| English
usaid banner

Issue. Articles

1(12) // 2013

 

 

1. Editorial

 

Acheivements and prospects of phthisiology

V.F. Moskalenko, V.I. Petrenko, H.V. Radysh

The article lighted up principal epidemiology data on tuberculosis as forn the end of 2012, and also describes current methods of diagnostics, treatment and prophylaxis, as far as it’s perspective development.

To download
full version need login

2. Editorial

 

Analysis of the data received in the process of HIV drug resistance early warning indicators (EWIs) collection in Ukraine

N.M. Nizova, M.H. Liulchuk, Yu.V. Kobyshcha, K.V. Voronova

Objective: to evaluate the effectiveness of the delivery of ART in Ukraine by analyzing the data of HIV drug resistance (HIVDR) early warning indicators (EWIs).
Materials and methods. The early warning indicators (EWIs) data were collected and analyzed. EWIs assess factors at the concrete clinics that are associated with the emergence of HIVDR.
Results and discussion. It was concluded that ART outcomes strongly depends on government ability for timely provision of patients with antiretroviral drugs. The patient’s adherence to the antiretroviral therapy requires further strengthening in the most regions of Ukraine.
Conclusions. The results showed that the health system which provides medical care for HIV-infected patients in Ukraine needs to be improved because the recommended EWIs targets were achieved in only two of the six regions involved in the study.

To download
full version need login

3. Original research

 

Influence of inductor of interferon on the dynamics of cavity closure in patients with the infiltrative newly diagnosed pulmonary tuberculosis

Yu.A. Varchenko

Objective: to clarify influence of inductor of interferon on the dynamics of cavity closure in patients with the infiltrative newly diagnosed pulmonary tuberculosis.
Materials and methods. The dynamics of cavity closure was analysed in 33 patients with the infiltrative newly diagnosed pulmonary tuberculosis (NDPT). Basic group of patients with NDPT, that received the inductor of interferon kagocel, included 16 persons. The group included also patient with treatment default on the 3rd month, but 2 month dynamics was present. The control group of patients, who received standard anti-tuberculosis treatment, included 17 persons.
Results and discussion. Kagocel administration during 1st month of treatment of patients with infiltrative newly diagnosed pulmonary tuberculosis promoted the dynamics of cavity closure after 2 months of therapy under the conditions of drug susceptibility. The further cavity closure dynamics without kagocel administration doesn’t differ from indexes of control group.
Conclusions. Kagocel administration during the 1st month of treatment significantly improves the dynamics of cavity closure after two months of treatment of patients with the newly diagnosed infiltrative pulmonary tuberculosis.

To download
full version need login

4. Original research

 

Features of the synthesis and metabolism of nitric oxide in patients with relapse and newly diagnosed cases of pulmonary tuberculosis during the initial phase of treatment

M.M. Kuzhko, O.S. Shevchenko, D.O. Butov, T.V. Sencheva, I.M. Kalmykov

Objective: to study characteristics of synthesis and metabolism of nitric oxide (NO) in patients with relapse (RPTB) and newly diagnosed cases of pulmonary tuberculosis (NDPT) during the initial phase of treatment.
Materials and methods. The investigation of the state of NO in 280 people, including 100 patients with RPTB, 150 patients with NDPT and 30 apparently healthy donors. In addition, patients were divided into two subgroups, each with and without the presence of destruction. NO state was assessed by inducible NO synthase (iNOS), nitrite and nitrate before hospitalization and two months after the start of the treatment.
Results and discussion. NO level in patients with pulmonary tuberculosis was significantly higher than in apparently healthy donors. There was a significant difference between patients with RPTB and NDPT before treatment, when rates of both NO synthesis and metabolism were higher in patients with NDPT
than RPTB. Patients with the destruction had significantly lower relative concentration of NO in comparison to the patients without destruction. A significant decrease of NO was observed after two months of therapy in patients with pulmonary tuberculosis in comparison to indicators before hospital
admission. Comparing NO between RPTB and NDPT patients revealed more marked significant decrease of NO in patients with NDPT than RPTB after two months of treatment.
Conclusions. Pulmonary tuberculosis showed a significant increase in NO indices in comparison to the healthy controls. Patients with RPTB before the start of treatment had significantly lower rates of NO than those with NDPT. A two-month chemotherapy resulted in a significant decline in NO in patients with
pulmonary tuberculosis. There were significant differences in the indices between patients with NO destructive and nondestructive pulmonary tuberculosis.

