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Issue. Articles

3(10) // 2012



1. Editorial


Partnership of Ukraine with the Global Fund to Fight AIDS, Tuberculosis and Malaria as a strengthening factor for the state role in the field of fighting against HIV infection/AIDS in Ukraine

N.M. Nizova

The HIV epidemic in Ukraine is one of the most critical in the Eastern Europe and the Commonwealth of Independent States. One of the most important factors of response to the epidemic in Ukraine is a partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria (hereinafter — the Global Fund), which provides financial assistance to Ukraine in HIV/AIDS prevention over the past eight years.
In 2002, Ukraine applied for funds intended to fight the epidemic and provide medical care to HIV-infected patients and people living with HIV/AIDS in the framework of the 1st round of the Global Fund. After having studied the situation, the Board of the Global Fund decided to provide financial assistance to Ukraine in the amount of 92 million USD for five years.
Since August 2007, Ukraine has been implementing a grant of the 6th round of the Global Fund with a budget of 136 million USD. Principal recipients of this grant are two non-governmental organizations — «International HIV/AIDS Alliance in Ukraine» and «All-Ukrainian Network of People Living with HIV». The main goal of the Round 6 program is to reduce HIV transmission, morbidity and mortality associated with HIV in Ukraine through the measures aimed at the most vulnerable groups of population.
December 15, 2011, the Board of the Global Fund fully supported Ukraine’s application for funding the Round 10 program «Development of the long-term system of provision of comprehensive services for HIV/AIDS prevention, treatment, care and support among the high-risk groups and PLWH in Ukraine» in 2012—2016 years in the amount of 301.7 million USD. Grant funds will be used to strengthen the capacity of AIDS service at the national and regional levels allowing to implement effective measures to fight AIDS epidemic in Ukraine without financial assistance from donors starting from 2017.

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2. Original research


The deviceless method of collapsotherapy of the pulmonary tuberculosis

B.V. Noreiko, V.V. Mozgovoi, S.B. Noreiko, Yu.A. Hrishun, T.V. Tlustova

Objective: to increase effectiveness of the complex treatment of the pulmonary tuberculosis.
Materials and methods. The paper presents primary application results for the author deviceless method of treatment.
Results and discussion. The use of the deviceless method of treatment in the complex treatment of patients with destructive pulmonary tuberculosis resulted in the earlier smear conversion and acceleration of healing of pulmonary destructive changes.
Conclusions. The deviceless method of treatment is considered to be simple, non-invasive method of treatment without contraindications.

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3. Original research


Apiproduct effect on immunological indices in patients with new-onset infiltrative pulmonary tuberculosis

Yu.P. Tsapenko, M.H. Boiko, H.M. Hrechka, N.I. Nosyk, O.O. Kraievska

Objective: to study apiproduct effect on the immune state indices in patients with new-onset pulmonary tuberculosis.
Materials and methods. The article describes immune state indices in patients with new-onset pulmonary tuberculosis. All the patients were divided into basic and control groups with 33 patients in each one. Standard antituberculosis therapy was carried out for the patients of both groups adding apiproduct (drone larvae homogenate) in the basic group. Immunological indices monitoring was carried out at the beginning of the treatment and on the 40—50 day in both groups.
Results and discussion. Immunity insufficiency and phagocyte chain changes were revealed in all patients. Normalization of cell immunity indices on the basis of DLH administration were observed, i.e. fraction of CD-3--lymphocytes (p < 0.001), CD-4--helpers (p < 0.005), CD-8--killers (p < 0.05),
CD-16 – natural killers (p < 0.1). There was improvement of IgA (p < 0.001) , IgG (p < 0.01), IgM (p < 0.05), CIC (p < 0.001) indices regarding humoral immunity. At the same time the decrease of HCT-test indices (p < 0.05) and PhI increase in basic group indicated the increase of cell ingestion rate.
Conclusions. Apiproduct (drone larvae homogenate) administration in complex therapy of patients with infiltrative pulmonary tuberculosis results in normalization of cellular and humoral immunity chains indices as well as blood cell ingestion rate.

