking into account the level of endoscopic service.The purpose of the study to demonstrate the high effectiveness of an integrated approach in the treatment of a patient with tuberculosis of the lungs and tracheobronchial tree.Methods. The materials of the study were: the outpatient card of the advisory department of the Central Tuberculosis Research Institute, the medical history of the inpatient patient and the results of a comprehensive examination.Results. The presented clinical example demonstrates the high effectiveness of an integrated approach in the treatment of a patient with a widespread tuberculosis process using anti-tuberculosis chemotherapy, inhalation and pathogenetic therapy. By 4 months of treatment, pronounced positive clinical and laboratory dynamics was observed, significant resorption of focal infiltrative changes in the leſt lung was achieved radiologically, and endoscopically, infiltrative tuberculosis of the trachea, leſt main bronchus and leſt upper lobe bronchus was cured.Conclusion. This clinical observation demonstrates the need for an integrated approach in the management of this category of patients and shows the high effectiveness of the treatment.

Indications for Extrapleural Thoracoplasty in HIV-Positive Patients with Destructive Pulmonary Tuberculosis

The objective: to specify indications for extrapleural thoracoplasty in patients with destructive pulmonary tuberculosis and comorbid HIV infection.Subjects and Methods. Results of surgical treatment of 78 destructive pulmonary tuberculosis patients were studied. Those patients underwent extrapleural thoracoplasty in Pulmonary Tuberculosis Surgery Unit of City Tuberculosis Hospital No. 2 in St. Petersburg from 2009 to 2022.Results. The article clarifies the indications for extrapleural thoracoplasty in patients with destructive pulmonary tuberculosis and comorbid HIV infection, in whom contraindications to pulmonary resections have been identified. Medical records of 78 patients with destructive tuberculosis were retrospectively analyzed, the patients were divided into two groups according to their HIV status. It has been established that with combination of adequate preoperative preparation and postoperative management, rational anti-tuberculosis chemotherapy and ART, extrapleural thoracoplasty for HIV-positive patients can be performed in accordance with general practice.

A Rare Case of Tuberculous Constrictive Pericarditis Due to Disseminated Tuberculosis with Response to Anti-tuberculosis Chemotherapy and Steroids in a Developed City State

A 27-year-old man presented with a 1-week history of atypical chest pain and sinus tachycardia. His physical examination was unremarkable. His resting ECG showed sinus tachycardia with widespread T-wave inversion. His initial blood tests show mildly raised troponin T and inflammatory markers and marked raised D-dimer. A CT pulmonary angiogram was performed to exclude pulmonary embolism but incidentally revealed an anterior mediastinal mass. A transthoracic echocardiogram and cardiac MRI showed features of constrictive pericarditis. A video-assisted thoracoscopic surgical biopsy of the anterior mediastinal mass showed thymic tissue with necrotising granulomatous inflammation and an acid-fast bacilli culture was positive to tuberculosis infection. The patient was started on anti-tuberculosis chemotherapy and a 6-week tapering course of oral steroids. A repeat cardiac MRI performed after 6 weeks of treatment showed a significant response to treatment with resolution of constrictive physiology.

Pneumothorax revealing miliary tuberculosis: A case report

Pulmonary tuberculosis can take several clinical and radiological forms; spontaneous pneumothorax is a serious complication of tuberculosis, and tuberculous miliary is a severe form of secondary tuberculosis due to hematogenous dissemination of Mycobacterium tuberculosis. We report a case of tuberculous miliary revealed by pneumothorax. The patient was 57 years old and a farmer. He was been presented to the emergency department of Mohamed VI University Hospital in Marrakech with acute dyspnea associated with chest pain. Clinical examination and imaging revealed a spontaneous pneumothorax that complicated tuberculous miliary. Treatment consisted of a combination of anti-tuberculosis chemotherapy, chest drainage, and kinesrespiratory therapy. The outcome was favorable, with improvement in clinical and radiological signs. Pneumothorax complicating TM requires careful diagnosis and prompt management to improve prognosis.