To download
full version need login

5. Original research

 

The differences between reasons of smear-positive and smear-negative pulmonary tuberculosis relapses

O.Yu. Hrib

Objective: to analyze the differences between reasons of smear-positive and smear-negative pulmonary tuberculosis relapses.
Materials and methods. The study was carried out using retrospective analysis of medical history of patients with pulmonary TB relapse cases who were treated in the Lugansk regional tuberculosis hospital from 2008 to 2012.
Results and discussion. The study revealed that quality of supervision according category 5.1 for patients with smear-negative pulmonary tuberculosis relapses was better in comparison to the smear positive cases. In addition, smear positive patients were regularly taking TB drugs during primary case in comparison to the patients with smear-positive relapses.
Conclusions. Thus, it is necessary to improve supervision of category 5.1 to prevent smear-positive relapses.

To download
full version need login

6. Original research

 

The experimental model of induced SiO2 granulomatous inflammation in the lungs of rats

M.H. Boiko, D.M. Boiko, D.E. Nikolenko

Objective: to analyze the method of modeling of granulomatous inflammation in rats by transthoracic introduction of particle suspension SiO2.
Materials and methods. The study included 18 mature Wistar rats with the weight of 255.8 (224.6—283.4) g and age of 7.1 (6.5—7.5) months. Rats were given transthoracic single dose of particle suspension of SiO2. Experiment lasted 8 weeks.
Results and discussion. 10 of the 12 rats who were artificially induced granulomatous inflammation in the lung by transthoracic injection of particle suspension SiO2 and being untreated, were found to have typical morphological features of granulomatous inflammation.
Conclusions. Comprehensive assessment of morphological changes in the lungs of rats with experimental modeling of granulomatous inflammation indicates a high level of reproducibility of the planned experimental pathology in animal groups.

To download
full version need login

7. Original research

 

The features of bronchoalveolar lavage cytokine profile in rats with modeled hepatopulmonary syndrome

I.Ya. Krynytska

Objective: to determine the content of pro- and anti-inflammatory interleukins in bronchoalveolar lavage in rats with hepatopulmonary syndrome (HPS) model.
Materials and methods. The experiments were performed on 60 nonlinear mature rats with hepatopulmonary syndrome model.
Results and discussion. The influence of two experimental models of hepatopulmonary syndrome on cytokine profile of bronchoalveolar lavage in rats has been studied. Significant increase of pro-inflammatory interleukins (IL-1β, IL-6, IL-8) content and decrease the anti-inflammatory interleukins (IL-10) content was observed in animals of both experimental groups.
Conclusions. Multidirectional reaction of pro-inflammatory and anti-inflammatory cytokines was observed in rats with experimental hepatopulmonary syndrome, what may play an important role in the initiation of HPS due to the accumulation and activation of alveolar macrophages and start of metabolic cascade reactions. IL-8 had undergone the most pronounced changes among the studied proinflammatory
cytokines in bronchoalveolar lavage.

