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Issue. Articles

№3(6) // 2011

 

Обкладинка

 

1. Editorial

 

Tuberculosis and migration: current problem state

V.I. Petrenko, L.D. Todoriko, G.V. Radysh, І.І. Shulzhyk

An increasing proportion of tuberculosis in developed countries is observed among immigrants born in countries with a high incidence of disease. In this group it is mainly a disease of young adults and may have unusual clinical presentation and a risk for drug resistance. The screening for tuberculosis in migrants, performed as soon as possible after entry into the country, with preventive treatment of infected migrants may reduce the risk of later reactivation of tuberculosis and transmission to the local population.

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2. Original research

 

Сравнение эффективности различных режимов химиотерапии у больных туберкулезом легких с неизвестной чувствительностью микобактерий к антибактериальным препаратам

Л.Д. Тодорико, В.И. Петренко, А.В. Бойко, О.В. Медвецкая

В статье приведены результаты изучения эффективности различных режимов химиотерапии у больных туберкулезом легких с неизвестной чувствительностью микобактерий туберкулеза (МБТ) к антимикобактериальным препаратам.
Цель исследования. Повысить эффективность лечения больных мультирезистентным туберкулезом легких с неизвестной чувствительностью к антимикобактериальным препаратам.
Материалы и методы. Было исследовано 227 ранее пролеченных новых случаев и рецидивов туберкулеза с использованием клинических, радиологических, клинико-лабораторных, микробиологических и статистических методов. Изучены распространенность и профиль мультирезистентности микобактерий у больных туберкулезом с повторным лечением по ретроспективным материалам фтизиотерапевтического отделения Черновицкого областного противотуберкулезного диспансера.
Результаты и обсуждение. Среди общего количества исследуемых больных (227) была отобрана группа больных — 43 пациента — с подозрением на мультирезистентный характер его течения и проведен анализ полученных данных. Почти у половины больных (44,2 %) с мультирезистентным туберкулезом (МРТ) установлена расширенная стойкость МБТ, и, кроме изониазида и рифампицина, была выявлена резистентность к стрептомицину (55,5 %), пиразинамиду (27,9 %), этамбутолу (32,6 %). Таким образом, для половины пациентов лечение по четвертой категории является невозможным.
Была проведена оценка эффективности стандартного и индивидуального режимов химиотерапии на момент получения результата теста чувствительности МБТ к противотуберкулезным препаратам, через 6 мес от начала  лечения и во время выписки больных из стационара (в среднем через (16,8 ± 7,2) мес). Полученные результаты указывают на эффективность эмпирического режима химиотерапии до определения резистентности микобактерий туберкулеза за счет назначения 5—7 препаратов с целью сохранения достаточно высокой вероятности того, что по крайней мере к 4 из них микобактерии туберкулеза сохраняют чувствительность.
При оценке режимов химиотерапии при выписке из стационара, несмотря на индивидуальный подбор химиопрепаратов, наиболее эффективным оказался стандартный режим (EK(Am)ZEt (PASS)Q или EZEtPASSQ) на основании использования препаратов 2-го ряда и фторхинолонов.
Выводы. Таким образом, целесообразно назначать стандартные режимы химиотерапии, основанные на четвертой категории, больным после неэффективного первого и повторного курса химиотерапии в случае отсутствия результата теста лекарственной чувствительности в начале лечения. Выявлено относительно невысокий уровень резистентности MБТ к канамицину и этионамиду — 2,3 % и 1,6 % соответственно, что предоставляет возможность пользоваться этими препаратами у пациентов, нуждающихся в повторном лечении по стандартному режиму химиотерапии в соответствии с четвертой клинической категорией, до получения результатов теста лекарственной чувствительности. Принимая во внимание присутствие расширенной лекарственной устойчивости у 44,2 % больных, в случае назначения эмпирического режима при рецидиве или прерванном лечении предпочтение должно отдаваться пероральным препаратам 2-го ряда (этионамид, протионамид, циклосерин, ПАСК) с целью предупреждения развития еще большей лекарственной устойчивости.

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3. Original research

 

Comparative study of M. tuberculosis isolation in liquid medium in automated system ВАСТЕС 960 and solid medium Lovenshtein — Jensen

O.A. Zhurylo, A.I. Barbova, S.V. Myronchenko, O.R. Smetanina, O.V. Yunatska, L.I. Piskovets

At present study a comparative characteristics of M. tuberculosis isolation in automated system ВАСТЕС 960 and on solid medium Lowenstein — Jensen is provided. It was shown that the efficiency of MTB isolation in automated system ВАСТЕС 960 is 1.2 times better versus the method of inoculation on solid medium Lewenstein — Jensen. Growth duration of MTB culture in liquid medium Middlbrook 7H9 in the ВАСТЕС 960 is reduced 3.1 times versus the method of inoculation on solid medium.