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4. Original research


Some aspects of apoptosis and its role in the formation of the general dysadaptation syndrome at the infiltrative pulmonary diseases

L.D. Todoriko, L.D. Myhailiuk

Objective: to analyse the study data on the apoptosis processes intensity and proliferative activity of the bronchopulmonary epithelial cells by means of immunocytochemical investigation at infiltrative pulmonary processes.
Materials and methods. The immunocytochemical study of Bcl-2, Bax, and PCNA (cell proliferation nuclear antigen) specific antigens in bronchial tissue was carried out in 17 patients with pulmonary
infiltrative inflammatory changes of various etiologies by applying TACS XL™ test system (R & D Systems Incorporation, USA).
Results and discussion. Study results revealed epithelial cells apoptosis increase due to intensification of the pro-apoptotic protein Bax production against the deficiency of antiapoptotic factors (Bcl-2 protein) synthesis. Study revealed no positive reaction to PCNA indicating decrease of proliferative activity of the bronchial epithelial cells.
Conclusions. The lung epithelial cell dying off at infiltrative pulmonary changes is accomplished by the increased apoptosis followed by compensatory increase of epithelial cells proliferation and Bax proapoptotic protein hyperproduction of coarse-granular type against the deficiency of antiapoptotic factors
(protein Bcl-2) synthesis. The PCNA expression at inflammation indicates the growth of the DNA replicative activity.

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5. Original research


Effect of cytokines on the modulation of the blood monoclonal antibodies in patients with new-onset pulmonary tuberculosis

M.M. Kuzhko, D.O. Butov, H.L. Stepanenko, O.O. Hrynishyna, O.. Maksymenko

Objective: to study the effect of cytokines on the modulation of the blood monoclonal antibodies in patients with new-onset pulmonary tuberculosis.
Materials and methods. The article provides results of the study of CD3, CD4, CD8, interleukin IL-2, IL-4, IL-10 and IFN-g in 180 people including 30 almost healthy donors and 150 patients with new-onset pulmonary tuberculosis.
Results and discussion. Patients with new-onset pulmonary tuberculosis showed significant decrease of CD3, CD4 and insignificant changes in CD8 count against significant increase of IL-2, IFN-g and decrease of IL-4, IL-10 in comparison with almost healthy donors. Standard two-month therapy provides a significant increase of CD3, CD4, CD8-lymphocytes and IL-4, IL-10 and a significant decrease of IL-2, IFN-g in patients with new-onset pulmonary tuberculosis.
Conclusions. The results show the ability of cytokine production (IL-2, IL-4, IL-10 and IFN-g) to affect blood monoclonal antibodies in patients with new-onset pulmonary tuberculosis. These indicators may characterize subpopulation number and activity of CD4.

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6. Original research


Features of changes in IL-8, IL-10 levels and in humoral immunity parameters in serum of patients with abdominal tuberculosis

N.Ye. Lapovets

Objective: to identify changes in IL-8, IL-10 levels and parameters of humoral immunity in serum of patients with abdominal tuberculosis.
Materials and methods. The study refers to the level of IL-8, IL-10, CIC, Ig A, M, G in serum of 20 almost healthy individuals and 30 patients with histologically confirmed abdominal tuberculosis with different process focuses.
Results and discussion. The study revealed activation of humoral immunity in patients with abdominal tuberculosis. The concentration of studied interleukins responded more delicately to the development of chronic abdominal pathology. The observed significant increase of IL-8 level in serum of patients with abdominal tuberculosis was ten times higher than normal rate and IL-10 level was five times higher in comparison with the control group.
Conclusions. Specific changes of immune and cytokine status contribute to the emergence of the abdominal cavity inflammation. Cytokines are sensitive indicators of immune response as biomarkers of inflammation. These changes enable early differential diagnosis of inflammatory processes.