To download
full version need login

8. Original research

 

Haematological and biochemical disorders in tuberculosis/HIV co-infected patients with different state of immunity

O.V. Korzh, O.A. Trunova, V.V. Mozghovy, O.V. Pavenko, N.S. Chursina, I.P. Uzun

Objective: to assess haematological and biochemical disorders in tuberculosis/HIV co-infected patients depending on the degree of immunosupression.
Materials and methods. 105 medical cards of HIV-infected patients with pulmonary tuberculosis were analyzed: 58 persons with CD4 count less than 200 cells/mcl (1-st group), and 47 persons with CD4 count more than 200 cells/mcl (2-nd group). All patients take medical treatment in an initial phase with five drugs, antiretroviral therapy was not administered. Data of general blood count, albumen, urea, creatinine, bilirubine, glucose, results of thimol test, activity of alanine aminotransferase, aspartate aminotransferase were analyzed.
Results and discussion. Half of the 1-st group of patients developed anaemia, 14 patients (24.1 %) — severe anaemia with the haemoglobine level less than 100 g.l–1. In other group anaemia was registered in 16 (34.0 %) cases, severe — in 3 cases (6.4 %), what was 3,7 time less frequent, p < 0,05. 9 patients (15.5 %) of the 1-st group died in hospital department before ending of treatment, 8 (88.9 %) among them had anaemia. 1 patient (2.1 %) of the 2-nd group died having normal haemoglobine level. Decrease of lymphocytes count, positive correlation between the CD4-lymphocytes and common quantity of lymphocytes, increase of urea, creatinine, bilirubine, glucose, results of thimol test, activity of alanine aminotransferase, aspartate aminotransferase were found in the 1-st group. The thimol test indices were increased practically in all patients of the 1-st and 2-nd groups: 52 (89.7 %) and 43 (91.5 %) persons respectively.
Conclusions. Haematological and biochemical disorders appear in co-infected TB/HIV patients with CD4 count less than 200 cells/mcl. Combination of the low level of CD4-cells and anaemia is an unfavorable prognosis factor, reduction of lymphocytes quantity less than 1000 cells/mcl indicates the immunosupre ssion and can be a reference criterion before immunological inspection. Reduction of
CD4-lym phocytes less than 200 cells/mcl is accompanied with severe violations of the organism’s functional state: increase of urea and creatinine content, activation of transaminases. Thimol test indices increase is the characteristic feature of HIV-infection even with the absence of the liver injury.

To download
full version need login

9. Original research

 

Some markers of endogenous intoxication in community-acquired pneumonia: importance for clinical use

N.A. Bilkevych

Objective: to study laboratory indexes of toxaemia and endotoxicosis in patients with different course of community-acquired pneumonia (CAP) for their clinical inportance evaluation and elaboration of objective criteria of pathological process severity.
Materials and methods. 175 in-hospital patients with CAP of I—III clinical groups were examined.
Indices of endogenous intoxication (EI) were studied in the groups of patients formed according to CAP clinical group what corresponds to the severity of the disease. Besides the studied EI indexes were compared in subgroups of patients of the III group with complications and without them. The control group
included 63 heathy persons. The following indices were studied: middle mass molecules (MMM254 and M280) in blood serum, leukocytes intoxication index (LII), blood serum toxicity (ST), antitoxic resistance of erythrocytes and leukocytes (ARE, ARL), and total toxicity of blood and interstitial fluid
(TTBIF).
Results and discussion. Violation of such indices representing toxins accumulation in blood of patients (toxinaemia), i. e. ST, MMM254, were found to be depending on direct ratio on the severity of CAP. A difference of absolute values of ST was significant in all three groups of patients ( < 0.01—0.001), while growth of MMM254 was proportional to the severity of pneumonia only for patients of I and II groups ( < 0.01—0.001). For the persons of III group that corresponds to the severe course of CAP, there was not a substantial increase of index in comparison to II group ( > 0.05), but marked growth of MM280 was
revealed ( < 0.02), what did not differ from a norm in I and II groups of patients. Correlation of TTBIF/ST in I and II groups of patients specified on the insignificant accumulation of toxins in the intersticial liquid (1.13 and 1.39 respectively), while it was equal 1.68 at severe course of CAP (III group), that specifies on considerably expressed endotoxicosis. ARE and ARL diminished proportionally to the severity of CAP, the difference of absolute values is significant in groups of patients ( < 0.01—0.001).
Complications of CAP were accompanied with more expressed changes of EI indexes, than in the III group of patients without complications. In patients with pleurisy toxaemia grew mainly, what was manifested with the increase of MM280 ( < 0.01) as well as in pulmonary tissue destruction with ST ( < 0.01). In pulmonary destruction and toxic shock on a background of high level of toxaemia endotoxicosis did prevaled, what was manifested with low values of ARE and ARL ( < 0.01).
Conclusions. The degree of EI and correlation of its constituents depend on the severity of CAP and its complications. In severe and complicated course of the disease endotoxicosis had a prevailing value. It may be objectively appraised by research of concentration of MMM280 in blood serum, antitoxic resistance of erythrocytes and leukocytes as well as total toxicity of blood and intersticial fluid.

