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Issue. Articles
№4(23) // 2015
1. Original researches
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 Duration of intensive phase chemotherapy in treatment the patients with multidrug-resistant tuberculosis (UKR)S.О. Cherenko, N.V. Grankina, M.V. Pogrebna |
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Objective — to study of the effectiveness of the 6- and 8-month intensive phase of chemotherapy, intreatment the patients with MDRTB.
Materials and methods. In a controlled study investigated the efficacy of intensive phase of 6- and 8-month duration in the treatment of patients with new cases of multidrug-resistant tuberculosis. 6-month duration of the intensive phase was applied in 95 patients with MDRTB (study group), 8-month duration — in 59 patients (control group). The patients in the comparison groups did not differ on the case of the disease, the spread of tuberculous process and MBTdrug resistance profile. In both groupsdominated thepatients with retreatment cases (failure I course, interrupted treatment, recurrences) — respectively in 61.1 and 63.2 % of patients. Evaluate the effectiveness of the treatment was carried out at the end of the intensive phase and the main course of chemotherapy for sputum conversion by culture. The study included only those patients who have known the result of treatment at the end of the basic course of chemotherapy and excluded patients who discontinued treatment in the continuation phase.
Results and discussion. In the study the sputum conversion at the end of the intensive phase occurred in 84.2 % of patients, in the control group — in 81.4 % of patients (p < 0.05). After completion of the basic course of chemotherapy (24 months) continues to define the sputum conversion in 69.5 % of patients in the study group and in 66.1 % of patients in the control group (p < 0.05). The sputum reconversion inthe continuation phase or after completion of the basic course of chemotherapy was respectively 14.7 and 15.3 % of patients (p < 0.05). Adverse reactions were 37.9 % in the study group and in 57.6 % of patients in the control group (p < 0.05), including the vestibular-ototoxic — in 12.6 and 23.7 % of patients (p > 0.5).
Conclusions. Lengthening the duration of intensive phase of chemotherapy with 6 to 8 months does not affect the results of treatment by the frequency sputum conversion as at the end of the intensive phase, and at the end of the basic course of chemotherapy, but significantly increases the number of adverse reactions. 6-month duration of the intensive phase of chemotherapy, as well as the 8-month provide high efficiency of the individualized treatment of patients with new cases MDR TB — cure is achieved, respectively in 69.5 % and 66.1 % of patients
Keywords: multidrug-resistant tuberculosis, duration of intensive phase of chemotherapy, treatment effectiveness.
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Original language: Ukrainian
2. jubilee
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 On the 85th anniversary of Leonid G. Averbukh (UKR) |
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Thirty first in October 2015 marked 85 years since the birth of one of the oldest phthisiologists Ukraine - Honored Doctor of Ukraine, Candidate of Medical Sciences Leonid G. Averbukh.
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Original language: Ukrainian
3. Original researches
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 Functional being of adrenoсortiсal system at patients with the tuberculosis/HIV (UKR)R.G. Proziuk, Yu.V. Zaguta |
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Objective — to study of particularities of the adrenocortical system functional condition at patients with pulmonary tuberculosis, associated with HIV-infection.
Materials and methods. 30 patients are examined with for the first time diagnosed by pulmonary tuberculosis and 81 patients with for the first time diagnosed by tuberculosis, associated with HIV-infection. The concentration of cortisol and adrenocorticotropic hormone explored with using of radioimmunological method. The said studies were also organized beside 24 healthy people such sex and age.
Results and discussion. The concentration cortisol beside patients without HIV-infections was in 2.4 times above, than beside healthy people, but beside patients with HIV-infection and in 1.7 times above. Such regularity is revealled and beside concentrations adrenocorticotropic hormone: concentration of this hormone beside patient without HIV-infections was above, than beside healthy people beside 4,2 times, but beside patient with HIV-infection in 2.5 times.
Functional condition adrenocortical system depended on clinical form of the tuberculosis only beside patient with HIV-infection. Beside patient with HIV-infection before moment of the address for medical help was noted big duration intoxication symptom (6 months). Possible expect that revealled change developed beside patient with HIV-infection for this length of time already. Beside all patients is revealled negative relationship between concentration hormone and latitude of the pulmonary process.
Conclusions. At patients with the tuberculosis/HIV by comparison to HIV-negative patients there is more low activity of the adrenocortical system, that represents exhausting of its functional reserve possibilities, in a greater measure by the shown exhausting of exactly function of adrenal cortex, which reminds primary insufficiency of adrenal cortex. Dependence of hormonal functions on prevalence of pulmonary process is also exposed
Materials and methods. 30 patients are examined with for the first time diagnosed by pulmonary tuberculosis and 81 patients with for the first time diagnosed by tuberculosis, associated with HIV-infection. The concentration of cortisol and adrenocorticotropic hormone explored with using of radioimmunological method. The said studies were also organized beside 24 healthy people such sex and age.
Results and discussion. The concentration cortisol beside patients without HIV-infections was in 2.4 times above, than beside healthy people, but beside patients with HIV-infection and in 1.7 times above. Such regularity is revealled and beside concentrations adrenocorticotropic hormone: concentration of this hormone beside patient without HIV-infections was above, than beside healthy people beside 4,2 times, but beside patient with HIV-infection in 2.5 times.
Functional condition adrenocortical system depended on clinical form of the tuberculosis only beside patient with HIV-infection. Beside patient with HIV-infection before moment of the address for medical help was noted big duration intoxication symptom (6 months). Possible expect that revealled change developed beside patient with HIV-infection for this length of time already. Beside all patients is revealled negative relationship between concentration hormone and latitude of the pulmonary process.
