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Issue. Articles

4(27) // 2016

 

 

1. Original researches

 

Costeffectiveness and tolerability of linezolid intravenous administration in patients with extensively drug resistant tuberculosis (UKR)

N. A. Lytvynenko

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

Objectives — to evaluate the efficacy of intravenous until the smear conversion versus oral administ­ration of linezolid and to compare the main cost of these two regimens.
Materials and methods. In the randomized controlled research participated 70 individuals with  extensively drug-resistant tuberculosis who received chemotherapy regimens included not less than 4 effectiveness antituberculosis drugs, including linezolid during intensive phase of treatment (240 doses ATDs). All patients had central-ized model of treatment: hospitalized phase — until the smear conversion, after this — ambulatory phase. These regimens differed only of method of administration of linezolid: the patients of the main group re-ceived linezolid 1200 mg daily intravenous until the smear conversion, turning after this the oral linezolid 600 mg daily before the end of the intensive phase; the patients of the control group received oral linezolid 600 mg daily throughout the all intensive phase.
Results and discussion. In patients of main group sputum conversion achieved in 97.1 vs. 94.3 % of con-trol (p > 0.05). The time to sputum conversion in the main group was significantly shorter vs. control: (46 ± 6.0) vs (109 ± 9.2) days, respectively (p < 0.05), and total treatment cost for 1th patient during intensive phase was the less: 57 342.2 vs 60 543.5 UAH, respectively. Tolerability of the treatment was the same in patients comparison groups.
Conclusions. Intravenous administration of linezolid in XDRTB patients resulted in a reduction of terms of smear conversion, which is a indicator of the reducing of the risk for further transmission of infec-tion and epidemiological threat for others. It is possible to start of ambulatory phase on the 63 days earlier and that in turn helped to decrease the overall cost of treatment.

Keywords: extensively drug-resistant tuberculosis, costeffectiveness, linezolid.

List of references: 1.    Barbova AI, Zhemkova GhA, Zhurylo OA, Myronchenko SV. The use of automated MGIT system for the diagnosis of pulmonary tuberculosis and drug resistance of Mycobacterium definition: guidelines (Ukr).  Instytut ftyziatriji i puljmonologhiji im. F. Gh. Janovsjkogho AMN Ukrajiny. Kyiv: IFP; 2007:24.
2.    Jeshhenko OGh. The unified clinical protocols of primary, secondary (specialized) and tertiary (highly specialized) medical care «Tuberculosis»: standard (Ukr). Kyiv: MOZ Ukrajiny; 2014:87 .
3.    Lapach SM, Chubenko AV, Babich PM. Statistical methods in biomedical research using Excel (Ukr). Kyiv: Morion; 2000:320.
4.    Lytvynenko NA. Efficiency of the different individualized regimes of chemotherapy in patients with extensively drug resistant tuberculosis (Ukr).  Zbirn nauk pracj spivrob NMAPO im PL Shupyka. 2013;22(2):394-399.
5.    Cherenko SO, Lytvynenko NA, Barbova AI, Zhurylo OA, Poghrebna MV, Senjko JuO et al. Drug resistance incidence and pattern in patients with MDR TB and XDR TB depending on the case of disease, previous treatment profile and duration (Ukr). Tuberkuljoz. Leghenevi khvoroby. VIL-infekcija. 2013;2(13): 9-25
6.    Caminero JA et al. Best drug treatment for multidrug-resistant and extensively drug-resistant tuberculosis. Lancet Infect. Dis. 2010;10:621-629.
7.    Chang K, Yew W. Management of difficult multidrug-resistant tuberculosis and extensively drug-resistant tuber­culosis: Upda­te 2012. Respirology. 2013;18:8-21.
8.    Cox H, Ford N. Linezolid for the treatment of complicated drug-resistant tuberculosis: a systematic review and meta-analysis. Int J Tuberc Lung Dis. 2012;16:447-454.
9.    Migliori GB et al. A retrospective TBNET assessment of linezolid safety, tolerability and efficacy in multidrug-resistant tuberculosis. Eur Respir J. 2009;34:387-393.
10.    Sotgiu G et al. Efficacy, safety and tolerability of linezolid containing regimens in treating MDR-TB and XDR-TB: systematic review and meta-analysis. Eur Respir J 2012;40:1430-1442.
11.    Tangg SJ et al. Efficacy and Safety of Linezolid in the Treatment of Extensively Drug-Resistant Tuberculosis. Japan J Inf Dis 2011;64(6):509-512.
12.    Xu HB, Jiang RH, Li L, Xiao HP. Linezolid in the treatment of MDR-TB: a retrospective clinical study. Int J Tuberc Lung Dis. 2012;16:358-363.

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Original language: Ukrainian

2. Original researches

 

Comparative assessment of tuberculosis patients according to the socio-medical factors in a high burden trans-border region (RUS)

E. Lesnic1, L. Todoriko2, A. Niguleanu1, I. Ieremenchuk2, I. Semianiv2

1 Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
2 HSEI «Bukovinian State Medical University», Chernivtsi, Ukraine

Objective — epidemiological indices of tuberculosis (TB) in two Moldovan overburden regions (Chisinau and Balti cities in comparison with national data) and Western Ukraine Region (Chernivtsi Oblast) and risk factors of patients from three selected overburden regions.
Materials and methods. It was performed a retrospective, randomized, selective, descriptive study targeting TB risk factors and socio-economical peculiarities of 228 new pulmonary TB cases from high two Moldovan city Chisinau and Balti and 271 new pulmonary TB cases from Chernivtsi region of Ukraine. Including criteria were: age > 18 years old, new case with pulmonary TB diagnosed through microbiological methods, all patients being positive at GeneXpert MTB/RIF assay, signed informed consent. First Moldovan sample included 185 patients selected as being diagnosed and therapeutically managed in the frame of medical specialized organizations of Chisinau city (Chisinau group — ​CG), second Moldovan sample included 43 patients from Balti city (Balti group — ​BG) and the third group, Ukrainian sample included 271 patients of Chernivtsi Oblast (Chernivtsi group — ​ChG) registered in the period of 01.01.2015—31.12.2015. There were used social, epidemiological collection methods, statistical analysis, graphic representation and analytical assessment through Microsoft Excel XP soft.
Results and discussion. The study was designed to incorporate health-related issues of TB morbidity into demographic measures. In the global epidemiological context the major epidemiological indices describing the spread of TB disease in the general population are: global incidence (number of new cases and relapses reported at 100.000 population), incidence of new case, prevalence and mortality. According to the published data by the Moldovan National Centre for the Management in Health during the period 2013—2015 it was registered an important decline of all TB indices. Patients was distributed according to the biological characteristics it was demonstrated that men and young individuals must be targeted by the screening methods and risk reduction measures.
Despite the fact that epidemiological impact is the most important factor influencing the tuberculosis morbidity the rate of patients from TB clusters are very low in all three regions, due to low quality of cross-investigation. Former detained patients were in a similar proportion in all three groups.
The most important role of the study represents the comparative assessment of risk factors in Moldovan-Ukraine trans-border region. A higher rate without achieving the statistical threshold showed the unemployed patients in ChG comparing with CG and BG. The distribution of pulmonary tuberculosis patients from 3 burden trans-border regions established that primary target groups are social and economical vulnerable, young groups, comorbid patients, migrants and alcohol abusers.
Conclusions. Republic of Moldova shows a continuously decreasing of its entire population and increasing of urban population that contributes to the polarization of health care services, which became much more accessible in urban area. Ukraine is experiences the increasing of its population due to territorial redistribution, despite this, the population of Chernivtsi region is decreasing as being reported to the entire Ukraine population. In 2015 global incidence in Ukraine is lower, but insignificantly in comparison with RM, and identified more lower in previous years (2013 and 2014). The increasing indices in Kyiv is contrasting with decreasing in Chisinau, although in Chernivtsi rest stable. Prevalence in Ukraine, Kyiv and Chernivtsi.

