To date, tuberculosis (TB) remains the primary cause of mortality in human immunodeficiency virus (HIV) patients in Russia. Since the beginning of 2000, a sharp change in the HIV patients’ structure, to the main known risk factors for HIV infection has taken place in Russia. The transmission of HIV through injectable drug use has begun to decline significantly, giving way to the prevalence of sexual HIV transmission today. These changes may require adjustments to organizational approaches to anti-TB care and the treatment of HIV-positive patients. Our study is aimed at identifying changes in TB-HIV coinfection patients’ structures in 2019 compared to 2000. Based on the results obtained, our goal was to point out the parameters that need to be taken into account when developing approaches to improve the organization of TB control care for people with HIV infection. We have carried out a cross-sectional, retrospective, epidemiological study using government TB registry data from four regions in two federal districts of Russia in 2019. The case histories of 2265 patients from two regions with high HIV prevalence, which are part of the Siberian Federal District of Russia, and 89 patient histories from two regions of low HIV prevalence, which are part of the Central Federal District of Russia, were analyzed. We found that parenteral transmission (69.4%) remains the primary route of HIV transmission among the TB-HIV coinfected. The unemployed of working age without disability account for 80.2% of all coinfected people, while the formerly incarcerated account for 53.7% and the homeless account for 4.1%. Those with primary multidrug-resistant TB (MDR-TB) comprise 56.2% of HIV-TB patients. When comparing the incidence of coinfection with HIV among TB patients, statistically significant differences were obtained. Thus, the chances of coinfection increased by 4.33 times among people with active TB (95% CI: 2.31; 8.12), by 2.97 times among people with MDR-TB (95% CI: 1.66; 5.32), by 5.2 times in people with advanced processes in the lungs, including destruction, (95% CI: 2.78; 9.7), as well as by 10.3 times in the case of death within the first year after the TB diagnosis (95% CI: 2.99; 35.5). The absence of data for the presence of TB during preventive examination was accompanied by a decrease in the chances of detecting coinfection (OR 0.36; 95% CI: 0.2; 0.64). We have identified the probable causes of the high incidence of TB among HIV-infected: HIV-patient social maladaptation usually results in delayed medical care, leading to TB treatment regimen violations. Furthermore, self-administration of drugs triggers MDR-TB within this group. Healthcare providers should clearly explain to patients the critical importance of immediately seeking medical care when initial TB symptoms appear.
Background: HIV infection was more often registered in the general population than in vulnerable groups according to official statistics from the Russian Federation in 2021. Aims: to determine the characteristic patient cohorts coinfected with tuberculosis (TB) and HIV in dynamic epidemiological environments, and propose additional organizational approaches for reducing TB incidence in patients with HIV. Materials and methods: we have investigated complete medical data for patients coinfected with TB and HIV in three Russian regions. Additionally, we analyzed the cohort of patients with TB, combined with HIV infection via sexual transmission. Furthermore, confidential interviews with patients coinfected with TB and HIV were undertaken. In particular, reasons for refusing clinical examination at a Russian Federal AIDS Center (RFAIDSC) were clarified. Results: among patients coinfected with TB and HIV, parenteral transmission remains the primary HIV infection route. At the same time, patients who become infected through sexual contact are also primarily socially disadvantaged, leading to the refusal of clinical examination and a consequent late detection of TB. On the other hand, patients report that due to unemployment, they do not have the financial means to travel to the regional RFAIDSC. More often, widespread, rapidly progressive MDR TB infections occurred among patients coinfected with TB and HIV, than for patients with TB but without HIV. Considering that every fourth TB patient in Russia has been diagnosed with HIV, and, at the same time, there are specific features regarding the development and course of TB, the generally accepted criteria for assessing the quality of TB without HIV care often become biased for coinfected patients. This can lead to unreasonably negative assessments of the antituberculosis system and its work. Conclusions: in view of the above, it is important to modify regulatory documents regarding informing patients about the importance of seeking timely medical help, solve the issue of travel for unemployed patients to medical examinations and in emergency cases. Additionally, it is important to introduce adjustments for the criteria in assessing the quality of patient TB care, thereby accounting for the pathogenesis of TB in patients with HIV coinfection.
Education systems around the world are changing rapidly to keep up with the latest technology and pedagogical innovations that have become a strategic topic for many educational institutions. The study determines the impact of M-learning tools on the non-technical learners’ achievements in Information Science and offers recommendations to educators for improving M-learning. The proposed tool had a positive impact on the students' academic achievements. The results of students actively used mobile Web 2.0 technology are statistically significantly higher in comparison with students studying the traditional way The results obtained can be used in the development of an improved program for the rationalization of the educational process for students so that their academic achievements can reach a new level. Keywords: academic achievements; digitalization; M-learning; motivation; Web 2.0.
Quinolones and their derivatives of the second to fourth generation (fluoroquinolones) are highly active antimicrobial agents. This research examines pharmacokinetic properties of fluoroquinolones in comparative aspect of their effect on pathogenic. Microflora of conjunctival cavity in children diagnosed with conjunctivitis and dacryocystitis. The study was carried out in 2020 in Ophthalmologic Polyclinics No. 1 (Moscow, the Russian Federation). The group comprised 200 children aged six years who were diagnosed with bacterial conjunctivitis and dacryocystitis. The composition of pathogenic microflora species and the effect of moxifloxacin and other fluoroquinolones on the sensitivity and resistance of microorganisms were analyzed using conjunctival scrapings. The presence of eight species of pathogenic microorganisms in the scrapings has been established. The majority of bacteria detected were gram-positive: St. epidermidis (59%) and St. aureus (21%), p ≤ 0.05. Other types of microorganisms, including gram-negative E. coli, K. pneumonia, and St. saprophycus, were discovered 20 times (p≤0.001 relative to St. epidermidis), 18 times (p ≤ 0.001), and 15 times (p ≤ 0.01) less frequently, accordingly. The levels of bacterial resistance were 13% for moxifloxacin, 16% for levofloxacin, and 21% for ciprofloxacin. Moxifloxacin monotherapy showed a 100% result. After five days of treatment, all patients demonstrated minimal values (0.5 and 0.1 points vs. 3.8 and 4.4 points at the beginning of treatment, p ≤ 0.01) for two parameters (conjunctival hyperemia and sticky eye), the other three parameters were zero. Fourth-generation fluoroquinolone (moxifloxacin) has been shown to be highly effective against gram-positive Staphylococcus aureus bacteria.
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