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Issue. Articles

4(19) // 2014



1. Editorial


The clinical forms of tuberculosis in patients with HIV infection

O.A. Holubovska, O.D. Nikolaeva, L.A. Klymanska, O.V. Yurchenko, S.V. Fedorenko

Objective — to study the clinical spectrum of forms of co-infection of HIV/TB patients in the late stages of HIV infection.
Materials and methods. The study involved 1022 patients with a confection of HIV/TB with signifi­cant violations of the immune status.
Results and discussion. During the period of 2009—2013 3410 patients who had 3rd and 4th clinical stage of HIV infection were examined. Among them tuberculosis was diagnosed in 1022 (30 %) patients. Newly diagnosed tuberculosis was stated in 885 (86.6 %) patients. In most patients — 379 (37 %) patients — it was extrapulmonary tuberculosis, with no signs of pathology in the lungs, predominantly TB of lymphatic system. In 84 % of patients with extrapulmonary TB / HIV CD4+ T cells count was less than 50 in 1 mm3. In order to confirm the diagnosis of tuberculosis various biological material, including biopsies have been studied.
Conclusions. Extrapulmonary tuberculosis tends to dominate in case of severe immunodeficiency, often with multiple locations without evidence of lung involvement. Diagnosis of tuberculosis is complicated by low efficiency of routine methods (detection of Mycobacterium tuberculosis in sputum, often atypical radiological picture) and, taking into account the usual frequency of extrapulmonary forms it requires additional methods.

Keywords: HIV, HIV/TB co-infection, extrapulmonary TB.

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2. Original research


Adverse reactions of anti-tuberculosis drugs in treatment of patients with tuberculosis

Yu.I. Feshenko, S.. Cherenko, .V. Matveeva, V.P. Yaychenya, I.O. Logvina

Objective — to analyse adverse reactions of anti-tuberculosis drugs on the base of clinical reports and assess the level of pharmacoviligance in the TB care in Ukraine.
Materials and methods. We analyzed all the clinical reports of adverse reactions (AR) of anti-TB drugs (TBD), which were sent to the SE «State Expert Center of Ministry of Health of Ukraine» during the 2007—2013. Data on the number of adverse reactions from clinical reports were compared with the data of national and foreign sources.
Results and discussion. In recent years, Ukraine shows a steady increase of number of clinical reports (CR) on the AR anti-TB drugs, but their number remains low (981 in 2013, of which 220 AR anti-TB drugs in treatment of MDRTB). The literature data (AR occurred at least in 8 % of patients with sensitive TB and 30 % of patients with MDRTB) and the incidence of tuberculosis in Ukraine (about 30 thousand of patients with new TB cases and 8944 patients with MDR TB started treatment in 2013), the current level of incoming clinical reports on AR of anti-TB drugs does not correspond to the actual situation regarding the occurrence of AR anti-TB drugs.
Conclusions. Pharmacoviligance in TB care in Ukraine is limited due to the several reasons, the main of which is the low activity of doctors in reportig of AR. A small number of clinical reports prevents carring full analysis and provision of accurate information to doctors about the effectiveness and safety of anti-TB drugs, limits the adoption of appropriate management decisions.

Keywords: pharmacoviligance, clinical reports of adverse reactions, anti-TB drugs.

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3. Original research


The potential effectiveness of roflumilast and quercetin combination treatment for aggravated chronic obstructive pulmonary disease complicated by coronary heart disease

P.R. Gerych, R.I. Yatsyshyn

Objective — to assess the effectiveness of the combination of roflumilast and quercetin as part of basic treatment of chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD).
Materials and methods. The study involved 72 patients with acute exacerbation of COPD. Depending on the characteristics of the disease, all patients were divided into two groups. The first group included 44 patients with acute exacerbation of COPD of the III stage, groups C, D in combination with concomi­tant comorbid coronary artery disease or stable angina, and II FC. The second group consisted of 28 pati­ents with acute exacerbation of COPD of the III stage, groups C, D with an isolated course. Depending on the choice of treatment, patients of the first group were divided into two groups — basic subgroup (26 patients), and subgroup for comparison (18 patients).
Results and discussion. The analysis of long-term results after 6 months of treatment resulted in the clinical recovery (remission phase) in significantly higher number of patients in the main subgroup — 21 (87.5 ± 8.2) % in comparison to the 9 (50.0 ± 11.4) % patients of comparison subgroup (p < 0.05). The rest of the patients in both subgroups were identified to have clinical improvement (partial remission phase).
Conclusions. Thus, revealed data indicated the feasibility and effectiveness of inclusion of roflumilast and quercetin into the basic therapy in patients with acute exacerbation of severe COPD when combined with stable angina and with the threat of destabilization of course.