Keywords: Tuberculosis, risk factors, social status.

List of references:  
1.    Centrul National de Management in Sanatate.— Chisinau, 2015.— http://www.cnms.md.
2.    Jenkins H., Ciobanu A., Plesca V. et al. Risk factors and timing of default from treatment for non-MDR TB in Moldova // Inter. J. Tuberculosis and Lung Diseases.— 2013.— Vol. 17 (3).— P. 373—380.
3.    Shivani C., Sharma N., Joshi K. et al. Resurrecting social infrastructure as a determinant of urban tuberculosis control in Delhi, India // Health Res. Policy Syst.— 2014.— Vol. 12 (3).— Doi: 10.1186/1478-4505-12-3.
4.    United Nations. Report on Millenium Development Goals.— Republic of Moldova, Chisinau, 2013.
5.    World Health Organization. The global plan to stop TB 2011—2015: transforming the fight towards elimination of tuberculosis. Geneva, 2011.
6.    World Health Organization. Tuberculosis diagnostics. Xpert MTB/RIF Test, 2013.
7.    http:// www.statista.com/statistics/513335/gross-domestic-product-gdp-per-capita-in-moldova/.
8.    Medstat.gov.ua/ukr.

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Original language: Russian

3. Original researches

 

Efficacy of selenium nitric inclusion in complex therapy of tuberculosis patients with thyropathy (RUS)

S. L. Matveyeva1, O. S. Shevchenko1, O.Yu. Philippova2

1 Kharkiv National Medical University, Kharkiv, Ukraine
2 Oblast TB Dispensary N 1, Kharkiv, Ukraine

Objective — to study the effect of selenium on the thyroid status and chemotherapy outcomes of patients with destructive pulmonary tuberculosis and thyroid pathology.
Materials and methods. Effects of selenium on thyroid status and chemotherapy outcomes were studied by observing 180 patients with tuberculosis and pathological structural changes in the thyroid gland. Out of these  observated subgroups 3 received selenium nitric during the first 2 months of standard chemother-apy, and 3 control subgroups — only standard chemotherapy. In the serum of venous blood in all patients prior to initiating therapy and at 2 months since its beginning found content levels of selenium, free thy-roxine, thyroid stimulating pituitary hormone, antibodies to thyroglobulin and thyroid peroxidase that were determined by of an ELISA method. Biochemical parameters before and after 2 months of the therapy were compared between the groups of monitoring and control. In addition, cure rates (% of bacteriological healing and destruction) were compared during the phase of intensive therapy.
Results and discussion. In tuberculosis patients including patients with multidrugresistant tuberculosis and coinfection tuberculosis/HIV with thyroid pathology was diagnosed a subclinical hypothyroidism worsening by antituberculosis chemotherapy. Prescribing of selenium nitric in complex therapy of tuber-culosis patients with thyroid pathology restored thyroid function protecting it from thyroid toxic action of antituberculosis chemotherapy. Exploiting of selenium nitric in intensive phase of antituberculosis chemo-therapy of tuberculosis patients with thyroid pathology and subclinical hypothyroidism improved the fre-quency of bacilli stopping with 6.66—20 % and healing of cavitation with 10 % in compare with the control.
Conclusions. In patients with tuberculosis in combination with thyropathy was diagnosed subclinical hypothyroidism which progressed on the background of anti TB chemotherapy. As selenium nitric restored thyroid function and optimizes the results of chemotherapy selenium nitric can be recommended as an drug accompaniment during chemotherapy for these patients.

Keywords: tuberculosis, thyroid, selenium, chemotherapy outcomes.

List of references:
1.    Matveyeva SL. Clinical characteristics and Outcomes of Chemotherapy in Persons with Pulmonary Tuberculosis and Pathology of Thyroid (in Rus). Tuberculosis. Pulmonary Diseases/ HIV-infection. 2011;2(5):39-44.
2.    Matveyeva SL. Role of Previous Thyroid State in Cellular Immunity Formation and Outcomes of Chemotherapy in Patients with Pulmonary Cavitary Tuberculosis  (in Rus). Problems of Endocrine Pathology. 2011;3:35-43.
3.    Cherenko SA, Matveyeva SL. Correlations of  Clinical Running of Pulmonary Tuberculosis,Thyroid Function and Some Cytokines. Ukr Pulm J. 2011;2:35-38.
4.    Unificated Clinical Protocol of Primary, Secondary (Specialized)and Tertian (High-specialized) Medical Care. Tuberculosis, the Order of Health Care Ministry of Ukraine. 21.12.2012;1091.
5.    Barclay MNI, MacPherson A, Dixon JJ. Selenium content of a range of UK foods. Food Comp Anal. 1995;8:307-318.
6.    Chabra N, Gupta N, Asiri ML et al. Analysis of thyroid function tests in patients of multidrug resistance tuberculosis undergoing treatment. J Pharmacol Pharmacother. 2011;2(4):282-285.
7.    Contempré B, Duale NL, Dumont JE et al. Effect of selenium supplementation on thyroid hormone metabolism in an iodine and selenium deficient population. Clin Endocrinol (Oxf). 1992;36 (579):83.
8.    Derumeaux H, Valeix P, Castetbon K et al. Association of selenium with thyroid volume and echostructure in 35- to 60-year-old French adults. Eur J Endocrinol. 2003;148(3):309-315.
9.    Dickson RC, Tomlinson RH. Selenium in blood and human tissues. Clin Chim Acta. 1967;16:311-321.
10.    Donelli Mc., Bravernan LE, Bernardo J. Hypothyroidism due to ethionamide. N Engl J Med. 2005;352:2757-2759.
11.    Drutel A, Archambeaud F, Caron P. Selenium and the thyroid gland: more good news for clinicians. Clin Endocrinol(Oxf). 2013;78(2):155-164.
12.    Gärtner R, Gasnier BC, Dietrich JW et al. Selenium supple­mentation in patients with autoimmune thyroiditis decreases thyroid peroxidase antibodiesconcentrations. J Clin Endo­crinol Metab. 2002;87:1687-1689.
13.    Lone Banke R, Lutz S. Selenium status, thyroid volume, and multiple nodule formation in an area with mild iodine deficiency. Eur J Endocrinol. 2011;164 (4):585-590.
14.    Rayman MP. The importance of selenium to human health. Lancet. 2000;356(9225):233-241.
15.    Takasu N. Rifampin-induced hypothyroidism. J Endocrinol Invest. 2006;29:645-649.
16.    Weetman A, McGregor AM. Autoimmune thyroid disease: Further developments in our understanding. Endocrinol Rev. 1994;15:788-830.

