Наукові праці. Кафедра інфекційних хвороб, дитячих інфекційних хвороб, фтизіатрії та пульмонології

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Features of the course of toxoplasmic encephalitis in hiv-infected patients
(2024) Veliieva, Tunzala; Bodnia, Kateryna; Makarenko, Valentyna; Pavliy, V.; Krokhmal, I.
This article presents the results of a retrospective analysis of clinical characteristics and examination outcomes in 23 patients with toxoplasmic encephalitis (TE) among HIV-infected individuals. Among the examined individuals, 11 (47.8%) were men and 12 (52.2%) were women. The patients' ages ranged from 31 to 55 years, with an average age of 37.5 ± 0.38 years. The average CD4+ lymphocyte count was 102.5 ± 21.2 cells/μl, and the HIV RNA load in plasma was 292,773.8 ± 113,180 copies/mL. All patients were confirmed to have stage 4 HIV infection (according to the CDC classification, 1993). Toxoplasmosis infection was confirmed by blood serology (presence of anti-Toxoplasma IgG antibodies via ELISA), and toxoplasmic encephalitis was diagnosed through MRI with characteristic focal brain changes. According to our analysis toxoplasmic encephalitis in HIV-infected patients develops gradually, with cognitive and psychiatric disorders as primary manifestations, followed by focal neurological impairments (hemiparesis, seizures, speech problems). All HIV patients with detected Toxoplasma antibodies at the onset of the disease can be considered at risk for developing toxoplasmic encephalitis. TE in the brain manifests when CD4+ cell levels drop below 200 cells/μL and is characterized by polysymptomatic presentation, with an average of 5.67±0.37 symptoms in our patients. The data from our correlation analysis between altered blood parameters and the presence of symptoms in TE among HIV-infected patients showed that the greater the severity, activity, and duration of toxoplasmic infection (indicated by eosinophilia), the more diverse the symptoms. This, in turn, leads to an increase in ESR, the development of leukocytopenia, and hypochromic anemia.
Зв’язок факторів постембріонального онтогенезу з ефективністю хіміопрофілактики туберкульозу у дітей
(ГО «Всеукраїнська асоціація інфекціоністів», 2024) Бодня, Катерина Ігорівна; Зосімов, Анатолій Миколайович; Асоян, Ірина Миколаївна; Навєт, Тетяна Іванівна; Кондратюк, Вадим Валентинович; Bodnia, Kateryna; Zosimov, Anatoly; Asoyan, Irina; Navet, Tatiana; Kondratyuk, Vadim
Дитячий організм як функціональна система формується, починаючи з внутрішньоутробного періоду. Тому аналіз навіть віддалених у часі ситуацій дозволяє виявити фактори, які впливають на функціонування дитячого організму у теперішньому часі і, можливо, на ефективність хіміопрофілактики туберкульозу у дітей.
Сторінками науково-практичної конференції з міжнародною участю «Мечниковські читання»: історія, надбання, перспективи
(Харківський національний медичний університет, 2024-11-01) Капустник, Валерій Андрійович; Козько, Володимир Миколайович; Юрко, Катерина Володимирівна; Бондар, О.Є.; Ткаченко, В.Г.; Kapustnyk, Valeriy; Kozko, Volodymyr; Bondar, O.; Tkachenko, V.
Слобожанська земля виплекала чималу плеяду вчених, неоціненний внесок яких продовжує поповнювати світову наукову скарбничку. Серед багатьох відомих і славнозвісних наших земляків ім’я Іллі Ілліча Мечникова займає особливе місце в історії медицини і науки. Уродженець маловідомого на середину 19-го століття села Іванівка Куп’янського повіту Харківської губернії став одним із фундаторів імунології, мікробіології та еволюційної ембріології, засновником теорії фагоцитозу і внутрішньоклітинного травлення, порівняльної патології запалення, фагоцитарної теорії імунітету, наукової геронтології, лауреатом Нобелівської премії 1908 року у галузі фізіології та медицини за праці про імунітет. Наукові здобутки І.І. Мечникова заклали міцний фундамент для розвитку багатьох галузей та напрямків медицини. Безумовно, що його відкриття і напрацювання сприяли становленню інфектології, як науки та базису клінічної дисципліни «інфекційні хвороби».
