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Issue. Articles

2(29) // 2017



1. Original researches


Cost-effectiveness of the short 12-month chemotherapy regimen in patients with multidrug-resistant tuberculosis (UKR)

Yu.I. Feschenko, N.A. Lytvynenko, H.O. Varytska, Yu.O. Senko

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

Objective — set the cost—effectiveness of short 12-month chemotherapy regimen based on use of linezolid in patients with multidrug-resistant tuberculosis (MDR-TB).
Materials and methods. In the clinical prospective «case—control» study 86 patients with new MDR-TB cases were included (without resistance to fluoroquinolones and aminoglycosides/polypeptides). For treatment of the patients in the main group (43 patients) were used regimen with: pyrazinamide (Z), kanamycin (Km) protionamid (Pt), linezolid (Lzd) (100—200 mg/kg), levofloxacin (Lfx) (15 mg/kg), cycloserine (Cs) and ± PAS (150 mg/kg) for 5 months of intensive phase of chemotherapy and the same regimen, except aminoglycoside/polypeptide were used for next 7 months of maintenance phase of chemotherapy. The patients in the control group (43 patients) were administrated with individualized chemotherapy regimens without linezolid of standard duration — 8 months and 12 months.
Results and discussion. The «effective treatment», using the 12-month short regimen in comparison with 20-months conventional regimen, were in 41 (95.4 %) versus 30 (69.8 %) patients (p < 0.05); one patient (23 %) reported «treatment failure» and «lost of follow up» (2.3 %) versus 13.9 % and 11.6 % of patients, respectively (p < 0.05).
The total cost of antimicobacterial treatment for one effectively treated patient using the short 12-month regimen was 69 208.8 UAH compared to 76 954.8 UAH as a result of using the conventional individualized 20-month regimen. The cost—effectiveness of short 12-month regimen for MDR-TB patient treatment was 1.5 times lower and amounted 726.2 UAH versus 1102.5 UAH, respectively.
Conclusions. The use of the 12-month short chemotherapy regimen in comparison with 20-month conventional regimen, allows to increase treatment efficacy in patients with new MDR TB cases from 69.8 to 95.4 % and reduce the total cost of treatment in 1.5 times.

Keywords: multidrug-resistant tuberculosis, short chemotherapy regimen, effective treatment, costeffectiveness.

List of references:
1.    Analytical-statistical handbook: Tuberculosis in Ukraine. d. NM Nizovoy, NV Golubchykova. Kyiv, 2016:141.
2.    Lytvynenko N, Varytska H, Denisov A. Efficacy of short regimens for treatment multidrug resistant tuberculosis by using injectible anti-tuberculosis drugs. Modern Science - ​Moderní věda. 2016;3:142-149.
3.    Lytvynenko N et al. Factors of unfavourable treatment outcomes in patients with multidrug resistant tuberculosis and extensively drug resistant tuberculosis. The scientific heritage. 2017;10(1):24-31.
4.    Parolina LYe, Morozova TI, Doctorova NP. Pharmacoeconomics in phthisiology: opportunities and prospects. Tuberculosis and lung diseases. 2012;2:8-15.
5.    Cherenko SO, Hrankina NV, Pogrebna MV. Duration of intensive phase of chemotherapy in the treatment of patients with MDR TB. Tuberkuljoz. Leghenevi khvoroby. VIL-infekcija. 2015;4(23):7-11.
6.    Aung KJM et al. Successful “9-month Bangladesh regimen” for multidrug-resistant tuberculosis among over 500 consecutive patients. Int J Tuberc Lung Dis. 2014;18:1180-1187. doi: 10.5588/ijtld.14.0100.
7.    Diel R et al. Costs of tuberculosis disease in the European Union: a systematic analysis and cost calculation. Eur Respir J. 2014;43(2). . 554-565. doi: 10.1183/09031936.00079413.
8.    Fitzpatrick C, Floyd K. A systematic review of the cost and cost effectiveness of treatment for multidrug-resistant tuberculosis. Pharmacoeconomics. 2012;30(1):63-80. doi: 10.2165/11595340-000000000-00000.
9.     Floyd K et al. Cost and cost-effectiveness of multidrug-resistant tuberculosis treatment in Estonia and Russia. Eur Respir J. 2012;40(1):133-42. doi: 10.1183/09031936.00169411
10.    van den Hof S et al.The socioeconomic impact of multidrug resistant tuberculosis on patients: results from Ethiopia, Indonesia and Kazakhstan. BMC Infect Dis. 2016;16(470):2-14. doi: 10.1186/s12879-016-1802-x.
11.    Rich M et al. Companion handbook to the WHO guidelines for the programmatic management of drug-resistant tuberculosis. Geneva: World Health Organization, 2014:403.
12.    World Health Organization. Global Tuberculosis Report 2014. Geneva: World Health Organization, 2014; http://www.who.int/tb/publications/global_report/en/ (access 5 March 2017)
13.    World Health Organization. WHO Treatment guidelines for drug-resistant tuberculosis. 2016 update. Geneva: WHO, 2016:45.

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Original language: Ukrainian

2. Original researches


Risk factors for multidrug-resistant tuberculosis treatment failure (UKR)

E.V. Lesnic1, L.D. Todoriko

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

The standard treatment of a new case of multidrug-resistant tuberculosis according to WHO recommenda­tions in the Republic of Moldova is performed since 2005 and shows a low treatment succes. Actually the treatment success rate increased due to excluding of MDR-TB patients from the general cohort. The major rate of patients with low outcome is represented by the treatment failed and lost to follow-up cases.
Objective — to assess the risk factors for MDR-TB treatment failure.
Materials and methods. A retrospective selective, descriptive study targeting social, demographic, economic and epidemiological peculiarities, case-management, diagnosis radiological aspects and micro­biological characteristics of 131 patients with pulmonary MDR-TB registered in Chisinau city from 2010 to 2015 with different outcomes was performed.
Results and discussion. It was established that the major risk factors for loss to treatment failure were patient’s social vulnerability and disease related charctersitics: extensive forms of pulmonary tuberculosis and involving more than 3 lung segments.
Conclusions. Raising awareness among all MDR-TB patients about treatment compliance and earlier diagnosis will improve disease outcome.

Keywords: Multidrug-resistant tuberculosis, risk factors.

List of references:
1.    Centrul National de Management in Sanatate [National Centre for Health Management] Chisinau, 2015.
2.    Lonnroth K, Jaramillo E, Williams BG et al. Drivers of tuberculosis epidemics: the role of risk factors and social de­­terminants. Social Sciences and Medicine. 2009;68(12):2240-2246.
3.    Todoriko LD, Semianiv IO. Analysis of the GSTM1 gene polymorphism in patients with tuberculosis with regard to the version of MBT resistance. Science and education a new dimension natural and technical sciences. 2016;9(83):61-63.
4.    World Health Organization. Equity, social determinants and public health programmes, Geneva, 2010.
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. Systematic screening for active tuberculosis. Geneva, 2013.
7.    World Health Organization. End TB Strategy. Geneva, 2014.
8.    World Health Organization. Global tuberculosis report, 2016.
9.    World Health Organization. Fact sheet on tuberculosis, 2016.
10.    World Health Organization. Treatment guidelines for drug-resistant tuberculosis, 2016 update, 2016.

