Purpose. Assessment of the prevalence of the wet form of age-related macular degeneration in the territory of the Republic of Bashkortostan.

Materials and methods. The Ural Eye and Medical Study conducted based on the Ufa Eye Research Institute. The study involved 5899 respondents aged 40 and older.

Results. The wet form of age-related macular degeneration found in 276 study participants – 6.9%, among them 6.6% of men, 7.0% of women, 9.0% of urban residents, 4.1% of rural residents. The prevalence of the wet form of age-related macular degeneration gradually increased with increasing age of the respondents, amounting to 1.6% in the age group of 40–49 years and reaching 18.8% in the age group of 90–99 years. The prevalence of the wet form of age-related macular degeneration was higher among urban residents (9.0%) than among rural residents (4.1%).

In order to study the diagnostic and prognosis role of a complex of serum biomarkers of inflammation in active sarcoidosis and tuberculosis (angiotensin-converting enzyme (ACE), adenosine deaminase (ADA), C-reactive protein (CRP), free radicals (FvR), resistance to oxidative stress (OSR), lipid profile, indicator of lipoidosis activity (PAL) according to the developed patented formula: PAL = TC/LDLxc+TGL, correlation coefficient (СС) according to the developed patented formula: CC  = FCT/ADA), a series of single-center prospective dynamic studies were conducted: 303 patients with respiratory sarcoidosis before treatment and every 2-6 months of treatment for 3 years (patients with severe diseases of the  cardiovascular system and taking angiotensin-converting enzyme inhibitor were excluded): group 1-193 patients without exacerbation of sarcoidosis (men/women 124 (65%)/69 (35%), median age 47.3, index body weight 24.9, group 2 – 51 patients with exacerbation not treated with corticosteroids (men/women 34 (66.7%)/17 (33.3%), median age 39.5, index body weight 29.2, group 3-59 patients with exacerbation treated with corticosteroids (men/women 31 (52.5%)/28 (47.4%), median age 34.7, index body weight 29.1; 273 patients before and after 2-6 months of treatment: 151 patients with sarcoidosis and 122 patients with tuberculosis. In sarcoidosis, inflammation was characterized by increased ACE, ADA, normal CRP, dyslipidemia with decreased PAL.In tuberculosis- increased ADA, CRP, normal ACE, dyslipidemia and lowel PAL than in sarcoidosis. In sarcoidosis, CC (ACE / ADA ratio) reflects inflammatory activity with a sensitivity of 85%, specificity of 78.8%, efficiency of 80%. The complex of ACE, ADA, CC, CRP, PAL, FvR, OSR is an effective tool for monitoring granulomatous and endogenous systemic inflammation in sarcoidosis and tuberculosis.

The results of a comprehensive morphological study of autopsy, surgical and biopsy material from patients with mycobacterial infections (tuberculosis – 69 people; mycobacteriosis caused by non-tuberculous mycobacteria – 21 people; complications of BCG vaccination – 7 people), including those with immunosuppressive conditions (55 people), were analyzed. To determine the microscopic differential diagnostic signs of mycobacterial and some other infectious granulomatous processes, the results of a study of material from patients with mycoses – 10 people, helminthiasis – 5 people, actinomycosis – 3 people, pneumocystosis – 3 people. The main morphological diagnostic signs of these diseases presented, attention paid to the microscopic features of various granulomatous processes, and a diagnostic algorithm formulated. Identification of the causative agent of the disease in the histological material makes it possible to correctly verify the disease.

Since ancient times, scientists have known about the defeat of tuberculosis in the upper back segments of the lungs. At the same time, the reason for the regular lesion of segments 1, 2, 6 in secondary tuberculosis is still unknown. In the world and Russian literature available to us, we did not find an explanation of the reasons for this regularity. For the diagnosis and differential diagnosis of tuberculosis from other lung diseases, the localization of the tuberculosis process is of no small importance. We believe that the reason for the regular defeat of segments 1, 2 and 6 in secondary tuberculosis is not one, but several.

High mortality from cardiovascular pathology is an actual problem of modern medicine. Among them, coronary heart disease, vascular lesions of the brain and arterial hypertension are more common. The aim of the study was to assess the prevalence of cardiovascular diseases among patients with pulmonary tuberculosis living in rural areas. The analysis showed that diseases of the cardiovascular system are more common in young and middle-aged men with pulmonary tuberculosis living in rural areas, and the presence of arterial hypertension, coronary heart disease, chronic heart failure, and hypercholesterolemia can aggravate the course of tuberculosis.

