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Issue. Articles

4(11) // 2012



1. Editorial


Current view on the problem of the associated triple infection: tuberculosis, HIV/AIDS, hepatitis B and

V.I. Petrenko

The article presents review of the recent data on the urgent issue of the associated triple infection tuberculosis, HIV and viral hepatitis B and , namely concerning the epidemiology, clinic, diagnostics and treatment.
Prevalence of triple infection can be estimated by some regional research data which shows prevalence of the co-infection for patients with tuberculosis (6.7 %) or HIV-infected persons (4.7 %). The plural ways of transmission of infections are stated, including both sexual, parenteral and contact, including that in medical and preventive establishments.
The complex influence of viruses, antibacterial, anti-viral and drugs in patients with tuberculosis associated with HIV and viral hepatitis leads to the marked toxic, cytolytic and immunosupressive effect on the whole organism thus predetermining development of complex of the persistent and progressive disbalance of metabolic homoeostasis. The research data revealed that these patients have complicated tuberculosis course 1.8 times more often, associating with propensity to rapid generalisation; more frequent sputum-positivity and destructive changes in lungs. These patients apears to have more often tuberculosis of intrathoracic lymphatic nodes, polyserositis and extrapulmonary tuberculosis.
Efficiency of antituberculous treatment for patients with the co-infection depends, first of all, on the HIV stage. Viral hepatitis promotes the risk of exitus letalis of tuberculosis cases on 80 %.
Thus, development and rationale of the preventive and treatment measures concerning patients with associated triple infection are very necessary.

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2. Original research


Peculiarities of clinical course and treatment results of the tuberculosis relapses in HIV-infected patients

S.. Cherenko, H.M. Roienko, M.V. Pohrebna

Objective: to study the features of clinical course of tuberculosis and results of treatment of HIV-in­fected tuberculosis patients.
Materials and methods. The randomized controlled retrospective research involved 255 HIV patients with the new-onset tuberculosis and 81 HIV-infected patients with the relapse of disease.
Results and discussion. Relapses couse with the great lesion site and localization in lungs, the presence of destructive changes and a positive smear/culture results is identic to the primary disease. Relapses cases are two times more often drug-resistant than new-onset cases due to multidrug resistance in 22.5 % relapses. The highest level of drug resistance is to isoniazid (38.8 %) and to streptomycin (34.7 %) due to multi- and polyresistance. Drug resistance to rifampicine (24.5 %) is determined mainly due to multidrug resistance. The treatment results in patients with the relapses of disease was significantly lower — effective treatment result were in 41.9 % patients, that is on 20.1 % less than in patients with new-onset cases. The decline of efficiency of treatment took place mainly due to the greater amount of lethal cases (27.2 % against 8.2 % in new cases, p < 0.05). The main reasons of death of patients with the new cases of tuberculosis were miliary forms of disease with severe immunodeficiency and concerning patients with relapses — multidrug resistance of MTB.
Conclusions. The isolated pulmonary tuberculosis in HIV-infected patients in case of the repeated disease has the same course as in new-onset primary desease, however there is a high level of multidrug resistance which prejudices efficiency of the standard treatment regimen by 2nd category in case of application of conservative methods of the 1-st line drug susceptibility testing.

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3. Original research


Clinical effectiveness of using endogenous interferon inductor in patients with new-onset pulmonary tuberculosis

