Medical Alliance

The burden of extrapulmonary tuberculosis in the world and the Russian Federation

2025-10-14T11:07:03+03:00

Extrapulmonary Tuberculosis (EPTB) presents a challenge due to difficulties in its detection and diagnosis, the diversity and subtlety of its clinical presentation, similarity with nonspecific diseases, and issues in statistics and reporting. Objective: to study the distribution of the burden of EPTB in Russia and worldwide. Methods. Data obtained from the WHO global tuberculosis database and official statistical surveillance forms from Russia were analyzed. In studying the worldwide distribution of EPTB, the definition of extrapulmonary tuberculosis (EPTB) was used, which includes all localizations except parenchymal lung involvement. In studying the prevalence of EPTB in Russia, distinctions were made between tuberculosis of extrapulmonary localizations (TEL) and tuberculosis of the respiratory organs of extrapulmonary localization (TREOL). Results. The highest proportion of EPTB cases was observed in countries around the Mediterranean and the Middle East. However, the greatest burden of EPTB was noted in Central and Southern Africa and Southeast Asia. In Russia, from 2015 to 2024, the burden of EPTB declined faster than its prevalence and incidence: 5.3, 3.0, and 2.5 times, respectively. The burden structure showed a decrease in urogenital tuberculosis (from 34% to 19%) alongside an increase in osteoarticular tuberculosis (from 39% to 46%), peripheral lymph node tuberculosis (from 10% to 17%), and tuberculous meningitis (from 2.7% to 5.4%). Geographic variations in EPTB burden were associated with HIV prevalence. The outcomes of EPTB included high mortality (12%) and a significant proportion of indeterminate outcomes (3.9%). Conclusion. The burden of EPTB generally mirrors the overall tuberculosis burden. The accelerated decline in EPTB burden in Russia is attributed to advancements in invasive diagnostic and therapeutic technologies, molecular genetic methods for diagnosis verification, and mandatory reporting of clinical cure post-treatment. Geographic disparities in EPTB burden within Russia are linked to HIV infection and the availability of specialists for managing EPTB at specific sites.

Social features and comparative assessment of the first episode of the disease in patients with late recurrences of tuberculosis

2025-10-14T11:13:08+03:00

The aim of the study: to identify key social and clinical determinants that play a role in the occurrence of late relapses of tuberculosis for the subsequent improvement of the effectiveness of preventive measures. Materials and methods of the study. A retrospective analysis of 158 outpatient cards of patients aged 18 to 65 years with tuberculosis was conducted. Patients were divided into 2 groups: group 1 — 66 people with late relapses of respiratory tuberculosis, group 2 — 92 people who completed observation in group 3 without relapse. Information about the first episode of the disease in patients of group 1 was present in 45 cases. The results of the study were processed statistically. Results of the study. Among the patients in the groups, men predominated — 80.3% and 65.2% (p<0.05), aged 41 to 50 years — 40.9% and 41.3% (p>0.05). In group 1, 7.6% of patients had only primary education, higher education was significantly less common — 6.1%, than in group 2 — 1.7% (p<0.05). Patients with relapses more often did not have a family (51.55% versus 28.3%, p<0.05), less often had children (40.9% versus 64.1%, p<0.05). Patients with late relapses of the disease were more often diagnosed with HIV infection (24.2% and 5.4%, p<0.05). Patients with late relapses of the disease more often had bad behavioral habits individually and in combination: smoking (51.5% and 25.0%, p<0.05), smoking and drinking alcohol (13.6% and 1.1%, p<0.05), smoking and using drugs (4.5%). Contact with tuberculosis patients occurred in 62.2% of cases in group 1 and in 14.1% in group 2 (p<0.05). The first episode of the disease in patients with late relapses and without relapses differed little, infiltrative pulmonary tuberculosis was predominant (84.5% and 76.1%, p>0.05), decay was only in 28.9% and 23.9% (p>0.05), while in most cases, during the first episode of tuberculosis in patients with relapses, there were clinical manifestations of the disease in the form of intoxication (84.6% and 20.7%) and bronchopulmonary (85.0% and 25.0%) syndromes (p<0.05), in patients with subsequent late relapses, during the first episode of the disease, bacterial excretion (37.7% and 17.4%, p<0.05) and drug resistance (15.5% versus 3.3%, p<0.05) were more often detected. In patients with late relapses of the disease, adverse reactions developed more often during treatment of the first episode of tuberculosis (24.4% and 6.5%), they more often stopped treatment (22.2% and 5.4%) (p<0.05). Conclusion. Late relapses of tuberculosis were more often observed in men aged 41–50, unmarried and childless. Unfavorable housing conditions, smoking, and abuse of several psychoactive substances were also risk factors. The first episode of tuberculosis was characterized by the presence of established contact with an infected person, a clinical picture with a predominance of intoxication and bronchopulmonary syndromes, destructive changes in the lungs and resistance to drugs, and was noted in patients with concomitant diseases.

