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Issue. Articles

1(20) // 2015



1. Editorial


Genomic analysis identifies targets of convergent positive selection in drug-resistant Mycobacterium tuberculosis

Mycobacterium tuberculosis is successfully evolving antibiotic resistance, threatening attempts at tuberculosis epidemic control. Mechanisms of resistance, including the genetic changes favored by selection in resistant isolates, are incompletely understood. Using 116 newly and 7 previously sequenced M. tuberculosis genomes, we identified genome wide signatures of positive selection specific to the 47 resistant genomes. By searching for convergent evolution, the independent fixation of mutations at the same nucleotide site or gene, we recovered 100 % of a set of known resistance markers. We also found evidence of positive selection in an additional 39 genomic regions in resistant isolates. These regions encode pathways of cell wall biosynthesis, transcriptional regulation and DNA repair. Mutations in these regions could directly confer resistance or compensate for fitness costs associated with resistance. Functional genetic analysis of mutations in one gene, ponA1, demonstrated an in vitro growth advantage in the presence of the drug rifampicin.

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2. Original research


Relation of polymorphism C159T of CD14 receptor gene and anti-endotoxin immunity in adult patients with early and late asthma onset

Yu.A. Bisyuk

Objective — to study the condition of anti-endotoxin immunity depending on the genotype polymorphism of C159T gene receptor of CD14 in patients with early and late asthma onset in the Crimean population.
Materials and methods. The condition of anti-endotoxin immunity has been researched as function of polymorphism (C159T) CD14 receptor in 262 adult patients with early-onset bronchial asthma and 69 patients with late-onset one. The control group consisted of 92 healthy individuals.
Results and discussion. The patients with early asthma onset and with TT genotype of 159 promoter region of CD14 gene have the highest activity of endotoxin-dependent chronic inflammation (the highest level of anti-ET-IgM and sCD14). The CT heterozygous genotype is characterized by reduction levels of nti-ET-IgG and anti-ET-sIgA. The CT genotype in patients with late-onset of bronchial asthma is protective in the implementation of non-specific component of (sCD14 level in serum and induced sputum did not differ from control) immune inflammation on systemic and local level.
Conclusions. It has been estimated that degree of endotoxin-mediated chronic inflammation in asthma is dependent on early or late-onset of the disease and the C159T polymorphism of CD14 receptor.

Keywords: bronchial asthma, endotoxin, C159T polymorphism of CD14.

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3. Original research


Peculiarities of functional state of adrenocortical system in coinfected TB/HIV patients

R.G. Protsyuk, Yu.B. Zaguta, O.E. Begoulev

Objective — to determine peculiarities of the functional state of adrenocortical system in co-infected TB/HIV patients.
Materials and methods. First group of the study included 30 newly diagnosed pulmonary TB patients with different clinical forms (14 patients with infiltrative and 16 with disseminative forms of TB). Second group included 81 patients with newly diagnosed pulmonary TB with HIV/AIDS (37 patients with infiltrative 44 with disseminative forms of TB). Average age of patients was from 19 to 50 years. To evaluate the functional state of the adrenocortical system was used radioimmunoassay method to measure glucocorticoid function of adrenal glands cortisol and adrenocorticotropic hormone (ACTH)
Results and discussion. The study found that co-infected TB/HIV patients, versus HIV negative patients, showed decrease in activity of adrenocortical system, due to reduction of functional reserve of it. Moreover, we found that reduction was because of decrease of the function of adrenal cortex. Also revealed levels of the hormones depend on the prevalence of pulmonary process.
Conclusions. In co-infected TB/HIV patients decreased activity of adrenocortical system, namely the function of the adrenal cortex. Prevalence of pulmonary process significantly affects levels of hormones of adrenocortical system.

Keywords: adrenocortical system, tuberculosis, HIV.