Conclusions. At patients with the tuberculosis/HIV by comparison to HIV-negative patients there is more low activity of the adrenocortical system, that represents exhausting of its functional reserve possibilities, in a greater measure by the shown exhausting of exactly function of adrenal cortex, which reminds primary insufficiency of adrenal cortex. Dependence of hormonal functions on prevalence of pulmonary process is also exposed
Keywords: adrenocortical system, tuberculosis, HIV.
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Original language: Ukrainian
4. Original researches
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 Effect doses of isoniazid and vitamin В6 on renal guinea-pigs under conditions of destructive pulmanary tuberculosis therapy (UKR)L.V. Gaeva |
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Objective — to identify the best combination of drugs for the treatment which is achieved at least a residual kidney damage, whose assessment carried out by the results of the morphological characteristics of internal tissues under treatment in different ratios doses of isoniazid and vitamin B6.
Materials and methods. This paper presents the results of treatment of destructive pulmonary tuberculosis different doses of isoniazid and vitamin B6.
Results and discussion. Studies to determine the protective action of isoniazid and vitamins B6 relative to the internal organs of guinea-pigs in experimental tuberculosis are intended to help find a correlation between the dose of isoniazid and vitamin B6, which is important to optimize treatment regimens TB and assessment antitoxic action of vitamin B6 in the conditions of isoniazid overdose.
Conclusions. The slightest sign of side effects on morphological features found in cases of (10 + 50) and (32 + 5) mg/kg, which is the best result of treatment compared with treatment doses (10 + 5) mg/kg, where side effects is more significant
Materials and methods. This paper presents the results of treatment of destructive pulmonary tuberculosis different doses of isoniazid and vitamin B6.
Results and discussion. Studies to determine the protective action of isoniazid and vitamins B6 relative to the internal organs of guinea-pigs in experimental tuberculosis are intended to help find a correlation between the dose of isoniazid and vitamin B6, which is important to optimize treatment regimens TB and assessment antitoxic action of vitamin B6 in the conditions of isoniazid overdose.
Conclusions. The slightest sign of side effects on morphological features found in cases of (10 + 50) and (32 + 5) mg/kg, which is the best result of treatment compared with treatment doses (10 + 5) mg/kg, where side effects is more significant
Keywords: tuberculosis of the lungs, spleen, liver, kidneys, indices of infestation, isoniazid, vitamin B6, the optimal ratio, mathematical model.
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Original language: Ukrainian
5. Original researches
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 Clinical and prognostic significance of biological markers in the diagnosis of the accompanying threat of destabilization of coronary heart disease in chronic obstructive pulmonary disease (UKR)P.R. Gerych, R.I. Yatsyshyn |
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Objective — to study the role of specific biochemical and immunological parameters in blood as diagnostic biological markers of cardiovascular risk in patients with exacerbation of chronic obstructive pulmonary disease (COPD).
Materials and metods. In 72 patients with COPD III it was analyzed levels of diagnostic biological markers (plasma concentrations of total cholesterol, triglycerides, high, low and very low density lipoproteins, immunoglobulins, blood C-reactive protein (CRP) and α2-macroglobulin), which were used us as a primary points of risk assessment, the severity and prognosis of coronary artery disease accompanying threat of destabilization.
Results and discussion. According to the serum lipids analysis in patients with exacerbation of COPD III difference was found for almost all indicators in the different study groups that found further explanation in the research results. Thus, total cholesterol rates in patients with combined cardiorespiratory pathology were significantly higher compared with the control group.
Conclusions. It was established that increasing levels of total cholesterol to (5.34 ± 0.19) and more to low-density lipoprotein (3.32 ± 0.14) mmol/l and more, very lipoprotein peak density to (0.96 ± 0.03) mmol/l and more to triglycerides (2.21 ± 0.13) mmol/l or more, to atherogenic factor (4.45 ± 0.18) and higher C-reactive protein in 1.67 times to (4.85 ± 0.42) mg/l and more, α2-macroglobulin in time to 2.16 (1.32 ± 0.27) mg/l and more, IgM in time to 1,49 (2.89 ± 0.11) mg/l and more and lower levels of peak density lipoprotein to (0.98 ± 0.04) mmol/l and less decrease in IgA levels to 1,49 times (1.32 ± 0.27) mmol/l or less and decrease in IgG 1.59 times to (9.30 ± 0.28) mg/l or less may be defined as antecedent and diagnostic markers unfavorable co morbid coronary artery disease in patients with acute exacerbation of COPD III severity.
Materials and metods. In 72 patients with COPD III it was analyzed levels of diagnostic biological markers (plasma concentrations of total cholesterol, triglycerides, high, low and very low density lipoproteins, immunoglobulins, blood C-reactive protein (CRP) and α2-macroglobulin), which were used us as a primary points of risk assessment, the severity and prognosis of coronary artery disease accompanying threat of destabilization.
Results and discussion. According to the serum lipids analysis in patients with exacerbation of COPD III difference was found for almost all indicators in the different study groups that found further explanation in the research results. Thus, total cholesterol rates in patients with combined cardiorespiratory pathology were significantly higher compared with the control group.
Conclusions. It was established that increasing levels of total cholesterol to (5.34 ± 0.19) and more to low-density lipoprotein (3.32 ± 0.14) mmol/l and more, very lipoprotein peak density to (0.96 ± 0.03) mmol/l and more to triglycerides (2.21 ± 0.13) mmol/l or more, to atherogenic factor (4.45 ± 0.18) and higher C-reactive protein in 1.67 times to (4.85 ± 0.42) mg/l and more, α2-macroglobulin in time to 2.16 (1.32 ± 0.27) mg/l and more, IgM in time to 1,49 (2.89 ± 0.11) mg/l and more and lower levels of peak density lipoprotein to (0.98 ± 0.04) mmol/l and less decrease in IgA levels to 1,49 times (1.32 ± 0.27) mmol/l or less and decrease in IgG 1.59 times to (9.30 ± 0.28) mg/l or less may be defined as antecedent and diagnostic markers unfavorable co morbid coronary artery disease in patients with acute exacerbation of COPD III severity.
