Multidrug-resistant tuberculosis in Uzbekistan: results of a nationwide survey, 2010 to 2011.

Multidrug-resistant tuberculosis (MDR-TB; resistance to at least rifampicin and isoniazid) is a global public health concern. In 2010­2011, Uzbekistan, in central Asia, conducted its first countrywide survey to determine the prevalence of MDR-TB among TB patients. The proportion of MDR-TB among new and previously treated TB patients throughout the country was measured and risk factors for MDR-TB explored. A total of 1,037 patients were included. MDR-TB was detected in 165 treatment-naïve (23.2%; 95% confidence interval (CI) 17.8%­29.5%) and 207 previously treated (62.0%; 95% CI: 52.5%­70.7%) patients. In 5.3% (95% CI: 3.1%­8.4%) of MDR-TB cases, resistance to fluoroquinolones and second-line injectable drugs (extensively drug resistant TB; XDR-TB) was detected. MDR-TB was significantly associated with age under 45 years (adjusted odds ratio: 2.24; 95% CI: 1.45­3.45), imprisonment (1.93; 95% CI: 1.01­3.70), previous treatment (4.45; 95% CI: 2.66­7.43), and not owning a home (1.79; 95% CI: 1.01­3.16). MDR-TB estimates for Uzbekistan are among the highest reported in former Soviet Union countries. Efforts to diagnose, treat and prevent spread of MDR-TB need scaling up.

Why do tuberculosis patients default in Tashkent City, Uzbekistan? A qualitative study.

BACKGROUND: Tuberculosis (TB) control in Tashkent City, Uzbekistan, is organised in accordance with the DOTS strategy. Intensive phase treatment is provided in hospital, while the continuation phase is given on an ambulatory basis. In 2005, the defaulter rate was 21%. An earlier quantitative study explored when patients default and identified some of the risk factors associated with default, but did not answer the question: 'Why do patients default?' OBJECTIVE: To investigate reasons for defaulting and to identify possible solutions. METHODS: We conducted a qualitative follow-up study consisting of 32 in-depth interviews with defaulters, patients who had completed treatment and health care providers. RESULTS: Communication between patients and health care staff is poor. Patients lack proper information on TB and its treatment. There is a widespread belief that TB is not curable. Hospitalisation is problematic due to poor general conditions in TB hospitals, costs incurred by patients during hospitalisation and because TB patients need to earn a living or take care of their families. CONCLUSION: Poor communication between health care staff and TB patients is a key issue underlying several of the causes of default identified, and needs to be addressed. Reducing the period of hospitalisation may also improve adherence to TB treatment.

Drug prescribing practices for tuberculosis in Uzbekistan.

SETTING: Uzbekistan has had 100% DOTS coverage since 2005; however, the treatment success rate has remained at around 80% for the last 4 years. Surveys from the capital city of Tashkent and from western Uzbekistan have shown high levels of primary multidrug resistance. OBJECTIVE: To assess treatment regimens prescribed for new cases of tuberculosis (TB), including the prescription of additional non-TB drugs, and the cost implications for the patient. DESIGN: We randomly sampled 30 clusters of seven new TB patients. Enrolled patients were interviewed and their medical records were reviewed. RESULTS: In general, the treatment regimens prescribed were correct; doses were high rather than low. Second-line anti-tuberculosis drugs were rarely prescribed. In addition to anti-tuberculosis drugs, patients were prescribed on average seven to eight non-TB drugs. The rationale for prescribing the non-TB drugs was, however, questionable. Patients incurred substantial costs for these drugs, some of which were not without risk. CONCLUSION: Prescriptions of anti-tuberculosis drugs for new TB patients are adequate; however, the practice of prescribing additional non-TB drugs needs to be reconsidered.

Mechanisms of heteroresistance to isoniazid and rifampin of Mycobacterium tuberculosis in Tashkent, Uzbekistan.

