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Issue. Articles

2(9) // 2012

 

 

1. Editorial

 

Features of epidemic of tuberculosis in Ukraine

T.. Aleksandrina

Today tuberculosis stirs large alarm among all countries of the world and particularly in Ukraine. According to the WHO data tuberculosis burden in Ukraine places the country on the second place among the countries of the European region. The most actual problems in control after tuberculosis in Ukraine are prevalence of multidrug-resistant tuberculosis and possibility of the cross infecting in the conditions of antituberculosis establishment, and also permanent increase of prevalence and death rate of co-infection tuberculosis/HIV.
Taking into account the modern features of the epidemic development the Anti-tuberculosis surveillance strategy in Ukraine for 2012—2016 years has been developed. The strategy targets are set in accordance to the Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-Resistant Tuberculosis in the European region 2011—2015, approved by the WHO European regional committee in 2011. The areas of intervention are aligned with the Global plan to Stop TB 2001—2015.
The aim of the Program is further improvement of epidemic situation in order to diminish general tuberculosis incidence, reduce tuberculosis and co-infection /HIV prevalence and death rate, to slow down the trend of multidrug-resistant tuberculosis spread by implementation of public policy, which is based on principles of providing universal access for population to high-quality services in prophylaxis, diagnosis and treatment of tuberculosis.

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2. ORIGINAL RESEARCH

 

Materials of study of antituberculosis effect of doxycycline in treatment of patients with drug-resistant destructive pulmonary tuberculosis with extensive or multidrug resistance of mycobacterium

.B. Bialyk, V.V. Davidenko

Objective: to study mybacteriostatic activity and efficiency of doxycycline in treatment of patients with drug-resistant destructive pulmonary tuberculosis with extensive or multidrug resistance of MTB.
Materials and methods. Mybacteriostatic activity of doxycycline was studied against standard laboratory MTB 37Rv strain in liquid synthetic Proskauer-Beck medium with serum and on solid egg Lowenstein-Jensen medium and also against strains that were isolated from patients with resistance to the 1-st—2-nd line drugs. Doxycycline in daily dose 0.2 g during 3—11 months was included into 4—7 mainly the 2-nd line and reserve drug regimens of antimycobacterial therapy of 44 patients with drug-resistant destructive pulmonary tuberculosis with extensive or multidrag resistance of MTB after previous ineffective treatment.
Results and discussion. Doxycycline inhibits growth of standard laboratory MTB 37Rv strain in liquid Proskauer-Beck medium and on solid Lowenstein-Jensen medium and its concentration 2.5 mcg/ml also inhibits growth of the strains isolated from patients with resistance to the 1-st—2-nd line drugs on
Lowenstein-Jensen medium. Inclusion of doxycycline in regimens of antimycobacterial therapy in 44 patients with drug-resistant destructive pulmonary tuberculosis with extensive or multidrug resistance of MTB increased frequency of smear conversion on 10.8 % (to 47.7 %) and increased frequency of
partial and full regression of caverns on 18.2 %. Medium terms of smear conversion were reduced on 1 month, healing of caverns — on 0.91 month. Tolerance of doxycycline was good.
Conclusion. Doxycycline shows moderate or low mybacteriostatic activity and can serve as reserve antituberculosis drug of choice in antimycobacterial therapy of drug-resistant destructive pulmonary tuberculosis patients with extensive or multidrug resistance of MTB.

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3. Original research

 

The results of determining of behavioral risks of HIV-infected population of Transcarpathian region related to labour migration

I.S. Myroniuk

Objective: to define behavioral risks among the inhabitants of Transcarpathian region, who are related to labor migration, that probably resulted in HIV-infection.
Materials and methods. The research was performed through an anonymous questionnaire of HIV-positive persons, who were followed up for five years and at the time of the establishment of HIV-positive status were associated with labor migration outside the region.
Results and discussion. The article presents the results of determination of the major behavioral risks that lead to HIV-infection among the inhabitants of Transcarpathian region, who are related to labor migration.
Conclusions. It was found that the most risky sexual behavior is typical of male migrant workers, who play a leading role in infecting their female sexual partners, who are not personally involved into labour migration.

