Tuberculosis Problem Research Articles

Tackling the Problem of Childhood Tuberculosis in Bangladesh

Abstract not available BANGLADESH J CHILD HEALTH 2023; VOL 47 (1) : 1-4

Modern problems of bronchial tuberculosis in the world and the Russian Federation: A review

In the Russian Federation there is a positive trend in reducing the incidence of tuberculosis. However, there is a tendency to increase the prevalence of tuberculosis in the bronchi. According to foreign authors, the prevalence of bronchial tuberculosis ranges from 10% to 40%. There are no official statistics on the incidence of bronchial tuberculosis in the Russian Federation. The main contingent of bronchial tuberculosis lesions are young non-smoking women. At the same time, the most common target is the left main bronchus. Currently, no additional methods have been developed in the scheme of specific treatment of patients with pulmonary tuberculosis complicated by bronchial tuberculosis. It is important to understand that the eradication of MBT after an effective course of chemotherapy does not prevent the formation of cicatricial bronchial stenosis. It is also important to note that bacterial excretion in patients with bronchial tuberculosis is much more common than in patients with a comparable process in the lungs, but without bronchial damage. Consequently, tuberculosis of the trachea and bronchi has not only clinical, but also great epidemiological significance.

Impact of post-pulmonary tuberculosis sequelae and its management in a tertiary care facility in South India

BackgroundPost-pulmonary Tuberculosis (PTB) sequelae are chest alterations caused by pulmonary tuberculosis problems, even after treatment and infection elimination. These alterations can cause pulmonary dysfunction, ranging from mild irregularities to acute dyspnea, increasing the risk of respiratory-related deaths. Current research aims to investigate the type, severity, clinical management, and impact on quality of life in affected individuals. Materials and methodsA prospective observational study with 66 patients was carried out in a South Indian tertiary care facility. We gathered sociodemographic and clinical data from the patients. Imaging investigations (chest X-ray, CT scans) and pulmonary function test reports (Spirometry) were used to assess the post-pulmonary TB sequelae. The patient's quality of life was evaluated using the WHOQoL-BREF questionnaire. ResultsOut of 66 patients, 66.7% were men, and the average age was 57.2 years. According to radiological analysis, most patients had airway difficulties (38%), followed by parenchymal problems (36.3%). Obstruction was the most typical abnormality identified (81.9%). Bronchodilators, LABA + ICS, SABA, leukotriene antagonists, antibiotics, and other fixed medications treat post-PTB sequelae. Substantial impairment was observed in quality of life. ConclusionPatients who have had pulmonary TB are prone to post-TB respiratory symptoms and sequelae. The quality of life noticeably declined. This study's findings underscore the importance of robust, evidence-based guidelines and practical implementation techniques for managing post-pulmonary TB.

Anti-tuberculosis effect of microbiome therapeutic PMC205 in extensively drug-resistant pulmonary tuberculosis in vivo

BackgroundTuberculosis is a highly contagious disease caused by Mycobacterium tuberculosis, and the increase in antibiotic resistance threatens humankind. Therefore, there is an urgent need to develop new anti-tuberculosis drugs that can overcome the limitations of existing drugs. Here, we report the anti-tuberculosis effect of microbiome therapeutic PMC205, a strain of Bacillus subtilis. MethodsThe anti-tuberculosis activity of probiotics was evaluated in mouse models of lethal and latent pulmonary tuberculosis induced by high or low-dose infection of the extensively drug-resistant strain. Probiotics were administered by inhalation, and the burden of M. tuberculosis in the lungs, along with mortality and clinical observations, were monitored for 12 weeks and 8 months, respectively. For an in-depth understanding, analysis of the microbiome and inflammatory profile of the lung microenvironment and induction of autophagy in vitro were explored. ResultsAfter inhalation administration of PMC205 for 3 months, the survival rate was 100%, unlike all deaths in the saline-treated group, and the burden of M. tuberculosis in the lungs was reduced by log 1.3 in the 8-month latent tuberculosis model. Moreover, PMC205 induced recovery of disrupted lung microflora, increased butyric acid, and suppressed excessive inflammation. It also promoted autophagy. ConclusionsThese results confirm PMC205’s anti-tuberculosis effect, suggesting that it can be developed as an adjuvant to current antibiotic therapy to solve the drug-resistant tuberculosis problem.