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4. Original research


The experience of using bacterial peptidoglycan in combined therapy of patients with drug-resistant destructive pulmonary tuberculosis

.M. Rekalova, Yu.O. Matvienko, O.R. Panasiukova, K.F. Chernushenko, L.P. Kadan, N.A. Litvinenko, O.A. Reva, S.G. Yasyr, .B. Singaievskyi

Objective — the improvement of the treatment of patients with drug-resistant destructive pulmonary tuberculosis (DRDPTB) with the additional use of the immunomodulatory drug — bacterial peptidoglycan «Blastomunil» in combination with specific anti-TB drug therapy.
Materials and methods. Were examined 46 patients with drug-resistant tuberculosis (DR-TB) and 20 healthy individuals (blood donors). 22 patients (main group) were prescribed the immunomodulatory drug «Blastomunil» in the intensive phase of the anti-TB drug therapy. 24 patients were in the control group with only appropriate chemotherapy regimens without the immunomodulator. The method of two-color flow cytometry was used with application of monoclonal antibodies for phenotyping of T and B-lymphocytes, natural killer cells and assessed the state of phagocytes of peripheral blood, defined the density of receptors for gamma-interferon on the surface of blood cells. The levels of serum immunoglo­bulins A, M, G and circulating immune complexes (CIC) were measured by ELISA-method.
Results and discussion. The use of Blastomunil in combination with anti-TB drug therapy in main group resulted in reduction of peripheral blood leukocytes number (partly due to lymphocytes), increase in the percentage of T-helper cells, stimulation of monocytes functional activity (increase in reactive oxygen species), reduction of the CIC in blood and increase in the number of leukocyte receptors for γ-IFN (the most expressed on monocytes) in contrast to the control group. In main group terms of resorption of infiltrative changes in the lungs reduced to (3.8 ± 0.8) months ((7.3 ± 0.6) months in the control group, p < 0.05), the percentage of patients with closed cavities in the lungs increased to (57.1 ± 2.3) % ((26.3 ± 1.6) % in control group, p < 0.05), duration of hospital stay reduced to (6.1 ± 0.4) months ((7.9 ± 0.5) months in the control group, p < 0.05).
Conclusions. The use of the bacterial peptidoglycan Blastomunil in the complex with anti-TB drug therapy in patients with drug-resistant destructive TB leads to reduction of the number of leukocytes and lymphocytes, increase in the percentage of T-helper cells, reduction of the CIC in their peripheral blood. Effect of the drug was an increase in density of leukocyte receptors for gamma-interferon on the surface of monocytes and stimulation of their functional activity with increased activity of oxygen-dependent metabolism of these cells. The positive effect of the revealed immunological changes was confirmed by the therapeutic effect of treatment: the reduction of infiltrative changes in the lungs, increase the percentage of patients with closed cavities in the lungs and shorten hospital stay.

Keywords: drug-resistant destructive pulmonary tuberculosis, bacterial peptidoglycan, immune system, gamma-interferon.

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5. Original research


State of liver function in patients with newly diagnosed pulmonary tuberculosis in combination with viral hepatitis B and/or C

A.F. Marchenko

Objective — to assess the biochemical parameters of blood and liver ultrasound especially in patients with tuberculosis and viral hepatitis B and/or hepatitis C co-infection.
Materials and methods. We examined 29 patients with newly diagnosed pulmonary tuberculosis in combination with hepatitis B and/or C. The evaluation of the functional state of the liver was performed on biochemical parameters of blood serum including enzyme activity of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AP) and gamma-glutamyl (GGT), as well as bilirubin level and thymol test (TT). Liver ultrasonography (Voluson 730 Expert, GE Healthcare) was conducted in all patients in order to assess the shape, size, density and structure of the liver parenchyma, to identify focal lesions, free fluid in the abdominal cavity, stones in the biliary tract, changes in large vessels, bile ducts.The study was conducted during the first 7-10 days after admission of patients to the TB dispensary and before start of anti-TB treatment. All patients were diagnosed with viral hepatitis B and/or C.
Results and discussion. The study revealed biochemical and ultrasound signs of high activity of liver function abnormalities in some patients with chronic hepatitis B and/or C, as well as the formation of liver cirrhosis. Indicators of TT were increased (more than 4 units) in 78 % of patients and GGT (more than 50 units/l) was increased in 89.7 %. Most insignificant deviation from the normal level was increase of total and direct bilirubin. Increase in ALT and AST levels was observed with great frequency, that indicates parenchymal liver disease.
Conclusions. The study revealed changes in biochemical parameters of blood and liver ultrasound data that shows high chance of developing cirrhosis of the liver in patients with tuberculosis and chronic hepatitis B and/or C co-infection.