Global, regional, and national burden of HIV/AIDS, 1990–2021, and forecasts to 2050, for 204 countries and territories: the Global Burden of Disease Study 2021
(Elsevier Ltd, 2024-11-25) Carter, Austin; GBD 2021 HIV Collaborators
Background As set out in Sustainable Development Goal 3.3, the target date for ending the HIV epidemic as a public health threat is 2030. Therefore, there is a crucial need to evaluate current epidemiological trends and monitor global progress towards HIV incidence and mortality reduction goals. In this analysis, we assess the current burden of HIV in 204 countries and territories and forecast HIV incidence, prevalence, and mortality up to 2050 to allow countries to plan for a sustained response with an increasing number of people living with HIV globally. Methods We used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 analytical framework to compute age-sex-specific HIV mortality, incidence, and prevalence estimates for 204 countries and territories (1990–2021). We aimed to analyse all available data sources, including data on the provision of HIV programmes reported to UNAIDS, published literature on mortality among people on antiretroviral therapy (ART) identified by a systematic review, household surveys, sentinel surveillance antenatal care clinic data, vital registration data, and country-level case report data. We calibrated a mechanistic simulation of HIV infection and natural history to available data to estimate HIV burden from 1990 to 2021 and generated forecasts to 2050 through projection of all simulation inputs into the future. Historical outcomes (1990–2021) were simulated at the 1000-draw level to support propagation of uncertainty and reporting of uncertainty intervals (UIs). Our approach to forecasting utilised the transmission rate as the basis for projection, along with new rate-of-change projections of ART coverage. Additionally, we introduced two new metrics to our reporting: prevalence of unsuppressed viraemia (PUV), which represents the proportion of the population without a suppressed level of HIV (viral load <1000 copies per mL), and period lifetime probability of HIV acquisition, which quantifies the hypothetical probability of acquiring HIV for a synthetic cohort, a simulated population that is aged from birth to death through the set of age-specific incidence rates of a given time period. Findings Global new HIV infections decreased by 21·9% (95% UI 13·1–28·8) between 2010 and 2021, from 2·11 million (2·02–2·25) in 2010 to 1·65 million (1·48–1·82) in 2021. HIV-related deaths decreased by 39·7% (33·7–44·5), from 1·19 million (1·07–1·37) in 2010 to 718000 (669000–785000) in 2021. The largest declines in both HIV incidence and mortality were in sub-Saharan Africa and south Asia. However, super-regions including central Europe, eastern Europe, and central Asia, and north Africa and the Middle East experienced increasing HIV incidence and mortality rates. The number of people living with HIV reached 40·0 million (38·0–42·4) in 2021, an increase from 29·5 million (28·1–31·0) in 2010. The lifetime probability of HIV acquisition remains highest in the sub Saharan Africa super-region, where it declined from its 1995 peak of 21·8% (20·1–24·2) to 8·7% (7·5–10·7) in 2021. Four of the seven GBD super-regions had a lifetime probability of less than 1% in 2021. In 2021, sub-Saharan Africa had the highest PUV of 999·9 (857·4–1154·2) per 100000 population, but this was a 64·5% (58·8–69·4) reduction in PUV from 2003 to 2021. In the same period, PUV increased in central Europe, eastern Europe, and central Asia by 116·1% (8·0–218·2). Our forecasts predict a continued global decline in HIV incidence and mortality, with the number of people living with HIV peaking at 44·4 million (40·7–49·8) by 2039, followed by a gradual decrease. In 2025, we projected 1·43 million (1·29–1·59) new HIV infections and 615 000 (567000–680000) HIV-related deaths, suggesting that the interim 2025 targets for reducing these figures are unlikely to be achieved. Furthermore, our forecasted results indicate that few countries will meet the 2030 target for reducing HIV incidence and HIV-related deaths by 90% from 2010 levels. Interpretation Our forecasts indicate that continuation of current levels of HIV control are not likely to attain ambitious incidence and mortality reduction targets by 2030, and more than 40 million people globally will continue to require lifelong ART for decades into the future. The global community will need to show sustained and substantive efforts to make the progress needed to reach and sustain the end of AIDS as a public threat.
