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4(31) // 2017



1. advanced article


Research of adenosine deaminase activity new additional method for TB diagnostics (UKR)

V.I. Petrenko, M.G. Dolynska, .V. Mamotenko

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

The review presents the biochemical basis and analyses clinical significance and perspective of adenosine deaminase (ADA) test use in TB diagnostics. This method demonstrated high sensitivity specificity, positive and negative predictive value in the establishment the diagnosis of extrapulmonary TB, in particular, pleurisy, peritonitis, pericarditis and meningitis of TB origin. Discussion on the cutoff value for each localization is still in progress. ADA serum and sputum activity in TB patients also differs from patients with other diseases. Nevertheless, diagnostic significance of these specimens requires further studying. Additional stimulation by mycobacteria antigen can increase the diagnostic significan­ce of the test.

Keywords: tuberulosis, diagnosis, adenosin deaminase.

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Original language: Ukrainian

2. advanced article


Conduct of adverse events during treatment of patients with tuberculosis and co-infection (tuberculosis/HIV/AIDS) (UKR)

Yu.I. Feshchenko1, N.A. Lytvynenko1, L.M. Protsy1, M.V. Pogrebna1, Yu.O. Senko1, O.P. Chobotar1, H.O. Varytska1, K.O. Hamazina2, O.V. Matvieieva3

1 F.G. Yanovsky National Institute of Phthisiology and Pulmonology NAMS of Ukraine, Kyiv, Ukraine
2 , Kyiv, Ukraine
3 Expert Center of the Ministry of Health of Ukraine, Kyiv, Ukraine

During the recent time, AE has been recognized as a source of unresolved problems of practical and public health, have a significant negative contribution to the morbidity and mortality of TB, as it is the main cause of interruptions in treatment. This situation contributes to the increase in the prevalence of drugresistant TB, which in turn leads to a significant increase in health care costs. Prevention (prophylaxis) of AE on antituberculosis drugs in patients with tuberculosis, primarily multidrug-resistant, is a priority to the treatment of AE, as it allows maintaining a high quality of life against the background of antiTB treatment, reducing stigma. The article provides the stages of providing medical care to patients with tuberculosis and co-infection who have AE during treatment, the principles of timely and proper treatment of most known AE, which will reduce their number and will contribute to improving the treatment efficiency of this category of patients.

Keywords: tuberculosis, HIV infection/AIDS, adverse events, treatment, prevention.

List of references:
1.    Klinichnyi protokol «Diahnostyka ta likuvannia opor­tunis­tychnykh infektsii i zahalnykh symptomiv u VIL-infiko­vanykh doroslykh ta pidlitkiv» [Clinical protocol «Diagnosis and treatment of opportunistictic infections and general symptoms in HIV-infected adults and teens»] [E-resource]. (2007). Retrieved from: http: //moz.gov.ua/ua/portal/dn_20070413_182.html. [in Ukr.].
2.    Unifikovanyi klinichnyi protokol ekstrenoi, pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy «Medykamentozna alerhiia, vkliuchayuchy anafilaksiiu», MOZ Ukrainy [Unified clinical protocols of emergency, primary, secondary (specialized) and tertiary (highly specialized) medical care «Drug allergy, including anaphylaxis»] [E-resource]. (2015). Retrieved from : http://www.moz.gov.ua/docfiles/dn_20151230_0916dod_ukp.pdf. [in Ukr.].
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6.    Unifikovanyi klinichnyi protokol pervynnoi, vtorynnoi (spetsializovanoi) medychnoi dopomohy «Peptychna vyrazka shlunka ta dvanadtsiatypaloi kyshky u doroslykh» / MOZ Ukrainy [Unified clinical protocols of primary, secondary (specialized) medical care «Peptic ulcer stomach and duodenum in adults»] [E-resource]. 2012. Retrieved from: www.dec.gov.ua/mtd/dodatki/2014_613…12paloi/2014_613ykpmd_PeptVyr.doc. [in Ukr.].
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8.    Unifikovanyi klinichnyi protokol pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) dopomohy «Virusnyi hepatyt V u doroslykh», MOZ Ukrainy [Unified clinical protocols of primary, secondary (specialized) and tertiary (highly specialized) medical care «Viral hepatitis B in adults»] [E-resource]. (2016). Retrieved from: www.dec.gov.ua/mtd/dodatki/2016_613…B/2016_613_YKPMD_vgB_dor.doc. [in Ukr.].
9.    Unifikovanyi klinichnyi protokol pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) dopomohy «Virusnyi hepatyt C u doroslykh», MOZ Ukrainy [Unified clinical protocols of primary, secondary (specialized) and tertiary (highly specialized) medical care «Viral hepatitis C in adults»] [E-resource]. (2016). Retrieved from : www.dec.gov.ua/mtd/dodatki/2016_729_VGC/2016_729_YKPMD_VGC.doc. [in Ukr.].
10.    Unifikovanyi klinichnyi protokol pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) dopomohy «Depresiia (lehkyi, pomirnyi, tiazhkyi, depresyvni epizody bez somatychnoho syndromu abo z somatychnym syndromom, rekurentnyi depresyvnyi rozlad, dystymiia)»,  MOZ Ukrainy [Unified clinical protocols of primary, secondary (specialized) and tertiary (highly specialized) medical care «Depression (mild, moderate, severe, depressive episodes without somatic syndrome or with somatic syndrome, recurrent depressive disorder, dystymia)»] [E-resource]. (2014). Retrieved from : http://moz.gov.ua/docfiles/dn_20141225_1003dod.pdf. [in Ukr.].
11.    Unifikovanyi klinichnyi protokol pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy «Alkoholnyi hepatyt»,  MOZ Ukrainy [Unified clinical protocols of primary, secondary (specialized) and tertiary (highly specialized) medical care «Alcoholic hepatitis»] [E-resource]. (2014). Retrieved from : http://moz.gov.ua/docfiles/dod_ukp_dn_20140616_1.pdf. [in Ukr.].
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14.    Unifikovanyi klinichnyi protokol pervynnoi, ekstrenoi,vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy «Stabilna ishemichna khvoroba sertsia»,  MOZ Ukrainy [Unified clinical protocols of emergency, primary, secondary (specialized) and tertiary (highly specialized) medical care «Stable coronary artery diseasethe heart»] [E-resource]. (2014). Retrieved from : : http://www.moz.gov.ua/docfiles/dn_20150716_1dod.pdf.  [in Ukr.].

