Tuberculous Research Articles

Sonographic changes of abdominal organs in children with different course of tuberculosis infection

In order to determine the frequency and nature of sonographic changes in abdominal organs in children with tuberculosis infection, 192 patients at the age of 6 months -14 years were examined on the basis of the tuberculosis department of City Children’s Infectious Hospital №3 for the period 2019-2021. 3 groups of patients were identified: group 1 - 92 children with active respiratory tuberculosis; group 2 – 52 children with residual post-tuberculosis changes; group 3 – 48 children with latent tuberculosis infection at risk of tuberculosis. Sonographic liver changes (reactive and/or intrahepatic cholestasis and/or hepatomegaly) were observed in children with active tuberculosis in 40.2±5.1% of cases, in children of group 3 - in 35.4±6.9% of cases and less often in children of group 2 - in 17.3±5.3% of cases (p<0.05). Changes of the gallbladder (violations of bile outflow and/or shape changes) were visualized in children with active tuberculosis in 73.9±4.6% of cases, in children of group 3 (60.4±7.1% of cases), less often in children of group 2 (55.8±6.7% of cases, p<0.05 for group 1). Changes of the pancreas were reactive and were more often observed in children of group 1 - in 14.1± 3.5% of cases than in children of group 2 (5.8±3.2% of cases, p<0.05) and group 3 (4.2± 2.9% of cases). Also, ultrasound changes of the spleen were more often detected in children with active tuberculosis - in 17.4±4.0% of cases than in children of group 2 (5.8±3.2% of cases, p<0.05) and group 3 (2.1±2.1% of cases, p<0.05).

Modern monitoring and evaluation of bacterial emission on the background of new micobacteria detection technologies and tuberculosis treatment schemes for respiratory tuberculosis in children

The problem of bacterial emission in tuberculosis of respiratory sistem is a current and significant problem from a practical point of view for modern pediatric phthisiology.Increased interest in this topic is due to the steady increase in tuberculosis (TB) cases in recent years due to drug-re- sistant strains of the pathogen and innovative laboratory technologies for determining the susceptibility of Mycobacterium tuberculosis to drugs, as well as difficulties in microbiological diagnosis. TB and treatment tactics for sick children who do not eliminate mycobacteria. The effectiveness of empirical treatment is demonstrated.

Diagnostic Problem in a Patient with Tuberculosis Arthritis

Extra-pulmonary tuberculosis (TB) remains a big public health problem worldwide. Although TB most commonly affects the lungs, any organ or tissue can be involved. TB arthritis is a rare form of extra-pulmonary TB. TB arthritis usually manifests as mild and non-specific arthritis. A 35-year-old male was admitted to the emergency room of Dr. Soetomo General Academic Hospital Surabaya due to pain of left knee since two days prior to admission. His symptom began on previous six months with the swelling of the left knee that gradually worsened so that he had an antalgic gait. Radiological examination of left knee joint showed inflammatory arthritis, accompanied by joint effusion and soft tissue swelling. USG examination of the left knee showed the presence of non-specific left knee arthritis. Patient underwent debridement. Anatomical pathology examination of the tissue obtained at the time of debridement, showed the TB granulomatous inflammation. The Ziehl-Nielson stain of left knee tissue also showed the TB granulomatous inflammation. Patient was then treated with analgesics and anti-TB drugs. The intensive phase of anti-TB therapy was planned to be 2 month, then evaluated and followed by continuation phase for about 7 months. The knee joint is the third most common site of osteoarticular TB after spine and hip. Insidious onset of pain which, in some patients may be present for years, is the usual presentation. The joint is usually warm, and wasting of the thigh muscles is usually marked. Synovial hypertrophy and effusion are present in most patients. The gold standard for diagnosis of TB arthritis is synovial biopsy, with positive results in 80% of cases. It shows caseating granulomas, lymphocytes, and giant cells with caseation, which are characteristics of TB arthritis. Synovial biopsy is generally recommended in any arthritis where clinical evaluation and routine investigations do not give a clear diagnosis.

