Chemotherapy for disseminated tuberculosis by the schemes regulated by the Order "On Improvement of Tuberculosis-Controlling Measures in the Russian Federation" issued by the Ministry of Health of the Russian Federation under No. 109 on March 21, 2003, leads to the regression of intoxication syndrome and the normalization of general blood analysis parameters in most patients, provides bacterial excretion cessation in 72.7% of the patients and decay cavity closure in 53.8%. The extent of the process, the presence of multiple decay cavities, and the detection of drug resistance are the main causes of ineffective treatment in patients with disseminated tuberculosis.
Follow-ups of 39 children aged 3 to 12 years who had various biomedical risk factors of local forms of primary tuberculosis. Difficulties in diagnosing the local clinical forms of primary tuberculosis with minor clinical and X-ray signs are shown. The authors show it necessary to use of a package of clinical, laboratory, and radiation techniques, by applying computed tomography. The latter excluded minor primary tuberculosis in 15.3+/-6.2% of children and confirmed an active tuberculous process in 23+/-6.7%, and referred it as an incomplete regression phase in 10+/-4.8% and assigned residual changes of spontaneous cure of primary tuberculosis in 9 (23+/-6.7%). There was agreement of these conventional radiation studies and computed tomography in 11 (28.12+/-6.2%) children.
The efficiency of combined treatment with retrosternal lymphotropic administration of drugs and pneumoperitoneum was comparatively analyzed in 148 new cases of destructive pulmonary tuberculosis. Both methods were applied during combined chemotherapy in a study group of 48 patients. In Group 2 (n = 54), lymphotropic procedure was employed alone during standard chemotherapy; in Group 3 (n = 46), only pneumoperitoneum was used in combination of chemotherapy. In 40 patients, pulmonary tuberculosis was acutely progressive. Drug resistance was identified in 81.7%, including multidrug resistance in 27.7%. With the combined use of retrosternal lymphotropic therapy and pneumoperitoneum, bacterial excretion ceased in 96.2% of new cases of drug-resistant tuberculosis; decay cavity resolved in 80.8%. The proposed therapeutic technology used in patients with persistent bacterial excretion and decay cavities after ineffective 4-9-month treatment could achieve abacillation in 90.9% of patients and resolve decay cavities in 77.3%. Retrosternal drug injection reduces a risk for complications due to bronchial tuberculosis involvement when pneumoperitoneum is applied.
The authors examined 51 patients aged 37.74 +/- 2.17 years who had tuberculous pleurisy and aged 49.8 +/- 4.6 years who had nonspecific pleurisy. Group 1 comprised 18 patients with isolated tuberculous exudative pleurisy. Group 2 included 13 patients with tuberculosis complicated by tuberculous pleurisy. Group 3 consisted of 10 patients with nonspecific exudative pleurisy. Catarrhal endobronchitis was the leading form of tracheo-broncheal tree lesion among patients with tuberculous exudative pleurisy (n = 20 (64.5%)). The activity of adenosine deaminase (ADA) was 2.18 +/- 0.73, 2.41 +/- 0.80, and 2.47 +/- 1.52 U/l in Groups 1, 2, and 3, respectively. Thus, the measurement of bronchoalveolar fluid ADA separately from other parameters is of no informative value in the differential diagnosis of the etiology of pleurisy. While analyzing the parameters, the authors introduced the coefficient of ADA (CADA) that was calculated using the formula: K(ADA) = ADA/cytosis. In patients with tuberculous pleurisy, K(ADA) was 0.65 +/- 0.17 (this was 0.52 +/-0.13 in isolated tuberculous exudative pleurisy and 0.84 +/- 0.36 in tuberculous exudative pleurisy complicated by pulmonary tuberculosis (p < 0.05), and 0.20 +/- 0.06 in nonspecific pleurisy (p < 0.05). The ADA coefficient of 0.52 or more confirms the tuberculous etiology in isolated pleurisies and permits a differential diagnosis to be made between specific and nonspecific pleurisy with and without lung changes.