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Original language: Ukrainian

3. Original researches


Algorithm of use of invasive methods for diagnostic the mediastinal lymphadenopathy syndrome (UKR)

M.S. Opanasenko, .E. Kshanovsky, I.M. Kupchak

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

Objective — to analyze the efficiency of invasive methods and develop an algorithm for optimal use.
Materials and methods. The study included 164 patients who took a diagnostic in SO «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine» during the period 2008—2014 years. For biopsy was used next invasive methods: endobronchial ultrasound transbronchial needle aspiration (48 or 25.3 %) interventions), mediastinoscopy (36 or18.9 %) times), video¬assisted biopsy (100 or 52.7 %) interventions), thoracotomy (6 or 3.2 %) interventions). The average age of patients was (37,0 ± 11,8) years; males — 96 (58.5 %), females — 68 (41.5 %).
Results and discussion. Informativeness of non-invasive methods is 21.4 %. The frequency of false diagnosis using non-invasive diagnosis is 64.3 %. Sensitivity of video-assisted biopsy without minithora­cotomy — 90.2 % video-assisted biopsy with minithoracotomy — 94.4 %, mediastinoscopy with biopsy — 88.9 % endobronchial ultrasound transbronchial needle aspiration — 72.9 % thoracotomy — 100.0 %. Based on acquired data, algorithm of use of invasive methods for verifying the diagnosis of mediastinal lymphadenopathy had been created.
Conclusions. Efficiency of use of invasive methods became the foundation to develop an algorithm of optimal use to improve the accuracy of diagnosis of mediastinal lymphadenopathy syndrome.

Keywords: mediastinal lymphadenopathy, invasive diagnostics, biopsy, algorithm.

List of references:  
1.    Babanov SA.Problems of differential diagnostics of mediastinal lymphadenopathy. Novosti meditsiny i farmatsii. 2012;4:22-24.(in Rus)
2.    Baranova OP, Ilkovich , Speranskaya. Challenges of diagnostics of pulmonary sarcoidosis. Prakticheskaya meditsina. 2011;51:58-62. (in Rus)
3.    Zaikov SV. Differential diagnostics of mediastinal lympha­denopathy syndrome. Klinicheskaya immunologiya alergologiya, infektologiya. 2009;4(53):16-24. (in Rus)
4.    Kelmanskaya SI et al. Diagnostic yield of mediastinoscopy in verification of mediastinal lymphadenopathy in TB dispansery. Vestnik neotlozhnoi i vosstanovitel'noi meditsiny. 2013;2:235-237.(in Rus)
5.    Lovacheva V. Methods of diagnostics of mediastinal lympha­denopathy. Tuberkulez i sotsial'no-znachimye zabole­vaniya. 2015;1:62-66.(in Rus)
6.    Potanin V, Vizel IYu, Potanin VP, Vizel . Invasive diagnostics for mediastinal lymphadenopathy and pulmonary dissemination. Vestnik sovremennoi klinicheskoi meditsiny. 2011;4(3):56-60.(in Rus)
7.    Sokolina I. Modern X-ray diagnostics of pulmonary sarcoidosis. Meditsinskii vestnik. 2009;29(498):9-10. (in Rus)
8.    Bangpattanasiri K et al. Accuracy of endobronchial ultrasound guided-transbronchial needle aspiration in mediastinal lymph node diagnosis. J Med Assoc Thai. 2012;93:19-23.
9.    Benouaich V et al. Anatomical bases of left recurrent nerve lesions during mediastinoscopy. Surg Radiol Anat. 2009;31:295-299.
10.    Nalladaru ZM, Wessels A. The role of mediastinoscopy for diagnosis of isolated mediastinal lymphadenopathy. Indian J Surg. 2011;73(4):284-286.
11.    Roviaro G et al. Videothoracoscopic approach to primary mediastinal pathology. Chest. 2000;117(4):1179-1183.
12.    Zhang RJ et al. Endobronchial ultrasound guided fine needle aspiration versus transcervical mediastinoscopy in nodal staging of non small cell lung cancer: a prospective comparison study. Cardiothorac Surg. 2012;6:51.

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Original language: Ukrainian

4. Original researches


Diagnosis of an exudative tuberculous inflammation of the spine (UKR)

G.G. Golka, V.V. Vesnin, O.G. Fadeev, V.V. Burlaka, A.. Oliynyk

Kharkiv National Medical University, Kharkiv, Ukraine

Objective — to draw the attention of medical practitioners to the important problem of TS diagnosis and to increase its effectiveness.
Materials and methods. The study involved the assessment of examination protocols and medical documentation of 175 patients with active newly diagnosed TS who underwent treatment from 2006 to 2015 at the Department of osteoarticular Tuberculosis at municipal healthcare institution Regional Tuberculosis Hospital N 1 of Kharkiv Regional Council and at the Department of Surgery at municipal healthcare institution Regional Antituberculosis Dispensary N 1 of Kharkiv Regional Council.
All the treated patients were divided into two groups. group 1 consisted of 93 (53.1 %) patients, whose treatment included surgical intervention on vertebrae affected by a specific destructive process and group 2 comprised 82 (46.9 %) patients who received conservative treatment. The age of the patients was from 17 to 75 years. The majority of patients in both groups had lesions in the bodies of two vertebrae, particularly 85 (93.4 %) in group 1, and 78 (95.1 %) in group 2.
Results and discussion. Among the patients under study, abscesses were found in 3 patients of group 1 with lesions of the cervical spine, in 30 patients of group 1 and in 20 patients of group 2 with lesions of the thoracic spine, in 4 patients of group 1 and in 6 patients of group 1 with lesions of the thoracolumbar spine, in 38 patients of group 1 and in 17 of group 2 with lesion of the lumbar and lumbosacral spine. Thus, exudative inflammation in tuberculous spondylitis was observed predominantly in the form of widespread paravertebral abscesses in group 1 patients and significantly less in group 2 patients. Abscesses were absent in 16 (17.7 %) group 1 patients and in 39 (47.5 %) group 2 patients. Intrathoracic abscesses in group 1 patients were considerably spread (4—5 vertebrae and more). Differences in the incidence and extent of psoas abscesses in both groups were also significant as group 1 patients had more severe abscesses. To clarify the presence of abscesses and determine their content, as well as localization and prevalence, the patients underwent ultrasound, X-ray tomography, CT and NMR.
Conclusions. A number of new technologies for imaging diagnosis of the spine have significantly extended the possibilities in diagnosis of exudative TS. Apart from the traditional X-ray method the patient’s state can be assessed by contrast myelography, computed tomography and magnetic resonance imaging.
Current world experience and our data show that none of these methods can solve all the diagnostic problems, if applied separately. The results of diagnostic studies in patients with exudative TS should always be considered among other clinical and radiological modalities.

Keywords: diagnosis of tuberculous spondylitis, laboratory, clinical, radiation methods, congestive abscess.

