The Ukraine ranks among the top 20 countries with the highest number of multidrug-resistant (MDR) and extensively drug resistant (XDR) cases in the world. However, little is known of the genetic diversity, i.e., resistance signatures, in clinical isolates from this region. We analyzed seven of most prevalent MDR/XDR antibiotic resistance-conferring genes from clinical isolates ( = 75) collected from geographically diverse Ukrainian oblasts and the southern Crimean peninsula. Genomic analysis revealed that 6 (8%) were sensitive, 3 (4%) were resistant to at least one antibiotic but were not MDR, 40 (53%) were MDR, and 26 (35%) were XDR. The majority of isolates (81%) were of the Beijing-like lineage. This is the first study to use next-generation sequencing (NGS) of clinical isolates from the Ukraine to characterize mutations in genes conferring drug resistance. Several isolates harbored drug resistance signatures that have not been observed in other countries with high-burden tuberculosis. Most notably, the absence of gene promoter mutations, a diversity of mutation types in the resistance-determining region, and detection of heteroresistance provide a broader understanding of MDR/XDR from this area of the world.
Genotypic variation in Beijing lineages of Mycobacterium tuberculosis (MTB), the causative agent of tuberculosis (TB), has been associated with hyper virulence and the spread of extensively and multiple drug (X/MDR) resistant MTB strains in Eastern Europe, Central Asia, and East Asia. The clinical outcomes of 215 new cases of TB among the population of the Kharkiv region of Eastern Ukraine were analyzed to uncover factors associated with severe infection. Infecting MTB strains were profiled by 5 locus exact tandem repeats (ETRs) and 15 locus mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) genotyping. Among diverse MTB genotypes discovered in Ukraine, the Beijing genotype (MIRU-VNTR 42425) was significantly associated with risk factors for severe outcomes of disease in the study population, including TB/HIV co-infection and treatment failure. Strain replacement (superinfection) was observed in 10 patients, suggesting repeated exposure to novel MTB strains in hospital or community settings. Inclusion of MTB genotyping data may identify at-risk patients and improve treatment adherence to prevent X/MDR development for effective public health response against tuberculosis in Ukraine.
Метою роботи було дослідження клініко-лабораторних даних хворих на вперше діагностований туберкульоз легень в умовах різного рівня споживання алкоголю. Матеріали і методи. У дослідження було долучено 102 хворих на вперше діагностований туберкульоз легень зі збереженою чутливістю до протитуберкульозних препаратів, які вживають алкоголь. Активність гамма-глутамілтранспептидази визначали кінетичним методом. Рівні С-реактивного білка визначали методом латексної аглютинації. Для аналізу параметрів якості життя пацієнтів використовувалася анкета SF-36. Оцінки характеру споживання алкоголю проводили за допомогою тесту Alcohol Use Disorders Identification Test. Отримані дані оброблені з використанням програми Statistica. Результати дослідження. За результатами опитувальника AUDIT пацієнти були поділені на три групи. Група 1-особи, які набрали 0-7 балів, група 2-8-15 балів, група 3-16 балів і більше. Показники якості життя в перших двох групах були на досить високому рівні з переважанням фізичної складової здоров'я. У третій групі середні показники за обома складовим виявилися достовірно нижче перших двох груп. Пацієнти групи 3 є більш соціально дезадаптованими. У групі зловживаючих алкоголем пацієнтів переважали процеси, що уражали більше однієї долі легень з ознаками деструктивних процесів легеневої тканини. У 82,1 % пацієнтів групи 3 були виявлені мікобактерії туберкульозу в мокротинні вже на етапі мікроскопічного дослідження. У хворих з туберкульозом зі зростанням рівня споживання алкоголю спостерігається збільшення рівнів в крові лейкоцитів, СРБ і показника ШОЕ, проявів анемії і зниження активності клітинного імунітету за рахунок зниження рівня лімфоцитів. Максимальні порушення мали місце в групі 3. Показники функціонального стану печінки, крім АЛТ, в групі 3 були достовірно вище, ніж в групі 1. Висновки. У хворих на туберкульоз, які вживають алкоголь мають місце зниження соціальної адаптації, рівня якості життя, наявність більш вираженого інтоксикаційного синдрому, превалювання поширених форм туберкульозу з масивним бактеріовиділенням, а також порушення функцій печінки.