Overview of pulmonary tuberculosis and extra pulmonary tuberculosis at the Siloam MRCCC Semanggi cancer hospital in 2018-2020

Clinical manifestations and results of investigations using imaging methods for pulmonary and extrapulmonary tuberculosis (TB) are often mistaken for malignancy, so TB is referred to as a "great imitator." This study aims to describe pulmonary TB and extrapulmonary TB patients at the Siloam MRCCC Semanggi Cancer Specialist Hospital in 2018-2020. A retrospective study design was used in the study with a sample of 71 patients according to the inclusion criteria. The research instrument used was the archives of the Anatomical Pathology Laboratory of the Siloam MRCCC Semanggi Cancer Special Hospital in 2018-2020. Pulmonary TB and extrapulmonary TB results were obtained in 2018 14 patients (19.7%), 31 patients (43.6%) in 2019, and 26 patients (36.7%) in 2020. Most TB occurred in the age range of 21-30 years (36.6%) and female sex (67.6%). Based on the location of the lesion, extrapulmonary TB was found in 64 patients (90.1%) and pulmonary TB in 7 patients (9.9%). Clinical diagnosis showed that 12 patients (17%) were suspected of malignancy, and 55 patients (77.4%) were not. After histopathological examination, 43 tuberculous lymphadenites (60.6%), seven bone and joint TB (9.9%), six lung TB (8.5%), four soft tissue TB (5.6%), 4 Genitourinary TB (5.6%), four gastrointestinal & peritoneal TB (5.6%), two cutaneous TB (2.8%), and one central nervous system TB (1.4%). Risk factors play an important role in the occurrence of pulmonary TB and extrapulmonary TB. Histopathological examination is important to exclude the possibility of malignancy in patients with pulmonary TB and extrapulmonary TB so that treatment can be carried out quickly and accurately.

Recent updates on correlates of vaccine-induced protection.

Correlates of protection are key for vaccine development against any pathogen. In this paper we summarize recent information about correlates for vaccines against dengue, Ebola, influenza, pneumococcal, respiratory syncytial virus, rotavirus, shigella, tuberculosis and Zika virus.

The surfactant inhaled therapy in a complex lung tuberculosis treatment: clinical reviews

The article describes the clinical case reports of patients with respiratory tuberculosis who were hospitalized at the Regional Clinical Antituberculosis Center in Kursk. One of them was in the pediatric department for patients with tuberculosis of respiratory organs and the other in the 1st department for patients with multidrug-resistant tuberculosis. As pathogenetic therapy in the complex treatment of pulmonary tuberculosis, in the intensive phase of anti-tuberculosis chemotherapy, we added inhalation therapy with surfactant (medicinal product surfactant-BL lyophilisate for emulsion preparation, 75 mg, manufactured by Biosurf LLC, Russia) according to the instructions to the drug. Treatment of pulmonary tuberculosis is performed by multiple inhalations of surfactant-BL as part of complex therapy against the background of fully deployed antituberculosis drugs (ATD), i.e. when the patient empirically or based on data on drug sensitivity of the pathogen is selected 4-6 ATD that are well tolerated by the patient in the prescribed dose and combination. It should be noted that an adult patient during the intensive phase of anti-tuberculosis chemotherapy had COVID-19. Against the background of inhalation therapy with surfactant, it was possible to stabilize the clinical and radiological condition of the patients, and to improve their condition. Clinically it was expressed in reduction of coughing, increase of tolerance to physical exertion. For example, according to spirometry data on the admission of an adult patient and in dynamics, the vital capacity index (VCI) increased from an extremely sharp decrease (31.25%) to 75%, which corresponded to a very mild decrease. At the moment the patient from the children’s ward is completing a course of antituberculosis therapy with small residual changes in the lungs, and the adult patient was operated on at the Russian Ministry of Health at the Federal State Budgetary Institution “National Research Center of Pulmonary Medicine” for installation of a bronchial valve. Based on the above, we can conclude about the successful, pathogenetically sound use of surfactant-BL in patients with respiratory tuberculosis in both children and adults.