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4. Original research

 

The system of tumor necrosis factor lfa in the pathogenesis of experimental acute lung injury

M.I. Marushchak

Objective: to evaluate the impact of tumor necrosis factor alpha in serum and bronchoalveolar lavage in the pathogenesis of acute lung injury in the experiment.
Materials and methods. 71 white nonlinear male rats with experimental acute lung injury were examined. Concentration of tumor necrosis factor alpha and TNF-R1 in blood and bronchoalveolar lavage was estimated.
Results and discussion. Significant increase in 4.78 times of level of the tumor necrosis factor in the serum was observed in the first phase of acute lung injury. After 6 hours of study the level significantly decreased in 3.13 times but practically didn’t change in the 4-th and the 5-th study groups. In contrast
to serum significant increase of TNF level (p1 < 0.001) in the bronchoalveolar lavage in approximately 9 times was recorded during the whole period of the experiment. There was also found significant increase of TNF-R1 level during progression of acute lung injury.
Conclusions. Disorders of tumor necrosis factor alpha system occur in HCl-induced acute lung injury.
The increase of TNF and TNF-R1 in bronchoalveolar lavage was observed to be more intensive than in blood while disease progression.

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5. ORIGINAL RESEARCH

 

Character of changes in the immune system after using ozone and laser therapy in complex treatment of tuberculosis

I.L. Platonova, H.A. Ivanov, .A. Tkach, M.B. Purska, O.I. Toporovych, N.Ye. Lapovets, H.V. Shchurko, Ye.I. Pysarenko, H.D. Shtybel, N.R. Hrechukha

Objective: to examine the nature of changes in the immune system after using ozone and laser therapy in complex treatment of patients with new-onset disseminated destructive pulmonary tuberculosis.
Materials and methods. Assessment of parameters of T-cell (E-RUC, RBTL with FGA), humoral (IgA, IgM, IgG, IgE, CIC) and specific TB immune state (I-RUC, RBTL with PPD-A) was carried out in 37 patients with pulmonary tuberculosis at the beginning and during completion of the intensive phase of
treatment. Patients of the control group received an intensive standardized antimycobacterial therapy, patients of the study group — complex combination of chemotherapy with ozone and laser therapy.
Results and discussion. Patients of the control group at the completion of the intensive phase were revealed to have significant decrease of blood IgM in comparison with baseline levels while other indices did not significantly change. Patients of the study group were statistically proven to have decrease of levels of I-RUC, RBTL with PPD-L, IgE in comparison with the control group and baseline levels and also decrease of levels of Ig M, CIC in comparison with baseline levels.
Conclusions. Positive changes in the immune system during treatment occur much faster in patients receiving methods of ozone and laser therapy in addition to intensive antimycobacterial therapy.

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6. Original research

 

Comparative analysis of quality of life and general health of the patients with pulmonary tuberculosis processes of different types

Yu.P. Tsapenko

Objective — to estimate quality of life and general health scores of new%onset pulmonary tuberculosis patients and patients with recurrent tuberculosis.
Materials and methods. The questioning of 65 pulmonary tuberculosis patients was carried out using the WHOQOL-100 questionnaire.
Results and discussion. Quality of life and general health scores (QOL) of tested patient groups were the following: 84.75 ± 0.68 points in the first group, 78.96 ± 0.74 points in the second group and 99.28 ± 0.18 points in the third (control) group. QOL of the patients with recurrent tuberculosis (second group) was very poor (78.96 ± 0.74 points) while QOL of the patients with new-onset pulmonary tuberculosis (first group) was 14.64 % lower (84.75 ± 0.68 points) in comparison with control group (99.28 ± 0.18 points).
Quality of life and general health of the patients with infiltrative pulmonary tuberculosis in both groups were better in comparison with patients with new-onset disseminated pulmonary tuberculosis and recurrent disseminated tuberculosis.
Conclusion. Total quality of life and general health scores of the patients with tuberculosis in tested groups were worthier in comparison with healthy persons. The type of tuberculosis process and its clinical form affects quality of life and general health of the patients with tuberculosis.