Evaluation of Systemic Inflammation Before and After Standard Anti-tuberculosis Treatment in Patients With Active Pulmonary Tuberculosis and Diabetes Mellitus.

Background Diabetes mellitus (DM) is a common comorbidity of active pulmonary tuberculosis (APTB) that increases the risk of treatment failure during anti-tuberculosis chemotherapy. Evaluating systemic inflammatory response could help determine differences in response to treatment between APTB patients and those with APTB and DM. Methodology To explore changes in systemic inflammation, measured by a set of inflammatory mediators in subjects with APTB and TBDM before and after six months of anti-tuberculosis chemotherapy, 30 APTB and nine TBDM subjects underwent cytokine testing, including interleukin (IL)-6, IL-8, IL-10, interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), and transforming growth factor-beta 1 (TGF-β1) by enzyme-linked immunosorbent assay, C-reactive protein by nephelometry, and sialic acid by colorimetric assay at baseline and following six months of standard anti-tuberculosis treatment. Sputum smear microscopy or molecular biology (Xpert MTB/RIF) was used for diagnosis, and sputum smear microscopy was performed monthly during the treatment of the patient with pulmonary tuberculosis to evaluate his evolution. Principal component analysis examined changes in the inflammatory status. Results Both groups showed negative sputum smear microscopy in the sixth month after starting anti-tuberculosis chemotherapy. TGF-β1 was found to be significantly higher in subjects with TBDM before treatment compared to APTB patients (p<0.001), and systemic inflammation continued only in TBDM subjects after treatment (accumulation and persistence of inflammatory mediators like IL-6, IL-8, IL-10, IFN-γ, TNF-α, TGF-β1, C-reactive protein, and sialic acid in blood). On the other hand, the mediators IFN-γ, C-reactive protein, and total sialic acid were found to be most influential in distinguishing pre- and post-treatment inflammatory response in subjects with APTB without DM. Conclusions Inflammatory mediators analyzed in combination, including IFN-γ, CRP, and total sialic acid, may be useful in evaluating the systemic inflammatory response in subjects with APTB and TBDM before and after anti-tuberculosis treatment. Determining these mediators revealed persistent systemic inflammation in TBDM subjects after six months of standard tuberculosis treatment, despite negative sputum smear microscopy results and good glycemic control. This suggests a need for inflammation-modulating therapies during tuberculosis control. Finally, monitoring sputum smear microscopy results alongside the determination of proposed inflammatory mediators (IFN-γ, CRP, and total sialic acid) are effective in evaluating the response to anti-tuberculosis treatment in APTB subjects without DM, warranting further investigation.

Retrospective Analysis of the Efficacy and Safety of Endoscopic Spinal Tuberculosis Focus Removal versus Posterior Pedicle Lesion Removal, Bone Grafting, and Internal Fixation Combined with Drug Chemotherapy for Thoracolumbar Tuberculosis.