Yu.A. Varchenko

Objective: to study changes of clinical-immunological signs in patients with infiltrative new-onset pulmonary tuberculosis (NTB) after using endogenous interferon inductor.
Materials and methods. Clinical signs, indexes of complete blood cell count and immunological test of 36 patients with NTB were analysed. Basic group included 15 patients with NTB, who underwent treatment with the interferon inductor kagocel. Control group consisted of 17 patients, who did not take medication. Data of the both groups of patients was compared to the data of 33 healthy persons. The dynamics of clinical-immunological changes was studied after 4—5 month of undergoing in-patients treatment.
Results and discussion. Kagocel-included treatment favoures lymphocytes level after 4—5 months of treatment, promotes the number of T-cell-helpers in comparison to healthy persons. The revealed sugnificant decline of NK-cell count (p < 0.001) testifies to positive influence of kagocel on the dynamics of NK-cell count decline in comparison to patients of control group and indirectly testifies to strengthening of specific cellular immunity under the kagocel intake. Monocytes count rises after the kagocel intake in comparison to the control group and group of healthy persons (p < 0.001). In other words kagocel therapy results in the system activating of phagocytes immunity. Influence of kagocel on other indexes of complete blood cell count, immunological test, clinical indexes wasn’t stated. Kagocel therapy hasn’t resulted in any side-effect for the whole study period.
Conclusions. The kagocel intake by patients with infiltrative NTB results in activating of cellular immunity, namely — phagocytes link by the increase of monocytes count. Kagocel intake by patients with infiltrative NTB favoures normal lymphocytes number and more rapid dynamics of NK-cell count decline, results in proliferation of T-cell-helpers (CD4+) in comparison to healthy persons. No influence on clinical indexes was observed.

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4. Original research


Efficiency of gemifloxacin-included treatment of patients with drug-resistant destructive pulmonary tuberculosis

H.V. Radysh

Treatment of drug-resistant tuberculosis requires emergency attention, what it associated with not only its high burden but also with low treatment efficiency. For this reason a search of new drugs is one of priority directions in the fight against tuberculosis.
Objective: to study and compare clinical efficiency of gemifloxacin in the individual regimens of antituberculous therapy of drug-resistant destructive pulmonary tuberculosis during the intensive phase with the ofloxacin- and levofloxacin-containing regimens.
Materials and methods. 78 patients with new-onset or previously treated destructive pulmonary tuberculosis underwent examination and standardized fluoroquinolone-including therapy. Patients were divided into three groups of 26 persons. The first group consisted of patients who recieved gemifloxacin as fluoroquinolone during 2—6 months of intensive phase. The second and third group consisted of patients who recieved levofloxacin and ofloxacin respectively.
Results and discussion. The 1-st and 2-nd groups data showed significantry more frequent reduction of intoxication (88 %; < 0.05) and regression of cavities (77 %; < 0.05) in comparison with the 3-rd group. Only the 1-st group revealed more frequent sputum conversion in comparison with the 3-rd group (85 %;  < 0.05). The obtained data testify to identical efficiency of the regimens with gemifloxacin and levofloxacin and significantly higher in comparison with the ofloxacin-containing regimen.
Conclusions. High clinical efficiency of individual antituberculosis therapy of drug-resistant pilmonary tuberculosis with inclusion of gemifloxacin allows to recommend this drug for the treatment of patients of this category.

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5. Original research


Secondary immunodeficiency: a consequence or the reason of bronchopulmonary diseases?

A.K. Asmolov

Objective: to study the functional state of organism, in particular, seaman in the conditions of marine transmeridian passage, immunological status and level of oligoelements in the blood serum depending on age, professional group and experience of work on the water craft.
Materials and methods. The study included 250 generally healthy seamen who were approven by medical board for the water craft work.
The examination of seamen in the conditions of passage included registration of R-R cardiogram intervals by pulse-measuring device «Elektronika IPP-OITS» 6 times per day (8 am, 12 pm, 4 pm, 8 pm, 12 am, 4 am), that corresponds to the basic office hours on a fleet — 4 hours watch in 8 hours. The study results were processed with the use of the program of mathematical analysis of heart rhythm with the calculation of next indexes: — mean of cardiointerval index (analized 100 R-R intervals), SD — standard deviation, 0 – mode amplitude, TI — tension index, Δ – variation scope, k — coefficient of correlation after the first change, m — numbers of changes of autocorrelation function to the first negative value, S – pover of spectrum of slow order waves, Sd — powers of spectrum of respiratory waves, S – power of spectrum of order slow waves, V — coefficient of variation, HR – heart rate.
Results and discussion. The pacemaker function on all stages of passage was characterized by moderate sine arrhythmia. The indexes of vegetative homoeostasis marked strengthening of the sympathetic nervous system tonus. Among professional groups the most reliable decline of level of such oligoelements as Fe, K, Mn, Mg, Se, Zn, was observed in motor mechanics, and then in mechanics i.e. workers of machine room, that it determinet by specific terms of labour of these groups in the water craft conditions. Significant changes of the cellular immunity indexes were revealed in different professional groups.
The most considerable changes such as decline of the levels of lymphocites count, T-cell count, T-suppressor-cell count, -helper count and NK-cell count were revealed in the rank personnel — sailors and motor mechanics,.
Conclusions. Seamen in the conditions of transmeridian passage have considerable tension of adaptation mechanisms, which along with the disbalance of oligoelements in blood results in development of secondary immunodeficiency. The revealed changes of immunological status of microelement indexes in serum may be the ground for heightening of morbidity of bronchopulmonary diseases.