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7. Original research


The study of the functional state of glutathione-dependent enzymes of erythrocytes in patients with idiopathic interstitial pneumonia

V.M. Zhadan

Objective: to carry out a comparative study of the functional state of glutathione-dependent enzymes of erythrocytes in patients with IIP depending on the nosological form of the disease.
Materials and methods. The study was carried out on 59 patients with IIP, who were divided into two groups. The 1st group consisted of 37 patients who were under in-patient treatment for the first time. The 2nd group consisted of 22 patients who came to the re-examination. The first group included 16 patients with IFA and 21 patients with NSIP, the second group included 10 patients with IFA and 12 patients with NSIP. The activity of glutathione-transferase (GT), glutathione-reductase (GR) and glutathione peroxidase (GP) were determined in the erythrocytes of venous blood.
Results and discussion. The study evaluated the activity of glutathione-dependent enzymes in the blood of patients with IIP according to nosological form of the disease. It is established that in the first group of patients (before treatment). The activity of GR before treatment was significantly lower in comparison with the control group: in NSIP patients it was 18.9 % lower and in patients with IFA it was 19.3 % lower. The activity of the GAP was also significantly reduced in both groups of patients: in NSIP patients it was 12.9 % lower, with IFA — 16.6 % lower. Revealed changes of the enzymatic activity of glutathione-dependent systems had the same trend after a course of therapy in patients with NSIP, as well as in NSIP patients of the 1st group. All three glutathione-dependent enzymes were significantly reduced in IFA patients of the 2nd group in comparison with control group.
Conclusions. The study showed a reduction in activity of glutathione-dependent enzymes in patients with IIP, but no clear pattern between the identified biochemical disorders and form of the disease was revealed. The studied changes are unidirectional and are typical both for NSIP and IFA patients.

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8. Original research


Analysis of tuberculosis epidemiological situation in radiological control zones of Vinnytsia region during 19862000 years

L.I. Borysova, S.V. Zaikov

Objective: to evaluate the epidemiological situation on tuberculosis (TB) in Vinnytsia region contaminated due to Chernobyl accident in comparison with non-contaminated region during the 15 years after the accident.
Materials and methods. Analysis of key indicators was carried out according to the official «Indicators of TB services in Vinnitsa region from 1986 to 2000».
Results and discussion. According to our data, the overall incidence of TB and the incidence of pulmonary TB during the first 15 years after the Chernobyl accident have increased in both regions, but significant difference is shown only in the II five years by both indicators. Indicators of bacterial and destructive TB in uncontaminated areas have not changed, but they have grown in contaminated areas in II and III five years. Significant difference is also found only in the II and in the III five-year periods by the increasing indicators in the contaminated areas. Indicators of morbidity (overall and pulmonary TB) have decreased and stabilized in II five years. Significant difference between two regions was found only in the II and in the III five years. TB mortality has increased among residents of contaminated areas in the III five-year period being at the same time significantly different from the uncontaminated regions.
Conclusions. Analysis didn’t reveal specific differences between the major TB epidemiological indicators in the Vinnytsia region after the first five years after the accident, although there were significant differences between almost all indicators in the II five-year period. These differences still exist in the III five-year period, but the contaminated areas showed increased TB mortality.

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9. Original research


Results of the assesment of measures of labor migrants engagement (the residents of Transcarpathia region) to learn their HIV status