The content of cytokines, the levels of antibodies (Ab) to proinflammatory cytokines and fetoproteins (FP) in serum, as well as the effects of fitohemagglutinin and FP on the level of cell production of cytokines into the conditioned medium were studied in relation to the pattern of a response of mononuclear cells (MNC) to FP. With the positive reaction of MNC to FP, estimated by an increment of CD9* cells and detectable in grades 2-3 dysplasias, the anti-inflammatory effect with lower anti-inflammatory cytokines was shown to be achieved due to elevated Ab levels, which may compensate for the low content of IL-4 and IL-10. With FP, there was an increase in the cell production of IL-10 that is known to stimulate antibody formation in the early phase of tumor growth, as evidenced by the association of the levels of Ab to FP with the grade of dysplasia.
The frequency and magnitude of hepatotoxic reactions were compared in 147 new cases of pulmonary tuberculosis within the first three months of chemotherapy (CT) by standard regimen 1 [H, R, Z, S (E)] (Group 1) and regimen 2B [the same drugs + kanamycin (amikacin) and fluoroquinolones] (Group 2). Their efficiency was evaluated from 6 serum indices--the level of bilirubin, the activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AP), and gamma-glutamyl transpeptidase (GGTP), and thymol test results. Tests were monthly carried out. The results were separately analyzed in patients with and without baseline abnormalities in the indices being tested. Within the first two months of CT, the patients without baseline abnormalities showed the slightly higher frequency and magnitude of hepatotoxic reactions on receiving regimen 2B. Following 3 months of CT combined with hepatoprotectors, the patients treated by standard regimen 1 had solitary laboratory signs of hepatic damage, but there was a regular elevation of GGTP in the regimen 2B group. After a month of regimen 1 CT in combination with hepatoprotectors, the patients with baseline abnormalities has positive changes in all the studied indices. In the patients treated by regimen 2B in combination with hepatoprotectors, the changes were the same, except for GGTP that remained to be at the increased baseline levels. Following 2 months of CT, in Group 1 positive changes continued in the studied markers and, with regimen 2B treatment, abnormal changes began increasing again. After 3 months abnormal changes were single in the markers of hepatic damage with regimen 1 treatment and there was a repeated significant rise in the values of AP and GGTP with regimen 2B. It is concluded that in addition to ALT and AST, GGTP is of great informative value in controlling the hepatotoxic effects of CT.
The impact of economic reformation on the incidence of tuberculosis has been studied in the Republic of Kazakhstan under new economic conditions. The highest tuberculosis morbidity rate regions have identified. The level of income is given by the country's regions and the lowest tuberculosis morbidity rate is shown in the best financial regions. The author shows that despite the fact that in the past years the socioeconomic indices have improved in the Republic of Kazakhstan as a whole, but in not all population groups they are increasing equally. The incomes of pensioners, unemployed, and workers of the budgetary sector remain low, causing a significant increase in the morbidity of tuberculosis in these social groups. The author notes that reducing the incidence of tuberculosis primarily requires improvement of the mechanisms of social protection (including the increase of the efficiency of provision of the most socially vulnerable strata with drugs).
After 3 weeks or more of treatment, 36 patients who were found to have X-ray signs of pneumonia (pulmonary infiltrative changes, fever, productive cough, weakness) were randomized into two matched groups (a study group and a control one). 77.7 and 55% of control and study group patients changed and continued antibacterial therapy. The study group patients were additionally given intravenous infusions of 400 ml of ozonized sodium chloride solution (pO3) containing 1.6 microg/ml of O3 twice weakly for 21 days. Blood ozonization considerably accelerated the resolution time of X-ray infiltrative changes so that they were undetectable in all study group patients by week 4 while they were only in 61.1% of the control groups. Blood ozonization used in combination with antibiotics permitted caused a sputum negative reaction against Chlamydia and Mycoplasma 2-3 weeks earlier. Infusions of pO3 just after the first ozonization made it possible to eliminate a clinical sign of chronic infection, such as weakness, to accelerate productive cough relief on day 10, and to reduce the number of fever patients. Ozone therapy for protracted pneumonias substantially enhances the efficiency of antibiotic treatment.
