Background . The stability of human organism for different kind of infection, including SARS-CoV-2 is significantly defined by the immune system. The mechanisms of the cellular immunity to the SARS-CoV-2 are not exactly defined and are under study. The aim . To study the features of cell immunity parameters in patients with lung damage up to 30 % in COVID-19. Material and methods . 73 people were examined during the 2020–2021 pandemic. The study group consisted of 31 patients with lung damage up to 30 % with COVID-19, the comparison group consisted of 42 people not infected with SARS-CoV-2. A complete clinical blood count was carried out using a Medonic M20 hematological analyzer (Boule Medical, Sweden), the level of lymphocyte subpopulations was determined using a FACS Calibur cytometer (BD, USA) and FITC- and phycoerythrin-labeled monoclonal antibodies (Sorbent, Russia). Differences were considered statistically significant at p < 0.05. Results . Patients with COVID-19 with lung damage according to computed tomography (CT) ≤ 30 % before the treatment had a restructuring in the ratio of lymphocyte subpopulations in 67.7 % of cases. Lymphopenia (< 1.1 × 10 9 cells/l) was detected in 34.4 % of patients: a decrease in the absolute count of CD3 + lymphocytes by 30.8 %, CD3 + CD4 + – by 35 %, CD3 + CD8 + – by 6.7 % (p < 0.05), CD16 + CD56 + natural killer (NK) cells – by 29.4 % (p = 0.009). The level of CD95 + lymphocytes in COVID-19 is 3.2 times higher than in healthy individuals. Elevated levels of HLA-DR + - (> 20 %) and CD3 + HLADR + lymphocytes (> 6 %) are recorded in 60 % and 86.7 % of patients, respectively. Elevated levels of CD19 + B lymphocytes (> 17 %) in COVID-19 are 2.6 times more common than in healthy individuals. Correlation dependences of the count of NK cells with a wide range of T lymphocyte subpopulations were revealed. Conclusion . Cellular immunity indicators in COVID-19 have a number of features that can serve as predictors of the progression of the severity of the disease.
The strategy of scientific and technological development of the Russian Federation prioritizes the formation of new approaches to the treatment of tuberculosis, including forms with multidrug resistance. In modern conditions the fulfillment of this task is impossible without the intensive introduction of advanced digital and intelligent technologies, robotic systems and systems using artificial intelligence methods. This approach should start with an important component –the creation of a knowledge base. Aim : To create a knowledge base of drug therapy based on the appropriate ontology, to assemble a prototype of a medical decision support system for managing the treatment of patients with pulmonary tuberculosis. Material and Methods . Current scientific data and recommendations for the treatment of pulmonary tuberculosis in adults were used, according to clinical recommendations approved by the Ministry of Health of the Russian Federation in 2022. The IACPaaS platform is used to implement the intelligent service. Results . A knowledge base has been created to manage the treatment of patients with pulmonary tuberculosis, which allows you to structure knowledge about drug therapy of tuberculosis, define concepts, relationships and axioms describing this process. Each element of the ontology includes a complexly structured block of conditions that allows you to describe in a formal presentation the necessary clinical criteria that determine the conditions for creating an intelligent assistant to a phthisiologist. Conclusion . The generation of the knowledge base will make it possible to switch to personalized medicine through the rational use of anti-tuberculosis drugs, which will reduce the time and improve the effectiveness of tuberculosis treatment.
In the period of global digitalization of society and healthcare, special attention is paid to the development of artificial intelligence (AI) technologies in medicine. To date, there are two main approaches to implementing AI technology based on machine learning methods and knowledge. In the former case, datasets are used; in the latter case, there is the knowledge acquired from scientific sources or experts. Each of the methods has both advantages and disadvantages. Medical decision support systems are being actively developed and implemented. But is everything so simple?
Mortality among people with human immunodeficiency virus (HIV) declined with the introduction of combination antiretroviral therapy. We investigated trends in mortality in people with HIV from 1999 through 2020. Data were collected from the Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) cohort between January 1999 through January 2015 and the International Cohort Consortium of Infectious Disease (RESPOND) from October 2017 through December 2020. Age-standardized all-cause and cause-specific mortality rates, classified using Coding Causes of Death in HIV, were calculated. Poisson models were used to assess mortality over time. Among 55 716 participants followed for median 6 years (interquartile range, 3-11), 5263 died (mortality rate [MR], 13.7/1000 person-years of follow-up [PYFU]; 95% confidence interval [CI], 13.4-14.1). Changing mortality was observed: AIDS mortality was most common between 1999-2009 (n = 952; MR, 4.2/1000 PYFU; 95% CI, 4.0-4.5) and non-AIDS-defining malignancy (NADM) between 2010-2020 (n = 444; MR, 2.8/1000 PYFU; 95% CI, 2.5-3.1). In multivariable analysis, all-cause mortality declined (adjusted mortality rate ratio [aMRR], 0.97 per year; 95% CI, .96-.98), mostly 1999-2010 (aMRR, 0.96 per year; 95% CI, .95-.97) but was stable 2011-2020 (aMRR, 1.00 per year; 95% CI, .96-1.05). Mortality due to all known causes except NADM also declined. Mortality among people with HIV in the D:A:D and/or RESPOND cohorts declined between 1999-2009 and was stable over the period 2010-2020. This decline in mortality was not fully explained by improvements in immunologic-virologic status or other risk factors.
