Interactive effect between temperature and fine particulate matter on chronic disease hospital admissions in the urban area of Tianjin, China.

This study focuses on effects of fine particulate matter (PM2.5) on chronic disease under different levels of temperature. We obtained type 2 diabetes, cerebral stroke and coronary heart disease hospital admissions (HAs) from five hospitals in urban Tianjin as well as the concentrations of PM2.5, nitrogen dioxide (NO2) and sulphur dioxide (SO2). We used distributed lag nonlinear models to explore nonlinear and lag effects of PM2.5. In single-pollutant models, PM2.5 was positively associated with type 2 diabetes, cerebral stroke and coronary heart disease HAs, with strongest effects at lag1, lag0 and lag06, respectively. The corresponding relative risk rates (RR%) were 1.836%, 2.083% and 6.428%. In co-pollutant models, the correlation between PM2.5 and HAs on high-temperature days was generally stronger than that on low-temperature days. This study indicated that PM2.5 can increase HA rates for these chronic diseases, and effects of PM2.5 on high-temperature days were stronger than that on low-temperature days.

Unidades de Enfermedad Renal Crónica Avanzada en España: una encuesta nacional sobre los estándares de estructura, recursos, resultados y seguridad del paciente / Advanced Chronic Kidney Disease Units in Spain: a national survey on standards of structure, resources, results and patient safety

ANTECEDENTES Y OBJETIVO: Recientemente, se han desarrollado en España las Unidades de Enfermedad Renal Crónica Avanzada (UERCA) con el objetivo de ofrecer una mayor calidad de vida a los pacientes con ERCA, mejorar su supervivencia y disminuir la morbilidad en esta fase de la enfermedad. Al día de hoy, hay poca evidencia en la literatura española e internacional con respecto a la estructura y cómo conseguir estos objetivos en las UERCA. Desde el grupo de trabajo ERCA de la Sociedad Española de Nefrología (SEN) se impulsa este proyecto para mejorar la atención a los pacientes ERCA a través de la definición de estándares de calidad para el funcionamiento de las UERCA. MATERIAL Y MÉTODOS: Se conformó una propuesta inicial de estándares de calidad sobre el funcionamiento de las UERCA a través de la consulta de principales fuentes de referencias y el asesoramiento de un grupo de trabajo de expertos a través de reuniones presenciales y no presenciales. A partir de esta propuesta inicial de estándares, se diseñó y envío una encuesta vía correo electrónico a 121 especialistas de nefrología y profesionales de enfermería con experiencia en UERCA españolas para conocer entre otros, la idoneidad de cada estándar, es decir, su obligatoriedad o recomendación como estándar. Se permitió acceso a la encuesta entre el 16 de julio de 2018, hasta el 26 de septiembre de 2018. RESULTADOS: Participaron un total de 95 (78,5%) profesionales de los 121 que fueron invitados a participar. De éstos, 80 fueron especialistas en nefrología y 15 profesionales de enfermería, obteniéndose una variada representación de profesionales de la geografía española. Tras analizar las opiniones de estos participantes, los estándares quedaron definidos a un total de 68, 37 de ellos (54,4%) obligatorios y 31 de ellos (45,5%) recomendables. Además, se observó que el volumen de pacientes atendidos en las UERCA se sitúa usualmente por encima de los 100 pacientes, y que el criterio de derivación por regla general está por debajo de 25-29 mL/min/1,73 m2 de filtración glomerular. CONCLUSIONES: Este trabajo constituye una primera propuesta de estándares de calidad para el funcionamiento de una UERCA en España. La definición de estos estándares ha permitido establecer las bases para la estandarización de la organización de las UERCA, y trabajar posteriormente en la configuración de un manual de estándares para la acreditación de estas Unidades

