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Issue. Articles

2(17) // 2014

 

 

1. Original research

 

Dynamics of sputum conversion terms in patients with new cases of extensively drug-resistant tuberculosis

S.O. Cherenko, N.V. Grankina, N.A. Litvinenko, M.V. Pogrebna, Yu.O. Senko

Objective — to study the dynamics of sputum conversion terms during the initial phase of chemotherapy to determine the optimal treatment duration.
Materials and methods. The study included 144 patients with new cases of extensively drug-resistant tuberculosis, which were detected among patients with newly diagnosed tuberculosis, retreatment cases (relapse, treatment failure of the first course, discontinued treatment) and retreatment failure. Patients treated with individualized chemotherapy regimens, including 4—6 effective drugs according to the test drug sensitivity.
Results and discussion. The sputum conversion during the initial phase of chemotherapy was detected in 49.3 % of patients, the rest of cases were stated as treatment failure. The sputum conversion was registe­red in the period from 1 to 4 month in 70.4 % of patients, in the rest of patients (29.6 %) — after five months of initial phase of chemotherapy.
The study revealed significant association between treatment failure and resistance to the PAS, sputum conversion during 4 months of initial phase and inclusion of linezolid in the treatment regimen. The study didn’t reveal any significant correlation between administering other anti-TB drugs of the 5th group (clarithromycin, clofazimine and isoniazid in high doses) and effective treatment.
Conclusions. 70.4 % of patients with new cases of XDR TB had sputum conversion during first 4 months, what say for the 6-months duration of the initial phase in most cases. 8-months duration of the initial phase should be used in patients with new XDR TB cases if linezolid is not included into the treatment regimen.

Keywords: XDR TB, duration of initial phase of treatment.

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2. Original research

 

Analysis of modern clinical and pathological indices in cases of pulmonary tuberculosis with the morphological features of progression (on surgical material)

I.V. Liskina, L.M. Zagaba

Objective — to establish the basic clinical and pathological indices of the pulmonary tuberculosis cases with additional surgery treatment and morphologically established high degree of activity of a specific inflammation.
Materials and methods. A randomized retrospective study included all patients with a diagnosis «pulmonary tuberculosis» (PTB) (forms: fibro-cavernous tuberculosis (FC TB), pulmonary tuberculoma and other forms of secondary pulmonary TB) who underwent additional surgical treatment at the clinic of SO «National institute of phthisiology and pulmonology named after F.G. Yanovsky National academy of medical sciences of Ukraine» in 2010—2012 yy.
Results and discussion. The study results revealed that the vast number of surgical procedures were performed due to the pulmonary tuberculomas, 57.6 % — in the period of investigation. Every year, 32.0 % of the operations on average are performed in cases of FC TB.
We revealed that pulmonary tuberculomas are morphologically characterized by a high degree of activity of a specific process in 19.7 % of all surgical interventions, whereas FC TB — in 47.5 % of cases respectively. The progression of the pathological process is not related with sex of patients and occurs predominantly in young working-age population. Hemilesion of lung usually occurs at the time of surgery regardless of the form of pulmonary tuberculosis. The extent of lesions at pulmonary tuberculomas varies from segment to one lobe (100.0 %), and in FC TB more often it affects the lobe and whole lung— (74.5 ± 6.4) % of cases.
The most common type of surgery is the resection of one or several segments of the lung and lobectomy, which present 79.3 % of all cases. In cases of FC TB with signs of progression of a specific inflammatory process lobectomy and pneumonectomy were performed significantly more often (85.1 %).
Microbiological examination revealed MBT significantly higher in patients with FCT (83.0 ± 5.5) % in comparison to the cases of tuberculomas — (28.6 ± 7.6) %. Drug susceptibility test revealed multidrug-resistant strains of MBT, and the XDR-resistant strains in (61.5 ± 7.8)% of sputum culture positive patients with FC TB.
Conclusions. Currently, additional surgical treatment is required for patients with pulmonary TB mainly for such forms as tuberculomas and fibro-cavernous tuberculosis. In 20.0 % of the pulmonary tuberculomas and almost in 50.0 % of the FC TB morphologically determined progression of the pathological process (high level of activity of inflammation) was identified at the time of surgery. In the cases of the FC TB the multidrug-resistant strains of the MBT and the strains with extensively drug-resistance (XDR-resistant) dominated quantitatively.

Keywords: fibro-cavernous tuberculosis, pulmonary tuberculoma, clinical and pathological parameters, activity of a specific inflammation.