The authors present the results of a comparative microscopic study of 502 sputum smears from the patients of the Republican Tuberculosis Dispensary. Sputum smear microscopy with the Ziehl Neelsen (ZN) method and fluorescence microscopy (FM) using a Mikmed 2 (LOMO) microscope and an Olympus SX microscope with a LED Lumin attachment were compared. The latter allows conversion of a light microscope to a fluorescence one. For 2 months sputum was randomly sampled from patients at the moment of diagnosis and from those who were treated at a clinic. A culture study was used as the gold standard, among other things, to calculate the sensitivity and specificity of different microscopy methods. The sensitivity of ZN microscopy, FM on a Mikmed microscope, FM using the Lumin attachment was 28.5, 52.5, and 72.8%, respectively. The Lumin attachment is a inexpensive, portable device that converts practically all models of light microscopes to fluorescence ones. Its life is as long as 25 years, it requires maintenance and both the routine supply line and a Krona storage battery or similar ones, as well as a solar battery may be used as a source of energy.
Eight hundred and thirty autopsy protocols of died patients with schizophrenia from 1952 to 2007 were studied. Respiratory pathology as a cause of death was noted in 29.8% of cases. There are great changes in the study parameters, which have been particularly evident in the past 2 decades: a reduction in the rate of lobar (croupous) and bronchial pneumonia, an increase in the number of cases of active pulmonary tuberculosis and chronic obstructive pulmonary disease, and lung cancer. The higher incidence of the two latter diseases is associated by the author with the side effects of phenothiazine neuroleptics in the long-term treatment of schizophrenia.
Seventy-eight patients, aged 15.69 +/- 0.15 years, who had infiltrative pulmonary tuberculosis, were examined. Roncoleukin was given intravenously in 20 patients of them (Subgroup 1a), in an indirect lymphotropic fashion in 30 patients (Subgroup 1b); 28 adolescents were treated with the conventional treatments (Group 2). A decay phase was recorded in 33 (66%) from Group 1 and in 16 (57.1%) from Group 2. On admission, all 78 (100%) patients had immunological disorders that required immunomodulation. Roncoleukin caused positive clinical and X-ray changes that were more pronounced in Subgroup 1b: bacterial excretion cessation was recorded in 100% of patients in Subgroup 1a (p < 0.05); in 94.4% in Subgroup 1b (p < 0.05), and in 68.7% in Group 2; decay cavities closed in 69.2, 60, and 37.5% in Subgroups 1a and 1b and Group 2. At the same time, the duration of a procedure considerably reduced, which positively affected adolescents' compliance.
One hundred and twenty-four patients with different forms of active pulmonary tuberculosis were examined. The fibrinolytic system was assessed from the time of plasma fibrin clot lysis, plasminogen (PG) concentrations, and alpha2-antiplasmin (alpha2-AP) activity. The findings were compared with the recordings of a coagulogram, the concentration ofintravascular coagulation (IVC) markers--soluble fibrinmonomer complexes (SFMC) and D-dimers (DD), as well as with systemic inflammation indices (C-reactive protein and haptoglobin). The patients with pulmonary tuberculosis were found to have a hypercoagulation shift in the hemostatic system, which was accompanied by IVC events and quantitatively associated with the degree of systemic inflammation. This was followed by the moderately elevated PG concentrations in a third of patients and enhanced alpha2-AP activity in two thirds. The prevailing alpha2-AP rise resulted in delayed forming fibrin lysis. When influenced by a number of competitive factors, the values of PG and alpha2-AP directly correlated only with fibrinogen levels (directly). The concentration of DD directly correlated with the markers of systemic inflammation and SFMC, showed no correlations with the indices of the fibrinolytic and hemostatic systems. No correlations between PG, alpha2-AP, and DD suggests that in addition to secretion of corresponding factors, processes of their uptake play a large role in the formation of the functional status of the fibrinolytic system.