BACKGROUND AND OBJECTIVE: Recently, the Advanced Chronic Kidney Disease Units (UERCA, in Spanish) have been developed in Spain to offer a better quality of life to patients with advanced chronic kidney disease (ACKD), improving their survival and reducing morbidity in this phase of the disease. Nowadays, there is not much evidence in the Spanish and international literature regarding the structure and how to achieve these objectives in the UERCA. From the ERCA working group of the Spanish Society of Nephrology (SEN), this project is promoted to improve care for ERCA patients through the definition of quality standards for the operation of the UERCA. MATERIAL AND METHODS: An initial proposal for quality standards concerning the operation of the UERCA was configured through consultation with the main sources of references and the advice of an expert working group through face-to-face and telematic meetings. Base on this initial proposal of standards, a survey was conducted and sent it via email to 121 nephrology specialist and nursing professionals with experience in Spanish UERCA to find out, among others, the suitability of each standards, that is, its mandatory nature or recommendation as standards. The access to the survey was allowed between July 16th, 2018, until September 26th, 2018. RESULTS: A total of 95 (78.5%) professionals participated out of the 121 who were invited to participate. Of these, 80 of the participants were nephrology specialists and 15 nursing professionals, obtaining a varied representation of professionals from the Spanish geography. After analyzing the opinions of these participants, the standards were defined to a total of 68, 37 of them (54.4%) mandatory and 31 of them (45.5%) recommended. Besides, it was observed that the volume of patients attended in the UERCA is usually above 100 patients, and the referral criteria is generally below 25-29 mL/min/1.73 m2 of glomerular filtration. CONCLUSIONS: This work constitutes a first proposal of quality standards for the operation of UERCA in Spain. The definition of these standards has made it possible to establish the bases for the standardization of the organization of UERCA, and to subsequently work on the configuration of a standards manual for the accreditation of ERCA Units

Detection of airborne bacteria from patient spaces in tuberculosis hospital.

Background: The spread of nosocomial bacterial infection greatly threatens public health and the impact of nosocomial infection worsens if highly pathogenic bacteria, Mycobacterium tuberculosis as an instance, involves. In this study, we have investigated the presence of airborne M. tuberculosis in a specialized tuberculosis hospital. Methods: The study sites selected were waiting room I, II, and ward VI patient lounge, Masan National Tuberculosis Hospital, where the modern ventilation system is on the operation for opportunistic infection prevention. The air samples were collected from the different sites three times for 1 day, and after air collection, air sampled disposable filter membrane was incubated for 4 weeks on nine Middlebrook 7H11 agar plates. Results: Our data showed that out of nine incubated 7H11 plate agars, four plates showed bacterial growth and these grown bacterial colonies were isolated and identified. Among bacterial species identified, there was a colony of Mycobacterium mageritense, one of nontuberculous Mycobacteria. Although there was no M. tuberculosis, the cause of tuberculous disease and transmitted through the nosocomial infection, all pathogens detected were known to be associated with nosocomial infection. Conclusions: Hospitals dealing with infectious diseases should always be wary that ventilation system does not guarantee safety from airborne pathogen exposure hence should continuously monitor the presence of other hospital-associated infection causing pathogenic microorganisms.

Clusters of COVID-19 in long-term care hospitals and facilities in Japan from 16 January to 9 May 2020.

AIM: To clarify the association of cluster number and size of coronavirus disease 2019 (COVID-19) in long-term care (LTC) hospitals/facilities, general medical/welfare facilities and non-medical/welfare facilities with morbidity and mortality in 47 prefectures during 16 January to 9 May 2020 in Japan. METHODS: Information on COVID-19 clusters (n ≥2), and morbidity and mortality of COVID-19 was collected. RESULTS: A total of 381 clusters with 3786 infected cases were collected, accounting for 23.9% of 15 852 cumulated cases on 9 May 2020. Although the cluster number (/107 subjects) in LTC hospitals/facilities was significantly smaller compared with those in the other two groups, the cluster size in LTC hospitals/facilities was significantly larger than that in non-medical/welfare facilities. Cluster numbers in general medical/welfare facilities and in non-medical/welfare facilities were significantly positively correlated with morbidity (/105 ), indicating relatively early identification of clusters in these facilities. Unlike in these facilities, cluster size in LTC hospitals/facilities was significantly positively correlated with morbidity, indicating that clusters in LTC hospitals/facilities were finally identified after already having grown to a large size in areas where infection was prevalent. Multivariate logistic regression analysis showed that both cluster number and cluster size only in LTC hospitals/facilities were independently associated with higher mortality (≥median 0.64/105 subjects) after adjustment. CONCLUSIONS: Preventive efforts against COVID-19 outbreaks even at the early phase of the epidemic are critically important in LTC hospitals/facilities, as both the larger number and size of clusters only in LTC hospitals/facilities were independently linked to higher mortality in prefectures in Japan. Geriatr Gerontol Int 2020; 20: 715-719.