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Original language: Ukrainian

3. Original researches


Assessment of TB-HIV co-infection according to the drug resistance profile (RUS)

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

TB-HIV co-infected patients have a greater risk for multidrug-resistance, that in association with lower cure rates and higher mortality endanger disease control. Objective — to perform a comparative assessment of TB-HIV co-infected patients according to the first-line anti-tuberculosis drug resistance profile.
Materials and methods. A retrospective selective, descriptive study targeting risk factors, biological, social, epidemiological peculiarities, case-management, diagnosis radiological aspects and microbiological characteristics of 248 patients with TB/HIV co-infected registered in Chisinau city from 2010 to 2015 was performed distributed in a confirmed or presumptive drug-susceptible tuberculosis group of 161 patients and confirmed MDR-TB group of 87 patients.
Results and discussion. Two third of patients were men, had less than 45 years old and the most of them were from urban districts. One third of the total sample was detected by primary health care and one third by the pulmonologist. Symptmatic patients were the majority of the total sample and by annual screening were detected only a small number of cases. The prevalent high risk was the previous history of tuberculosis and the low rate of infectious contact demonstrated poor screening in high risk groups. The majority were treated according to the regimen of drug-susceptible TB, despite the differences in the drug resistance profile. Low treatment outcome in both groups and high rate of death de­monstrated poor case-management of the TB/HIV co-infected patients.
Conclusions. Low treatment outcome in both groups and high rate of death demonstrated poor case-management of the TB/HIV co-infected patients.

Keywords: HIV, tuberculosis, risk factors, outcome.

List of references:
1.    Centrul National de Management in Sanatate [National Centre for Health Management] Chisinau, 2015.
2.    odoriko LD, Pidverbetska V. Clinical features of the drug susceptible, multi drug resistant and HIVassociated pulmonary tuberculosis depending on the degree of colon dysbiosis. Science and education a new dimension natural and technical sciences. 2016;9(83):64-67.
3.    World Health Organization. Tuberculosis case with TB-HIV co-management, Geneva 2007.
4.    World Health Organization. Systematic screening for active tuberculosis, Geneva, 2013.
5.    World Health Organization. End TB Strategy, Geneva, 2014.
6.    World Health Organization. Global tuberculosis report, 2016.
7.    World Health Organization. Fact sheet on tuberculosis, 2016.
8.    World Health Organization. Treatment guidelines for drug-resistant tuberculosis, 2016 update, 2016.