Possibilities of modern computational diagnostics of chronic obstructive pulmonary disease (review)

2025-10-14T12:26:34+03:00

Progress in computer medical technologies opens new possibilities to improve diagnostic accuracy, forecasting and management of COPD patients. Маterials and methods. A search was conducted for the studies in whichthe algorithm for COPD computer diagnostics was applied. Results. Most often the following methods are used, support vector machine, or SVM, boosting, random forest, logistic regression, and decision tree. The support vector machine was applied to monitor 135 COPD patients in the course of 363 days with the aim of forecasting hospitalisation. Machine learning algorithm based on 57,150 episodes provided ROC- curve (AUC) 0.74 (95% CI 0.67–0.80). CatBoost Model with the inclusion of attributes (sounds) from electronic stethoscope was mostly effective: AUC 0.9721, 95% CI: 0.9623–0.9810. The analysis of CatBoost Model in this study showed that the attributes from electronic stethoscope are of greater importance than those from portable spirometer. The boosting method was used when analyzing data of in-ear photoplethysmography (PPG) signal: in case of COPD the duration of inhalation decreased, while the amplitude of inhalation increased compared to the amplitude of exhalation. These differences ware used to diagnose COPD and for COPD and idiopathic pulmonary fibrosis differential diagnostics. Sensitivity and accuracy of the model amounted to 87% and 92%, respectively. Conclusion. Computer technologies and computer diagnostic algorithms have a broad range of applications, they increase the accuracy of medical decisions. Future studies are to be focused on raising the interpretability of the computer diagnostic models and checking these algorithms in the clinics.

Cellular biomarkers of calcium imbalance in lung cancer (review)

2025-10-14T13:46:52+03:00

In normal physiology, calcium concentration is tightly regulated intracellularly and extracellularly; it acts as a versatile second messenger regulating many functional processes, such as muscle contraction, hormone secretion, cell division, apoptosis, and cell motility. Imbalance of calcium signaling in lung cancer has a significant impact on key molecular processes, including the regulation of calcium channels, pumps, calcium-binding proteins, and mitochondrial regulators. Disruption of these systems contributes to the development of the tumor process, resistance to apoptosis and activation of angiogenesis, which makes the molecules of these signaling pathways promising biomarkers for diagnostics, prognostic assessment, as well as potential targets for the development of new therapeutic approaches. Therapeutic management of calcium balance in lung cancer is considered as a promising strategy for targeted therapy.

Tumors of the small intestine. Experience of treatment in the emergency surgery department

