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Issue. Articles

3(26) // 2016



1. Editorial


Multidrugresistant tuberculosis and co-infection HIV/TB:
 features of epidemic situation in Ukraine and Belarus (RUS)

L.D. Todoriko1, V.I. Petrenko2, S.B. Volf3, M.. Kuzhko4, I.S. Gelberg3, .. Alekso3, I.. Semianiv1

1 HSEIU «Bukovinian State Medical University», Chernivtsi, Ukraine
2 A.A. Bogomolets National Medical University, Kyiv, Ukraine
3 EEt «Belarusian State Medical University», Grodno, Belarus
4 SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine», Kyiv, Ukraine

Objective — analysis of the epidemiological situation with multidrugresistant tuberculosis and HIV/TB  co­infection in certain regions of Ukraine and Belarus.
Materials and methods. Statistical analysis of the official figures concerning the epidemiology of multidrug­resistant tuberculosis and HIV/TB co-infection in Ukraine and Belarus in recent years.
Results and discussion. The rate of active tuberculosis in combination with human immunodeficiency virus related disease was 10.4 and 10.3 per 100 thousand people in Ukraine in 2014 and 2015 respectively. The rate of incidence of active tuberculosis combined with HIV related disease in Chernivtsi region per 100 thousand people was 3.4 in 2014 and 5.2 in 2015 (16.4 per 100 thousand people in Ukraine in 2012). Analysis of tuberculosis rates with multidrugresistance (MDR­TB) in the Grodno region showed that its share among new cases of TB of respiratory organs with release of bacteria amounted to 37.9 %. The share of extensively drug­resistant tuberculosis (XDR­TB) among new cases of the respiratory system TB, where MBT was identified, was 2.2 %.
Conclusions. The main problem for implementation of anti­tuberculosis program both in Ukraine and in Belarus is drug­resistant tuberculosis, which, is in the form of multi­drugresistance, tends to increase in patients with newly diagnosed tuberculosis, which is a very bad prognostic sign, as it is accompanied by lack of treatment efficacy and an increase in HIV/TB co­morbidity is particularly alarming. One of the priorities in the fight against tuberculosis is a search for new treatments, development of existing chemotherapy programs, insertion ofkkj new anti­TB drugs.

Keywords: tuberculosis, multi resistance, disease prevalence, mortality, HIV/TB coinfection.

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Original language: Russian

2. Original researches


Chemotherapy effectiveness and complications for lung cancer patients (RUS)

Yu.V. Dumanskiy, V.A. Stepko, O.V. Syniachenko, G.S. Taktashov, .A. Gomozova

Donetsk National Medical University of Maxim Gorky, Lyman

Objective — to estimate effectiveness of various hemotherapeutic methods (CT) for various lung cancer (LC) disease states, identify possible complications and define some prognostic criteria.
Materials and methods. 437 LC patients (aged 26—86, average age 59.85 % males and 15 % females), have been examined during our investigation. Cancer of central type has been diagnosticated in 80 % of patients, cancer of peripheral type — in 20 %. Smallcelled histological disease variant has been diagnosed in 28 % of patients, non smallcelled — in 72 %. Lymphagland metastases, distant organs metastases and bone ones have been diagnosticated in 89, 39 and 20 % of patients respectively.
Results and discussion. CT effectiveness depends negatively on clinical course severity, metastases number inside lymphagland, metastasis processes inside distant organs, perineal lymph nodes and skeleton. For smallcelled form of disease survival rate is pretty low, but there is a positive effect of platins and taxane drugs usage, as well as docetaxel, topotecan and doxorubicin ones. Various complications of CT are obser­ved for quarter of LC patients, but complication level depends on presence of associated hypertensive disease, chronic obstructive pulmonary disease and chronic pancreatitis. These diseases designate progression of vasogenic shock, tubuloin interstitial nephritis, interstitial pneumonitis, pulmonary hypertension and thrombophlebitis. Chemotherapeutic agent side effect are determined by disease state severity, magnocellular carcinoma variant, wet pleuritis occurrence, malignant invasion to alimentary canal and type of metastasis. The most important are metabolic poison, anthracycline, camptothecin, po­­dophyllotoxin and taxane groups. For individual medical drugs — vincristine, gemcitabine, fluorouracil, cisplatin and etoposide.
Conclusions. Acquired data could be useful for rational medicated nosotropic LC patients’ treatment medical technology and effective prognostical possible CT complication technology development teams.

Keywords: cancer, lung, chemotherapy, effectiveness, complications.

