[Relationship between the endogenous interferon IFN-gamma level and risk of hepatotoxic liver damage in tuberculosis patients].

Results of investigation in a group of 91 patients with infiltrative and disseminative forms of tuberculosis are presented. It is established that, at an initial level of IFN-gamma below 100 pg/ml, a higher frequency of development of the drug-induced liver injury takes place as manifested by increasing activity of the basic markers of cytolysis. Administration of the interferon inductor (cycloferon) favors positive clinical and laboratory dynamics of the tubercular process, increases the level of endogenous IFN-gamma (especially for an initial level below 100 pg/ml), and restricts the expression of drug-induced hepatotoxicity reactions.

[Remaxol hepatoprotective therapy of patients with tuberculosis and HIV infection in day unit of tuberculosis dispensary].

To improve the treatment of hepatotoxic responses to antituberculosis polychemotherapy, the impact of remaxol on the biochemical indices and parameters of the antioxidant system in patients with tuberculosis and HIV infection was estimated. The use of remaxol having cytoprotective, anticholestatic, antihypoxitic and antioxidant effects in the treatment of patients with tuberculosis and HIV infection and liver drug damage due to tuberculosis polychemotherapy significantly improved the biochemical indices and lowered the level of the cytolytic and cholestatic syndromes. Remaxol increased the antioxidant system potential and had an antihypoxitic effect.

[Treatment of non-motor fluctuations with combined drug stalevo in patients with Parkinson's disease].

All patients with Parkinson's disease (PD) with motor fluctuations due to long-term levodopa therapy have at least one non-motor fluctuation symptom. Fluctuations of non-motor symptoms associated with levodopa action phases may influence patient's quality of life more negatively than motor fluctuations. However issues related to treatment of non-motor fluctuations have not been specially studied so far. We have carried out an open observational study of an effect of a combined formulation of levodopa, carbidopa and entacapone (stalevo) on non-motor fluctuations. Forty patients with PD were included in the study. A self-reported daily diary has been administered for assessment of motor and 12 most frequent non-motor symptoms (e.g., sweating, bladder dysfunction, short-breath, pain, fatigue, dysphoria, irritability). The principle of equivalence of levodopa daily dose was used while switching patients from a bicomponent levodopa formulation to stalevo. The condition of patients was evaluated at baseline and after 3 months of treatment. The duration of off-period has decreased on the average by 1,8 h a day. The reduction of autonomic and neuropsychiatric symptoms (sweating, heat and cold sensations, bladder dysfunction, short-breath, slowness of thinking) was found. The decrease in non-motor fluctuation severity was correlated with the reduction of off-period duration. Thus, stalevo exerts the effect both on motor fluctuations and on a wide range of fluctuating non-motor symptoms.

[The use of cycloferon in the combined treatment of tuberculosis patients infected with HIV and viral hepatitis].

The study was designed to evaluate efficiency of 8-week treatment of 86 patients with tuberculosis and concomitant mild hepatitis B using cycloferon tablets. This therapy had beneficial effect on the symptoms of intoxication syndrome and respiratory manifestations of tuberculosis; in addition, it improved hemograms. By the end of the treatment the frequency of sputum abacillation was 4.9 times and positive X-ray dynamics (cavity closure) 2.2 times higher than in control. Therapy positively influenced hepatic function assessed from activity of cytolitic enzymes and bilirubin level; also, it improved serum levels of total protein.

[Combined cycloferon treatment of tuberculosis in patients infected with HIV].

Outcome of treatment of 102 patients co-infected with HIV and tuberculosis hospitalized at Second Municipal Tuberculosis Hospital (St. Petersburg) is analyzed. The median period of follow up was 8 weeks. In order to select the optimum treatment scheme, all patients were divided into three groups (I-III). Group I (51 patients) received, in addition to antituberculosis medications, cycloferon 600 mg tablets on alternate days. Group II (16 patients) received alpha and gamma interferons (Interal injection, 3 MU and Ingaron injection, 500,000 on alternate days) in combination with antituberculosis medications. Control group III (35 patients) received antituberculosis treatment plus placebo. Assessment of the outcome of TB treatment upon 8 weeks of follow up showed a remarkable improvement of clinical and immunological conditions in the patients who received interferons and cycloferon.

[Effect of dopamine agonist pramipexole (mirapex) on tremor, affective disorders and quality of life in patients with Parkinson's disease].