Effect of adequacy of empirical antibiotic therapy for hospital-acquired bloodstream infections on intensive care unit patient prognosis: a causal inference approach using data from the Eurobact2 study
(Elsevier B.V., 2024) Loiodice, Ambre; Bailly, Sebastien; Ruckly, Stephane; Buetti, Niccolo; Barbier, François; Staiquly, Quentin; Tabah, Alexis; Timsit, Jean-François; Sokhan, A.; Burma, Ya.
Objectives: Hospital-acquired bloodstream infections (HA-BSI) in the intensive care unit (ICU) are common life-threatening events. We aimed to investigate the association between early adequate antibiotic therapy and 28-day mortality in ICU patients who survived at least 1 day after the onset of HA-BSI. Methods: We used individual data from a prospective, observational, multicentre, and intercontinental cohort study (Eurobact2). We included patients who were followed for - 1 day and for whom time-to appropriate treatment was available. We used an adjusted frailty Cox proportional-hazard model to assess the effect of time-to-treatment-adequacy on 28-day mortality. Infection- and patient-related variables identified as confounders by the Directed Acyclic Graph were used for adjustment. Adequate therapy within 24 hours was used for the primary analysis. Secondary analyses were performed for adequate therapy within 48 and 72 hours and for identified patient subgroups. Results: Among the 2418 patients included in 330 centres worldwide, 28-day mortality was 32.8% (n ¼ 402/1226) in patients who were adequately treated within 24 hours after HA-BSI onset and 40% (n ¼ 477/1192) in inadequately treated patients (p < 0.01). Adequacy within 24 hours was more common in young, immunosuppressed patients, and with HA-BSI due to Gram-negative pathogens. Antimicrobial adequacy was significantly associated with 28-day survival (adjusted Hazard Ratio (aHR), 0.83; 95% CI, 0.72e0.96; p 0.01). The estimated population attributable fraction of 28-day mortality of inadequate therapy was 9.15% (95% CI, 1.9e16.2%). Discussion: In patients with HA-BSI admitted to the ICU, the population attributable fraction of 28-day mortality of inadequate therapy within 24 hours was 9.15%. This estimate should be used when
Relation of the immunologic status of blastocystosis patients with the effectiveness of their therapy
(WHO Office in Azerbaijan, 2024-05) Bodnia, I.; Yurko, K.; Bodnia, K.
To study the presence of a relationship between the state of immunologic homeostasis and the effectiveness of blastocystosis therapy, the values of immunity indices were compared in 300 patients with blastocystosis in alternative groups: group A − with good therapeutic effect (n = 162) and group B − with satisfactory effect (n = 138). Group A included patients who had an overall clinical symptom regression rate of ≥33% after 1 month of treatment, and group B included patients who had an overall regression rate of ≤32%. When comparing the correlation structures of immunity indices in the groups, it was found that they differ significantly (by 90%) in their “portrait” properties (nature of correlation). In patients with a good therapeutic effect in comparison with the alternative group is characterized by a more pronounced antibodyalogenesis of all classes of antibodies (Ig M, Ig A, Ig G and IgE), which indicates their leading role in the formation of protective reactions in patients with blastocystosis. The established significant (90%) differences in the nature of relationships in the groups indicate that in patients depending on the effectiveness of their therapy, fundamentally different pathogenetic matrices of immune homeostasis are formed, which substantiates the possibility of using immune indicators as predictors.