Experience in using the method of valve bronchial block in Primorsky Krai in treatment of respiratory tuberculosis in a child

This paper presents a clinical case of destructive pulmonary tuberculosis in a child with drug resistance successfully treated using endoscopic bronchial valve therapy. In the context of the developed drug resistance to the causative agent of tuberculosis, ineffectiveness of the conducted treatment and negative radiological dynamics, the method of endoscopic bronchial valve treatment allows the patient’s condition and their clinical and radiological indicators to be improved. In the presented case, a positive X-ray dynamic was achieved in the form of closure of the decay cavity after the installation of an endobronchial valve. Following nine months, the installed endobronchial valve was removed during bronchoscopy and the continuation of chemotherapy was recommended.

Sex transition from female to male as a risk factor for sleep-disordered breathing

AimThe female-to-male (FtM) sex transition requires lifelong supplementation with male sex hormones, resulting in high prevalence of weight gain, fat redistribution and other metabolic changes. Although sleep-disordered breathing (SDB) data for this group of patients are very limited, increased prevalence is expected. We report a mini-series of six case reports of FtM transsexuals treated in our centre. Patients and methodsAll reported cases are consecutive patients referred to a department of respiratory diseases and tuberculosis of a university hospital from 2017 to 2022. The standard pulmonary examination was performed, followed by limited polysomnography. ResultsIn all FtM subjects, SDB was present and continuous positive airway pressure (CPAP) therapy was indicated. The sex transition process was completed in three individuals while the other three only took testosterone supplementation at the assessment time. The subjects’ age ranged from 21 to 38 years, the apnoea-hypopnea index ranged from 17.3 to 104.1, and the BMI was 33.48–43.41. The CPAP therapy was effective in five patients, with one requiring bi-level positive airway pressure therapy. One subject committed suicide before the first check-up, four patients had a good level of compliance at one-year follow-up, and one had insufficient CPAP adherence. ConclusionSDB decreases the quality of life and life expectancy of FtM individuals. Their prognosis is undoubtedly better with effective treatment. Hence, obese FtM subjects should be considered at risk and screened for SDB.

Difference between the blood samples of patients with bone and joint tuberculosis and patients with tuberculosis studied using machine learning.

Tuberculosis (TB) is a chronic infectious disease. Bone and joint TB is a common type of extrapulmonary TB and often occurs secondary to TB infection. In this study, we aimed to find the difference in the blood examination results of patients with bone and joint TB and patients with TB by using machine learning (ML) and establish a diagnostic model to help clinicians better diagnose the disease and allow patients to receive timely treatment. A total of 1,667 patients were finally enrolled in the study. Patients were randomly assigned to the training and validation cohorts. The training cohort included 1,268 patients: 158 patients with bone and joint TB and 1,110 patients with TB. The validation cohort included 399 patients: 48 patients with bone and joint TB and 351 patients with TB. We used three ML methods, namely logistic regression, LASSO regression, and random forest, to screen the differential variables, obtained the most representative variables by intersection to construct the prediction model, and verified the performance of the proposed prediction model in the validation group. The results revealed a great difference in the blood examination results of patients with bone and joint TB and those with TB. Infectious markers such as hs-CRP, ESR, WBC, and NEUT were increased in patients with bone and joint TB. Patients with bone and joint TB were found to have higher liver function burden and poorer nutritional status. The factors screened using ML were PDW, LYM, AST/ALT, BUN, and Na, and the nomogram diagnostic model was constructed using these five factors. In the training cohort, the area under the curve (AUC) value of the model was 0.71182, and the C value was 0.712. In the validation cohort, the AUC value of the model was 0.6435779, and the C value was 0.644. We used ML methods to screen out the blood-specific factors-PDW, LYM, AST/ALT, BUN, and Na+-of bone and joint TB and constructed a diagnostic model to help clinicians better diagnose the disease in the future.

