[Effect of Remaxol on the efficiency of standard treatment for infiltrative pulmonary tuberculosis].

AIM: To investigate the effect of Remaxol on the efficiency of standard treatment in patients with infiltrative pulmonary tuberculosis (IPT). MATERIALS AND METHODS: The results of treatment were analyzed in 90 patients with new-onset IPT in the phase of decay who received basic tuberculosis treatment regimens I, IIb, and IV. In addition, a study group of 45 patients used dropwise intravenous Remaxol 400 ml daily and a control group 45 patients had dropwise intravenous 5% glucose solution 400 ml daily. All the patients underwent clinical, laboratory and instrumental (X-ray) examinations over time. RESULTS: The incorporation of remaxol into the combination treatment of IPT enhanced the efficiency of therapy, which manifested as reductions in the hepatotoxicity of etiotropic drugs and in the degree of dysproteinemia and as accelerated destructive regression in tuberculous infiltrates with a subsequent decrease in the need for phthisiosurgical care. Remaxol included into the standard complex treatment regimens for IPT contributed to the rapider normalization of laboratory parameters of the liver and to the accelerated regression of destructive changes in the tuberculous infiltrates. CONCLUSION: Incorporation of remaxol into the combination treatment of patients with IPT enhances the efficiency of its therapy, promotes the rapider normalization of laboratory indices of the liver and the accelerated regression of destructive changes in tuberculous infiltrates, which reduces the need for phthisiosurgical care.

[Stating the need of surgical treatment of the infiltrative lung tuberculosis].

To reveal predictors of demand formation in phthisiosurgical care during standard treatment of infiltrative pulmonary tuberculosis. Clinical, radiological, laboratory and psychological examination of 103 patients with new-onset infiltrative pulmonary tuberculosis in exsolved phase (ICD-10 A15. and A16.) before standard therapy were done. All patients were divided into two groups (with indications to phthisiosurgical treatment and without indications to transthoracic operation) based on prospective 12-months follow-up results. Predictors of demand formation in phthisiosurgical care were revealed based on results of intergroup comparison and stepwise logistic regression. It was established that demand formation in phthisiosurgical care during conservative treatment of infiltrative pulmonary tuberculosis linked with M. tuberculosis presence in sputum and relative increasing sizes of tuberculous infiltrates, content of erythrocytes in blood, thymol test, atherogenic index and circulating ceruleoplasmin concentration at a time when depressive soreness and asthenia relatively decreased. Integrate algorithm of demand in phthisiosurgical care prognosis was formed by dint of stepwise logistic regression. This algorithm is based on consideration of integrated index of clinical symptoms severity, hidrosis, number of destruction in tuberculous infiltrate and its sizes, HDL concentration, total protein and serum beta-globuline percentage. Algorithm formed with logistic regression offers the possibility to make a prognosis of demand in phthisiosurgical care with 72,7% responsiveness and 80% specificity.

[Predictors of the closure of tuberculosis infiltrate decay cavities during the conservative treatment of infiltrative tuberculosis].

We studied predictors of the closure of tuberculosis infiltrate decay cavities (DC) in the affected regions in patients with infiltrative lung tuberculosis (ILT) by clinical examination. X-ray laboratory and psychological methods 103 patients were under observation for 12 months and received standard therapy. The closure was achieved during the first 4 months in 74 patients but did not occur in 29 ones. Logistic regression analysis showed that the probability of DC closure in the first 4 months decreases in parallel to the initial character of complaints of "chest pain", the size of tuberculosis infiltrates determined in X-ray study, results of thymol test, content of lipid peroxides in expirates, depressive "fatigue" and "suicidal thoughts". The probability of DC cavity during 4 months increased with the initial "number of destructions" in the infiltrate (by X-ray) and depressive "loss of working ability". Results of regression analysis permit to predict the closure of DC during the first 4 months with sensitivity 98.3% and specificity 82.4%.

[Predictors of the inefficiency of combination treatment in patients with infiltrative pulmonary tuberculosis].