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3. Original researches


The efficacy of the treatment patients with lung tuberculosis and concomitant chronic obstructive pulmonary disease with application in complex therapy rdosteine (UKR)

M.M. Kuzhko, T.V. Tlustova, A.V. Taranenko

SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of NAMS of Ukraine», Kyiv, Ukraine

Objective — to study of efficacy of medicine erdosteine in patients with lung tuberculosis and chronic obstructive pulmonary disease.
Materials and methods. There was examined 64 patients with lung tuberculosis and chronic obstructive pulmonary disease, grade I—II, divided in two groups. Subjects from main group, to the contrast of control group patients, in addition to standard anti¬tuberculosis chemotherapy and bronchodilators received erdosteine (Erdomed).
Results and discussion. It was established that the use of erdosteine (Erdomed) helped to decrease respiratory symptoms intensity, improved lung function and decreased bronchial mucosa inflammation in majority of patients.
Conclusions. Application erdosteine (Erdomed) combined with bronchodilator drugs are an effective way pathogenetic treatment of patients with pulmonary tuberculosis combined with chronic obstructive pulmonary disease.

Keywords: tuberculosis, chronic obstructive pulmonary disease, lung function, erdosteine.

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The role and importance of polymerase chain reaction 
in the diagnostics of the bone and joint tuberculosis (UKR)

G.G. Golka1, I.M. Kalmykova2, O.G. Fadeev1, A.O. Oliinyk1, .V. Tantsura2

1 Kharkiv National Medical University, Kharkiv, Ukraine
2 Regional TB Dispensary N 1, Kharkv, Ukraine

Objective — to study the effectiveness of polymerase chain reaction in the diagnostics of the bone and joint tuberculosis.
Materials and metods. The basis of the clinical part of the work is on data protocols, surveys and medical records of 85 patients who were in the period from 2009 to 2015 in the department of articular bone tuberculosis of the Public Health Institution «Regional TB Hospital N 1» of Kharkiv regional council and in the surgical department of the Public Health Institution «Regional TB Dispensary N 1» of Kharkiv regional council.
All examined patients were divided into two groups. The first group included 60 (70.6 %) patients (the main group), in which a specific diagnosis of a firstly diagnosed active joint damage tuberculous was confirmed according to reliable clinical and pathological studies. The second group included 25 (29.4 %) patients (the control group) with suspected joint tuberculosis and in which specific diagnosis of tubercu­lous inflammation was not confirmed after a thorough examination.
In the majority of observations in both groups the destruction of large joints of the lower limbs was observed: in the main group (I) — 42 patients (70 %), in the control group (II) — 19 patients (76 %). It is important to emphasize that the main group included patients only with local specific (tuberculosis) diseases of the joints (the most difficult category of patients in terms of diagnostic).
The certified PCR test system and an Ample­sense 100 for MTB were used for the research. The study and interpretation of the results were performed according to the instructions (protocol) in a certified laboratory.
In order for study to use the PCR method the pathological material which was in contact with the hearth of the destruction was used — the synovial fluid or the joint washout, the puss of floating abscess. The collection of biological material was   obligatory performed under the sterile conditions by puncturing the affected joint or floating abscess.
Results and discussions. The following results were gained while studying the indices of specificity and sensitivity of PCR method in the groups of monitored patients: PCR specificity is 92 % and its sensitivity — 86.7 %, the total value of the test — 88.2 %. By linking these indices we get the prognostic value of a positive result 96% that is while gaining the positive result of PCR for MTB at the differential diagnosis we can diagnose tuberculosis with a high probability. Thus, PCR is an effective method of early diagnosis in patients with tuberculous lesions of the joints.
Conclusions. For early diagnostics of bone and joint tuberculosis along with radiation methods and microbiological studies PRC method should be used. This technique greatly complements the arsenal of diagnostic tools in the diagnosis and has high sensitivity, expressiveness (speed), relative simplicity and safety; it has high diagnostic sensitivity, specificity and prognostic value.

Keywords: diagnosis of bone and joint tuberculosis, polymerase chain reaction (PCR) roentgen tomography, bacteriological studying.

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5. Original researches


Effect of antituberculosis drugs on certain indices of metabolism in hepatic cells of experimental animals (RUS)