Robot-assisted complex urinary tract reconstruction using intestinal segments: redefining the paradigm.

Complex urinary tract reconstruction has significantly advanced with the increasing use of robot-assisted procedures. Robotic surgery aims to achieve the same outcomes as open surgery while minimizing morbidity by causing less blood loss, faster postoperative recovery, and reducing complications.This article shares our technique, challenges encountered, and experience of robot-assisted complex urinary tract reconstruction using intestinal segments.Between January 2020 to March 2022, 6 patients who underwent robot-assisted complex urinary tract reconstruction using intestinal segments at our centre were retrospectively reviewed. Demographic, clinical, and operative data were recorded. Patients underwent renal function tests, blood gas analysis, and radiographic imaging in the follow-up. Symptomatic and radiologic relief were the criteria for success. Out of 6 cases, three patients underwent ileal ureter replacement, two combined ileal ureter with augmentation ileo-cystoplasty and one augmentation ileo-cystoplasty alone. The mean age, estimated blood loss, length of hospital stay, and follow-up period were 32.6years, 110 ± 13.1mL, 7.0 ± 1.1days, and 11.3months, respectively. The indications for surgery were either benign ureteral stricture following lithotripsy or sequelae of genitourinary tuberculosis. No intra-operative complications were found. Clavien-Dindo grade-II and Grade-IIIa were found in three and one patient, respectively. During follow-up, none had compromised renal function or acidosis. Robot-assisted complex urinary tract reconstruction using intestinal segments is safe and offers the advantages of minimally invasive techniques. Techniques demonstrated in this article make these reconstructions feasible with good surgical and clinical outcomes.

Hematological Parameters as Potential Markers for Distinguishing Pulmonary Tuberculosis from Genitourinary Tuberculosis.

Mycobacterium tuberculosis complex (MTBC) infection is an important public health concern in Taiwan. In addition to pulmonary tuberculosis (PTB), MTBC can also cause genitourinary tuberculosis (GUTB). This study aimed to examine the role of laboratory data and the values that can be calculated from them for the early detection of GUTB. Patients admitted from 2011 to 2020 were retrospectively recruited to analyze their associated clinical data. Statistical significance was analyzed using the chi-square test and univariate analysis for different variables. A receiver operating characteristic (ROC) curve analysis was used to evaluate the performances of the examined laboratory data and their calculated items, including the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to-monocyte-plus-lymphocyte ratio (NMLR), and platelet-to-lymphocyte ratio (PLR), in diagnosing PTB or GUTB. A p-value of <0.05 was considered significant. The ROC curve showed that the discriminative power of the neutrophil count, NLR, and MLR was within the acceptable level between patients with both PTB and GUTB and those with GUTB alone (area under the curve [AUC] values = 0.738, 0.779, and 0.725; p = 0.024, 0.008, and 0.033, respectively). The discriminative power of monocytes and the MLR was within the acceptable level (AUC = 0.782 and 0.778; p = 0.008 and 0.010, respectively). Meanwhile, the neutrophil and lymphocyte counts, NLR, NMLR, and PLR had good discriminative power (AUC = 0.916, 0.896, 0.898, 0.920, and 0.800; p < 0.001, <0.001, <0.001, <0.001, and 0.005, respectively) between patients with GUTB and those with PTB alone. In conclusion, the neutrophil count, lymphocyte count, NLR, NMLR, and PLR can be used as potential markers for distinguishing PTB from GUTB.