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Original language: Russian

4. Original researches

 

Genetic diversity of mycobacterium tuberculosis that were isolated in patients sputum of different age groups (UKR)

O. S. Konstantynovska1, O. O. Liashenko2, P. I. Poteiko1, I. I. Hrek1, A. V. Rohozhyn1, O. S. Solodiankin3, A. P. Gerilovych3, V. I. Bolotin3

1 Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
2 V. N. Karazin Kharkiv National University, Kharkiv, Ukraine
3 National Scientific Center «Institute of Experimental and Clinical Veterinary Medicine», Kharkiv, Ukraine

Objective — to determine the genotypes of Mycobacterium tuberculosis that were isolated in patient’s sputum of different age groups, in Kharkiv tuberculosis hospitals.
Materials and methods. Were identified 115 strains of Mycobacterium tuberculosis by VNTR-­method for ETR A—E loci that were isolated from the sputum of patients with pulmonary tuberculosis in different age groups (Group 1 — over 55 years and Group 2 — younger 54 years). The study was conducted within the framework of scientific cooperation NSC IECVM and the Kharkiv Medical Academy of Postgraduate Education (KhMAPE).
Results and discussion. There were identified 6 families of Mycobacterium tuberculosis: Beijing, LAM, Haarlem, Ural/Uganda 1, Siberian (S), Africanum. The most frequent were: Beijing (60 %), LAM (16.5 %) and S  (8.7 %). Other family profiles and individual genotypes (GIP) ranged from 0.9 to 5.2 %. Revealed 20 unique and 12 repeated VNTR­-profiles. Strains of Mycobacterium tuberculosis were belong to two groups: East Asian and Euro­-American. There was no statistically significant difference in the number of isolates of Beijing, S and LAM families depending on the age of patients. Among the Mycobacterium family Beijing was found a large cluster of 42435 (53 isolates), which was found in both groups (42.5 and 50 % of isolates). Isolates of Haarlem family were more marked in group 1 (among older patients) and each of them had a unique VNTR-profile.
Conclusions. Given the dominance of strains of genotype Beijing (especially VNTR-­profile 42435) in populations of Mycobacterium tuberculosis in Kharkiv region, it is useful to identify isolates of this family throughout Ukraine using simple and affordable for most laboratories methods.

Keywords: VNTR, genotyping, Mycobacterium tuberculosis, tuberculosis, strain, Beijing, LAM, Haarlem, elderly and senile age.

List of references:
1.    Antonenko PB. Sovremennoe sostoianye medikamentoznoi rezistentnosty vozbuditelia tuberkuleza i vozmozhnosty ego genotypycheskogo  opredelenyia [Tekst]. Klynycheskaia medytsyna. 2014;43(3):813 (rus).
2.    Zdorov'e pozhilyh: doklad komiteta ekspertov VOZ. VOZ, Zheneva, 1992:7,13,16 (rus).
3.    Moskalenko VF, Holubchykov MV. Sotsialno-hihiienichnyi analiz demohrafichnoi sytuatsii v Ukraini. Medychnyi vsesvit. 2003;2:44-51 (Ukr).
4.    Nakaz MOZ Ukrainy N 620 vid 04.09.2014 «Unifikovanyi klinichnyi protokol pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy. Tuberkuloz» (ukr)5.    Pokaznyky zakhvoriuvanosti na tuberkuloz Ta diialnist protytuberkuloznykh zakladiv Ukrainy za 2015 rik. za red. MV Holubchykova: K.; 2016 (Ukr).
6.    Skornjakov SN, Umpeleva TV, Vjazovaja AA i dr. Genotipirovanie ural'skih izoljatov Mycobacterium tuberculosis [Tekst]. Biologicheskie nauki. 2014;11(9):2485-2488 (Rus).
7.    Tuberkuloz v Ukraini: Analitychno-statystychnyi dovidnyk. Za red.  NM Nizovoi, MV Holubchykova.— K., 2016:37 (Ukr).
8.    Umpeleva TV. Molekuljarno-geneticheskaja harakteristika klinicheskih izoljatov Mycobacterium tuberculosis, vydelennyh ot bol'nyh tuberkulezom v ural'skom federal'nom okruge rossijskoj federacii. Dissertacija na soiskanie uchenoj stepeni kandidata biologicheskih nauk. Ekaterinburg, 2014.:146 (Rus).
9.    Fitzgibbon MM, Gibbons N, Roycroft E A. Snapshot of genetic lineages of Mycobacterium tuberculosis in Ireland over a two-year period, 2010 and 2011. Euro Surveill. 2013;18(3):1-7.
10.    http://www.miru-vntrplus.org/
11.    http:/www.who.int/tb/publications/global_report/en
12.    Liu Y, Tian M, Wang X et. al. Genotypic Diversity Analysis of Mycobacterium tuberculosis Strains Collected from Beijing in 2009, Using Spoligotyping and VNTR Typing. PLoS One. 2014;9,(9):e106787. Doi: 10.1371/journal.pone.0106787.
13.    Nikolayevskyy V, Trovato A, Broda A et al. MIRUVNTR Genotyping of Mycobacterium tuberculosis Strains Using QIAxcel Technology: A Multicentre Evaluation Study. PLoS ONE;11(3):e0149435. Doi:10.1371/journal.pone.0149435.
14.    Noguti EN, Leite C Q, Malaspina A C et. al. Genotyping of Mycobacterium tuberculosis isolates from a low-endemic setting in northwestern state of Paraná in Southern Brazil. Memórias do Instituto Oswaldo Cruz. 2010;105(6):779-785. Doi: 10.1590/s0074-02762010000600008.
15.    Ojo OO, Sheehan S, Corcoran D G et. al. Molecular epide­miology of Mycobacterium tuberculosis clinical isolates in Southwest Ireland. Infection, Genetics and Evolution. 2010;10(7):1110-1116. Doi: 10.1016/j.meegid.2010.07.008.
16.    Roetzer A, Schuback S, Diel R et. al. Evaluation of Myco­bacterium tuberculosis typing methods in a 4-year study in Schleswig-Holstein, Northern Germany. J Clin Microbiol. 2011;49(12):4173-4178. Doi: 10.1128/jcm.05293-11.
17.    Rovina N, Karabela S, Constantoulakis P et. al. MIRU-VNTR typing of drug-resistant tuberculosis isolates in Greece. Therapeutic Advances in Respiratory Disease. 2011;5(4):229-236. Doi: 10.1177/1753465811402120.
18.    Scott A, Weisenberg S A, Gibson A L et. al. Distinct Clinical and Epidemiological Features of Tuberculosis in New York City Caused by the RDRio Mycobacterium tuberculosis Sublineage. Infect Genet Evol. 2012;12(4):664-670. Doi: 10.1016/j.meegid.2011.07.018.