This study aims to investigate the clinical efficacy of endoscopic spinal tuberculosis focus removal, posterior pedicle lesion removal, bone grafting, and internal fixation combined with drug chemotherapy in treating thoracolumbar tuberculosis. It also seeks to summarize strategies for preventing complications and provide a reference for clinical treatment. We retrospectively analyzed 105 patients with spinal tuberculosis treated in our hospital from January 2018 to December 2022. Patients were divided into two groups: Group A (n=38), who underwent endoscopic spinal tuberculosis focus removal, and Group B (n=67), who underwent posterior pedicle lesion removal, bone grafting, and internal fixation. All patients received preoperative quadruple anti-tuberculosis drug chemotherapy (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol) for 2-4 weeks. We recorded and compared parameters such as operation time, intraoperative blood loss, postoperative drainage, recovery time, hospital stay, blood transfusion, and complications. We also compared pre- and postoperative lumbar VAS, ODI, erythrocyte sedimentation rate, C-reactive protein, Procalcitonin, D-Dimer, Neutrophil to Lymphocyte ratio, hemoglobin, total protein, and Cobb angle to evaluate kyphotic deformity and correction. Preoperative data including age, sex, body mass index, segment involvement, past medical history, smoking history, preoperative erythrocyte sedimentation rate, C-reactive protein, Procalcitonin, D-Dimer, Neutrophil to Lymphocyte ratio, hemoglobin, total protein, lumbar VAS score, lumbar ODI score, and spinal Cobb's angle showed no significant difference between the groups (P>0.05). Main postoperative indicators revealed that Group A had significantly lower lumbar VAS scores, higher hemoglobin and total protein levels, and a lower recurrence rate than Group B at the last follow-up (P<0.05). Secondary postoperative indicators showed that Group A required significantly less blood transfusion, had shorter operative time, less intraoperative blood loss, shorter postoperative hospitalization time, and lower Cobb Angle than Group B (P<0.05). Endoscopic spinal tuberculosis focus removal can achieve comparable safety to posterior pedicle lesion removal, bone grafting, and internal fixation, with shorter operation time, less intraoperative bleeding, lower postoperative recurrence rate, and less postoperative drainage. This method can effectively improve blood sedimentation, lumbar function, restore Cobb angle, and reduce pain, making it worthy of promotion and application.

EFFECTIVENESS AND SAFETY OF CARBOPLATIN-CONTAINING ANTITUMOR THERAPY REGIMENS IN A MODEL OF COEXISTANCE OF LUNG CARCINOMA AND TUBERCULOSIS

Introduction. Treatment of the coexistent pathology of lung cancer and tuberculosis remains the prerogative of experimental research, since the optimal treatment strategy for the coexistence of these two diseases has not yet been developed. The purpose was to study the effectiveness and safety of carboplatin-containing antitumor therapy regimens in combination with anti-tuberculosis chemotherapy. Material and methods. The study was conducted on 64 C57BL/6 mice aged two months with a previously modeled coexistant pathology of lung carcinoma and tuberculosis. Depending on the therapy, 4 groups were formed: 1 – control without treatment (n=16), 2 – antitumor (carboplatin + paclitaxel) + antituberculosis therapy (n=16), 3 – antitumor (carboplatin + pemetrexed) + antituberculosis therapy (n=16), 4 – antitumor (carboplatin + gemcitabine) + anti-tuberculosis therapy (n=16). The anti-tuberculosis therapy regimen included the administration of isoniazid, rifampicin, pyrazinamide and ethambutol. The antitumor effect (tumor growth index, tumor growth inhibition), antituberculosis effect (CFU per lung weight), toxicity (clinical blood test parameters, biometric indicators of internal organs), and survival were assessed. Statistical processing was carried out using non-parmetric statistics methods. Results. The lowest average body weight was recorded in group 4 from 7 to 21 days. The greatest differences between groups in the volume of the tumor node were observed from 12 to 16 days of the experiment under the influence of antitumor drugs. At the same time, the greatest inhibition of tumor growth was observed in group 4. On day 9 in group 2 there were signs of the myelo-immunosuppressive effect of antitumor therapy in the form of a decrease in the concentration of leukocytes, lymphocytes and monocytes. In the study groups, there were no statistically significant differences in the survival rate of the experimental and control groups. In all experimental groups, significantly lower spleen MC values were recorded, and in group 4, significantly lower liver MC values were also recorded. The highest level of mycobacterial load was recorded in the control group. The lowest CFU per lung weight was found in the carboplatin and gemcitabine treatment group. Conclusion. Carboplatin-containing chemotherapy regimens for lung carcinoma in tuberculosis-infected mice have both antitumor and antituberculosis effects. The most pronounced antimycobacterial activity was recorded when using a combination of antituberculosis therapy with carboplatin and gemcitabine.