2025-10-14T12:41:24+03:00

Tumors of the small intestine account for only 1–3% of all gastrointestinal neoplasms, but their diagnosis remains challenging due to nonspecific symptoms and diagnostic difficulties. Most patients present with complications (intestinal obstruction, bleeding), which worsens the prognosis. Objective: to analyze the clinical features, diagnostic methods, and outcomes of surgical treatment for small intestine neoplasms, as well as to propose ways to improve early detection. Materials and methods. A retrospective analysis was conducted on 26 patients (mean age 55.7±2.5 years) treated at St Petersburg City Hospital No. 40 (2010–2023). The main diagnostic methods included oral contrast-enhanced computed tomography (70% efficacy), endoscopy (EGD, colonoscopy, capsule endoscopy, enteroscopy), and histological examination of the lesions. Statistical analysis was performed using Excel 365 and SPSS Statistics Version 26. Results. 57.7% of patients were admitted with intestinal obstruction, 26.9% with bleeding, and 11.5% with perforation. The tumor was localized in the jejunum in 38.5% of cases and in the ileum in 38.5%. Histological examination revealed adenocarcinoma in 34.6% of patients, neuroendocrine tumors in 19.2%, GIST in 11.5%, and lymphoma in 7.7%. Small intestine R0 resection was performed in 73.1% of cases. Mortality was 7.7% (2 cases due to perforated peritonitis). Postoperative complications included wound suppuration (7.7%) and adhesive obstruction (3.8%). The overall one-year survival rate was 80.8%, and the five-year survival rate was 57.7%. Statistical analysis did not reveal a significant correlation between clinical presentation, tumor location, histological type, or tumor stage (p>0.05). Conclusion. Small intestine tumors are often diagnosed at late stages due to the absence of early symptoms. Surgical treatment remains the primary method, but its effectiveness depends on timely diagnosis. The introduction of enteroscopy and improved access to CT could enhance detection rates. Further research is needed to develop standardized management algorithms for these patients.

Modified periacetabular osteotomy technique utilizing a system of navigation devices fabricated using additive manufacturing

2025-10-14T12:48:17+03:00

Introduction. The success of periacetabular osteotomy (PAO) is closely linked to the surgeon’s expertise and the necessity for intraoperative radiographic control, which increases the risk of errors and radiation exposure. Additive manufacturing technologies offer the potential to improve accuracy; however, their application in PAO has not been previously studied. Objective. To evaluate the accuracy of acetabular correction and the complication rate following PAO modified by the use of a patientspecific navigation system. Materials and methods. A prospective study included 39 patients (40 hip joints) with stage I–II dysplasia (Crowe/Hartofilakidis). During preoperative planning, 3D models of the patients’ pelvic bones were created, and two patient-specific devices were designed: one for osteotomy and one for acetabular fragment positioning. Surgeries were performed without intraoperative radiographic guidance. Postoperative assessment included CT and X-ray imaging to measure angles (Wiberg, AcetAV, etc.), along with an analysis of perioperative complications. Results. The deviation of the postoperative Wiberg and AcetAV angles from the planned values was 2.3° (IQR: 1.2–4.0) and 1.7° (IQR: 0.5–4.4), respectively. The overall complication rate was 27.5%, with the most common being lateral femoral cutaneous nerve neuropathy (22.5%). Correction errors (overcorrection) were observed in 7.5% of cases. The mean duration of surgery was 60 minutes (IQR: 60–90), and mean blood loss was 350 mL (IQR: 250–400). Conclusion. The modified PAO technique utilizing a patient-specific navigation system provides high correction accuracy, reduces operative time and radiation exposure for both patients and medical staff. This method decreases reliance on the «human factor» but requires optimization of the ischial osteotomy technique. Long-term functional outcomes require further investigation.

Rare clinical case of a parasitic exudative pleurisy with free echinococcal cysts in the pleural cavity

2025-10-14T12:52:51+03:00

Our team of authors has described a clinical case of exudative pleurisy with a large number of free echinococcal cysts in the pleural exudate which provoked the long course of pleurisy and the differential diagnostics difficulties. Such cases have not been described in medical literature.