I.S. Myroniuk

Objective: to evaluate effectiveness of measures of engaging representatives of labor migrants and their inner circle to the Counseling and Testing (CaT) for HIV in Transcarpathian region.
Materials and methods. The results of the analysis of the registration cards of HIV-infected persons and the original ad hoc questionnaires determined the number of persons by the code causes of HIV screening and belonging to the research target group — persons involved in labour migration beyond permanent residence: labor migrants and their inner circle. Representatives of the target group (94 persons) were combined into 2 groups based on the primary source of requests for testing: Group A (CaT on the initiative of the client) and Group B (CaT on the initiative of medical workers). The study presents evaluation of the percentage changes of HIV-positive persons between Group A and B who first applied for the services of a CaT before and after the introduction of measures of raising awareness of the population through the mass media about the value of HIV CaT services.
Results and discussion. 94 HIV-positive people who involved in migration beyond permanent residence were put on dispansery records in Transcarpathian region during the 2007—2011. Among them the group A included 43 people (45.7 % of the target group), group B — 51 person (54.3 %). Most of the men of the target group contacted for the CaT on its own initiative — 32 (59.3 %), and women, on the contrary, in most cases took a survey of health by medical workers initiatives — 29 persons (72.5 %). Before CaT measures implementation for representatives of target groups (2007—2009) members of the Group B dominated in the structure of registered HIV-positive persons: in 2007, 2008 and 2009 they worked out 72.2 %; 69.2 %; 71.4 % respectively. The study revealed that after the start of the implementation of CaT target measures in 2010 and 2011 the primary address of representatives of target groups for CaT services on its own initiative were in group A. So, in 2011 the Group A worked out 58.3 % of all inquiries and its part has risen to 64 % in 2011. More marked growth of the procentage of individuals in Group A was observed among HIV-positive women: from 5 % in 2007 up to 50 % in 2011.
Conclusions. Implemented measures of engaging to the CaT services by informing the labor migrants through mass media and their inner circle were found to be effective. The study revealed the rise of the level of informed representatives of target groups of addressing medical professionals to determine their HIV status, what enables early detection of HIV infection and implementation of health measures to prevent secondary infection and improve the quality of life of HIV-positive persons.

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10. Original research


Clinical characteristics of the course of HIV infection with concomitant cryoglobulinemia

V.D. Moskaliuk, S.R. Melenko

Objective: to identify the features of cryoglobulinemia of different types at all clinical stages of HIV infection and under different methods of treatment.
Materials and methods.The study involved 127 patients with HIV/AIDS of the different stages.
Results and discussion. The cryoprecipitation phenomenon becomes more characteristic with the advance of HIV infection. However the development of HIV wasting syndrome (4th clinical stage) results in diagnosing cryoglobulinemia less frequently — only in single patients. Standard first-line antiretroviral therapy and especially its combination with additional use of dipyridamole allow to slightly lower percentage of patients with the cryoprecipitation phenomenon.
Conclusions. Concomitant cryoglobulinemia has significant influence on the course of HIV infection what needs to be considered when diagnosing and treating disease.

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11. Original research


The possibilities of implementation of skin test with opportunistic pathogenic fungi for evaluation of the functional state of the immune system in the tuberculosis patients

A.Ye. Bohomolov, S.V. Zaikov

Objective: to improve diagnostics of the abnormalities of the cell-mediated immune system in the tuberculosis patients with the use of intradermal testing with the antigens of opportunistic pathogenic fungi, such as lternaria alternata, Cladosporium sp., Monilia sitophyla, Chrysonilia sitophila, Botrytis cinerea, Aspergillus mixt (A. fumigatus, A. niger), Penicillum sp. and tuberculine.
Materials and methods. The study was carried out with the use of clinic-anamnestic, physical, X-ray (biplane X-ray, tomography), laboratory (complete blood count, sputum analysis with drug susceptibility), immunological (immunological anamnesis, skin testing, IML reaction), instrumental (electrocardiography, spirography, fibrobronchoscopy), statistical methods.
Results and discussion. The results of testing with the opportunistic pathogenic fungus antigens correlated with the intoxication and bronchopulmonary syndromes manifestation, leukocyte migration inhibition reaction (Spearman coefficient range between 0.55 and 0.63, inverse correlation) and blood count data (Spearman coefficient range between 0.50 and 0.65).
Conclusions. The standard chemotherapeutic course of treatment improves the condition of the cell-mediated immune system. The difference in the condition of the cell-mediated immunity in tuberculosis patients and almost healthy persons is sighnificantly reflected by such antigens as lternari alternata, Penicillum sp., Chrysonilia sitophila, Monilia sitophila.

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12. Reviews


The native achievements in the field of specific immunotherapy of the patients with bronchial asthma

B.M. Pukhlyk, S.V. Zaikov, I.V. Hohunska, I.V. Koritska, O.K. Yakovenko, B.Ya. Buleza

Declaration EAACI (2011) encourages leaders of the European countries to review health services attitude towards allergic diseases (AD) treatment and to give priorities to allergen-specific immunotherapy (SI) implication instead of pharmacological therapy since the first one is able to break off AD development significantly improving the quality of patients’ life and minimizing corresponding economical damage. The authors of the article cite appropriate experimental and clinical results (selecting dozens and hundreds of patients from population scale, thousands of patients from all over Ukraine) testifying to a high clinical effectiveness of parenteral and peroral SI in bronchial asthma treatment.
The authors underline that this is possible only while using highly specific regional allergens that ensures not only high effectiveness of treatment but also minimal side effect particularly at peroral SI.