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Original language: Russian

4. Original researches


The frequency and profile of drug resistance of Mycobacterium Tuberculosis in HIV-positive patients with tuberculosis (rifampicin-resistant lung, multidrug-resistant miliary and multiresistant nervous system), depending on the level of CD4 (UKR)

V.I. Petrenko1, O.V. Panasiuk1—4, G.V. Padysh1, O.B. Holub4, Ya.V. Lopatina4

1 .. Bogomolets National Medical University, Kyiv, Ukraine
2 Kyiv Medical University UAFM, Kyiv, Ukraine
3 L.V. Gromashevsky Research Institute of Epidemiology and Infectious Diseases, NAMS of Ukraine, Kyiv, Ukraine
4 Kyiv Area City Center for Prevention and Control of AIDSth, Kyiv, Ukraine

Objective — the study aimed to determine the frequency and profile of drug resistance of MBT in PTP in HIV-positive patients with rifampicin-resistant tuberculosis (RifTB), multidrug-resistant miliary (MRTB), and MRTB of the nervous system depending on the level of CD4 cells/mm3.
Materials and methods. The clinical study involved 60 adults with HIV-positive TB patients (RifTB of lungs, MRTB of a miliary and MRTB of the nervous system), which were examined by Nationally valid standards. Patients are divided into three identical groups of 20 people depending on the organopathic localization: group I — patients with Reef TB of the lungs, II patients with MRTB miliary, and III patients with MRTB of the nervous system.
Results and discussion. The results show that the patients of each group do not differ in 6 indicators (sex, age, CD4 cells/mm3 level of peripheral blood, the case of development of TB disease, comorbidity, frequency and profile of drug resistance of MBT in PTP I and II series). An exception was the radial organopathy patient, which characterizes the severe clinical condition of patients with a high incidence of pulmonary hypertension with simultaneous damage to other organs. The revealed identical frequency and profile of drug resistance of MBT to PTP in each group suggested studying this index depending on the level of CD4 cells/mm3.
Conclusions. Among HIV-positive patients with Rif TB lung, MRTB miliary, MRTB of the nervous system, advanced-resistant tuberculosis (RRTB) diagnosed with the same frequency in patients with different immunodeficiency: at a deep 24.0 %, with a pronounced 31.0 % at a moderate — in 33.0 % of cases (p > 0.05). Together with the increased resistance, fluoroquinolone-resistance in these patients detected in 46.0, 43.0, 66.0 %, aminoglycoside-polypeptidase resistance, respectively, in 54.0, 43.0, 66.0 % of cases (p > 0.05).
In HIV-positive patients with RifTB lung, MRI of a billion and MRRI of the nervous system, the same frequency of MBT resistance to PAP, regardless of the organopathic location of tuberculosis and the depth of immunodeficiency.

Keywords: Multidrug-resistant tuberculosis, lungs, miliary tuberculosis, nervous system, chemoresistant, immunodeficiency, combination with HIV.

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10.    Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF assay for the diagnosis of pulmonary and extrapulmonary TB in adults and children. Policy update. Ceneva: World Health Organization; 2013 [WHO/HTM/TB/2013.16; http: //www.stoptb.org/wg/gli/assets/documents/WHO Policy Statement on Xpert MTB-RIF 2013 pre publication 22102013.pdf, access 15 february 2017.
11.    Global Tuberculosis Report 2016. Geneva: World Health Organization; 2016 [WHO/HTM/TB/2016.13; http: //apps.who.int/iris/bits-tream/10665/250441/1/9789241565394/eng.pdf, access 15 february 2017.
12.    Roadmap to implement the tuberculosis action plan for the WHO European Region 2016-2020. [WHO Regional Office for Europe; 2016 [http:. www.euro.who.int/_ _data/assets/pdf_fike/0020/318233/Roadmap_implement-TBC-action-plan‑20162020.pdf, access 15 february 2017.
13.    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.

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5. Original researches


Measures to improve blood oxygen saturation in lung tuberculosis patients (UKR)

S.I. Kornaha1, V.I. Pyatnochka1, I.T. Pyatnochka1, N.V. Thork2

1 I.Ya. Horbachevsky Ternopil State Medical University, Ministry of Healthcare of Ukraine, Ternopil, Ukraine
2 Shumsk Central District Hospital, Shumsk, Ukraine