List of references:
1.    Gholka GG. Shljakhy pidvyshhennja efektyvnosti likuvannja tuberkuljoznogho spondylitu. Ortopedyja, travmatologhyja y protezyrovanye. (in Ukr). 2004;2:14-19.
2.    Diagnostika i lechenie vnelegochnogo tuberkuleza: prakticheskoe rukovodstvo. Pod red. MI Perelmana, YuN Levasheva. M.: Meditsina i zhizn, (in Rus). 2002:600.
3.    Kornev PG. Khirurgiya kostno-sustavnogo tuberkuleza: v 3 t.  PG Kornev. L.: Meditsina (in Rus). 1971:810.
4.    Kostno-sustavnoi tuberkulez. od. red. YuN Levasheva i AE Garbuza. M.: Meditsina i zhizn’. (in Rus). 2003:294.
5.    Pozaleghenevyj i miliarnyj tuberkuljoz u khvorykh na koinfekciju TB /VIL/ VI Petrenko, MGh Dolynsjka, OM Raznatovsjka. ​[Vydavnyctvo], (in Ukr). 2015:114.
6.    Tuberkuljoz v Ukrajini: [analitychno-statystychnyj dovidnyk za 2004-2014 / Vidpovidaljni redaktory: NM Nizova, MV Gholubchykov] Kyjiv, (in Ukr). 2015:116.
7.    Ul’rikh EV, Mushkin YuM. Vertebrologiya v terminakh, tsifrakh, risunkakh. SPb.: Elbi-SPb (in Rus). 2002:186.
8.    Ftyziatrija: pidruchnyk. za red. prof. VI Petrenko. Kyjiv: Medycyna (in Ukr). 2015:472.
9.    Global tuberculosis control 2011: World Health Organization [ ]. http://www.who.int/tb/publications/global_report/2011/.

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Original language: Ukrainian

5. Original researches


Variability of primary resistant M. tuberculosis strains in nti-TB services (UKR)

P.I. Poteiko1, A.V. Rohozhyn1, .S. Konstantynovska1, I.M. Kuznietsova2, O.S. Solodiankin3, I.I. Hrek1

1 ​Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
2 «Regional Tuberculosis Hospital N 1», Kharkiv, Ukraine
3 ​NSC «Institute of Experimental and Clinical Veterinary Medicine», Kharkiv, Ukraine

Objective — ​to trace M. tuberculosis (MTB) strains variability in patients with drug resistance lungs TB during treatment and to study clinical and X-ray features of lungs TB dynamics among these patients.
Materials and methods. In 105 patients with primary resistance lungs TB were investigated MTB strains variability and clinical and X-ray dynamics of pulmonary TB during treatment.
All patients passed detailed clinical and X-ray examination, laboratory tests and instrumental methods in the hospital. There were studied in detail the complaints, anamnesis and physical data. For detect of MTB strains variability from patients were selected 4 samples of MTB culture, which were grown on solid media by bacteriological method, made before the treatment and with intervals of 1, 3 and 8 months. All isolates were typed by using the method of genotyping (VNTR) on five ETR A-E loci.
Results and discussion. As a result of VNTR-typing of 105 patients with lungs drug resistance TB, which was to study the MTB strains variability, a significant number was the family of Beijing strains — 64.8 %.
Among 105 patients with lungs drug resistance TB in hospital in 10 (9.5 %) patients observed changes of MBT strains. Determined significant tendency of changes from the less virulent strains of MTB to more virulent: 3 cases of GIP (URAL) on LAM and Beijing, 3 cases of Haarlem on LAM and Beijing. Among these patients an intoxication syndrome of the first stage was frequently observed, and in patients who had growth of intoxication was found MTB strains change on Beijing and LAM genotypes. After 8 months of treatment in 4 (40 %) patients were closing cavities, and only 2 (20 %) stopped bacterial excretion by the culture method. In 30 % patients revealed acquired resistance of MTB to drugs.
Conclusions. The presence of changes in nosocomial conditions of MTB strains suggests that TB hospitalization in the department of medical facilities is a kind of exogenous risk of tuberculosis superinfection caused by pathogens that are more virulent with drug resistance. The study of the different MTB strains prevalence in different Ukrainian regions, their variability during the treatment, the clinical course and the effectiveness of treatment of pulmonary tuberculosis depending on the genotype MBT is very perspective direction in Phthisiology.

Keywords: tuberculosis, Mycobacterium tuberculosis, genotype, drug resistance tuberculosis, variability, VNTR.

List of references:  
1.    Nakaz MOZ Ukrayiny N 620 vid 04.09.2014 «Unifikovanyj klinichnyj protokol pervynnoyi, vtorynnoyi (specializovanoyi) ta tretynnoyi (vysokospecializovanoyi) medychnoyi dopomogy. Tuberkuloz». (Ukr)
2.    Poteyko PI. Kliniko-laboratornaya harakteristika intoksikat­sionnogo sindroma u bolnyih tuberkulezom legkih i effektivnost detoksikatsionnoy terapii. Dis. na soiskanie stepeni kand. med.nauk. M, 1991:239. (Rus)
3.    Savilov ED, Sinkov VV, Ogarkov OB. Epidemiologiya tuber­kuleza na Evro-Aziatskom kontinente: otsenka globalnogo dviz­he­niya shtammov genotipa «Pekin», Irkutsk: RIO GBOU DPO IGMAPO, 2013:120. (Rus)
4.    Standarty vyznachennya medykamentoznoyi stijkosti miko­bakterij do preparativ 1-go ta 2-go ryadu na ridkomu zhy­vylnomu seredovyshhi pry zastosuvanni systemy MGIT: metod. rek. Kirovograd: Polium, 2012:22. (Ukr)
5.    Tuberkuloz v Ukrayini. Analitychno-statystychnyj dovidnyk za 2000-2011 rr: spravochnoe izdanie. K, 2012:97. (Ukr)
6.    Umpeleva TV, Vyazovaya AA, Kravchenko MA. Genotipirova­nie izolyatov Mycobacterium tuberculosis rpyppyi non-Beijing, tsirkuliruyuschih v Uralskom regione. Uralskiy meditsinskiy zhurnal. 2013;2:150-154. (Rus)
7.    Cherednyk YuO, Anopriyenko OV, Gorovenko NG, Feshhen­ko YuI. Problemy kompleksnoyi laboratornoyi PLR-diagnos­tyky i genotypuvannya shtamiv Mycobacterium tuberculosis v Ukrayini. Dosyagnennya i problemy genetyky, selekciyi ta biotexnologiyi: zb. nauk.pr. 2012;3:398-403. (Rus)
8.    Joseph BV, Soman S, Radhakrishnan I et al. Molecular epide­miology of Mycobacterium tuberculosis isolates from Kerala, India using IS 6110-RFLP, spoligotyping and MIRU-VNTRs. Infect Genet Evol. 2013;16:157-164. doi.org/10.1016/j.meegid.2013.01.012.
9.    Kanduma E, McHugh TD, Gillespie SH. Molecular methods for Mycobacterium tuberculosis strain typing: a users guide. J Appl Microbiol. 2012;94(5):781-791.
10.    Kato-Maeda M, Kim EY, Flores L et al. Differences among sublineages of the East-Asian lineage of Mycobacterium tuberculosis in genotypic clustering. Int J Tuberc Lung Dis. 2010; 14(5):538-544.
11.    Kurbatova EV, Kaminski DA, Erokhinetal VV. Performance of Cepheid® XpertMTB/RIF® and TB-Biochip® MDR in two regions of Russia with a high prevalence of drug-resistant tuberculosis. Eur J Clin Microbiol Infect Dis. 2013;32(6):735-743. doi.org/10.1007/s10096-012-1798-0
12.    Liu B, Zhao P, Liu B et al. Genetic diversity of Mycobacterium tuberculosis isolates from Beijing, China assessed by Spoli­gotyping, LSPs and VNTR profiles. BMC Infectious Diseases. 2012;12:372. doi.org/10.1186/1471-2334-12-372
13.    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.org/10.1128/jcm.05293-11
14.    Supply P, Allix C, Lesjean S et al. Proposal for Standardization of Optimized Mycobacterial Interspersed Repetitive Unit-Variable-Number Tandem Repeat Typing of Mycobacterium tuberculosis. J Clin Microbiol. 2006;44:4498-4510. doi.org/10.1128/jcm.01392-06
15.    Thong On A, Smittipat N, Juthayothin T. et al. Variable-number tandem repeats typing of Mycobacterium tuberculosis isolates with low copy numbers of IS 6110 in Thailand. Tuberculosis (Edinb). 2012;90(1):9-15. doi.org/10.1016/j.tube.2009.10.006
16.    World Health Organization. Global Tuberculosis Control report. WHO report. 2012. Geneva, Switzerland:273.
17.    Yokoyama E, Hachisu Y, Hashimoto R et al. Concordance of variable-number tandem repeat (VNTR) and large sequence polymorphism (LSP) analyses of Mycobacterium tuberculosis strains. Infect Genet Evol. 2010;10(7):913-918. doi.org/10.1016/j.meegid.2010.05.013
18.    Zhang Y, Yew WW. Mechanisms of drug resistance in Mycobacterium tuberculosis. Int J Tuberc Lung Dis. 2015;19:1276-1289. doi.org/10.5588/ijtld.15.0389