ЗАБОЛЕВАЕМОСТЬ ТУБЕРКУЛЕЗОМ ОРГАНОВ ДЫХАНИЯ В КАЛУЖСКОЙ ОБЛАСТИ В ПЕРИОД ДО И ВО ВРЕМЯ ПАНДЕМИИ COVID-19

Significance. Over the past two years the Covid-19 pandemic has disrupted the ten-year stable rate of decline in morbidity and mortality from tuberculosis (TB) in the Kaluga Region. The study results showed that the decrease in the incidence of respiratory tuberculosis during the pandemic was due to the negative impact of restrictive measures introduced during the pandemic on the schedule of TB screening, causing its reduction rather than the improved epidemic situation. As a result, the number of patients with common forms of respiratory tuberculosis has increased, which could have been sources of tuberculosis infection among the population for a long time, contributing to a higher number of TB cases over the subsequent years. Resuming the schedule of TB screening after the pandemic will also contribute to a higher number of newly detected TB patients. Purpose: to analyze the incidence of respiratory tuberculosis in the Kaluga region in the period before and during the Covid-19 pandemic. Material and methods. The analysis used data of the Federal statistical observation forms No. 8 and No. 33 for 2010-2021. To assess the screening effectiveness and TB epidemic situation in Russia and the Kaluga region, the following indicators were calculated: coverage of adults with TB screening with fluorography (2015-2021), TB incidence (2010-2021) and TB mortality (2015-2021). The analysis of the respiratory TB incidence in the Kaluga region covered the period from 2015 to 2021, including the pre-pandemic period from 2015 to 2019 and the pandemic – 2020-2021. Statistical analysis was carried out using the StatTech program v.2.8.8 (developed by Stattech LLC, Russia). Pearson's Chi-squared test was used for data analysis. The differences were recognized as significant at p &lt;0,05. Results. Over a decade (2010-2019) before the pandemic, the TB incidence in Russia and the Kaluga region was steadily decreasing. In 2015-2019, the adult coverage with TB screening in the region was high adding up to 64.8% on average. However, the effectiveness of screening was declining, since in order to detect the first patient with respiratory tuberculosis in 2019, it took to examine 3,438 healthy individuals, which was 1.8 times more than in 2015. During the pandemic (2020-2021) in Russia and the Kaluga Region, significant changes were registered in the respiratory TB incidence dynamics due to a rapid decrease in its values. The reason for this situation was the introduction of restrictive measures (lockdown), which lasted longer for older adults. The decreased coverage with TB screening in the Kaluga region aimed at early TB detection, and the reduced number of TB cases detected have resulted in the accelerated rates of reduction in the respiratory TB incidence. Conclusion. The study results showed that the decreased incidence of respiratory tuberculosis during the pandemic in the Kaluga region was due to the negative impact of the restrictive measures on the schedule of TB screening, causing its reduction, resulting in the decreased number of patients with respiratory tuberculosis detected rather than improvements in the epidemic situation.

Анализ эпидемиологической ситуации по туберкулезу в Республике Татарстан за период с 2012 г. по 2021 г.

In the Republic of Tatarstan, in the period 2012 to 2021 we observed a twofold decrease in the incidence of tuberculosis: from 48 cases per 100 thousand population to 23.4 cases per 100 thousand population. However, there is an increase in the proportion of patients with respiratory tuberculosis in the decay and contamination phase, as well as fibrotic-cavernous and multiple drug-resistant forms of tuberculosis. It is important to analyze the epidemiological situation over a ten-year period, that will allow to develop or adjust measures for the prevention of tuberculosis in the Republic of Tatarstan. Objective: To establish patterns of manifestations of the epidemic process based on the indicators of the general incidence of tuberculosis in the Republic of Tatarstan for the period 2012-2021. Materials and methods: The study design is a descriptive epidemiological study. A retrospective epidemiological analysis of the incidence of general tuberculosis in the Republic of Tatarstan for 2012-2021 was carried out. The analysis of the long-term dynamics of the tuberculosis incidence in the population of the Republic of Tatarstan was carried out. Intensive indicators of morbidity in general, by contingents and ages were calculated. The structure of tuberculosis incidence in the Republic of Tatarstan was assessed, extensive morbidity rates in percentages (%) were calculated. Results: The long-term dynamics of annual morbidity rates of newly diagnosed tuberculosis in the Republic of Tatarstan in 2012-2021 is characterized by a statistically significant downward trend (р = -0,973 р &lt; 0,001) at a rate of 7.8% per year. The indicated speed of the trend has reduced the incidence of newly diagnosed tuberculosis in 10 years from 48 cases per 100 thousand of population to 23.4 per 100 thousand of population, or twofold. Conclusion: Despite a significant decrease in the overall incidence of tuberculosis over a ten-year period, both in newly diagnosed patients and registered patients, in the Republic of Tatarstan the clinical structure of tuberculosis becomes more severe, namely, we experience an increase in the proportion of patients with respiratory tuberculosis in the phase of decay and contamination among newly diagnosed patients, with fibrous-cavernous tuberculosis among registered patients with multidrug-resistant tuberculosis.