Keywords: COPD, co morbid coronary artery disease, biomarkers cardiorespiratory disease.
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Original language: Ukrainian
6. Original researches
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 The effectiveness of the intensive phase of antituberculosis chemotherapy using inhalation drugs in patients with newly diagnosed pulmonary tuberculosis (UKR)M.M. Kuzhko, L.M. Protsyk, N.M. Gulchuk, O.V. Avramchuk |
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Objective — to determine the effectiveness of isoniazid and rifampicin nebulized inhalation in the intensive phase of antituberculosis chemotherapy in patients with concomitant pulmonary tuberculosis with tuberculosis trachea and bronchi.
Materials and methods. The study involved 48 patients with respiratory tuberculosis who were divided into two groups: primary, in which 21 patients received standard antituberculous chemotherapy and additional isoniazid and rifampicin inhaled nebulized and salmeterol and fluticasone propionate during the intensive phase of treatment, and control, in which 27 patients received only standard antituberculous therapy.
Results and discussion. After completion of the intensive phase of chemotherapy in patients of the observed increase in the frequency of cessation bacterial excretion by 29.7 %, reducing large residual changes in lungs by 28.1 %, stenosis of the bronchi scar II—III stage by 38.7 % in comparison with the control group (p < 0.05), reducing the time to cessation of bacterial excretion (1.4 ± 0.3) months. reduce the overall length of hospital treatment to (2.4 ± 0.4) months (p < 0.05).
Conclusions. In patients with pulmonary tuberculosis with concomitant with tuberculosis trachea and bronchi use of isoniazid and rifampicin inhaled nebulized and salmeterol and fluticasone propionate additionally to standard antituberculosis chemotherapy, can significantly increase the frequency of the cessation bacterial excretion, reduce the incidence of scar stenosis of the bronchi, leads to a significant reduction in the total duration of hospital treatment
Materials and methods. The study involved 48 patients with respiratory tuberculosis who were divided into two groups: primary, in which 21 patients received standard antituberculous chemotherapy and additional isoniazid and rifampicin inhaled nebulized and salmeterol and fluticasone propionate during the intensive phase of treatment, and control, in which 27 patients received only standard antituberculous therapy.
Results and discussion. After completion of the intensive phase of chemotherapy in patients of the observed increase in the frequency of cessation bacterial excretion by 29.7 %, reducing large residual changes in lungs by 28.1 %, stenosis of the bronchi scar II—III stage by 38.7 % in comparison with the control group (p < 0.05), reducing the time to cessation of bacterial excretion (1.4 ± 0.3) months. reduce the overall length of hospital treatment to (2.4 ± 0.4) months (p < 0.05).
Conclusions. In patients with pulmonary tuberculosis with concomitant with tuberculosis trachea and bronchi use of isoniazid and rifampicin inhaled nebulized and salmeterol and fluticasone propionate additionally to standard antituberculosis chemotherapy, can significantly increase the frequency of the cessation bacterial excretion, reduce the incidence of scar stenosis of the bronchi, leads to a significant reduction in the total duration of hospital treatment
Keywords: tuberculosis, lungs, bronchi, nebulizer, chemotherapy.
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Original language: Ukrainian
7. Original researches
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 Risk factors for complications of BCG vaccination (UKR)I.D. Duzhiy, M.Yu. Shevchenko, Yu.Yu. Shevchenko, D.V. Ovechkin, N.M. Demeha |
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Objective — to study the risk factors for complications of BCG vaccination.
Materials and methods. The analysis of prophylactic vaccination in Sumy region during 2001—2014 years.
Results and discussion. In 182 children found «local» complications, including changes in the area of immunization and lymphadenitis; 36 children — disseminated complications. Risk factors were: environmental impacts (residence), age, sex, comorbidities and maternal disease, smoking and alcohol consumption in families.Complications of BCG vaccination occurred mainly in winter and spring (78.8 %), reflecting a decrease in immunity. 97.2 % of children with local complications were under the age of 1 year, and BCG osteitis occurred in 77.7 % of children aged 1—3 years.
Conclusions. Authors have found such «provoking factors» in the development of BCG complications: inflammatory diseases, anemia, congenital diseases, nervous system diseases, smoking and alcohol abuse, environmental and seasonal effects.
Materials and methods. The analysis of prophylactic vaccination in Sumy region during 2001—2014 years.
Results and discussion. In 182 children found «local» complications, including changes in the area of immunization and lymphadenitis; 36 children — disseminated complications. Risk factors were: environmental impacts (residence), age, sex, comorbidities and maternal disease, smoking and alcohol consumption in families.Complications of BCG vaccination occurred mainly in winter and spring (78.8 %), reflecting a decrease in immunity. 97.2 % of children with local complications were under the age of 1 year, and BCG osteitis occurred in 77.7 % of children aged 1—3 years.
Conclusions. Authors have found such «provoking factors» in the development of BCG complications: inflammatory diseases, anemia, congenital diseases, nervous system diseases, smoking and alcohol abuse, environmental and seasonal effects.
Keywords: BCG-vaccination, complications, risks.
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Original language: Ukrainian
8. Original researches
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 Study of proliferative activity and intensity of bronchial epitheliocyte apoptosis in case of pulmonary multidrug-resistant tuberculosis (UKR)L.D. Todoriko, I.V. Ieremenchuk, I.S. Davydenko |
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Objective — to investigate the proliferative activity and the intensity of the bronchial epithelial cells apoptosis in patients with newly diagnosed multidrug-resistant pulmonary tuberculosis (MRTB).