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Original language: Ukrainian

6. Original researches


Efficacy of 7 % sodium chloride solution for improvement of bacteriological diagnostics in patients with newly diagnosed pulmonary tuberculosis (RUS)

M.M. Kuzhko1, D.O. Butov2, T.V. Tlustova1, N.S. Chursina3, O.S. Denysov4

1 SI «National Institute of Phthisiology and Pulmonology named by F.G. Yanovsky NAMS of Ukraine», Kyiv, Ukraine
2 Kharkiv National Medical University, Kharkiv, Ukraine
3 Regional Territorial Medical Tuberculosis Association, Lutsk, Ukraine
4 PO «Association for Intensive Treatment of Infectious Diseases «INCURE», Kyiv, Ukraine

Objective — to evaluate the usability of 7 % sodium chloride solution (LORDE Max 7) for the improvement of bacteriological diagnosis in patients with newly diagnosed pulmonary tuberculosis.
Materials and methods. We examined 101 patients 21 to 62 years old with newly diagnosed pulmonary tuberculosis. In 42 patients (main group) we performed sputum induction, 59 patients (control group) produced sputum spontaneously.
Before the start of antimycobacterial chemotherapy all patients of main group received Inhalation 7 % sodium chloride solution for 5 minutes. After this 3 samples of sputum were collected for further testing using bacterioscopy, culture and amplification methods. In control group patients, who produced sputum spontaneously, the same sputum tests were used.
Results and discussion. Acid fast bacilli were revealed in samples of 29 ((69.05 ± 7.13) %) patients from main group and in 24 ((40.68 ± 6.40) %) patients from control group ( < 0.05). Positive cultures were obtained in 38 ((90.48 ± 4.53) %) patients of main group and in 39 ((66.10 ± 6.16) %) patients of control group ( < 0.05). Amplification tests results were about the same in both groups.
Conclusions. In order to improve diagnostics accuracy, it is recommended: 1. Use hypertonic saline solution for induced sputum procedure on the day of hospital admission. 2. On 2 consecutive days the sputum should be collected after spontaneous expectoration. No significant adverse events were reported using current method.

Keywords: pulmonary tuberculosis, hypertonic saline solution, diagnostics.

List of references: References
1.    Lapach SN, Chubenko AV, Babich PN. Statistical methods in biomedical studies using Excel. K; 2000: 320. (n Rus)
2.    Nakaz MOZ Ukrayiny N 45 vid 06.02.2002 “Instrukcija z bakteriologhichnoji diaghnostyky tuberkuljoznoji infekciji”.(n Ukr)
3.    Todoriko LD, Petrenko VI, Volf SB et al. Multidrugresistant tuberculosis and co-infection HIV/TB: features of epidemic situation in Ukraine and Belarus. Tuberculosis, lung diseases, HIV infection. 2016;3(26):10-16. (n Ukr)
4.    Tuberkuljoz v Ukrajini: analitychno-statystychnyj dovidnyk / Ukrajinsjkyj centr kontrolju za socialjno nebezpechnymy khvorobamy Ministerstva okhorony zdorov’ja Ukrajiny; Centr medychnoji statystyky Ministerstva okhorony zdorov’ja Ukrajiny. K;2016:235. (n Ukr)
5.    Feshchenko YuI, Melnyk VM, Turchenko LV et al. A fight with tuberculosis in Ukraine: view on a problem. Ukrainskyi pul’monologichnyi jurnal. Ukr Pulmonol J. 2016;3:5-10. (n Ukr)
6.    Feshchenko YuI, Melnyk VM, Bilogortseva OI et al. Peculiarities of tuberculosis epidemiology in children in Ukraine. Ukr Pulmonoly J. 2016;4:5-8. (n Ukr)
7.    Alvarez-Puebla MJ, Olaguibel JM, Almudevar E et al. Mannitol versus hypertonic saline: Safety and efficacy of mannitol and hypertonic saline in sputuminduction and bronchial hyperreactivity assessment. Chron Respir Dis. 2015;12(3):197-203.
8.    Atwine D, Nansumba M, Orikiriza P et al. Intra-gastric string test: an effective tool for diagnosing tuberculosis in adults unable to produce sputum. Int J Tuberc Lung Dis. 2015;19(5):558-564.
9.    Bart IY, Mourits M, Van Gent R et al. Sputum Induction in Children Is Feasible and Useful in a Bustling General Hospital Practice. Glob Pediatr Health. 2016;4(3):233-244.
10.    Gopathi NR, Mandava V, Namballa UR et al. Comparative Study of Induced Sputum and Bronchial Washings in Diagnosing Sputum Smear Negative Pulmonary Tuberculosis. J Clin Diagn Res. 2016;10(3):07-10.
11.    Jochmann A, Artusio L, Robson K et al. Infection and inflammation in induced sputum from preschool children with chronic airways diseases. Pediatr Pulmonol. 2016;51(8):778-786.
12.    Rao GN, Venu M, Rani NU, Sravani M. Induced sputum versus bronchial washings in the diagnosis of sputum negative pulmonary tuberculosis. J Family Med Prim Care. 2016;5(2):435-439.
13.    Sabi I, Kabyemera R, Mshana SE et al. Pulmonary TB bacteriologically confirmed by induced sputum among children at Bugando Medical Centre, Tanzania. Int J Tuberc Lung Dis. 2016;20(2):228-234.
14.    Tarran R, Donaldson S, Boucher RC. Rationale for hypertonic saline therapy for cystic fibrosis lung disease. Semin Respir Crit Care Med. 2007;28 (3):295-302.
15.    World Health Organization. A guide to monitoring and evaluation of collaborative TB/HIV activities: 2015 revision. World Health Organization. Geneva, Switzerland, 2015:48.
16.    Zampoli M, Pillay K, Carrara H et al. Microbiological yield from induced sputum compared to oropharyngeal swab in young children with cystic fibrosis. J Cyst Fibros. 2016;15(5):605-610.