S.B. Volf

EI «Grodno State Medical University», Grodno, Grodno, Republica Belarus

Objective — to estimate the influence of antituberculosis drugs on lipid peroxidation and antioxidant system which causes detoxification of the liver in experimental animals.
Materials and methods. The influence of antituberculosis drugs on indices of lipid peroxide homeostasis which causes detoxification of the liver in experimental animals and possible corrections of the revealed disorders were studied in the experiment. Of guinea pigs 3 groups were formed: 2 experimental and one control group. The first control group received physiological saline, the second — 5 antituberculosis drugs, the third — antituberculosis drugs + vitamins E, A, C and sorbent.
Results and discussion. It has been revealed that longterm introduction of antituberculosis drugs tilts the balance of lipid peroxidation and antioxidant system towards lipid peroxidation. This leads to suppressed oxidationreduction reactions impairing detoxification of antibiotics and functioning of glutathione in the liver. Vitamins E, A, C in combination with sorbent significantly neutralize these negative consequences.
Conclusions. Longterm (60 days) introduction of antituberculosis drugs influences negatively the balance of lipid peroxidation and antioxidant system capacity in hepatic cells of experimental animals.
As a result of increased lipid peroxidation in hepatic cells the functioning of glutathione which is invol­ved in metabolism of xenobiotics and increases the resistance of the cells to negative effects.
Decreased activity of GPP dehydrogenase (key enzyme of pentosephosphate pathway and direct glucose oxidation), NADH dehydrogenase and NADPH dehydrogenase and increased SDH activity (key enzyme of Krebs cycle) have been revealed in hepatic cells.
Vitamins E, A, C in combination with sorbent significantly neutralize these negative consequences and this allowed to maintain the balance of lipid peroxidation and antioxidant system in hepatic cells of experimental animals and to prevent the disorders in detoxifying system of the liver.

Keywords: tuberculosis, chemotherapy, lipid peroxidation, glutathione.

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Original language: Russian

6. Original researches


Relevant issues of drug resistant tuberculosis in pregnant women (UKR)

.. Sakhelashvili1, .. Savula2, .L. Platonova3, .V. Lutsyshyn1, .Ya. Soldatenko1, .. Sakhelashvili1

1 Danylo Halytskiy Lviv National Medical University, Lviv, Ukraine
2 I.Ya. Horbachevsky Ternopil State Medical University, Ministry of Healthcare of Ukraine, Ternopil, Ukraine
3 S «Lviv RI of Epidemiology and Hygiene of MOH of Ukraine», Lviv, Ukraine

Objective — to study the peculiarities of the clinical course and the treatment of tuberculosis in pregnant women depending on the sensitivity/ resistance of the tuberculosis mycobacterium strains to antimycobacterial medications.
Materials and methods. 61 pregnant women have been examined as to active pulmonary tuberculosis: 41 patients with drug­sensitive tuberculosis, control group, and 20 persons with of drug­resistant tubercu­losis (the main group).
Results and discussions. 82.9 % of pregnant women from the control group have been diagnosed with the specific process for the first time (first diagnosed tuberculosis, FDTB); destructive changes in lung tissue have been present in 21.9 % of women. In main group FDTB has been revealed in 45.0 %, recurrence — in 30.0 %, chronic disease — in 25.0 %, the occurrence of destruction in 90.0 % of women. In the vast majority of the patients from the control group tuberculosis had mild symptoms, in 36.6 % of cases it has been found during a routine of photofluorography at the maternity hospital. In the main group the process has been developing with distinct clinical symptoms (in 88.9 %) and was diagnosed after self-­referral (in 90.0 % of cases). Operative delivery took place in 4.9 % of women from the control group and in 15.0 % of women from the main one. 88.7 and 55.5 % of patients respectively have been transferred to category 5.1 (residual changes after cured tuberculosis).
Conclusions. Pregnant women having drug resistant pulmonary tuberculosis suffer from: widespread destructive processes with the pulmonary involvement of both lungs, massive bacterioexcretion, chronici­ty of specific inflammation, treatment low efficiency, and operative delivery more often than at the tuberculosis with the pathogen preserved sensitivity.

Keywords: pulmonary tuberculosis, pregnancy, clinical, treatment.

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Original language: Ukrainian

7. Original researches


The impact of the territorial factor on the timeliness verification of pleural effusion syndrome (UKR)

I.D. Duzhiy, G.P. Oleshchenko, I.Ya. Gresko, V.O. Oleshchenko

Sumy State University, Sumy, Ukraine

Objective — to analyze the timeliness of diagnosis of syndrome of pleural effusion in patients, depending on their place of residence.
Materials and methods. 329 patients were studied with syndrome of pleural effusion, who were divided into two groups. The basic group included 123 (37.4 %) persons, living in rural areas and the comparison group — 206 (62.6 %) of urban residents.
Results and discussion. On time (5—9 day) around 28 (19.7 %) patients of Ia and IIa subgroups addressed  the doctor, including 9 (32.1 %) rural residents, 19 (67.9 %) city residents. Not on time (after 10 days) 114 (80.3 %) persons approached the doctor. Among them, villagers were 50 (43.9 %), residents of the city — 64 (56.1 %).
In I and II b subgroups in a timely manner (5—9 day) seek medical attention 35 (18.7 %) people: the villagers were 9 (25.7 %), citizens — 26 (74.3 %). Out of time (after the 10 th day), seek medical attention 152 (81.3 %) people, of whom 55 (36.2 %) the villagers and 97 (63.8 %) of citizens.
Conclusions. belated handling for medical help villagers occurred in 85.4 % of cases, due to most of the social and economic problems. In urban residents belated conversion to 78.2 % due to, in most cases, inadequate attitude towards their health because of the backdrop of bad habits. Ways of overcoming delays in handling of the   medical assistance for the villagers must be public organizational activities; for city residents — health education and the fight against of bad habits.