Materials and methods. 15 patients with primary diagnosed pulmonary tuberculosis (PDTB) and 15 MDR TB patients aged from 20 to 45, mostly male, were examined. All patients were diagnosed with destructive tuberculosis (TB): 66.4 % — disseminated TB and 33.6 % — TB with infiltrates. Brush-biopsy (by the standard method) was performed for intrevital morphological study of bronchial epitheliocytes with electron microscope as well as antigens Bax, Bcl-2, PCNA- and TUNEL-positive nuclei immunohistochemical definition was carried out.
Results and discussion. The apoptotic reactions is higher in Patients with MDR TB in comparison with preserved MBT sensitivity and is accompanied by an increased proliferative activity of bronchial epithelial cells. The intensity of the apoptosis-brush bioptat in MDR TB patients occurs due to a lower percentage of positive PCNA — nuclei and enhancement of TUNEL-positive nuclei with increased concentration of proapoptotic protein Bax. Activated apoptotic process with a transition into an uncontrollable natural cell death is characterized by prevalence and progression of tuberculous process, clinical manifestation and prognosis of the residual changes formation.
Conclusions. It is proved that a substantial violation between apoptosis and proliferation processes takes place in patients with newly diagnosed multidrug-resistant pulmonary tuberculosis. Method of counting of the number of structures (indexes of apoptosis and proliferation) may be used to determine the earliest manifestations of apoptotic activity, prognosis of clinical manifestations and residual changes formation.
Materials and methods. 15 patients with primary diagnosed pulmonary tuberculosis (PDTB) and 15 MDR TB patients aged from 20 to 45, mostly male, were examined. All patients were diagnosed with destructive tuberculosis (TB): 66.4 % — disseminated TB and 33.6 % — TB with infiltrates. Brush-biopsy (by the standard method) was performed for intrevital morphological study of bronchial epitheliocytes with electron microscope as well as antigens Bax, Bcl-2, PCNA- and TUNEL-positive nuclei immunohistochemical definition was carried out.
Results and discussion. The apoptotic reactions is higher in Patients with MDR TB in comparison with preserved MBT sensitivity and is accompanied by an increased proliferative activity of bronchial epithelial cells. The intensity of the apoptosis-brush bioptat in MDR TB patients occurs due to a lower percentage of positive PCNA — nuclei and enhancement of TUNEL-positive nuclei with increased concentration of proapoptotic protein Bax. Activated apoptotic process with a transition into an uncontrollable natural cell death is characterized by prevalence and progression of tuberculous process, clinical manifestation and prognosis of the residual changes formation.
Conclusions. It is proved that a substantial violation between apoptosis and proliferation processes takes place in patients with newly diagnosed multidrug-resistant pulmonary tuberculosis. Method of counting of the number of structures (indexes of apoptosis and proliferation) may be used to determine the earliest manifestations of apoptotic activity, prognosis of clinical manifestations and residual changes formation.
Keywords: multidrug-resistant tuberculosis, proliferation, apoptosis, epitheliocytes.
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Original language: Ukrainian
9. Original researches
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 Awareness of MDR TB patients regarding tuberculosis (UKR)S.I. Kornaha, I.T. Pyatnochka |
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Objective — to find out the level of awareness of MDR TB patients regarding their disease.
Materials and methods. 70 patients with MDR TB from the inpatient department of TB hospital were interviewed in order to collect the information. Special questionnaire of 18 questions was developed for this purpose. The questionnaire included general questions about tuberculosis and its infection agent, sources of infection, ways of TB transmission, clinical manifestations of the disease, the ways of early detection, MDR TB causes, and forms of prevention and treatment.
Results and discussion. Of all the answers provided by MDR TB patients 38.8 % of the answers were correct, 17.7 % — partially correct and 43.5 % — were wrong. The results show very low level of awareness of patients on TB. TB specialists are also responsible for such poor results because they currently do not pay much attention to the health education of MDR TB patients. Without everyday health education among such difficult patients, without generating in patients personal hygiene behavior, adequate behavior in the family and the community, without reasonable adequate adherence to treatment the fight against drug-resistant tuberculosis is doomed to failure.
Conclusions. The results of MDR TB patient’s survey showed low level of awareness on some issues of TB, since only 38.8 % of respondents provided correct answers to the questions. The lowest level of awareness was among rural patients and male patients, respectively, 49.4 and 47.7 %. Without significant improvement of adequate health education, especially on individual basis it is impossible to achieve positive results in the fight against MDR TB. TB specialists, implementing the tasks of uniform clinical protocol (UCPMH) «Tuberculosis» (2014) should daily work to improve awareness of the population and MDR TB patients in particular
Materials and methods. 70 patients with MDR TB from the inpatient department of TB hospital were interviewed in order to collect the information. Special questionnaire of 18 questions was developed for this purpose. The questionnaire included general questions about tuberculosis and its infection agent, sources of infection, ways of TB transmission, clinical manifestations of the disease, the ways of early detection, MDR TB causes, and forms of prevention and treatment.
Results and discussion. Of all the answers provided by MDR TB patients 38.8 % of the answers were correct, 17.7 % — partially correct and 43.5 % — were wrong. The results show very low level of awareness of patients on TB. TB specialists are also responsible for such poor results because they currently do not pay much attention to the health education of MDR TB patients. Without everyday health education among such difficult patients, without generating in patients personal hygiene behavior, adequate behavior in the family and the community, without reasonable adequate adherence to treatment the fight against drug-resistant tuberculosis is doomed to failure.
Conclusions. The results of MDR TB patient’s survey showed low level of awareness on some issues of TB, since only 38.8 % of respondents provided correct answers to the questions. The lowest level of awareness was among rural patients and male patients, respectively, 49.4 and 47.7 %. Without significant improvement of adequate health education, especially on individual basis it is impossible to achieve positive results in the fight against MDR TB. TB specialists, implementing the tasks of uniform clinical protocol (UCPMH) «Tuberculosis» (2014) should daily work to improve awareness of the population and MDR TB patients in particular
Keywords: multidrug-resistant tuberculosis, health education.