Evaluation of the multiple doses thiozonide’s pharmacokinetics in patients diagnosed with pulmonary tuberculosis with multidrug-resistant or extensively drug-resistant &lt;i&gt;Mycobacterium tuberculosis&lt;/i&gt;

Relevance. The increase in the number of cases of multidrug-resistant tuberculosis (MDR-TB) determines the relevance of the development of new anti-TB drugs (ATDs). Determining the pharmacokinetics of a drug in the context of MDR-TB therapy is an integral part of the study of the original drug. Objective. Evaluation of the pharmacokinetic properties of a new original drug, thiozonide, in patients with MDR-TB with multiple doses of the drug. Methods. Thiozonide was used in patients with a verified diagnosis of MDR-TB as part of a clinical trial according to protocol No. THIO22 "Multicenter 12-week doubleblind, randomized, placebo-controlled clinical trial on the selection of optimal dosages of the drug thiozonide, capsules (CJSC Pharm-Sintez") for against the background of standard anti-tuberculosis chemotherapy in patients diagnosed with pulmonary tuberculosis with multidrug-resistant or extensively drugresistant Mycobacterium tuberculosis” (permission of the Ministry of Health of the Russian Federation No. 661 dated 11/24/2014). Results. The pharmacokinetic characteristics of thiozonide were determined during its repeated use in patients diagnosed with pulmonary tuberculosis with multidrug-resistant or extensively drug-resistant mycobacterium tuberculosis, receiving standard anti-tuberculosis chemotherapy, by HPLC with mass spectrometric detection. The time to reach the maximum concentration T max of thiozonide with repeated administration at a dose of 200 mg, 400 mg and 600 mg was 4.21 ± 1.23 hours, 4.9 ± 1.08 and 5.29 ± 0.91, respectively; the half-life T1/2 for the same dosages of the drug was 7.84 ± 1.86, 7.56 ± 1.92 and 6.3 ± 2.12 hours, respectively. The maximum concentration of thiozonide after taking the drug thiozoinide by volunteers was Cmax was observed at the level of 1386.89 ± 533.68 ng / ml in the group taking 200 mg of thiozonide per day, 2684.48 ± 712.40 when taking the drug at a dosage of 400 mg and 5558, 99 ± 2143.81 – at a dosage of 600 mg. Conclusion. A linear dependence of the maximum concentration and the area under the pharmacokinetic curve on the dose taken and also the average concentration of thiozonide in the blood plasma of patients with pulmonary tuberculosis with multidrug resistance of the causative agent of the disease was revealed.

Interstitial lung diseases in persons infected with human immunodeficiency virus

Diagnosis of interstitial lung diseases (ILD) in individuals infected with the human immunodeficiency virus (HIV) remains poorly understood.The purpose of the work was to demonstrate approaches to the diagnosis of ILD in HIV-infected patients with different levels of CD4 lymphocytes. An analysis of literature data and clinical observations of ILD in HIV-infected individuals (n = 2) whose CD4 lymphocyte count was 677 (37.5%) and 1 (0.21%) cells/μl are presented. The patients were observed and treated for a long time by pulmonology specialists, including anti-tuberculosis chemotherapy. The patient with CD4 lymphocyte count of 677 cells/μl in the absence of Mycobacterium tuberculosis in the sputum had an established diagnosis of idiopathic pulmonary fibrosis with the progressive development of respiratory failure and progression of the computed tomographic pattern from large areas of “ground glass” to the formation of reticular changes and “honeycomb” lung within 2 years. The patient with CD4 count of 1 cell/μl was diagnosed with nonspecific interstitial pneumonia based on characteristic clinical manifestations of increasing respiratory failure against the background of diffuse interstitial pneumofibrosis in the absence of bacterial excretion, the effects of antimycobacterial, antibacterial and antifungal treatment for 7 months, and excluding other causes of lung damage.Conclusion. The development of interstitial fibrosing pulmonary process of non-infectious etiology in HIV-infected patients with different states of T-helper immunity has been demonstrated. After excluding opportunistic infections, the influence of other factors, and concomitant diseases, these patients were diagnosed with various forms of idiopathic interstitial pneumonia. However, existing reports of the direct damaging effects of the virus on the pulmonary parenchyma also suggest the possibility of HIV-associated interstitial pulmonary fibrosis.