Objective — to outline measures to improve the oxygen saturation of lung tuberculosis patients from the beginning of treatment, in its process, and also after the completion of longterm chemotherapy.
Materials and methods. The degree of arterial blood saturation with oxygen in 575 lung tuberculosis patients has analyzed and in 21 patients with residual changes after tuberculosis. The control group, consisted of 37, healthy individuals. Determination of saturation of arterial blood with oxygen was carried out in the lying position of patients using the pulsoximer «Yutasoksi-201». The digital material was statistically processed with the deduction of the probability indicator.
Results and discussion. The degree of oxygen saturation of blood in different types, clinical forms, phases of the tuberculosis process and, in particular, multidrug resistance has been studied. It has been established that with the method of «chronization», the severity of the process, the presence of destructive changes and, in particular, multiresistance, the oxygen blood saturation is significantly reduced. Based on literature data and own research, measures to improve oxygen saturation in lung tuberculosis patients are proposed.
Conclusions. Correct organization and conducting of antimycobacterial therapy, pathogenetic treat­ment, adherence to optimal diet and rest with a gradual transition from strictly bedtograded training and adequate physical activity is important for the maintenance of the pulmonaryheart system in the optimal condition, as well as providing blood with oxygen.

Keywords: tuberculosis, multidrug resistance, blood oxygen saturation.

List of references:
1.    Byalyk IB, PetrenkoVM, DavydenkoVV. Suchasni mozhlyvosti pidvyshchennya rezultativ chimioterapii chvorych na chimiorezystentnyi tuberculoz legen (Ukr). Ukrainskyi pulmonologichnyi jurnal [Ukrainian Pulmonology Journal] (Ukr). 2008;3:7-9.
2.    Gavrysiuk VK. Respiratory failure: mechanisms of development, evaluation methods, oxygen therapy (Ukr). Ukrainskyi pulmonologichnyi jurnal [Ukrainian Pulmonology Journal] (Ukr).2016;4:56-58.
3.    Zilber AP Intensivnaya terapiya dychatelnoi nedostatochnosti. Metody, technika, protcedura: Uchebnoe posobie dlya subordinatorov-terapevtov i vracheyi-internov. Petrozavodsk; 1984:200.
4.    Ilyina TYa, Zhingireev AA, SidorenkoOA. Osobennosti bakteriovydeleniya chuvstvitelnosti mikobacterii tuberculoza k chimiopreparatam u bolnych s retsidivami tuberkuloza lehkih (Rus). Problemy tuberculoza i boleznei lehkih (Rus). 2008;5;20-22.
5.    Mogyryova LA. Vyvchennya antymikobakterialnoi aktyvnosti - ​osnova poshuku novych protytuberkuloznych fitopreparativ (Ukr). Liky (Ukr). 2005;1-2:19-21.
6.    Novoselova VL. O zakonomernostyach protcessov zazhyvleniya tuberkuloznoi kaverny lehkoho (Rus). Problemy tuberculoza (Rus).1981;2:52-56.
7.    Protsyuk RG. Suchasni problemy epidemiologii tuberkul'ozu v Ukraini: prychynyishlahy podolannya (Ukr). Zdorovya Ukrainy (Ukr). 2008;16(1);63-66.
8.    Todoriko LD, Petrenko VI, Grishin VV. Resistance of Mycobacterium tuberculosis: myths and reality (Ukr). Tuberkuloz, legenevi chvoroby, VIL-infektsiya [Tuberculosis, Lung Diseases, HIV Infection] (Ukr)2014;1:60-67.
9.    Tuberculosis in Ukraine (Analitychno-statystychnyidovidnykza 2000-2010 roky) (Ukr). Kyiv; 2011:103.
10.    Tuberculosis in Ukraine (Analitychno-statystychnyidovidnyk) (Ukr). Kyiv; 2015: 31.
11.    Feshchenko YuI. Stan nadannya ftuziatrychnoi dopomogy naselennyu Ukrainy(Ukr). Ukrainskyi pulmonologichnyi jurnal [Ukrainian Pulmonology Journal] (Ukr). 2008;3:7-9.
12.    Frayt V, Frayt O, Frayt YU. Legeneve krovopostachannya, gpertenzya tuberkuloz. Vdrodzhennya; 2001: 291.
13.    Boger JA, Lepler L. Hemoptysis in a 28-year-old active duty soldier. J Mil Med. 2004;169(9):754-756.
14.    Styblo K. Epidemiology of Tuberculosis [Text]/Haque: KNCV: 2001:136.
15.    Van den Brande P, Demedes M. Pulmonary tuberculosis in the geriatric patients: clinical and roentgenographic spectrum. Amer Rev Dis. 1990;141(4):785.