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Original language: Russian

7. Original researches


Hematological parameters in first diagnosed susceptible and multidrug-resistant disseminated lung tuberculosis patients (UKR)

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

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

Objective — to conduct a comparative analysis of blood cell elements in first diagnosed sensitive and multidrugresistant disseminated lung tuberculosis patients.
Materials and methods. Comparative analysis of hematological parameters was performed in patients with first diagnosed disseminated sensitive (61 patients) and MDR (58 patients) lung tuberculosis. Patients were representative by age, sex and the prevalence of specific process. Digital material was subjected to statistical analysis to determine the reliability index.
Results and discussion. The comparative analysis of hematological parameters in patients with first diagnosed sensitive and MDR disseminated lung TB showed that the latter have more pronounced negati­ve changes. In particular, there was a decrease in the level of hemoglobin, total protein, an increase in the number of leukocytes with a more pronounced shift of the leukocyte formula to the left and toxic granula­rity against a background of a decrease in the number of lymphocytes. In addition, in patients with multidrug-resistant tuberculosis, a more accelerated ESR was observed. All of this is a consequence of a significantly more severe course of the disease and a lowered immunological status due to the aggressiveness of multidrugresistant MBT.
Conclusions. Over the past decade, stated a significant adverse change in cytological and protein composition of blood. In addition, these changes were significantly more pronounced in patients with MDR, compared with sensitive disseminated lung tuberculosis. This caused much harder immunosup­pressive unfavorable course of multidrugresistant tuberculosis. All this requires a complex pathogenesis of measures aimed at improving performance hemograms and protein composition of blood, against modern antimycobacterial therapy.

Keywords: multidrug-resistant tuberculosis, disseminated, hematological parameters.

List of references:
1.    Kazmirchuk VE. Interpretation and leykohramy immunogram under current positions (Ukr). Vnutrishnya medicina [Internal Medicine] (Ukr). 2007;4;36-44.
2.    Kassirsky IA, Alekseeva GA. Clinical hematology (Rus). — ​Publishing house Medicine: Moscow, 1970:800.
3.    Mel’nyk VM, Doroshenko PM, Valetskyy YM, Drach KM. Laboratory diagnosis of pulmonary tuberculosis (Ukr). Zhurnal praktychnoho likarya. [Journal practitioner] (Ukr). 2003;2:30-32.
4.    Mel’nyk VM, Novozhilova IA, Matusevich VG at all. Pathomorphism of lung tuberculosis during epidemic: clinical course, radiological and bacteriological peculiarities (Ukr). Ukrainskyi pul’monologichnyi jurnal [Ukrainian Pulmonology Journal] (Ukr). 2007;2:49-52.
5.    Feshchenko Yu, Mel’nyk V. ​Ftyzioepidemiolohiya (Ukr). Kyiv: Zdorov’ya, 2004:624.

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8. Original researches


Efficiency of treatment in patients with pre-extensively drug resistant tuberculosis as a results of using the short 12-month chemotherapy with maximum bactericidal effect (UKR)

N.. Lytvynenko, O.P. Chobotar, V.V. Davydenko

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

Objective — to determine the effectiveness of treatment in patients with multi-drug resistant tubercu­losis and to fluoroquinolones or aminoglycosides/polypeptides (pre-XDR TB), by using short 12-month regimen with the inclusion of 7 anti-TB drugs, three of which have a pronounced bactericidal effect.
Materials and methods. In a clinical prospective study «case—control» were included 64 patients with pre-XDR TB (Multidrug-resistant tuberculosis with resistance to fluoroquinolones or aminoglycosides/polypeptides). For the treatment of patients in the main group (32 patients) used a regimen consisting of: pyrazinamide (Z) capreomycin (Cm), protionamid (Pt), linezolid (Lzd) (100—200 mg/kg), moxifloxacin (Mfx), cycloserine (Cs) isoniazid (H) (18—20 mg/kg) during 6 months of intensive phase of chemotherapy and continued during maintenance phase of chemotherapy in the same regimen, except for aminoglycoside (polypeptide), for another 6 months. Patients in the control group (32 patients) received individualized regimens with standard duration — 8 months of intensive phase and 12 months during maintenance phase of chemotherapy without linezolid.
Results and discussion. Among pre-XDR TB patients, who were treated with the 12-month short regimen, set the better efficacy of treatment as at the end of the intensive phase and whole course of chemotherapy.
The «effective treatment», using the 12-month short regimen in comparison with 20-months conven­tional regimen, were in 29 (90.6 %) vs 15 (46.9 %) patients, one patient (3.1 %) was reported «treatment failure» and two (6,3 %) «lost of follow up» versus nine (13.9 %) and three (11.6 %) patients, respectively.
Side effects were registered in the same number of patients of the comparison groups — in 31.3 % versus 37.5 % (p > 0.05).
Conclusions. The use of 12-month short regimen, compared with the standard 20-month course, allows to increase treatment efficacy in patients with pre-XDR TB at the end of treatment from 46.9 to 90.6 %.

Keywords: multi-drug resistant tuberculosis with resistance to fluoroquinolones or aminoglycosides/polypeptides (pre-XDR TB), short chemotherapy regimen, effective treatment.

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9. Original researches


Vats surgery of pulmonary and pleural tuberculosis (UKR)

M.S. Opanasenko, S.M. Shalahai, O.E. Kshanovsky

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

Objective — to present our own experience of VATS operations in patients with tuberculosis of lungs and pleura during the period from 2008 to 2016.
Materials and methods. In 8 years were performed 94 VATS operations in TB patients: lobectomy — 28 (29.8 %) cases pulmonectomy — 2 (2.1 %), lower bilobektomy — 1 (1.1 %), combined resection of inferior lobe and S 6—1 (1.1 %), typical segmentectomy — 22 (23.4 %), atypical segmentectomy — 9 (9.6 %), VATS parietal pleurektomy with decortication of the lung in 31 (32.9 %).
Results and discussion. The postoperative period was characterized by: early mobilization and short term pain  relief with narcotic analgesics, the level of postoperative complications — 14 (14.9 %) cases. The total efficiency of VATS surgery was 97.9 %.
Conclusions. VATS operations are efficient, convenient, low­impact treatment of patients with tuberculous lung and pleura, better cosmetic effect than with thoracotomy, That allows typical lung resection with separate processing of structural elements or complete parietal pleurektomy with decortication of the lung.

