O.N. Barkanova

OBJECTIVES: To evaluate the access to comprehensive diagnostics and novel antituberculosis medicines in European countries. METHODS: We investigated the access to genotypic and phenotypic Mycobacterium tuberculosis drug susceptibility testing and the availability of antituberculosis drugs and calculated the cost of drugs and treatment regimens at major tuberculosis treatment centres in countries of the WHO European region where rates of drug-resistant tuberculosis are the highest among all WHO regions. Results were stratified by middle-income and high-income countries. RESULTS: Overall, 43 treatment centres from 43 countries participated in the study. For WHO group A drugs, the frequency of countries with the availability of phenotypic drug susceptibility testing was as follows: (a) 75% (30/40) for levofloxacin, (b) 82% (33/40) for moxifloxacin, (c) 48% (19/40) for bedaquiline, and (d) 72% (29/40) for linezolid. Overall, of the 43 countries, 36 (84%) and 24 (56%) countries had access to bedaquiline and delamanid, respectively, whereas only 6 (14%) countries had access to rifapentine. The treatment of patients with extensively drug-resistant tuberculosis with a regimen including a carbapenem was available only in 17 (40%) of the 43 countries. The median cost of regimens for drug-susceptible tuberculosis, multidrug-resistant/rifampicin-resistant tuberculosis (shorter regimen, including bedaquiline for 6 months), and extensively drug-resistant tuberculosis (including bedaquiline, delamanid, and a carbapenem) were €44 (minimum-maximum, €15-152), €764 (minimum-maximum, €542-15152), and €8709 (minimum-maximum, €7965-11759) in middle-income countries (n = 12) and €280 (minimum-maximum, €78-1084), €29765 (minimum-maximum, €11116-40584), and €217591 (minimum-maximum, €82827-320146) in high-income countries (n = 29), respectively. DISCUSSION: In countries of the WHO European region, there is a widespread lack of drug susceptibility testing capacity to new and repurposed antituberculosis drugs, lack of access to essential medications in several countries, and a high cost for the treatment of drug-resistant tuberculosis.

Autopsy material and medical history were studied and analyzed in a 20-year-old male patient who had died from COVID-19 infection with the development of acute SARS-CoV-2-associated hemorrhagic necrotizing encephalopathy in adults with obvious endothelial dysfunction confirmed by virological examination of the autopsy material. In this case, the brain structures displayed the main found histopathologic signs: widespread vasculitis (endotheliitis) with varying degrees of segmental and total endothelial destruction; thrombosis mainly of the vessels of the microcirculatory bed; parenchymal hemorrhagic necrosis and inflammation (encephalitis); severe necrobiotic damage to neurons. Cerebrovascular immune damages and hypercoagulable states, which were observed in some acute viral neuroinfections, are the basis for the neurological complications of COVID-19. In this case of bicausal diagnosis (the presence of a comorbidity), the primary disease contributed to the acute progression of the background disease (secondary infiltrative tuberculosis with the development of specific pleuritis and pneumothorax with the addition of acute bilateral focal confluent bronchopneumonia with a history of undifferentiated immunodeficiency syndrome. Emphasis is laid on the possibility and importance of involving the brain structures in the process in COVID-19 for the timely diagnosis of emerging neurological disorders. A brief literature review is given.

Analyzed 2 deaths from pathological and forensic practice in order to show that comorbid diseases in young patients in the context of the COVID-19 pandemic increase the risk of an adverse outcome due to the potentiation of the systemic damaging action of the viral agent, decompensation of chronic therapeutic pathology, the development of acute complications and status, possible drug interactions. The management of this category of patients requires knowledge of the characteristics of a viral infection, its clinical manifestations in combination with comorbid diseases.

At present days the great attention is paid to studying of tuberculosis with multidrug resistance (MDR), when mycobacteria tuberculosis (MBT) has resistance to isoniazid and rifampicin. High level of MDR-tuberculosis has essential influence on spreading of tuberculosis by means of accumulation of sources of an infection due to low efficiency of treatment. The MDR-tuberculosis has increased in 5.9 times at the last 14 years.

The choice of lung cancer treatment method directly depends on the diagnostisc and verification of the histological type of tumor. Important diagnostic criteria are DNA accumulation index and proliferation index of Ki-67. Materials and methods. DNA accumulation index was assessed in 200 cases of lung cancer using a microspectrophotometric method. Ki-67 proliferative index was calculated using immunohistochemical study in histological material with antibodies to Ki-67, Cytokeratin 5/6, TTF-1, Chromogranin A, Synaptophysin, Keratin.Pan, CD56. Results. As the degree of tumor differentiation decreases, DNA accumulation index and Ki-67 proliferative index increase, serving as criteria for the aggressive behavior of the tumor. Conclusions. Correlation analysis revealed a statistically significant relationship between DNA accumulation index and Ki-67 proliferative index (r = 0.987, p 0.05). The obtained data may be useful for diagnosis and prognosis in patients with lung cancer.