Trends and Patterns of Respiratory Tuberculosis Mortality in Rural and Urban - China, 1987-2021.

In China, an estimated 780,000 individuals contract tuberculosis (TB) every year. With TB ranked as the second most prevalent disease in terms of the morbidity and mortality rates for legally infectious diseases, it imparts a substantial disease burden on families and society. This study identifies specific periods and cohort effects related to trends in respiratory TB mortality in both rural and urban regions of China. The mortality rates have been found to decrease at an annual rate of 5.5% in urban regions and 6.6% in rural ones, with a more marked decline evident in rural areas. These findings represent a significant milestone in the prevention and treatment of respiratory TB in China, especially in its rural locales. This research contributes to policymakers' comprehension, assisting in the early formulation of cogent optimization policies, thereby further supporting the United Nations Sustainable Development Goals (SDGs) and the Endeavor to End Respiratory TB Strategy. It is recommended that policymakers prioritize key groups such as children, young adults aged 20-30 in rural areas, and older men (60 years and over) in urban areas when developing these astute optimization policies.

A retrospective observational study of presentation, diagnosis, and management of patients with genitourinary tuberculosis in a tertiary care hospital of India

Objectives: To study the clinical features, diagnostic methods, and management of genitourinary tuberculosis (GUTB). Methods: This retrospective study included 117 patients with GUTB admitted over a period of 10 years. The analysis of the patients was done in terms of presentation, organ involved, diagnostic methods, and management. The 6-month anti-tubercular treatment (ATT) was given to all patients, which included isoniazid, rifampicin, and ethambutol/pyrazinamide. Follow-up period was 1–10 years. Results: The mean age of the patients was 32.5 ± 6.4 years with a male: female ratio of 1:1.51. The majority of the patients presented with irritative voiding symptoms (66.47%) and hematuria (47.6%). The common infected organs were kidney (64.9%), ureter (27.35%), urinary bladder (17.09%), prostate (3.4%), and epididymis (5.19%). 25.6% of patients had positive chest X-ray, and 61.2% of the patients had positive Mantoux test. The diagnostic positivity rate for polymerase chain reaction, urine Mycobacteriumtuberculosis culture test, and urine acid-fast bacilli test was 67.7%, 35.4%, and 21.6%, respectively. 71 (60.13%) of the patients needed surgical intervention. After medical therapy, the adverse reactions noted were abnormal liver function in four cases, pruritus in three cases, and skin eruption in one case. Among the total of 117 patients followed over a period of 1 year to 10 years, none recurred. Conclusion: In a retrospective study of 117 patients with GUTB, majority had bladder symptoms, 60.13% needed surgery, and all were treated with 6-month course of ATT regimen consisting of isoniazid, rifampicin, and ethambutol/pyrazinamide, with none showing recurrence during the period of 1–10 years of follow-up.

Role of Real Time Polymerase Chain Reaction Targeting mpb64 Gene in the Diagnosis of Genitourinary Tuberculosis: A Cross-sectional Study