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Original language: Ukrainian

5. Original researches

 

Clinical parameters of vitamin D in children with tuberculosis (UKR)

L. I. Mykolyshyn1, Z. I. Piskur1, Y. Y. Didyk2, O. S. Sikirynska2

1 Danylo Halytskyi Lviv National Medical University, Lviv, Ukraine
2 PILRC «Lviv Tuberculosis Dispensary», Lviv, Ukraine


Objective — to identify clinical parameters of 25(OH)D in children with severe and uncomplicated forms of tuberculosis and seasonal variations in the level of 25(OH)D in tuberculosis.
Materials and methods. The study involved 38 children who were treated due to tuberculosis (study group) and 14 healthy children (control group).
Results and discussion. Vitamin D deficiency was found among children with tuberculosis in (71.1 ± ± 8.9) %, its deficiency was revealed in (21.1 ± 15.4) % and the level of 25(OH)D was within normal range only in (7.8 ± 19.0) % of children. The deficiency of 25(OH)D was significantly more common in children with severe intrathoracic and extrathoracic tuberculosis than in children with uncomplicated forms of respiratory tuberculosis ((90.9 ± 6.6) vs. (43.8 ± 20.1) %; p < 0.05), that indicates the severity of the disease is dependent on its level. The average parameter of vitamin D concentration in children with tuberculosis was significantly lower than in healthy ones ((17.29 ± 1.66) vs. (59.35 ± 3.70) ng/ml; p < 0.001). Moreover, it was significantly lower both in children suffering from intrathoracic and extratho-racic tuberculosis ((14.60 ± 1.18) vs. (59.35 ± 3.70) ng/ml; p < 0.001) and in children with uncomplicated TB ((21.00 ± 3.45) vs. (59.35 ± 3.70) ng/ml; p < 0.001). It was established that the average monthly level of vitamin D in patients with tuberculosis was lower than in healthy children, and monthly levels of sea-sonal variations of 25(OH)D in children with tuberculosis were much more pronounced in the summer months.
Conclusions. Low level of vitamin D is a risk factor for tuberculosis in children. The severity of disease depends on the level of vitamin D. Low levels of vitamin D can be caused by activation of latent TB infec-tion in children in the summer months.

Keywords: vitamin D, tuberculosis, children, seasonal prevalence.

List of references:
1.    Mazur IP, Novoshytskyi VYe. Vitamin D: metabolizm, funktsii ta vazhlyvist dlia orhanizmu liudyny. Rol u patohenezi heneralizovanoho parodontytu. Chastyna 1 (Ukr). Sovremennaia stomatolohyia (Ukr). 2014;1:40-45.
2.    Tkachenko N. Vitamin D: rol u proty infektsiinomu zakhysti (Ukr). Dytiachyi likar (Ukr). 2011;4:78-80.
3.    Bergman P, Norlin A-C, Hansen S et al. Vitamin D3 supple­mentation in patients with frequent respiratory tract infections: a randomised and double-blind intervention study. BMJ Open. 2012;2(6).
4.    Braegger C, Campoy C, Colomb V et al. Vitamin D in the Healthy European Paediatric Population. J Pediatric Gastroenterology & Nutrition. 2013;56:692-701.
5.    Coussens AK, Timms PM, Boucher BJ et al. 1α,25-dihydroxyvitamin D3 inhibits matrix metalloproteinases induced by Mycobacterium tuberculosis infection. Immunology. 2009;127:539-548.
6.    Chocano-Bedoya P, Ronnenberg AG. Vitamin D and tuberculosis. Nutrition Reviews. 2009;67(5):289-293.
7.    Chesney RW. Vitamin D and The Magic Mountain: the anti- infectious role of the vitamin. J Pediatrics. 2010;156(5):698-703.
8.    Ginde AA, Mansbach JM, Camargo JrCA. Association between serum 25-hydroxyvitamin D level and respiratory tract infection in the Third National Health and Nutrition Examination Survey. Archives of nternal Medicine. 2009;169(4):384-390.
9.    Hughes DA, Norton R. Vitamin D and respiratory health. Clinical and experimental immunology. 2009;158:20-25.
10.    Lemire J.M. Immunomodulatory role of 1,25-dihydroxyvitamin D3. J Cellular Biochemistry. 1992;49:26-31.
11.    Lips P. Vitamin D deficiency and secondary hyperparathyroi­dism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocrine Reviews. 2001;22:477-501.
12.    Liu PT, Stenger S, Li H et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science. 2006;311:1770-1773.
13.    Luquero F.J, Sanchez-Padilla E, Simon-Soria F. et al. The Union Trend and seasonality of tuberculosis in Spain, 1996–2004. International. J Tuberculosis and Lungs Disease. 2008;12:221-224.
14.    Parrinello CM, Crossa A, Harris TG. Seasonality of tuberculosis in New York City, 1990-2007. International J Tuberculosis and Lungs Disease. 2012;16:32-37.
15.    Rathored J, Sharma SK, Singh B et al.  Risk and outcome of multidrug-resistant tuberculosis: vitamin D receptor polymorphisms and serum 25(OH) D. Int J Tuber and Lungs Dis. 2012;16(11):1522-1528.
16.    Talat N, Perry S, Parsonnet J et al. Vitamin D deficiency and tuberculosis progression. Emerging Infectious Diseases. 2010;16(5);853-855.
17.    Venturini E, Facchini L, Martinez-Alier N et al. Vitamin D and tuberculosis: a multicenter study in children. BMC Infectious Diseases. 2014;14:652-662.
18.    Wingfield T, Schumacher SG, Sandhu G et al. The Seasonality of Tuberculosis, Sunlight, Vitamin D, and Household Crowding. J Infectious Disease. 2014;210:774-783.
19.    Xin-Xu Li, Li-Xia Wang, Hui Zhang et al. Seasonal Variation in Notification of Active Tuberculosis cases in China, 2005-2012. Plos ONE. 2013;8:8.

