Problemy tuberkuleza i boleznei legkikh最新文献

The possibility of predicting the outcomes of infiltrative pulmonary tuberculosis (IPT) depending on the procedure of its detection and on the manifestations of clinical and X-ray symptoms has been assessed. The severity of clinical symptoms of IPT is shown to be much higher in patients who actively seek medical aid than that in patients identified at planned fluorographic study. Actively seeking medical aid and the high baseline degree of clinical and X-ray manifestations have been found to be significant predictors of a good response to combined drug therapy for IPT with the clinical recovery being achieved in patients, the minor residual (posttuberculosis) changes developed in the lung, and the decreased need for surgical treatment for IPT.

The authors studied statistical data on the trend in quantitative and qualitative tuberculosis epidemiological indices in Armenia in the period of 1997 to 2006. They ascertained a 1.7-fold rise in the incidence and prevalence of tuberculosis per 100,000 (from 27.8 to 48.6 and from 103.8 to 176.1), by preserving the mortality rates at the same level (4.3). However, morbidity rates have become steady-state in the past 2 years. Along with this, that was a slight deterioration in the qualitative indices--new tuberculosis cases showed increases in the proportion of destructive forms from 62.9 to 67.7%, bacteria-discharging persons from 70 to 75.9%, extrapulmonary forms from 7.3 to 9.3%, childhood morbidity from 9.6 to 19.1% with reductions in their proportion among all detected patients from 12.2 to 9.9%; an increase in the proportion of deceased persons within the first year of the disease from 20.6 to 35.0% and in postmortem diagnosis rates from 0.7 to 0.8%. The cure rates comprised an increase in cavern closure rates from 55.4 to 66%, with the preservation of bacterial discharge cessation at the level of 73-74%, a reduction in mortality rates among both new cases from 3.5 to 2.5 and the contingent of tuberculosis patients from 4.8 to 3.5%, a 3.3-fold rise in early recurrences (from 0.9 to 1.3 per 100,000). The further task of the republic's antituberculosis service, planned by the authors, is to improve work in actively detecting tuberculosis in risk groups and treatment monitoring in patients with tuberculosis.

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.

Enzyme immunoassay (EIA) was used to study the diagnostic value of PTAT circulating in the free and attached state as part of serum circulating immune complexes (CIC) in 34 patients with tuberculosis (TB), 38 with concomitant HIV/TB infection, and 92 with HIV infection without active tuberculosis. A humoral immunological response as circulating PTAT and PTAT conjugated in specific CIC depends on both the form and degree of pulmonary tuberculosis and may be employed to diagnose a disease running as both an independent entity and in the concomitant HIV/TB infection. The use of specific CIC yields additional information on the presence and circulation of mycobacterial antigenic components, which should be borne in mind at the early stages of the disease. EIA diagnosis of pulmonary tuberculosis from the significant titer of PTAT is relatively effective at the stages with infiltration and it ascertains destructive changes before their detection on X-ray and tomographic films.

The clinical and hematological manifestations and functional state of the immune system were comparatively evaluated in patients with concomitant HIV/tuberculosis (TB) infection (n = 84) and in those with HIV infection without tuberculosis (n = 106). The course of concomitant HIV-TB infection was ascertained to differ from HIV monoinfection in a diversity of additional exposures that aggravated the patients' general condition. These included: the parameters of a long proceeding inflammatory process, which were accompanied by the signs of the infection-toxic syndrome, inflammatory changes in the hemogram, by a sharp stimulation of the nonspecific link of immunity. So the comparative analysis of the trend in HIV infection in combination with active tuberculosis and HIV monoinfection revealed a prompter progression of the disease in the former case.

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 erythrocytic sedimentation rate method has been long known in medicine and extensively used in laboratory practice in tuberculosis facilities. However, many authors note that the erythrocytic sedimentation rate phenomenon has not clearly understood. By applying the total theory of relativity and quantum mechanics, the author discloses the physical essence of erythrocytic sedimentation in the gravitation field of the Earth.