Keywords: newly diagnosed pulmonary tuberculosis, hepatitis B, hepatitis C, co-infection TB/viral hepatitis B and/or C.

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6. Original research


Abilities of ultrasound diagnostics of gastroesophageal reflux in patients with bronchial asthma

I.V. Krasiuk

Objective — to identify capability of ultrasound diagnostics (US) in the diagnosis of gastroesophageal reflux disease (GERD) in patients with bronchial asthma (BA).
Materials and methods. The study included 81 patients with asthma. For the diagnosis of GERD in patients with asthma used special techniques, including ultrasound of the esophagus.
Results and discussion. In 88.8 % of cases contrast ultrasound of the esophagus reveals a pathological gastroesophageal reflux in patients with clinical symptoms of GERD. US of esophagus reveals as informative for the diagnosis of hiatal hernia, which was found in 43.8 % of patients. Comparison of ultrasound data versus results of other methods of instrumental diagnostics showed that in 3 patients with normal US results, changes were found in FEGDS and radiography of the esophagus and stomach. Contrawise 3 of 4 patients with normal FEGDS with additional ultrasound showed signs of GERD.
Conclusions. Was reviled high informativity of esophageal ultrasound as an additional method of primary diagnosis of GERD. In people with asthma especially with severe forms is advisable to carry out a comprehensive examination of the upper gastrointestinal tract using ultrasound of the esophagus for the detection of GERD.

Keywords: bronchial asthma, gastroesophageal reflux disease, esophageal ultrasound diagnostics.

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7. Original research


Anemic syndrome in pulmonary inflammatory diseases of specific and nonspecific origin as the manifestation of the pituitary-thyroid imbalance systematic influence in pulmonary in elderly patients

L.D. Todorico

Objective — assessment of thyroid gland homeostasis, thyrotropic pituitary function and cortisol content in elderly TB and chronic obstructive pulmonary diseases patients with anemic syndrome; definition of the hormonal imbalance in the development of anemia of chronic disease.
Materials and methods. 380 patients with COPD and 65 primary diagnosed pulmonary tuberculosis patients with different sensitivity to anti-TB drugs aged from 44 to 87 years have been involved in the study. The function of the thyroid gland (TG) is estimated by measuring the level of thyroid stimulating hormone (TSH), antibody concentrations to thyroid peroxidase, concentration of thyroid free fractions hormones (triiodothyronine, thyroxine) and the calculation of the index of peripheral conversion of free thyroid hormones , depending on the nature of the content of TSH levels of thyroxine, in plasma by enzyme immunoassay method.
Results and discussion. Results of the study randomized sampling testified that anemic syndrome develops among older patients with COPD in 55.1 % cases.
Conclusions. Hypoxia and systemic inflammation accompanying with chronic lung disease, lead to thyroid hormonal imbalance and hypercortisolemia in elderly patients, which provoke development of anemia of chronic disease aggravating hypoxic-metabolic imbalance, and creating a vicious circle of disease progression and boosting of complications.

Keywords: thyroid hormones, chronic obstructive pulmonary diseases, tuberculosis, anemia.

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8. Original research


Efficacy of aktovegin and immunofan in the treatment of patients with drug-resistant tuberculosis