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6. Original research


Terms and causes of tuberculosis relapses in HIV-infected persons

H.M. Roienko, S.O. Cherenko, M.V. Pohrebna, Yu.O. Senko

Objective: to evaluate the terms and causes of tuberculosis relapses in HIV-infected persons
Matherials and methods. The controlled retrospective study involved 81 patients with recurrent tuberculosis, who underwent full basic course of treatment of the primary disease.
Results and discussion. In cases of detection of HIV before or concurrent with new-onset tuberculosis in the absence of ART developed early relapses of tuberculosis as a result of HIV disease progression in terms of (24.4 ± 2.4) months after the primary disease. TB relapse in these patients with ART occur in signifi­cantly fewer cases as a syndrome of immune system resuming. Late relapses are used to develop in terms of (57.7 ± 3.3) months when HIV was detected after new-onset tuberculosis in the absence of ART. The study did not reveal any causal link between the intensity, duration of standard chemotherapy (6-month four-component or 8-month five-component course), anti-relapse chemotherapy and risk of recurrence of tuberculosis.
Conclusions. Inadequate chemotherapy of the primary disease (quantity of daily doses and schedule), not receiving ART or ART appointed after completion of treatment of the primary disease with the progression of immunodeficiency are sighnificantly associated with the risk of tuberculosis relapses in HIV-infected persons.

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7. Original research


Status of function of kidneys in patients with pulmonary tuberculosis according to genotypes GSTM1, GSTT1 and NAT2

.K. Asmolov, Ya.V. Beseda

Objective: to study relation between polymorphism of genes of detoxification of xenobiotics and func­tion of kidneys in patients with pulmonary tuberculosis.
Materials and methods. The study included 75 patients with pulmonary tuberculosis, 56 of them had new-onset pulmonary tuberculosis and 19 patients had chronic pulmonary tuberculosis. DNA-extraction was carried out from the leucocytes of peripheral blood in patients with pulmonary tuberculosis and from scrapes of orap cavity epithelium in 36 healthy persons (control group) with further determining of polymorphism of GS1, GS1, N2 (2*4, 2*5, 2*6, 2*7).
Results and discussion. In 3 months after the initiation of treatment in patients essential growth of contained general fiber of urine compared with the previous stages of inspection is marked. The indicator microalbuminuria increases in all groups of the surveyed patients throughout the treatment in comparison with the beginning of treatment. In 3 months after the start of treatment patients with chronic tuberculosis presents the higheer level of microalbuminuria, than in the previous stages. The study showed that level of low-molecular fibers considerably exceeds amount of high-molecular fibers except for genotype NAT2*2*4 almost in all groups. Genotypes NAT2 of homozygote, del GSTM1 and GSTT1 play the special role in development of the pathological status. Presence of NAT2*2*5 and NAT2*2*6 alleles is connected with considerable changes in drug-induced kidney tissue impairment indicators.
Conclusions. Standard antituberculosis therapy of pulmonary tuberculosis is revealed to affect considerably kidney reabsorbtion and secretion functions.
Presence of genotypes NAT2 of heterozygote, NAT2 of homozygote, del GSTM1, del GSTT1 and NAT2*2*5 allele may be one of provocative factors of development of kidneys secretory system impairment against the background of treatment with and line antituberculosis drugs.

