3 articles
Tuberculosis continues to be the primary cause of death among individuals living with human immunodeficiency virus, with co-infection significantly influencing the clinical course, severity, and outcomes of the disease. Although the interaction between the two conditions is well recognized, regional data from Eastern Europe remain insufficient.
A retrospective, cross-sectional comparative study was carried out in the Republic of Moldova in 2021. A total of 320 patients with newly diagnosed pulmonary tuberculosis were included and divided into two matched groups: the study group consisted of 160 patients with confirmed human immunodeficiency virus co-infection, and the control group included 160 patients without human immunodeficiency virus infection. The groups were comparable in terms of age, sex, residence, and resistance profile of Mycobacterium tuberculosis. Data were collected from national clinical records and analyzed using descriptive statistical methods.
Among 320 patients, those with HIV co-infection had significantly higher rates of generalized TB (28.8% vs. 2.5%; p < 0.0001), subacute onset (71.9% vs. 22.5%; p < 0.0001), and severe/very severe condition at diagnosis (27.4% vs. 10.6%; p = 0.0017). Anemia (58.8% vs. 23.1%; OR = 4.73, p < 0.0001), leukopenia (16.3% vs. 1.3%; OR = 15.33, p < 0.0001), and ESR >60 mm/h (25.0% vs. 5.6%; OR = 5.59, p < 0.0001) were significantly more common in co-infected patients. Bilateral lung lesions were more frequent (65.6% vs. 59.4%), while cavitary destruction predominated in TB-only patients (59.4% vs. 34.4%; p < 0.0001). Smear positivity was lower in the HIV group (38.8% vs. 55.0%; p = 0.0036). Complications (48.1% vs. 20.6%; p < 0.0001) and opportunistic infections (17.5% vs. 0%) were more prevalent in co-infected patients. Mortality was significantly higher among HIV-positive cases (28.1% vs. 6.9%; OR = 5.20, p < 0.0001).
Human immunodeficiency virus infection significantly modifies the clinical presentation of tuberculosis, favoring more severe, atypical, and extrapulmonary forms, along with higher complication rates and mortality. These findings highlight the urgent need for early diagnosis, adapted diagnostic approaches, and integrated treatment strategies in patients with dual infection, particularly in high-burden settings.
Chronic obstructive pulmonary disease is a major cause of morbidity and mortality worldwide, often associated with multiple comorbidities that may complicate its clinical course. These comorbidities can exacerbate respiratory symptoms, impair lung function, alter imaging findings, and significantly affect prognosis.
This analytical, observational, cross-sectional study included 80 patients with confirmed chronic obstructive pulmonary disease, divided into two equal subgroups according to spirometric severity: GOLD 1-2 (n = 40) and GOLD 3-4 (n = 40). Clinical, functional, and radiological parameters were evaluated. Comorbidity burden was assessed using validated composite indices: Charlson Comorbidity Index, COTE, COPDCoRi, CODEX, and COMCOLD. Associations between comorbidity scores, pulmonary function, high-resolution computed tomography findings, and clinical outcomes were analyzed using SPSS v22.0. A p-value < 0.05 was considered statistically significant.
The presence of comorbidities was high across all domains, with only minor differences between spirometric stages. Structural abnormalities (emphysema, bronchiectasis, pulmonary hypertension) were more prevalent in GOLD 3-4 patients. A strong correlation was observed between composite indices and parameters such as forced expiratory volume in 1 second,dyspnea, exacerbation rate, radiological findings, and GOLD stages. Logistic regression models showed that the combination of COPD-specific indices (COTE, CODEX, COPDCoRi) significantly outperformed the Charlson index in predicting severe COPD (AUC 0.86 vs. 0.63). High-resolution computed tomography findings variables also demonstrated strong predictive value (AUC 0.81).
Comorbidities play a central role in shaping chronic obstructive pulmonary disease severity and prognosis. The integration of composite comorbidity indices and imaging biomarkers enhances multidimensional patient stratification, aligning with GOLD 2024 recommendations for personalized care.
Gout is a metabolic disorder characterized by the deposition of uric acid in the form of excess sodium urate in the blood in the joints, leading to repeated episodes of arthritis. Most commonly, the condition is monoarticular, with a preference for the joints of the lower limbs: metatarsophalangeal, tibiotarsal, and knee. Deposition also occurs in other systems and organs: renal, leading to