M.I. Sakhelashvili, I.L. Platonov, T.M. Balyta, G.D. Shtybel

Objective — to examine and compare the clinical efficacy of Actovegin and immunofana in treatment of children and adolescent patients with drug-resistant tuberculosis.
Materials and methods. Examined and treated 58 patients with newly diagnosed pulmonary drug-resistant tuberculosis 49 (84.5 %) of them — adolescents and 9 (15.5 %) are children. The first group of patients (22 pers.) received antimycobacterial therapy (AMBT) based on the results of drug susceptibility testing of Mycobacterium tuberculosis (MBT) to AMBP, the second one (18 pers.) — AMBT with the aktovegin at the beginning of the intensive phase of therapy (AMBT + Ak) third (18 pers.) — AMBT combined with aktovegin and immunofan (AMBT + Ak + Im). The results of treatment were evaluated on the basis of a comprehensive study of the clinical and radiological, bacteriological, common laboratory and immunological studies.
Results and discussion. Applying Actovegin and Immunofan during intensive phase AMBT (AMBT + + Ak, AMBT + Ak + Im) increases its efficiency, significantly reduces time and increases the frequency of cease of bacterioexcretion, symptoms of intoxication, normalization of the hemogram and ESR, eliminates irregularities in the immune defense system, promote resorption of focal, infiltrative changes and adhesion of cavities in the lung tissue.
Conclusions. Clinical effectiveness of treatment of drug-resistant tuberculosis in children and adoles­cents was the best under the regimen AMBT + Ak + Im.

Keywords: drug-resistant tuberculosis, children, adolescents, treatment regimens and their effectiveness.

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9. Original research


State of adaptive immunity in patients with destructive pulmonary tuberculosis with different expression receptors for interferon-gamma by lymphocytes

I.F. Ilyinskaya, Yu.O. Matvienko, I.V. Koposova, S.G. Yasyr, M.B. Singaievskyi

Objective — to revise the state of the adaptive immunity in patients with destructive pulmonary tuberculosis (DPTB) with differential lymphocytes (Lf) expression of interferon-gamma receptors (IFN-γR1) for further use of this data in the development of γ-IFN management.
Materials and methods. Assessment of T- and B-immunity systems was performed in 30 DTBL patients with high γ-IFN lymphocyte reception and in 38 patients — with reference and reduced reception. The control group was represented by 30 healthy volunteers.
Immunological examination included leukogramm determination; lymphocytes phenotyping and estimation of density of IFN-γR1 Lf expression by aser flow cytometry; assessment of proliferation activity in mitogene — phytohemagglutinin (PHA) — response in reaction of lymphocytes blast-transformation (RLBT). Levels of IgA, IgM and IgG in serum were detected by ELISA. Middle and small circulating immune complexes (CIC) were evaluated in the microprecipitation test in polyethylene glycol. Specific reactivity was assessed by RLBT with BCG and serum levels of anti-TB IgG-antibodies (ELISA).
Results and discusion. The study results showed that patients with low and reference γ-IFN lympho­cyte reception had decreased absolute content of cytotoxic T-cells. Almost identical reduction of the T-cells proliferation activity in PHA response was found in both groups, whereas the decrease in the proliferative response to a specific agent — BCG was detected only in patients with a high density of lymphocytes IFN-γR1 expression. In both groups, the study revealed hyperimunoglobulinemiya, which was manifested by increased IgM and IgG serum levels. Levels of middle and small CIC and anti-TB IgG-antibodies in patients of both groups were also high, but this increase was more significant in patients with elevated γ-IFN reception.
The patients with low and reference γ-IFN lymphocyte reception had comparative lymphocytosis in every 5-th case (in patients with high reception — in 13.3 %, p > 0.05), absolute lymphocytosis — 13.2%, whereas only one case of 30 was revealed in the group of patients with high γ-IFN lymphocyte reception. The study demonstrated that third part of all patients in both groups had the absolute content of cytotoxic T cells decreased, whereas its increase was recorded only in 13.3 % of patients with high IFN-γR1 lymphocyte expression and in 18.4 % in group with the reference and low expression (p > 0.05). Also, inhibition of the proliferative response of T cells to PHA occurred in the majority of patients of both groups, that resulted in a negative RLBT with BCG — in 52.0% and 44.4 %, respectively. At the same time, the increase of the levels of anti-tuberculosis antibody was detected only in 48.0 % and 28.9 % of patients of these groups respectively.
Conclusions. Decrease of IFN-γR1 density on lymphocytes in DTBL patients is not always accompanied by a decrease of these cells content and inhibition of their functional activity, and vice versa. Evidences of interferon failure are: low T-cells and their subpopulations count, reduced number of NK cells, inhibition of the proliferative lymphocetes response on PHA and BCG, as well as low levels of anti-TB antibodies.
The high γ-IFN lymphocytes reception in patients with specific T cell and humoral response depression may be due to cytokine deficiency, caused by inhibition of its production or binding by soluble ligands or autoantibodies. To determine the presence and frequency of these mechanisms further investigation is required.