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8. Original research


The influence of glucocorticosteroids on the dynamics of clinical symptoms and systemic value of pro- and anti-inflammatory cytokines in patients with sarcoidosis

M.H. Boiko, D.M. Boiko

bjective: to analyze the effect of glucocorticosteroid therapy on clinical status and dynamics of system levels of pro-and anti-inflammatory cytokines in patients with sarcoidosis.
Materials and methods. The study involved 25 generally healthy individuals and 25 patients with sarcoidosis. All participants underwent a comprehensive clinical and instrumental examination, including morphological studies and determination of the level of (IL) -1, -4, -6, -8, -10, TNF-α in serum. All patients with sarcoidosis were examined during an exacerbation before prescribing treatment and after 6 months of treatment with corticosteroids.
Results and discussion. The therapy with glucocorticosteroids for 6 months significantly (p < 0.05) reduced the severity of dyspnea (MRC scale), whereas lung function and pulse oximetry did not change significant­ly. During the exacerbation of sarcoidosis patients had statistically significant (p < 0.05) increased level of the proinflammatory cytokines indices (IL-1, IL-8, TNF-α) and decreased almost 1.76 times level of IL-10 in comparison to the control group. Use of corticosteroids in patients with sarcoidosis during exacerbations was accompanied by a reduction of the system value of proinflammatory cytokines (IL-1, IL-8, TNF-α), along with increasing concentrations of IL-4 and no statistically significant difference in IL-10 levels in patients between aggravation and after 6 months of treatment.
Conclusions. Use of glucocorticosteroids in complex treatment of patients with sarcoidosis promotes positive dynamics of clinical status and significantly (p < 0.05) decrease in the serum levels of proinflammatory cytokines (IL-1, IL-8, TNF-α) on the background of low levels of IL-10.

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9. Original research


Impact of pharmacotherapy of pulmonary tuberculosis

M.M. Kuzhko, M.T. Klimenko, N.M. Hulchuk, M.I. Linnik, O.V. Avramchuk, L.M. Procyk

Objective: to study the expediency of research of clinical efficiency of intravenous chemotherapy in the intensive phase of treatment of patients with the new-onset pulmonary tuberculosis on the basis of data of pharmakokinetics and bacteriostatical activity of blood (BAB) at the different ways of antituberculous drug administration.
Materials and methods. The comparative analysis of pharmakokinetics and BAB of at the different ways of rifamycin administration was carried out. The study of clinical efficiency of parenteral way of rifa­mycin SV, izoniazid and ethambutol application was also carried out in 60 patients by the estimation of process dynamics using computer tomography.
Results and discussion. The mean of rifamycin natrium salt maximal concentration after intravenous administration in the dose of 450—600 mg presented (22.9 ± 2.3) mcg/ml which sighnificantly ( < 0.05) exceeds the rifampicin concentration after capsules administration in the dose of 450—600 mg (8.9 ± 1.3) mcg/ml. The minimum ingibitory concentration of rifa­mycin SV was revealed to be in 10 times less than than analogical index of rifampicin — 0.03 and 0.3 mcg/ml respectively.
BAB high levels were accessed in 100 % patients who received izoniazid, rifa­mycin SV and ethambutol by intravenous administration. At peroral administration of izoniazid, rifampicin and ethambutol perorally high levels of BAB were accessed in (90.9 ± 8.7) % patients. Results of research of BAB dynamics during six hours was testified to maintenance of indexes within the limits of high and middle levels.
As a result of clinical research the patients of basic group, who received drug by parenteral administra­tion, showed extinction of the symptoms of intoxication in (2.2 ± 0.2) weeks in comparison with the patients of control group — (3.1 ± 0.4) weeks ( < 0.05). Sputum conversion by microscopy was 100% in the patients of basic group and only 14 (82.4 ± 9.2) % in the control group while conversion by culture was revealed in basic and control groups in 21 (100 %) and 16 (80.0 ± 8.9) % patients respectively ( < 0.05). The middle terms of healing of cavities for the patients of basic group presented (3.1 ± 0.3) month, in a control group — (3.7 ± 0.5) month ( > 0.05).
Conclusions. The maximal concentration of rifa­mycin SV natrium salt after intravenous administration was 2,5 times higher that concentration at the peroral administration in capsules. Complex intravenous application of antituberculous drugs was accompanied only by large and middle levels of BAB. Middle terms of observation of symptoms of intoxication in the basic group of patients with parenteral administ­ration of izoniazid, rifa­mycin SV and ethambutol were sighnificantly lower than in the control group. The basic group presented the tendency to more rapid sputum conversion by both microscopy and culture, and more rapid rates of scarring of cavities in comparison with the control group.

