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Issue. Articles

3(3) // 2010



1. Editorial


Control for the tuberculosis in Ukraine during today stage

Y.I. Feschenko, S.O. Cherenko

In the article the analysis of epidemic situation is resulted in relation to tuberculosis in Ukraine on the end of 2010. A conclusion is done, that the attained successes in relation to the decline of morbidity and death rate from tuberculosis it is possible to consider temporal, as on a background stabilizing and improvement of epidemiology situation in relation to ordinary tuberculosis through distribution of epidemic of HIV/AIDS ut the accumulations of bias errors in realization of Program of counteraction a disease on tuberculosis in 2007—2011 years acquire extraordinary actuality two problems: increase of morbidity and death rate from a o-infection tuberculosis/HIV; distribution of multiresistant tuberculosis including with extended resistant which reduces efficiency of treatment among patients with the new cases of tuberculosis and promotes the cost of treatment. These problems for today were not yet marked on a general epidemic situation, but will swiftly spread in the case of delay with their immediate decision.

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2. Original research


State of a ventilation function of lungs and heart structural functional parameters as criteria of the combined clinical course of chronic obstructive pulmonary diseases and coronary heart disease

P.R. Gerych

The Aim of research was the study of a clinical particularities, a lungs ventilation function measures and structural functional parameters endocardial and pulmonary hemodynamics for patients with exacerbation of COPD of II—III stages for the detection of criteria of the combined course with CHD.
Materials and methods. The features of clinical particularities, ventilation disorders and changes of heart and lungs central hemodynamics were analysed with the use of electrocardiography and Doppler echocardiography in 72 patients with the COPD of II—III stages. All patients were divided on two groups. The first group was consisted of 28 patients with the isolated clinical course of COPD, the second — 44 patients with the COPD of II—III stages in combination with CHD of I—II functional class, what were randomized on two subgroups (basic and comparison).
Results and discussions. Comparative analysis of heart structural functional state showed that in patients with isolated clinical course of COPD the parameters of size and contractile function were close by a normal, while in patients with mixed pathology these parameters were increased, indicating development of hypertrophy and dilation.
Conclusion. Thus, the combination of moderate and severe COPD with concomitant or comorbid CHD affects adversely on heart functional status and leads to a moderate dilation of heart chambers, pressure increase in the pulmonary artery system, which manifested by systolic heart function decrease. Concomitant or comorbid CHD in patients with COPD of II—III stages are risk factors for development of right- or left ventricular failure, which significantly worsens the prognosis of the disease.

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3. Original research


Retrospective analysis chemoresistsnt pulmonary tuberculosis in Bukovina

L.D. Todoriko, I.V. Yeremenchuk

The retrospective analysis of chemoresistant TB in Bukovina which showed the reduction of mycobacteriums sensitiveness in patients with newly diagnosed pulmonary tuberculosis and the growth of resistant forms of mycobacteriums in patients with repeated treatment, but relapse.

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4. Original research


Displays of stomatological diseases for tubercular patients

L.G. Ermakova, S.H. Pavlenko

Entry. In literature patients with have the lighted not enough up questions of prevalence of stomatological diseases with lung tuberculosis: does not studied dependence of character of stomatological defeats is on a clinical form and sharpness of tubercular process; does not found out influence of treatment and prophylaxis of stomatological diseases is on efficiency of treatment of basic disease.
Materials and methods. A research group was made in 119 persons (71 men, 48 women) of patients with a lung tuberculosis from 20 to 74 years old. A control group was made 59 practically healthy persons of persons of analogical age (37 men, 22 women). For the estimation of clinical flow of carious illness used the analysis of data of clinical research (to anamnesis, visual and index estimation of the state of hard fabrics of teeth, index estimation of prevalence and intensity of caries (KPV), cariesresistant enamel. For the estimation of prevalence of pathological defeats of fabrics of periodontal used — analysis of lateral data, visual and index estimation of the state of fabrics of periodontal (indexes of the Fedorova — Volodkina, Green — Wermillion, , G, CPITN). Verification of diagnosis of diseases of periodontal tissue was carried out with the use of roentgenologic methods. The state of mucous membrane of cavity of mouth and red framing of lips was diagnosed and estimated by sight, taking into account a color, humidity, integrity, oedematousness, consistency, relief. For all inspected patients conducted the microscopy of strokes from the cavity of mouth on determination of mushrooms of Candida. Diagnostics of leucoplakia was conducted with the use of auxiliary method — luminescence.
The results of the conducted researches confirm, that stomatology diseases for patients with a white plague are characterized prevalence and tendency to progress that results in the loss of teeth and complicates motion of tubercular process.
Conclusions. On the basis of findings it follows to select the followings recommendations for the dentists: have to know the symptoms of defeat of cavity of mouth and pathogeny of disease; to take part in raising of diagnosis «tuberculosis» from the beginning and to the terminal stage; have to give a patient with a lung tuberculosis adequate stomatological help at adherence of rules of aseptic and antiseptic.