AIM: To reveal the predictors of inefficiency of combination treatment in patients with infiltrative pulmonary tuberculosis (IPT). SUBJECTS AND METHODS: One hundred and three patients with new-onset IPT underwent a complex clinical, radiological, laboratory and psychological examination before treatment. The findings were compared with the results of combination treatment for IPT within a year after the initiation of therapy. RESULTS: The standard treatment regimens was ascertained to cause no clinical recovery in 6.8% of the patients who were characterized by the baseline excretion of M. tuberculosis and sputum in 100% of cases, by the highest X-ray and clinical manifestations of IPT with simultaneously evolving leukocytosis, increased erythrocyte sedimentation rate (ESR), elevated serum ceruloplasmin and enzyme markers of cholestasis, depressive fatigability, weight loss, and a worsening quality of life because of pain. Discriminant analysis yielded an algorithm for predicting the inefficiency of standard treatment for IPT, which was based on the integrative evaluation of thoracic pain, ESR, circulating ceruloplasmin levels, gamma-glutamyl transpeptidase and alkaline phosphatase activities in the serum. CONCLUSION: It has been demonstrated that the inefficiency of IPT therapy may be predicted from the data of a complex clinical, hematological, and biochemical examination of patients before therapy.

[Compliance predictors of patients with pulmonary tuberculosis needing phthisiological treatment].

The factors predicting initial readiness of patients with infiltrative pulmonary tuberculosis to give their consent to transthoracic interventions were investigated. It was shown that initial readiness of patients to give their consent to phthisiological treatment directly depended on the indices of "social functioning" and lymphocyte percentage in leukogram. The total prognosis algorithm with 94.1% sensitivity and 75% specificity is presented as discriminative function estimated by "social functioning" data, lymphocyte percentage in leukogram and ordinal evaluation of complaints to sweating.

[The medical social characteristics of patients with joint tuberculosis and HIV-infection].

The survey of 335 patients with joint tuberculosis and HIV-infection was carried out to establish the main medical social characteristics of the given category of patients. The sample consisted of persons characterized by of able-bodied age, education of not high level, no profession or occupied in entry-level professions, low or unstable level of income and having no family and children. The distinctive characteristic of patients with joint tuberculosis and HIV-infection is high prevalence of alcohol and drugs abuse. The concurrence of both alcohol and drug dependence was established in every one often respondent. The survey revealed very low level of medical activity of respondents. Almost half of the respondents were never examined on the subject of tuberculosis in the AIDS Center Only one third of respondents undergo the preventive fluorography timely.

Effect of pro- and antioxidants on insulin sensitivity and glucose tolerance.

We studied the correlation between the effect of α-lipoic acid, emoxipin, reamberin, and mexidol on LPO in vitro and the action of these drugs on insulin sensitivity and tolerance to glucose load in vivo. It was found that the preparations producing prooxidant effect in vitro (α-lipoic acid and reamberin) are characterized by pronounced insulin-potentiating activity, but only slightly increase (α-lipoic acid) or even decrease (reamberin) tolerance to glucose load. 3-Hydroxypyridine derivatives (emoxipin and mexidol) producing an antioxidant effect in vitro increase glucose tolerance, but exhibit relatively weak insulin-potentiating activity. These results suggest that differential use of the studied drugs in patients with diabetes mellitus depending on the type of the disease and individual insulin requirement is a promising trend in medical studies.

[Effect of ascorbic acid and emoxypine on the dynamics of the quantitative roentgenological and clinical semiology parameters during infiltrative tuberculosis of lungs].

Prospective, placebo-controlled randomized investigation has been performed to evaluate the effect of ascorbic acid and emoxypine on the dynamics of changes in the roentgenological and clinical pattern during infiltrative tuberculosis of lungs in comparison to the rate of Micobacterium tuberculosis eradication during the standard chemotherapy. The results show that it is expedient to include these substances in the standard chemotherapy scheme. The administration of ascorbic acid and emoxypine during the first 10 days of the standard schedule ensures accelerated resolution of tubercular infitrates and increased rate of closing of the tuberculous disintegration cavities. The use ofemoxypine accelerates the eradication of M. tuberculosis.