To download
full version need login

10. Original research

 

Diagnostics and treatment of the destructive tuberculosis, complicated by endobronchial pathology

E.P. Shimko, V.V. Skryp, V.V. Moisiuk, Y.F. Sarvash

Objective: comparative study of features of symptoms and clinical course of processes in patients with destructive tuberculosis according to the nature of pathological changes in the bronchi and the duration of their outcomes.
Materials and methods. The study involved 210 adult patients with destructive changes in the lungs, who were divided into two groups. The first group consisted of 136 (65.0 %) patients with newly diagnosed pulmonary tuberculosis of different clinical forms. The second group included 74 (35.0 %) patients with relapses and chronic processes. Age of the disease in the first group was from 3 to 8 months, and in the second — from 2 to 6 years. On the basis of complex clinical and X-ray, bacterial and bronchial examination of the patients we can set the number of patterns that determine further medical tactics.
Results and discussion. The frequency of infiltrative forms of endobronchites among patients of the second group is 24.1 % higher than in the patients of the first group. These morphological changes lead to the formation of coarse fibrous scar tubercular formations in 18.0 % of patients of the second group vs.1.4 % in the first. Irreversible changes in the form of stenosis of bronchi were observed in 41.8 % of patients of the second group and they weren’t observed among patients with newly diagnosed forms of the disease.
Therapeutic measures were based on the rating of general clinical picture and local changes in the bronchi.
Conclusions. The study revealed that the nature of morphological changes in the bronchi in patients with destructive pulmonary tuberculosis highly depends on the duration and period of the disease. The technique of local sanitation of endobronchites taking into account the period of their occurrence, the rate
of return under the influence of complex therapy was suggested.

To download
full version need login

11. Original research

 

Pulmonary tuberculosis in combination with vegetativevascular dystonia

S.I. Kornaha

Objective: to study incidence, clinical manifestations, treatment efficiency of pulmonary tuberculosis patients in combination with vegetativevascular dystonia on data of regional TB dispensary.
Materials and methods. The vegetativevascular dystonia prevalence and treatment outcomes were analyzed according to the 6696 medical records of pulmonary tuberculosis patients for 2002—2011 years, including the last five years 3243 patients with newly diagnosed pulmonary tuberculosis.
Results and discussion. Comorbidities, particularly cardiovascular system in pulmonary tuberculosis patients have become more frequent in recent years: in 2002—2006 coronary heart disease, hypertension and vegetativevascular dystonia (VVD) wer observed in 11.2 % patients, in 2007—2011 — in 14.1 % (p < 0.05), VVD — in 0.9 and 1.8 % patient respectively (p < 0.05). Adverse events in newly diagnosed pulmonary tuberculosis patients (FDLTB) combined with the VVD were observed in 58.2 %, sputum smear conversion — in 88.1 %, healing of the cavities— in 57.1 %, what is significantly lower than the
treatment patients with TB without concomitant VVD.
Conclusions. Vegetative-vascular dystonia in newly diagnosed pulmonary tuberculosis patients was observed in 2 % of cases and in the majority (in 73.8 %) it manifested with subjective symptoms of the cardiovascular system and, fist of all, with the cardia-type reaction. Adverse events observed significantly
more often during antimycobacterial therapy in patients with newly diagnosed pulmonary tuberculosis combined with VVD and treatment efficacy was lower than in patients without this comorbidity.