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6. Original researches


Efficacy and safety of ivabradine in patients with combined cardiorespiratory pathology (UKR)

P.R. Gerych

Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine

Objective — evaluate clinical efficacy and safety of vabradine in the basic treatment of stability ischemic heart disease in patients with the acute period of COPD II—III stages.  
Materials and methods. The study has been worked out the results of the investigation of clinical and functional indices of respiratory and cardiovascular systems of 44 patients with combined cardiorespiratory pathology are demonstrated. The patients were randomized to take the basic treatment (main group, n = 26) or the combined therapy with ivabradine (Coraxan, Servier, France), given in doses of 5mg to 10 mg (comparison group, n= 18). 19 (67.85 %) patients of the main group had stable angina class and 7 (32.14 %) — class II. The heart rate reduction (from (81.4 ± 3.6) beats per minute to (68.3 ± 3.8) beats per minute), the decreasing of the number of angina attacks (from (12.1 ± 1.9) to (8.41 ± 1.5)) and nitrate consumption (from (12.6 ± 2.1) to (9.80 ± 1.2) tablets per week) were observed in the patients receiving the complex therapy (p < 0.05).
Results and discussion. The study showed the decreasing of the number of supraventricular extrasystole (from (9.8 ± 2.0) to (3.8 ± 1.2) per day ( < 0.05) and ventricular extrasystole (from (13.8 ± 2.9) to (5.8 ± 1.4) per day (p < 0.05)) without the influence on the cardiac conduction system (the changes of the P-R interval, the Q-T interval and the T wave were non-significant (p > 0.05).
Conclusions. The addition to the complex therapy in patients with exacerbation of COPD II—III degree in combination with SCHD VF — FC the «rhythm slowing» agent ivabradine (in the average dose of 7.5 mg/day) promotes slowdown of heart rate reduction, reduction of the number of episodes of myocardial ischemia, increase the tolerance to physical activity, reduce the duration of pain and painless myocardial ischemia, the number of ventricular and supraventricular extrasystoles without affecting the conductive system of the heart and bronchial patency, which improves the state of coronary and myocardial reserve of the heart.

Keywords: chronic obstructive pulmonary disease, concomitant and comorbid stable ischemic heart disease, systemic inflammation, concomitant diseases, ivabradine.

List of references:
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3.    Belousov YuB, Erofeeva SB, Maneshina OA. Ivabradin - ​pervyi F-ingibitor izbiratelnogo i spetsificheskogo deistviya, novyi preparat dlya lecheniya stabilnoi stenokardii. Kardiologiya. 2006;8:88-91. (in Rus.).
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6.    Gavrisyuk VK. Sistemnye proyavleniya KhOBL: Osobennosti kliniki, diagnostiki i lecheniya. Ukr pulmonol zhurn. 2009;2:7. (in Rus.).
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9.    Karoli NA. Khronicheskaya obstruktivnaya bolezn legkikh i kardiovaskulyarnaya patologiya: kliniko-funktsionalnye vzaimo­otnosheniya i prognozirovanie techeniya: diss. d-ra med. nauk. 2007:398. (in Rus.).
10.    Kilessa VV. Osoblyvosti patohenezu, kliniky ta likuvannya spoluchenoho perebihu nespetsyfichnykh zakhvoryuvan leheniv iishemichnoy khvoroby sertsya: avtoref. dys. d-ra med. nauk. Yalta. 2005:40. (in Ukr.).
11.    Kozlova LI, Aisanov ZR, Chuchalin AG. V chem opasnost dlitelnogo primeneniya p2-blokatorov u bolnykh IBS s soputstvuyushchei KhOL? Ter arkh. 2005;7(3):18-23. (in Rus)
12.    Kozlova LI. Funktsionalnoe sostoyanie respiratornoi i serdech­no-sosudistoi sistem bolnykh KhOL i IBS: avto- ref. dis. d-ra med. nauk. M, 2001. (in Rus.).
13.    Kozlova LI. Khronicheskie obstruktivnye zabolevaniya legkikh i ishemicheskaya bolezn serdtsa: nekotorye aspekty funktsionalnoi diagnostiki. Pulmonologiya. 2001;2:9-12. (in Rus.).
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15.    Lutai AV, Efimova EG, Bobkov VA, Sakova SA. Reologicheskie svoistva krovi i tyazhest dykhatelnoi nedostatochnosti pri obostrenii khronicheskogo obstruktivnogo bronkhita. Pulmonologiya. 2000;104. (in Rus.).
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18.    Nakaz MOZ Ukrayiny za N 152 «Unifikovanyy klinichnyy protokol pervynnoyi, vtorynnoyi (spetsializovanoyi) ta tretynnoyi (vysokospetsializovanoyi) medychnoyi dopomohy “Stabilna ishemichna khvoroba sertsya”» vid 02.03.2016 r. (in Ukr.).
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20.    Paleev NR, Chereiskaya NK, Afanaseva IF. i dr. Rannyaya diagnostika ishemicheskoi bolezni serdtsa u bolnykh khronicheskimi obstruktivnymi zabolevaniyami legkikh. Ter arkh. 1999;9:52-5621.
21.    Palivoda SN, Krivenko VI, Evchenko LN. Otsenka kachestva zhizni bolnykh s metabolicheskoi kardiomiopatiei. Ukr revmatol zhurn. 2001;2(4):55-57. (in Rus).
22.    Sychev OS, Chubuchnyi VN, Romanova TV, Getman SI. i dr. Variabelnost ritma serdtsa v razlichnye periody pro-gressiruyushchei stenokardii. Ukr kardol zhurn. 2002;1:25-27. (in Rus.).
23.    Tatarchenko IP, Pozdnyakova NV, Kapelovich VYu., Biryu- chenko MV. Koraksan i atenolol: skhodstva i razlichiya v korrektsii klinicheskikh i funktsionalnykh pokazatelei pri lechenii bolnykh ishemicheskoi boleznyu serdtsa. Klin med. 2008;3:47-51. (in Rus.)
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26.    Shostak NA, Yakushin SS, Filippov EV. Kardiomiopatii. Kardiologiya: Natsionalnoe rukovodstvo / Pod red. YuN Belenkova, RG Oganova. M: GEOTAR-Media, 2007:887-900. (in Rus).
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7. Original researches


