Multidrug-resistant tuberculosis patients' views of interventions to reduce treatment loss to follow-up.

SETTING: Patients who initiated treatment for multidrug-resistant tuberculosis (MDR-TB) at 15 Programmatic Management of Drug-resistant Tuberculosis (PMDT) health facilities in the Philippines between July and December 2012. OBJECTIVES: To describe patients' views of current interventions, and suggest changes likely to reduce MDR-TB loss to follow-up. METHODS: In-depth interviews were conducted between April and July 2014 with MDR-TB patients who were undergoing treatment, had finished treatment at the time of the interview (controls), or had been lost to follow-up (LTFU). Responses were thematically analyzed. RESULTS: Interviews were conducted with 182 patients who were undergoing or had completed treatment and 91 LTFU patients. Views and suggestions could be thematically categorized as approaches to facilitate adherence or address barriers to adherence. The top themes were the need for transportation assistance or improvements to the current transportation assistance program, food assistance, and difficulties patients encountered related to their medications. These themes were addressed by respectively 63%, 60%, and 32% of the participants. CONCLUSIONS: A more patient-centered approach is needed to improve MDR-TB treatment adherence. Programs should strive to provide assistance that considers patient preferences, is adequate to cover actual costs or needs, and is delivered in a timely, uninterrupted manner.

Multidrug-resistant tuberculosis patients lost to follow-up: self-reported readiness to restart treatment.

SETTING: Multidrug-resistant tuberculosis (MDR-TB) patients lost to follow-up (LTFU) from Programmatic Management of Drug-resistant Tuberculosis facilities in the Philippines. OBJECTIVES: To gain insight into patients' readiness to return to treatment. METHODS: MDR-TB patients who initiated treatment and were categorized as LTFU were identified using TB registers, contacted, and asked to consent to an interview and medical record review. At the conclusion of the interview, patients' readiness to restart treatment was assessed and examined in relation to demographic, clinical, and interview data. Odds ratios were calculated. RESULTS: When asked if they would consider restarting MDR-TB treatment, 3% of the 89 participating patients reported that they had already restarted, 34% indicated that they wanted to restart, 33% had not considered restarting, 28% were undecided, and 2% had decided against restarting. Patients who wanted to restart treatment were more likely to report having borrowed money for TB-related expenses (OR 5.97, 95%CI 1.27-28.18), and were less likely to report being self-employed (OR 0.08, 95%CI 0.01-0.67), or perceive themselves at low or no risk for TB relapse (OR 0.30, 95%CI 0.08-0.96) than patients who did not indicate an interest in restarting treatment. CONCLUSIONS: Efforts to re-engage LTFU patients in care should consider financial barriers, knowledge gaps, and personal adherence challenges in patients.

[Peculiarities of sanitary and epidemiological (preventive) measures aimed at contraction and spread control of Ebola virus disease].

Now the Ebola virus continues to extend in the Western Africa. Cases, including with lethal outcomes are also registered in the countries of Europe and America. The probability of drift of this disease on the territory of the Russian Federation, including through the foreign military personnel who is trained in the country isn't excluded. For prevention of drift and distribution in Russia of the illness caused by the Ebola virus the complex of sanitary and anti-epidemic (preventive) actions is developed and introduced in practice of military health care. The specified actions allow to control an epidemiological situation on this infection and can be recommended for use to military medical experts at all levels.

Programmatic management of multidrug-resistant tuberculosis: models from three countries.

BACKGROUND: Although multidrug-resistant tuberculosis (MDR-TB) is a major global health problem, there is a gap in programmatic treatment implementation. METHODS: This study describes MDR-TB treatment models in three countries--Peru, Russia and Lesotho-- using qualitative data collected over a 13-year period. RESULTS: A program analysis is presented for each country focusing on baseline medical care, initial implementation and program evolution. A pattern analysis revealed six overarching themes common to all three programs: 1) importance of baseline assessments, 2) early identification of key collaborators, 3) identification of initial locus of care, 4) minimization of patient-incurred costs, 5) targeted interventions for vulnerable populations and 6) importance of technical assistance and funding. Site commonalities and differences in each of these areas were analyzed. CONCLUSIONS: It is recommended that all programs providing MDR-TB treatment address these six areas during program development and implementation.

[Adaptive immune response of people living near chemically hazardous object].