To download
full version need login

12. Original research

 

The analysis of tuberculosis morbidity among population in the dessa region during 20092011 years

.K. Asmolov, .E. Shpota

Objective: to analyze the tuberculosis morbidity among all ages of Odessa region population.
Materials and methods. The main indices were analyzed according to the official «Indicators of TB services in Odessa region».
Results and discussion. The analysis of tuberculosis morbidity in Odessa region showed negative dynamics in comparison to two last years. The increasing level of tuberculosis morbidity and HIV/tuberculosis co-infection mortality along with the prevalence of drugresistant tuberculosis is the current issues.
Conclusions. The 2011 year morbidity is higher than the country level. The morbidity increased in our region during last three years, what can be explained by increasing number of patients with drugresistant tuberculosis, patients with co-infection tuberculosis/HIV. Also increasing indexes may be explained by increasing number of population who underwent mass radiography.

To download
full version need login

13. Original research

 

Experimental modeling of tuberculosis of bones and joints

H.H. Holka, T.H. Holka, .M. Kuznetsova, .A. Synenko

Objective: to describe the process of modeling of tuberculosis of bones and joints and its peculiarities in Guinea pigs for the further use of the results of the experiment in the medical and scientific practice.
Materials and methods. The experiment was conducted on 30 Guinea pigs. Modeling of tuberculous arthritis of the knee joint was carried out on the basis of authors patented method (Patent 70401 (UA)). All the animals were under dynamic observation including clinical, Xray, pathomorphlogical and laboratory
examination. The euthanasia of animals was made at the early developed of tuberculous process.
Results and discussion. Authors managed to trace the stages of the development of the tuberculosis gonitis in the Guinea pig and track the modern features of clinical, -ray and pathomorphological course.
the identity of the model of the main clinical forms of tuberculosis of the knee joint in the Guinea pig and a human was found.
Conclusions. This experimental model of tuberculosis of the bones and joints gives an opportunity to develop an experimental model of various surgical interventions depending on the stage of the disease and gives the opportunity to study the diagnostic value of various laboratory methods of diagnostics of osteoarticular tuberculosis, including polymerase chain reaction.

To download
full version need login

14. Original research

 

Features of viral response in patients with hepatitis /HIV co-infection depending on stage of the disease

E.S. Mamedov

Objective: to estimate efficiency of treatment of chronic hepatitis C (CHC) in HIV infected patents depending on the amount of CD4-cells.
Materials and methods. The study included 111 HIV infected patients with CHC co-infection.
A control included 150 monoinfected with CHC. The blood biochemical analyses with aminotransferase activity, bilirubin and its fractions, viral load (HIV and HCV), HCV genotype were carried out for all patients. CD4-cell count was carried out for the patients of basic group. Treatment efficacy was assesed by the dynamics of decline of the viral load during therapy and during a supervision after treatment for 24 weeks. A rapid virologic answer (RVA) corresponded to the undetermined level of the viral load after 4 weeks of therapy, early (EVA) — after 12 weeks and a stable virologic answer (SVA) corresponded to the undetermined level of the viral load after 24 weeks of treatment.
Results and discussion. The ultimate goal of therapy (achievement of SVA) was the least achieved for patients with the CD4-cells count 250—350 cells. This group also had the least patients, who achieved RVA and EVA. The group with the CD4-cell count > 500 cells had practically an identical amount of patients as in control group, who achieved EVA (97.2 and 98.4 % respectively), however SVA was achieved in 79.8 and 88.2 % respectively. The group with the CD4-cells count 350—500 cells achieved EVA in 92.2 %, SVA — in 69.2 %.
Conclusions. Advancing of HIV-infection is accompanied by progressive decline of chances of SVA achievement — from 81.8 % for patients with the CD4-cell count > 500 cells to 46.9 % at the CD4-cell count 250—350 cells. Virus genotype dependent decrease of virologic answer did not have a significant
difference in all groups.