[Cytoflavine effect on exudative-destructive manifestations of lung tuberculosis in children and teenagers].

A prospective, placebo-controlled ordinary-"blind"-randomized investigation of the cytoflavine effect on roentgenological manifestations of exudative-destructive processes in pulmonary tissues in cases of tuberculosis in children and teenagers has been performed in comparison to changes in the the functional state of neutrophilic granulocytes and Micobacterium tuberculosis incidence in sputum during a standard four-months course of antituberculosis therapy. It is estasblished that the administration of cytoflavine at the beginning of antituberculosis complex therapy (10 mL per 24 hours, for 5 days) results in rapid suppression of exudative-destructive disease manifestations and quick cavity repair in tuberculosis-affected areas, at an increase in the probability of outcome with "small post-tuberculosis changes". The rapid suppression of exudative-destructive processes in patients having received cytoflavine was caused by its optimizing influence on phagocytic blood capacity and did not depend on the development of abacillarity in patients.

[Prediction of infiltrative pulmonary tuberculosis outcomes depending on the procedure of its detection and on the manifestation of clinical and x-ray symptoms].

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.

[Predictors of bacterial excretion in patients with infiltrative pulmonary tuberculosis].

An association of bacterial excretion with the magnitude of the X-ray and clinical symptoms of infiltrative pulmonary tuberculosis, with the intensity of concomitant anxiety-depression disorders and the results of complex laboratory peripheral blood tests was studied in 100 patients with this condition. The fact that M. tuberculosis was present in the sputum was shown to be linked to the significant increase in the size of tuberculous infiltrates, the extent of decay in the latter, their connection with the root of the lung, the spread of excretion foci, and the intensity of cough and bloody expectoration. The similar trend was demonstrated in the degree of situational anxiety, depressive indecision, and pessimism, as well as in the values of leukocytosis and erythrocyte sedimentation rate. The predictive informative value of a set of findings is illustrated by the discriminant function equation that allows the correct prediction of bacterial excretion in 76.8% of cases.

[Effect of ascorbic acid and emoxypin on the efficiency of complex chemotherapy for infiltrative pulmonary tuberculosis].

AIM: to evaluate the effect of ascorbic acid and emoxypin on the efficiency of complex chemotherapy for infiltrative pulmonary tuberculosis. SUBJECTS AND METHODS: One hundred patients with infiltrative pulmonary tuberculosis in a phase of decay were examined. The patients were divided into 3 groups. Group 1 received the standard therapy (n = 34); Groups 2 (n = 33) and 3 (n = 33) had additionally daily intravenous dropwise infusions of ascorbic acid (500 mg) (OAO "Novosibkhimpharm") or emoxypin (150 mg) (Moscow Endocrine Plant). The drugs were injected for 10 days. Therapeutic efficiency was evaluated during 12 months. RESULTS: Additional use of ascorbic acid decreased the likelihood of progression of the disease to fibrocavernous tuberculosis and promotes a good completion of 12-month course of therapy providing small posttuberculous changes. The administration of emoxypin contributes to eradication of Mycobacterium tuberculosis, reduces the time of decay cavity closure and a need for surgical treatment of pulmonary tuberculosis. CONCLUSION: The findings show it expedient to include ascorbic acid and emoxypin into the combined treatment regimen for infiltrative tuberculosis in a phase of decay.

[The values of the lipid peroxidation-antioxidative defense system as predictors of the poor course of infiltrative pulmonary tuberculosis].