Antituberculosis drug prescribing for inpatients in a national tuberculosis hospital in China, 2011-2015.

OBJECTIVES: This study aimed to describe trends in antituberculosis drug prescribing for inpatients from 2011-2015 in a Chinese national tuberculosis (TB) hospital. METHODS: This retrospective study, performed in March 2016, reviewed the medical records of all inpatients from Beijing Chest Hospital diagnosed with TB between 2011-2015. Medication used for TB treatment during the inpatient period was recorded. RESULTS: A total of 11465 inpatients were enrolled in the study. The most frequently prescribed drug for inpatients was isoniazid (71.2%; 8164/11465), followed by ethambutol (67.5%; 7738/11465), pyrazinamide (59.7%; 6839/11465) and rifampicin (40.0%; 4589/11465). In addition, amikacin (16.5%; 1889/11465), levofloxacin (33.0%; 3789/11465), para-aminosalicylic acid (12.4%; 1422/11465) and clarithromycin (3.5%; 406/11465) were the most common drugs used in the treatment of inpatients for Group II, III, IV and V drugs, respectively. A significant increasing trend in prescribing was found for rifampicin, pyrazinamide, capreomycin, moxifloxacin, prothionamide, para-aminosalicylic acid, cycloserine, clofazimine and linezolid, respectively, whilst there was a significant decreasing trend in the rate of prescribing of ethambutol, amikacin, levofloxacin, amoxicillin/clavulanic acid and clarithromycin during the 5-year study period (Ptrend<0.01). CONCLUSIONS: These data demonstrate that prescription of anti-TB drugs varied greatly across clinical diagnostic categories, treatment history and drug susceptibility profiles of TB patients. The World Health Organization (WHO)-endorsed standard regimen should be more extensively employed under conditions where drug susceptibility testing is unavailable in order to guide clinicians to formulate a suitable treatment regimen for TB patients.

Characteristics of Drug Resistant Tuberculosis in Sanatoria of North Korea.

Although several reports about drug-resistant tuberculosis (TB) in North Korea have been published, a nationwide surveillance on this disease remains to be performed. This study aims to analyze the drug resistance patterns of Mycobacterium tuberculosis among the patients in the sanatoria of North Korea, especially during the period when second-line drugs (SLDs) had not yet been officially supplied to this country. The Eugene Bell Foundation (EBF) transferred 947 sputum specimens obtained from 667 patients from 2007 to 2009 to the Clinical Research Center, Masan National Tuberculosis Hospital (MNTH), South Korea. Four hundred ninety-two patients were culture positive for TB (73.8%). Drug susceptibility test (DST) was performed for the bacilli isolated from 489 patients. Over 3 quarters of the cases (76.9%) were multidrug-resistant (MDR)-TB. Additionally, 2 patients had extremely drug-resistant (XDR)-TB. Very high resistance to first-line drugs and low resistance to fluoroquinolones (FQs) and injectable drugs (IDs) except for streptomycin (S) were detected. A small but significant regional variation in resistance pattern was observed. Big city regions had higher rate of MDR-TB, higher resistance to FQs and IDs than relatively isolated regions. In conclusion, significant number of drug-resistant TB was detected in North Korean sanatoria, and small but significant regional variations in resistance pattern were noticeable. However, the data in this study do not represent the nationwide drug resistance pattern in North Korea. Further large-scale evaluations are necessary to estimate the resistance pattern of TB in North Korea.

Use of low-dose computed tomography to assess pulmonary tuberculosis among healthcare workers in a tuberculosis hospital.