To download
full version need login

15. Reviews

 

Differential diagnosis of mediastinal changes

V.I. Petrenko, E.N. Raznatovskaya, N.O. Skorokhodova, M.V. Bendus, H.V. Zubov

The article presents the clinical-radiographic manifestations, diagnosis and differential diagnosis of mediastinal changes.

To download
full version need login

16. Reviews

 

Chronic obstructive pulmonary disease accompanied by ischemic heart disease and arterial hypertension

L.D. Todoriko

Peculiarities of the course of chronic obstructive pulmonary disease (COPD), especially, in the elder age groups were analyzed. The presence of high comorbidity of the pulmonary and cardiac pathology associated with ischemic heart disease and arterial hypertension is a characteristic feature for these patients.
The data concerning the rational choice of hypotensive drug for patients with COPD accompanied with ischemic heart disease were presented by the author in by literature review. The rational choice of the hypotensive drugs is based on its pharmodynamics and pharmokinetics as well as the clinical situation (age, arterial hypertension degree, complications, concomitant diseases) and influence of hypotensive therapy side effects on the course of chronic obstructive pulmonary disease (protussive action, absence of negative influence on bronchial passage, absence of hypokaliemia effect, pharmacology drug interaction) should be taken in consideration.

To download
full version need login

17. from experience

 

School for newly diagnosed pulmonary tuberculosis patients as a fragment of a complex treatment at the hospital stage

B.V. Noreiko, V.V. Mozghovoy, H.L. Fedorovskaya, M.V. Zabirov, V.N. Nosach

Increase of efficiency of treatment of tuberculosis is the most important condition of a successful fight against the epidemic of this disease.
Experience of organizing and conducting Tuberculosis Patients’ school on the basis of the Donetsk Regional Clinical TB Hospital showed that the final result of a complex treatment and especially the outcome of chemotherapy largely depend on the involvement of the patient in process of treatment. The main purpose achieved by the patients’ school is attracting patients to active and conscious participation in the practical realiza tion of medical advice and upbringing of the adherence of patients to treatment and conducting a healthy way of life.
Topics of the talks held in the framework of Patient’s school by employees of TB Hospital, is specified depending on the stages of the treatment. The first conversations are for the comprehensive discussion of the tasks of the patient during the period of the initial phase of chemotherapy. Then, after 2 months of intensive chemotherapy and sputum conversion the patient is being prepared for his new role in the period of the treatment continuation phase.
The active participation of the patients in the implementation of the medical recommendations with the support of the Patients’ School has contributed to increasing the effectiveness of the treatment in the Department 1 of the TB Hospital up to 95 %.
The main positive outcome of the School for TB patients is the reduction of cases of «treatment default» in Donetsk to 3 % in 2011 and up to 2 % in 2012 at the admissible norm (display) up to 5 % of the total contingent of patients being treated in the Donetsk Regional Clinical Tuberculosis Hospital.

To download
full version need login

18. QUESTIONS OF CLASSIFICATION

 

Classification of critical conditions at pulmonary tuberculosis

N.I. Fomichova, N.A. Hritsova, .. Raznatovska

The paper describes a new classification of the critical conditions for pulmonary tuberculosis taking into account the nature of pathological and functional changes, the degree of severity, the provision of care depending on the category and stage of the critical conditions (Copyright certificate 47484 Scientific writing «Classification of critical conditions for pulmonary tuberculosis»).

To download
full version need login


Publisher


Services


Partners


Advertisers


Subscribe








© VIT-A-POL