Keywords: syndrome of pleural effusion, the territorial factor, verification.

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8. Original researches


Influence of multivitamin infusion complexes on the dynamics of clinical and biochemical parameters of patients with toxic adverse reactions during treatment of tuberculosis (UKR)

Yu.V. Prosvetov1, .V. Levich1, N.. Skorohodova1, .Yu. Gusarova1, S.M. Kudilchuck2, A.G. Makarovich2, S.G. Gujilovsky2

1 SI «Zaporizhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine», Zaporizhia, Ukraine
2 SI «Zaporizhia Regional Clinical TB Dispensary», Zaporizhia, Ukraine

Objective — to estimate influence of «Readon» on dynamic of clinical and biochemical parameters and to study expediency of its usage in patients with toxic adverse reactions during treatment of tuberculosis with pronounced intoxication syndrome.
Materials and methods. We observed 60 patients with tuberculosis and toxic complications of chemotherapy. Patients received standard anti­tuberculosis treatment. 30 patients of the main group (MG) also received «Readon», 30 patients of the control group (CG) — 5 % solution of glucose (400 ml). Clinical and laboratory parameters, complete blood count, levels of AlAT, AsAT, bilirubin and total protein level were evaluated.
Results and discussion. In both groups of patients, that got treatment, was noted decreasing of toxic adverse reactions (AR). But the dynamics of the regression of chemotherapy complications was higher among patients of MG. In 24 (92.3 %) patients of MG and 19 (76 %) patients of CG were observed reduction of dyspeptic symptoms and in 19 (73 %) and 11 (44 %) patients, respectively — it complete disappearance. Headaches decreased or disappeared in 7 (77.7 %) and 4 (50 %) of patients, and dizziness — in 5 (62.5 %) and 2 (20 %) respectively. AlAT and AsAT content in MG in the background of the therapy was signifi­can­tly (p < 0.05) decreased by 40 % and 35.4 %, respectively, while in the control group a decrease of these parameters was not so pronounced, amounting to 17.4 % (AlAT) and 12.1 % (AsAT).
Conclusions. «Readon» reduces clinical signs of toxic adverse reactions n anti-tuberculosis drugs and general intoxication, promotes normalization of clinical and laboratory parameters in patients with tuberculosis.  It improves the tolerability of chemotherapy, making appropriate use of this vitamin complex in treatment of tuberculosis and the complications of chemotherapy on the stationary phase.

Keywords: adverse reaction of antituberculosis drugs, tuberculosis intoxication, multivitamin infusion complex, Readon.

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Original language: Ukrainian

9. Original researches


An evaluation of probiotic effects in the gut flora of HIV infected patients (RUS)

K.M. Gorobchenko1, A.G. Dyachenko1, O.M. Savinova2, T.V. Majstat2

1 Sumy State University, Sumy, Ukraine
2 Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine

Objective — our study goal was to determine whether the use of a probiotics can recover normal gut flora in chronically HIV infected adults.
Materials and methods. Standard bacteriological methods were used to exam the gut microbial content of the 40 HIV infected patients.
Results and discussion. Changes of intestinal microbiota were found in all of the patients. In the most cases the decrease of obligatory microorganisms, especially Bifidobacterium spp. (in 90 % of patients) was found. Overgrowth of major opportunistic pathogens (S. aureus and Candida spp.) was registered in only a minority of patients. The probiotic interventions resulted in significantly elevated levels of beneficial bacteria load (such as Bifidobacterium spp., Lactobacillus spp.) and a decrease in patogenic bacteria load (such as Clostridium, Candida spp.).
Conclusions. Probiotic preparations can successfully augment the levels of beneficial species in the gut during chronic HIV infection. These findings may help inform future studies aimed at testing pre and probiotic approaches to improve gut function and mucosal immunity in chronic HIV infection.

Keywords: HIV infection, intestinal microflora, probiotics.