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Original language: Ukrainian
10. Original researches
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 Tuberculous meningitis combined with pulmonary tuberculosis in children (UKR)Z.I. Piskur |
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Objective — to study features of clinical course of tuberculous meningitis combined with pulmonary tuberculosis and causes of late diagnosis of the disease in children.
Materials and methods. 131 medical in children cards for the age group from 0 to 15 years old who were treated on local forms of extrapulmonary tuberculosis in a specialized children’s department for the last 26 years have been analyzed.
Results and discussion. It has been established that out of 131 children with extrapulmonary tuberculosis the tuberculous meningitis is equal to 23.0 %. Among all the forms of extrapulmonary tuberculosis the tuberculous meningitis combined with pulmonary tuberculosis is equal to 18.3 %. Children aged from 0 to 4 years old prevailed 58.3 %. Severity of the disease was intensified by other diseases — in 70.8 % of children. Factor of social risk was found out in 54.2 % cases. In most cases the disease was diagnosed late (62.5 %): the results of tuberculin tests at the beginning of the disease were found out in 79.2 %, spinal puncture — in 50.0 %. Insufficient information of tuberculine tests impeded diagnosing: Mantoux test was not done in 20.8 % of the cases and in 15.8 % — tuberculine negative. Unknown contact (45.8 %) made it also difficult to recognize the disease.
Conclusions. The combination of tuberculous meningitis with pulmonary tuberculosis is a severe disease leading to lethal outcome in 8.3 % cases. To recognize tuberculous meningitis at an early stage it is necessary to improve knowledge in diagnosing and clinic of the disease for general practitioners and phthisiologists and intensify specific, health and social preventive measures
Materials and methods. 131 medical in children cards for the age group from 0 to 15 years old who were treated on local forms of extrapulmonary tuberculosis in a specialized children’s department for the last 26 years have been analyzed.
Results and discussion. It has been established that out of 131 children with extrapulmonary tuberculosis the tuberculous meningitis is equal to 23.0 %. Among all the forms of extrapulmonary tuberculosis the tuberculous meningitis combined with pulmonary tuberculosis is equal to 18.3 %. Children aged from 0 to 4 years old prevailed 58.3 %. Severity of the disease was intensified by other diseases — in 70.8 % of children. Factor of social risk was found out in 54.2 % cases. In most cases the disease was diagnosed late (62.5 %): the results of tuberculin tests at the beginning of the disease were found out in 79.2 %, spinal puncture — in 50.0 %. Insufficient information of tuberculine tests impeded diagnosing: Mantoux test was not done in 20.8 % of the cases and in 15.8 % — tuberculine negative. Unknown contact (45.8 %) made it also difficult to recognize the disease.
Conclusions. The combination of tuberculous meningitis with pulmonary tuberculosis is a severe disease leading to lethal outcome in 8.3 % cases. To recognize tuberculous meningitis at an early stage it is necessary to improve knowledge in diagnosing and clinic of the disease for general practitioners and phthisiologists and intensify specific, health and social preventive measures
Keywords: tuberculous of meningitis, pulmonary tuberculosis, diagnosis.
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Original language: Ukrainian
11. Original researches
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 Application of moxifloxacin in modified standard chemotherapy regimen in patients with new cases of co-infection tuberculosis/HIV with concomitant hepatitis B and/or C (UKR)S.О. Cherenko, L.Ya. Maniv, M.V. Pogrebna |
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Objective —the study of the efficacy and tolerability of a modified standard chemotherapy regimen for Category 1 using moxifloxacin instead of pyrazinamide for treatment of patients with new cases of co-infection of TB/HIV with concomitant hepatitis B and/or C.
Materials and methods. Controlled randomized prospective study included 30 patients with new cases smear positive pulmonary tuberculosis co-infected HIV with concomitant hepatitis B and/or C. Randomized method of random numbers, patients were assigned to the comparison group to 30 people. In the study group used a modified chemotherapy regimen, which included intensive phase of moxifloxacin — 2HRMfxE4HR, in the comparison group — the standard regimen — 2HREZ4HR.
The patients in the comparison groups did not differ in form and severity of immunodeficiency — with the same frequency determined by the destructive process (respectively in 46.7 and 50.0 % of patients), dominated the infiltrative form (respectively in 60.0 and 53.3 % of patients), the remaining patients had disseminated form of tuberculosis, p > 0.05. ART in the intensive phase of chemotherapy received 17 (56.7 %) and 15 (50 %) patients, p > 0.05.
Results and discussion. As a result of the modified chemotherapy regimen effectiveness of treatment after completion of the intensive phase of chemotherapy was significantly higher — sputum conversion — 73.3 versus 46.7 % (p < 0.05), the disappearance of clinical symptoms and resorption infiltrative changes in the lungs — 80.0 vs 50.0 % (p < 0.05), than in the standard treatment for 1 clinical category. The incidence of adverse reactions of anti-TB and antiretroviral drugs was significantly lower — 30.0 versus 56.7 % (p < 0.05), including severe, which demanded the withdrawal the anti-TB and antiretroviral therapy — 3.3 % versus 30.0 %.
Conclusions. The inclusion of moxifloxacin instead of pyrazinamide in the standard chemotherapy regimen in patients with co-infection TB/HIV with concomitant hepatitis B and/or C allows allows to increase the frequency of smear conversion at the end of intensive phase of chemotherapy on 36.3 %, reduce the incidence of hepatotoxic adverse reactions on 47.1 % and reduce the severity of their manifestations, which ensures continuous treatment.
Materials and methods. Controlled randomized prospective study included 30 patients with new cases smear positive pulmonary tuberculosis co-infected HIV with concomitant hepatitis B and/or C. Randomized method of random numbers, patients were assigned to the comparison group to 30 people. In the study group used a modified chemotherapy regimen, which included intensive phase of moxifloxacin — 2HRMfxE4HR, in the comparison group — the standard regimen — 2HREZ4HR.