One world but miles apart: great mimicry of nasopharyngeal tuberculosis with nasopharyngeal carcinoma

Nasopharyngeal tuberculosis is rare, even in endemic areas. It can be primary or secondary to pulmonary or systemic tuberculosis. Although nasopharyngeal tuberculosis represents less than 1% of all tuberculosis cases, there has been an increase in cases reported recently. The variety of presenting symptoms in nasopharyngeal tuberculosis makes it challenging to diagnose because the condition commonly mimics other pathologies. In this paper, we would like to share our experience managing three cases of rare primary nasopharyngeal tuberculosis with different backgrounds. We provide a comparison in their clinical presentations, and endoscopic and radiological features, highlighting the situations when nasopharyngeal tuberculosis needs to be considered as a differential diagnosis. A nasopharyngeal biopsy is helpful to establish the diagnosis. The patients responded well to anti-tuberculosis chemotherapy. The variation in findings proves that it is important to have a high index of suspicion in order to get an accurate early diagnosis and initiate proper treatment.

IMPACT OF SELENIUM IN RESTORATION OF THYROID FUNCTION AND OUTCOMES OF ANTI-TUBERCULOSIS CHEMOTHERAPY IN THYROIDAL DYSFUNCTION

The effect of selenium on thyroid status and outcomes of chemotherapy was studied at examination of 180 tuberculosis patients with the pathological structural changes of thyroid. A subclinical hypothyroidism was diagnosed at this category of patients. Subclinical hypothyroidism progressed under antituberculosis chemotherapy. Prescribing of selenium nitric restored thyroid function with the increasing of blood level of free thyroxine and decreasing of thyroid stimulating hormone and also optimized the results of chemotherapy with increasing the percentage of tuberculosis patients stopped bacilli excretion and healing of the cavities in lungs. Thus sodium selenite was recommended like accompanying medicine if antituberculosis chemotherapy. &#x0D; &#x0D; &#x0D;

Evaluation of effectiveness of transcranial mesodiencephalic modulation within comprehensive treatment of pulmonary tuberculosis patients with various comorbidities

The objective: to study the impact of transcranial mesodiencephalic modulation on eff ectiveness of comprehensive treatment of pulmonary tuberculosis patients with various comorbidities.Subjects and Methods. 48 patients who received standard regimens of anti-tuberculosis chemotherapy participated in the study; the patients were divided into two groups. In Group 1, patients additionally underwent sessions of mesodiencephalic modulation (MDM), while in Group 2, no MDM was administered.Results. Two months after the start of the study, in Group 1, positive radiological changes were recorded more often – in 91,7% (22/24), in Group 2, positive changes were observed in 62,5% (15/24) of patients (p=0,047; χ2); the same pattern was observed with positive changes of laboratory rates – 91,7% (22/24) versus 66,7% (16/24), (p=0,033; χ2), respectively. In patients of Group 1 compared to Group 2, symptoms of tuberculosis and comorbid conditions fully disappeared or became less intensive in 79,2% (19/24) versus 41,7% (10/24), (p=0,009; χ2). In Group 1, adverse drug reactions were registered in 16,7% (4/24), in Group 2 – 43,5% (10/24), (p=0,05; χ2).

