ІІ групі на +20,5 % (р<0,05). В ІІІ групі компонент ТР зростав у 2,4 рази порівняно з показником в контрольній групі (р<0,05). Співвідношення Е/А за даними ЕХОКС в ІІІ групі менше, ніж в ІІ групі на-18 % (р<0,05). За результатами ROC-аналізу визначений рівень індексу «Міокард» >18,28 % як прогностичний маркер кардіореспіраторних порушень у хворих з поєднаним перебігом ОАС та ГЕРХ. Висновки: У хворих з коморбідним перебігом ОАС та ГЕРХ виявлені найвагоміші порушення функціонування серцево-судинної системи. Для визначення ефективності лікування кардіоваскулярних порушень у хворих на ОАС і ГЕРХ доцільно проводити динамічне спостереження за варіабельністю серцевого ритму та пaрaметрaми ехокардіографії Ключові слова: обструктивне апное сну, гастроезофагеальна рефлюксна хвороба, кардіоваскулярні порушення, вегетативна нервова система
The own observation of pregnancy and tuberculosis after COVID-19 in a patient who was treated in the pulmonary tuberculosis department N 2 of the Zaporizhia Regional Phthisiopulmonology Clinical Medical Diagnostic Center is presented. According to the presented clinical case, a woman, who had pulmonary tuberculosis 9 years ago, underwent mild COVID-19 at the 20th week of pregnancy and did not receive any treatment. The patient had of the dispensary observation in the phthisiatrician and regularly underwent preventive check-up, because of her previous tuberculosis. However, the patient was hospitalized in the intensive care unit of the PNE «Regional Perinatal Center» ZRC with moderate preeclampsia, signs of intrauterine fetal hypoxia, in which the mother needed medical care, at the 32nd week of pregnancy. Three days after hospitalization, in view of the fetal distress and preeclampsia, it was made a decision to perform assisted delivery by cesarean section. The child was born alive, vertical transmission of COVID-19 was not diagnosed. Taking into account the history of tuberculosis in anamnesis, the woman underwent X-ray examination of the thoracic cavity organs, where the reactivation of a specific process, on the background of metatuberculous changes, were revealed. The woman was diagnosed of multidrug-resistant tuberculosis (MDR-TB) with a destructive process in the lungs by further examination, that’s why, she was hospitalized to Zaporizhia Regional Clinical and Diagnostic Center of Phthysiatry and Pulmonology» of Zaporizhia Regional Council for further treatment. A course of antimycobacterial therapy (AMBT), according to the modified short-term treatment regimen, was prescribed to the patient. Against the background of AMBT, rapid positive dynamics was determined: stable cessation of bacterial excretion was determined after 1 month of AMBT, and healing of destruction with the formation of residual post-tuberculosis changes — after 2 months. The presented clinical case demonstrates the negative impact of COVID-19 both on the course of pregnancy (moderate preeclampsia, which led to cesarean section at 32nd weeks of pregnancy) and on the reactivation of the tuberculous process, with its course in the form of MDR-TB.
Aim. To analyze the features of the simultaneous course of pulmonary aspergillosis and multidrug-resistant pulmonary tuberculosis (MDR-TB) on the background of type 1 diabetes mellitus, on the example of a clinical case of our practice. Materials and methods. Clinical case of our practice of simultaneous pulmonary aspergillosis and MDR-TB on the background of type 1 diabetes mellitus in a patient, who was treated in Pulmonary tuberculosis department No. 2 of clinical base of Phthisiatry and Pulmonology Department of Zaporizhzhia State Medical University at Communal Non-Commercial Enterprise of the “Zaporizhzhia Regional Clinical and Diagnostic Center of Phthisiatry and Pulmonology” of Zaporizhzhia Regional Council. Results. In the presented clinical case, the patient had been suffering from diabetes mellitus for 8 years and had been receiving insulin therapy for all these years. One year before the TB disease, he had contact with an index patient, but he categorically refused a course of preventive chemotherapy. Also, the patient did not make a comparison X-ray TCO after 6 months, as a contact person. MDR-TB and aspergilloma of the left lung of the patient were diagnosed simultaneously on the background of severe condition with decompensated form of type 1 diabetes mellitus, severe intoxication syndrome and inflammatory process, massive hemoptysis. Aspergilloma of the left lung was diagnosed using X-ray TCO and cultural examination of bronchial aspirate for Aspergillus, which was not difficult to diagnose. Diagnosis of MDR-TB was also not difficult, because the patient had MBT, which contributed to the timely and correct appointment of antimycobacterial therapy. Surgery for aspergilloma of the left lung was contraindicated, as the type 1 diabetes was in decompensation. Persistent hyperglycemia remained, despite the fact of antifungal therapy and constant correction of insulin therapy prescribed for the patient. Endocarditis quickly developed in the patient, which was the reason of patient’s death. Conclusions. The decompensated form of type 1 diabetes mellitus caused persistent hyperglycemia, which was the reason of immune disorders and this made the patient’s body susceptible to bacterial (MDR-TB) and fungal (aspergillosis) infections, which led to the development of the complication of endocarditis and death. A big mistake in his case, was a categorical refusal by the patient to receive a course of preventive chemotherapy, as a contact person with an index patient. In view of this, in the presence of type 1 diabetes, the patient should have not neglected it. And as a result, the patient had a MDR-TB, one year after. At the same time, the patient did not make a comparison X-ray TCO, after 6 months, as a contact person, which was a possible reason for the missing of early diagnosis of pulmonary aspergilloma. That’s why, a correct treatment of type 1 diabetes mellitus and timely preventive radiological examination of the thoracic cavity organs are especially important, as the diabetes mellitus is the most common premorbid background for TB and aspergillosis.
Цель работы -изучить особенности сочетанного течения обструктивного апноэ сна (ОАС) и гастроэзофагеальной рефлюксной болезнью (ГЭРБ) на основании клинического исследования и кардио-респираторного мониторинга.
We present our own observation of the multidrug-resistant tuberculosis course case, complicated by esophageal-pulmonary fistula, in a palliative patient who was treated in the Pulmonary Tuberculosis Department No. 2 of the Zaporizhzhia Regional Phthisio-pulmonology Clinical Treatment and Diagnostic Center. An esophago-pulmonary fistula in the patient with multidrug-resistant tuberculosis was detected in the area of the right upper lobectomy, wich was perfomed 8.5 years ago. The patient was on palliative treatment for almost 6 years before hospital admission when a tubercular esophago-pulmonary fistula was diagnosed. The patient was admitted to the hospital in serious condition, which significantly worsened over the course of a month. A decision was made to perform a computed tomography of the chest cavity (Сhest CT) as the patient's cough and chest pain were associated with liquid food intake. Esophageal-pulmonary fistula was detected on the Chest CT as a linear air defect of the esophageal wall up to 1.5 mm, which conjugates with the cavern in the upper lobe of the right lung. The small size of the esophageal-pulmonary fistula (1.5 mm) indicates the timeliness of its detection. In the presented case, the patient is on palliative treatment. Therefore, in order to prevent the progression of the esophageal-pulmonary fistula, feeding through a nasogastric tube and antibiotic therapy were prescribed. Thus, if a palliative patient with multidrug-resistant tuberculosis has a paroxysmal cough that occurs during or immediately after eating, the use of Chest CT is relevant for the timely diagnosis of esophagealpulmonary fistula. If such a fistula is diagnosed, it is necessary to use parenteral feeding and antibiotic therapy.
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