Tuberculosis in children and adolescents is closely associated with the tuberculous infection reservoir existing in the Saratov Region. In this region, the tuberculosis epidemiological situation has improved and stabilized in the past 7 follow-up years, which is undoubtedly associated with the better organization of performed tuberculosis-controlling measures.
By applying the interferon-gamma (IFN-gamma) induction technique in the whole blood samples exposed to short-term (22-24-hour) incubation in the presence of Mycobacterium tuberculosis antigens--PPD tuberculin and specific recombinant ESAT-6 lacking in the cells of vaccine BCG and other non-tuberculous mycobacteria, the authors studied the groups of children and adolescents with a negative Mantoux test (n = 31), with postvaccine BCG allergy (n = 40), as well as patients with primary tuberculous infection (n = 84) and those with pulmonary tuberculosis (n = 44). Patients with primary tuberculous infection and a high sensitivity (94%) and a high specificity (97%) may be differentiated from children and adolescents with postvaccinal allergy when the recombinant ESAT-6 antigen and the critical IFN-gamma level (greater than 70 pg/ml) detectable in the plasma samples after incubation with the antigen. It has been also shown that in adolescents with local forms of pulmonary tuberculosis specific IFN-gamma induction may be suppressed in number of cases, which is ascribed to decreased specific immunity.
The paper analyzes the efficiency of vaccination and tuberculin diagnosis in the megapolis on the basis of official reporting forms Nos. 8 and 33 approved by the 11 November, 2005 Resolution of the Russian Statistics Agency and the Moscow tuberculosis monitoring system. It is concluded that refusals to undergo vaccination and tuberculin diagnosis may result in the system crisis of antituberculous care to the pediatric population. For the optimum solution of reducing the rate of refusals to take the drugs prescribed by a physician, the authors propose to use in pediatric antituberculous care the marketing methods that level off the responsibility of the parties in taking a decision whether a medical service is expedient. Under the marketing conditions of medical services, combating the foci of tuberculous infection should be a main line to reduce the prevalence of tuberculosis. Prevention of tuberculosis is most effective with the active interaction of medical services (pediatric phthisiological and primary pediatric care services) and society and with the needs being molded in it (as a market medical service) in the population.
The indices of life quality were estimated by the Seattle questionnaire in 140 patients aged 19 to 79 years who had chronic obstructive pulmonary diseases (COPD). The results of the study determined the lower life quality indices in patients with COPD according to a number of social factors: domicile, occupation, number of family members, living conditions, and medical care.
The authors studied the efficiency of material incentives in the amount of 300 rubles for each case to medical workers of the general health care network for early detection and to those of tuberculosis facilities for effective treatment us in 2001-2007. Due to the tuberculosis-controlling measures made in these years with the mechanism of material incentives to medical workers being introduced, the tuberculosis situation stabilized and the major epidemiological indices, such as morbidity, mortality, and prevalence, decreased by 1.3, 2.2, and 1.7 times, respectively. The higher fluorographic coverage of the population and the introduction of microscopy at the general health care facilities resulted in that the number of new cases of fibrocavernous tuberculosis from 5.6 to 0.7% and, on the contrary, the proportion of bacteria-excreting subjected among the new cases of pulmonary tuberculosis increased from 18.4% in 2000 to 45.2% in 2007 or by 2.5 times (p < 0.001). The results of treatment of the new cases became better. Thus, there were increases in the rate of bacterial discharging cessation from 67% in 2000 to 84.5% in 2007 (p < 0.001), that of cavity closure from 59% in 2000 to 75.2% in 2007 (p < 0.001), and that of transfer to diagnostic registration group III from 23.1% in 2000 to 32.4% in 2007 (p < 0.01). Thus, introduction of the material incentives to the medical workers of the general health care network and tuberculosis facilities had a positive impact on the quality of diagnosis and the efficiency of treatment in patients with tuberculosis.