Keywords: immunodeficiency, gamma-interferon receptors, pulmonary tuberculosis, lymphocytes, T-cells, B-cells, adaptive immunity.

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10. Original research


Clinical X-ray manifestations of lung pathology caused by pneumocystis in AIDS patients

S.V. Limarev, I.O. Kramnoy, I.O. Voron’zhev

Objective — to study the clinical and radiographic features of lung changes in pneumocystosis in AIDS patients.
Materials and methods. The X-ray data of the chest direct and additional projections in 56 AIDS patients aged 18—62 years, were performed in the Kharkiv Regional Clinical Hospital of Infectious Diseases. The diagnosis was verified by clinical laboratory testing.
Results and discussion. The results of the data analysis allowed to distinguish changes in pneumocys­tosis and identify 3 major radiological syndromes. First syndrome occurs in the early development of PCP, is not specific, the X-ray pattern of pulmonary pathology manifests in enrichment and prominence of perihilar markings. In the first 5—8 prominence usually began with juxtahilar departments (76.8 %) or basal-medial, and later spread to both lungs. Second syndrome characterized with progression of changes in the form of appearance of light transparency (decrease), which was a reflection of inflammation within the next 5—10 days. In the next 3—4 weeks radiological changes manifested wuth diffuse lateral radiograph, juxtahilar interstitial infiltrates, often lower-basal, which later spread from the roots to the periphery (a symptom of «frosted glass», «blizzard», «cotton» light). These changes were revealed inl 30.4 % of patients and corresponded to the atelectatic phase. Pneumonia in AIDS patients differed substantially and showed up as diffuse disease of both lungs with the involvement of intrathoracic lymph nodes. Third syndrome reflected changes of pleura. Radiographs in 33.9 % cases showed induration of pleura by the way of right additional horizontal fissura. In 8.9 % cases bilateral pneumonia was complicated by pleurisy with a small amount of fluid, mainly in the lateral sinuses.
Conclusions. Chest X-ray radiographic features allowed to establish manifestations of the modern trend of PCP in AIDS patients in three major syndromes — from primary pulmonary pattern changes to the occurrence of significant picture due to an inflammatory process.

Keywords: AIDS, neumocystis pneumonia, chest radiography.

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11. Original research


Characteristic of pharmacokinetic features of Gatifloxacin and Levofloxacin in patients with newly diagnosed pulmonary tuberculosis depending on the method of their administration

.V. Avramchuk

Objective — to detect the pharmacokinetic characteristics of III—IV generation fluoroquinolones depending on the method of administration in patients with newly diagnosed pulmonary tuberculosis.
Materials and methods. 20 patients were enrolled in the study: 10 patients treated with levofloxacin 1000 mg and 10 — gatifloxacin 400 mg. Detection of fluoroquinolones concentration in blood serum was made 6 times a day: up to application, 1, 2, 4, 8, 24 hours after drug administration.
Results and discussion. In 1 hour after intravenous use of levofloxacin and gatifloxacin the blood serum concentrations of the drugs were authentically high — (17.8 ± 1.2) µg/ml and (5.6 ± 0.2) µg/ml than after oral use — (13.7 ± 1.5) µg/ml and (3.6 ± 0.2) µg/ml, accordingly, < 0.05. In 24 hours after intravenous and oral use the blood plasma concentrations of levofloxacin — (0.4 ± 0.1) µg/ml and (0.5 ± 0.1) µg/ml, were less than the minimum inhibitory concentration. Gatifloxacin concentration in a blood plasma persists for the whole day and greatly exceeds the minimum inhibitory concentration — (0.4 ± 0.1) mcg/ml both after intravenous and oral administration, p < 0.05.
Conclusions. High concentrations of these fluoroquinolones lasts for 2 hours after their taken and doesn’t depend from a route of their use. After 24 hours the concentration in the blood plasma of gatiflo­xacin after oral and intravenously use, above the minimum inhibitory concentration drug, as opposed to levofloxacin, which through the day will not create bactericidal concentrations.