The patients in the comparison groups did not differ in form and severity of immunodeficiency — with the same frequency determined by the destructive process (respectively in 46.7 and 50.0 % of patients), dominated the infiltrative form (respectively in 60.0 and 53.3 % of patients), the remaining patients had disseminated form of tuberculosis, p > 0.05. ART in the intensive phase of chemotherapy received 17 (56.7 %) and 15 (50 %) patients, p > 0.05.
Results and discussion. As a result of the modified chemotherapy regimen effectiveness of treatment after completion of the intensive phase of chemotherapy was significantly higher — sputum conversion — 73.3 versus 46.7 % (p < 0.05), the disappearance of clinical symptoms and resorption infiltrative changes in the lungs — 80.0 vs 50.0 % (p < 0.05), than in the standard treatment for 1 clinical category. The incidence of adverse reactions of anti-TB and antiretroviral drugs was significantly lower — 30.0 versus 56.7 % (p < 0.05), including severe, which demanded the withdrawal the anti-TB and antiretroviral therapy — 3.3 % versus 30.0 %.
Conclusions. The inclusion of moxifloxacin instead of pyrazinamide in the standard chemotherapy regimen in patients with co-infection TB/HIV with concomitant hepatitis B and/or C allows allows to increase the frequency of smear conversion at the end of intensive phase of chemotherapy on 36.3 %, reduce the incidence of hepatotoxic adverse reactions on 47.1 % and reduce the severity of their manifestations, which ensures continuous treatment.
Keywords: new cases of co-infection of TB/HIV, viral hepatitis B and C, TB chemotherapy, moxifloxacin, hepatotoxic side effects.
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Original language: Ukrainian
12. Original researches
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 Moderate correlation between the soluble markers of microbial translocation and system inflamation in the chronic HIV infection (UKR)K.M. Gorobchenko, A.G. Dyachenko, O.M. Savinova |
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Objective — our goal was to assess the correlation between markers of microbial translocation, monocyte/macrophage activation and system inflammation in chronic HIV infection.
Materials and metods. The study involved 78 HIV-infected patients, 61 — were receiving antiretroviral therapy (ART), the rest — were preparing for it. Control group consisted of 28 healthy donors. Marker of microbial translocation (16S rDNA) was determined in plasma by polymerase chain reaction (PCR), markers of systemic inflammation (sCD14, IL-6) — linked immunosorbent assay (ELISA). Statistical analysis was performed using the program Statistica 10.0.
Results and discussion. It was shown the bacterial DNA level in plasma of HIV-infected pations (M ± SD) at the several time more than control base level ((769 ± 123) and (182 ± 40) copies/mcL). There were also increased concentrations of soluble activation macrophage|monocytes marker sCD14 and system inflammation marker IL-6. There was positive moderate correlation between the analyzed indicators.
Conclusions. The moderate correlation between the studied indicators means the processes translocation, monocyte/macrophage activation and system inflammation have relatively independed origins or various pathogenic develop pathways.
Materials and metods. The study involved 78 HIV-infected patients, 61 — were receiving antiretroviral therapy (ART), the rest — were preparing for it. Control group consisted of 28 healthy donors. Marker of microbial translocation (16S rDNA) was determined in plasma by polymerase chain reaction (PCR), markers of systemic inflammation (sCD14, IL-6) — linked immunosorbent assay (ELISA). Statistical analysis was performed using the program Statistica 10.0.
Results and discussion. It was shown the bacterial DNA level in plasma of HIV-infected pations (M ± SD) at the several time more than control base level ((769 ± 123) and (182 ± 40) copies/mcL). There were also increased concentrations of soluble activation macrophage|monocytes marker sCD14 and system inflammation marker IL-6. There was positive moderate correlation between the analyzed indicators.
Conclusions. The moderate correlation between the studied indicators means the processes translocation, monocyte/macrophage activation and system inflammation have relatively independed origins or various pathogenic develop pathways.
Keywords: HIV infection, antiretrovirus therapy, microbial translocation, soluble translocation markers.
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13. Original researches
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 The effectiveness of standard antimycobacterial chemotherapy in patients with relapse of pulmonary tuberculosis (UKR)D.O. Butov |
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Objective — To study the antimycobacterial effectiveness of chemotherapy in patients with relapse of pulmonary tuberculosis (RPTB).
Materials and methods. The observation was 285 TB patients, including 126 patients with RPTB (I group) and 159 patients with newly diagnosed pulmonary tuberculosis (NDTB) (group II). In all patients was observed infiltrative pulmonary tuberculosis. The effectiveness of the main course antimycobacterial therapy we was evaluated according to: terms of normalization of clinical manifestations of tuberculosis, bacterial termination, closure of cavities, loss infiltrative and focal changes in lung tissue, and final clinical efficacy of treatment.
Results and discussions. The elimination of clinical symptoms was observed significantly faster in the second group than in patients with RPTB, (2.25 ± 0.11) and (3.40 ± 0.15) months, accordingly (p < 0.001). Termination of bacteria was observed after 6 months of treatment in 112 ((91.06 ± 2.57) %) patients with NDTB and 89 ((76.72 ± 3,92) %) patients with I group (p < 0.05). Closing cavities happened to 6 months of chemotherapy only 55 ((60.44 ± 5.13) %) patients with RPTB and 93 ((88.57 ± 3.10) %) patients NDTB (p < 0.05).
Conclusions. The effectiveness of standard treat patients with NDTB usually appears more rapid improvement and stabilization of the general condition of patients, less severe rate of toxic side effects antimycobacterial drugs, earlier appears termination bacteria, increased frequency of closing cavities and frequency of achievement of certain clinical and radiological cure of patients, with a decrease in the number of large residual changes after treatment compared with RPTB.