Heteroresistance of Mycobacterium tuberculosis (MTB) is defined as the coexistence of susceptible and resistant organisms to anti-tuberculosis (TB) drugs in the same patient. Heteroresistance of MTB is considered a preliminary stage to full resistance. To date, no mechanism causing heteroresistance of MTB has been proven. Clinical specimens and cultures from 35 TB patients from Tashkent, Uzbekistan, were analysed using the Genotype MTBDR assay (Hain Lifescience, Nehren, Germany), which is designed to detect genetic mutations associated with resistance to rifampin and isoniazid. Cases of heteroresistance were further subjected to genotyping using mycobacterial interspersed repetitive unit-variable-number tandem repeat typing, spoligotyping and IS6110 fingerprinting. Heteroresistance to rifampin and/or isoniazid was found in seven cases (20%). In five of them, heteroresistance was caused by two different strains and in two by a single strain of the Beijing genotype. The latter cases had a history of relapse of their TB. For the first time, two different mechanisms of heteroresistance in tuberculosis have been proven using a stepwise molecular-biological approach: 1) superinfection with two different strains, which is of interest for clinical infection control practitioners; and 2) splitting of a single strain into susceptible and resistant organisms. The latter mechanism is most likely to be related to poor treatment quality and could serve as a quality marker for tuberculosis therapy programmes in the future.

[Detection of tuberculosis in the countries of Central Asia by the electronic monitoring system data].

The basic stages of putting into practice of tuberculosis monitoring systems in the Central Asian Region (CAC) (Uzbekistan, Kazakhstan, Kyrghyz, and Tajikistan) with the assistance of the USA Centers for Disease Control and Prevention, Central Asian Region Programs (CDC/CAR), and the USA Agency for International Development in 2000-2006 are considered. These stages comprised: 1) modification of accounting and reporting forms in accordance with the requirements of the uniform statistical tuberculosis registration system; 2) development, adaptation, and introduction of an electronic tuberculosis monitoring and management system (ETMMS) in the regions and countries of Central Asia; 3) epidemiological analysis of information of tuberculosis monitoring systems, by using the elements of evidence-based medicine. At present, policy electronic tuberculosis monitoring systems entirely cover the areas of three countries of the region. The quality of entries and their processing and analysis is assured by a wide training system set up by the CDC/CAR jointly with the leading national tuberculosis facilities of CAR with the support of the Global Fund for AIDS, Tuberculosis, and Malaria Control. The information obtained by ETMMS has permitted a detail comparative analysis of the structure of tuberculosis at the level of individual regions to identify characteristic groups of areas in the demographic and sociooccupational characteristics of new tuberculosis cases.

[Some aspects of disability in patients with diabetes mellitus pa]. / Nekotorye aspekty invalidnosti bol'nykh sakharnym diabetom.

In the article, results are submitted of the study of disability of those persons presenting with diabetes mellitus (DM) in Tashkent over the period 1997-1998. Among DM subjects referrable to the examination, there prevails type 2 DM (13.9 +/- 1.6) and (10.6 +/- 0.7) years in duration in 1997 and 1998 respectively. Average DM subject age was (52.7 +/- 1.0) in 1997 and (49.7 +/- 0.8) in 1998 at the time the examined person was declared an invalid. Invalidism is noted to be on the increase (141%). At examination, more than 80 percent of persons presenting with DM are declared disabled.

[Prevalence of bronchial asthma in Uzbekistan]. / Rasprostranennost' bronkhial'noi astmy v Uzbekistane.

The prevalence of bronchial asthma has tended to increase in Uzbekistan. It is highest in the Republic of Karakalpakstan and least in the Samarkand Region. Its prevalence differs in some areas of Uzbekistan--highest in children in Karakalpakstan and in elderly persons in Tashkent. The prevalence of bronchial asthma is associated with smoking.

[Analysis of bronchial hypersensitivity in patients with bronchial asthma]. / Analiz sostoianiia giperchuvstvitel'nosti bronkhov bol'nykh bronkhial'noi astmoi.

AIM: To analyse correlation between bronchial hypersensitivity in bronchial asthma (BA) and environmental factors; to propose methods of relevant correction. MATERIAL AND METHODS: The trial included 97 BA patients (42 males, 55 females) aged 17-79 years. Bronchial sensitivity was studied by means of dose-dependent bronchial resistance curve (Rrs) plotted by the unit Masterlab (Germany) in the course of long-term inhalation of a gradually rising dose of methacholine. A regression analysis was made of the dependence of fluticasone bipropionate effectiveness on clinical symptoms of the disease. RESULTS: Bronchial hypersensitivity depends on initial clinical symptoms of BA, in a less degree on bronchial permeability, severity of inflammation of bronchial mucosa. CONCLUSION: Local corticosteroid fluticasone propionate is a drug of choice in the treatment of mild and moderate BA.