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Original language: Russian

10. Original researches


Activation of lipid peroxidation by antiretroviral drugs (RUS)

M.M. Kurbat, V.M. Tsyrkunov, I.E. Gulyai

EE «Grodno State Medical University», Republic of Belarus

Objective — to xamine the state of the system of lipid peroxidation (LPO) in HIV infected patients receiving antiretroviral therapy (ART) and to identify the role of intermediate of LPO products in the development of a druginduced liver disease (DILI) by ART.
Materials and methods. The study included 132 HIV infected patients receiving ART according schemes. LPO activity was evaluated by the content of the primary (diene and triene conjugates, crotonaldehyde) and secondary (malondialdehyde) lipid peroxidation products in plasma and erythrocytes.
Results and discussion. ART in 74.3 % of patients causes activation of POL processes in the body and this is a pathogenetic mechanism of hepatocyte damage. The lack of activation of lipid peroxidation in 25.7 % of patients provided by physiological compensation of the antioxidant system, which in the conditions of immune deficiency restricts nonenzymatic freeradical oxidation of lipids in the body. In case of violation of functioning hepatocytes and the development of hepatotoxicity with ART the level of primary and secondary lipid peroxidation products in blood plasma increases, especially the concentration of triene conjugates.
Conclusions. Treatment of HIV patients without laboratory signs of hepatotoxicity by ART do not lead to activation of LPO in blood plasma and erythrocytes, while HIV patients with DILI observed activation cascade of LPO. The most likely point of the toxic effect of the ART applications are mitochondrial dysfunction that underlies drug liver damage.

Keywords: HIV, antiretroviral drugs, lipid peroxidation, liver toxicity, the mitochondria.

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11. Original researches


Evaluation of activity of glutathionedependent enzymes of erythrocytes in experimental emphysema (UKR)

V.M. Zhadan, V.I. Korzhov

SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of NAMS of Ukraine», Kyiv, Ukraine

Objective — to evaluation of the activity of glutathione system enzymes of erythrocytes in experimental emphysema when administered different doses of papain in the dynamics of pathology development.
Materials and methods. The study was conducted on 62 white mongrel rats of both sexes. Experimental emphysema was reproduced by single intratraheal introduction under light ether anesthesia of a 0.5 ml of papain solution in doses 0 mg/kg, 75 mg/kg and 100 mg/kg of body weight. State of glutathionedependent enzyme system was studied by enzymes activity — glutathione¬reductase, glutathionetransferase, and glutathioneperoxidase.
Results and discussion. In the work it was investigated and evaluated parameters of blood glutathione­dependent enzyme system at experimental pulmonary emphysema depending on the applied doses of papain in the development of the pathology. The decreasing in the activity of key glutathionedependent enzymes was revealed, which indicates the reducing of the processes of antioxidant protection, which may lead to systemic metabolic disturbances. No clear interdependencies were revealed between biochemical distur­bances and a dose of papain and the time that has passed after modeling pathology, changes of enzyme activity no were proportional to the severity degree of experimental lung emphysema. Inactivation of the key glutathionedependent enzymes is one of the important links of pathogenesis of emphysema.
Conclusions. Experimental pulmonary emphysema is accompanied by serious disturbances from fermentative link of antiperoxide protection in the blood (decreasing of the activity of glutathionedepen­dent enzymes), which indirectly may be evidence about the beginning of the breakdown of compensatory mechanisms in the glutathione system.

Keywords: pulmonary emphysema, enzymes of glutathione metabolism (glutathionereductase, glutathionetransferase, glutathioneperoxidase).

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Original language: Ukrainian

12. Reviews


Algorithm for the diagnosis and treatment of pulmonary hemorrhage and hemoptysis (UKR)

R.G. Protciuk

O.O. Bogomolets National Medical University, Kyiv, Ukraine

Hemoptysis and pulmonary hemorrhage are rather frequent and potentially dangerous complications of various diseases and chest cavity injuries. Diagnostical tactics should correlate with the degree of PH and the patient’s condition. In cases of PH of I—II grades the therapy should be directed at the eliminating of the root cause of this complication. At the same time a massive PH is an urgent potentially fatal complication that requires an integrated and adequate treatment at all stages of a medical care — from first-­aid to the specialized one (including the use of conservative, endoscopic and surgical methods). After stopping PH it is necessary to carry out the most complete diagnostic research to determine its causes and to treat the underlying disease.

Keywords: pulmonary hemorrhage, hemoptysis, thoracic cavity injury, hemostasis.