Against the background of priority attention paid to the COVID-19 pandemic, there are also cases of community-acquired pneumonia of a different genesis. Identification of the features of lung lesions in such diseases is relevant during the spread of seasonal respiratory infections. The comparative study of the dynamics of hematological and hemostasiological parameters of blood in patients with pneumonia of various origins is of interest in terms of searching for predictors of the prognosis of the diseases development. Aim. To compare the features of clinical symptoms, hematological and hemostasiological parameters in patients with pneumonia caused by COVID-19 and in patients with community-acquired pneumonia. Materials and methods. During cross-sectional study two groups were formed: group 1 consisted of 92 patients diagnosed with moderate community-acquired pneumonia caused by COVID-19 infection; group 2 included 40 patients diagnosed with moderate community-acquired bilateral polysegmental pneumonia. Results. It was found that patients with COVID-19 had an older age (69 vs 39.3 years), a lower body temperature at admission (37.5 vs 38.85 °C), a lower percentage of reduced oxygen saturation (less than 89 % in 5.4 % of cases vs 10 % of cases). In most cases, the average values of some hematological parameters in patients with COVID-19 did not go beyond the reference range. Leukopenia (below 4 × 109 cells/l) and lymphopenia (below 1.1 × 109 cells/l) were observed in 26 % and 38 % of cases respectively; thrombocytopenia (less than 100 × 109 cells/l) – in 12.2 % of cases; hyperfibrinogenemia (more than 4 g/l) – in 65.3 % of cases. A direct correlation was found between platelet levels and leukocytes (R = 0.53; p < 0.001) and lymphocytes (R = 0.29; p = 0.06). Compared with the patients of the group 2, on average, patients with COVID-19 had significantly lower levels of leukocytes and lymphocytes (2.5 times each; p < 0.001) and an increased level of fibrinogen (by 45 %; p < 0.001). Conclusion. In patients with pneumonia caused by COVID-19, we revealed the particular features of clinical symptoms, hematological and hemostasiological blood parameters compared to community-acquired nonspecific pneumonia.
The analysis of the data of patients hospitalized with the diagnosis of “community-acquired pneumonia” to the pulmonology center based in Samara City Hospital №4 over the period two years was carried out. Every year the highest number of hospital admissions is registered among young patients of working age, mainly men. One of the main causes of mortality in patients with community-acquired pneumonia remains HIV-infection, often at the stage of severe immunosuppression. Meanwhile, the commitment to highly active antiretroviral therapy (HAART) in patients with HIV-infection and community-acquired pneumonia is 5,14%. The number of newly diagnosed patients with tuberculosis (TB) also remains high (17%) and requires the active cooperation of pulmonology and TB-services.
In modern conditions, telecommunication technologies (TMT), designated by the term “telemedicine,” are increasingly used to provide medical services at a distance. Purpose. To analyze the work of telemedicine consultations (TMK) during the COVID-19 pandemic. Material and methods. The experience of using TMT (telemedicine) in a city hospital, on the basis of which a “Covid hospital” was opened during the spread of COVID-19 from September 2020 to September 2021, is presented. Patients applied for TMK through call centers or the clinic’s registry. Results. The operating principles of telemedicine have been formed, the possibilities of outpatient patient management in a remote format, a minimum list of examinations at home, routing rules and indications for inpatient treatment have been determined. Based on the identification of key complaints and diagnostic criteria, a questionnaire was created that reduces consultation time. The experience gained allows us to make wider use of remote management technologies, TMK, medical consultations, to develop and implement monitoring technologies for monitoring patients at home to optimize the work of primary healthcare.
The issues of concomitant pathology of HIV infection and tuberculosis are becoming increasingly relevant in the period of improving the epidemiological situation of tuberculosis. HIV-associated tuberculosis is given more attention due to the peculiarities of the processes characterized by generalization, progression and high lethal outcomes. Objective. The purpose of this work is to study the characteristics of tuberculosis in patients with HIV infection in a region with a high prevalence of HIV infection with fatal outcomes. Materials and methods . For a comparative analysis, depending on the outcome of the disease, 2 groups were formed: 1 st group — 70 patients with tuberculosis and HIV infection (tuberculosis/HIV) who died within a month after admission to the tuberculosis hospital (main group), 2 nd group — 70 tuberculosis/HIV patients were discharged from the hospital with improvement (comparison group). All patients received treatment in accordance with clinical guidelines. In statistical calculations, the Pearson c 2 -criterion or the c 2 -criterion with the Yeats correction with the number of degrees of freedom f=1 (f=(r–1)×(c–1)) was used. The level of significance was taken as a value of 0,05 or less. Results . In the first group, tuberculosis was more often detected upon admission to non-main hospitals ( c 2 =5,28; р=0,0216), diagnosed with pneumonia ( c 2 =9,46 р=0,0021) in the absence of fluorography in the current year. Mortality was more common in people under the age of 30 years who had no family ( c 2 =18,72; p=0,00001) who were in prison ( c 2 =7,96; p=0,0048) and led an antisocial lifestyle. An analysis of the manifestations of tuberculosis revealed no differences that determine the lethal outcome. The difficulty of diagnosing tuberculosis occurred when the CD4+ level was less than 300 cells. Comorbidity of tuberculosis and HIV infection is characterized by a commonality of many clinical manifestations regardless of the outcome. The presence of burdened social status increases the likelihood of dying with concomitant HIV/TB diseases.
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