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4. Original research

 

Tuberculosis incidence analysis among young children in Lugansk region

N.A. Grytsova, T.V. Rumyantseva, М.V. Dorda, L.А. Onishchenko

Objective — to study the incidence structure and case detecting peculiarities in young children.
Materials and methods. Retrospective analysis of 99 tuberculosis cases among children aged from 0 to 3 years between 1991 and 2010 had been performed. Incidence retrospective analysis was done by the annual statistic reports survey of Lugansk regional tuberculosis dispensary and Lugansk regional statistic office.
Results and discussion. The percentage of children under 3 among entire child tuberculosis incidence rose 11.5 times since 1991 and reached 30 % in 2010. Average infancy tuberculosis incidence rose 6.7 times in 2010 versus the period of 1991—1995, and general children tuberculosis incidence increased 3.2 times during that period. Growth rate of the infancy tuberculosis incidence went 2.5 higher than among general children population (population of age 0—14). In infants classic primary tuberculosis forms are predominant. Bone and joint tuberculosis incidence rose 2.5 times since pre-epidemic period, what needs further explanation.
Conclusions. Significant growth of tuberculosis incidence among infants was revealed and probably indicates the poor efficiency of preventional interventions in the tuberculosis hotbeds as well as tuberculosis control system in general. Thorough epidemiological analysis of tuberculosis among children is required in order to improve the case detecting quality in Lugansk region.

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5. Original research

 

Peculiarities of clinical course of renal tuberculosis

M.I. Sakhelashvili, T.V. Lutsyshyn

Research objective — to study peculiarities of clinical course and diagnostics of renal tuberculosis in the modern context.
Materials and methods. An analysis of peculiarities of clinical course of renal tuberculosis was performed using clinical, radiological and standard laboratory examinations data of 199 patients divided into two groups. The first group was composed of the patients with associated pulmonary and renal tuberculosis (1134 patients), the second — patients with renal tuberculosis without pulmonary lesions (65 patients).
Results and discussion. Clinical, radiological and tomographic studies allowed to diagnose renal tuberculosis in 42.5 % of patients. With the additional use of radiographic contrast urography and renal ultrasound scanning frequency of verification of the diagnosis went 19.2 % up.
Conclusion. Patients with combined pulmonary and renal tuberculosis had severe tuberculous intoxication symptoms (96.2 %), pulmonary affection signs (51.5 %) and 1,8 times fewer — renal affection signs (29.8 %). Majority of the patients with local, infiltrative and disseminated tuberculosis were noted to have also associated parenchymal renal tuberculosis. At the same time in 35.7 % of the patients we found fibrocavernous form of both pulmonary and renal tuberculosis. In case of renal tuberculosis alone fibrocavernous specific lesion was revealed 4.3 times more often then parenchymal and cavernous ones. All examined patients were referred to TB hospitals in a year and later, therefore it was out of time.

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6. Original research

 

Tuberculous mesenteric adenitis in emergency surgery

P.V. Stroganov, S.A. Geshelyn, Nguen Van Khan

Introduction. Tuberculous mesenteric adenitis complicated with peritonitis and acute intestinal obstruction causes indications for emergency surgery.
Objective — to analyze the treatment outcomes of patients being operated for urgent complicated tuberculous mesenteric adenitis depending on the characteristics of complications and HIV-infection.
Materials and methods. 13 patients with complicated tuberculous mesenteric adenitis were examined. All patients performed a biopsy of mesenteric lymph nodes and histological examination. Autopsy with macroscopic and microscopic assessments of the internal organs was carried out for all death cases according to standard protocol.
Results and discussion. Tuberculous mesenteric adenitis was complicated with peritonitis in 7 patients (3 were HIV-positive), abscesses between intestinal loops — in 3 (2 of them were HIV-positive), acute intestinal obstruction — in 3 (all 3 of them were HIV-positive). 8 patients died, 6 of thеm were HIV-positive.
Conclusions. Mortality rate of patients being operated for urgent complicated tuberculous mesenteric adenitis is high. HIV-infected patients prevailed over the dead. Mortality rate of patients died after being operated for urgent complicated tuberculous mesenteric adenitis (diffuse peritonitis, abscesses between intestinal loops, acute intestinal obstruction) did not have significant differences.