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2.    Kozlovskyi VY, Karpytskyi AS, Shylenok DV. Hemoptysis and pulmonary hemorrhage. (in Rus) Military Medical Journal. 1997;6:29-35.
3.    Luzan LV. Pulmonary hemorrhage. (in Ukr) Ukr pulmonology journal. 2009;4:28-31.
4.    Marchenkov IuV, Iakovlev VN, Korzheva YIu et al. Algorithms for the diagnosis and treatment of pulmonary hemorrhage. (in Rus) General Intensive Care. 2013;9:45-54.
5.    Moroz VV, Marchenkov IuV, Lysenko DV et al. Antibiotic therapy of nosocomial pneumonia caused by multidrug-resistant flora in patients in critical conditions (in Rus). General Intensive Care. 2007;3:90-94.
6.    Perederii VH, Tkach SM. Basics of Internal Medicine (in Ukr). T.1. (Vinnitsa) New Book. 2009:640.
7.    Perelman MN. Pulmonary hemorrhage (in Rus). Consilium Medicum. 2006:8(3);88-92.
8.    Feshchenko IuY, Opanasenko NS. Differential diagnosis with hemoptysis. (in Ukr) http://therapia.ua/therapia/2006-/11-/differentsialnaya- diagnostika-pri-krovokharkane.
9.    Fomichova NI, Hritsova NA, Raznatovska OM, Klepikova TIu. Hemoptysis and pulmonary hemorrhage with respiratory tuberculosis, pathogenesis, pathomorphism, clinical manifestations, diagnosis and emergency care (in Ukr). Tuberculosis, Lung diseases, HIV infection. 2013:3;76-85.
10.    David H. Ingbar. Overview of massive hemoptysis. http://www.uptodate.com/ contents/overview-of-massive-hemoptysis. 2013.
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13.    Lordan JL, Gascoigne A, Corris PA. Assessment and manage­ment of massive haemoptysis. Thorax. 2003:58;814-819.
14.    Scolapio JS. Methods for decreasing risk of aspiration pneumonia in critically ill patients. J Parenter Enteral Nutr. 2002:26 (6);58-61.

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13. Reviews


Tuberculosis for the patients of elderly and senile age: features of pathogenesis, clinicoradiological course, treatment (UKR)

O.S. Konstantynovska

Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine

Tuberculosis in the persons of elderly and senile age, socalled «senile tuberculosis», for today is one of actual and difficult problems of not only phthisiology but also geriatrics. Difficulties of this problem is largely related to inopportuneness of diagnostics, that predefined by the presence of the plural united pathology for the persons of elderly and senile age. It conduces to the frequent exposure of specific process only at a section.
The clinical course of tubercular process at this category of persons differs in an aggressiveness, preva­lence of defeat, in swingeing majority of cases accompanied by destruction of lung’s tissue and spreading the sputum with massive MBT (Mycobacterium tuberculosis), that creates a high epidemic dangerous for surrounding people, especially because the considerable role of elderly people in caring and education of children in family.
The features of epidemiology and pathogenesis, clinicoradiological course, concomitant pathology, treatment of tuberculosis for the patients of elderly and senile age are described in the article.

Keywords: tuberculosis, elderly and senile age, clinical course, concomitant pathology, treatment.

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22.    Surkova AK, Dyusmikeeva MI. Tuberkulez, ne diagnostirovannyiy pri zhizni bolnogo, kak prichina smerti. XIV natsionalnyiy kongress po boleznyam organov dyihaniya. M.;2004:413 (in Rus).
23.    Uvarova TE. Effektivnost intensivnoy himioterapii tuberkuleza legkih u bolnyih pozhilogo i starcheskogo vozrasta: avtoref. dis. kand. med. nauk. M.;2003:19 (in Rus).
24.    Harangi L, Stsemeni K. Patologiya tuberkuleza v pozhilom vozraste: per. s angl. M. Meditsina;1978:274 (in Rus).
25.    Chernyih NA, Karachunskiy MA, Kaminskaya GO, Kossiy YuE. Effektivnost intensivnogo etapa himioterapii u bolnyih vpervyie vyiyavlennyim tuberkulezom legkih i saharnyim diabetom. Probl Tub i Bol Legkih. 2004;12:30-32 (in Rus).
26.    Shprykov AS, Mishanov RF. Tuberkulez legkih u lits starshe 60 let. Probl Tub i Bol Legkih. 2011;5:241 (in Rus).
27.    Yaschenko BP. Ftiziogeriatriya. K. Zdorov’ya;1991:207 (in Rus).
28.    Beck-Sague C, Dooley SW, Hutton MD et al. 176 Hospital outbreak of multidrug-resistant Mycobacterium tuberculosis infections. Factors in transmission to staff and HIV-infected patients. JAMA. 1992;268:1280-1286.
29.    Busby J, Caranasos GJ. Immune function, autoimmunity, and selective immunoprophylaxis in the aged. Med Clin North Am. 1985;69, N 369:465-474.
30.    Chan CHS, Woo J, Or KKH et al. The effect of age on the presentation of patients with tuberculosis. Int J Tuberc and Lung Dis. 1995;76:290-293.
31.    Kaufmann Stefan HE. How can immunology contribute to the control of tuberculosis? Nature Reviews Immunology. 2001;1:20-30.
32.    Leung Chi C, Lam Tai H, Wai M. Chan Diabetic Control and Risk of Tuberculosis: A Cohort Study. Am J Epidemiol. 2008;167:1486-1494.
33.    Liu J, Segre M, Segre D. Changes in suppressor, helper, and B-cell functions in aging mice. Cell Immunol. 1982;66:372-382.
34.    Lukacova D, Litomericky S. Pneumological problems in pa - tients above 65 years in policlinica practice. Stud Pneumot Cech. 1985;45(10):660-664.
35.    Mori T, Leung CC. Tuberculosis in the global aging population. Infect Dis Clin North Am. 2010;24:751-68.
36.    Rajagopalan S, Yoshikawa TT. Rajagopalan S. Tuberculosis in the elderly. Z Gerontol Geriatr. 2000;33:374-380.
37.    Rizvi N, Shah R, Hussain N. Clinical presentation of pulmonary tuberculosis in association with age. Int J Tuberc Lung Dis. 2001;5(11):147-148.
38.    Stead WW. Tuberculosis among elderly persons, as observed among nursing home residents. Int J Tuberc Lung Dis. 1998;2(9):64-70.
39.    Tatar D, Keskin O, Halicolar H. Similarity and differences of pulmonary tuberculosis in the young and old patients. Europ Resp J. 2001;18(33):472.
40.    Vienovic M, Jelack D. Clinical and radiological characteristics of pulmonary tuberculosis in the elderly. Europ Resp J. 2000;16:184.