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7. Original research

 

The role of alveolar macrophages in the pathogenesis of experimental hepatopulmonary syndrome

I.Ya. Krynytska

Objective: to determine the alveolar macrophage count in the bronchoalveolar lavage fluid in rats with experimental hepatopulmonary syndrome.
Materials and methods. Bronchoalveolar lavage fluid differential cell count was performed on 32 non-linear mature rats with two experimental models of hepatopulmonary syndrome.
Results and discussion. The influence of two experimental models of hepatopulmonary syndrome on bronchoalveolar lavage fluid cell count in rats was estimated. The significant increase of absolute content of alveolar macrophages and increase of alveolar macrophages/cytosis ratio were observed in animals of
both experimental groups.
Conclusions. The alveolar macrophages are observed to accumulate in experimental hepatopulmonary syndrome model, that may be an important component of its pathogenesis.

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8. Original research

 

Biochemical blood indices in pulmonary tuberculosis patients during chemotherapy

I.T. Piatnochka, S.I. Kornaha, V.I. Piatnochka

Objective: to examine biochemical blood indices in the patients with various types of pulmonary tuberculosis during antimycobacterial therapy.
Materials and methods. 135 patients with different types of disseminated pulmonary tuberculosis (45 cases of each type) were examined before the start of the treatment, after accomplishment of the intensive phase and before discharge. The assessment of general clinical symptoms and biochemical indices such as whole blood protein, bilirubin, AST, ALT, glucose, urea, creatinine, thymol test indices was carried out.
Results and discussion. The study revealed increased levels of bilirubin, transaminase activity, thymol test indices in pulmonary tuberculosis patients during antimycobacterial therapy, that indicates the drug liver lesion that develops from the first months of intensive phase of treatment. Metabolism and kidney function was noted to be impaired that was manifested in increased levels of creatinine and urea. This impairment was more evident and stable in chronic pulmonary tuberculosis patients.
Conclusions. Impairment of some blood biochemical indices particularly bilirubin, transaminases, thymol test indices, serum creatinine and urea was observed in pulmonary tuberculosis patients during chemotherapy along with improving of general state. These changes were more evident in chronic pulmonary tuberculosis patients. All that findings indicates the negative effects of antimycobacterial therapy particularly on the liver and kidneys functional state and requires timely adequate correction.

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9. Original research

 

Level of antibodies to the atypical collagen in patients with pulmonary tuberculosis depending on the state and degree of connective tissue dysplasia

L.A. Sukhanova

Objective: to study level of antibodies to the atypical collagen (ABAC) in blood serum in patients with pulmonary tuberculosis depending on the presence of connective tissue dysplasia (CTD).
Materials and methods. 76 patients with new-onset pulmonary tuberculosis were examined. The 1st (basic) group included 37 (48.7 %) patients with phenotypical signs of CTD, 39 (51.3 %) persons made the control group. Basic group was divided into 2 sub-groups depending on expressiveness of phenotypical signs of DCF: 1st sub-group included 24 (64.9 %) patients with 3—4 main phenotypical signs of DCF, 1 sub-group — 13 (35.1 %) patients with 2 main phenotypical signs of CTD.
Results and discussion. The study showed that ABAC level depends on the presence and degree of CTD. Indices in basic group and its sub%groups with small and extensive processes were 2—4 times higher than control ones both before and after treatment. The maximal level of ABAC was found in persons with II degree CTD and extensive processes and was 3 times higher than in control group.
Conclusions. The revealed increase of ABAC level indicates the connective tissue failure.