Keywords: chronic obstructive pulmonary disease, coronary heart disease, roflumilast and quercetin.

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4. Original research


Contingent of patients at high risk of multidrug-resistant tuberculosis Rif+ from the results of the survey of patients using GeneExpert MBT/RIF

S.. Cherenko, H.A. Varytska, A.I. Barbova, P.S. Trofimova

Objective — to define groups of patients at high risk of MDR TB Rif+ on the basis of the survey of patients using GeneXpert MBT/RIF to order to expand the indications for using this method.
Materials and methods. 121 patients with tuberculosis were examined using GeneXpert MBT/RIF, 74 (61.2 %) men, women — 47 (37.9 %) among them. The average age of the patients was (34.5 ± 2.2) years. Newly diagnosed tuberculosis was in 86 (71.1 %) patients, relapse of tuberculosis — 19 (15.7 %) patients, previously treated patients (treatment after interruption, failure of treatment I) were 16 (13.2 %) patients. 71 (58.7 %) patients were sputum smear positive, the rest — negative.
Sputum examination was performed on one sample using GeneXpert MBT/RIF and culture method with liquid medium in the automated microbiology system BACTEK-960. Testing drug susceptibility to anti-TB drugs of the I and II lines was also performed in the automated microbiology system BACTEK-960. The results of the MTB/Rif analysis were compared with culture results and phenotypic methods for determining susceptibility to anti-TB drugs.
Results and discussion. Smear positive patients had positive result of PCR+ in 81.7 % cases, smear negative — in 38.0 %. However, these patients showed rifampicin resistance Rif+ with the same frequency — in 55.2 % and 52.5 % of cases respectively (p > 0.05). In most cases, resistance to Rif in GeneXpert test was associated with multidrug resistance — in 83.3 % of cases, 4.8 % — with polyresistance, including resistan­ce to Rif. Thus, Rif resistance using GeneXpert was confirmed in 37 (88.1 %) patients. Among patients with PCR+/Rif+ 27 were new cases of TB (31.4 % of the total number of new cases), 9 cases were relapses of TB (47.4 % of the total number of relapse cases), 6 (54.5 %) patients had treatment failure.
Conclusions. In order to determine the most appropriate treatment regimen it is nessesary to carry out GeneXpert MBT/RIF for all TB patients regardless of smear results and the case of disease due to high level of resistance to Rif.

Keywords: GeneXpert MBT/RIF, multidrug-resistant tuberculosis.

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5. Original research


Epidemiological features of HIV infection among injective drug users in Kyiv

N.S. Bugayenko, T.A. Sergeyeva

Objective — to study the main manifestations of HIV infection epidemic process among injective drug users (IDUs) in Kyiv in comparison to Ukraine.
Materials and methods. Analysis and synthesis of the following data was conducted: the absolute number of HIV cases among IDUs; the proportion of IDUs among people with new cases of HIV infection; HIV infection rate among IDUs; the incidence of substance abuse disorders; HIV prevalence among IDUs; the growth rates of new HIV infections; the structure of HIV transmission routes; distribution of HIV-positive injective drug users by age.
Results and discussion. HIV infection rates among IDUs in Kiev in 2008—2012 was 2,3 times higher than the average for Ukraine. The proportion of IDUs among the total number of HIV-positive persons was 1,4 times higher and the prevalence of drug addiction — almost 2 times higher. The common trends between the level of infection in IDUs and rates of prevalence and incidence of drug addiction in Kiev were identi­fied to be 0.95 and 0.70. Highly significant association between the incidence of HIV infection and newly registered cases of drug addiction (0.81), HIV infection rates and the proportion of IDUs in the total number of HIV-positive persons (0.96) was found. The most affected age-group of IDUs is persons 30—39 years.
Conclusions. In Kyiv, in comparison to other Ukrainian territories, injective way of HIV transmission retains epidemiological significance for a longer perioud. Measures to control HIV are closely related to the prevention and treatment of drug addiction, which involves a complex approach taking into account regional features of epidemic process’ development in certain high-risk groups.