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14. Reviews


Diagnostic possibilities of the immunohistochemistry at tuberculosis inflammatory process (UKR)

I.V. Liskina

SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of NAMS of Ukraine», Kyiv, Ukraine

The article presents an analysis of the current state of the histological diagnosis of tuberculous lesions of various human tissues and organs — namely the widespread introduction in practical medicine and scien­tific research studies of the immunohistochemical method, which allows you to visualize fragments or whole structure of mycobacteria by their antigens. The data on the use of a number of specific antibodies to the antigens of M. Tuberculosis are shown, describing their advantages and disadvantages, as well as possible ways to further improving of this method.

Keywords: tuberculosis inflammation, immunohistochemistry, antibodies to the antigens of the MTB.

List of references:
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3.    Semenov SA, Semenova NYu, Chibirov KKh et al. Immunohistochemical diagnosis of urinary bladder tuberculosis. Journal Infectology. 2014;6(1):41-46 (n Rus).
4.    Ellinidi VN, Ariel BM, Samusenko IA, Tugolukova LV. Immunohistochemical study in the diagnosis of tuberculosis. Ark. Path. 2007;5:36-38 (n Rus).
5.    Ade S, Harries AD, Trébucq A. National profile and treatment outcomes of patients with extrapulmonary tuberculosis in Bénin. PLoS One. 2014;9(4):e95603. Available at: doi: 10.1371/journal.pone.0095603. e-Collection 2014.
6.    Bekmurzayeva A, Sypabekova M, Kanayeva D. Tuberculosis diagnosis using immunodominant, secreted antigens of Mycobacterium tuberculosis. Tuberculosis. 2013;93:381-388.
7.    Che N, Qu Y, Zhang C et al. Expression pattern of Mycobacterium tuberculosis Ag85B and its value in pathological diagnosis. Zhonghua Bing Li Xue Za Zhi.2014.;43(9):600-603.
8.    Che N, Qu Y, Zhang C et al. Double staining of bacilli and antigen Ag85B improves the accuracy of the pathological diagnosis of pulmonary tuberculosis. J Clin Pathol. 2015;0:1-7. Available at: doi:10.1136/jclinpath-2015-203244.
9.    Corbett EL, Watt CJ, Walker N et al. The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Archives of Internal Medicine. 2003;163(9):1009-1021.
10.    D’Avila H,  Maya-Monteiro CM, and Bozza PT. Lipid bodies in innate immune response to bacterial and parasite infections. International Immunopharmacology. 2008;8(10):1308-1315.
11.    Du S-S, Zhao M-M, Zhang Y et al. Screening for differentially expressed proteins relevant to the differential diagnosis of sarcoidosis and tuberculosis. PLoS ONE. 2015;10(9):e0132466. Available at: doi:10.1371/journal. pone.0132466.
12.    Furák J,  Troján I, Szóke T et al. Histological and immunohistochemical structure of pulmonary tuberculotic granulomas in untreated cases and cases treated with antitubercular drugs. Orvosi Hetilap. 2003;144(27):1347-52.
13.    Global Tuberculosis Report 2015. 20th edition. France: WHO Press, 2015:204.
14.    Goel MM, Budhwar P. Immunohistochemical localization of Mycobacterium tuberculosis complex antigen with antibody to 38 kda antigen versus ziehl neelsen staining in tissue granulomas of extra- pulmonary tuberculosis. Indian J Tuber. 2007;54:24-29.
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17.    Kang Y-J, Jo J-O, Ock MS et al. Over-expression of thymosin ß4 in granulomatous lung tissue with active pulmonary tuberculosis. Tuberculosis. 2014;94:323-331.
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26.    Mustafa T, Wiker HG, Mørkve O and Sviland L. Reduced apoptosis and increased inflammatory cytokines in granulomas caused by tuberculous compared to non-tuberculous mycobacteria: role of MPT64 antigen in apoptosis and immune response. Clin and Exp Immunol. 2007;150:105-113.
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31.    Purohit MR, Mustafa T, Wiker HG, Mørkve O, and Sviland L. Immunohistochemical diagnosis of abdominal and lymph node tuberculosis by detecting Mycobacterium tuberculosis complex specific antigen MPT64. Diagnostic Pathology. 2007;2:36. Available at: http://www.diagnosticpathology.org/content/2/1/36.
32.    Ryu YJ. Diagnosis of Pulmonary Tuberculosis: Recent Advances and Diagnostic Algorithms. Tuberc. Respir. Dis. 2015;78:64-71.
33.    Sabbian S, Eugenin E, Kaplan G. Detection of Mycobacterium tuberculosis in latently infected lungs by immunohistochemistry and confocal microscopy. J Med Microbiol. 2014;63:1432-1435.
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39.    Ulrichs T, Lefmann M, Reich M et al. Modified immunohistological staining allows detection of Ziehl–Neelsen-negative Mycobacterium tuberculosis organisms and their precise localization in human tissue. J. Pathol. 2005;205:633-640.
40.    Zielonka TM. Risk factors for tuberculosis and specific manifestations of disease. Przegl. Epidemiol. 2014;68:637-643.