Materials and methods. The observation was 285 TB patients, including 126 patients with RPTB (I group) and 159 patients with newly diagnosed pulmonary tuberculosis (NDTB) (group II). In all patients was observed infiltrative pulmonary tuberculosis. The effectiveness of the main course antimycobacterial therapy we was evaluated according to: terms of normalization of clinical manifestations of tuberculosis, bacterial termination, closure of cavities, loss infiltrative and focal changes in lung tissue, and final clinical efficacy of treatment.
Results and discussions. The elimination of clinical symptoms was observed significantly faster in the second group than in patients with RPTB, (2.25 ± 0.11) and (3.40 ± 0.15) months, accordingly (p < 0.001). Termination of bacteria was observed after 6 months of treatment in 112 ((91.06 ± 2.57) %) patients with NDTB and 89 ((76.72 ± 3,92) %) patients with I group (p < 0.05). Closing cavities happened to 6 months of chemotherapy only 55 ((60.44 ± 5.13) %) patients with RPTB and 93 ((88.57 ± 3.10) %) patients NDTB (p < 0.05).
Conclusions. The effectiveness of standard treat patients with NDTB usually appears more rapid improvement and stabilization of the general condition of patients, less severe rate of toxic side effects antimycobacterial drugs, earlier appears termination bacteria, increased frequency of closing cavities and frequency of achievement of certain clinical and radiological cure of patients, with a decrease in the number of large residual changes after treatment compared with RPTB.
Keywords: tuberculosis, relapse pulmonary of tuberculosis, treatment, treatment efficacy.
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14. Original researches
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 Administration of clarithromycin in complex treatment of patients with extended drug resistant tuberculosis (UKR)O.E. Begoulev |
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Objective — to study of the efficiency and safety of clarithromycin of patients with extended drug resistant tuberculosis (XDR TB).
Materials and methods. The control study was to investigate the efficiency of individualized chemotherapy regimens that included clarithromycin for 37 patients with XDR TB. In the group of comparison , which was formed according to the method of selecting a pair of cases and drug resistance profile MBT, were used the same individualized chemotherapy regimens without clarithromycin. In each group the patients with repeated cases prevailed — 30 (81.1 %). Clarithromycin was used at a dose of 1.0 g/day for 8 months.
Results and discussion. Results showed that the abacillation and subsidence of clinical signs was in 16 (43.2 %) of patients of the main group and in 40.5% of cases in control group. Hepatotoxic and gastrointestinal adverse reactions of complex chemotherapy was observed in 21.6 and 40.5 % patients of the study group and in 5.4 and 18.9 % patients of the control group.
Conclusions. Adding clarithromycin to chemotherapy regimens does not increase the effectiveness of treatment XDR TB, but significantly increases the incidence of hepatotoxicity and gastrointestinal adverse reactions. Clarithromycin is not appropriate to include in the chemotherapy regimens of the patients with XDR TB.
Materials and methods. The control study was to investigate the efficiency of individualized chemotherapy regimens that included clarithromycin for 37 patients with XDR TB. In the group of comparison , which was formed according to the method of selecting a pair of cases and drug resistance profile MBT, were used the same individualized chemotherapy regimens without clarithromycin. In each group the patients with repeated cases prevailed — 30 (81.1 %). Clarithromycin was used at a dose of 1.0 g/day for 8 months.
Results and discussion. Results showed that the abacillation and subsidence of clinical signs was in 16 (43.2 %) of patients of the main group and in 40.5% of cases in control group. Hepatotoxic and gastrointestinal adverse reactions of complex chemotherapy was observed in 21.6 and 40.5 % patients of the study group and in 5.4 and 18.9 % patients of the control group.
Conclusions. Adding clarithromycin to chemotherapy regimens does not increase the effectiveness of treatment XDR TB, but significantly increases the incidence of hepatotoxicity and gastrointestinal adverse reactions. Clarithromycin is not appropriate to include in the chemotherapy regimens of the patients with XDR TB.
Keywords: extended drug resistant tuberculosis, clarithromycin.
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Original language: Ukrainian
15. Reviews
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 Concept of nutrition of the patients with tuberculosis (UKR)R.G. Protsyuk, I.O. Galan |
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The article discussed the problem of nutrition of the patients with tuberculosis. The growth of TB caused by socio-economic and health factors, including high levels of poverty and malnutrition as a result, HIV/AIDS and the spread of resistant forms of Mycobacterium tuberculosis. Among the factors that determine the development of tuberculosis infection, in addition to general information, is the importance of quality nutrition. Fasting, insufficient, unbalanced intake of nutrients basic rights not only contribute to the formation and progression of TB, but also cause a decrease in effectiveness of treatment. It is proved that under starvation and even unbalanced diet, especially in the diet deficient in protein and vitamins, often a reactivation of tuberculosis. Special Diet rations able to correct major violations homeostasis and increases the effectiveness of treatment, as detailed basic malnutrition contributing to the development of tuberculosis, still remains topical issues of tuberculosis.
Keywords: tuberculosis, nutrition, diet rations.
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16. Reviews
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 Role and importance of cord factor in the pathogenesis of primary and secondary tuberculosis (RUS)I.V. Liskina, V.P. Silchenko |
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The paper presents the current data on the cord factor — a substance of organic nature, which is a component of the membrane of M. Tuberculosis, and is a major factor in virulence of mycobacteria. Established biological activities of this substance, its features, depending on the spatial configuration and the value in the development of primary and secondary tuberculosis are carefully presented.
Keywords: M. Tuberculosis, cord factor, pathogenesis of tuberculosis.
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Original language: Russian
17. practice and experience
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 Postmortem diagnosis formulation in patients with co-infection TB/HIV/AIDS (UKR)P.V. Kuzyk, V.A. Dibrova |
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The article presents data about peculiaritis of postmortem diagnosis formulation and integration of information for patients with various forms of co-infection TB/HIV/AIDS.