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7. Original research

 

Endoscopic characteristics of tracheobronchial tree in patients with the new-onset pulmonary tuberculosis

A.В. Dudnyk, O.Ts. Pavelchuk

The aim of our study was evaluation of endoscopic features of tracheobronchial tree in patients with the new-onset pulmonary tuberculosis.
Materials and methods. Retrospective evaluation of the fiber-optic bronchoscopy results in 260 patients with the new-onset pulmonary tuberculosis who received hospital treatment in Vinnytsia Anti-tuberculosis Dispensary over 2007—2009 years was made.
Results. The analysis of association between frequency of endobronchitis and clinical and functional features of obstructive syndrome in patients with this pathology was carried out.
Conclusions. The presence of obstructive syndrome in patients with the new-onset pulmonary tuberculosis increases chances of endobronchial pathology detection with different genesis.

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8. Original research

 

Immunocorrective influence of regional lymphotropic therapy with the further ultrasound therapy of underarm area in patients with destructive forms of pulmonary tuberculosis

S.O. Polyakova

Basic indices of the immunity system in patients with pulmonary tuberculosis were analyzed in this article.
Aim of research. To learn the changes of immune system indices under the impact of regional lymphotropic therapy with the further ultrasound therapy of introduction area versus similar indices in patients with lymphotropic therapy alone and patients with traditional anti-tuberculosis therapy alone.
Materials and methods. All patients (152 persons) were divided into 3 groups: the 1 and the 2 main groups and the control group. In all groups complex anti-tuberculous treatment was used with standard combinations of drugs in a standard dosages, together with pathogenetic drugs and symptomatic treatment. Regional lymphotropic therapy with further ultrasound therapy was used in the 1 main group, regional lymphotropic therapy alone was used in the 2 main group. The control of immunological indices was carried out at the beginning of treatment in both groups, in the three month of treatment in a control group and at the end of magnetic and low frequency ultrasound therapy in main group.
Results and discussion. On the 3 month of treatment after regional lymphotropic therapy with further ultrasound therapy the index of relative amount of lymphocytes in blood considerably differed from the one before treatment in the patients of the 1 main group (36.0 ± 1.2) % (р < 0.001); a considerable improvement is was marked for СD3-Т-lymphocytes (59.6 ± 1.6) % and reaches the level of this index for healthy donors (60.7 ± 2.3) % (р > 0.05); in СD4-Т-helpers count in a 1 main group were found statistically meaningful differences (р < 0.001); in СD22-В-lymphocytes in a 1 main group were found considerable deviations toward normalization (17.9 ± 1.1) % versus the period before the treatment (15.3 ± 1.5) % (р < 0.001). In a control group statistically reliable difference between analogical indexes was not found.
Conclusions. The study results demonstrated positive influence of regional lymphotropic therapy with further ultrasound therapy on cellular and humoral links of the immunity system in patients with destructive forms of pulmonary tuberculosis.

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9. Original research

 

Tuberculosis аnd microelements

V.I. Zozulyak

Complex metabolic and energy processes in human organism have been formed over a period of millions of years. Homeostatic indexes have become constants over a long evolution process. Plenty of severe and persistent diseases result in alterations of these indexes as well as in disorder of the (Krebs) citric acid cycle. Tuberculosis is one of the diseases, which cause marked pathological alterations in the patient's organism.
The research deals with the complex chemico-clinical aspects of the microelements and metal enzymes metabolism disorders and antioxidant system inhibition indexes in patients with first diagnosed tuberculosis. In the course of investigation features of metal enzymes metabolism disorder have been established along with first identified syndrome of microelements disorder. Obtained data contributes to the clinical appliance, suggests classification, elucidates sequence of pathogenesis, prophylaxis, diagnosis and treatment options.

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10. Original research

 

Pulsation blood flow in the pulmonary circulation

B.V. Noreyko, S.B. Noreyko, Yu.A. Gryshun

The aim of the work is to estimate diagnostic abilities of the pulmonary pulsocardiografy (PPCG) in the assessment of pulmonary haemodynamics condition. 15 patients with limited forms and 18 patients with common forms of tuberculosis and sylicotuberculosis that formed the 1st and the 2nd clinical groups have been examined. 18 healthy people formed the control comparison group. Curves registration was conducted using the author's method. When estimating PPCG qualitatively and quantitatively three types of the curves reflecting of pulmonary haemodynamics condition have been identified: normal, hyperdynamic and hypodynamic.

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11. Original research

 

Nitroxydergic aspects of acute lung injury pathogenesis in experiment

M.I. Marushchak

Objective — to study the content of nitric oxide metabolites and oxidative modification of proteins in serum and lung homogenate and to show their role in the pathogenesis of experimental acute lung injury.
Materials and methods. The concentrations of nitrite anion and oxidative modification of proteins in serum and lung homogenate in 30 white mature rats with HCl-induced acute lung injury was evaluated.
Results and discussion. The content of nitric oxide metabolites and oxidative modification of proteins in serum and lung homogenate in acute lung injury was investigated. These data indicate, that in rats in serum, as far as in lung homogenate significant increase of nitric oxide metabolites and oxidative modification of proteins are observed in all groups of investigation.
Conclusions. In case of acid aspiration-induced lung injury an activation of nitroxydergic processes and oxidative stress occurs due to nitric oxide influence.