Keywords: VATS resection, VATS, decortication, pleurectomy, miniinvasive.

List of references:
1. Hiller DB, SadovnikovaSS, Papkov AV et al. Efficiency of video-assisted anatomic resection of the lungs. Ros. Medical-biol. after acad. I.P. Pavlov. 2014;1:126-130.
2. Izmaylov EP, Rodin SD, Naumova TA. The results of the use of video-assisted mini-thoracotomy in the treatment of acute pleural empyema / 21st National. Congress. On diseases of the respiratory system. Ufa, 2011:101-102.
3. Shevchenko JL, Ablitsov JA, Vetshev PS et al.. Video technologies in thoracic surgery. Almanac of Clinical Medicine. 2007;16:214-216.
4. Shulutko AM, Ovchinnikov AA, Yasnogorodsky OO et al. Endoscopic thoracic surgery. M. Medicine, 2006:392.
5. Augustin F, Maier H, Lucciarini P. Extended minimally invasive lung resections: VATS bilobectomy, bronchoplasty, and pneumonectomy. Langenbeck’s Archives of Surgery. 2016;401(3):341-348. D: 10.1007/s00423-015-1345-4.
6.    Chambers A, Routledge T, Dunning J et al. Video-assisted thoracoscopic surgical decortication superior to open surgery in the management of adults with primary empyema? Int CardioVasc Thorac Surg. 2010;11(2):171-177.
7.    Gonzalez-Rivas D, Delgado M, Fieira E et al. Uniportal video-assisted thoracoscopic major pulmonary resections: experience with 323 cases. Interact CardioVasc Thorac Surg. 2014;18(1):34-35.
8.    Yablonskii P, Kudriashov G, Vasilev I et al. Thoracoscopic lobectomies for TB and non-TB pulmonary diseases: What differences between RATS and VATS technique? Eur Resp J. 2016;48(60):2495. D: 10.1183/13993003.congress‑2016.PA2495.

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10. Reviews


The ability of computed densitometry for determination the activity process of the pulmonary tuberculomas (UKR)

M.I. Lynnyk1, I.V. Liskina1, V.M. Tomyn2

1 SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of NAMS of Ukraine», Kyiv, Ukraine
2 P.L. Shupyk National Medical Academy of Postgraduate Education, Ministry of Healthare of Ukraine, Kyiv, Ukraine

Today TB remains an actual medical and social problem for developing countries. Early diagnosis and appropriate treatment are good prerequisites for its solution. Modern radiological diagnostic methods, in particular computed tomography (CT), on information content equal to histopathological research and can be used for the early detection, performance monitoring and correction of the treatment of tuberculosis. Tuberculomas a form of pulmonary tuberculosis with torpid course and a high probability of reactivation after clinical and radiological stabilization requires a comprehensive approach in the choice of treatment. Morphological research is the most informative for assessing the activity of the tuberculomas, but can only be applied retrospectively after their surgical removal. At the same time when densitometric measurements may CT correlate well with the degree of their activity, and therefore can serve as an indicator for disease prognosis and selection of treatment.

Keywords: densitometry, activity of specific tuberculosis process, computed tomography, tuberculoma.

List of references:
1. Averbah MM. Tuberkulomy legkogo [Pulmonary tybercules] (Rus). Moscow: Gos. izd-vo med. lit.;1962:343.
2. Zahaba LM, Liskina IV, Kuzovkova SD, Mel'nyk OO. Current clinical and anatomical characteristics of pulmonary tubercules (Ukr). Visnyk VDNZU «Ukrayins'ka medychna stomatolohichna akademiya» (Ukr). 2016;16;3:61-66.
3. Kornienko V.N. Sovremennoe sostojanie i perspektivy razvitija nejrorentgenologii (Rus). Vopr. nejrohirurgii [Issues of neurosurgery] (Rus). 2008;3:12-13.
4. Lynnyk NI, Kuzhko MM, Avramchuk OV, Protsyk LM. Computed densitometry assessment in an intensive phase of  chemotherapy with different routes of  administration of  anti-tuberculosis drugs in patients with newly diagnosed pulmonary tuberculosis (Ukr). Ukr Pulmonol J. (Ukr). 2016;3:44-48.
5. Lynnyk NI, Musiyenko NN. The role of a multislice computed tomography in timely detection of tuberculosis and prevention of hyperdiagnostics (Rus). Ukr Pulmonol J. (Ukr). 2011;4:28-32.
6. Lynnyk MI, Avramchuk OV. Possibility of computer densitometry to evaluate the efficacy of antibiotic therapy for patients with pulmonary tuberculosis (Rus). Tuberculosis, lung disease, HIV infection (Ukr). 2016;2:113-119.
7. Liskina IV et al. Histolohichna diahnostyka stupenya aktyvnosti tuberkul'oznoho zapal'noho protsesu pry tuberkul'omakh lehen': informatsiynyy lyst (Ukr). Kyiv: DU NIFP NAMNU; 2010:4.
 8. Liskina IV, Kuzovkova SD, Zagaba LM, Lukuanchuk VG. The modern histological peculiarities of lung tuberculomas at different activity degree of specific inflammatory process (Ukr). Suchasni infektsiyi [Modern infection] (Ukr). 2010;1:65-72.
9. Rabuhin AE. Tuberkulez organov dyhanija u vzroslyh (Rus). Moscow: Medicina;1976:328.
10. Riekstinja V, Torp L, Lejmane V. Faktory riska rannih recidivov tuberkuleza v Latvii (Rus). Probl tuberkuleza i boleznej legkih [The problems of tuberculosis and lung disease] (Rus). 2005;1: 3-47.
11. Tleubaeva ZhO. Rol' cifrovyh luchevyh metodov v issledovanii i dooperacionnoj diagnostike patologii organov grudnoj kletki. Mater. Vseros. nac. kongressa luchevyh diagnostov i terapevtov (Rus). Moscow; 2009:528.
12. Edited by Frieden T. Toman’s tuberculosis. Case detection, treatment and monitoring - questions and answers (Rus). Geneva: World Health Organization; 2004:388.
13. Unifikovanyy klinichnyy protokol pervynnoyi, vtorynnoyi (spetsializovanoyi) ta tretynnoyi (vysokospetsializovanoyi) me dychnoyi dopomohy doroslym. Tuberkul'oz [Nakaz Ministerstva okhorony zdorovya Ukrayiny vid 04.09.2014 r. N 620] (Ukr). Kyiv: Ministerstvo okhorony zdorovya; 2014:128.
14. Fechshenko YuI, Linnik NI. Multislice computed tomography in phthisiology and pulmonology: software (Rus). Zhurn NAMN Ukrayiny (Ukr). 2014;20;4:453-458.
15. Feshchenko YuI, Mel'nyk VM. Suchasna stratehiya borot'by z tuberkul'ozom v Ukrayini (Ukr). K.: Zdorovya; 2007:664.
16. Feshchenko YuI, Petrenko VM, Cherenjko SA et al. New cases of pulmonary tuberculosis: results of treatment and causes of insufficient efficiency (Ukr). Zhurn AMN Ukrayiny (Ukr). 2007;13;3:567-578.
17. Kholodok OA, Grigorenko AA, Cheryemkin MI. Clinical observation of lung tuberculomas course and morphological interpretation of their activity (Rus). Bjul fiziol i patol dyhanija (Rus). 2014;51:137-140.
18. Kholodok OA, Grigorenko AA, Cheryemkin MI. Pulmonary tuberculoma as a form of tuberculous process (Rus). Bjul. fiziol. i patol. dyhanija (Rus). 2014;53:126-131.
19. Flohr TG, Schaller S, Steirstorfer K et al. Multi-detector row CT system and imagereconstruction techniques. Radiology. 2005;235:756-773. DOI:10.1148/radiol.2353040037.
20. Goo JM, Im JG. CT of tuberculosis and nontuberculous mycobacterial infections. Access: https://www.ncbi.nlm.nih.gov/pubmed/11813821.