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Original language: Ukrainian

6. Original researches

 

Analysis of the effectiveness of tuberculosis multidrug resistant therapy in patients registered in 20092014 in the Kharkiv Region (RUS)

O. S. Shevchenko, I. A. Ovcharenko

Kharkiv National Medical University, Kharkiv, Ukraine

Objective —to conduct a comparative analysis of the effectiveness of standard treatment regimens for multidrug resistant tuberculosis according to health care protocols valid at the time of registration of the patients.
Materials and methods. 68 case histories of patients with newly diagnosed multidrug resistant tubercu-losis, who were treated at the Kharkiv Regional TB Dispensary N 1 in the period from 2009 to 2014 and received tubercular regimen according to the clinical protocols of medical treatment of patients with mul-tidrug resistant tuberculosis valid at that time (group I — order of the Ministry of Health of Ukraine N 600, group II — order of the Ministry of Health of Ukraine N 1091) were analyzed.
Results and discussion. The conducted study identified that among patients of the group II, the posi-tive X-ray dynamics was observed on the 2nd month of treatment more often (84.2 %) than in patients of the group I (73.5 %). Similarly, in the group II, less patients had lung tissue degradation after 6 months of treatment (47.4 %) and cough (15.8 %) than in the group II — 67.3 % and 44.9 % respectively. Efficiency of treating patients in the group I was lower in the subgroup using isoniaside.
Conclusions. The result of the retrospective analysis indicates a more favorable course of TB during treatment with standard regimens in patients of the II group.

Keywords: ultidrug resistant tuberculosis, effectiveness of the treatment, criteria for the treatment effectiveness, isoniaside.

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Original language: Russian

7. CASE FROM PRACTICE

 

Unique clinical case of the co-infection of tb with versatile defeat and profound immunodeficiency are treated with isoniazid on a background of antiretroviral therapy of HIV infection (UKR)

O. V. Panasiuk1, L. S. Nychyporenko1, L. A. Kolomiychuk1, S. A. Evdokimov1, H. V. Radysh2

1 SI «V.L. Gromashevsky Research Institute of Epidemiology and Infectious Diseases», Kyiv, Ukraine
2 O.O. Bogomolets National Medical University, Kyiv, Ukraine

Patient ., 49 years old, diagnosed with «Synchronous cancer of the lower lobe of the right lung T2NxM0 St. IN CL. gr. II non-Hodgkin’s lymphoma, stage IA (MALT) also lesions of the stomach, HIV infection, leukopenia, stage III, and stage IV of thrombocytopenia» was sent from the thoracic branch of the National Cancer Institute (NCI, Kyiv) for a consultation to the national center for HIV, to determine fur-ther tactics lacinia.
In the clinic of the SI «V.L. Gromashevsky Research Institute of Epidemiology and Infectious Diseases» (Kyiv) patient on 29.05.2015 has been registered as HIV positive, stage IV with immune status: CD4 — 16 (3.8 %) of cells per 1 mm3. At first doctors suspected tubercu-lous etiology with revealed inflammation of the regional lymph nodes, infiltration in S 6 of the right lung and ulcer stomach form.
02.06.2015 patient was appointed antiretroviral therapy by receiving isoniazid 0.3 g daily and Biseptol 2 tablets on a daily basis. The patient tolerated the treatment well, further a positive dynamics in all parame-ters of the examination was noted and on the 13th month a conclusion was released. Effects of tuberculosis (code B90) in  a form of complete resorption of infiltration in S6 of the right lung, scarring of the ulcer of the stomach, reducing the compaction on the right and perigastric bron-chopulmonary lymph nodes, healing of the fistula in the stomach wall after the treatment (Cat. 5.1) of tu-berculosis that was  diagnosed for the first time (28.05.2015) and perigastric bronchopulmonary lymph nodes, stomach, S6 of the right lung without the reference to bacteriological and histological confirmation, that meets the codes A16.7 and A18.3 International classification of diseases, X revision.

Keywords: cure, tuberculosis, isoniazid, HIV infection, antiretroviral therapy.

List of references:  
1.    Antoniak SM, Burhai OS, Haiovych HYa, Panasiuk VO, Panasiuk OV, Smetanina OR et al. Diahnostyka pozalehenevoho tuberkul'ozu u VIL-infikovanykh ta khvorykh na SNID: metod.rekom., zatverdzheni Nakazom MOZ Ukrayiny vid 06.09.2006 r. N 597. (Ukr.) K., 2009:48.
2.    Mizhnarodna statystychna klasyfikatsiya khvorob ta sporidnenykh problem okhorony zdorovya, X perehlyad (perelik tryznachnykh rubryk). K., MOZ Ukrayiny, Tsentr medychnoyi statystyky. Instytut zdorovya imeni LI Medvedya. (Ukr.) 1996:160.
3.    Nakaz MOZ Ukrayiny N1039 vid 31.12.2014 r. «Pro zatverdzhennya ta vprovadzhennya medyko-tekhnolohichnykh dokumentiv zi standartyzatsiyi medychnoyi dopomohy pry ko-infektsiyi (tuberkul'oz/VIL-infektsiya/SNID) (Ukr.).
4.    Panasiuk OV, Antoniak SM, Hetman LI, Holub OB, Doan IT, Yevdokymov AS et al. Klinichna kharakterystyka khvorykh na ko-infektsiyu tuberkul'oz / VIL za danymy rehional'nykh tsentriv SNIDu Ukrayiny pid chas provedennya 115 klinichnykh nastavnyts'kykh vizytiv za 10 ostannikh rokiv. Tuberkul'oz, lehenevi khvoroby, VIL-infektsiya [Tuberculosis, lung diseases, HIV infection] (Ukr.). 2015;3(22):105-106.
5.    Feshchenko YuI, Ilnytskyi IH, Melnyk VM, Melnyk VP, Panasiuk OV Pul'monolohiya ta ftyziatriya: nats. pidruchnyk u 2-kh t. (Ukr.) / Kyiv-Lviv. Atlas, 2012:1362.

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8. CASE FROM PRACTICE

 

Tuberculosis and diabetes problem (RUS)

I. A. Sirenko, E. A. Levchenko, L. A. Sukhanova, O. Yu. Marchenko

Kharkiv Medical Academy of Postgraduate Education

The article presents the problem of a combination of tuberculosis and diabetes. Relevance of the topic determined the tense situation on tuberculosis and the steady increase in diabetic patients who have pul-monary tuberculosis occurs in 3—11 times more likely than the general population.
Numerous factors that predispose diabetics to tuberculosis: violation of all types of metabolism, particu-larly carbohydrate, pathophysiological conditions that lead to metabolic disorders, immunological changes and immunogenetic mechanisms were established. All of the above contributes to the severe course of tu-berculosis in patients with diabetes, it complicates treatment of tuberculosis and is accompanied by its low efficiency.
Presented by the clinical observation of the teenager with caseous pneumonia, which developed diabetes mellitus type 1.

