For the forest-steppe and steppe regions of Central Russia, the problem of spreading watererosion processes on catchments of small rivers is especially acute. In this regard, the task of ecological rehabilitation of the floodplain-channel zone of the river using forestry measures is relevant. Currently, for the small rivers of the region, there are no specific water management and environmental measures considered from environmental and hydrological positions and necessary for the integrated environmental recovery of the territory. The author considered the problem of substantiating the optimal distribution of forestson the catchment area of a small river in the Belgorod region. An analysis of the geomorphological features of the basin of one of the transboundary rivers (Lopan) was carried out using modern GIS technologies to determine the areas of land with high erosion hazard. The result of the study is proposals for the implementation of forestry measures for continuous afforestation of plots (on an area of 433.3 hectares) and strip water-regulating afforestation (on an area of 40.4 hectares). Increasing the total forest cover of the catchment will optimize the moisture turnover in the river basin and support the protection and protection functions of existing plantations.
The pulmonary disease caused by nontuberculous mycobacteria (NTM) is a chronic respiratory infection resulting in declining lung function, worsening life quality, and increasing mortality rates. Most patients with pulmonary nontuberculous mycobacteriosis (PNTM) have concomitant chronic diseases (bronchiectatic disease, COPD, diabetes mellitus, etc.) PNTM is a refractory disease as mycobacteria are located intracellularly in alveolar macrophages. Mycobacteria can develop a biofilm, which impedes antibiotic penetration and protects them. Treatment for PNTM is long-term with low effectiveness due to innate or acquired mycobacterial resistance. The article outlines the modern concepts of drug resistance development in NTM, refractoriness of the disease, and the current mechanisms to overcome it.
Show the possibilities of diagnosing non - tuberculous mycobacteriosis of the lungs (NTML) in the practice of the pulmonologist.A survey of 90 patients with a confirmed diagnosis of non - tuberculous mycobacteriosis of the lungs (NTML) was presented. The diagnosis of pulmonary mycobacteriosis was established in accordance with the criteria proposed in 2007 by the American Thoracic Society and the American Society of Infectious Diseases (ATS/IDRS). Among the patients, 55 (61.1%) women prevailed, the average age was 51.2±15.3 years. Patients were evaluated complaints, the presence of concomitant diseases of the lungs, was carried out computed tomography of the chest high - resolution (HRCT), a culture study of sputum, in the absence of sputum or a single determination of the NTM culture in it, a study was conducted on materials of bronchoalveolar washout (ALS/BAL), or lung biopsies. Statistical processing of the research results was performed using descriptive statistics using Microsoft® Excel for Windows xp® on a personal computer.As a result of the study, it was revealed that before the diagnosis of NTML was established, 66.7% of patients were long observed for chronic lung diseases (chronic obstructive pulmonary disease, chronic bronchitis), and in 55.6% of cases (50 people) were registered with a phthisiologist about pulmonary tuberculosis. According to the CT scan of OGK, dissemination was determined in 66.7% of cases, in 48.9% - bronchiectasis, single or multiple destruction cavities - 46.7% of cases. In 72.2% of cases, non - tuberculous mycobacteria (NTM) were found in sputum, in 33.3% - in ALS and in 22.2% of NTMs were found in the surgical material. In 14.4% of cases, only surgery allowed to establish the diagnosis of mycobacteriosis.Цель исследования. Показать возможности диагностики нетуберкулезных микобактериозов легких (НТМЛ) в практике пульмонолога. Материалы и методы. Представлены материалы обследования 90 пациентов с подтвержденным диагнозом НТМЛ. Диагноз микобактериоза легких установлен в соответствии с предложенными в 2007 г. критериями Американского торакального общества и Американского общества инфекционных болезней (ATS/IDRS). Среди пациентов преобладали женщины - 55 (61,1%) человек, средний возраст составил 51,2±15,3 года. У пациентов оценивали жалобы, наличие сопутствующих заболеваний легких, проводили компьютерную томографию высокого разрешения органов грудной клетки (КТ ОГК), культуральное исследование мокроты, в случае отсутствия мокроты или однократного определения в ней культуры нетуберкулезных микобактерий (НТМБ) проводилось исследование материалов бронхоальвеолярного смыва (БАС/БАЛ) или биоптатов легких. Статистическая обработка результатов исследования выполнена методом описательной статистики с использованием Microsoft® Excel для Windows хр® на персональном компьютере. Результаты и заключение. В результате проведенного исследования выявлено, что до установления диагноза НТМЛ 66,7% пациентов длительно наблюдались по поводу хронических заболеваний легких (хроническая обструктивная болезнь легких, хронический бронхит), а в 55,6% случаев (50 человек) находились на учете у врача - фтизиатра по поводу туберкулеза легких. По данным КТ ОГК в 66,7% случаев определялась диссеминация, в 48,9% - бронхоэктазии, в 46,7% - одиночные или множественные полости деструкции. В 72,2% случаев НТМБ были найдены в мокроте, в 33,3% - в БАС и в 22,2% обнаружены в операционном материале. В 14,4% случаев только оперативное вмешательство позволило установить диагноз микобактериоза.