Introduction: Genitourinary Tuberculosis (GUTB) remains an important cause of infertility in India. The clinical manifestations of GUTB are non specific, resulting in delayed diagnosis and initiation of Anti Tubercular Treatment (ATT). This delay can lead to various complications such as kidney dysfunction, ureteral strictures, and a shrunken bladder. Aim: To evaluate the diagnostic importance of Real Time Polymerase Chain Reaction (RT-PCR) targeting the mpb64 gene for the rapid and accurate diagnosis of GUTB. Materials and Methods: A cross-sectional hospital-based observational study was conducted in the Department of Microbiology at Subharti Medical College and associated Chhatrapati Shivaji Subharti Hospital in Meerut, Western Uttar Pradesh, India. The study was conducted over a three-year period, from January 2019 to December 2021. A total of 200 genitourinary samples were collected from female patients with clinical suspicion of Tuberculosis (TB) and subjected to direct microscopy, mycobacterial culture by BacT/Alert 3D (Biomerieux, France), and RT-PCR targeting the mpb64 gene (Qiagen). Demographic details were recorded in a predesigned proforma. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) software version 26.0 (IBM Corp., Armonk, NY, USA). The p-value was calculated using the Chi-square test. Results: RT-PCR showed a higher positivity rate of 56 (28.9%) compared to 47 (24.2%) by culture. Acid Fast Bacilli (AFB) microscopy was the least sensitive, detecting only 7 (3.6%) cases. When comparing the results of RT-PCR with conventional methods, RT-PCR had a sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of 91.9%, 99.4%, 85.1%, and 93.8%, respectively. Conclusion: RT-PCR targeting the mpb64 gene is a specific and effective additional test that aids in the early and accurate diagnosis of Extrapulmonary Tuberculosis (EPTB), including GUTB, compared to conventional methods. Early diagnosis facilitates timely initiation of ATT, leading to better clinical outcomes.

Microbiological confirmation of tuberculous pleurisy with medical thoracoscopy: targeted pleural washing and pleural biopsy.

Due to the pauci-bacillary nature of tuberculous (TB) pleurisy, clinical diagnosis is common, but microbiological confirmation is necessary to determine drug resistance. This study aimed to investigate the diagnostic yield of medical thoracoscopy (MT) for microbiological confirmation of TB pleurisy. Medical records of patients diagnosed as TB pleurisy with microbiological or histologic evidence who underwent MT between May 2015 and July 2023 at Incheon St. Mary's Hospital were retrospectively reviewed. Sensitivities of microbiological results [acid-fast bacilli (AFB) culture or TB-polymerase chain reaction (PCR)] of pre-MT pleural fluid and those of targeted pleural washing fluid and pleural tissues obtained during MT were compared. Difference in sensitivity was verified with McNemar's test. A total of 72 patients were enrolled. With pre-MT pleural fluid, sensitivities of AFB culture and TB PCR were 5.6% (4/72) and 1.4% (1/72), respectively. With targeted pleural washing fluid, sensitivities of AFB culture and TB-PCR were 23.6% (17/72) and 12.5% (9/72), respectively. With pleural tissues, sensitivities of AFB culture and TB-PCR were 18.1% (13/72) and 40.3% (29/72), respectively. MT showed an additional 27.8% [95% confidence interval (95% CI): 14.2-40.1%, P<0.001] of sensitivity gain in AFB culture and 40.3% (95% CI: 25.7-52.5%, P<0.001) of sensitivity gain in TB-PCR. With pleural washing, additional 19.4% (95% CI: 6.8-31.6%, P=0.001) of sensitivity gain in microbiological confirmation was identified, whereas additional 37.5% (95% CI: 22.6-50.2%, P<0.001) of sensitivity gain was identified with pleural biopsy. With MT, 44.4% of additional sensitivity gain in microbiological confirmation of TB pleurisy was identified. This underscores the role of MT in the diagnosis of TB pleurisy.