Keywords: tuberculosis, diabetes, metabolic disorders.

List of references: 1.    Dedov YY. Sakharnyy dyabet - ​opasneyshyy vyzov myrovomu soobshchestvu. Vestn RAMN. 2012:1:7-13.
2.    Kamynskaya HO, Abdullaev RYu. Patofyzyolohycheskye predposylky neblahopryyatnoho vlyyanyya sakharnoho dyabeta na techenye tuberkuleza lehkykh. Tuberkulez y bolezny lehkykh. 2014;3:5-10.
3.    Komyssarova OH. Tuberkulez u bolnykh sakharnym dyabetom. Tuberkulez y bolezny lehkykh. 2012;11:3-7.
4.    Korovkyn VS. Tuberkulez lehkykh u bolnykh sakharnym dyabetom. Mynsk, 1995:190.
5.    Papenova EL, Odynets VS, Zadremaylova TA y dr. Vlyyanye ranneho vyyavlenyya tuberkuleza orhanov dykhanyya u bolnykh sakharnym dyabetom na effektyvnost lechenyya v Stavropolskom krae. Tuberkulez y bolezny lehkykh. 2015;7:109-110.
6.    Petrenko VI, Protsyuk RH. Problema tuberkulozu v Ukrayini. Tuberkuloz, lehenevi khvoroby, VIL-infektsiya. 2015;2(21):16-29.
7.    Smurova TF, Kovaleva SY. Tuberkulez y sakharnyy dyabet. M.: Medknyha, 2007:317.
8.    Taran Y. Tuberkulez: sytuatsyya trebuet ekstrennykh mer reahyrovanyya. Hazeta. 2000;16(169). 22-28 aprelya 2016 h.
9.    Feshchenko YuI, Lytvynenko NA, Pohrebna MV ta in. Likuvannya khvorykh na multyrezystentnyy tuberkuloz ta tuberkuloz iz poshyrenoyu rezystentnistyu mikobakteriy tuberkulozu do protytuberkuloznykh preparativ: osnovni prychyny nyzkykh rezultativ. Tuberkuloz, lehenevi khvoroby, VIL-infektsiya. 2016;2(25):22-29.
10.    Fyrsova VA. Tuberkulez u podrostkov. M, 2010:82-86.
11.    Chukanova VP, Serheev AS, Pospelov LE, Sobkyn AL.Epydemyolohycheskyy y ymmunohenetycheskyy analyz vzaymosvyazy tuberkuleza y sakharnoho dyabeta. Probl tuberkuleza. 2000;4:11-14.
12.    Al-Attiyah RJ, Mustafa AS. Mycobacterial antigen induced helper type 1 (Th1) and Th2 reactivity of peripheral blood mononuclear cells from diabetic and non-diabetic tuberculosis patients and Mycobacterium bovis bacilli Calmette-​Gurin (BCG) — ​vaccinated healthy subjects. Clin Exp Jmmunol. 2009;158:64-73.
13.    Jeon CY, Murray MB. Diabetes mellitusin creases the risk ac­tive tuberculosis: A systematic reviewof 13 Observational Studies. Plos Medicine. 2008;5:e 152. Doi: 10. 1371/ journal. pmed. 0050152.
14.    Ottmani SE, Murray MB, Jeon CY at al. Consultation me­­eting ontuberculosis and diabetes mellitus: meeting summary and recommendations. Int J Tuberc Lung Dis. 2010;14(12):1513-1517.
15.    Patel AK, Rami KC, Ghanchi FD. Radiological presentation of patients of pulmonary tuberculosis with diabetes mellitus. Lung India. 2011;28(1):70.  Doi: 10. 4103/0970-2113. 76308.
16.    World Health Organization. Global tuberculosis control. 2011. Report. WHO/HTM/TB/2011.16.
17.    Zhang Q, Xiao H, Sugawara I. Tuberculosis complicated by diabetes mellitus at Shanghai pulmonary hospital. Chine Jpn J Infect Dis. 2009;62:390-391.

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9. CASE FROM PRACTICE

 

Pulmonary aspergillosis (UKR)

O. D. Nikolaeva

P.L. Shupyk National Medical Academy of Postgraduate Education, Ministry of Health Care of Ukraine, Kyiv, Ukraine

The case of a development of aspergillosis of lungs in combination with multiresistant tuberculosis, di-agnostics possibilities and treatment in modern conditions are described in this article.

Keywords: aspergillosis, diagnosis algorithm, differential diagnostics.

List of references:
1.    Klimko NN, Vasil’eva N V. Mikozy legkikh. Pul’monologiya: Natsional’noe rukovodstvo / od red. A G Chuchalina. ​Moskva: GEOTAR-Media, 2009:282-300
2.    Lizkina IV, Kuzovkova SD. Aspergilloma legkogo. Mezhdunarodnyi med zhurn. 2011;4:41-48.
3.    Walsh TJ, Anaissic EJ, Denning DW et al. Infectious diseases Society of America. Treatment of aspergillosis: clinical practice guidelines of the Infections diseases Society of America. Clin Infect Dis. 2008;46:327-360.

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10. epidemic situation

 

Characteristics of the TB epidemic: integral assessment, simulation, visualization, social and economic dependence (RUS)

A. D. Krissilov, L. G. Averbukh, S. V. Pozdnyakov, V. A. Krissilov, V. V. Chumachenko, T. V. Gerasimenko

SI «I. I. Mechnikov Ukrainian Anti-Plague Research Institute», Ministry of Healthcare of Ukraine, Odesa, Ukraine

Objective — to provide a holistic system of characteristics of the epidemics of tuberculosis — in a country as a whole and in individual administrative areas by the construction of integral indicators, their visualization and refinement of the space-time characteristics of the spread of the disease, which allows you to create a comprehensive picture of the «image of the epidemic» and predict its dynamics.
Materials and methods. The data of statistical yearbooks (Ukraine and Odessa region) and reference «Tuberculosis in Ukraine». The methodological basis of this work is a systematic approach to the descrip­tion of complex objects and processes, and a comparative analysis of aggregated estimates of TB epidemic in areas and a number of cities in Ukraine — in connection with the socio-economic status of these territories, and, partly, with their resource of medical support, as well as mapping and other visualization techniques — based on a specially developed goal-oriented multidimensional vector model.
Results and discussion. A generalized characteristics of TB epidemics for various administrative territorial objects of Ukraine were made as well as a comparative analysis of its dynamics and social and economic status of these territories. Implemented visualization of results and issued the appropriate atlas.
Conclusions. The above model provides a more reliable picture of the «image» of the epidemic. With its help an integrated evaluation of other epidemic processes can be created, a number of other complex objects can be built. The developed approaches allow an objective comparative analysis of the intensity of the epidemic in different areas (countries, regions, provinces, districts), their ranking, followed by the study of the causes of «gap» areas and the adoption of a number of measures to improve the situation there. Their use also creates the possibility of reliable estimation of dynamic trends in the epidemiological situation of the studied observation periods.