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12. EPIDEMIC SITUATION

 

The analysis of morbidity of HIV-infected patients

V.S. Goydyk, N.S. Goydyk, V.V. Shukhtin, A.I. Gozhenko

The survey deals with the study of age and morbidity structure of HIV/AIDS patients admitted to the Odessa regional Center on AIDS prevention and treatment. Study of time history of appropriate indicators and morbidity level among the discharged and departed patients over last years was carried out for the purpose of revealing patterns of morbidity growth or decrease in patients with immunosuppression.
2263 case histories have been analysed and it was found out that along with diseases with constant level — hepatitis, a pyelonephritis, there are series of the diseases with decreasing level — pneumonia, widespread forms of a candidosis, severe anemias). Among diseases with growing level is also pulmonary tuberculosis. As a conclusion, it is necessary to provide further study of morbidity tendency to make diagnostics easier and raise efficiency of treatment, modify and make more productive preventive measures.

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13. EPIDEMIC SITUATION

 

Epidemiology and clinical aspects of HIV-associated tuberculosis course in Ternopil region

L.A. Hryshchuk, M.M. Savula, V.D. Rudyk, N.S. Mayovetska, O.I. Gradova, T.V. Burtnyak

The survey revealed AIDS and HIV-associated tuberculosis growth tendency over recent years. The percentage of HIV-infection detection among TB patients increased over the past 5 years (from 0.21 % to 0.62 %). Tuberculosis is the most common AIDS-surveillance disease, the amount of cases in the Ternopil region increased from 22 in 2008 (68.4 %) to 35 (77.7 %) in 2010. The percentage of sexual transmission (44.8 %) is increasing over the last years. The cause of death in patients with associated disease was complicated tuberculosis course with concurrent AIDS and other diseases.

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14. EPIDEMIC SITUATION

 

HIV-associated tuberculosis in the Kherson region

N.I. Ryzhenko, Ya.S. Zyatyuk, G.B. Dymchenko

The paper analyzes the features of clinical and radiologic picture of tuberculosis in HIV-infected and AIDS patients on a background of antibacterial and anti-retroviral therapy. The main clinical forms of tuberculosis accompanied by impairment of the immune system of varying severity are identified in these patients. The study of Mycobacterium tuberculosis drug-resistance was carried out.

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15. Reviews

 

Pathogenetic, pathomorphological and clinical characteristics of respiratory distress syndrome

L.D. Todoriko, V.I. Petrenko

Authors acquaint readers with present pathogenetical mechanisms, morphological and clinical characteristics, standards of therapy of acute respiratory distress-syndrome.

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16. Clinical case

 

Generalized tuberculosis in HIV infection: clinical and pathomorpho-logical analysis of treatment of TB cases healing process

P.V. Kuzyk, Yu.B. Shevchuk

A clinical and pathomorphological analysis of treated generalized HIV-associated TB healing case was carried out. It is shown that the healing of tuberculous inflammation in HIV-infected patients is possible in case of limited spread of the process, the timely and adequate treatment, absence of drug resistance.

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17. MEDICAL MANAGEMENT

 

Optimization of the main levels of management of tuberculosis through improving the work of medical expert committee of Transcarpathian region

V.V. Skryp, E.P. Shymko

This article presents medical expert committee and the central medical expert committee resolutions for 2704 tuberculosis patients with different localization of the process and category, as well as for patients with suspected tuberculosis over 2010 year.

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18. MEDICAL MANAGEMENT

 

Contest organizing experience among medical staff of TB service in Donetsk region, Ukraine

S.M. Lyepshyna, V.V. Vladzymyrsky, I.I. Soshenko, V.V. Mozgovoy, E.V. Tyshchenko, N.V. Obukhova, D.L. Shestopalov, M.A. Myndrul

The article presents the results of two contests for medical staff of anti-tuberculosis service to the title of «Best in Profession» held in the Donetsk region in 2008 and 2010, with technical and material support of Rinat Akhmetov's Foundation «Development of Ukraine». Contests consisted of 3 stages. The first stage was carried out on the local level using the developed criteria, the second — on the basis of Training Center of Regional Clinical TB Hospital, the third stage was summing-up and the award of winners. For the second stage of contest staff of phthisiology and pulmonology department of Donetsk national medical university developed tests, types of situational tasks and system of assessment (evaluation) knowledge by using current computer technology. It was established that the contest can assess the level of professional knowledge of medical staff of TB services, identify the strengths and weaknesses of their training on topical phthisiology issues ,as well as motivate them to further improving their professional level.

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