Impact of the war in Ukraine on the epidemic situation with tuberculosis as a challenge for the world community

ABSTRACT. Since wars have a powerful impact on public health and the health care system, the purpose of this analysis of available scientific sources is to examine the impact of the war in Ukraine on the state of the tuberculosis problem in the world. The review presents the epidemic situation with tuberculosis before the start of the war in Ukraine. It is especially emphasized that Ukraine ranks second in Europe in terms of the burden of HIV infection / acquired immunodeficiency syndrome and fifth in the world in terms of the number of confirmed cases of tuberculosis with multiple drug resistance. It is emphasized that the COVID-19 pandemic has seriously undermined the progress achieved in the fight against tuberculosis worldwide. The expected worsening of the epidemic situation with tuberculosis in Ukraine due to the war and its impact on the world health care systems are substantiated, and attention is focused on the urgent need to coordinate the efforts of the world community to overcome such a challenge. Problematic issues regarding the readiness of international health care systems to combat tuberculosis in the conditions of war in Ukraine are analyzed. Studying the current state of the problem “tuberculosis and the war in Ukraine” will allow us to act in the direction of reducing the negative impact of the war on the epidemic situation with tuberculosis both in Ukraine and partially in the whole world.

Genital Tuberculosis as a Socially Significant Disease (Literature Review)

Globally, TB is the second leading cause of death from infectious diseases after COVID-19. Tuberculosis of the female genital organs is a type of extrapulmonary tuberculosis.It is known that both clinically pronounced and latent forms of this disease can cause both primary and secondary infertility due to pathogenetically caused disruption of the structure of the fallopian tubes and changes in the susceptibility of the uterine endometrium. It can be assumed that the problem of genital tuberculosis in Russia is still very relevant, although its true prevalence is unknown. This assumption is based on the facts of the projected growth of indicators the incidence of extrapulmonary tuberculosis, the obvious discrepancy between the real incidence and the official figures, as well as the increasing incidence of tubal-peritoneal infertility, which is often caused by genital tuberculosis. It is known that tuberculosis of the female genital organs is a difficult disease to diagnose. This is determined, in particular, by the fact that it does not have specific (so-called "marker") manifestations. Low rates of diagnosis of extrapulmonary forms of TB create a false sense of well-being, which does not reflect its true epidemiological picture. An obvious need today is the development of an optimal diagnostic complex, the use of which would contribute to accelerating the diagnosis of genital tuberculosis in women and, as a result, preventing the occurrence of irreversible changes in the female reproductive system caused by it. The authors used the scientific databases CyberLeninka, ELibrary and PubMed. Articles were searched for the following keywords: "tuberculosis", "genital tuberculosis", "infertility and tuberculosis". The paper analyzes articles published over the past 10 years.

Diagnosis and Management of Latent Tuberculosis Infection: Updates.

India has the largest problem of tuberculosis (TB) infection globally (estimated at about 35-40 crores cases), and around 18-36 lakh develop active tuberculosis annually. Latent TB is defined as a state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens with no evidence of clinically manifested active TB. The progression of a latent infection to active tuberculosis increases several-fold in children < 5 years of age and in people with some or the other form of an immunocompromising condition. Therefore, to cater to this gigantic problem of tuberculosis, it is necessary to have awareness about latent tuberculosis infection (LTBI) amongst clinicians and to prioritise its diagnosis and treatment in high-risk groups. India plans to end TB well before the deadline set by the World Health organisation (WHO). However, this can only be achieved with effective strategies targeting LTBI. Multiple treatment regimens have been approved for LTBI treatment, and all have comparable efficacy. The selection of one regimen over the other depends on various factors, such as availability, risk of adverse events, age, and drug interactions. Recently, the WHO, as well as the Revised National TB Control Programme (RNTCP), have updated their guidelines on TB preventive treatment in 2020 and 2021, respectively. This review has been especially prepared to acknowledge the differences in approach to LTBI in developed and developing countries.