Adjunctive Dexamethasone for Tuberculous Meningitis in HIV-Positive Adults

BackgroundAdjunctive glucocorticoids are widely used to treat human immunodeficiency virus (HIV)–associated tuberculous meningitis despite limited data supporting their safety and efficacy.MethodsWe conducted a double-blind, randomized, placebo-controlled trial involving HIV-positive adults (≥18 years of age) with tuberculous meningitis in Vietnam and Indonesia. Participants were randomly assigned to receive a 6-to-8-week tapering course of either dexamethasone or placebo in addition to 12 months of antituberculosis chemotherapy. The primary end point was death from any cause during the 12 months after randomization.ResultsA total of 520 adults were randomly assigned to receive either dexamethasone (263 participants) or placebo (257 participants). The median age was 36 years; 255 of 520 participants (49.0%) had never received antiretroviral therapy, and 251 of 484 participants (51.9%) with available data had a baseline CD4 count of 50 cells per cubic millimeter or less. Six participants withdrew from the trial, and five were lost to follow-up. During the 12 months of follow-up, death occurred in 116 of 263 participants (44.1%) in the dexamethasone group and in 126 of 257 participants (49.0%) in the placebo group (hazard ratio, 0.85; 95% confidence interval, 0.66 to 1.10; P=0.22). Prespecified analyses did not reveal a subgroup that clearly benefited from dexamethasone. The incidence of secondary end-point events, including cases of immune reconstitution inflammatory syndrome during the first 6 months, was similar in the two trial groups. The numbers of participants with at least one serious adverse event were similar in the dexamethasone group (192 of 263 participants [73.0%]) and the placebo group (194 of 257 participants [75.5%]) (P=0.52).ConclusionsAmong HIV-positive adults with tuberculous meningitis, adjunctive dexamethasone, as compared with placebo, did not confer a benefit with respect to survival or any secondary end point. (Funded by the Wellcome Trust; ACT HIV ClinicalTrials.gov number, NCT03092817.)

A 270° Retention of Spinal Structure in the Treatment of Thoracic and Lumbar Tuberculosis via Posterior-Only Approach

Objective The necessity of radical debridement in the treatment of thoracic and lumbar tuberculosis is increasingly challenged. We introduce the 1-stage surgical treatment with 270° retention of the spinal structure via a posterior-only approach and investigate the clinical efficacy and feasibility of this method in treating thoracic and lumbar spinal tuberculosis. Summary of Background Data In former research articles, many potential disadvantages are found in the treatment of thoracic and lumbar tuberculosis after radical debridement, such as prolonged operative time, increased the surgical trauma, unsatisfactory bony fusion, instability of the spine, and too much blood loss. Methods Twenty-one patients who had thoracic and lumbar tuberculosis were admitted to our hospital between January 2013 and September 2014. All of them were treated with 1-stage surgical treatment by internal fixation, focal debridement, and fusion via the posterior-only approach. Then, the clinical efficacy was evaluated, with the Cobb angle reflecting spinal kyphotic angles, erythrocyte sedimentation rate (ESR), Frankel Grade scores, and imaging examination preoperatively and postoperatively. Results Patients were followed up for 24 to 40 months (mean, 29.95 months), Fusion occurred at 4 to 9 months (mean, 5.86 months). There were significant differences between groups regarding the Cobb angle, ESR, and Frankel Grade scores. Delayed wound healing affected 1 patient because of diabetes. No complications regarding the internal fixation and no tuberculosis recurrence were observed during follow-up. Conclusions Combined with anti-tuberculosis chemotherapy, the method, characterized by 270° retention of the spinal structure, can be an effective and feasible method in treating thoracic and lumbar spinal tuberculosis.

Effectiveness of one-stage total knee arthroplasty in treatment of advanced active knee tuberculosis

