[Effectiveness of an intensive chemotherapy stage in new cases of pulmonary tuberculosis and diabetes mellitus]. / Effektivnost' intensivnogo étapa khimioterapii u bol'nykh vpervye vyiavlennym tuberkulezom legkikh i sakharnym diabetom.

Intensive chemotherapy for first detected pulmonary tuberculosis was initiated in 110 patients with diabetes mellitus (DM). Types 1 and 2 DM was present in 52 and 58 patients, respectively. In accordance with the WHO recommendations, isoniazid, rifampicin, pyrazinamide, and streptomycin or ethambutol were given to the patients at the first loading stage. Following 2-3 months, they were treated with isoniazid and rifampicin (as well as with pyrazinamide in some cases). A good or fair tolerability of the first stage of chemotherapy was noted in 86 (78.2%) patients with concurrent pathology (Group 1). The signs of intolerability developed in the remaining 24 (21.8%) patients forced them have an individually chosen chemotherapy regime instead of the standard one (Group 2). Both groups were comparable by age, gender, the pattern of a pulmonary process, the types and severity of DM. The effect of treatment was much higher in Group 1 patients. According to the data of bacterioscopy and inoculation, bacterial isolation ceased in them earlier and achieved more frequently than in Group 2 patients (83.7 and 54.5%, respectively; p < 0.05). Better X-ray lung changes were revealed after 4-month therapy. Decay cavity closure after 10 months of treatment was achieved in 69.3 and 30% of the patients in Groups 1 and 2, respectively (p < 0.05). Thus, most patients with DM tolerated intensive chemotherapy for pulmonary tuberculosis well or satisfactorily. The higher efficiency of this therapy than that of individually selected regiment allows the author recommend its wider use in patients with this concomitant pathology.

[Pulmonary tuberculosis in patients with different types of diabetes mellitus]. / Tuberkulez legkikh u bol'nykh s razlichnymi tipami sakharnogo diabeta.

Comparing the clinical and X-ray characteristics of pulmonary tuberculosis developed in 110 patients with type 1 diabetes mellitus (Group 1) and in 40 patients with type 2 (Group 2) revealed significant differences between these groups. An acuter onset and rapid progression, formation of extensive lesions with multiple, but small decay areas were typical for type 1 diabetes patients. Intensive chemotherapy for tuberculosis according to the standard WHO regimens is successfully tolerated by patients with different types of diabetes mellitus. Slight changes in hepatic functions (elevated levels of total bilirubin and aminopherases) are not beyond the ranges of allowable fluctuations and they do not prevent the first stage of treatment to be performed. The short duration of this stage of treatment is a determinant of a satisfactory tolerance of intensive chemotherapy at its first most loaded stage. The outcomes of the therapy were more favourable in patients with type 1 diabetes mellitus. Their bacterial isolation ceased early and more frequently and decay cavities closed in a larger number of cases as compared with patients with type 2 diabetes mellitus. The higher efficiency of treatment in Group 1 patients was caused not only by the specific features of the genesis of a tuberculous process and the nature of its clinical and X-ray manifestation, but also by differences in isoniazid inactivation processes. The significantly higher incidence of a slight inactivation of this drug in Group 1 patients determined its higher blood concentration and more pronounced therapeutical effect.

[Experience with kipferon use in the treatment of patients with pulmonary tuberculosis]. / Opyt primeneniia kipferona pri lechenii bol'nykh tuberkulezom legkikh.

Kipferon that is a combination of recombinant human (2-interferon and a complex of immunoglobulins G, M and A, was used in suppositories as an auxiliary agent in the routine chemotherapy in 36 new cases of pulmonary tuberculosis. A control group included 19 patients identical in sex, age, and the pattern of pulmonary tuberculosis. The clinical, X-ray, and laboratory indices (primarily cellular immunity) were studies before and 1 and 3 months after treatment. The beneficial effect of kipferon was manifested by a more rapid arrest of symptoms of total intoxication eliminated after 2 weeks in 39% of patients in the experimental group and only in 21% in the controls. Normalization of blood parameters occurred following a month in 58.3 and 47% of patients, respectively. Mycobacteria tuberculosis disappeared in the sputum smears following a month of treatment in 62% of those isolating bacteria in the experimental group and only in 37.5% in the controls (P > 0.1; t = 1.6). Positive lung X-ray changes as resolved infiltration, the reduction and closure of caverns were more pronounced in the patients of the experimental group. The most characteristic change in the parameters of cellular immunity during kipferon was a short (as long as 1-1.5 months) decrease in RBT to FGA, which was noted in 47% and 6.7% of patients in the experimental and control groups, respectively (P < 0.01) and which was followed by an increase in the count of CD8+ cytotoxic lymphocytes. This is indicative of the enhancement of these mechanisms of immunity and a reduced need of enhancing or maintaining the activity of proliferative reactions of immunocompetent cells under the conditions of a favourable influence on the course of tuberculous infection.

[Features of isoniazid activation in patients with tuberculosis and diabetes mellitus]. / Osobennosti inaktivatsii izoniazida u bol'nykh tuberkulezom i sakharnym diabetom.

Isoniazid inactivation was studied in 60 patients with concomitant diseases (pulmonary tuberculosis and diabetes mellitus). Thirty three patients had type 1 diabetes mellitus (Group 1) and 27 had type 2 (Group 2). Weak isoniazid inactivators were 81.2% in Group 1 and 51.9% (p < 0.02), which was much greater than those in patients with tuberculosis alone. The distinctive features of isoniazid metabolism in patients with diabetes mellitus were decreased acetylation of the drug and appropriate increased splitting and oxidation. In patients with type 1 diabetes mellitus, the prevalence of weak drug inactivation may both promote higher chemotherapeutical efficiency and enhance the likelihood of side effects.

[Liver function at the stage of intensive tuberculosis treatment of patients with diabetes mellitus]. / Funktsiia pecheni na étape intensivnoi terapii tuberkuleza u bol'nykh sakharnym diabetom.

Intensive pulmonary tuberculosis treatment was performed in 65 patients with this disease concurrent with diabetes according to the WHO recommendations. Among them there were 44 new cases and 21 cases with relapse. Comparing the hepatic functional parameters before the first intensive stage of treatment and after its termination (following 2-3 months) showed a regular and statistically significant increase in the activity of aminotransferases and a clear tendency for increases in the values of total bilirubin and thymol tests. These changes were equally pronounced with both treatment regimens in patients with types both I and II diabetes mellitus and within normal ranges and allowed the drug treatment regimens to be continued.

[Clinical symptoms and course of pulmonary tuberculosis in patients with various types of diabetes mellitus]. / Osobennosti klinicheskoi simptomatiki i techeniia tuberculëza lëgkikh u bolnykh s raznymi tipami sakharnogo diabeta.

Clinical symptoms and progress of pulmonary tuberculosis (PT) were compared for 110 patients with insulin-dependent diabetes mellitus (IDDM) and 40 patients with non-insulin-dependent diabetes mellitus (NIDDM). PT in IDDM patients is characterized with acute onset and manifest clinical symptoms. The lung involvement becomes rapidly advanced with exudation and multiple small-size foci of destruction. PT in NIDDM runs often asymptomatically and torpidly, specific changes in the lungs seem limited, foci of destruction are solitary and large. More favourable course and outcomes of the disease are registered in IDDM patients which can be related to younger age and early diagnosis of PT.