ЭПИЗООТИЧЕСКАЯ СИТУАЦИЯ ПО ТУБЕРКУЛЕЗУ КРУПНОГО РОГАТОГО СКОТА В ОМСКОЙ ОБЛАСТИ

The purpose of research is to study and assess the current epizootic situation regarding tuberculosis in the administrative-territorial formations of the Omsk Region based on the results of allergic and bacteriological studies. The paper presents the results of an analysis of data from allergic and bacteriological stu¬dies on bovine tuberculosis conducted in the Omsk Region from 2016 to 2022. It is shown that after an increase by 2018 to 0.28 % of cases of detection of positive reactions in animals to intradermal administration of tuberculin subsequently noted a gradual decrease in their number to 0.10 % by 2022. As the compiled cartogram showed, over the entire observation period, the greatest degree of spread of delayed-type skin hypersensitivity was recorded in cattle in the southern districts of the region (Moskalensky, Isilkulsky and Pavlogradsky) with the absence or isolated cases of its manifestation in the northern districts. Due to the wide distribution of non-tuberculous mycobacteria in the region, which are the main cause of non-specific reactions during allergic testing, all animals that gave a positive reaction to intradermal injection of tuberculin are examined by palpebral test, which prevented the unreasonable slaughter of a significant number of cattle. Of the responders, from 1.73 to 4.32 % of heads with pronounced swelling were identified annually when the allergen was introduced into the thickness of the eyelid, with the most frequent cases of reaction observed in the Kalachinsky, Sargatsky, Lyubinsky, Pavlogradsky, Moskalensky and Isilkulsky Districts. When conducting bacteriological studies of biological material from forcedly killed animals over the entire period of observation, 33 strains of bovine mycobacteria and 7 strains of NTM of groups II and III according to the Runyon classification were isolated. Despite the significant improvement in the epizootic situation, the problem of bovine tuberculosis in the Omsk Region remains relevant today due to cases of registration of isolated foci of infection in the Isilkulsky, Tavrichesky and Muromtsevsky Districts of the Omsk Region.

Peculiarities of Providing Palliative Care to Tuberculosis Patients

The data from literary sources (the electronic database of medical publications PubMed) have been summarized to highlight contemporary concepts of providing palliative care and recent statistics regarding the provision of palliative care to tuberculosis patients in Ukraine were analyzed. Objective of this analysis was to highlight problematic issues and aspects that require improvement in the field of providing palliative care to tuberculosis patients in Ukraine.The problem of tuberculosis remains relevant today. Despite significant achievements in the fight against tuberculosis, the effectiveness of treating this disease in Ukraine does not reach the target set by the WHO. The issue of drug-resistant tuberculosis remains acute. Individuals with tuberculosis and their families face a range of physical, socio-economic, and psychological challenges associated with the illness, which dimi­nish their quality of life and require a comprehensive approach to address them. Therefore, according to modern concepts, an important component of managing patients with tuberculosis, especially drug-resistant forms, is palliative care. The modern concept of palliative medicine envisions the earliest possible initiation of palliative care for patients with indications as early as possible, simultaneously with curative therapy, gradually increasing the scope of palliative care interventions until completely replacing curative treatment as the disease progresses. Early integration of palliative care for tuberculosis patients enhances the quality of life for patients and their families, promoting better adherence to etiotropic treatment.For the further development and improvement of the palliative care system for tuberculosis at the state level, the resolution of the following issues is necessary: ensuring the integration of palliative care services at all levels of medical care; strengthening and expansion of personnel potential in matters of palliative care; improvement and implementation of guidelines for integrated palliative care for tuberculosis at all levels of care; integration of palliative care into the program management system of drug-resistant tuberculosis from the first day of diagnosis; ensuring sustainable and comprehensive access of people suffering from tuberculosis to essential medicines for providing palliative care; improving the quality of providing psychological assistance to patients and their families.