Possibilities of transpedicular reposition of the spine. A clinical case

2025-10-14T12:56:35+03:00

Introduction. The effectiveness of restoring the vertical dimensions of the bodies of damaged vertebrae during closed decompression of the spinal canal, depending on the damage to the bone and ligamentous formations of the spine and the time since the injury, remains controversial. Objective. Using a clinical example, to show the possibilities of performing hardware reposition of the L_I vertebra body with the achievement of calculated individual targets, at a time traditionally considered late for the ligamentotaxis effect. Materials and methods. A 43-year-old patient with a compression comminuted fracture of the L_I vertebra, type A4 according to AOSYPE, D degree neurological disorders according to ASIA. Results. After calculating the real and theoretical vertical dimensions of the damaged vertebra with adjacent discs, as the first stage of the planned decompression-stabilizing operation, on the 23^rd day after the injury, the spine was repositioned and fixed with a transpedicular system, which ensured, without decompression, the restoration of the anterior vertebral body size from 59.3% to 91.6%, the posterior from 71.4% to 97.4%, and the correction of angle of deformation from 17.2° to –2.5° (by 19.7°) with a decrease in the degree of compression of the spinal canal from 58.3% to 23.4%, followed by regression of neurological disorders. Discussion. Described are the restoration of anatomical parameters of a damaged vertebra when using a closed reposition at different times after injury. Conclusion. Clinical observation demonstrates the possibility of effective reposition of a vertebral fracture with restoration of the calculated body sizes, interbody spaces and segmental angle within three weeks from the moment of injury, which is traditionally not recommended for closed indirect decompression of the spinal canal due to ligamentotaxis. The use of preoperative planning and step-by-step repositional maneuvers made it possible to achieve anatomical correction of deformity, closed decompression of the spinal cord and stable fixation of the spine.

How tobacco smoking influences surgical interventions effectiveness (review)

2025-10-14T13:00:45+03:00

Tobacco smoking not only leads to the development of diseases of organs and systems of the body, but also worsens the results of treatment, including surgical interventions. Objective: analysis of data on the results of surgical interventions depending on the status of smoking to determine the factors that contribute to/hinder smoking cessation in the perioperative period, the possibilities of providing assistance in quitting tobacco consumption. Materials and methods. A search and analysis of studies in the MEDLINE, Embase, Cochrane CENTRAL, CINAHL and PsycINFO databases was conducted. Results. Increased risks of complications after surgery in smoking patients have been proven in numerous studies: smokers had a 1.38 (95% CI, 1.11–1.72) times higher risk of death than those who had never smoked. They were also more likely to be diagnosed with pneumonia (OR 2.09), require unplanned intubation (OR 1.87) and mechanical ventilation (OR 1.53), and more often had cardiac arrest (OR 1.57), myocardial infarction (OR 1.80), stroke (OR 1.73), postoperative infections (OR 1.42), and sepsis (OR 1.30). Multivariate analysis revealed factors that reduce the risk of postoperative complications: preoperative cessation of TC two or more months before surgery, male gender, histological type and size of the tumor, concomitant cardiovascular and respiratory diseases. The main obstacles to cessation of TC in the perioperative period were: lack of time doctors and medical personnel can allocate to the issue, lack of knowledge of methods of assistance in cessation of TC and treatment of NZ. Conclusion. Smoking worsens the results of surgical interventions. The optimal period for quitting smoking is considered to be a period of 4 weeks or more, while the effectiveness of cessation is influenced by the recommendations of the attending physician and the appointment of treatment, referral to services for assistance in quitting smoking.

The Impact of automated analysis results on decision-making by radiology residents when evaluating solitary pulmonary nodules

2025-10-14T13:22:34+03:00

Background. The evaluation of solitary pulmonary nodules (SPNs) is a complex diagnostic challenge, particularly for radiology residents, whose limited experience increases the risk of errors. Artificial intelligence (AI) systems are seen as a promising tool to enhance diagnostic accuracy, but their impact on residents’ decision-making remains understudied. Aim. To investigate the impact of AI-assisted automated analysis of SPNs on the diagnostic accuracy and decision-making processes of radiology residents. Materials and methods. A two-phase prospective study involved 4 residents evaluating 100 CT scans without and with AI support (Hiveomics Malignancy Index). The AI classified nodules using a 5-tier malignancy scale. Ground truth diagnoses were confirmed via histopathology, microbiology, and clinical follow-up. Results. Without AI, residents’ mean accuracy was 43%, with the highest errors in inflammation (17.9%) and tuberculosis (32.1%) detection. AI improved overall accuracy by 8.8% (p=0.0003), notably for malignant neoplasms (+13.4%), but had limited impact on tuberculosis (+3.6%). Conclusion. AI significantly enhances malignant SPN diagnosis for radiology residents but requires refinement for complex cases (tuberculosis, hamartomas). The results highlight AI’s potential as an educational and clinical decision-support tool.