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3. Original research

 

The effectiveness of treatment of HIV/AIDS-associated newly diagnosed pulmonary tuberculosis with the use of aprotininum, glutoximand and laser

.S. Shalmin, R.M. Yasinskiy, .. Rastvorov, .. Pirog, .P. Hohlova

Objective — to determine the effectiveness of treatment of patients with newly diagnosed HIV/AIDS-associated tuberculosis, who received additional pathogenetic therapy with the inclusion of aprotininum, glutoximand and laser herapy.
Materials and methods. The 1st group included 14 patients with HIV/AIDS-associated newly diagno­sed pulmonary tuberculosis who received additional pathogenic therapy (APT) using aprotininum (in cases with a systemic inflammatory response syndrome, the number of CD4+ cells less than 200 and diffused pulmonary lesions, multiple organ dysfunction, the presence of 4 and more laboratory criteria for progres­sion of co-infection), glutoxim, low-level laser therapy. The 2nd group included 18 patients with co-infec­tion who received ART but didn’t receive APT. The 3rd group included 15 patients with co-infection TB/HIV/AIDS who didn’t receive neither ART nor APT.
Results and discussion. The intoxication symptoms disappeared over 1.3 months in the 1st group, among patients in the 2nd group they were present for 1.8 times longer, and in the 3rd group of patients — 3.16 times longer. Terms for both respiratory and intoxication symptoms subsidence were equal. Lethal cases among patients who received APT were not observed. The smear conversion was determined earlier in the 1st group. Destructions in the lungs healed faster in patients treated with APT in comparison to the patients receiving ART.
Conclusions. The intoxication symptoms, respiratory manifestations of the disease disappeared and the smear conversion occured faster in patients who received additional pathogenetic therapy in comparison to the patients who did not receive it. Destructions in the lungs after treatement with additional pathogenetic therapy healed faster in comparison with patients receiving ART. Resorption of infiltrative tuberculosis changes in the lungs occurred in the majority of cases of the 1st group in comparison to the patients who did not receive additional pathogenetic therapy.

Keywords: HIV/AIDS-associated newly diagnosed pulmonary tuberculosis, aprotininum, glutoxim and laser therapy, effectiveness of treatment.

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4. Original research

 

Effectiveness of antiretroviral therapy f HIV infection in resource-limited settings

S.L. Grabovyi, A.G. Dyachenko, .P. Panchenko, L.. Panasenko

Objective — to determine the efficiency of combined antiretroviral therapy of HIV infection in the one of Ukrainian regions.
Materials and methods. The analys of current and reporting documentation of the Sumy Regional AIDS Profilaxis and Control Centre for the period from 05.2006 till 12.2013 was carried out.
Results and discussion. The maximum survival rate across 12 months after treatment start (number of surviving patients in the cohort) was 93.6 %. The part of patients with disabilities and/or not capable to self-service in 2006—2007 was approximately 50—60 % of all patients, who were appointed ART; in 2010—2012 — only 35.2 %. The patients’ condition improved according to the duration of treatment. If at the beginning of therapy only 65.4 % of patients met the criteria of functional status of «able-bodied», after 3—4 years the papameter increased to 94—96 %. ART stimulates restoration of the number of CD4+ T cells in the blood of patients: at the beginning of the treatment only 18.3 % of patients demonstrated excess of the cell number over 350 in 1 ml, six months after initiation of ART percent of such patients rised to approximately 50 %, and after 4 years of therapy — approximately 90 %. Suppression of viral replication is faster than restoring of the immune system: before the treatment only 0.7 % of HIV-infected had no viraemia, six months later this percentage rises to 77. Maximum value of inhibiting effect was observed after 2 years, when 92 % of patients experience complete suppression of viral replication, the rest has partial virologic response.
Conclusions. Highly active (combined) antiretroviral therapy even in resource-limited conditions is very effective way for HIV infection control. Thus, the majority of patients achieved a complete suppres­sion of the current cycles of virus replication, minor population of patients show a partial virologic response.

Keywords: HIV infection/AIDS, antiretroviral therapy.