The aim of the research: identify combinations of genetic and neurohumoral factors that influence the development of true resistance to antihypertensive therapy (AHT) in patients with concomitant obesity (OB). The study included 200 patients aged 45–55 with uncontrolled hypertension and obesity. Treatment was prescribed in accordance with the European Guidelines 2018. Thiazide-like diuretics were additionally prescribed to those patients who did not reach the target blood pressure (BP) level after 3 months of dual therapy. Resistant hypertension was diagnosed in 48 patients who had an uncontrolled course of hypertension at the optimal doses of three antihypertensive drugs during the next month of their reception, while true resistance was found in 21 patients. The effectiveness of comprehensive treatment was evaluated after 6 months. The application of the logistic regression method at the stage of initial examination of patients showed that the early predictors of the formation of truly resistant hypertension in obese patients are CIMT, HOMA index and genetic polymorphism IRS-1. After treatment, the model of truly resistant hypertension in patients with obesity included indicators that influenced its formation at the pre-treatment stage, as well as the new ones: adiponectin, waist circumference and genetic polymorphism ADIPOQ. Genetic markers, insulin resistance, and vascular wall status play a leading role in the development of true resistance to AHT in obese patients. It is established that the main determinants of the formation of true resistance to AHT in patients with this comorbidity are IRS-1 polymorphism, HOMA index and CIMT.
The aim. Assessment of the initial psychological status of men with first diagnosed pulmonary tuberculosis and the study of its associations with the clinical course of the disease. Materials and methods. The study involved 54 men with first diagnosed pulmonary tuberculosis. Patients had a dynamic complex clinical, laboratory and instrumental examination with an assessment of the psychological status according to the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI). Results. The evaluating of initial psychological status in patients with first diagnosed pulmonary tuberculosis, depressive states of varying severity were found in 47.05 % of patients, moderate state anxiety – in 74.51 % of patients, moderate trait anxiety – in 35.29 %. We revealed associations of the levels of anxiety and depression with the degree of bacterial excretion and the duration of the intensive phase of therapy. Conclusions. To assess the psychological status of patients with first diagnosed infiltrative pulmonary tuberculosis, it is advisable to use the STAI and the BDI. Patients with first diagnosed infiltrative pulmonary tuberculosis in 100 % of cases have psychological status disorders with a predominance of moderate state anxiety and the absence of depressive disorders in only half of them. More expressed violations of the psychological status (anxiety, depression) identifies patients who are married and have a steady job. In patients with first diagnosed infiltrative pulmonary tuberculosis, an increase in the severity of anxiety and depression is associated with more expressed bacterial excretion, decrease in body weight, greater frequency of destruction of lung tissue, prevalence of the tuberculosis process by more than 2 lung segments, decrease in the effectiveness of standard therapy and prolongation intensive phase of treatment.
Patients with ACO have significant poorer health-related quality of life and more severe functional limitations compared to asthma and COPD alone. Most commonly, chronic respiratory disease is associated with cardiovascular disease, such as arterial hypertension. However, the impact of concomitant cardiac diseases on the quality of life and functional status of patients with ACO remains poorly understood. The aim of the work was to study dynamics of functional condition and quality of life in with ACO and concomitant AH against the background of complex therapy. Materials and methods. We selected for participating in the study 100 patients with ACO and concomitant AH. Examination of the patients included: clinical methods, spirometry, and questinaries – mMRS, CAT, SGRQ, performing 6MWT. Results. After 16 weeks of treatment there were no changes in lung functional status in patients on standard treatment, at the same time, in group of patients who had an active rehabilitation program, there was a significant improvement in the bronchial response to the action of bronchodilators, although other indicators of the functional status of the lungs didn't show significant changes. Patients who additionally used an active rehabilitation program had a significant improvement in clinical symptoms, shortness of breath, and quality of life according to CAT, mMRC, and SGRQ scores, respectively. There was also a significant increase in distance during the 6MWT in this group of patients. Conclusions. Conducting an active rehabilitation program (physical rehabilitation in combination with an educational program and self-management) in group of patients with ACO and concomitant AH, who are on standard medical treatment, significantly improves the bronchial response to the action of bronchodilators, decreases clinical manifestations, shortness of breath and improve quality of life and exercise tolerance, according to CAT, mMRC, SGRQ and 6MWT questionnaires, respectively.
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