Secondary Metabolites Production of Bacillus spp. Isolated from Sea Cucumbers (Holothuria scabra) and their Activity against Mycobacterium smegmatis

New anti-tuberculosis agents are very important due to Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis problems. Mycobacterium smegmatis can be used to replace Mycobacterium tuberculosis as bacteria test to increase the velocity of anti-tuberculosis screening. To answer the need for new drugs, exploration of secondary metabolites from Bacillus spp. can be conducted. Bacillus spp. are known to produce antimicrobials, including discovery of iturins, fengycins, and pumilacidins. This study explored the Bacillus spp. isolated from fermented intestines of Holothuria scabra. The production of Bacillus sp. Holothuria scabra Fermented Intestine (HSFI) secondary metabolites was done using culture media containing starch as a carbon source, as well as yeast and peptone as a nitrogen source. Production capacity of secondary metabolites of Bacillus sp. HSFI was calculated, to determine its potential as an antibacterial producer. Inhibition testing of secondary metabolites of Bacillus sp. HSFI against M. smegmatis was performed using the Kirby-Bauer disk diffusion method. Based on the results of the inhibition test, it was concluded that Bacillus sp. HSFI-9 has the greatest potential to inhibit the growth of M. smegmatis, with a moderate inhibition (7.67 mm). Production of secondary metabolites from Bacillus sp. HSFI-9 is exceptionally good with an extract production capacity of 24.6 mg/L.

“Application of Anuj Transform to Solve the Tuberculosis Bacteria Growth Model”

Integral transform methods offer analytical solutions to the difficulties so academics are now highly interested in using them to solve problems in the fields of engineering, medicine, chemistry, economics, physics, national defense, geology, biology, and social sciences. The authors of this work discussed a novel use of the Anuj transform to ascertain the answer to the problem of tuberculosis (TB) bacteria growth model. Results of the paper indicate that Anuj transform provide the solution of the problem of tuberculosis (TB) bacteria growth model with great accuracy.

Genotypic and phenotypic comparison of drug resistance profiles of clinical multidrug-resistant Mycobacterium tuberculosis isolates using whole genome sequencing in Latvia

BackgroundMultidrug-resistant tuberculosis (MDR–TB) remains a major public health problem in many high tuberculosis (TB) burden countries. Phenotypic drug susceptibility testing (DST) take several weeks or months to result, but line probe assays and Xpert/Rif Ultra assay detect a limited number of resistance conferring gene mutations. Whole genome sequencing (WGS) is an advanced molecular testing method which theoretically can predict the resistance of M. tuberculosis (Mtb) isolates to all anti-TB agents through a single analysis.MethodsHere, we aimed to identify the level of concordance between the phenotypic and WGS-based genotypic drug susceptibility (DS) patterns of MDR–TB isolates. Overall, data for 12 anti-TB medications were analyzed.ResultsIn total, 63 MDR–TB Mtb isolates were included in the analysis, representing 27.4% of the total number of MDR–TB cases in Latvia in 2012–2014. Among them, five different sublineages were detected, and 2.2.1 (Beijing group) and 4.3.3 (Latin American-Mediterranean group) were the most abundant. There were 100% agreement between phenotypic and genotypic DS pattern for isoniazid, rifampicin, and linezolid. High concordance rate (> 90%) between phenotypic and genotypic DST results was detected for ofloxacin (93.7%), pyrazinamide (93.7%) and streptomycin (95.4%). Phenotypic and genotypic DS patterns were poorly correlated for ethionamide (agreement 56.4%), ethambutol (85.7%), amikacin (82.5%), capreomycin (81.0%), kanamycin (85.4%), and moxifloxacin (77.8%). For capreomycin, resistance conferring mutations were not identified in several phenotypically resistant isolates, and, in contrary, for ethionamide, ethambutol, amikacin, kanamycin, and moxifloxacin the resistance-related mutations were identified in several phenotypically sensitive isolates.ConclusionsWGS is a valuable tool for rapid genotypic DST for all anti-TB agents. For isoniazid and rifampicin phenotypic DST potentially can be replaced by genotypic DST based on 100% agreement between the tests. However, discrepant results for other anti-TB agents limit their prescription based solely on WGS data. For clinical decision, at the current level of knowledge, there is a need for combination of genotypic DST with modern, validated phenotypic DST methodologies for those medications which did not showed 100% agreement between the methods.