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5. Original research

 

Some aspects of ecological and industrial pollution and epidemiological indicators of tuberculosis in the Carpathian region

V.I. Zozulyak, N.V. Zozulyak, Z.V. Zozulyak

Objective — to examine the prevalence and characteristics of ecological and industrial pollution and epidemiological indicators of tuberculosis in the Carpathian region.
Materials and methods. The study used reports of Ivano-Frankivsk Regional Phthisiopulmology Center, epidemiological indicators of tuberculosis control for 2011—2012 years: the overall incidence, incidence for pulmonary tuberculosis, incidence for destructive tuberculosis, the proportion of cavities, incidence of sputum positive tuberculosis, incidence among adolescents and children, mortality rate in some districts. We also used the background monitoring of pollution of the biosphere, soil, air and water.
Results and discussion. The obtained results of epidemiological studies and data of medical statistics clearly confirm the trend towards deterioration in health, as well as increased morbidity and mortality from tuberculosis in contaminated areas in the Carpathian region. Adverse environmental factors and high levels of anthropogenic pollution lead to a disruption in the body’s antioxidant system, which in turn can run multiple mechanisms of tuberculous process, increases the incidence of functional disorders of the liver.
Conclusions. The tendency of the balance between ecological and industrial pollution and improving of epidemiological indicators of tuberculosis in parts of Carpathians are observed.

Keywords: epidemiological indicators of tuberculosis, the environment, technological environment, tuberculosis.

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6. Original research

 

Blood plasma free histamine in patients with pulmonary tuberculosis and adverse reactions associated with anti-tuberculosis drugs

M.M. Savula, I.A. Martynjuk, S.M. Pochyljak, N.M. Lopushanska

Objective — to study the blood plasma free histamine (H) in patients with pulmonary tuberculosis and adverse reactions associated with anti-tuberculosis drugs (AD).
Materials and methods. 20 patients with pulmonary tuberculosis and adverse reactions associated with AD were included in the study. 1st-line anti-tuberculosis drugs were prescribed to nineteen patients from this group. Control group consisted of 10 patients. The level of free H was detected with Enzyme Immune Assay.
Results and discussion. The adverse reactions were observed more frequently in elderly and were associated with different comorbidity. The allergic and dyspeptic symptoms prevailed. The increase of H was detected in 50 % of patients of control group and in 80 % patients with different adverse reactions. The average level of H was higher in patients with adverse reactions. Possible mechanisms of H elevation in both groups were discussed.
Conclusions. The revealed increase of H level in patients with adverse reactions and without it and also possible effect of isoniazid on this mediator inactivation calls for more studies of H metabolism especially in patients without isoniazid treatment.

Keywords: antituberculosis drugs, adverse reactions, histamine.

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7. Original research

 

The results of clinical application of the deviceless method of collapsotherapy

B.V. Noreyko, V.V. Mozgovoy, T.N. Klimenko, Yu.A. Grishun

Objective — to increase effectiveness of treatment of patients with destructive pulmonary tuberculosis.
Materials and methods. The primary results of the use of a deviceless method of treatment according to the author’s method are introduced in the article.
Results and discussion. In this paper the positive results of clinical application of new methods of treatment of destructive pulmonary tuberculosis are presented. Earlier smear conversion, reduction of terms of healing of destructive changes in the lungs and significant increase in the caverns healing while using the deviceless method of treatment in the complex treatment of patients with destructive pulmona­ry tuberculosis were noted.
Conclusions. Deviceless method of treatment is considered to be simple, non-invasive, without contraindications and highly efficient method of treatment.

Keywords: pulmonary tuberculosis, method of treatment, collapsotherapy.

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8. Original research

 

Gender-based characteristics of people living with HIV as a component of the gender-based characteristics of HIV/AIDS epidemic in the region (using the example of Transcarpathian region)

I.S. Myronyuk, L.I. Andrushchak, C.D. Calancea

Objective — development of the gender-based characteristics of people living with HIV (PLWH), in the Transcarpathian region as a component of the gender-based characteristics of HIV/AIDS epidemics in the region.
Materials and methods. The object of the research was a group of 282 HIV positive adults (all above 18 years old), 142 men and 140 women, all of them were registered with the AIDS Centre and Regional «Trust Rooms» in the Transcarpathian region as on January, 1, 2014. The social-demographic and medical-social components of the gender-based characteristics of the adult PLWH population of the Transcarpa­thian region were identified according to the results of the official data obtained from the official medical registration documents and from special socio-epidemiological surveys, which were undertaken by the specialists of the Regional AIDS Centre during the years 2007—2013 among the HIV positive persons of the dispensary group.
Results and discussion. The analysis of obtained data according to the social-demographic and medical-social components presented gender-based characteristics of the adult PLWH population in the region: for HIV positive men and HIV positive women of the dispensary group. Significant differences were identified in the main social-demographic and medical-social characteristics of HIV positive men and HIV positive women from the dispensary group.
Conclusions. Existence of significant differences in the portraits of the HIV positive men and HIV positive women indicate that the peculiarities of the gender portraits of HIV positive man and HIV positive woman are necessary to be taken into account in the process of developing of concrete activities of the Regional AIDS Programme in the Transcarpathian region with regards to service delivery of secondary prevention, diagnosis, treatment care and support of PLHW it in order to create conditions that would be most comfortable and attractive for the service beneficiaries based on the gender aspects of the target group.