Keywords: HIV infection, epidemic process, high risk groups, injective drug users.

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6. Original research


Character endoscopic evidence of a mucosa of the bronchial tree in pulmonary tuberculosis

I.G. Ilnytskyj, O.P. Kostyk, H.I. Volnytska, L.I. Bilozir

Oblective — to explore the nature of the pathological changes in the mucous membrane of the bronchial tree in patients with different clinical forms of the specific process, burdened by «modifying» factors.
Materials and methods. The study included 157 patients with various forms of pulmonary tuberculosis and assessed the condition of the mucous membrane of the bronchial tree by FBS. Endoscopic picture was estimated taking into account the clinical form, phase process, the bacteria, the nature of the severity of radiographic changes, duration of disease, presence of «modifying» factors.
Results and discussion. Patients did not show endoscopic pathology, as they were mostly patients with limited TB (55.5 %) without the presence of bacteria in sputum and destructive changes and with a high proportion of doubtful and moderate of tuberculin sensitivity. Patients with endoscopic picture of inflammation of the bronchial mucosa showed multidirectional nature of bronchial changes. Patients who were diagnosed so-called «local» endobronchitis, that was seen as a complication of the underlying disease, had widespread tuberculosis with the presence of bacteria in sputum and destructive changes. Endoscopic signs of inflammation in this situation were characterized by the presence of limited edema, hyperemia and infiltration, mainly on the side of maximum destruction. Thus 66 (42.0 %) patients had aggravating factors in the form of chronic nonspecific foci of infection. The study revealed inflammation of the bronchial tree in most cases with no clinical data and auscultative, except infiltrative-ulcerative and infiltrative-bronchial fistulas form of tuberculosis, in which there was prolonged cough in the presence of hemoptysis. That picture was estimated to be reactive imflammatiion, so-called «paraspecific» endibronchitis, that has the same manifestations as the focal reaction at the positive tuberculin skin test and probably is due to the direct toxico-allergic influence of the tunerculosis course.
Conclusions. Endoscopic picture of the bronchial tree in tuberculosis of the respiratory system is characterized with unspecific catarrhal-purulent endobronchitis — absolute signs of chronic bronchitis, «local» endobronchitis as a result of complicated course of pulmonary tuberculosis in the form of infiltrative tuberculosis of the bronchi and the so-called reactive, «paraspecific» endobronchitis as a consequence of toxic-allergic influence of tuberculous process.

Keywords: tuberculosis of the respiratory system, endoscopy, bronchial tree.

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7. Original research


Clinical and roentgen (X-ray) characteristics of patients with the repeated cases of the tuberculosis treatment

O.D. Nikolaeva, T.M. Martsyniuk

bjective — to analyze repeated tuberculosis cases and to examine the frequency and characteristics of drug-resistant tuberculosis in patients who were enroled to the treatment according to the second category.
Materials and methods. 51 patients were surveyed and refered to the hospital with the following diagnoses.
Results and discussion. 19 persons with relapse TB (37.3 % of patients), 21 persons with the treatment failure (41.2 % of patients), 10 persons with other TB cases (19.6 % of patients), 1 person with treatment after discontinuation (1.9 % of patients). The analysis of unsuccessful treatment and relapse were made.
Conclusions. Performed analysis of the re-treatment TB cases made it possible to conclude that among 51 patients tuberculosis diagnosis was confirmed among 48 (94.1 %) patients, other 3 patients had other diseases. Other 18 (37.5 %) patients were diagnosed drug-resistant tuberculosis, including 6 (12.5 %)patients with multi-drugresistant forms of tuberculosis, 1 (2.1 %) patient with the extended drug-resistance and 6 (12.5 %) with poly-resistant and 5 (10.4 %) with mono-resistant tuberculosis. Patients with diagnosis of treatment failure should have obligatory confirmation of the diagnosis. The causes of relapse cases were different comorbidity (26.3 % of patients): HIV infection and diabetes. Almost half of the patients with TB relapses (47.6 % of patients) were diagnosed resistance to anti-tuberculosis drugs.

Keywords: the repeated cases of tuberculosis, drug-resistant tuberculosis, other forms of tuberculosis, treatment failure, treatment after discontinuation.