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5. Original research


Frequency and some features of motion of bronchial asthma in patients with tuberculosis of breathing organs

Yu.M. Valecky, V.M. Zagorulko, I.V. ul

The Aim was to learn prevalence of bronchial asthma among adults patient with the first diagnosed tuberculosis of breathing organs and to find out some features of its motion.
Materials and methods. Was analyzed medical documentation of all of patients with the first diagnosed tuberculosis of breathing organs which were registered on this occasion in the Volyn regional territorial medical hospital from 2000 to 2009 year. Them it was 6 237.
Results and discussions. From 6 237 patients with the first diagnosed tuberculosis of breathing organs which were found out during the last 10 years (2000—2009), bronchial asthma, as concomitant pathology, took place in 260 (4.17 %) patients. From them in 25 (9.62 %) persons both diseases are diagnosed simultaneously, and in other 235 (90.48 %) patients experience of bronchial asthma made from 1 to 39 years (in middle — 11.43 ± 0.94 years); First degree of bronchial asthma had 33 (12.69 %) patients, second degree of bronchial asthma had 151 (58.08 %) patient, the third degree of bronchial asthma had 69 (26.54 %) patients, fourth degree of bronchial asthma had 7 (2.69 %) patients .
Frequency of exposure of destructive forms for patients with a tuberculosis in combination with bronchial asthma met on 5.87 % more frequent, than for patients without combination of these pathologies (38.98 % against 33.11 %, < 0.05), however high percent of patients with open form of tuberculosis statistically did not differ for certain (50.31 % against 48.64 %, > 0.05).
Conclusion. Prevalence of bronchial asthma among patients with the first diagnosed tuberculosis of breathing organs the last 10 years (2000—2009) in the Volyn area is 4.17 ± 0.09 %; increased on 34.32 %; almost in 8 times higher, than in general in Ukraine.

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6. Lectures


Actual problems of a flu

S.A. Kramarev

A flu is a viral disease, that behaves to family of Orthomyxoviridae and includes three serotypes of virus — A, B and C. Every year are ill 20 % children and 5 % grown man population. Diagnostics of flu step must provided above all things clinically. It is necessary to conduct laboratory confirmation of disease not later than 4—5 day at the adults, and for children it is possible later. Prophylactic inoculations are necessary to conduct against a grip step, taking into account contra-indications. Treatment in the conditions of epidemic and pandemic of flu is needed a inhibitors of the neuraminidase.

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7. Lectures


uberculosis in HIV-nfected persons: pathogenesis, diagnostics, treatment

.D. Nicolaeva

One of most issues of the day of phthisiology there is HIV-associated tuberculosis. HIV facilitates prevalence of tuberculosis a few methods. It assists development of tuberculosis at the primary infecting and due to an endogenous reactivation of the  infection. Favourable terms for development of tuberculosis are created as a result of  the human immunodeficit virus destroys lymphocytes and monocytes — main cells of defence, which resist a tubercular infection. On the measure of decline of T-cell (CD4), the immune system can not stop persistence of MBT from reproduction which results in development of active disease. The clinical picture of tuberculosis depends on the state of the immune system. During heavy immunodeficit tuberculosis runs across atypically and with lines characteristic for primary tuberculosis, often there are outlungs forms, generalization impressions. A diagnosis is based on the same principles as for HIV-negative persons: etiologic confirmation, morphological and clinical. Diagnostics of tuberculosis in HIV-positive persons requires the obligatory setting of antiretrovirus therapy. A timely exposure and diagnostics of tuberculosis, effective treatment and early setting of antiretrovirus therapy, undoubtedly will allow to decide the task of increase of duration and quality of life of the HIV-infected patients.

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8. Lectures


Features and efficiency of physical rehabilitation of patients with respiratory diseases

V.A. Shapovalova, V.. Korshak, L.I. Honcharenko

The article describes the main aspects of physical rehabilitation of patients with respiratory diseases. After care physical therapy in inpatient treatment assists to accelerate inflammatory infiltration resorption, pulmonary surfactant renewal, normalizes bronchial tubes function, and prevents the onset of adhesions and pulmonary collapse. Physical rehabilitation in out-patient treatment leads to patients' full recovery. In chronic disease case physical after treatment brings patients into remission.