To investigate the effectiveness of one-stage total knee arthroplasty (TKA) in the treatment of advanced active knee tuberculosis. The clinical data of 38 patients with advanced active knee tuberculosis who received one-stage TKA between January 2011 and December 2020 were retrospectively analyzed. There were 20 males and 18 females. The age ranged from 20 to 84 years, with an average of 52.8 years. The body mass index ranged from 17 to 36 kg/m 2, with an average of 23.05 kg/m 2. The preoperative C reactive protein (CRP) was (23.49±4.72) mg/L, erythrocyte sedimentation rate (ESR) was (45.95±8.82) mm/1 h. The Hospital for Special Surgery (HSS) score was 48.8±9.1. During the operation, the infected lesions of the knee joint were completely removed, and the operative area was repeatedly soaked with 3% hydrogen peroxide solution and 0.5% povidone iodine solution. The intraoperative pathological examination confirmed the tuberculosis of the knee joint, and systemic anti-tuberculosis treatment was performed. The operation time, postoperative hospitalization stay, postoperative anti-tuberculosis chemotherapy time, and complications were recorded. CRP and ESR were recorded and compared before and after operation. Anteroposterior and lateral X-ray films of the knee joint were taken to evaluate whether the prosthesis had signs of loosening and sinking, and to determine whether there was recurrence of tuberculosis. The knee joint function was evaluated by HSS score. With treatment failure due to any reason as the end event, the survival time of prosthesis was analyzed by Kaplan-Meier survival curve. All operations were successfully completed without fracture, vascular and nerve injury, deep vein thrombosis, and other complications. All incisions healed by first intention after operation. The operation time ranged from 80 to 135 minutes, with an average of 102.76 minutes; postoperative hospitalization stay was 5-16 days, with an average of 9.7 days; the duration of postoperative anti-tuberculosis chemotherapy ranged from 1 to 18 months, and the median duration was 12 months. All 38 cases were followed up 3-133 months (mean, 63.7 months). At last follow-up, CRP was (4.88±1.24) mg/L and ESR was (13.00±2.97) mm/1 h, both of which were significantly lower than those before operation ( t=20.647, P<0.001; t=20.886, P<0.001). During the follow-up, 3 patients (7.89%) had tuberculosis recurrence. Two patients had tuberculosis recurrence due to withdrawal of anti-tuberculosis chemotherapy at 1 and 2 months after operation, respectively. One patient was cured after debridement, preservation of prosthesis and anti-tuberculosis chemotherapy for 12 months, and 1 patient was cured after oral administration of anti-tuberculosis drugs for 12 months. Another 1 patient had recurrent tuberculosis and mixed infection ( Corynebacterium gehreni) at 2 months after operation, and the infection was not controlled after debridement, and finally the thigh was amputated. Except for the patients with recurrent infection, no complications such as prosthesis loosening, periprosthetic fracture, and periprosthetic infection were found. At last follow-up, the HSS score of the knee joint was 86.8±4.8, and the knee joint function significantly improved when compared with that before operation ( t=-31.198, P<0.001). Prosthesis survival time was (122.57±5.77) months [95% CI (111.25, 133.88) months], and the 10-year survival rate was 92.1%. One-stage TKA combined with postoperative antituberculous chemotherapy in the treatment of advanced active knee tuberculosis can achieve satisfactory infection control and joint function.

The mycobacterial ImuA'-ImuB-DnaE2 mutasome: composition and recruitment in live cells.

A DNA damage-inducible mutagenic gene cassette has been implicated in the emergence of drug resistance in Mycobacterium tuberculosis during anti-tuberculosis (TB) chemotherapy. However, the molecular composition and operation of the encoded 'mycobacterial mutasome' - minimally comprising DnaE2 polymerase and ImuA' and ImuB accessory proteins - remain elusive. Following exposure of mycobacteria to DNA damaging agents, we observe that DnaE2 and ImuB co-localize with the DNA polymerase III β subunit (β clamp) in distinct intracellular foci. Notably, genetic inactivation of the mutasome in an imuBAAAAGG mutant containing a disrupted β clamp-binding motif abolishes ImuB-β clamp focus formation, a phenotype recapitulated pharmacologically by treating bacilli with griselimycin and in biochemical assays in which this β clamp-binding antibiotic collapses pre-formed ImuB-β clamp complexes. These observations establish the essentiality of the ImuB-β clamp interaction for mutagenic DNA repair in mycobacteria, identifying the mutasome as target for adjunctive therapeutics designed to protect anti-TB drugs against emerging resistance.