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8. Original research


Level of endogenous intoxication in experimental pulmonary edema

V.M. Zhadan, V.I. Korzhov, N.A. Kasyan

Objective — to study of spectral features of erythrocytes and plasma molecules with medium mass  in experimental adrenaline (hemodynamic) pulmonary edema when administered different doses of adrena­line and in the dynamics of the pathology development.
Materials and ethods. 105 white mongrel rats of both sexes were used in the study. Pulmonary edema (PE) was modelled by single intramuscular administration of 0.18 % adrenaline tartrate solution in doses  of 2.5 mg/kg, 1.5 mg/kg, 1.0 mg/kg and 0.5 mg/kg of the body weight. The content of the medium molecular peptides was evaluated on the basis of direct spectrometry of deproteinised supernatant at wavelengths of 230 nm, 254 nm, and 280 nm.
Results and discussion. In this work we investigated and evaluated the spectrum of MMM erythrocytes and blood plasma in experimental PE depending on the adrenaline dose and in the dynamics of the pathological development. The study revealed hemodynamic fatal PE (adrenaline dose 2.5 mg/kg of the body weight) is followed by a sighnificant endogenous intoxication, i. e. a phase of total saturation — in both plasma and erythrocytes was observed maximum concentration of pathological substances.
Administration of other doses of adrenaline resulted in a phase of toxic products cumulation, that is associated with erythrocytes saturation and emergence of endotoxins in plasma in 24 hours after the experimental pathology modeling. In 3, 7 and 11 days after the administration of adrenaline, MMM level in the blood plasma comes to the control levels, whereas content of MMM nuclear fraction in erythrocytes remains high.
Conclusions. In experimental PE, regardless of the adrenaline dose administered to the animals (except for the lethal dose), typical are the metabolic manifestations of endogenous intoxication, which consist in histone proteins and DNA decomposition products predominance in the «medium molecules» of erythrocytes and blood plasma.

Keywords: pulmonary oedema, middle weight molecules, erytrocites, bloood plasma.

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9. Original research


The risk factors of progression and evaluation criteria for the course of the HIV/AIDS-associated pulmonary tuberculosis

O.S. Shalmin, R.M. Yasinskiy, O.A. Rastvorov, D.V. Miroshnichenko

Objective — to identify the progression factors of HIV/AIDS-associated tuberculosis by clinical, radiological, haematological, biochemical and immunological parameters and to establish criteria for evaluation of the course of HIV/AIDS-associated newly diagnosed pulmonary tuberculosis.
Materials and methods. The study included 47 patients with HIV/AIDS-associated tuberculosis. We determined the hematological, biochemical (acute phase agents, proteinogramm, coagulogram) and immunological (number of cells CD4+, α1-antitrypsin) rates in patients with co-infection. The presence of additional systemic inflammatory response syndrome (SIRS), the prevalence of tuberculous lesions (pul¬monary and extrapulmonary — ETB) and the degree of polyorganic dysfunction (OD) were also estimated. The total clinical and radiological criteria (CRC): CRC1 — in cases with local lung lesions, CRC2 — in cases with diffuced lung lesions, or with local lung lesions and ETB1 either (and) OD1, CRC3 — in cases with ETB2 either (and) OD2 or diffuced lung lesions and ETB1 either (and) OD1 separately determined.
Results and discussion. It was determined, that SIRS (p < 0.05), decrease of the number of CD4+ cells less than 200 (p < 0.05), anemia (p < 0.005), lymphopenia (p < 0.05 ), increase of LII more than 4 and INS more than 0,3 units (p < 0.05), decrease of albumin-globulin ratio (0,5 orless), (p < 0.05), albumin’s level (35 and less) (p < 0.005), γ-globulin level increase (40 % ormore) (p < 0.05), fibrin level increase (19 or more) (p < 0.05), decrease in hematocrytis level less than 35 % (p < 0.005) and the presence of CRC3 (p < 0.05) contribute to the progression of TB/HIV/AIDS co-infection.
Conclusions. Progression of TB/HIV/AIDS co-infection occurs in the cases of development of SIRS, dissemination of tuberculosis lesions or in combination with extrapulmonary lesions of the nervous system, or with the disfunction of other organs and systems. Sighnificant immunodeficiency, anemia, lymphopenia, decreased albumin level and albumin-globulin ratio imbalance, decreased haematocrytis level also contribute to the progression of the disease. The study evaluated criteria for assessment of co-infection course to design algorithm of further treatment strategy for HIV/AIDS-associated tuberculosis.