The authors have studied whether an indirect clinical-and-laboratory assessment of the extent of a destructive process in the tuberculous infiltrates and that of concomitant pleural affection can be made from the values of the lipid peroxidation-antioxidative defense (PLO-AOD) system in the blood of patients with infiltrative pulmonary tuberculosis (IPT). Regression analysis has indicated that PLO-AOD values significantly reflect the extent of X-ray verified destructions in the tuberculous infiltrates, concomitant pleural involvements, the specific features of immunity of patients with IPT. The neural network technology used to analyze the baseline PLO-AOD values has been ascertained to permit a reliable prognosis of decay cavity closure 4 months after the initiation of medical treatment and of a need for surgical treatment for IPT.

[Impaired emotional sphere in patients with infiltrative pulmonary tuberculosis].

The emotional sphere was studied in 100 patients with infiltrative pulmonary tuberculosis. They were ascertained to have anxiety and depressions the degree of which largely reflected the severity of the patients' clinical. The depressive libido loss index was shown to make a valid prediction of decay cavity closure 4 months after the initiation of antituberculous therapy.

[Ordinal scales for quantification of x-ray and clinical manifestations of infiltrative pulmonary tuberculosis].

Ordinal scales for quantification of X-ray and clinical manifestations of infiltrative pulmonary tuberculosis are proposed. Correlation analysis was made to compare the values of the proposed ordinal scales with the clinicohematological and clinicoimmunological parameters of a systemic reaction to inflammation, as well as with admission body temperature and the blood levels of lipid peroxidation products. The findings suggest the adequate validity of the proposed scales for practical application.

[The effectiveness of ascorbic acid and emoxipin in treatment of infiltrative pulmonary tuberculosis].

The aim of this prospective placebo-controlled randomized study was to assess the effectiveness of ascorbic acid or emoxipin in the regimen of the therapy of infiltrative pulmonary tuberculosis. Emoxipin vs. ascorbic acid favored the eradication of tuberculosis mycobacteria. Both preparations decreased the blood level of the contra-inflammatory cytokine tumor necrosis factor-alpha (TNF-alpha), shortened time to the closure of degeneration cavities in tubercular infiltrations, decreased the risk of the development of destructive forms, and lowered the need for surgical interventions for infiltrative pulmonary tuberculosis.

[Optimization of the detection, diagnosis, and prevention of advanced forms of pulmonary tuberculosis]. / Optimizatsiia vyiavleniia, diagnostiki i profilaktiki zapushchennykh form tuberkuleza legkikh.

A rise in the number of patients with disseminated and advanced forms of tuberculosis becomes a great problem in phthisiology. The quality of tuberculosis control depends on the organization of examination of patients with the suspected tuberculosis etiology of the disease. Thus, the authors propose to optimize both general and addressing tuberculosis controlling measures, which include among them to improve general practitioners' qualification as the latter largely determines the efficiency and timeliness of verification of a tuberculous process.

[The analysis of cases of delayed diagnosis of tuberculosis among the population of the Cheliabisk district]. / Analiz sluchaev zapozdaloi diagnostiki tuberkuleza u naseleniia Cheliabinskoi oblasti.

There was a steady-state rise in tuberculosis morbidity in the Chelyabinsk Region in the 1990s. At the same time, the number of patients whose disease is untimely detected was on the increase and in some cases the disease is found just at autopsy. These facts result from the lower efficiency of tuberculosis controlling measures, from low training of general physicians in detecting and diagnosing tuberculosis, and from failure to meet the standards for examining all those who have fallen ill.

[Clinical and morphological characteristics of deaths in patients with tuberculosis]. / Kliniko-morfologicheskaia kharakteristika letal'nykh sluchaev u bol'nyk tuberkulezom.

The clinical, morphological, and tanatological features of tuberculosis have been studied in patients who died in 1994-1996. Group 1 and Group 2 included 91 and 190 patients, respectively. It has been found that the present-day stage is marked by a trend for tuberculosis reversion with the characteristics typical of the preantibiotic period. Along with worse epidemiological parameters, there is an increase in the incidence of miliary tuberculosis and caseous pneumonia. The common cause of death is tuberculosis progression. The present stage differs from the preantibiotic period by the fact that progression rapidly occurs with specific therapy due to an increase in cases with documented drug resistance.