Адрес для корреспонденции: Нестеренко Оксана Валериевна-к.м.н., доцент кафедры факультетской педиатрии Саратовского государственного медицинского университета им. В. И. Разумовского Горемыкин Владимир Ильич-д.м.н., проф., зав. той же кафедрой Елизарова Светлана Юрьевна-к.м.н., доцент той же кафедры Утц Сергей Рудольфович-д.м.н., проф., зав. кафедрой кожных и венерических болезней того же учреждения Бородулин Владимир Борисович-д.м.н., проф., зав. кафедрой биохимии того же учреждения Бобылева Елена Владимировна-к.м.н., ассистент той же кафедры Моисеева Юлия Михайловна-зав. отделением клиники кожных и венерических болезней того же учреждения Утц Денис Сергеевич-студент 6 курса педиатрического факультета того же учреждения 410012 Саратов, ул. Б. Казачья, д. 112. Комарова Елена Викторовна-зав. клинико-диагностической лабораторией Клинической больницы им. С. Р. Миротворцева 410054 Саратов, ул. Большая Садовая, д. 137

Aim. To study death risk factors in patients with community-acquired pneumonia in municipal hospitals in Samara. Methods. 75 cases of deaths of patients hospitalized because of community-acquired pneumonia were studied (study group), 300 convalescent patients with community-acquired pneumonia discharged from the hospital were included in the control group. The retrospective comparative «case control» study was performed. Results. Mean age of the patients who died was 47.4±2.2 years; men were more prevalent (70.6%), time since admission date till death was 6.5±2.5 days, more than a third (36.0%) died before 24 hours after admission. The study group contained significantly higher number of unemployed (72.0%) and intravenous drugs users (16.0%). HIV infection was found in 37.3% of the patients who died, compared to 19.6% prevalence in control group. Multifactorial logistic regression of clinical signs revealed the following death risk factors in patients with community-acquired pneumonia: infiltrates on X-ray involving more than one lung lobe, arterial hypotension (systolic blood pressure ≤100 mm Hg, diastolic blood pressure ≤60 mm Hg), tachypnea (breath rate over 25 per minute). Conclusion. Factors having the highest positive prognostic value for a lethal outcome at patients with community-acquired pneumonia are: late admission, multilobar pneumonia; arterial hypotension; tachypnea; HIV infection, social unemployment and male gender.