Keywords: HIV/AIDS-associated tuberculosis of lungs, the risk factors of progression.

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10. Original research


Oral hygiene and periodontaltis suesin patients with tuberculosis

L.G. Ermakova

Studying of tuberculosis as an internal risk factor in the development of dental disease, identification of prognostic risk factors and individual program of dental prophylaxis for this group of patients becomes particularly urgent problem during recent years.
Objective – to study the clinical manifestations and course of dental diseases the patients have pulmo­nary tuberculosis.
Materials and methods. The study included clinical and laboratory research in 119 (71 men, 48 women) patients with pulmonary tuberculosis at the age of 20 to 74 years who were hospitalized at the Kyiv City Tuberculosis Hospital N 1 with dispensary department. The control group included 59 persons of similar age (37 males, 22 females) healthy, with no pathological changes.
Results and discussion. Lesions in periodontal tissues were found (99.9 ± 4.5) % patients with pulmo­nary tuberculosis in comparison to the control group — (23.7 ± 5.5) %. Course of pathological process in periodontal tissues in patients with pulmonary tuberculosis is complicated by low level of oral hygiene (2.75 ± 0.086, p < 0.05) and a set of indicators to assess the state of oral health – «poor», «bad», «very bad» (79.7 %) compared to the control group (32.18 %).
Conclusions. High performance indices of oral hygiene in patients with pulmonary tuberculosis was associated with inadequate oral hygiene and requires the appointment of therapeutic and preventive measures aimed at prevention and treatment of dental diseases. Patients with pulmonary tuberculosis require in-depth skills training of oral hygiene and regular dental supervision conducting professional oral hygiene.

Keywords: pulmonary tuberculosis, oral hygiene, dental disease.

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11. Original research


State of oxidant-antioxidant blood system of rats in experimental pulmonary edema

V.I. Korzhov, V.M. Zhadan, T.V. Loza, N.A. Kasian

Objective — to determine the status of oxidant-antioxidant system in the blood at the experimental adrenaline (hemodynamic) pulmonary edema (PE) after administration of different doses of adrenaline and during the disease course.
Materials and methods. The study was conducted on 105 white mongrel rats of both sexes. Pulmonary edema was modeled by a single intramuscular injection of 0.18 % solution of adrenaline tartrate at doses 2.5 mg/kg, 1.5 mg/kg, 1.0 mg/kg and 0.5 mg/kg. In order to evaluate the intensity of lipid peroxidation amount of malondialdehyde (MDA), lipid hydroperoxides (HPL), the content of diene (DC) and triyenovyh conjugates (TC), schiff bases (O), peroxide resistance of erythrocytes were determined. State of protective antioxidant system was assessed by the activity of catalase and ceruloplasmin content.
Results and discussion. The study assessed the values of oxidant — antioxidant system in the blood of rats with experimental LF depending on the applied dose of adrenaline and the dynamics of the disease. Regardless of the applied dose of adrenaline and the time elapsed after the simulation LN, POL disorder was observed with significant increase of MDA in erythrocytes. The most significant changes were revealed in the oxidant — antioxidant system of blood after administration of adrenaline at a dose of 1.5 mg/kg body weight on the 3rd and 11th days after disease modeling: increased MDA, SC, LC and ORs, decreased activity of catalase, peroxide resistance of erythrocytes.
Conclusions. The experimental PE showed a number of biochemical disturbances that play definite role in the pathogenesis of this disease. These disorders manifest changes in the functional state of oxidant-antioxidant blood system. Lipid peroxidation products are excessively accumulated and activity of catalase and peroxide resistance of erythrocytes is reduced.

Keywords: pulmonary edema, red blood cells, blood plasma, oxidant-antioxidant system.

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12. Reviews


Vaccinal prevention of hiv infection: the phantom of hope or close to reality?

V.O. Kurganska, A.G. Dyachenko, O.M. Miroshnechenko

Development of a safe and effective prophylactic HIV-1 vaccine presents unique challenges. The pessimism following the failure of two HIV-1 vaccine concepts in clinical trials — HIV-1 gp120 and an adenovirus-based approach to induce only cellular immune responses, has been replaced by cautious optimism engendered by the RV144 trial outcome. Intensive efforts are underway to prevent of viral acquisition by active or passive immunization.