Keywords: newly diagnosed pulmonary tuberculosis, levofloxacin, gatifloxacin, pharmacokinetics.

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12. Original research


Quality of life and the risk of osteoporosis in patients with chronic obstructive pulmonary disease

N.P. Masik

Objective — to study the quality of life in patients with COPD with the definition of the risk of osteoporosis.
Materials and methods. A total of 696 patients with age (55.40 ± 14.98) years. There were 391 men mean age 54.09 ± 14.04 years and 305 women mean age 56.98 ± 15.88. Comorbidities were diagnosed in 347 (49.86 %) patients. Quality of life was measured using a questionnaires SF-12 and EuroQol-5D. Assessment of risk factors for osteoporosis was performed using minute test (one — minute osteoporosis risk test), proposed by the International Association of osteoporosis.
Results and discussion. Clinical characteristics of patients were association of symptoms COPD and signs of lesions of the musculoskeletal system (pain in the spine, joints, muscles, reducing growth, thoracic kyphosis). Thus, 46.80 % of patients with COPD noted pain/discomfort, and 19.15 % of the patients indicated a pronounced vertebral pain. In patients with severe COPD stage twofold as to be found to reducing of the physical status, decline of general health and social activity. Reduction of mental status was noted in 85.10 % COPD patients on firtst stage, 65.96 % patients on second stage, which might indicate a lack of adaptation to the disease, and in 48.94 % of patients on fourth stage. Disorders of physical activity was diagnosed in 59.94 %, altered mental status — in 79.83 % of COPD patients with comorbidities. Using minute test for osteoporosis risk assessment give us opportunity to detect patients with structural and functional disorders of bone tissue.
Conclusions. COPD leads to a limitation of all components of the normal life of patients namely reduction of life quality, the intensity of the changes is determined by the clinical symptoms, the degree of bronchial obstruction, duration and severity of illness, presence of comorbidities, age and sex of the patients. Existance of vertebral pain syndrome in patients with COPD requires further examination of the patient.

Keywords: chronic obstructive pulmonary disease (COPD), quality of life, osteoporosis, risk factors.

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13. Original research


Selective computer-mathematical tracking morbidity of tuberculosis in MS xcel system

Ya.M. Ilnitsky, G.I. Ilnitsky

The aim — to describe the epidemiological situation of tuberculosis in different age groups with the use of computer and information technology.
Materials and methods. Based on a digital computer and information technology for the monitoring, held selective evaluation of the tuberculosis infection in different age groups. For this purpose, used the annual reportable materials provided by the Ministry of Health of Ukraine, the results of own observations and the data base in MS xcel system.
Results and discussion. Initial positions were formed based on epidemiological indicators in Ukraine and Lviv region for the period of ten years (2000—2009 years), which in connection with various characteristics of digital has been divided into two phases. First phase (2000—2004 years) gave evidence about progressive deterioration of the epidemiological situation of tuberculosis, and during the second phase (2005—2009 years) was noted relative stabilization of the morbidity. The results were processed using statistical and mathematical functions of the MS Excel program, parametric and non-parametric characteristics to establish the correlation in the evaluation of the dynamics of the epidemiological characteristics.
Conclusions. The average morbidity of tuberculosis in Ukraine significantly higher that in the Lviv region, without distinction of the age of the population. At the same time, the incidence of tuberculosis infection in the outbreak showed an increase in this indicator in the Lviv region in children, adolescence and adults, which substantiates the need for better implementation of therapeutic and preventive measures.

Keywords: epidemiology of tuberculosis, information technology, children, adolescents, adults.

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14. Reviews


Treatment as prevention of HIV infection. End of the epidemic?