Tuberculosis of the Skin: Modern Clinical and Epidemiological Features and the Necessity of a Multidisciplinary Approach for Timely Diagnosis and Comprehensive Therapy (Review)

The seriousness of the global significance of tuberculosis, an infection that is both old and new, was discussed extensively at the UN General Assembly meeting in New York in the summer of 2023. This seemingly purely medical issue received widespread attention for the public's understanding of the corresponding «Political Declarations on Tuberculosis» and the agreement on key issues related to combating tuberculosis. It was emphasized that the sphere of public health encompasses the unequivocal preservation of human health as the primary objective in the social development of any specific state. This clearly includes measures aimed at preventing the occurrence of tuberculosis and other infectious diseases.Objective — to conduct an analysis of professional publications of recent years regarding the modern clinical and epidemiological features of the clinical course of skin tuberculosis and to determine organizational measures to ensure the sanitary and epidemiological well-being of the public health of the population of Ukraine in wartime conditions and the conduct of active hostilities. And also to remind doctors of various specialties about the significant diversity of modern clinical manifestations of various forms of skin tuberculosis. Materials and methods. Official documents and scientific publications related to public health policy, approaches to overcoming the tuberculosis epidemic, incidence dynamics and forms of skin tuberculosis in Ukraine were analyzed. Results and discussion. The content of the analyzed professional publications indisputably proves that the problem of tuberculosis has gone far beyond the scope of the purely medical field and has acquired the status of national significance. A modern approach to improving the state of public health requires the constant coordination of the efforts of different people, who at the same time have a wide range of professional skills in many different disciplines, as well as the ability to work fruitfully with others in joint multiprofessional teams to achieve a common goal — to overcome the tuberculosis epidemic. Conclusions. Analysis of scientific publications of recent years on the problem of skin tuberculosis indicates an urgent need to consider this disease in the state Public Health system as a general infectious disease of the whole organism, in which pulmonary and formally extrapulmonary (skin) lesions are pathogenetically linked in a single chain of pathological changes. This requires an interdisciplinary ap­proach and systematic methodological cooperation of phthisis doctors, dermatovenerologists and family doctors in the aspect of timely diagnosis and complex therapy of this infection.

The ability of Sitophilus oryzae (Coleoptera, Curculionidae) to transmit Mycobacterium bovis: Morphology, cultural biochemical properties of the bacteria

The problem of tuberculosis has been relevant for many years due to active spread of the infection pathogen around the globe, in particular in Ukraine. In this article, we determined the epizootic role of the rice weevil (Sitophilus oryzae (Linnaeus, 1763); Coleoptera, Curculionidae) in the spread of Mycobacterium bovis. We identified the effect of the beetle on properties of the pathogen, particularly the changes in morphology, cultural, biochemical, and biological properties after the bacteria had travelled through the body of the rice weevil. To achieve our objectives, we used the museum 100th passage of the virulent strain of M. bovis. We employed microscopic, cultural, biochemical, biological (infecting the biological model), pathoanatomic, histological methods, and PCR studies. The rice weevil is able to retain mycobacteria and release them into their environment for 30 days after becoming infected, with gradual decrease in the number of microbial cells. According to morphology and cultural properties, the pathogen we isolated in the experiment was identical to the initial culture. Enzymatic activity of the bacteria varied. The bacteria that had passed through the intestines of M. bovis were observed to have changes in the biochemical parameters which helped them to adapt to the new environment. We measured the effect of the rice weevil on pathogenicity of M. bovis, isolated directly from the beetle and from grain contaminated with the insects during the experiment. The practical importance of the study consists in expansion of our understanding of the ways M. bovis spreads, identification of effect the rice weevil has on mycobacteria. It also might help in the search for ways to interrupt the chain of tuberculosis transmission – prevention of spread of the disease to favourable areas.