The article presents data dynamics of adaptive immune responses of people for a long time living in adverse environmental conditions caused by pollution of the environment by industrial toxic waste. It is shown that in the process of adaptation to adverse environmental factors, changes in the immune system are in the phase fluctuations of immunological parameters that are accompanied by changes in the structure of immunodependent pathology. Most sensitive to prolonged exposure to toxic compounds are the cellular mechanisms of immune protection. Violations of the structural and quantitative and functional parameters of the link of the immune system are leading to the formation of immunopathological processes.

'Sputnik': a programmatic approach to improve tuberculosis treatment adherence and outcome among defaulters.

SETTING: A novel patient-centered tuberculosis (TB) treatment delivery program, 'Sputnik', was introduced for patients at high risk of treatment default in Tomsk City, Russian Federation. OBJECTIVE: To assess the effects of the Sputnik intervention on patient default rates. DESIGN: We analyzed the characteristics of patients referred to the program, treatment adherence of Sputnik program enrollees before and during the intervention, and final outcomes for all patients referred to the Sputnik program. RESULTS: For patients continuing their existing regimens after referral to the program (n = 46), mean adherence to treatment increased by 56% (from 52% of prescribed doses prior to enrolment to 81%). For patients initiating new regimens after referral ( n = 5), mean adherence was 83%. Mean adherence for patients with multidrug-resistant TB (MDR-TB; n = 38) was 79% and for all others (n = 13) it was 89%. The cure rate was 71.1% for patients with MDR-TB, 60% for all others and 68% in the program overall. CONCLUSION: The Sputnik intervention was successful in reducing rates of treatment default among patients at high risk for non-adherence.

Studying the photoprotective activity of a new class of heteroaromatic antioxidants.

Photoprotective activity of heteroaromatic compounds (derivatives of 3-hydroxypyridine, amino-6-hydroxybenzothiazole, and 5-hydroxybenzimidazole) was studied in the system of UV-induced cardiolipin peroxidation. Although all three compounds had the antioxidant effect during free radical oxidation of luminol, only derivatives of amino-6-hydroxybenzothiazole and 5-hydroxybenzimidazole inhibited the process of UV-induced lipid peroxidation. The 3-hydroxypyridine derivative did not inhibit UV-induced cardiolipin peroxidation, which was probably related to degradation of this compound under the influence of UV light and formation of degradation products that cannot inhibit free radical processes.

Ultrasonic immersion echomammography: state of the art and prospects.

This article discusses the state of the art and the prospects of evolution of ultrasonic immersion mammographs. It is shown that ultrasonic immersion mammography for diagnostics of surface organs has a preference over existing ultrasonic scanning devices of contact type. An immersion mammograph has been developed, a characteristic of which is the use of compact ring multielement antenna with the electronic dynamic focusing block.

[Tomoangiography in neurosurgical clinical practice]. / Tomoangiografiia v nirokhirurgicheskoi klinike

The method of tomoangiography was developed on the "Neuroprincips" apparatus (of CGR company, France) provided with a simultaneous casset (7 films every 0.3--0.5 cm) that permits to obtain linear slides up to 2 mm thick in any phase of cerebral circulation, and in any plane and position of the patient. The examinations were conducted in 51 patients: 16 with saccular aneurysms, 9 with arteriovenous malformations, 7 with carotid-cavernous fistulas, 16 with brain tumours, 3 with orbital pathology. In 42 patients the carotid artery system was examined, in 6--the ventebrobasilar one, in 3--the venous system of the orbit, in 3--the zone of the cavernous sinuses. Tomoangiography provided additional information on the borders and depth of various pathological formations in the brain.

[The diagnostic value of pneumotomoencephalography in patholigic processes in the region of the sella turcica]. / Diagnosticheskoe znachenie pnevmotomoéntsefalografii pri pathologicheskikh protsessakh v oblasti turetskogo sedla

The pneumotomoencephalographic procedure applied by the authors in pathological processes in the region of sella turcica is indicated in cases when during pneumocisternography the air fails to fully fill the chiasmal cisternae and it is impossible to obtain a clearcut idea about the presence and the size of the tumour. In such instances an additional introduction of 8--10 ml of air into the ventricular system permits it with a changed position of the patient's head to distinctly see on the tomogram the condition of the anterio-inferior portion of the III ventricle, which is the first to suffer from the compression or newgrowth proliferation in the region of sella turcica and in this way to obtain the primary roentgenological signs in the form of its filing defects. Pneumotomoencephalography was helpful in examining 74 patients with tumours in the region of sella turcica and suffering from sequelae of inflammatory affections. In all of these cases pneumotomoencephalography furnished better diagnostic results than did pneumocisternography. In the case of large-sized tumours compressing the CSF passages this procedure helps to readily establish the lower level of their occlusion.