Keywords: human immunodeficiency virus, HIV-1, vaccine.

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13. Reviews


Methods of pulmonary sarcoidosis imaging

G.L. Gumeniuk

The article is dedicated to the diagnosing of sarcoidosis. Due to difficulties in clinical and laboratory distinguishing of sarcoidosis case, the leading role in its diagnostics belongs to medical imaging methods, such as radiography, computed tomography (CT), magnetic resonance imaging (MRI), radioisotope methods, ultrasound imaging (USI), including endobronchial ultrasound guided fine-needle lymph node biopsy.
Diagnostic value of commonly used diagnostic methods were studied. As demonstrated, conventional radiological methods such as fluorography and anterior-posterior chest radiography were valuable only at initial stage of pulmonary sarcoidosis diagnostics. Special radiological tests, such as linear tomography, administration of radiological contrast and radiological-functional tests, have very limited use at present.
The major focus of current report was a multislice computed tomography (MSCT). The sensitivity of this method reached 98.5 %, whereas specificity approached to 94 %. The diagnostic accuracy of MSCT in thoracic lymphnode sarcoidosis was 98.5 %, in lung sarcoidosis — 92.6 %.
In order to increase diagnostic yield of MSCT it is feasible to store the examination data on digital storage devices and use special software to process the data. MSCT is currently the most effective and cost-efficient methods of pulmonary sarcoidosis imaging, completely reflecting chest anatomy and helping to locate tissue lesions accurately. In terms of informational value current method approaches to pathohisto­logical examination.

Keywords: sarcoidosis, imaging, multislice computed tomography.

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The causes of death of HIV-infected patients in antiretroviral era: a paradigm shift

A.G. Dyachenko, S.L. Graboviy, O.P. Panchenko, L.M. Panasenko

The analysis of mortality of 194 HIV-infected persons during 2010—2013 revealed that AIDS and AIDS-associated diseases caused death in 67 (35 %) cases, other diseases — 107 (55 %) cases. In the vast majority of death cases patients were not taking antiretroviral therapy (ART) or have started it in the late stages of the disease or had arbitrarily interrupted treatment. No cases of death of AIDS among people who have been on ART for a long time were revealed during the monitoring period. At the same time increased multimorbidity and mortality of HIV-infected persons from other diseases was observed. TB was the leading cause of death for HIV-infected persons — 37.6 % (73 persons).

Keywords: HIV, HIV infection, AIDS.

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15. problems of medical education


Use of web-platform Moodle for distance learning at the department of phthisiology and pulmonology of DonNMU

S.M. Lyepshina, .V. Tyshchenko, M.A. Mindrul, N.V. Obukhova, S.V. Deryuga

A center of distance learning that provide resources for self-studying of students, interns and doctors exists at the Department of Phthisiology and Pulmonology DonNMU named after M. Gorky from 2008. The basis of a learning management system is web-platform Moodle (Modular Object-Oriented Dynamic Learning Environment). Moodle is written in PHP, can run on computers with different operating systems (Windows, Linux, etc.). Moodle is a web application located on a server that is available through a browser (Internet Explorer, Mozilla FireFox, Opera, etc.). Experience of using this platform for 6 years (2008—2014) shows that it can significantly improve the organization of the educational process and the quality of students preparation.

Keywords: web-platform, Moodle, distance learning, phthisiology.

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16. figures


Herman Rafailovich Rubinstein and first Ukrainian childrens tuberculosis sanatorium. To the 100-th anniversary of the foundation

V.I. Petrenko, L.L. Vinitsky, Yu.G. Vilensky

Subject article is dedicated to the 100-th anniversary of the first Ukrainian children’s tuberculosis sanatorium. On the basis of previously unknown archive materials authors present 20 years of work of H.R. Rubinstein in Kyiv, in particular, his activities in the «Society for control of tuberculosis and tuberosity» together with F.G Yanovsky and V.P. Obrazcov as well as in organized by him «Society of free summer sanatoriums for sick Jewish children of Kyiv», within the framework of which in 1914 he initiated the construction of the sanatorium using the funding of Kiev’s philanthropists. A biography of H.R. Rubinstein and historical information about the sanatorium founded by him arepresented in the article. 

Keywords: childrens tuberculosis sanatorium, H.R. Rubinstein, history.

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