Transformation Concept of Artificial Intelligencein the Early Identification of Tuberculosis Recovery Phase: A Systematic Literature Review

Background: Another chronic problem in tuberculosis (TB) eradication programs amid the widespread use of artificial intelligence (AI) in the health world is that early identification of the healing phase has not been found using similar technology. The purpose is to find if the transformation concept of AI will be able to help identify symptoms of early recovery of TB. Methods: This research used a document review with a descriptive design. Data was processed by PRISMA analysis. The keywords were Artificial Intelligence, convalescence phase, and tuberculosis. The data were filtered from Google Engine included from Google Scholar, ResearchGate, PubMed, and Semantic Scholar screened in the last 5 years (2018-2023), in English or Indonesian. The stages of document screening were adjusted to the PRISMA diagram, and were analyzed descriptively. Results: The study shows that the majority of AI studies discussed diagnosis (n=9 or 69.2%), only 3 documents (23.1%) discussed on TB treatment, and 1 document (7.7%) on monitoring. In conclusion, early identification of the recovery phase of TB patients is supported by previous researchers and can be done in the form of an application. Conclusions: Artificial intelligence in the TB eradication program has value especially if conducted integrated with other health programs.

Socialization of TB Zero Program During The COVID-19 Pandemic for Residents of Islamic Center Residences in Kediri

Tuberculosis (TB) problem is still a challenge for Indonesia today. The World Health Organization reports that Indonesia is the third country with the highest TB burden globally. All component of society must take a role in dealing with the global TB problem to achieve Zero TB in 2050. As the implementation, the Pesantren 2 Primary Health Care conducted socialization in the Wali Barokah Islamic Center, Kediri City. Socialization about knowledge to residents of Islamic Center, this study aims to determine the essential characteristics of Islamic Center residents against TB disease. Questionnaires related to knowledge were filled out before and after explanation using PowerPoint and leaflet media. By using purposive, sampling method obtained 100 respondents. The survey results showed a significant increase in the knowledge of Islamic Center residents about TB disease after socialization in terms of signs and symptoms of the disease (p &lt; 0.02), modes of transmission (p &lt; 0.02), and methods of prevention of transmission (p &lt; 0.01). Negative attitudes are still visible by stigmatizing TB sufferers from being ostracized (62.7%). The majority of subjects will go to health facilities (6.9%), but subjects still choose not to go for treatment (68%). The presentation of material about TB leads to reduce the burden of TB disease in TB endemic communities by modifying attitudes and behavior.

The increasing problem of Tuberculosis in Nepal

The increasing problem of Tuberculosis in Nepal

Tuberculosis and pregnancy: literature review

Aim: To evaluate the modern view on the problem of tu-berculosis (TB) in pregnant women and puerperae. Materi-als and methods. A search was performed in the electron-ic databases PubMed, eLIBRARY.RU and CyberLeninka, the following terms were used: «tuberculosis», «pregnancy», «mycobacterium tuberculosis», «diagnosis», «treatment», «infertility», «postpartum period», «puerperants». 130 ref-erences were found and 50 articles selected. Results. Com-plaints in pregnant women with TB depend on the location of the infectious process, the duration of pregnancy and the time of TB detection. Diagnosis of TB in pregnant wom-en includes chest X-ray, rapid molecular diagnostics, con-ventional culture, and others. Most studies have shown the negative impact of pregnancy on the course and outcome of TB, as well as the occurrence of various complications of pregnancy. Also, women with TB often have various ma-ternal and perinatal adverse outcomes. The postpartum period is most often complicated, and a baby can become infected with TB from the mother transplacentally, trans-amniotically and by airborne droplets at birth. Expressed breast milk is a safe alternative while breastfeeding. Con-clusions. The problem of diagnosing and treating TB in pregnant women is quite relevant at the present time and requires special attention of phthisiatricians and obstetricians- gynecologists, which is due to higher risks of progression of the infectious process and the occurrence of various complications during pregnancy, childbirth, or the postpartum period.