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10. Original research

 

New diagnostic capabilities for assessment of pulmonary circuit vessels elasticity

B.V. Noreiko, S.B. Noreiko, Yu.A. Hrishun

Objective: to study capability of assessment of arterial and venous vessels of pulmonary artery system using oscillograph charts, that were recorded from the arterial vessels of systemic circuit.
Materials and methods. 108 patients with destructive pulmonary tuberculosis were examined with the use of arterial oscillograph. The 1st group included patients with local forms of new-onset pulmonary tuberculosis and with mild pulmonary dysfunction. The 2nd group included patients with fibrocavernous pulmonary tuberculosis complicated with severe restrictive pulmonary failure.
Results and discussion. Obtained data of assessment of functional state of pulmonary circuit allow to distinguishing three types of oscillograph charts, which testified to different vessel elasticity and correlated with pulmonary failure stage, lesion site and age.
Conclusions. The use of arterial oscillography significantly extends capability of assessment of functional state of pulmonary circuit vessels.

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11. NEW TECHNOLOGIES IN MEDICINE

 

Prospects of application of a telemedicine in care for the HIV-infected patients

V.S. Hoidyk, N.S. Hoidyk, S.K. Servetsky

The article presents the review and possibilities of development of basic directions of telemedicine in the modern health service, substantiates actuality of implementation of this direction in care for the HIV-infected patients, describes experience of telemedicine implementation into the consultative structure of the Odessa regional center on AIDS prevention and control.

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12. HISTORY OF MEDICINE

 

Historical stages of struggle against tuberculosis in the Odessa region

A.K. Asmolov, I.N. Smolskaia, Ye.A Baburin

The article presents the data on the historical stages of struggle against tuberculosis in the Odessa region from the pre-revolutionary period till today.

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13. HISTORY OF MEDICINE

 

The experience of the favorable cooperation of the department of phthisiology IFNMU and Regional Phthisiopulmonology Centre during 20 years

V.I. Zozuliak, L.S. Malophii

The article presents the materials of the close cooperation of the department of phthisiology IFNMU with Regional Phthisiopulmonology Centre, which is based on the 31 of December 1991 on the basis of the Ivano-Frankivsk regional antituberculosis dispensary. The article highlights the historical aspect of the close cooperation of the staff of the department and employees of the Regional Phthisiopulmonology Centre in the medical, diagnostic, scientific, educational and preventive fields. The article presents also the achievements in the struggle against the tuberculosis epidemic in the Carpathian region.

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14. TRAINING

 

rganization of the 4th year students training on phthisiology at Maksim Gorky Donetsk national medical university

S.M. Liepshyna, Ye.V. Tyshchenko, N.V. Obukhova, Ye.H. Hurenko, S.I. Kelmanskaia, M.A. Mindrul, D.L. Shestopalov, Yu.N. Horbunova

The educational process for the 4th year students at the phthisiology and pulmonology department of Donetsk national medical university is organized with the use of credit-modular system with applying modern technologies. Various formats of multimedia presentations are used during lectures. Complete methodological support is created for practical classes: guidelines for students and for teachers, case tasks, sets of radiograph films, training history cases, samples of medical records and medical instruments are prepared for the development of practical skills. Computer testing in a computer class is used to assess the level of knowledge during practical classes. A lot of attention is paid to interactive teaching methods during the independent classroom work of the students. The department information system has been created for the independent extracurricular work. The advantage of this approach is in providing
the opportunity for students to work at a convenient time as long as necessary in order to master the material using modern textbooks, manuals, additional literature and training tests. The system of extracurricular work is widely used by students in training for the practical classes on phthisiology, it enables to shorten the time to master the material and to improve the quality of preparation for the successful passing of module check-up. The implementation of educational credit-modular system has allowed assessing the knowledge and skills of the 4th year students on tuberculosis in more verifiable way, and modern computer technology greatly helped in that.

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15. EPIDEMIC SITUATION

 

Results of monitoring of AIDS death cases in the Luhansk region during 20052011 years