The effectiveness of treatment of pulmonary tuberculosis in medical workers in Vinnytsya region (UKR)

O.P. Litvinyuk1, S.V. Zaikov2, M.A. Thorovsky3

1 National Pirogov Memorial Medical University, Vinnytsya, Ukraine
2 P.L. Shupik National Medical Academy of Postgraduate Education, Kyiv, Ukraine
3 Vinnytsya Regional Specialized Territorial Medical Association «Phthisiology», Vinnytsya, Ukraine

Objective — to analyze the effectiveness of TB treatment in the MW Vinnitsa region in 2007—2015.
Materials and methods. We analyzed the treatment results of 131 MW who became ill with TB. Only MW of medical and preventive establishments of Vinnytsya oblast who had medical education and became sick with TB during the specified 9 year period was included in the study. By official documentation (disease history, reporting forms), the schemes, timing, results, and outcomes of the treatment of MW were determined.
Results and discussion. On average, the incidence of TB in the region’s MW for the 9 year study period was 48.7 per 100,000 MP. Pulmonary tuberculosis detected in 115 (87.8 %) people, and extrapulmonary — in 16 (12.2 %) MWs. Sputum smear microscopy identified bacterial excision in 43 (37.4 %) patients with pulmonary TB, and in culture (57 (49.6 %)). In 100 patients, there was a diagnostic TB of the lung TDFT without signs of resistance to anti¬TB drugs. Of these, in 56 (56.0 %) people the process in the lungs was accompanied by bacterial secretion, and in 42 (42.0 %) persons, the destruction of the pulmonary parenchyma. After completion of IPC, bacterial secretion stopped at 46 (82.1 %) of 56 MW from MBT+, and positive radiological dynamics observed in 90 (90.0 %) MW patients. At the same time, 4 (9.5 %) MW during this period of time also observed scarring of destruction in the lungs. The results of IPCT in the MW and the population of the region were identical, with p > 0.05 for all cases. The discontinuation of bacterial secretion in TB tuberculosis after MCCT observed in 53 (94.6 %) of 56 people, on average, (1.8 ± 0.3) months. From the beginning of treatment. The onset of destructive changes in the lungs after MCCT occurred in 41 (97.6 %) of 42 MW with destructive lung tuberculosis. At the same time, the average scarring time for destruction in the lungs was (5.7 ± 0.7) months. In 97.0 % of cases, the results of treatment of MW were effective and exceeded the corresponding results of treatment of the population in the region (82.4 %), p < 0.05.
Conclusions. The results of IPCT in the MW and the population of the region were identical, but scarring of destruction in the lungs at the end of the IPCT in the MW was observed in 2.3 times more often than among the population of the region. Upon completion of MCCT in the MW, scarring of the destruc­tion in the pulmonary parenchyma occurred faster than in the population of the region. The effectiveness of treatment of MW at the time of completion of MCCT on the indicators of cohort analysis is better than the population of the region (97.0 vs. 82.4 % of cases).

Keywords: tuberculosis, medical workers, Vinnitsya region, effectiveness of treatment, results of treatment.