Keywords: tuberculosis, integrated assessment modeling, correlations, visualization.

List of references:
1.    Averbukh L, Yesypenko S, Krisilov A ta in. Medychno-sotsialni aspekty epidemii tuberkulozu: porivnialni doslidzhennia. Epidemiolohiia, hihiiena, infektsiini khvoroby. 2012;2 (7):36-42.
2.    Averbukh LH Tuberkulez: tap borb, obretenyia y potery. Odessa: Optymum, 2005. 350 s.
3.    Berliant AM. Obraz prostranstva: karta y ynformatsyia. M.: Misl, 1986:286.
4.    Bortkevych S. Shcho maie buty zmineno u derzhavnii politytsi protydii zakhvoriuvanniu na tuberkuloz v Ukraini? (Ievropeiskyi informatsiino-doslidnytskyi tsentr). K, 2016:31.
5.    Dziuba IV. Sotsialno-ekonomichne stanovyshche naselennia: ranzhuvannia rehioniv. Statystyka Ukrainy». 2004:72-90.
6.    Zakon Ukrainy «Shchodo protydii zakhvoriuvanosti na tuberkuloz» N 2586 vid 05.07.2001 r.
7.    Krysylov AD. Yntehralnaia otsenka sotsyalno-konomycheskoho razvytyia prymorskykh oblastei Ukrayni: resursi, sytuatsyia, pryoryteti. Natsionalni i rehionalni osoblyvosti reformuvannia sotsialno-ekonomichnykh vidnosyn i rehuliuvannia ekolohichnykh protsesiv v Ukraini ta Polshchi. Kyev-​Odessa-Varshava, 1997:145-158.
8.    Krysylov AD. O vivode obobshchennoho koeffytsyenta kachestva / Metodycheskye rekomendatsyy Mynysterstva sviazy USSR po probleme kompleksnoi system upravlenyia kachestvom. K, 1978:1-8.
9.    Krysylov AD, Krysylov VA. Formyrovanye tseleoryenty­ro­vannoi vektornoi modely dlia postroenyia ahrehyrovannikh otsenok slozhnikh obektov. Metodi reshenyia kolohycheskykh problem / Pod red. prof. L. Melnyka. Sumi: Kozatskyi val, 2005:138-155.
10.    Ohliad sotsialno-ekonomichnoho stanu rehioniv Ukrai­ny. Skorochenyi zvit Instytutu stratehichnykh doslidzhen RNBO Ukrainy. K, 2011:2-4.
11.    Petrenko VI. Ftyziatriia. K.: Zdorovia, 2008:486.
12.    Porivnialni dani pro rozpovsiudzhenist tuberkulozu ta efektyvnist roboty protytuberkuloznoi sluzhby Odeskoi oblasti (shchorichni, za 1998-2010 rr.).
13.    Pryvalov YuO, Chepurko HI, Trofymenko OV ta insh. Zvit za rezultatamy epidemiolohichnoho doslidzhennia z modeliuvannia rozvytku epidemii, zumovlenoi poiednanoiu ko-infektsiieiu tuberkuloz/VIL, v Ukraini. K, 2014:27.
14.    Sbornyky «Statystychnyi shchorichnyk Ukrainy» y «Narodnoe khoziaistvo Ukrayni» za 1991-2012 hh. K.
15.    Svidotstvo N 47988 pro reiestratsiiu avtorskoho prava na tvir «Yntehralnaia otsenka yepydemycheskoho protsessa tuberku­leza na osnove yspolzovanyia vektornoi modely». 2013.
16.    Stepanov V, Krysylov A, Holiaeva Y, Bliukher B. Prymenenye kvalymetrycheskykh modelei v sotsyalno-zkonomycheskykh zadachakh. Proc. of intern. conf. Knowledge-Dialogue- ​Solution. Sofyia-Varna, 2005:48-57.
17.    Tuberkuloz v Ukraini (Analitychno-statystychnyi dovidnyk za 1998-2008 roky). K, 2009:88.
18.    Tuberkuloz v Ukraini (Analitychno-statystychnyi dovidnyk za 2000-2010 roky). K, 2011:102.
19.    Tuberkuloz v Ukraini (Analitychno-statystychnyi dovidnyk za 2001-2012 roky). K, 2013:128.
20.    Tuberkuloz, ko-infektsiia TB/VIL, sotsialno-ekonomichnyi stan terytorii ta orhanizatsiino-medychne zabezpechennia naselennia v Ukraini i v Odeskii oblasti v 1998-2012 rr. (kartohrafuvannia, intehralne otsiniuvannia, modeliuvannia, analiz)». DU «UNDPChI im. II Mechnikova» MOZ Ukrainy: Atlas analitychnykh kart-materialiv. Odesa: Osvita Ukrainy, 2014:118.
21.    Unifikovanyi protokol pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi medychnoi dopomohy. Tuberkuloz. K, 2012:171.
22.     Feshchenko Yu.I, Melnyk VM Ftyzioepidemiolohiia. K.: Zdorovia, 2005:623.
23.    Cherkasskyi BH Rysk v pydemyolohyy. M.: AYST, 2007. 480 s.
24.    lektronni resurs [URL ftp://ftp1.ifp.kiev.ua/original/2015/feschenko 2015.pdf.

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11. epidemic situation

 

Drug resistant tuberculosis: the dynamic of epidemiological indicators in groups of patients with new and reccured cases (UKR)

O. S. Shevchenko, O. . Hovardvska

Kharkiv National Medical University, Kharkiv, Ukraine

Objective — to study the dynamic of epidemiological indicators of drug resistant tuberculosis (DR TB) in Kharkiv region in the period from 2012 to 2015 years, to compare the results in groups with new and recurring cases of TB, to determine the most common and important strains of MBT in both groups.
Materials and methods. The retrospective analysis of the standard statistic forms was made. The results of DST defined the drug resistant TB in 1971 patients who were divided into groups. The first group in-cluded people with new cases of TB (n = 1112), the second group included the recurrent TB cases (n = 859). Statistical processing was performed by Microsoft Office Excel 2007.
Results and discussion. During the studied period the rates of drug resistant categories changed: mon-oresistant TB increased, the rate of poly resistant TB was stable, multidrugresistant (MDR) TB decreased. In the first group a significant increase is observed in the profile of monoresistance and less in polyresis-tance. Another dynamic was noticed in the second group — a rise of monoresistant strains and a significant negative trend in poly resistant.
Conclusions. In the period from 2012—2015 in the Kharkiv region the rise of DR TB was detected. Among patients with bacterial excrection of MBT in 2015, this indicator reached 51.1 %. However, the increasing of DR TB is significantly higher in the group with new cases of TB and is determined by mono and polyresistant strains (average 4 years +15.4 % +5.9 %, respectively). In recurred cases, the DR in-creased only by monoresistant strains (4 years +23.5 %). The most common monoresistant strains are: among the new cases of H and S among the reurred cases R and S; polyresistant strains — HS and HES. Negative growth of MDR strains of MBT in both groups of patients can be a positive sign of stabilization of the spread of MDRTB in Kharkiv region.

