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Issue. Articles

4(7) // 2011



1. Editorial


Rationale choice of fluoroquinolones in treatment of patients with multidrug resistant tuberculosis and comparative evolution of their efficacy and tolerability

Yu.I. Feshchenko, S.. Cherenko

On the basis of literature data about activity of fluoroquinolones against Mycobacterium tuberculosis, their pharmacokinetics, pharmacodynamics and side effects, cost effectiveness in Ukraine authors present the rationale choice of fluoroquinolones in treatment of patients with multidrug resitant tuberculosis. According to many studies universal fluoroquinolone without regard for its cost is levofloxacin. Levofloxacin has the highest activity against MTB than ofloxacin, has the best farmakokinetic characteristics, which provide a bactericidal effect in comparison with other fluoroquinolones, a good safety profile. In conditions of limited resources, patients with new cases of MDR TB, who had never been treated by fluoroquinolones and had no contact with patients with multidrug resistant tuberculosis, ofloxacin should be used as the cheapest and the most effective fluoroquinolone.

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2. Editorial


Tuberculin skin test: insulin or tuberculin syringes?

V.I. Petrenko

Research objective — Evaluate capability adequacy of insulin and tuberculine syringes for tuberculin dose volume.
Materials and methods. Comparative analysis of syringes of three manufactureres was perfomed: tuberculin one (China), insulin ones (USA, Spain). Measuring of tuberculin dose volume was performed repeatedly for assessment of test accuracy.
Results. Insulin syringes are not only inadequate to dose volume, but also differ from the real syringe volume, that results in efficiency changes of using insulin syringes for Mantoux test.
Conclusions.The use of insulin syringes results in inaccurate dosing of tuberculin, that can cause unreliability of results.

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3. Original research


Hormonal and metabolic mechanisms of preclinical carbohydrate metabolism disturbances pathogenesis in patients with pulmonary tuberculosis

.H. Andrieieva

Objective. Define the features of hormonal and metabolic mechanisms of preclinical carbohydrate metabolism disorders in tuberculosis patients and develop the pathogenetically based correction method.
Methods: ommon clinical, roentgenological, microbiological, immunoenzyme and radioimmunological hormonal, biochemical, statistical.
Results and discussion. There are signs of relative insulin insufficiency with functional backup limitation of the β-cells complex relative to the adequate providing of glucose homoeostasis against the background of hormonal contra insulin systems activation in lung tuberculosis patients with preclinical carbohydrate metabolism disorders. Application in treatment of the so-called anabolic doses of insulin results in normalization of insulin and C-peptide dynamics indexes (strengthening of early phase of secretion with the simultaneous decline of insulin spike on the test eventual stages), recovery of tissue sensibility to the insulin hypoglycemic action, decline of the adaptation hormonal systems activity with recovery of its functional spare capacities, diminishing of oxidative stress displays, increase of cells power status.
Conclusions. Addition of insulin for 90 days in a daily dose 0.2 U/kg in complex therapy of patients with preclinical glycemia disorders results in normalization of glucose oral tolerance test results in 66.7 % of patients relative to 14.8 % of patients without correction.

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4. Original research


Efficacy and tolerability of antituberculosis therapy in combination with antiretroviral therapy in patients with TB/HIV co-infection

S.O. Cherenko, .V. Pohrebna, H.M. Roienko, O.. Reva

In order to study the frequency of adverse reactions in patients with TB/HIV coinfection while undergoing both antituberculosis chemotherapy and antiretroviral therapy (ART) and to establish the results of tuberculosis treatment a controlled retrospective study involving 64 patients with this pathology was carried out.
Materials and methods. Using the method of matching the form and extent of tuberculosis, the severity of HIV-infection patients were divided into 2 groups of 34 persons, depending on the application of ART (study group) during antituberculosis chemotherapy the intensive phase. Patients in both groups had
concomitant viral hepatitis B or C, respectively in 88.2 % and 85.3 % of cases. Antituberculosis chemotherapy was started according to the standard schedule for the 1-st clinical category. In 24 (70.6%) patients ART regimen included (efavirenz / nevirapin) + (lamivudine + zidovudine), the rest cases — (kaletra) + (lamivudine + zidovudine).
Results. Adverse reactions occurred mainly as a result of antituberculosis chemotherapy, as far as they developed before the application of ART. High rates of adverse reactions were recorded in both groups respectively in 64.7 % and 55.9 % of cases (p > 0,05). The most often occured hepatotoxic reactions — 41.2 % of patients in the study group and in 35.5 % of patients in the control group (p > 0,05), probably due to the high incidence of viral hepatitis in these patients. During the antituberculosis chemotherapy intensive phase 80.0 % of patients in the study group and 45.5 % of patients in the control group achieved sputum conversion (p < 0,05).
Conclusions. Patients with TB/HIV coinfection with a high frequency suffer from the adverse reactions mainly due to the antituberculosis chemotherapy — 64.7 %—55.9 % of cases, mainly by hepatotoxic adverse reactions. ART did not significantly increase (13.6 %) the adverse reactions frequency, however, increased the effectiveness of treatment by sputum conversion rate in 1.8 times.