R.B. Chkhetiani, V.V. Nabokina, Ye.H. Zahanova, Z.P. Ivonina, A.A. Shkurat

HIV-infection is a disease, related to the expressed immunodeficiency. In spite of being described as a certain disease only in 1981 HIV-infection stands now in the 9th place among causes of child's death and in the 7th place among causes of death among 15—24 years old persons. Thus the number of the registered patients continuously increases every year, including women of reproductive age. A peak of prevalence among women is in the age of 20—40 years. Today according to the different estimation data there are about 33.4 million persons in the world who live with HIV-infection and more than 15 million persons already died from this disease. An indicator of death rate is one of basic indices, which characterizes the epidemic situation of HIV-infection/AIDS.
Objective: to analyze death rate among HIV-positive persons and its dynamics, structure, causes and factors.
Materials and methods. The retrospective analysis of the reporting documentation was carried out on the base of the Luhansk regional center on the AIDS prophylaxis and control.
Results and discussion. Increase of number of persons, who died from AIDS is observed during all period of epidemiological supervision of HIV-infection in Ukraine. In Ukraine over 2.5 thousand people die from AIDS-associated diseases annually during the last years according to the Regional AIDS centers data, and almost twice as much — according to the data of Centralized Ukrainian Statistical Centre. It testifies to the underestimation of scales of  HIV-infection/AIDS epidemic and necessity of substantial increase of ARV-therapy scope for patients who need it. Results of last year scientific researches in the different countries of the world and presented at the 18th International conference on HIV/AIDS in Vienna, Austria on the 18th—23th July 2011 showed that high-activity antiretroviral therapy (HR) influence positively not only on the state of health of patients and on the death rate among them, but is also a powerful prophylactic measure.
Conclusions. The results of the analysis testify to the necessity of substantial improvement of medical, social and psychological care for HIV-infected patients regardless of the clinical stage of disease.

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16. EPIDEMIC SITUATION

 

Prevalence and clinical and immunological features of association of tuberculosis and HIV/AIDS in Bukovina

L.D. Todoriko, O.V. Pidverbetska, A.V. Boiko

Objective: to study the prevalence and clinical-immunological peculiarities of HIV-associated tuberculosis.
The most capable of working and the most reproductive part of the population was prevalent among TB/HIV/AIDS patients. The largest number of cases (74 %) was in the age group of 25—49 years. The combination of TB and HIV/AIDS has clearly malignant nature with combined lesions of internal organs and systems, characterized by variety of clinical manifestations (pulmonary and extrapulmonary lesions) with tendency of specific process generalization. Active TB in HIV-positive people may develop at relatively high rates of CD4+ lymphocytes and leads to the decrease in its level and increase in viral load (number of viral particles in the blood sample, which indicates active multiplication of HIV in the body). It's advisory to provide treatment of patients with HIV-associated tuberculosis in tuberculosis hospital and under constant surveillance, promoting patient therapy compliance.

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17. EPIDEMIC SITUATION

 

Tuberculosis prevalence among children and adolescents from the sites of tuberculosis infection

M.I. Sakhelashvili, T.M. Balita, I.L. Platonova, H.S. Matsekh, Y.Y. Didyk, Yu.O. Lets, T.B. Rak

Objective: to study prevalence and character of tuberculosis course in children and adolescents from a contact, who became ill during 2001—2010 years.
Materials and methods. Tuberculosis prevalence in the different age-groups of the Lviv region and among children and adolescents from the sites of tuberculosis infection during periods of 2001—2005 years and 2006—2010 years was analyzed.
Results and discussion. Epidemic situation on tuberculosis among children and adolescents remains difficult, especially in the group of high risk, including group from the sites of tuberculosis infection. The highest tuberculosis prevalence is observed during the first year of life, during the 5th—6th years, 13th—4th years and in 16th—17th years. During the second period both children and adolescents are revealed to have advanced cases of tuberculosis more often than during the first period, and generalized processes with the affection of the lungs and bones are present.
Conclusions. Under present-day conditions of epidemic improvement of prophylactic measures among children and adolescents especially from the sites of tuberculosis infection is still very important.

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18. Clinical case

 

Course of tuberculosis in the patient with panhypopituitarism

M.M. Savula, N.M. Lopushanska, .. Hradova

The article describes the clinical observation of the course of tuberculosis in the patient suffering from panhypopituitarism. There were analyzed the causes and clinical symptoms of described disease. The possible mechanisms of immunosuppression induced by hormonal imbalance and its role as a risk factor in the development of tuberculosis were dicussed.

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