Chest X-ray alone is insufficient for predicting drug-resistant pulmonary tuberculosis
(Elsevier B.V., 2024-05) Pedersen, Ole Skouvig; Butova, Tetiana; Borovok, Natalia; Akymenko, Oleksandra; Sapelnik, Nadiya; Tantsura, Oleksandr; Knysh, Vitaliy; Fløe, Andreas; Butov, Dmytro
The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections
(Springer Verlag, 2024-06) Buetti, Niccolò; Tabah, Alexis; Setti, Nour; Ruckly, Stéphane; Barbier, François; Akova, Murat; Aslan, Abdullah Tarik; Leone, Marc; Bassetti, Matteo; Morris, Andrew Conway; Arvaniti, Kostoula; Paiva, José‑Artur; Ferrer, Ricard; Qiu, Haibo; Montrucchio, Giorgia; Cortegiani, Andrea; Kayaaslan, Bircan; De Bus, Liesbet; De Waele, Jan J.; Timsit, Jean‑François; Sokhan, A.; Burma, Ya.
Purpose: The primary objective of this study was to evaluate the associations between centre/country-based factors and two important process and outcome indicators in patients with hospital-acquired bloodstream infections (HABSI). Methods: We used data on HABSI from the prospective EUROBACT-2 study to evaluate the associations between centre/country factors on a process or an outcome indicator: adequacy of antimicrobial therapy within the frst 24 h or 28-day mortality, respectively. Mixed logistical models with clustering by centre identifed factors associated with both indicators. Results: Two thousand two hundred nine patients from two hundred one intensive care units (ICUs) were included in forty-seven countries. Overall, 51% (n=1128) of patients received an adequate antimicrobial therapy and the 28-day mortality was 38% (n=839). The availability of therapeutic drug monitoring (TDM) for aminoglycosides everyday [odds ratio (OR) 1.48, 95% confdence interval (CI) 1.03–2.14] or within a few hours (OR 1.79, 95% CI 1.34–2.38), surveillance cultures for multidrug-resistant organism carriage performed weekly (OR 1.45, 95% CI 1.09–1.93), and increasing Human Development Index (HDI) values were associated with adequate antimicrobial therapy. The presence of intermediate care beds (OR 0.63, 95% CI 0.47–0.84), TDM for aminoglycoside available everyday (OR 0.66, 95% CI 0.44–1.00) or within a few hours (OR 0.51, 95% CI 0.37–0.70), 24/7 consultation of clinical pharmacists (OR 0.67, 95% CI 0.47–0.95), percentage of vancomycin-resistant enterococci (VRE) between 10% and 25% in the ICU (OR 1.67, 95% CI 1.00–2.80), and decreasing HDI values were associated with 28-day mortality. Conclusion: Centre/country factors should be targeted for future interventions to improve management strategies and outcome of HABSI in ICU patients.
Clinical predictors of Вlastocystosis treatment efficacy
(Georgian Association of Business Press, 2024-04) Bodnia, I.; Bodnia, K.; Maslova, V.; Ogienko, V.; Pavliy, V.