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5. Original research


Prognostic indexes of the extensive drug resistance development in patients with multidrug resistant tuberculosis

N.. Lytvynenko, M.V. Pohrebna, S.. Cherenko, Yu.. Senko, V.V. Davydenko, .. Barbova

The problem of extensively drug resistant tuberculosis became in 2010 year challenging problem in 54 country of the word. Prevalence of extensively drug resistant tuberculosis is promoted by high reproductive ability of multidrug resistant cultures of MTB, especially the Beijing family ones.
Objective — finding the prognostic indexes of extensive drug resistance development in patients with multidrug resistant tuberculosis.
Materials and methods. The study included 244 patients from 2 therapeutic departments of State organization «F.G. Yanovsky National phthisiology and pulmonology institute of Academy of medical sciences of Ukraine», who underwent treatment from 2007 to 2010 years. Drug resistance data was taken from case histories and contained MTB drug susceptibility tests.
Results and discussion. The most significant unfavorable prognostic indexes of extensive drug resistance development were identified in 244 patients with multidrug resistant tuberculosis.
Conclusions. Patients had high chances of development the extensively drug resistant tuberculosis with the following prognostic indexes: prior exposure to a second line antituberculosis drugs; the presence of bilateral and cavitary lesions; the presence of severe side effects at the intensive phase of chemotherapy,
which resulted in abolition of antituberculosis drug; low treatment adherence at the intensive phase of chemotherapy.

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6. Original research


Diagnostics of the immunity cellular link state in HIV-infected patients using opportunistic fungi antigen complex

B.A. Hunko

Objective — optimization and increasing of diagnostics of the immunity cellular link state in HIV-infected patients.
Materials and methods. The results of intradermal tests with opportunistic fungi allergens (Alternaria, Aspergillius mixt, Cladosporium, Chrisonilla, Monililia, Penicillinum, Botrytis sinerea) were studied in 33 HIV-infected patients and in 25 healthy volunteers.
Results and discussion. The revealed difference between healthy persons and HIV-infected patients represent mitogens as the cellular immunity makers. Besides, Chrysonilia sitophila, Alternaria sp., Cladosporium sp. allergens were proven to be the most reliable.
Conclusions. It was demonstrated that the method of opportunistic fungi hypersensitivity determination can be used in medical establishments for determination of the cellular immunity state due to the low cost and simplicity in implementation.

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7. Original research


Dysmicroelementosis syndrome as lung tuberculosis complication

V.I. Zozuliak

Objective was to study the clinico-biochemical features of dysmicroelementosis at tuberculosis.
Materials and methods. The clinico-radiological, laboratory, bronchological, bacteriological and biochemical data were studied in 421 patients. Besides, the essential microelements and dependent metalloenzymes and metalloproteines metabolism and also free-radical reactions intensity and liver function indexes were studied in progress in 173 patients.
Results and discussion. Microelements metabolism (Cu, Cr, Fe, Mg, Zn, Co, Cd, Li, K, Na), their daily balances, and also metalloenzymes activity: ceruloplasmin, catalase, carbonic anhydrase, iron and chrom saturation of transferin were studied in patients with destructive tuberculosis. Besides, free-radical reactions intensity (chemicoluminescence) was estimated in patients plasma. It was defined that patients under study develop dysmicroelementosis syndrom (internal microelements deficiency and
increase of free-radical reactions intensity). The syndrom pathogenesis, diagnostics, clinic, treatment and prevention are described.
Conclusions. Thus, sophisticated specific tuberculosis process causes significant alterations in all types of metabolism, what manifests in dysmicroelementosis syndrome development. Dysmicroelementosis syndrome has its features of diagnostics, clinic, treatment and prophylaxis, and its timely detection and treatment improves more rapid and complete recovery of the patients.