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10. Original research


Regarding characteristics of combined chronic tuberculous pleurisy

I.D. Duzhyi, H.P. Piddubna, L.A. Bondarenko, N.I. Hlazunova, R.Z. El-Astal

Objective: to establish communication with various forms of pulmonary tuberculosis, its course, treatment and development of chronic pleurisy.
Materials and methods. The study involved 181 patients. Standard, radiological and microbiological studies were applied.
Results and discussion. There was found that 93 (51.4 %) individuals suffered various forms of tuberculosis of the lungs and pleura in the past, but they did not receive systematical treatment. 12—48 months later process reactivation with the development of tuberculous pleurisy and its chronicity were observed. In 88 (48.6 %) patients pulmonary tuberculosis and pleurisy developed simultaneously with symptoms of chronicity of the latter. In order to prevent further progression of the disease and prevention of pulmonary heart after antibiotic preparation simultaneous interventions based on pleurectomy were performed.
Conclusions. A desultory treatment of patients with pulmonary tuberculosis and tuberculous pleurisy is accompanied by progression of pulmonary tuberculosis, development of a combined chronic pleurisy, progressive resistance of mycobacterium tuberculosis to antibiotics and the development of pulmonary heart that can be prevented by timely performed surgical operation of simultaneous nature.

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11. Original research


Clinical symptoms of endogenous intoxication: diagnostic meaning for its evaluation in community-acquired pneumonia

N.A. Bilkevych

Objective: to study clinical indices of endogenous intoxication in patients with different severity of community-acquired pneumonia (CAP).
Materials and methods. 175 in-hospital patients with CAP of I—III clinical groups were examined. The expression and frequency of endogenous intoxication (EI) clinical symptoms (complaints, data of physical assessment and some laboratory tests) were evaluated.
Results and discussion. Frequency of appearance of the evaluated signs and their values changed dependently on the severity of the disease (especially involving data of complete blood count and urinalysis, leucocyte intoxication index), however these relations were not always proportional. In severe course of CAP there were registered both increase and diminishing of some indices. Such indices as erythrocites sedimentation rate, percentage of eosinophils and stub neutrophils in complete blood count formula as well as proteinuria were the most clear indicators of the disease severity.
Conclusions. Unspecificity and considerable amount of endogenous intoxication clinical symptoms predetermine the necessity of more specific criteria application with the purpose of EI level estimation in community-acquired pneumonia.

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12. Original research


Hyperuricemia in patients with pulmonary tuberculosis during treatment

M.M. Savula, N.M. Lopushanska, S.M. Pohyliak, N.S. Maiovetska, I.S. Yakymets, O.V. Lazarchuk

Objective: to study the concentration of uric acid in serum of patients with pulmonary tuberculosis.
Materials and methods. The serum uric acid levels was examined in one hundred nighty seven patients (158 — with new-onset tuberculosis and 39 — with relapses and chronic forms) in different time points.
Results and discussion. The study revealed the increase of uric acid in serum in 9.2 % patients with new-onset tuberculosis. No significant increase of the uric acid level in patients with lung destruction, concomitant diseases and significant increase during chemotherapy and in patients with relapses and chronic forms of tuberculosis was also stated.
Conclusions. The hyperuricemia is possible in patients with tuberculosis, especially during chemothe­rapy. The intervention depends on clinical manifestation and possible mechanisms of its development.