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11. Reviews


Emergency medical care in case of acute respiratory failure (UKR)

R.G. Protsiuk1, G.I. Vlasova-Protsiuk2

1 .. Bogomolets National Medical University, Kyiv, Ukraine
2 Kyiv City TB Hospital N 1, Kyiv, Ukraine

Acute respiratory failure (ODN) refers to life-threatening critical conditions, capable of causing death in a few minutes or hours. Therefore, this state is considered urgent. The first help is to eliminate the causes of ODN, oxygenation, and if necessary — artificial ventilation. ODN can be central (inhibition of the respiratory center), neuromuscular (paralysis of the respiratory musculature), thoraco-diaphragmatic (restriction of mobility of the chest, lungs, pleura, diaphragm) and broncho-pulmonary (due to impaired airway patency at different levels).

Keywords: acute respiratory failure, local protocol of medical care, medical care at prehospital and hospital stages, artificial ventilation.

List of references:
1.    Zylber AP. Klynycheskaia fyzyolohyia v anestezyolohyy y reanymatolohyy. ​M.: Medytsyna, 1984:480.
2.    Zylber AP. Respyratornaia medytsyna. ​Petrozavodsk, 1996:487.
3.    Nakaz MOZ Ukrainy N 132 vid 23.02.2012 r. «Pry zatverdzhennia Prymirnoho tabelia osnashchennia likuvalno-profilaktychnykh pidrozdiliv zakladiv okhorony zdorovia, shcho nadaiut pervynnu medychnu (medyko-sanitarnu) dopomohu».
4.    Nakaz MOZ Ukrainy N 370 vid 01.06.2009 r. «Pro yedynu systemu nadannia ekstrenoi medychnoi dopomohy», zareiestrovanyi Ministerstvom yustytsii Ukrainy za 863/16879 vid 14.09.2009 r.
5.    Nakaz MOZ Ukrainy N 999 vid 17.11.2010 r. «Pro zatverd­zhennia form zvitnosti ta medychnoi oblikovoi dokumentatsii sluzhb shvydkoi ta nevidkladnoi medychnoi dopomohy Ukrai­ny», zareiestrovanyi Ministerstvom yustytsii Ukrainy za N 147/8885 vid 03.02.2011 r.

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12. Education


Future of higher education in the dynamics of coordinates modification of communication space (UKR)

L.D. Todoriko1, V.I. Petrenko2, O.S. Shevchenko3, A.D. Todoriko1, I.. Semianiv1

1 HSEI Ukraine «Bukovinian State Medical University», Chernivtsi, Ukraine
2 .. Bogomolets National Medical University, Kyiv, Ukraine
3 Kharkiv National Medical University, Kharkiv, Ukraine

The given analysis for the prospects of higher education in the dynamics of coordinates modification of communication space, indicative of necessity of extensive training students and high school teachers in Ukraine, when in the difficult period of integration of educational change and reforms to preserve as close as possible positive achievements of national higher education system, and effectively use the experience of developed countries to prepare a mobile and creative professional of high qualification. Creation of electronic resource centers is an effective tool for simulation of training students, doctors, objective assessment of professional competence, and also is the basis for management decisions concerning quality control and meeting the health services.

Keywords: internet technology, online learning, electronic resources, information platform, cognitive and creative potential, sociotypes.

List of references:
1.    Boychuk TM, Herush IV,  Khodorovskyy VM. Server dystantsiynoho navchannya BDMU - ​efektyvnyy instrument orhanizatsiyi ta kontrolyu samostiynoyi roboty studentiv. Materialy KH yuvileynoyi Vseukrayinskoyi navchalno-naukovoyi konferentsiyi z mizhnarodnoyu uchastyu «Kredytno-modulna systema orhanizatsiyi navchalnoho protsesu u vyshchykh medychnykh (farmatsevtychnomu) navchalnykh zakladakh Ukrayiny na novomu etapi». 2013;2:73-76. (Ukr).
2.    Neizvestnyy Yung. Sobraniye perevodov. Perevod s nemetskogo VP Terina. M: Kolos, 2010:188. (Rus).
3.    Petrenko VI, Dolynska MN,  Hultay VV ta in. Resursnyy tsentr z tuberkulozu - ​persha v Ukrayini kompleksna platforma dlya symulyatsiynoho do - ​ta pislya dyplomnoho navchannya medykiv ta spetsialistiv nemedychnykh haluzey, zaluchenykh do kontrolyu za tuberkulozom. Tuberkuloz, lehenevi khvoroby, VIL-infektsiya. 2017;1:16-19. (Ukr).
4.    Todoriko LD, Todoriko AD, Semyaniv IO. Pedahohichno-psykholohichni aspekty zastosuvannya informatsiynykh tekhnolohiy navchannya pry pidhotovtsi maybutnoho likarya. Realizatsiya zakonu Ukrayiny «Pro vyshchu osvitu» u vyshchiy medychniy ta farmatsevtychniy osviti Ukrayiny: materialy KHII Vseukrayinskoyi navchalno-metodychnoyi konferentsiyi z mizhnarodnoyu uchastyu, prysvyacheniy pamyati rektora, chl.kor. NAMN Ukrayiny, prof. LYA Kovalchuka (m. Ternopil 21-22 travnya 2015 r.). Ternopil: TDMU «Ukramedknyha». 2015:234-235. (Ukr).
5.    Todoriko LD, Semyaniv IO, Yeremenchuk IV. Suchasni tekhnolohiyi navchannya u vyshchiy medychniy shkoli. Dosyahnennya i perspektyvy vprovadzhennya kredytno-modulnoyi systemy orhanizatsiyi navchalnoho protsesu u vyshchykh medychnykh (farmatsevtychnomu) navchalnykh zakladakh Ukrayiny za dopomohoyu videokonferents-zvyazku): materialy Vseuk. navch.-nauk. konf. z mizhnar. uchastyu (Ternopil 15-16 travnya 2014r.): u 2 ch. Ternop. derzh. med. un-t im. I.YA. Horbachevskoho. Ternopil: TDMU, 2014:311-312. (Ukr).
6.    Todoriko LD, Todoriko AD, Yeremenchuk IV. Innovatsiyni tekhnolohiyi ta vprovadzhennya interaktyvnoho navchannya v ramkakh Bolonskoho protsesu / Vyshcha osvita v Ukrayini i Bolonskyy protses: stan, problemy i perspektyvy: materialy mizhnar. nauk.-prakt. internet-konf., 24 trav. -1 hrud. 2013 r. 2013:70-73. (Ukr).
7.    Todoriko LD, Shevchenko OS, Shevchenko RS. Vplyv stylyu pedahohichnoyi diyalnosti vykladacha na stavlennya studenta do navchannya. Aktualni pytannya yakosti medychnoyi osvity (z dystantsiynym pidyednannyam VM (F) NZ Ukrayiny za dopomohoyu videokonferents-zvyazku): materialy KHIII Vseuk. nauk. prakt. konf. z mizhnar. uchastyu (Ternopil, 12-13 trav. 2016 r.): u 2 t. Ternop. derzh. med. un-t im. I.YA. Horbachevskoho. Ternopil: TDMU, 2016;1:114-115. (Ukr).