Keywords: pathoanatomical diagnosis, principles of formulation, co-infection TB/HIV/AIDS.
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18. scientific research
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 Diagnosis of inflammatory syndrome of immune system reconstitution (UKR)L.D. Todoriko, O.V. Pidverbetska, O.Y. Pidverbetskyi, M.D. Gorda, U.O. Dudko, О.М. Tunguskova |
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IRIS is a paradoxical inflammatory immune response against the foreign antigen in HIV-positive patients due to excessive activation of the immune system against the persistent and viable pathogens as a result of started antiretroviral therapy. The article presents diagnostic criteria of IRIS, which can be used in resource-limited countries.
Keywords: tuberculosis, HIV, immune reconstitution inflammatory syndrome.
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19. scientific research
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 Risk factors for development of severe forms of TB in current epidemiological situation (RUS)Е. Lesnic, O. Caraiani, L. Todoriko, S. Аleksandru, B. Мeshteshug, S. Ghinda |
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Objective — to assess the role of risk factors in the development of severe forms of infiltrative pulmonary tuberculosis.
Materials and metods. A retrospective, selective and descriptive study of total number of 254 patients (main group was of 129 patients with pulmonary infiltrative tuberculosis with severe evolution (65 caseous pneumonia and 64 tuberculous lobitis) and 125 patients with pulmonary infiltartive tuberculosis with favorable evolution) was conducted.
Results and discussion. The study established that the risk factors for severe evolution of pulmonary tuberculosis are: multiple and divers social risk factors, tuberculous contacts, comorbidities. late detection Specific case management and caused the diagnosis of severe forms of tuberculosis.
Conclusions. Complex approach to patients with pulmonary tuberculosis with multiple risk factors must be performed appropriatly and early, considering the severity of the epidemiological situation with TB in Moldova.
Materials and metods. A retrospective, selective and descriptive study of total number of 254 patients (main group was of 129 patients with pulmonary infiltrative tuberculosis with severe evolution (65 caseous pneumonia and 64 tuberculous lobitis) and 125 patients with pulmonary infiltartive tuberculosis with favorable evolution) was conducted.
Results and discussion. The study established that the risk factors for severe evolution of pulmonary tuberculosis are: multiple and divers social risk factors, tuberculous contacts, comorbidities. late detection Specific case management and caused the diagnosis of severe forms of tuberculosis.
Conclusions. Complex approach to patients with pulmonary tuberculosis with multiple risk factors must be performed appropriatly and early, considering the severity of the epidemiological situation with TB in Moldova.
Keywords: tuberculosis, risk factors.
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Original language: Russian
20. scientific research
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 Current trends of laboratory diagnosis of HIV-associated TB (UKR)O.V. Pidverbetska, V.I. Slyvka, T.I. Ilchyshyn, O.D. Klim, I.A. Klimuk, I.V. Molokus |
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One of the main tasks of phthisiology is timely diagnosis of tuberculosis in HIV/AIDS-positive patients. The main methods of the diagnosis of the tuberculosis are the bacterioscopic, bacteriological and molecular-genetic sputum examination. This article presents the results of the analysis of effectiveness of these methods of sputum examination in co-infected patients.
Keywords: tuberculosis, HIV-infection, co-infection.
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21. scientific research
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 The quality of life in patients with chronic obstructive pulmonary disease with comorbid arterial hypertension (UKR)M.M. Yusupaliieva |
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Objective — to study the influence of comorbid hypertension on quality of life patients referred for treatment in the sanatorium-type seaside.
Materials and methods. To study the influence of comorbid arterial hypertension (AH) on the quality of life (QL) of patients with chronic obstructive pulmonary disease (COPD). 164 patients with COPD were examined, among which 112 persons also suffered from AH II — III stage. QL was assessed on admission to the sanatorium and after the course of sanatorium-resort treatment (SRT) using the MOS SF-36 questionnaire.
Results and discussion. There were found the significant negative influence of AH upon all QL-indexes in patients with COPD and direct correlation among QL-reduction with severity of comorbid cardiovascular pathology and the degree of high blood pressure.
Conclusions. Was determined that restorative resort treatment and adequate hypotension therapy lead to the great improvement of common health and QL in such patients.
Materials and methods. To study the influence of comorbid arterial hypertension (AH) on the quality of life (QL) of patients with chronic obstructive pulmonary disease (COPD). 164 patients with COPD were examined, among which 112 persons also suffered from AH II — III stage. QL was assessed on admission to the sanatorium and after the course of sanatorium-resort treatment (SRT) using the MOS SF-36 questionnaire.
Results and discussion. There were found the significant negative influence of AH upon all QL-indexes in patients with COPD and direct correlation among QL-reduction with severity of comorbid cardiovascular pathology and the degree of high blood pressure.
Conclusions. Was determined that restorative resort treatment and adequate hypotension therapy lead to the great improvement of common health and QL in such patients.
Keywords: Chronic obstructive pulmonary disease, arterial hypertension, quality of life, sanatorium-resort treatment.
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Original language: Ukrainian
22. scientific research
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Notice: Undefined index: pict in /home/vitapol/tubvil.vitapol.com.ua/en/svizhij_nomer.php on line 74 A clinical case of tuberculosis of the skin (UKR)L.D. Todoriko, T.I. Ilchyshyn |
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This article describes a clinical case of ulcer-necrotic tuberculosis of skin, characterized peculiarities of clinical case and efficiency of treatment.
Keywords: scin tuberculosis, ulcerative-necrotic phase, extrapulmonary TB, treatment.
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Original language: Ukrainian
Current Issue Highlights
№4(31) // 2017
Assessment of TB-HIV co-infection according to the drug resistance profile
E.V. Lesnic1, L.D. Todoriko2
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