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8. Original research


Cytocine profile in blood serum of patients with abdominal tuberculosis and acute appendicitis

V.M. Akimova, N.Ye. Lapovets, B.M. Beliavska, L.Ye. Lapovets, M.P. Zaletskyi

Objective — detecting the presence of cytokine dysregulation in inflammatory processes of various origin in the abdominal cavity.
Materials and methods. The levels of IL-1β, -6 and -10 in the serum of healthy individuals (20) and patients with the abdominal cavity inflammation of different etiology were studied: the abdominal tuberculosis (AT) (30 persons), phlegmonous appendicitis (PhA) (40 persons), gangrenous appendicitis (GA) (20 persons). Determination of interleukins in the serum was provided with a set of «Diaclone» France reagents.
Results and discussion. Levels of IL 1β, 6 and 10 in all examined groups of patients were significantly increased. The level of IL-1β in the group of patients with PhA increased more than 20 times relative to healthy individuals. In patients with AT level of IL-1β has increased 5 times relative to controls. In the group of patients with GA level of IL-1β increased 2 times relative to healthy people. In the group of patients with AT level of IL-6 also increased significantly, though was much lower than in other groups (PhA-group showed 8-fold increase vs. control, GA-group — 4-fold vs. control). Patients with AT had significant (5-fold relative to healthy persons) increase of IL-10. In the PhA-group level of IL-10 increased 2 times relative to controls. The most prominant increase of interleukin (9.5 times) was noticed in a group of patients with GA.
Conclusions. Clear changes of interleukins under study allows to differentiate the type of inflammation in the abdominal cavity.

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9. Original research


Specialites of treatment of irritable bowel syndrome in patients with infectious exacerbation of chronic obstructive pulmonary disease

C.V. Kovalenko, L.D. Todoriko

Objective. To study an influence of Spasmomen (Otyloni bromide) on the course of the irritable bowel syndrome (IBS) at antibacterial therapy of COPD infectious exacerbation.
Materials and methods. 45 patients with COPD of II—III stages (60 ≤ PEV1 % and ≥ 30 of reference value) and IBS aged from 5 to 15 years were examined. All patients with infectious exacerbation of COPD were treated with standard antibacterial therapy. The 1st group (23 persons) was given Spasmomen since the 3rd day of antibacterial therapy in a dose of 1 tablet per day during 10 days. The 2nd group (22 persons) was treated with the only basic COPD remedies plus antibiotics.
Results. Negative effect of antibacterial therapy of COPD infectious exacerbation on the IBS course was revealed. The revealed strengthening of the abdominal pain syndrome (in 81 %) required medicamental care. Positive effect of Spasmomen as a spasmolytics on the IBS course at COPD infectious exacerbation is proved.
Conclusions. When providing antibacterial therapy of COPD infectious exacerbation accompanied with IBS, the aggravation of the irritable bowel syndrome was observed first of all by strengthening of the abdominal pain syndrome. Implementation of Spasmomen in complex treatment of patients with COPD infectious exacerbation leads to abdominal pain decay in a shorter period, decrease of flatulence and tenderness along the sigmoid bowel promoting underlying disease course improvement, treatment term reduction and life quality improvement.

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10. Original research


Differential diagnostics of bronchial obstruction in patients with COPD and lung tuberculosis

M.H. Boiko, T.A. Sukhomlyn, D.M. Boiko, Yu.P. Tsapenko, O.O. Kraievska

Research objective was studying of lungs ventilation parameters in patients with COPD and tuberculosis in order to define tactics of treatment and rehabilitation.
Materials and methods. The COPD and lung tuberculosis diagnostics in 161 patients was carried out with the use of spirography, pulsoxymetry, videobronchoscopy, spiral CT. Medical Research Council Grading System (MRC) classification was used to estimate clinical features. Sputum analysis was made
by a method of Mycobacterium tuberculosis identification by DNA fingerprinting.
Results and discussion. Bronchial obstruction was diagnosed at 67 % of the patients with lung tuberculosis. Bronchial obstruction was a consequence of specific process in 25.4 %. The parameters of respiratory function in patients with the III stage COPD and lung tuberculosis had lower measures (FEV1, FEV1/FVC).
Conclusions. Presence of lung tuberculosis causes respiratory function impairment, namely bronchial obstruction and associated increase in lungs hyperinflation, especially in combination with COPD.

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11. Original research


Chemokine-induced synthesis of bronchial epithelium by TNF-α cells in patients with COPD, who have had pulmonary tuberculosis

Ya.V. Ivanova, M.N. Hryshyn

The article presents results of the study of chemokine TARC/CCL17 level and TARC/CCL17-induced synthesis of proinflammatory cytokines TNF-α in cultured cells of bronchial epithelium in patients with chronic obstructive pulmonary disease (COPD) who have had pulmonary tuberculosis (TB). It is established that the chemokine-induced synthesis of TNF-α in cultured cells of bronchial epithelium were significantly higher than LPS-induced one, and besides it was significantly higher in patients with COPD, who have had pulmonary tuberculosis, than in patients with COPD without TB anamnesis.