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9. Clinical case


The Aplication of the Artificial Pneumothorax in the Complex Treatment Course of Patients with Pulmonary MDR-TB

B.V. Noreyko, Yu.A. Grishun, N.A. Podchos, V.V. Mozgovoy

The increase in the specific gravity of the destructive forms of tuberculosis, primary and secondary resistant of the mycobacterium tuberculosis to TB-drugs and the high level of an attendant pathology reduce sufficiently efficiency of the standard scheme of chemotherapy. In such circumstances the importance of the complex treatment using the collapsotherapeutic methods increases. In the given clinical case the dynamics of infiltrative changes resolve and a cavity destruction healing were observed at the patient after having put an artificial pneumothorax during one month.

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10. Clinical case


Peculiarities of the course of HIV-associated tuberculosis in pregnant women

M.I. Sakhelashvili, M.M. Savula, T.V. Burtnjak, H.S. Majovetska, L.R. Ostapjuk, M.L. Pavlenko, S.S. Butko, N.A. Khopjak

The frequency and peculiarities of the course of HIV-associated tuberculosis in pregnant women who were delivered of child in Lviv and Ternopil region were studied.
Disseminated pulmonary tuberculosis with signs of generalization, often with bacterial, fungal affection and sepsis, multi — and extensively drug resistant disease were the most frequent forms of tuberculosis in pregnant women with HIV- infection. Outcome in pregnancies, complicated by HIV- associated tuberculosis was progression of disease and often — lethality.

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11. Clinical case


Problems of diagnostic of HIV-infection: the case from clinical practice

O.A. Golubovskaya, A.M. Pechinka, O.A. Goodzenko

By comparison to other civilized world in Ukraine morbidity is high on HIV-infection. The insufficient level of knowledges of population in relation to modern possibilities of ART results in the late exposure of disease. With the purpose of illustration is the clinical case of diagnostics of HIV-infection pointed in the terminal stage of illness — on the stage of development  abscess of brain. The question of necessity of improvement of the system of supervision is HIV-infection. At the terms of high morbidity and late appeal for medical help it is important to perfect the system of defence of healthy from possible HIV-infection — to do diagnostic of HIV-infection as skrining, as well hepatitis B, C, sifilis.

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Clinical and pathogenetic features of reasons and progressing of pneumonias, caused by viral and viral-bacterial infections under flu epidemy of 2009 in Precarpathian

M.M. Ostrovskyy, I.O. Savelikhina

Viral respiratory infections are the most common disease among children and adults, which can cause various diseases, from gravedo to serious pneumonia and lead to significant morbidity and mortality.
Nowadays, according to WHO (2009) epidemiology of pandemic virus infection (H1N1), shows that the highest incidence was observed among children and youth, and it shows a wide spectrum of clinical symptoms, ranging from light untemperatured diseases of upper respiratory tract, including subfebrile flu-like states, ending severe or even fatal complications, in most cases fast-progressive viral-bacterial pneumonia.
During the epidemic of influenza in October and November 2009 in Ukraine, was clearly identified that physicians have dealt with the outbreak of seasonal influenza in combination with influenza A 1N1, the situation was difficult, especially in western Ukraine, where in these months was the highest incidence and mortality from pneumonia.
This article gives an overview of the literature relating to international experience to overcome the pandemic influenza virus strain H1N1, its effects and complications, as well as experience in medicine of the Precarpathia against the development of complications in this disease.

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S.M. Mishchuk, V.M. Zahorulko, N.V. Bobryk, I.S. Bobryk

Tuberculosis and AIDS in the Volyn region

To study the detection, dynamics and structure of morbidity, the results of treatment of patients with combined pathology of HIV/TB.
survey methods used for retrospective analysis of health cards, stationary and ambulatory patients during the period from 2007 to 2010 (1892 cards).
analysis of clinical cases of tuberculosis and HIV / AIDS indicates that early administration of ART leads to improving the treatment of tuberculosis patients.
The timely appointment of antiretroviral therapy and the condition of early detection of tuberculosis in patients with combined pathology of HIV/TB observed positive dynamics of clinical and radiological.

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14. short message


The efficiency of treatment patients with new occurrences of pulmonary tuberculosis in Transcarpathion region on information of cohorts analysis

V.V. Skrip, E.P. Shimko, L.Yu. Markovtsiy

Was conducted the estimation of effectiveness of treatment of 700 patients with pulmonary tuberculosis in Transcarpathion region on information of cohorts analysis.
Analysis of indices of cohorts analysis of results treatment of patients with tuberculosis are confirmed by efficiency and effectiveness of the inputting antituberculosis measures in region and is important for their subsequent improvement, acceptance of administrative decisions in relation to the improvement of realization of measures of the programs of counteraction a disease on tuberculosis and removal of found out failings.

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