The role of melatonin in the formation of tuberculotic inflammation, forecast regarding the influence on the effectiveness of treatment in the conditions of the COVID­-19 pandemic (literature review)

Objective — to study the role of melatonin in the formation of tuberculous inflammation and the prospects of its influence on increasing the effectiveness of treatment in the conditions of the COVID-19 pandemic, by conducting an analysis of information from available sources of literature on the selected topic.&#x0D; Materials and methods. The research was carried out for the period from December 2021 to September 2022. Access to various full-text and abstract databases was used as the main source of research.&#x0D; Results and discussion. A large number of studies carried out so far prove the connection between the influence of melatonin and tuberculosis inflammation, since tuberculosis infection can be associated with seasonal changes in the immune system, and these processes are correlated and accompanied by fluctuations in the level of melatonin. Th1-type specific cellular immunity is responsible for protective immunity in tuberculosis, while the Th2-type response underlies the progressive nature of inflammation. T-lymphocytes and macrophages have been shown to have receptors for melatonin, and they are also target cells for its immunomodulatory function. Melatonin has been shown to regulate gene expression of several immu­nomodulatory cytokines, including TNF-α, transforming growth factor-β, and macrophage stem cell factor.Thus, the conducted narrowly differentiated analysis based on available literature sources allows us to predict that melatonin can stimulate the Th1 immune response in TB and may have an immunoprotective effect on the Th1-type subtype of the delayed-type immune response during the acute phase of mycobac­terial inflammation.&#x0D; Conclusions. The analysis of the tuberculosis situation in Bukovina indicates a tendency towards an increase in the incidence rate in 2021 compared to 2020. The same dynamics are maintained in the first half of 2022. At the same time, no significant changes in the mortality rate were found. The above analysis of the main indicators of epidemiology indicates the sufficient importance of the problem of tuberculosis for the coming years, and therefore, the search for methods of increasing the effectiveness of the treatment of this pathology, especially under the conditions of multiple and extended drug resistance, is an important task of modern phthisiology. The analysis of the available data base accumulated to date on the role of melatonin in the pathophysiology of the formation of an inflammatory reaction in the lungs and its influence on the clinical course and effectiveness of anti-tuberculosis therapy is a promising scientific direction of research. The appointment of melatonin along with traditional methods of treatment of tuberculosis can have a positive effect on increasing the effectiveness of anti-tuberculosis therapy in patients with the pulmonary form of tuberculosis.

Female genital tuberculosis: a clinical lecture

The problem of extrapulmonary tuberculosis (EPT) remains urgent since, along with a decrease in the incidence of the disease, there is an increase in the number of neglected, late diagnosed cases. Female genital tuberculosis (FGT) is a relatively rare disease difficult to diagnose, occurring on average in 0.52.0 cases per 100,000 population; in recent years, an increase of EPT in this localization has been observed. Tuberculosis can affect any organ of the female genital system, either single or in combination. The most frequently involved are the tubes (95100%), endometrium (5060%), ovaries (2030%), cervix (515%), myometrium (2.5%) and vagina/vulva (1%). The most common symptom of FGT that makes patients seek medical advice is infertility. Other symptoms of FGT include menstrual irregularities (oligo-, hypo-, dis-, amenorrhoea as well as meno- and metrorrhagia), pelvic pain, and abnormal vaginal discharge. In postmenopausal women, FGT is characterized by symptoms resembling endometrial malignancy, such as postmenopausal bleeding, persistent leukorrhea, and pyometra. The diagnosis is based on a thorough history, clinical examination, and proper examination of the sample material obtained by endoscopy. Tuberculin test with intradermal injection of 2 TU of tuberculin (Mantoux test) was positive in 42.6% of patients with genital tuberculosis. Hysterosalpingography is an important method for diagnosing FGT, which assesses the internal structure of the female reproductive tract and the patency of the fallopian tubes. On ultrasound, the fallopian tubes may appear dilated, thickened, or filled with serous discharge (hydrosalpinx) or caseous mass (pyosalpinx). Laparoscopy and dye hydrotubation are reliable tools for the diagnosis of genital tuberculosis, especially for the involvement of the fallopian tubes, ovaries, and peritoneum. Microbiological examination of sampled material in FGT using solid media is low-informative; polymerase chain reaction and other molecular diagnostic methods should be used. It should be acknowledged that FGT is not a rare condition, but it is often overlooked. The two main reasons for late diagnosis are vague clinical signs and low alertness. Since infertility is a frequent complication of FGT, all infertile women should be screened for tuberculosis: tuberculin, ultrasound, hysterosalpingography, and in complicated cases, diagnostic laparoscopy with obligatory tissue sampling for pathomorphological and microbiological studies.