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13. Original research


The results of lymph nodes histological investigation in patients with lymphadenopathy at HIV-infection in relation to the baseline count of CD4+-lymphocytes

I.N. Baskakov, R.B. Chkhetiani, O.N. Skachko, K.A. Liniov

Objective: to study features of histological picture of bioptated lymphonoduss in patients with lymphadenopathy (LAP) at HIV-infection depending on the amount of CD4+-lymphocites.
Materials and methods. The study involved 80 patients with LAP at HIV-infection in age from 23 to 47 who were performed biopsy of lymphonodus with a subsequent Ziehl—Neelsen microscopy and histolo­gical verification of tuberculosis. Besides that CD4+-lymphocites count in the peripheral blood was performed with the use of flow cytometry. According to the obtained results all patients were divided into two groups: the basic group (CD4+-lymphocites count less than 200 cells/mcl) and the group of comparison (CD4+-lymphocites — 200 cells/mcl and more).
Results and discussion. The histological research of lymphonoduss revealed reactive LAP (16 (61.5 %) in the group of comparison, 26 (48.1 %) in the basic group), malignant tumours (6 (23.1 %) in the group of comparison, 8 (14.8 %) in the basic group) and tuberculous lymphadenitis (4 (15.4 %) in the group of comparison, 20 (37.0 %) in the basic group). Tuberculosis lymphadenitis in the basic group was significantly more frequent than in the group of comparison ( < 0.05). Significant difference in the prevalence of reactive LAP, malignant tumours in the studied groups was not revealed.
Conclusions. The study revealed that lowering of CD4+-lymphocites count level below 200 cells/mcl is more often observed at tuberculosis lymphadenitis with caseous necrosis of lymphonodus. Thus, biopsy of lymphonodus with histological analysis is recommended for these patients.

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14. Original research


Profile of drug resistance to antituberculosis drugs in patients with MDR and XDR tuberculosis depending on the case definition of the disease

N.A. Litvinenko, S.O. Cherenko, M.V. Pohrebna, Yu.O. Senko, V.V. Davidenko, H.I. Barbova, H.M. Roienko, C.P. Vasilenko

Objective: to study the profile of drug resistance to antituberculosis drugs in patients with MDR and XDR tuberculosis depending on the case definition of the disease.
Materials and methods. The randomized retrospective research involved 420 patients with MDR and XDR tuberculosis, who were carried out drug susceptibility test to the 1-st and the 2-nd line antituberculo­sis drugs.
Results and discussion. MDR-TB patients showed higher frequency of XDR-TB — 21.9 %. MDR-TB patients in comparison with XDR-TB patients were «new cases» in 15.5 % against 6.5 % (p < 0.05), although the number of the «repeated treatment» or «chronic tuberculosis» cases was almost equal (in 64.9 and in 65.2 % of MDR-TB patients and 19.5 and 28.2 % XDR-TB patients respectively (p > 0.05).
Drug resistance was more frequent to S — in 89.0 %, E — in 68.8 % and Et — in 54.8 % patients. Among XDR-TB patients drug resistance to all 1-st and 2-nd line antituberculous drugs (S, E, Et, Pas, aminoglycosides, fluoroquinolones), except Z was noted more often in compararison with MDR-TB patients.
MDR-TB patients with the «new cases» of disease showed more rare resistance to Km (Am, Cm) in comparison with the cases of the «retreatment up to 2 years» (in 15.7 against 31.9 % respectively; < 0.05), and also showed a tendency of lower rate of resistance to other antituberculous drugs in comparison with the cases of the «retreatment up to 2 years» and «chronic tuberculosis». XDR-TB patients with the «new case» of disease were revealed to have less frequent resistance to Z and Pas (p < 0.05) in comparison with «retreatment up to 2 years» and «chronic tuberculosis» cases. Drug resistance to E, Et, Cm was stated to be of identical rate in all patients.
Conclusions. XDR-TB was revealed in 21.9 % patients with MDR-TB, thus the «new cases» of disease presented 6.5 %. MDR-TB patients had less frequent drug resistance to the majority of antituberculous drugs of the 1-st and the 2-nd line in comparison with XDR-TB. Patients with the «new cases» of disease revealed less frequent drug resistance to some 1-st and 2-nd line antituberculous drugs in comparison with the cases of the «retreatment up to 2 years» and «chronic tuberculosis».