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15. epidemic situation


The epidemiological situation of tuberculosis in Dnipropetrovsk region on the basis of 2015 (UKR)

D.G. Kryzhanovsky, A.O. Kotelnikova

KP «Dnepropetrovsk regional clinical preventive medical association «Phthisiology» Dnepropetrovsk Regional Council

The article summarizes the results of the current TB situation in Dnipropetrovsk region and the measu­res to control this disease, which aim to reduce mortality, morbidity and prevalence of tuberculosis.

Keywords: epidemiology of tuberculosis, coinfection HIV/TB treatment efficacy.

List of references:  
1.    Golubchikov MV. Key indicators of tuberculosis by 2015 compared to the same period in 2014. Statistics Directory. 2016:4.
2.    Nizova NM et al. Tuberculosis in Ukraine. Analytical and statistical handbook. 2015:20.
3.    Rostochylo SS et al. Health resources Dnipropetrovsk region and their use in 2014-2015 years. Statistical Directory. 2016:57-58.

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16. epidemic situation


Structural dynamics of sick patients in regional TB hospital fot the last decade (UKR)

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

I.Ya. Horbachevsky Ternopil State Medical University, Ministry of Healthcare of Ukraine, Ternopil, Ukraine

Objective — to find out the structural dynamics of the patients of TB hospital in recent years and the frequency of multidrugresistance  in  patients sick with tuberculosis of lungs.  
Materials and methods. The dynamics of the structure of patients who are hospitalized in Ternopil regional TB dispensary in the years 2005—2014 was analized, as well as the frequency of multidrugtesis­tance in TB patients.
Results and discussion. During the period from 2005 to 2014 in the hospital of the regional TB dispensary were treated 14,418 patients, of whom 46.1 % suffered from tuberculosis, 53.9 % — other pulmonary pathology. Among the total number of TB patients multiresistance was pronounced at 8.5 % of total number of patients. The total number of patients with multidrugresistance and patients other diagnosis was significantly greater in the second five year period. In particular, it was patients sick with pneumonia and sarcoidosis. It is caused by inadequate examinations of patients prior their hospitalization, the difficulty of diagnosis, modern pathomorphosis and lack of competence of TB specialists in pulmo­nology issues.
Conclusions. For there is an urgent need for TB specialists, along side with a mastery of all new TB deeper and reasoned study of the diversity of modern pulmonology. Without a deep knowledge in pulmonology there will not be true of specialists in modern TB.

Keywords: tuberculosis, pathomorphosis, multiresistance.

List of references:
1.    Melnyk V. Tubercul’os — problema social’na i ekologichna (Ukr). Vashe zdorovya newspaper (Ukr). 2012;40-41:8.
2.    Melnyk VM, Novozhilova IA, Matusevich VG, Arefyeva LV, Prychodko AN. Pathomorphism of lung tuberculosis during epidemic: clinical course, radiological and bacteriological peculiarities (Ukr). Ukrainskyi pul’monologichnyi jurnal [Ukr Pulmonol J] (Ukr). 2007;2:49-52.
3.    Petrenko VI, Todoriko LD, Hryschuk LA et al. Phthiatria (Ukr). Kyiv: VSV Medicina; 2015:472.
4.    Feshchenko YuI, Melnyk VM. Control’ za tubercul’ozom v umovah adaptatsiynoi DOTS-strategii (Ukr). Kyiv: Medicina; 2007:480.

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