Keywords: gender-based characteristics, people living with HIV, HIV/AIDS epidemics, Transcarpathian region.

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9. Original research

 

Characteristics of cytotoxic effect of decametoxine in different cell cultures

S.I. Panchuk, O.P. Trokhimenko

Objective — to study parameters of cytotoxic effect of decametoxine in cell cultures.
Materials and methods. Cultivated cells of human adenocarcinoma of the larynx (HEP-2) and dog kidney (MDCK) were exposed to 0.02 % solution decamethoxine to evaluate its cytotoxic effect.
Results and discussion. The study established that mean cytotoxic dose of decametoxine CD50 in HEP-2 cell culture was 3.213 and ranged from 2.627 to 3.716 mg/ml. Therefore, mean MIC value in this culture was 1.563 and ranged from 1.314 to 1.858.
Estimation of cytotoxic action of decametoxine in MDCK cell culture revealed that CD50 made up 12.5 mg/ml and ranged from 10.51 to 14.87 mg/ml, MIC made up 6.25 and ranged from 5.26 to 7.43 mg/ml. In terms of indices of cytotoxic action (CD50 and MIC) decametoxine was 4.0 times less toxic in MDCK cell culture than in HEP-2 cell culture.
Conclusions. Cytotoxic effect of decametoxine depends on type of the culture, concentration of the drug substance and duration of the drug exposure of the cells.

Keywords: decametoxine, quaternary ammonium compounds, cell culture, cytotoxic effect, parameters of cytotoxicity.

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10. Original research

 

Clinical features of the newly diagnosed pulmonary tuberculosis and its relapses

M.M. Kuzhko, O.M. Starkova, L.M. Protsyk, N.M. Gulchuk, O.V. Avramchuk

Efficiency of treatment of pulmonary tuberculosis relapses remains low enough for sputum conversion, and their healing goes with the development of massive residual changes. Treatment of patients with pulmonary tuberculosis relapses always requires more efforts than treatment for the newly diagnosed pulmonary tuberculosis, and with the constant increase in the incidence and reduce in the efficiency of the treatment, this problem it rather timely.
Objective — to determine the objective and accurate picture of the structure of modern features and clinical course of newly diagnosed pulmonary tuberculosis and it’s relapse.
Materials and methods. The study included monitored and analyzed case histories of 58 tuberculosis patients who were admitted to the in-patient department of State organization «National Institute of phthisiology and pulmonology named by F.G. Yanovsky of National academy of medical sciences of Ukraine». The subjective and objective clinical data, laboratory, radiological, instrumental methods of investigation in the same patients with primary pulmonary disease and it’s relapce were compared.
Results and discussion. Study revealed that relapses of disease have more severe clinical course with a significant predominance of infiltrative (63.8 %) and disseminated (27.6 %) clinical forms, with frequent destructive changes in the lungs (86.2 %) and Mycobacterium tuberculosis excretion (87.9 %) than in newly diagnosed tuberculosis. In 72.4 % cases pulmonary tuberculosis relapses are detected by referring patients to hospitals, indicating the need for new preventive measures to prevent disease relapses.
onclusions. Clinical features of pulmonary tuberculosis relapses are the presence of pronounced cough — in 79.3 %, with mucopurulent sputum— in 44.8 %, dyspnea — in 46.6 %, increase in body temperature — in 69.0 %, moist rales — in 29.3 %, inclease of leukocytes count — in 24.1 %, stab shift to the left — in 37.9 % of patients.

Keywords: newly diagnosed pulmonary tuberculosis, relapse, clinical picture.

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11. Original research

 

Myopathy criteria in patients with chronic obstructive pulmonary disease in combination with gastroesophageal reflux disease

Yu.L. Shkarivskyy, M.A. Stanislavchuk

Objective — to study the absolute and relative skeletal muscle mass, absolute and specific respiratory muscle strength and improve criteria of evaluation for muscle disorders in patients with chronic obstructive pulmonary disease (COPD) in combination with gastroesophageal reflux disease (GERD).
Materials and methods. 131 patients with COPD stage II—III, age 22—75 years, 115 (88 %) men were included into the study. The combination of COPD with GERD was present in 62 (47.3 %) patients. The control group consisted of 34 healthy participants. The absolute and relative muscle mass, absolute and specific respiratory muscle strength were evaluated.
Results and discussion. 77—78 % of patients with COPD possessed a significant reduction in absolute and relative muscle mass (< 21 kg and < 30 %). Muscle mass deficiency and dysfunction of respiratory muscle depended on COPD stage and comorbid GERD. 60—70 % of these abnormalities developed during the first 5—10 years. A significant decrease in 6MWD test and increase in severity of performance status by MRC and BODE scales in COPD patients were accompanied with the decrease in muscle mass < 21 kg and in the part of muscles in body weight < 30 %.
Conclusions. Comprehensive assessment of absolute muscles mass, its part in the body weight and respiratory muscle strength in COPD patients with comorbid GERD adequately permits to assess the severity of muscular disorders.