Improvement of methods and criteria for diagnostics of human blastocystosis and selection of drugs for etiotropic therapy remain urgent scientific tasks of the present day. Clinical manifestations of blastocystosis in humans are diverse, and in this regard, their influential role on the effectiveness of blastocystosis therapy cannot be excluded. Materials and methods: To assess the predictor properties of clinical symptoms, we retrospectively analyzed them in 300 patients with blastocystosis in alternative groups: group A − with good therapeutic effect (n = 162) and group B − with satisfactory effect (n = 138). Group A included patients who had an overall regression rate of clinical symptoms ≥ 33% after 1 month from the start of treatment and ≤ 32% in group B. Results and discussions: Preliminary analysis showed that reliable differences between the groups were established for most clinical symptoms, which provided the basis for the development of a prognostic algorithm using a heterogeneous sequential Wald-Henkin procedure [19]. It was found that high prognostic informativity was shown by liver enlargement (J= 3,38), the presence of heaviness in the right subcostal area (J = 2,45), tachycardia (J = 1,76), decreased efficiency (J = 1,63), the degree of manifestation of clinical symptoms in general (J = 1,74), the nature of body temperature (J = 1,56), the presence of dizziness (J = 1,46) and duration of the disease (J = 1,07). Moderate predictive properties were characterized for the patient's age (J = 0,67) and the presence of vegeto-visceral dysfunction (J = 0,96), joint pain (J = 0,87), headache (J = 0,67), heart pain (J = 0,64), and muscle pain (J = 0,53). Low prognostic informativeness was established with regard to the presence of seizures (J = 0,42), lymphoadenopathy (J = 0,33) and spleen enlargement (J = 0,30). No predictor value was found for symptoms such as abdominal pain syndrome (J = 0,09), memory impairment (J = 0,008), skin manifestations (J = 0,04), jaundice (J = 0,02), and patient gender (J = 0,01). The testing of the predictive algorithm on the training group (n=300) established its high efficiency, as the erroneous predictions amounted to 3% and did not exceed the specified (5%; p < 0.05) level of reliability. Correct predictions amounted to 77% and uncertain predictions amounted to 20% of cases. Conclusions: Using the heterogeneous sequential Wald Genkin procedure, an algorithm was created to predict the effectiveness of therapy for patients with blastocystosis, which determined the values of the prognostic coefficients of each gradation of indicators and their general prognostic information content. The highest prognostic informativeness was found for clinical symptoms such as liver enlargement (J = 3,38), right subcostal heaviness (J = 2,45), tachycardia (J = 1,76), degree of manifestation of clinical symptoms (J = 1,74) and body temperature (J = 1,56). Testing the algorithm at 95% reliability level on the training group (n=300) revealed its high efficiency, as the erroneous predictions amounted to 3% and did not exceed the specified (5%; p < 0,05) reliability level. Correct predictions amounted to 77% and uncertain predictions amounted to 20% of cases.
Upgrading Master's Training for Higher Education Instructors in the Digital Era: Public Health Education as an Example
(Jacobs Verlag, 2024-05-24) Kasyanova, Olena; Kvasnyk, Olga; Bodnia, Igor; Rudnyeva, Iryna; Bespartochna, Olena; Poyasok, Tamara
This study elucidates the theoretical underpinnings and underscores the imperative of enhancing master's training programs for higher education teachers within the educational digitalization landscape on the public health education example. The research elucidates that at the core of this evolution lies the technological concept, necessitating the development of a meticulously grounded model for the purposeful and well organized training of higher education faculty within a digitally transformed educational framework. This model delineates a meticulously outlined structure, content framework, a judicious selection of methodologies and techniques, and a methodical integration of technological advancements to ensure the realization of desired educational outcomes. The structural-functional model encompasses integral components such as the methodological-objective facet (incorporating societal demands, educational objectives, conceptual approaches to professional development, and digitalization elements), the constructive-procedural dimension (comprising educational directions, organizational forms in the digital paradigm), the profession-specific aspect (encompassing content, technologies, methods, pedagogical tools), and the analytical-effective domain (defining criteria, process metrics, diagnostic tools), in conjunction with organizational-pedagogical parameters. Emphasis is placed on nurturing a tailored educational milieu and fostering educational innovations to augment the efficacy of training enhancements with a specific lens toward public health implications. The article substantiates the criteria and metrics for bolstering master's training initiatives for higher education instructors, underlining the distinct facets of national educational digitalization and the unique dynamics among higher education stakeholders. The contemporary relevance of revamping master's programs for teachers is underscored through exploring diverse digital learning formats employing information technologies, digital resources, and cloud-based tools. Initiatives aimed at reshaping the master's educational landscape to align with the digital era will entail validating the proposed model's efficacy through experimental validation across domestic and international educational realms.