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15. Original research


Changes of prooxidant-antioxidant system in patients with pulmonary tuberculosis relapses against the background of standard antituberculosis chemotherapy

M.M. Kuzhko, D.O. Butov, I.M. Kuznetsova

bjective: to study the changes of prooxidant-antioxidant system in patients with pulmonary tuberculosis relapses (RPTB) against the background of standard antituberculosis chemotherapy.
Materials and methods. A spectrophotometric study of the prooxidant-antioxidant system in the blood serum was performed in 30 healthy donors and 100 patients with infiltrative RPTB including 29 patients without destructive processes in the lungs and 71 — with destruction. Indicators of lipid peroxide oxidation (LPO) (trienoic conjugates (TC) and lipofuscin pigments (LP)) and antioxidant protection (AOP) — superoxide dismutase (SOD), total antioxidant activity (TAA), glutathioneperoxidase (GP) and glutat­hione reductase (GR)) were evaluated.
Results and discussion. The study revealed abnormalities in prooxidant-antioxidant system in patients admitted to the hospital: a significant increase of TC and LP levels and significant decrease of the levels of SOD, TAA, GP, GR in comparison with generally healthy persons. The increase of levels of AOP indices and decline of POL indices' levels after two months of standard antimycobacterial therapy were also stated.
Conclusions. The study results allow to conclude that significant changes in the functioning of prooxidant-antioxidant system occurs in patients with RPTB and shows up with the abnormalities of the levels of AOP indices and accumulation of lipid peroxidation products. Quite significant difference was stated between patients with and without destructive processes in the lungs before the standard chemotherapy. Standard antimycobacterial therapy provides insufficient recovery in prooxidant-antio­xidant system that may serve as an indication for use of antioxidant and membrane-stabilizing drugs in the treatment of tuberculosis patients.

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16. Epidemic situation


Strain composition of influenza viruses population isolated in Ukraine in 20112012

O.V. Onyshchenko, O.S. Holubka, A.P. Mironenko, D.O. Stepansky

Results of type and strain identification of influenza viruses isolated in Ukraine during 2011—2012 epidemic are presented. It was found that identical influenza viruses caused influenza epidemic in Ukraine and in the world.

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17. Education


Methodological support for the phthisiology classes in the implementation of credit-module system

L.A. Hryshchuk, I.T. Piatnochka, M.M. Savula, N.S. Kravchenko, S.I. Kornaha

The article describes the results of the latest techniques implementation into the educational process at the Ternopil State Medical University named after I. Ya Horbachevsky, especially on the phthisiology course. A number of new techniques were implemented into the learning process as a result of the study of international best practices: «Single day» training technique; Z-System; practical skills matriculas; semester test control, Moodle student remote monitoring programme.

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18. Methods of evidence-based medicine


Evaluation of the different methods of transformation of the statistical indicators for the integrated rating of the regions of Ukraine on epidemic situation of HIV infection

O.V. Postnov

Objectives: To investigate the characteristics of some statistical indicators used for the integrated rating of the regions of Ukraine on epidemic situation of HIV infection and the impact of different methods of the statistical indicators making on the final integrated rating; to assess the compliance of the rank method for integrated rating and possibility of usage of the normalized indicators for it.
Materials and methods. Statistical data on HIV epidemic in the regions of Ukraine for 2011 were used. We described the statistical characteristics of the indicators statistical arrays. The internal structure of the statistical arrays was analyzed using the hierarchical and two step cluster analysis. The statistical arrays were standardized and integrated rating was calculated by two methods: sum of rank and sum of standar­dized indicators.
Results and discussion. We showed that most indicators have distribution that differs from the uniform distribution. Statistically significant clusters were identified in the statistical arrays of the all indicators. Uneven distribution results in significant deformation of the final integrated rating.
Conclusions. The method of rank is not consistent with the characteristics of statistical indicators of HIV infection. Application of this method for the integrated rating does not allow to adequately reflect the territorial heterogeneity of the epidemic process of HIV infection. Application of standardization of statistical indicators improves epidemic diagnosis of HIV infection. The best method of standardiza­tion of statistical indicators is a question for further research.

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