List of references:  
1.    Barbova AI. Sovremennye podhody k diagnostike multi-rezistentnogo tuberkuleza. Ukr pulmonol zhurn. 2016;2:28-29.
2.    Bektasova MV. Ocenka i upravlenie professionalnymi riskami kak osnova profilaktiki professionalnoj zabolevaemosti medicinskogo personala (pa primere Pri morskogo kraja): avtoref. dis. …d-ra med. nauk: 14.02.01. M, 2015:17-19.
3.    Borodulina EA, Borodulin BE. Zabolevaemost tuberkulezom medicinskih rabotnikov v Samare. Tuberkulez segodnja: mater. VIII Ros. sezda ftiziatrov. M.: BINOM, 2003:213.
4.    Nizova AV. Analiz ustojchivosti klinicheskih shtammov Mycobacterium tuberculosis k lekarstvennym preparatam pervogo i vtorogo rjada. Jepidemiologija i infekcionnye bolezni. 2007;4:7-11.
5.    Kornachev AC, Semina HA, Golubev DN. Prichiny razlichija v aktivnosti jepidemicheskogo processa tuberkuleza v regionah Rossijskoj Federacii. Vnutribolnichnye infekcii: mater. IX sezda Vserossijskogo nauchno-prakticheskogo obshhestva jepi­demio­logov, mikrobiologov i parazitologov. 2007;2:189.
6.    Pilishenko VA, Kurkin DP, Glushkova NJu. Sostojanie pro­fessional'noj zabolevaemosti rabotnikov zdravooh ranenija v Ros­sijskoj Federacii v 2011 g. Zdorove naselenija i sreda obi­tanija. 2012;10:28-30.
7.    Pjatnochka , Kornaga S, Thorik NV. Pro prihil Nst do lkuvannja hvorih na tuberkuloz. Tuberkuloz, legenev hvorobi, VL-nfekcja. 2015;1:108-112.
8.    Naidoo A, Naidoo S, Gathiram P, Lalloo U. Tuberculosis in medical doctors — ​a study of personal experiences and attitudes. South African Medical Journal. 2013;3:31-37.

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8. Original researches


Clinical evaluation of the efficacy of glucosaminilmuramilpmentapeptide and middle methylxanthine in the complex therapy of patients with multidrugresastant tuberculosis (UKR)

G.D. Shtybel

Danylo Halytskiy Lviv National Medical University, Lviv, Ukrain

Objective — is to study the effectiveness of the use of glucosaminylmuramylpentapeptide and derivative methylxanthine in the treatment of patients with multidrugresistant tuberculosis.
Materials and methods. 53 patients took part in the survey. As pathogenetic drugs against antituber­cular treatment (AMBT) used glucosaminylmuramylpentapeptide (conventionally named GAMPED) and derivative methylxanthine (conventionally named MEX).The patients were divided into three groups: the first, control — 22 patients who received only antituberculartreatment; the second — 15 people, in the complex treatment of which GAMPED (AMBT + GAMPED) was added and the third group — on the background of AMBT received GAMPED and MEX (AMBT + GAMPED + MEX). All patients in the intensive phase of AMBT (before treatment, after 2, 4, 6 and 8 months) conducted a comprehensive clinicalradiological, microbiological and general laboratory examination.
Results and discussion. When applied against the background of AMBT glucosaminylmuramyl­pentapeptideand derivative methylxanthine, an acceleration of the termination of bacterial excretion observed on (2.7 ± 0.3) months, resorption of foci and infiltration at (2.3 ± 0.3) months and healing of cavities of decay on (2.6 ± 0.3) months, compared to control.
Conclusions. The use of glucosaminylmuramylpentapeptideand methylxanthine derivative (third regimen), or glucosaminylmuramylpentapeptide alone (second regimen), increases the efficacy of treatment in patients with multidrugresistant tuberculosis, compared with patients receiving AMT.

Keywords: ultidrugresistant tuberculosis, clinical evaluation, pathogenetic treatment, efficacy.