Modern treatment regimens for tuberculosis with multiple and broad drug resistance (MDR/XDR) of the pathogen provide for the simultaneous administration of several drugs with a proven cardiotoxic effect in the form of prolongation of the QTc interval and provocation of life-threatening arrhythmias. In conditions of the spread of cardiovascular and other comorbid pathology, it is important to assess the risk of cardiotoxic reactions and ensure the safety of patients during the entire course of treatment. The aim of the study was to assess the degree and risk of prolongation of the QTc interval in tuberculosis patients with MDR/XDR pathogen, including concomitant cardiological pathology, against the background of treatment regimens with the inclusion of bedaquiline.

Materials and methods of research. The retrospective study included 185 tuberculosis patients with MDR/XDR of the causative agent: 70 people with cardiovascular pathology (except decompensation of heart failure, bradyarrhythmias, ventricular arrhythmias and QTc prolongation in the anamnesis) and 115 people. without it, who received chemotherapy with the inclusion of bedaquiline and fluoroquinolones. The dynamics of clinical symptoms and ECG were evaluated against the background of treatment. Risk factors for cardiotoxic reactions were determined using the method of multiple logistic regression.

The results of the study. Prolongation of the QTc interval was observed in 58 people (31.4%, 95% CI 25.1–38.4%), clinically significant (more than 500 ms, 60 ms or more from the baseline, with ventricular arrhythmia) – 4.3%; bradycardia – 3.8%, cardialgic syndrome – 8.1%. Risk factors for prolongation of the QTc interval were the presence of any cardiovascular disease (OR 2.33, 95% CI 1.23-4.41), simultaneous administration of three or more drugs that can lead to QTc prolongation (OR = 3.31, 95% CI 1.73–6.32), clarithromycin administration (OR = 4.01, 95%CI 1.4710.97), the number of points on the Tisdale scale is more than 6 (OR = 3.42, 95% CI 1.78–6.62).

Conclusion. Prolongation of the QTc interval is a common adverse reaction in the treatment of tuberculosis with MDR /XDR pathogen, clinically significant in 4.3% of cases. The use of a standard ECG monitoring scheme is justified; it is necessary to avoid prescribing three or more drugs that affect the QTc interval to patients with any cardiovascular pathology with a Tisdale score of more than 6 points.

The article presents the results of clinical and pathomorphological studies of a patient who died from the rapid development of acute respiratory distress syndrome and the collapse of the capsule of fibrous-focal pulmonary tuberculosis against the background of COVID-19 infection.

Description of the case. Patient G.L., 48 years old, hospitalized for some hours on May 28, 2023 at the emergency hospital of the Ministry of Health of Chuvashia. Computed tomography revealed signs of bilateral viral interstitial pneumonia, the percentage of lung tissue damage was 61%. Signs of fibrous-focal tuberculosis were determined in the lower parts of the left lung. PCR analysis for COVID-19 was positive. The assessment of the condition on the NEWS2 scale was 11 points. In the general blood test: leukocytes: 14.3 (3.39–8.86) × 109/l, lymphocytes: 5 (19–37) %, ESR: 49 (2-15) mm / hour, D-dimer: 345 (0–250). Despite the started treatment, a fatal outcome suddenly occurred.

Conclusion. A case of a rare localization of pulmonary tuberculosis (S8–9), which proceeded for several years, is described. It should be noted the features of this form after infection with SARS-CoV-2: despite the favorable course of the process, signs of amyloidosis were determined in the vessels of the lungs. Against the background of COVID-19 infection, a disintegrated capsule with signs of tuberculous granulomatous inflammation noted in the lower parts of the lungs. Tuberculous caseous foci with exudative-productive inflammation along the periphery of the necrotic focus were determined. It should be noted that vessels with amyloid were detected with signs of alterative processes. 

The article presents the results of 2-year follow-up of a clinical case that confirmed the nosology of the identified case not only with immediate, but also with long-term results. This case allowed to verify the diagnosis of pulmonary sarcoidosis and effectively help the patient despite the presence of very convincing radiographic findings of tuberculosis and complex time-consuming diagnostic search. The most significant contribution to the establishment of the etiology of the disease was made by such a modern highly informative research as immunohistochemistry.