A.G. Dyachenko, S.L. Grabovyi, P.A. Dyachenko, K.M. Gorobchenko

Long-term efforts to create a traditional HIV vaccine that would induce protective production of (ideal­ly — virus neutralizing) antibodies due to structural peculiarities and pathogenesis of the virus have failed. At the same time the expansion of global access to antiretroviral therapy (ART) contributed to a dramatic reduction not only in mortality from HIV-associated diseases, but also in morbidity.
The article reviews the strategy of «treatment as prevention» and the issue of increasing the effectiveness of individual components of preventive stage.

Keywords: HIV, AIDS, antiretroviral therapy, prevention, ways of transmission.

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15. Reviews


Genotyping methods in phthisiology

O.O. Liashenko

To resolve problems in epidemiology of tuberculosis required methods that allow to distinguish M. tuberculosis. One of the first methods was the division of mycobacteria based on their biochemical properties but because of low efficiency and ambiguity of results technique is not using now. Later appeared methods with more discriminate ability based on difference in the genome of mycobacteria. Moreover data that received from different scientists can be compared.

Keywords: M. tuberculosis, genotyping, phthisiology, RFLP, VNTR, spoligotyping.

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Peculiarities of extrapulmonary tuberculosis in children with unknown contact

L.I. Mykolyshyn, Z.I. Piskur

Objective — to explore peculiarities of extrapulmonary tuberculosis in children with unknown contact.
Materials and methods. Analysis of 117 case histories of children treated for extrapulmonary tuberculosis in 1988—2013.
Results and discussion. In 66.7 % of the children contact with TB patients was not detected. In the structure of clinical forms of extrapulmonary tuberculosis dominated TB of lymph nodes (36.0 %), bones and joints (24.4 %), and the meninges and central nervous system (18.0 %). In 69.2 % of children extrapulmonary tuberculosis was combined with pulmonary tuberculosis. 24.4 % of children suffered from complicated forms of tuberculosis. It is important that all children belonged to risk groups. Premorbid conditions of vast majority of children (79.5 %) were aggravated by past illnesses and associated diseases, 46.2 % of children were from socially deprived families. The majority of children (70.0 %) with severe and complicated forms were either not vaccinated with BCG or vaccinated inefficiently. Almost all cases (96.2 %) were revealed while children parents were seeking medical care. An incomplete volume of preventive measures for tuberculosis carried out among children at risk resulted in severe and complicated forms of pulmonary and extrapulmonary tuberculosis and in two cases in children death.
Conclusions. In order to reveal sources of infection it is necessary to intensify preventive measures among adult population aimed at timely detection of TB and isolate all patients who discharge bacilli until they stop discharging. TB preventive measures among children at risk should be reinforced also.

Keywords: extrapulmonary tuberculosis, respiratory tuberculosis, contact, prevention.

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17. from experience


About attitude to the treatment of TB patients

I.T. Pyatnochka, S.I. Kornaha, N.V. Thoryk

Objective — to improve attitude to treatment of TB patients due to adequate individual approach taking into account possible neuropsychic violations.
Methods and materials. Neuropsychic functional disorders studied in 153 patients with pulmonary TB with the use of psychological methodology of LNP (N.B. Lasko, 1978). Used the results of the survey (67 patients), determination of saturation of blood by oxygen (485 persons), and also individual work taking into account the psychological condition of each patient.
Results and discussion. Long-term supervisions and researches showed that for patients with pulmo­nary TB various functional neuropsychic violations that arise up in connection with the diagnosis of tuberculosis are possible, as a result of intoxication or on soil of chemotherapy and other factors. Neuropsychic violations are established in 70.6 % patients (psyhopatizatoin at 30.8 %, neurotization at 23.9 % and their combination at 15.9 %). All these psychical violations mostly can be leveled, primarily insistent, friendly, personal influence on the psyche of the patient’s by the TB doctors. And, as a result, considerably to improve a attitude to treatment on different stages and to attain more ponderable positive results of treatment considerably.
Conclusions. In 70.6 % patients with pulmonary TB appears different functional neuropsychic violations that is  predefined by the different factors. These psychical violations, largely, it canlevel, mainly, by friendly, personal influence on the psyche of the patient and considerably to improve attitude to treatment and thus attain the best results.

Keywords: tuberculosis, attitude, treatment.

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