ФГБОУ ВО «Самарский государственный медицинский университет» МЗ РФ, г. Самара, Россия Цель: оптимизировать выявление туберкулеза в пульмонологическом отделении� Материалы и методы. В пульмонологическом отделении пациентам с подозрением на туберкулез проводили диагностический минимум: ставили пробу с аллергеном туберкулезным рекомбинантным, проводили анализ мокроты (трехкратно) и жидкости бронхоальвеолярного лаважа (БАЛЖ) методами микроскопии по Цилю -Нильсону, в лаборатории противотуберкулезной службы диагностический материал исследовали с помощью GeneXpert MTB/RIF, Bactec MGIT� Проанализировали результаты диагностического процесса у 70 больных с этиологически подтвержденным диагнозом� Результаты. Целенаправленный опрос, сбор анамнеза были информативными в 4%, проба с АТР -в 27,1%, GeneXpert MTB/RIF -в 100%, Bactec MGIT -в 97,1%� Внедрение ускоренных методов диагностики в пульмонологическом отделении сокращает средний койко-день от поступления до установления диагноза туберкулеза и перевода в противотуберкулезный стационар до 9,80 ± 4,72 дня� Молекулярно-ге-нетический метод можно рекомендовать в общую лечебную сеть как диагностический минимум при обследовании пациентов с высоким риском подозрения на туберкулез� WAYS TO OPTIMIZE DETECTION OF TUBERCULOSIS IN A PULMONOLOGY UNIT E. А. BORODULINА, А. T. INKOVА, B. E. BORODULIN, L. V. POVАLYAEVА Samara State Medical University, Samara, RussiaThe objective: to optimize detection of tuberculosis in a pulmonology unit� Subjects and methods. In a pulmonology unit, patients suspected of having tuberculosis had a minimum number of diagnostic tests: a skin test with tuberculous recombinant allergen, three consecutive Ziel-Nelson microscopies of sputum and fluids of bronchoalveolar lavage, and in the laboratory of TB services they performed GeneXpert MTB/RIF, Bactec MGIT� Results of the diagnostics were analyzed in 70 patients with etiologic confirmation of diagnosis� Results. A targeted inquiry and taking the patient's history were informative in 4% of cases, skin test with TRA -in 27�1%, GeneXpert MTB/RIF -в in 100%, and Bactec MGIT -in 97�1%� Introduction of express diagnostic methods to a pulmonology unit reduced the average number of bed-days from admission to diagnostics of tuberculosis and transfer to a TB in-patient unit down to 9�80 ± 4�72 days� Molecular genetic methods can be recommended for introduction to general medical services as a diagnostic minimum when examining patients with a high risk of tuberculosis� /2075-1230-2018-96-5-22-26 Своевременное выявление больных туберкуле-зом в первичном звене здравоохранения являет-ся определяющим фактором как в выздоровлении пациента, так и эпидемической обстановки по ту-беркулезу в целом [2]� Средние сроки диагности-ки туберкулеза в общей лечебной сети составляют 1,5-2,0 мес� Наиболее часто с проблемой диагно-стики туберкулеза сталкивается врач-пульмонолог стационарного отделения [2, 8]� Обнаружение ми-кобактерий туберкулеза (МБТ) имеет решающее значение не только для диагностики туберкулеза, оно чрезвычайно важно п...

SummaryThe aim. The purpose of this study was to analyze causes of deaths of hospitalised HIV infected patients with tuberculosis. Methods. Medical reports of patients with tuberculosis who died in a specialized hospital of Samara city in 2013 were analyzed using the total sampling method. Results. Ninety per cent of deaths in hospitalised HIV infected TB patients were caused by end stage AIDS with the high proportion (82%) of miliary tuberculosis, involvement of multiple organs (53%) and drug dependence (88%). Conclusion. Improving interaction of TB specialists and experts on HIV infec tion is needed to improve statistic analysis of morbidity of and mortality from tuberculosis and to reduce mortality from these comorbid diseases.

The aim of the study was to investigate new methods for pulmonary tuberculosis (TB) detection at a pulmonology inpatient department.Methods. Pulmonary TB cases (n = 49) newly diagnosed at a pulmonology department of a hospital were involved in the study; among them, 69.4% of patients were infected with human immunodeficiency virus (HIV). All patients were asked if he/she had previously contacted with other TB patients, and if he/she was diagnosed with TB previously. The patients were also about family history. Posteroanterior and lateral chest X-ray and laboratory analyses were performed in all patients. Mycobacteria tuberculosis (MBT) were searched using smear microscopy, GeneXpert MTB/RIF molecular method and culturing (BACTEC MGIT) of sputum and bronchoalveolar lavage fluid (BALF) obtained during bronchoscopy. Patients with positive results only were included in the analysis in order to investigate and to compare diagnostic value of the methods.Results. Questioning patients at admission was useful to diagnose TB in 4% of patients. Sputum smears were positive in 12 patients (27.3%). BALF was obtained in 18 patients (36.7%); among them, MBT was identified in 52 (5%). Molecular testing was positive in all 49 patients (100%); among them, BACTEC MGIT culturing yielded MBT in 48 patients (97.9%). In patients with negative sputum smears during the first 3 days after admission, GeneXpert required 10.4 ± 5.3 days.Conclusion. GeneXpert method was highly useful to diagnose TB and was comparable with BACTEC. Routine sputum and BALF smear microscopy was significantly less rapid and less sensitive method. The diagnostic accuracy could be increased with the use of molecular methods in patients with negative sputum smears obtained at a general hospital. Therefore, molecular methods could be used in patients highly suspected for TB.