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13. Epidemic situation


Dynamics of HIV infection in Zhytomyr region (UKR)

V.I. Shatylo1, J.Ya. Halinskyi2, V.M. Kosenko1

1 MHEI «Zhytomyr Nursing Institute» of Zhytomyr Regional Council, Zhytomyr, Ukraine
2 Zhytomyr Regional Center for HIV/AIDS Prevention of Zhytomyr Regional Council, Zhytomyr, Ukraine

Objective — the analyze of incidence dynamics of HIV infection in Zhytomyr region based on the records of Zhytomyr Regional Center for HIV/AIDS Prevention.
Materials and methods. Annual reports of Zhytomyr Regional Center for HIV/AIDS Prevention from 1996 till 2016 have been considered and examined. Bibliosemantic, system analysis, logic generalization and statistical data processing methods were used.
Results and discussion. 5.600 cases of HIV infection were recorded by center practitioners within the period from 1996 to December 2016. The records in Zhytomyr Region do not exceed the average ones over Ukraine. Zhytomyr Region belongs to regions with small amount of HIV-infected patients. From 2010 the number of HIV positive patients (diagnosed for the first time) is stabilizing: 462 persons in 2010; 458 in 2011; 400 in 2012; 423 in 2013; 403 in 2014; 463 in 2015 and 455 in 2016. The total number of persons living with AIDS in Zhytomyr region is 1.822 (ended January 1, 2017). The number of AIDS fatal cases has been increasing each year. From 5 to 14 patients died of AIDS in 2016. 1.051 HIV-infected children have been born in Zhytomyr region from 1996 to 2016. Nowadays 1.084 HIV positive pregnant women are registered to regular health care check-up in Zhytomyr Region Center for HIV/AIDS Prevention.
Preventive programs realized by Center practitioners help to control the incidence of HIV/AIDS. Preventive measures are directed not only towards certain public groups (sexual minorities, drug addicted persons), but towards all the population of Zhytomyr Region.
Conclusions. The number of HIV-infected patients in Zhytomyr Region has shown a stabilization trend recently. HIV affects labor pool mostly giving rise to medical and social problems. Tests for HIV are to be performed on a regular basis among the patients with STDs, drug addicted persons and other patients at risk. HIV tests should be proposed to women at risk that are pregnant or are planning to be pregnant. During awareness education healthy lifestyle and strong family relationship should be advised for reliable protection against HIV infection.
Active control of AIDS pandemic and its consequences should be both of medical and national concern. The highly infectious disease accentuates the demographic issues in the country and rises a number of social and ethical problems.

Keywords: HIV-infected, spreading, Zhytomyr region.

List of references:
1.    Analiz poshyrennia VIL-infektsii v Ukraini. — [Elektronnyi resurs]. — ​Rezhym dostupu: http://infolight.org.ua/content/analiz-poshirennya-vil-infekciyi-v-ukrayini. (data zvernennia 6.09.2016). ​Nazva z ekrana.
2.    V Ukraini do 2014 roku vdvichi zbilshytsia kilkist VIL-infikovanykh. — [Elektronnyi resurs]. ​Rezhym dostupu: http://ua.korrespondent.net/tech/295160-v-ukrayini-do‑2014-roku-vdvichi-zbilshitsya-kilkist-vil-infikovanih. (data zvernennia 6.09.2016). ​Nazva z ekrana.
3.    Kilkist VIL-infikovanykh v Ukraini ne znyzytsia. — [Elektronnyi resurs]. ​Rezhym dostupu: http://www.experts.in.ua/baza/prognoz/index.php? ELEMENT_ID=55118. — (data zvernennia 6.09.2016). ​Nazva z ekrana.
4.    Skilky v Ukraini VIL-infikovanykh. [Elektronnyi resurs]. — ​Rezhym dostupu: https://health.unian.ua/country/722922-skilki-v-ukrajini-vilinfikovanih.html. (data zvernennia 6.09.2016). ​Nazva z ekrana.
5.    Skilky v Ukraini VIL-infikovanykh i vid choho yim zahrozhuie smert. — [Elektronnyi resurs]. — ​Rezhym dostupu: http://4vlada.com/rivne/36843. (data zvernennia 6.09.2016). — ​Nazva z ekrana.

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14. To the history of the phthisiatrician service of Ukraine


Sorrowful history about TB sanatoriums in Boyarka (UKR)

V.I. Petrenko, R.G. Protsiuk, I.P. Tarchenko, Yu.M. Bondarenko, D.V. Dobriansky, N.V. Tarchenko

.. Bogomolets National Medical University, Kyiv

The article describes the history of the resort Boyarka (Budaevka) and its famous inhabitants in the late 19th century. For a long time, this region was the only climatic resort for the people of Kiev with special healing air of a pine forest, a combination of trees and grasses, which contributed to the successful treatment and recovery of patients with chronic respiratory diseases. In the years 1882—1883 in Boyarka appears the Clinical medical institution, the initiators of which were the leading professors of the medical faculty of the Kiev University of St. Vladimir, in particular F.G. Yanovsky. In 1899 with settlements from the Jewish charitable society in the summer house of General O. Spiller a sanatorium was opened for the treatment of patients of Jewish origin with tuberculosis. Later it was closed. In 1903, a summer colony of Boyarka appeared at the summer house of a peasant Grigory Naumenko. In 1913 a sanatorium was opened in the massif Peski. There are evidences about the organization of a sanatorium for adults suffering from tuberculosis in 1920. In 1921, another sanatorium was organized at the summer house of Boyarka’s resident N. Burlyai, which was soon closed down, and the children were transferred to the sanatorium of Pushcha Voditsa. For a long time in Boyarka on the territory of Victory Park worked sanatorium «Barvinok», which was closed in 1978. Today he again works outside the city in the depths of Boyarsky Forest.

Keywords: Boyarka, Budaevka, Yanovskiy, tuberculosis, sanatorium.

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