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Analysis of HIV/AIDS morbidity and the results of monitoring of AIDS deaths in the Luhansk region

R.B. Chkhetiani, V.V. Nabokina, E.H. Zahainova, Z.P. Ivonina

Luhansk region is a region with a fairly high incidence of HIV-infection/AIDS. It was found that in recent years there is a tendency to the increasing of HIV-infection/AIDS cases number in Luhansk region. At the same time sexual transmission is constantly increasing (47.4 %). The proportion of women
among the total number of HIV-infected people changed from 16 % to 37 %. About 80 % are women of reproductive age and as a result the number of children born of HIV-infected mothers is increasing. The leading cause of death among HIV-infected individuals is tuberculosis. The prevalence of HIV-infection in the region depends on the strategy and tactics of HIV testing, development of infrastructure of the health facilities.

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13. Lectures


Fungal lesions of lungs at immunodeficiency conditions Part 2

O.D. Nikolaieva, .V. Liskina

The study objective is to provide review on the clinical manifestations of deep fungal infections, mainly affecting the lungs against the background of immune deficiency of various etiologies, to the wide range of general practitioners, pulmonologists, and TB specialists. Tactic of diagnosis and treatment of various fungal infections is presented with clinical cases and illustrations.

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14. Lectures


Viral hepatitis: problems and prospects

O.A. Holubovskai

The article presents basic modern approach to viral hepatitis with an accent on the most actual parenteral hepatitis B and . Description of their causative agents, virus replication features and modern approach to the prognosis and therapy efficiency is provided. Authors describe the modern world tendency to the solution of viral hepatitis problem on the national level and efforts that were made in Ukraine for upgrading of medical service for the patients with chronic viral hepatitis.

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15. Reviews


Treatment and prevention features of the lipodystrophy syndrome and dyslipidemia, associated with the human immunodeficiency virus, against the background of antiretroviral therapy

L.N. Prystupa, O.V. Psariova

The article presents the literature review of the treatment and prevention features of the lipodystrophy syndrome and dyslipidemia, associated with the human immunodeficiency virus against the background of antiretroviral therapy.

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16. Reviews


Safety of fluoroquinolones in pediatrics

V.I. Petrenko, H.V. Radysh

Based on joint toxity of fluoroquinolones observed in immature animals this class of antimicrobial agents is officially contraindicated in children. Clinical data on efficacy and safety of fluoroquinolones demonstrate that these agents could be used for the treatment of severe bacterial infections in children caused by drug resistant microorganisms, and refractory to standard antimicrobial regimens. Both short-and long-term administration of fluoroquinolones have shown not to affect cartilage tissue, bones and joints, as well as child growth and development.
General well tolerance of fluoroquinolones in children and low risk of adverse events, such as joint toxity, promise that developing of new standards and instructions will allow estimating the spectrum of fluoroquinolones use according to new data on its safety in children.

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17. Clinical case


Case study: diffuse lymphangioleiomyomatosis with disseminated lung tuberculosis

P.V. Kuzyk, S.F. Koshak

The article presents retrospective analysis of a fatal case of clinically undiagnosed diffuse lymphangioleiomyomatosis and disseminated tuberculosis of both lungs in 51-year old woman. Current data on the epidemiology, ethiology, pathomorphogenesis of lungs lymphangioleiomyomatosis are presented. Authors accentuate the importance of lung biopsy in early stages of disease in establishing of the correct diagnosis.

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18. Clinical case


Value of anemia in general condition of HIV-positive patient

V.S. Hoidyk

This article presents data about prevalence of anemia among HIV-positive patients, who undergo treatment in the Odessa regional Center for AIDS prevention and control. Authors describe the case of serious anemia that together with other diseases caused fatal outcome. The conclusion on drawn on high prevalence of an anemia among a HIV-positive patients, importance of its correction and necessity of the further researches for this sphere was made.

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19. Clinical case


Rare neurological manifestations of chronic tuberculous pleurisy

I.D. Duzhy, N.I. Hlazunova, A.V. Yurchenko, Raied Ziad El-Astal

Late diagnosis of tuberculous pleurisy in some patients causes chronic complication of this process that in majority of cases requires traumatic surgery — pleurectomy, which prevents lesser circuit hypertension and the development of cor pulmonale. «Interchangeable» clinical manifestations including neurological ones are one cause for late diagnosis. The authors share their experience of diagnosis and treatment of such rare clinical manifestations in these patients.

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