The article describes a clinical observation, which demonstrates difficulties in diagnosis and stage-by-stage surgical treatment of a patients with a comorbidity of mycobacterial infection followed by the development of lung cancer.
Aim: to study radiological semiotics of peripheral pulmonary lesions (PPLs) detected by CT of the chest, and establish radiological patterns, which significantly increase effectiveness of navigation bronchobiopsies. Materials and methods. A cohort retrospective study included 278 patients with PPLs with verified diagnoses established by invasive diagnostic procedures (navigation bronchoscopy with a complex of biopsies and/or diagnostic thoracic surgery). The study included 162 (58.3%) women aged 13 to 80 yrs. (average age – 46.21 ± 5.23) and 116 (41.7%) men aged 14 to 85 yrs. (average age – 46.05 ± 3.49). The patients were divided into 4 nosological groups: pulmonary TB patients – 158 (56.8%), neoplastic patients – 79 (28.4%), nontuberculous pulmonary mycobacteriosis (NTPM) patients – 21 (7.6%), and protracted course community-acquired pneumonia (CAP) patients (presentations of PPLs) – 20 (7.2%). Results. According to chest CT data, PPLs had three major radiological sings, defined as “infiltrate”, “rounded shadow”, and “focus”. Rounded shadows prevailed in NTPM patients and neoplastic patients. Statistically significant differences between the groups were as follows: the medium maximum size and contour of PPLs (focus / rounded shadow / infiltrate), the presence of bronchiectasis and the type of foci (lobular/sublobular/acinar) in the lung parenchyma surrounding PPLs, the presence of calcification, cavitation, or air bronchograms inside PPLs. The total effectiveness of bronchoscopic verification of PPLs in patients with “CT bronchus sign” was 79.4%, which significantly exceeded diagnosis verification in patients without it (17.9%) (р < 0.001). The effectiveness of diagnosis verification by bronchobiopsy in patients with PPLs less than 20 mm (CT data) achieved 50% irrespective of etiology. The most effective bronchoscopic verification of diagnoses was observed in TB and NTPM patients with PPLs ≥ 20 mm – 83.3% and 100.0% respectively, and in neoplastic patients with PPLs ≥ 30 mm it reached 93.0%. The lobar localization of the process did not affect the diagnostic effectiveness of bronchobiopsies. Conclusion. The highest effectiveness of bronchobiopsies was observed in patients with the CT bronchus sign and with PPLs ≥ 20 mm or ≥ 30 mm (CT data). The volume of diagnostic biopsies obtained by navigation bronchoscopy or surgical resection should be determined by radiological morphology of PPLs with estimation of malignancy or benign signs revealed by CT of the chest.
Objective: to evaluate treatment effectiveness in patients with mycobacterial pulmonary disease and its association with mycobacteria detection in sputum. Materials and methods. The study enrolled 196 patients with confirmed mycobacterial pulmonary disease. The diagnosis was established as per ATS/IDSA criteria (2007). The patients were divided into two groups: group 1 consisted of 108 patients with nontuberculous mycobacteria (NTM) detected in sputum; group 2 consisted of 60 patients with NTM detected in BAL and/or lung tissue samples. Female patients prevailed (78.6%). The average patients’ age was 56.9 ± 11.3 years. The time period from diagnosing pulmonary mycobacterial disease to commencementof combination antibacterial therapy varied from one month to 3.5 years. Patients were followed up during one year after treatment completion. Results. The most commonly identified NTM were MAC (M. аvium, M. intracellulare) and M. kansasii. The combination antibacterial therapy was administered to 168 (85.7%) patients. Clinical cure was more frequently achieved in the patients of group 2 compared to group 1 (21.7 and 3.7% respectively, р < 0.01). The frequency of clinical improvement without conversion of biological samples did not significantly differ between the groups (40 and 54.6% respectively, …). The frequency of relapse was similar in both groups and did not exceed 5%. Conclusion. The presence of NTM in BAL while the absence of NTM in sputum allows predicting more favourable disease course and better response to treatment.
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