What are the consequences of the «uncontrolled» use of radiation diagnostic methods in pediatrics? (review)

2025-10-14T13:30:32+03:00

In recent decades, there has been an increase in the use of radiological methods in pediatric practice, where approximately one-third of children receive medical radiation annually. Some patients in this category do not report health complaints and do not show deviations in laboratory diagnostics of biological fluids (blood, urine). Another group has been monitored for stable picture in lung tissue over a long period. Children are more sensitive to ionizing radiation due to the high proliferative activity of their tissues. The greatest number of radiological studies is associated with diseases of the respiratory system, including the use of high-tech diagnostic methods such as computed tomography and magnetic resonance imaging. According to both domestic and international studies, women are more susceptible to radiation effects, however, children and adolescents have a significantly higher risk of developing radiation-related diseases, including cancer. The most sensitive organs to radiation are the lungs, thyroid gland, and red bone marrow. Radiation safety regulations require control over the use of ionizing radiation. Established principles of regulation aim to minimize radiation doses. The effects of ionizing radiation can cause both deterministic effects, which occur in emergency situations, and have an action threshold (with clear symptoms), as well as stochastic (probability-based) effects, where even small doses of radiation can change the likelihood of their occurrence. The exacerbation of this issue requires continuous study of the risks associated with the use of ionizing radiation, particularly in terms of its impact on children’s health. The necessity for a thorough justification for the use of radiation-based research methods becomes key from the point of view of patients’ safety.

Degree of transversal expansion of the upper jaw using the Marco Ross appliance

2025-10-14T13:53:05+03:00

Rapid palatal expansion is a widely used method for correcting transverse discrepancies and cramped teeth in the upper jaw. The effectiveness of palatal expansion largely depends on the patient’s age, since the median palatal suture gradually closes during puberty. However, there is no consensus in the literature on the effectiveness of transverse expansion of the upper jaw using palatal expansion devices. Аim: to evaluate the degree of transversal expansion of the upper jaw using the Marco Rossa apparatus during the period of mixed dentition. Materials and methods. A total of 30 patients aged 7.5±1.2 years were examined during the mixed dentition. Clinical, anthropometric, radiological and statistical methods were used. In order to measure the width of the dental arch and the upper jaw, biometric measurements were taken on 3D control and diagnostic models using the Pon method before and after the expansion of the upper jaw using the fixed Marco Ross appliance. Statistical processing of the obtained data was carried out using the Statistica 10.0 package (Dell Inc., USA). According to the Kolmogorov–Smirnov criterion, the results of the study approached the normal distribution of signs. The data is given in the form of the arithmetic mean (M) and their average squared deviation of the result (SKO). Results. In the majority of examined patients during the period of mixed bite, distoocclusion (86.0%) was detected in combination with crowding of teeth (100%) and narrowing of the upper and lower jaws. After 6 months of treatment with the Morko-Rossa appliance, expansion in the area of temporary molars on the upper jaw was 4.6±1.1 mm, and in the area of first molars, it was 3.9 mm. Expansion on the lower jaw after 6 months of treatment in the area of temporary molars was 3.2±0.9 mm, and in the area of first molars, it was 4.2±1.2 mm. Conclusion. Effective transverse expansion using the Marco Rossa device allows to correct the close position of teeth, cross occlusion in the anterior and lateral sections, as well as to normalize the conditions for the growth and development of the maxillofacial region with the prevention of the formation of skeletal pathology, functional displacement of the lower jaw, as well as dysfunction of the temporomandibular joint.

Дорогие коллеги!

2025-10-14T13:55:46+03:00