BACKGROUND: According to the World Health Organization, China is one of 22 countries with serious tuberculosis (TB) infections and one of the 27 countries with serious multidrug-resistant TB strains. Despite the decline of tuberculosis in the overall population, healthcare workers (HCWs) are still at a high risk of infection. Compared with high-income countries, the TB prevalence among HCWs is higher in low- and middle-income countries. Low-dose computed tomography (LDCT) is becoming more popular due to its superior sensitivity and lower radiation dose. However, there have been no reports about active pulmonary tuberculosis (PTB) among HCWs as assessed with LDCT. The purposes of this study were to examine PTB statuses in HCWs in hospitals specializing in TB treatment and explore the significance of the application of LDCT to these workers. METHODS: This study retrospectively analysed the physical examination data of healthcare workers in the Beijing Chest Hospital from September 2012 to December 2015. Low-dose lung CT examinations were performed in all cases. The comparisons between active and inactive PTB according to the CT findings were made using the Pearson chi-square test or the Fisher's exact test. Comparisons between the incidences of active PTB in high-risk areas and non-high-risk areas were performed using the Pearson chi-square test. Analyses of active PTB were performed according to different ages, numbers of years on the job, and the risks of the working areas. Active PTB as diagnosed by the LDCT examinations alone was compared with the final comprehensive diagnoses, and the sensitivity and positive predictive value were calculated. RESULTS: A total of 1 012 participants were included in this study. During the 4-year period of medical examinations, active PTB was found in 19 cases, and inactive PTB was found in 109 cases. The prevalence of active PTB in the participants was 1.24%, 0.67%, 0.81%, and 0.53% for years 2012 to 2015. The corresponding incidences of active PTB among the tuberculosis hospital participants were 0.86%, 0.41%, 0.54%, and 0.26%. Most HCWs with active TB (78.9%, 15/19) worked in the high-risk areas of the hospital. There was a significant difference in the incidences of active PTB between the HCWs who worked in the high-risk and non-high-risk areas (odds ratio [OR], 14.415; 95% confidence interval (CI): 4.733 - 43.896). Comparisons of the CT signs between the active and inactive groups via chi-square tests revealed that the tree-in-bud, cavity, fibrous shadow, and calcification signs exhibited significant differences (P = 0.000, 0.021, 0.001, and 0.024, respectively). Tree-in-bud and cavity opacities suggest active pulmonary tuberculosis, whereas fibrous shadow and calcification opacities are the main features of inactive pulmonary tuberculosis. Comparison with the final comprehensive diagnoses revealed that the sensitivity and positive predictive value of the diagnoses of active PTB based on LDCT alone were 100% and 86.4%, respectively. CONCLUSIONS: Healthcare workers in tuberculosis hospitals are a high-risk group for active PTB. Yearly LDCT examinations of such high-risk groups are feasible and necessary.

[Prevalence and characteristics of the "burnout syndrome" of the medical staff of cancer and TB institutions of Primorskii Krai].

As 50 doctors and 70 nurses in oncologic dispensaries as well 90 doctors and 110 nurses in tuberculosis dispensaries in Primorye have been studied on the basis of voluntary testing methods supposed by C. Maslach and V.V. Boiko. The aim of this study was to estimate the relative prevalence and psychological features of the "burnout syndrome" among doctors and nurses of oncologic and tuberculosis dispensaries in Primorye Territory. "Emotional burnout" in various stages of its development is much more common among nurses (75% of respondents), compared with physicians (less than 50% tested). In nursing professional burnout syndrome developed significantly more frequently in the more severe form, and with less seniority of professional activity. The dependence of burning on the age and professional experience is more common for physicians. There is an urgent need to study the epidemiology of the "burnout syndrome" and identify ways to prevent the formation of social syndrome in medical personnel.

The implications of long-term acute care hospital transfer practices for measures of in-hospital mortality and length of stay.

RATIONALE: The National Quality Forum recently endorsed in-hospital mortality and intensive care unit length of stay (LOS) as quality indicators for patients in the intensive care unit. These measures may be affected by transferring patients to long-term acute care hospitals (LTACs). OBJECTIVES: To quantify the implications of LTAC transfer practices on variation in mortality index and LOS index for patients in academic medical centers. METHODS: We used a cross-sectional study design using data reported to the University HealthSystem Consortium from 2008-2009. Data were from patients who were mechanically ventilated for more than 96 hours. MEASUREMENTS AND MAIN RESULTS: Using linear regression, we measured the association between mortality index and LTAC transfer rate, with the hospital as the unit of analysis. Similar analyses were conducted for LOS index and cost index. A total of 137 hospitals were analyzed, averaging 534 transfers to LTAC per hospital during the study period. Mean±SD in-hospital mortality was 24±6.4%, and observed LOS was 30.4±8.2 days. The mean LTAC transfer rate was 15.7±13.7%. Linear regression demonstrated a significant correlation between transfer rate and mortality index (R2=0.14; P<0.0001) and LOS index (R2=0.43; P<0.0001). CONCLUSIONS: LTAC hospital transfer rate has a significant impact on reported mortality and LOS indices for patients requiring prolonged acute mechanical ventilation. This is an example of factors unrelated to quality of medical care or illness severity that must be considered when interpreting mortality and LOS as quality indicators.