Ileal neobladder adenocarcinoma occurring 25 years post ileocystoplasty: a case report

De-tubularised ileum is one of the most common segments used for augmentation cystoplasty. It is associated with complications such as metabolic disturbances, recurrent urinary tract infections, and stone formation. However, adenocarcinoma arising in an augmented bladder is a rare occurrence. We report a 37-year-old female, case of ileocystoplasty 25 years ago due to a thimble bladder (genitourinary tuberculosis) who presented with hematuria for one month. Cystoscopy showed bladder mass in the transposed ileal segments. The patient underwent transurethral resection of the bladder lesion, and the histopathology was suggestive of adenocarcinoma of the ileum. Subsequently, she underwent anterior pelvic exenteration and post-operative recovery was uneventful. The 6-month follow-up showed that the patient was asymptomatic without recurrence. In conclusion, even though adenocarcinoma in the ileal neobladder is rare, life-long with close follow-up with routine cytologic, radiologic, and cystoscopic evaluation for early cancer detection and treatment at an early stage is crucial.

Comparative characteristics new cases of respiratory tuberculosis among HIV infected patients in consideration of detecting ways

The aim of the study: to compare clinical and X-rays characteristics respiratory tuberculosis identified by screening or uptake with complains among HIV infect-ed patients. Materials and methods. Research includ-ed all new cases of respiratory tuberculosis among HIV infected patients of Leningrad district from 2014 to 2016 years. Patients had been identified by two ways: uptake with complaints and screening. Statistical evalu-ation of groups by tuberculosis signs was carried out: du-ration of HIV infection, severity of immunosuppression, extent of lung lesions, cavitations, increased lymph nodes, positive sputum smears or positive sputum cultural for tuberculosis, clinical forms and mortality during the first year treatment. Results. There are 852 HIV/TB patients included in the research. According to these ways all patients separated in two groups: pa-tients with complaints contain 454 persons (53,3%) and patients detected by screening 398 persons (46,7%). Conclusion. Our research showed that there are no any significant difference between HIV/TB patients identi-fied by these ways (by screening or uptake with com-plains) when comparing on using these tuberculosis signs.

Clinical example of effective treatment of a patient with a combination of fibrous-cavernous tuberculosis and chronic aspergillosis of the right lung

ntroduction. The combination of destructive tuberculosis and chronic pulmonary aspergillosis remains a pressing and understudied problem. Respiratory tuberculosis is a significant risk factor for bronchopulmonary aspergillosis in 40–72% of cases. The current treatment strategy for pulmonary tuberculosis and bronchopulmonary aspergillosis is governed by clinical guidelines. However, the issues of surgical treatment tactics in complicated forms of the combination of active tuberculosis and pulmonary aspergillosis require discussion and remain relevant at present. Material and methods. A clinical case of complex treatment of a patient with a combination of fibrous-cavernous tuberculosis and chronic aspergillosis of the right lung is described. Patient S., 42 years old, became ill with infiltrative tuberculosis of the right lung in August 2008. On the background of a 9-month anti-tuberculosis chemotherapy according to the I regimen she was cured and in 2012 was removed from the dispensary registration. In February 2018, an episode of pulmonary hemorrhage (volume 200 ml) occurred, and was stopped by conservative methods. At the follow-up examination, tuberculosis recurrence was verified in the right lung with the formation of fibrous-cavernous lesion. On the background of the repeated 6-month course of treatment according to the I regimen no dynamics was obtained, pulmonary hemorrhage of the Ia stage recurred regularly. In September 2018, the patient was hospitalized to SPb NIIF. Pre-examination revealed chronic pulmonary aspergillosis. Voriconazole therapy was started, and correction of the ongoing antituberculosis therapy was carried out, taking into account drug interaction. Surgical treatment was indicated. Results. On 09.25.2018, an upper bilobectomy was performed on the right side. There were no intraoperative complications. The operation was completed by draining the pleural cavity with two drains and suturing the thoracotomy wound. Postoperative period without complications. In order to correct the volume of hemithorax, an artificial pneumoperitoneum of 1000 ml was applied. The drains were removed on the 4thand 5th days after surgery, the surgical wound healed by primary tension. At the follow-up examination after five years, there was no evidence of disease recurrence or late surgical complications. Conclusion. Providing medical care to patients with a combination of tuberculosis and pulmonary aspergillosis requires the organization of full-fledged primary diagnosis and routing of patients to a specialized hospital. A complex approach to treatment allows for successful treatment outcomes with minimal risks.