The open 6-month study (the MIRAG study) on the effect of D2/D3 dopamine agonist pramipexole (mirapex) on tremor, affective disorders and quality of life in patients with Parkinson's disease (PD) was carried out. Ninety-eight patients, aged from 42 to 75 years (mean age 63.2+/-10.2 years) were included in the study. Scores on the Hoehn and Yahr scale varied from 1 to 4 (mean 2,5+/-0,8). Seventy percent of patients received levodopa in average dose 351.2+/-279.4 mg; 62% of patients had motor fluctuations and 43% had dyskinesias. Pramipexole was titrated to the effective dose (maximum 3 mg/d, mean 2.1 mg/d). In the end of the study, resting tremor was reduced by 54%, postural and kinetic tremor, as assessed with UPDRS and spirography, by 50% and 15%, respectively. The severity of depressive symptoms measured with the Montgomery-Asberg Scale and a modified version of the Geriatric-Depression Scale (GDS-15) was reduced by 56%. Motor fluctuations and dyskinesias were significantly reduced while cognitive functions were not changed. The clinically significant effect reflected in the reduction of motor and non-motor symptoms was observed in 83% of patients, regardless of disease duration, severity of motor deficit, affective and cognitive disorders,. The drug was well tolerated in all patients, including those older than 70 years. Pramipexole improved quality of life in PD patients due to the attenuation of cardinal motor parkinsonian symptoms as well as symptoms, which were relatively resistant to levadopa, e.g. postural and kinetic tremor, and depression. The therapeutic effect remained for at least 6 months.

[Efficacy of rasagiline in patients with advanced Parkinson's disease with motor fluctuation (azimut study)].

An open observational 3-month study of efficacy and safety of selective MAO B inhibitor rasagiline (АZIlect) in advanced Parkinson's disease (PD) patients with mоtor fluctuations on the long-term levodopa therapy (the "АZIMUT" study) has been conducted. Forty five non-demented patients with PD (mean age 64,7±8,4 years, mean duration of disease 9,5±4,0 years, mean Hoehn-Yahr stage 3,0±0,4, mean levodopa dose 673,9 mg/d) have been included in the study. All patients received rasagiline at a dose of 1 mg once daily as an adjunct to a stable anti-parkinsonian therapy. Patient's clinical state has been assessed at baseline and after 1 and 3 months of therapy. Forty two (93%) patients have completed the study. At the end of the third month of therapy, the daily off-time was decreased by 1,7 h. The ADL score (off-state) decreased by 22%, and the UPDRS-III score (on-state) decreased by 10%. The Global Clinical Improvement Scale revealed the marked improvement in 12% patients and moderate improvement in 43% patients. The severity of freezing of gait declined by 15%. Moreover, the initial severity of freezing seems to be a predictor of rasagiline clinical efficacy. The clinical effect of rasagiline steadily increased over 3 months. The fair tolerability of the drug and low rate of dyskinesias and other complications were demonstrated. In conclusion, the study has shown that rasagiline effectively reduces the off-time duration as well as the disability in off- and on-time and optimizes levodopa efficacy at the routine clinical practice setting.

[Possibilities for the correction of immune disorders during tuberculosis infection].

Modem immunopathogenetic concepts of tuberculosis infection are summarized. Th1-mediated immune response is shown to play a leading role in the formation of antituberculosis immunity. Cytokine balance (especially that of interferon-y) has marked influence on the outcome of infection. The data on efficiency of modern immunotropic drugs suggest advantages of interferon inductors, in the first place cyclopheron, for pathogenetic therapy. Cyclopheron participates in regulation of endogenous interferon-gamma production and thereby in activation of TH1-mediated immune response that accelerates abacillation, closes cavities in organs undergoing degeneration, and improves the X-ray picture. A succinate-containing cyclopheron solution was shown to positively change the cytokine profile and X-ray structure of respiratory organs in patients with tuberculosis.

[Pathogenetic therapy of tuberculosis of respiratory organs during sanatorium-and-spa treatment].

The objective of this study was to evaluate the efficiency of combined inhalation of cycloferon for 5 weeks and oral intake of cytoflavin during the period of sanatorium-and-spa treatment of the patients with pulmonary tuberculosis. It was shown that combined immunotrophic and antioxidative treatment promotes resolution of focal and infiltrative lesions in the lungs, normalization of hemograms, and minimization of the activity of cytolytic and cholestatic markers of the liver.

[Influence of dopamine agonist pramipexole (mirapex) on tremor, cognitive and affective impairment in patients with Parkinson's disease].

The open 3-month study of influence of D2/D3 dopamine agonist pramipexole on of Parkinson's disease (PD) features, which are relatively resistant to traditional dopaminergic therapy: tremor, affective and cognitive impairment, has been conducted. Ninety-eight patients with PD, aged from 42 to 75 years (mean age 63,2+/-10,2 years), have been included in the study. Twenty percents of patients included were older than 70 years. The Hoehn and Yahr stage varied from 1 to 4 (men stage 2,5+/-0,8). Seventy percents of patients received levodopa (mean dosage 351,2+/-279,4 mg); 62% had motor fluctuations and 43% - dyskinesias. Pramipexole was titrated to effective dose (maximum 3 mg/d, mean 2,1 mg/d). The decrease of resting tremor by 50% and postural and kinetic tremor (assessed with the UPDRS and spiralography) by 37% was noticed to the end of 3 month. The severity of depressive symptoms measured with the Montgomery-Asberg scale and a modified version of the Geriatric Depression scale was reduced by one third. The statistically significant decrease of motor fluctuations and dyskinesias, increase of verbal fluency (but not other cognitive functions) were also found. The clinically significant effect of reducing of motor and non-motor symptoms was seen in 86% patients regardless of their age, illness duration, severity of motor deficit and affective and cognitive disturbances. The fair tolerability of the drug was shown including patients older than 70 years.