List of references:
1.    Barbova AI, Cherenko S, Starychek GV, et l. Variants mono- and polirezystentnosti Officeto anti-TB drugsand a number of patients withnew and recurrentcases of tuberculosis. Tuberculosis, pulmonary disease, HIV infection. 2016;123-26.
2.    Esipenko SV, Filyuk V, Gerasimova NA. Analysis of the causes prevalence of multidrug-resistant tuberculosis in the Odessa region. Tuberculosis, pulmonary disease, HIV infection. ​2014;3(18):85-89.
3.    Zaikov SV, Plykanchuk OV. Results of treatment of patients with newly diagnosed pulmonary tuberculosis in the application of immunomodulator number muramilpeptydnoho. Ukr pulmonol J. 2010;3:30-32.
4.    Ylynskaya IF. Principles of pathogenetic immune yndyvydualyzyrovannoy in Tuberculosis. Clin Immunol, Allergol, nfectol. 2011;3:55-60.
5.    Kuzhko M, Hulchuk NM, Linnik MI. uberculosis Himiorezystentnyy: prospects for prevention and treatment. Ukr pulmonol J. —2014;3:12-16.
6.    Litvinenko NA. The effectiveness of treatment of MDR tuberculosis and tuberculosis with enhanced resistance to Mycobacterium tuberculosis TB drugs based on prior treatment history. Ukr  pulmonol J. 2015;1:10-14.
7.    Milnyk V, Novozhilova IA, Matusevych VH. Himiorezystentnyy tuberculosis: the state of the problem in Ukraine. Ukr Med J. 2013;6:26-28.
8.    Melnyk O, Miller O, Ostrowski M. Prospects for muramilpeptydnoho number immunomodulator in patients with infiltrative tuberculosis combined with chronic bronchitis. Bukovynskiy Med J. 2015;19(4):220-222.
9.    Petrenko V, Radysh GV. Achievements and prospects of development of tuberculosis. Tuberculosis, pulmonary disease, HIV infection. 2013;1(12):5-13.
10.    Petrenko VI, Dolynska MG. Unite to end tuberculosis! Tuberculosis, pulmonary disease, HIV infection. 2016;1:5-6.
11.    Sakhelashvili MI, Platonov IL, Balyta TN, Shtybel GD. Efficacyan dactovegin Immunofanin the treatmentof patients with tuberculosis himiorezystentnyy. Tuberculosis, lungdisease, HIV infection. 2015;1:47-52.
12.    Feschenko YI, Melnyk IV, Zaikov SV, et al. Features of the current situation of tuberculosis in Ukraine. Ukr pulmonological J. 2016;1:5-9.
13.    Prammananan , et al. In vitro activity of Iinezolid against multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant (XDR)-TB isolates. Int J Antimicrob Agents. 2009;33:190-191.
14.    Sardar , et al. Intensive phase non-compliancetoantitubercular treatment in patient swith HIV-TB co-infection: a hospital-based cross-sectionalstudy. J Com Health. 2010;35(5):471-478.
15.    Shin SS. Development of extensively drug resistant tuberculosis during multidrug-resistant tuberculosis treatment. Am Respir Crit Care Med. 2010;2(8):426-432.
16.    Walls T, Delane Shingadia. The epidemiology of paediatric tuberculosis in Europe. Current Paediatrics. 2004;14:258-262.
17.    World Health Organization. Global Tuberculosis Control report. WHO report. Geneva: Switzerland, 2012. 273 p.

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9. Original researches


Bone tuberculosis ​the cause of other forms of tuberculosis (UKR)

I.D. Duzhyi1, L.A. Bondarenko2, V.O. Oleshchenko2

1 Sumy State University, Sumy, Ukraine
2 Sumy Regional Clinical TB Dispansary, Sumy, Ukraine

Objective — to share observations of the development of pulmonary and spinal tuberculosis, provoked by extrapulmonary forms.
Materials and methods. By generalclinical and radiological methods, a retrospective analysis of the course of osteoarticular tuberculosis performed in 129 patients.
Results and discussion.Within 10 years among these patients 77 (59.7 %) persons had tuberculosis of the spine, 52 (40,3 %) — tuberculosis of tubular bones, which in 2 (3.8 %) patients was complicated by pulmonary tuberculosis, in 1 (1.9 %) — multiorgan MDR TB, in 1 (1.9 %) — tuberculosis of the spine. These forms of tuberculosis were detected after 12—14-month treatment of bone tuberculosis in elderly patients.
Conclusions. The authors are convinced of the necessity of the existence of the institute of orthopedic phthisiatrician and his continuous improvement.

Keywords: bone tuberculosis, complications, other forms of tuberculosis.

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Analysis of the causes of undiagnosed alive tuberculous meningoencephalitis in an infant (UKR)

M.B. Dasho, S.A. Lyshenyuk, U.B. Chulovska, H.O. Lytvyn

Danylo Halytskiy Lviv National Medical University, Lviv, Ukraine

It was analyzed the case of tuberculous meningoencephalitis in the child’s first year of life at all stages of its development — from the tuberculosis of lungs to a generalized form with a defeat of the central nervous system and cause, which led to the late (postletal) diagnosis of this disease.

Keywords: children, tuberculous meningoencephalitis, epidemiological anamnesis, clinical and laboratory diagnosis.

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Original language: Ukrainian