Keywords: tuberculosis, epidemiology, monoresistant TB, poly resistant TB.

List of references:  
1.    Barbova AI, Cherenko S, Starichek GV and ot. Patterns of mono- and poly-resistance MBT to I line of antiTB drugs of patients with the new and recurrent cases of tuberculosis (Ukr). Tuberkuloz, lehenevi khvoroby, VIL-infektsiia [Tuberculosis, lung diseases, HIV-infection] (Ukr). 2016;1(24):23-26.
2.    Melnik VM, Novojilova IO, Matusevich VG Deiaki vazhlyvi aspekty problemy khimiorezystentnoho tuberkulozu u publi­katsiiakh 2012-2015 rr (Ukr). [Elektronnyi resurs]. ftp://ftp1.ifp.kiev.ua/original/2015/melnyk2015.pdf.

3.    Madhukar Pai, Ziad A. Memish and ot. Antimicrobial resistance and the growing threat of drug-resistant tuberculosis// J  Epidemiol Global Health. 2016;6(2):45-47.
4.    Udwadia ZF, Amale RA, Ajbani KK. Totally drug-resistant tuberculosis in India (Eng.) Clin Infect Dis. 2012;54(4):579-581.
5.    WHO Companion handbook to the WHO guidelines for the programmatic management of drug-resistant tuberculosis (Eng).World Health Organization, Geneva (2014).
6.    WHO Global Tuberculosis Report 2015 (Eng). World Health Organization, Geneva (2015).

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12. epidemic situation

 

The epidemiological situation of multidrugresistant tuberculosis 
in the Ternopil region (20062015) (UKR)

S. I. Kornaha, I. T. Pyatnochka

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

Objective — analysis of the epidemiology of multidrug­resistant tuberculosis (MDR TB) in the area of individual regions and the city of Ternopil.
Materials and methods. Statistical analysis of the official figures relating to the epidemiology MDR TB in the Ternopil region for 2006—2015. The objects of the study were 630 patients (13 of them homeless) on MDR TB lung treated permanently in the Ternopil regional TB dispensary over the past 10 years. The structure of patients was monitored for periods of five years. Digital material was subjected to statistical analysis to determine the reliability index.
Results and discussion. Among the total 630 patients MDR TBL majority were man (85.4 %), rural residents (60.9 %) aged 17 to 81 years (average 44.1 ± 3.18). During the second period of five years the number of patients had increased from 37.6 to 62.4 %, mainly due to relapse (46.6 %) and first diagnosed (32.3 %) patients, and in particular, infiltrative (50.2 %) and disseminated (36.6 %) forms of lung TB. Effective treatment in the first five years ascertained in only 9.3 %, in the second — 24.9 % of the patients, died of, respectively, 18.6 and 13.5 % men. Alarmingly poor results of MDR TB treatment of patients are of particular concern, since the effectiveness of the treatment is the most important link in the process of breaking the epidemic of infection, as well as a pledge in reducing morbidity and mortality.
Conclusions. Over the past decade, significant participation MDR TB in all areas of the Ternopil region, primarily in patients with recurrent and first diagnosed. The main reasons were very limited amount of preventive measures, late detection of TB and often unwarranted short ­term inpatient treatment without regard to the nature and characteristics of a specific process, as well as insufficient sanitary educational work among the population and patients.

Keywords: tuberculosis, multi drug resistant, the epidemiological situation.

List of references:
1.    Kornaha SI, Pyatnochka IT. Sanitary-education of people - reduce the spread of multi-resistant tuberculosis as important factor (Ukr). Tubercul'oz, lehenevi chvoroby, VIL-infectzhiya. [Tuberculosis. Lung diseases. HIV infection] (Ukr). 2015;4;48-52.
2.    Kryzhanovky DG, Kotelnikova AO. The epidemiological situation of tuberculosis in Dnipropetrovsk region on the results of 2015 (Ukr). Tubercul'oz, lehenevi chvoroby, VIL-infectzhiya. [Tuberculosis. Lung diseases. HIV infection] (Ukr). 2016;3;101-105.
3.    Pyatnochka IT, Kornaha SI, Pyatnochka VI. Compatible clinical protocol of medicare «Tuberculosis» (2012) high-efficiency dynamic pointer (Ukr). Visnik sotsialnoji gigieni ta organizatsiji okhoroni zdorovya Ukrajini [Bulletin of Social Hygiene and Health Protection   Organization of Ukraine] (Ukr). 2014;1;31-35.
4.    Pyatnochka IT, Kornaha SI, Thoryk NV. Gap analysis and their elimination - the key to reducing the spread of drug-resistant TB(Ukr). Visnik sotsialnoji gigieni ta organizatsiji okhoroni zdorovya Ukrajini [Bulletin of Social Hygiene and Health Protection   Organization of Ukraine] (Ukr). 2016;1;41-44.
5.    Pyatnochka IT, Kornaha SI, Thoryk NV. Ways of decline of multirezistens tuberculosis distribution from the point phthisioepidemiology (Ukr). Visnik sotsialnoji gigieni ta organizatsiji okhoroni zdorovya Ukrajini [Bulletin of Social Hygiene and Health Protection   Organization of Ukraine] (Ukr). 2014;4;67-70.
6.    Todorico LD, Petrenko VI, Volf  SB t all. Multidrugresistant tuberculosis and co-infection HIV/TB: features of epidemic situation in Ukraine and Belarus (Rus). Tubercul'oz, lehenevi chvoroby, VIL-infectzhiya. [Tuberculo-sis. Lung diseases. HIV infection] (Ukr). 2016;3;10-16.
7.    Todorico LD, Petrenko VI, Grishin MM. Resistance of Mycobacterium tuberculosis: myths and reality (Ukr). Tubercul'oz, lehenevi chvoroby, VIL-infectzhiya. [Tuberculosis. Lung diseases. HIV infection] (Ukr). 2014;1;60-67.
8.    Tuberculosis in Ukraine (Analitychno-statystychnyi dovidnyk) (Ukr). Kyiv: 2015.
9.    Feshchenko YuI, Melnyk VM, Turchenko LV. A fight with tuberculosis in  Ukraine: view on a problem (Ukr). Ukrainskyi pul'monologichnyi jurnal [Ukrainian Pulmonology Journal] (Ukr). 2016;3;5-10.
10.    Feshchenko YuI, Melnyk VM. Control' za tubercul'ozom v umovah adaptatsiynoi DOTS-strategii (Ukr). Kyiv: Medicina; 2007: 480.

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