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13. Reviews


Extrapulmonary tuberculosis in HIV-infected patients

O.D. Nikolaeva

The article introduces one of the urgent questions of phthisiology — extrapulmonary tuberculosis diagnostics in HIV-infected patients. Extrapulmonary tuberculosis is often observed in patients with immune deficiency. The most significant among clinical forms is lymphatic system tuberculosis, timely diagnosing it helps to begin treatment earlier and to prevent generalization. The article presents diagnostics minimum for early detection of extrapulmonary tuberculosis forms.

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14. Reviews


Gamma-interferon system and its role in pathogenesis of tuberculosis

I.F. Il’inska

The article presents recent data analysis on gamma-interferon system, its role in the immunological control of Mycobacterium tuberculosis and reviews the mechanisms of impact of this pathogen on gamma-interferon production and reception in tuberculosis.

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15. Reviews


Does pulmonary tuberculosis patient need thyroid state screening? Analytical review and own study results

S.L. Matveieva, O.S. Shevchenko, S.. Cherenko, T.V. Sencheva, O.Yu. Philipova

Pulmonary tuberculosis is frequently accompanied by the broad spectrum of thyroid state disorders like euthyroid pathologic syndrome, subclinical hypothyroidism and autoimmune thyroiditis. Some antituberculosis drugs (rifampicin, ethambutol, ethionamide and PAS) can induce euthyroid or hypothyroid goiter development. As thyroid hormones are the modulators of immune response to tuberculosis infection, thyroid pathology development provokes worsening of tuberculosis course and outcomes. Thyroid dysfunction in tuberculosis patients must be diagnosed in time in order to provide adequate treatment.

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16. Clinical case


Case study: transitory obstructive jaundice in HIV-infected patient with tuberculosis of lymph nodes

V.S. Hoidyk

The paper presents the case of the obstructive jaundice caused by enlarged lymph nodes package obstructing common bile duct in HIV-infected patient with tuberculosis of lymph nodes under the treatment in the in-patient department of the Odesa regional center to prevent and fight AIDS. The case emphasizes the necessity of recognizing possibility of development of such complications in patients with grave immunosuppression.

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Using interactive teaching methods in an independent work in practical classes of medical university students

S.M. Lepshyna, M.A. Mindrul, Ye.V. Tishchenko, N.V. Obukhova

Nowadays tuberculosis is a global problem. Donetsk National Medical University named after M. Gorky is training Ukrainian and foreign students. Providing basic knowledge on Phthisiology for the 4th year students is the goal of the department.
Objective: to analyze grade on Phthisiology of the 4th year students of the international medical faculty after using interactive methods as teaching aids for independent work in practical classes.
Materials and methods. The following types of interactive training for the independent work in practical classes were used: working in a small group, case study method, role play, brainstorming, mapping and discussions.
Results and discussion. Comparing the initial and final control results of the knowledge levels of students indicates a higher level of training of students who studied with the use of interactive methods in comparison with students who studied in the traditional form.
Conclusions. Interactive teaching methods help students of international medical faculty to learn the subject better.

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A potential breakthrough in the treatment of drug-resistant tuberculosis

In July 2012 world learned about the first promising results of the new three drugs combination trial for threatment of the multidrug resistant tuberculosis (MDR-TB) conducted by the Global Alliance for TB drug development and sponsored by Bill and Melinda Gates Foundation.The trial showed that «cocktail of drugs» known as PaMZ led to the death of 99 % of the pathogen in sputum of TB patients within two weeks after starting the treatment. The new combination of drugs was not only safe and highly effective for the MDR-TB, but is considerably cheaper than existing regimens and probably compatible with antiretroviral drugs.

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