The value of multimodal ultrasonography in evaluating therapeutic response of cervical tuberculous lymphadenitis to anti-tuberculosis drugs.

In order to research the value of multimodal ultrasonography in evaluating therapeutic response of cervical tuberculous lymphadenitis to anti-tuberculosis drugs. Sixty-one patients with cervical tuberculous lymphadenitis were enrolled in this study. Ultrasound examination was performed before systemic standard anti-tuberculosis treatment and within 1-2 months after treatment, and the patients were divided into effective group and ineffective group according to the follow-up at the sixth month. The multimodal ultrasound signs of the two groups were compared and analyzed. In the effective group, there were significant differences in the maximum diameter of lymph nodes, the echo of the surrounding tissue and the enlargement of the contrast area before and after treatment (p < 0.05). At 1-2 months after treatment, there were significant differences in the maximum diameter, pus changes, CDFI, elasticity scores, echo of surrounding tissues, changes in enlarged and non-enhanced areas after contrast enhancement between the effective group and the ineffective group (p < 0.05). The multimodal ultrasound signs of the appearance of internal pus or non-enhancement area enlargement, enhanced echo of the surrounding tissue and enlargement after CEUS are related to poor prognosis, and may be used to evaluate the response of anti-tuberculosis chemotherapy when the size change of lymph node is not obvious in individual treatment.

Microbiological evaluation of probiotic therapy in patients with pulmonary tuberculosis

Patients with pulmonary tuberculosis and multiple pathogen resistance (MDR) develop persistent disorders of the intestinal microbiome during prolonged multicomponent chemotherapy requiring correction. However, there is limited data on the use of bacterial drugs in patients with tuberculosis followed by assessing their effectiveness. The aim of the study was to evaluate changes in the intestinal microbiome after a course of probiotics along with anti-tuberculosis chemotherapy in patients with MDR tuberculosis.&#x0D; Materials and methods. The design a prospective small-cohort study (n = 30). Patients with pulmonary tuberculosis received anti-tuberculosis drugs according to the IV or V regimen, the median of the doses taken was 34.5 (30; 57.5); gastrointestinal syndrome was recorded in all study subjects. Probiotic therapy was applied by using a preparation containing Bifidobacterium bifidum and B. animalis and Lactobacillus casei, L. plantarum, L. delbrueckii subsp.bulgaricus, L. acidophilus. The course of therapy comprised 21 days,1 capsule twice a day. Before and 7 days after probiotics therapy, studies on composition of the intestinal microbiota were carried out, the frequency of virulence factors Enterococcus spp., Staphylococcus spp., Candida spp. was examined; fatty acid composition and activity of enterococcal organic acid production were studied.&#x0D; Results. After a course of probiotics, a significant increase in lactobacillus titers was recorded from 5.2 (4.0; 6.0) to 6.1 (6.0; 8.0) lg CFU/g (p = 0.05). The frequency of mucosal colonization by Candida fungi and lactose-negative Escherichia decreased by 2-fold (p = 0.001) and 3-fold (p = 0.05), respectively. The frequency of detected virulent strains significantly decreased: hemolysin-producing staphylococci by 9 times (p = 0.009), enterococci with gelatinase activity by 6 times. E. faecalis membrane oleic acid level significantly increased (C9-C18:1) (p = 0.03). In E. faecium, cis-7-palmitoleic acid (C7-C16:1) and oleic (C9-C18:1) fatty acid level increased by 2-fold (p = 0.05), and for linoleic acid (C18:2) by 4 time (p = 0.04) accompanied by elevated acid formation by 1.5 times.&#x0D; Conclusion. A single course of probiotic therapy in patients with pulmonary tuberculosis leads to qualitative microbiome changes, which are characterized by decreased levels of conditionally pathogenic microorganisms with virulent properties and altered composition of the enterococcal cell membrane accompanied by their increased biochemical activity.