Keywords: chronic obstructive pulmonary disease, gastroesophageal reflux disease, muscle mass, respiratory muscle strength, body mass index.

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12. Instrumental diagnostic methods

 

Possibilities of modern computer tomography in the diagnosis of tuberculosis and sarcoidosis

M.I. Linnik, G.L. Gumenuk

The article discusses the problem of X-ray imaging in the diagnosis of tuberculosis and sarcoidosis. Leading radiological diagnostic method becomes computed tomography. The method at this pathology presents 98.5 % sensitivity and up to 94.0 % specificity.
Implementation in practice of multislice computed tomography diagnosis took the radiology to a new level of diagnostics. The advantage of digital media storage, when all examination data is being stored is emphasized. Digital information can be processed on any personal computer with adequate software and allows to obtain objective indices (dynamic of sizes and densitometric parameters) in patients with sarcoidosis and  tuberculosis which are the most important criteria for diagnosis and assessment of the treatment efficacy. Information capacity of multislice computed tomography is near to the capacity of hystopathological methods.
Further studies are needed to assess densitometric parameters changes over time at sarcoidosis and tuberculosis patients in order to develop an algorithm of diagnosis and treatment.

Keywords: tuberculosis, sarcoidosis, differential diagnosis, multislice computed tomography.

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13. Epidemic situation

 

Analysis of the implementation of the hernivtsi regional tuberculosis control programme

L.D. Todoriko, I.O. Semianiv, I.I. Havrysh, I.I. Huska, A.M. Tesliukova, Z.V. Suliatytska

Objective — to analyze the efficiency of implementation of the Chernivtsi regional tuberculosis control programme.
Materials and methods. Statistical analysis of the official information concerning the antituberculous service activity in Chernivtsi region during recent years was conducted.
Results and discussion. Antituberculosis activity in Chernivtsi region was aimed at execution of the Law of Ukraine 4565-VI dated 22.03.2012 «On fighting tuberculosis». The incidence of all forms of active tuberculosis in Chernivtsi region decreased from 48.5 per 100 thousand people in 2012 to 45.9 per 100 thousand people in 2013 (in Ukraine in 2012 — 68.1 per 100 thousand people,  in 2013 — 67.9). Relapses incidence (pulmonary and extrapulmonary) in 2012 was 9.8 per 100 thousand people and in 2013 — 6.6 (in Ukraine in 2012 — 12.4 per 100 thousand people, in 2013 — 9.6).
Conclusions. The main problems in implementing of regional tuberculosis control programs in Chernivtsi region are: drugresistant tuberculosis which along with the multidrug resistance is observed in almost 19% of patients with newly diagnosed tuberculosis, that is a very bad prognostic sign for tuberculosis control in general; lack of efficacy of treatment (due to high treatment failure and mortality); low quality of examination for acid-fast bacteria detection in biological materials in a primary health care facilities.

Keywords: tuberculosis, multi-drug resistance, morbidity, prevalence, mortality.

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14. Infection control

 

Peculiarities of respiratory protective equipment use in tuberculosis services

Rodion Kartavykh

The paper discusses the importance of use and proper fitting of respiratory protective equipment. Also the importance of perfect conformity and the comfort use is emphasized.

Keywords: respiratory protective equipment, fit-test.

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15. Pages of history

 

Case history and death of Taras G. Shevchenko

R.G. Prociuk, G.Y. Prociuk-Vlasova

The paper presents the literature survey on the list of illnesses of . Shevchenko, and its clinical picture. The analysis of clinical displays showed that . Shevchenko had had rheumatism, active phase, continuous­ly recrudescent rheumatic heart disease. The combined cardiac malformation with predominance of steno­sis of aortic ostium and insufficiency of left atrioventicular valve developed in the terminal period. Against the background of this cardiac anomaly heart failure developed, progressed and became a reason of death.

Keywords: common cold, scarlet fever, typhoid fever, spotted fever, rheumatism.

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