[Clinical features of tuberculous pleurisy in viral hepatitis and HIV infection at penitentiaries].

In 1999 to 2005, the penitentiaries of Saint Petersburg and the Leningrad Region saw a drastic (almost 30-fold) increase in the number of patients with tuberculous pleurisy concurrent with viral hepatitis and HIV infection. The convicts with concomitant stages IVa, IVb, and IVc HIV infection currently fall ill with tuberculous pleurisy more frequently. In patients with viral hepatitis concurrent with HIV infection, tuberculous pleurisy develops and runs more gravely in proportion to the number of mixed infections than in those without infectious comorbidity. The patients with tuberculous pleurisy concurrent with viral hepatitis and HIV infection show a preponderance of acute progressive pleurisy with the frequently observed tuberculosis generalization and high mortality rates.

[Analysis of death rates in patients with tuberculosis and HIV infection].

The proportion of those who died at a hospital in 2001 is 3.8% of the treated patients and that in 2002 is 4.2%. In 2003, mortality rates increased more than 3-fold and accounted for 13.4%. Patients with a long history of tuberculosis were found to have pulmonary tuberculosis without extrapulmonary foci. Generalized forms of tuberculosis were detectable in more than a third of the cases and more frequently encountered in patients with significant immunodeficiency for whom tuberculosis was opportunistic infection.

[Tuberculosis in the HIV-infected: early detection and prevention].

Tuberculosis in the HIV infected becomes an urgent problem the phthisiologists of Saint Petersburg face. The test using tuberculin in a dose of 2 TE remains the most informative method for determining Mycobacterium tuberculosis (MBT) infection in HIV-affected persons. It is a more information method than the Mantoux reaction using 5 TE. The diagnostic value of enzyme immunoassay employing tuberculous antigen is low in the persons infected MBT and HIV. There is evidence for the effectiveness of prophylactic double (isonizid and ethambutol) component courses against the development of tuberculosis for those infected with MBT and HIV.

[Use of regional lymphotropic therapy in the treatment of pulmonary tuberculosis in HIV-infected individuals]. / Primenenie regionarnoi limfotropnoi terapii v lechenii tuberkuleza legkikh u VICH-infitsirovannykh lits.

The efficiency of regional lymphotropic therapy (RLT) used to treat tuberculosis in HIV-infected patients was analyzed. With this treatment, the symptoms of intoxication are eliminated more rapidly. In shorter periods, bacterial isolation ceases and decay cavities close in the majority of patients. This chemotherapy is better tolerated and toxic reactions occur less frequently. Due to its absolute controllability, RLT is may be used in socially dysadapted patients.

[Echocardiographic evaluation of pulmonary tuberculosis in adolescent and young patients]. / Ekhokardiograficheskoe obsledovanie bol'nykh tuberkulezom legkikh podrostkovo i molodogo vozrasta.

Echo ranging and perfusion scintigraphy were performed in 52 adolescents and young subjects with new-onset pulmonary tuberculosis. At admission, enhanced myocardial echo resonance was observed in 19.2% of patients. This percentage increased to 33.9% at the end of the main treatment course. Systolic pressure in the pulmonary artery above 25 mm Hg was recorded in 44.2% of patients. The majority of them had disseminated tuberculosis and lymphatic intrathoracic disease. Pericardial inflammation developed in 23.1%, pericarditis in 9.6% of the examinees.

[Doppler-echocardiographic examination of patients with pulmonary tuberculosis]. / Ekhodoplerkardiograficheskoe obsledovanie bol'nykh tuberkulezom legkikh.

Echocardiography of 110 newly diagnosed patients with pulmonary tuberculosis was undertaken to find anatomic changes and certain blood flow indices in the right heart. These changes were represented by an enlarged chamber of the left ventricle in over half of the patients and that of the left atrium in 1/3 of them (including myocardial hypertrophy also detected most commonly in the ventricular septum in 1/3 of the cases); fibroplastic changes in the anterior wall and ventricular septum; and induration of the cusps and semilunums of the tricuspid and pulmonary valves with subvalvular structures in 1/5 of the patients. In addition to hypertrophy of the ventricular septum, an enlarged chamber of the right ventricle and the left atrium was most frequently revealed in patients with primary tuberculous process. Fibroplastic changes in the myocardium plus calcinosis were traced in the majority of the patients with disseminated tuberculosis. Higher blood pressure in the outlet chamber of the right ventricle was mostly observed in patients with intrathoracic lymph nodes and disseminated tuberculosis, elevated pressure largely coinciding with right ventricle and pulmonary artery dilatation.