A retrospective study of seasonal variation in the number of cases diagnosed at a tertiary care tuberculosis hospital.

OBJECTIVE: To study the seasonality of tuberculosis (TB) in a tertiary care tuberculosis and respiratory hospital in Delhi. METHODS: Data from a tertiary care respiratory hospital in south Delhi over a six years period from April 2002 to March 2008 were analysed. RESULTS: Symptomatics: A total of 192,863 patients were registered newly in the hospital during this period. Maximum number of symptomatic patients reported to the out-patient department during April-June and the minimum during October-December. An increase of about 25% in symptomatics was observed (p < 0.05) in the period from April to June in comparison to October to December. The amplitude of seasonal variation was estimated as 11% of the annual mean symptomatics. Tuberculosis cases: The maximum sputum-positive TB cases were diagnosed during the period from April to June and the number was least during October to December. There was an increase of about 34% in sputum-positive cases (p < 0.001) during the period from April to June against October to December. The amplitude of seasonal variation was estimated as 14.4% of the annual mean smear-positives per quarter. The extra-pulmonary TB (EPTB) cases were the maximum during April-June. Chest symptomatics of all types of TB cases were the lowest in January. CONCLUSIONS: A seasonal pattern of TB was observed for pulmonary TB and EPTB cases. This information would be useful for administration and managers to take extra care to arrange and provide extra facilities during the peak seasons.

[Periodicity and quality of clinical diagnostics of protracted pneumonia in a tuberculosis clinic].

Analysis of the quality and modes of clinical diagnostics of protracted pneumonia in a tuberculosis clinic revealed the most frequent causes of this condition responsible for hyperdiagnostics of tuberculosis. These are concomitant diseases, pneumosclerosis, chronic bronchitis, fibrous transformation of the bronchial tree, complicated clinical course of pneumonia, age above 60 years, history of tuberculosis, inadequate or short-term antibiotic therapy at the initial stages of diagnostics. Motivational prerequisites for high-quality diagnostic work include compliance with standards and guidelines for the examination and management of patients suspected of having pneumonia with a view to detecting tuberculosis. Such approach would decrease the frequency of ungrounded hospitalization of patients at tuberculosis clinics.

[Multidrug-resistant tuberculosis management in three French hospitals]. / Prise en charge de la tuberculose multirésistante dans trois hôpitaux français.

INTRODUCTION: Multidrug-resistant tuberculosis (MDR-TB) management is based on specific WHO guidelines. OBJECTIVES: The authors report MDR-TB management, in three French hospitals. METHOD: The authors retrospectively included patients with positive sample for multidrug-resistant Mycobacterium tuberculosis (isoniazid+rifampicin) from January 1, 2000 to December 31, 2005. The management was compared to the French and international prevalent guidelines. RESULTS: Sixteen patients were initially managed for MDR-TB by eight different medical teams over 6 successive years: 12 (75%) presented with primary MDR-TB. Management advice from the national referee center (NRC) for tuberculosis was reported in seven out of 14 treated cases. The median length of the intensive treatment was 2 months (IQR: 1-3). Eight patients (58%) had an overall treatment length of 18 months. The median number of effective drugs prescribed was 4 (IQR: 4-5). Nine patients (64%) were also managed in a sanatorium. Only eight patients (57%) completed the prescribed treatment. Nine patients were clinically cured and still followed-up, six of whom were bacteriologically cured. CONCLUSION: TB-MDR management was not conform to WHO guidelines in our study. Management in a sanatorium, NRC involvement, ambulatory DOT were highly beneficial.

Treatment interruptions among patients with tuberculosis in Russian TB hospitals.

OBJECTIVE: To evaluate risk factors for in-patient treatment interruptions (TIs) in Russian tuberculosis (TB) hospitals. METHODS: The regional case-based registers for all TB patients registered in the main regional TB hospitals were analyzed for the period 1993-2002. Multivariable analysis of risk factors for TIs was performed using logistic regression. The prediction rule was developed based on the final multivariable model coefficients obtained from analysis of the largest (Lipetsk) database. RESULTS: During the study period, 18-50% of new cases and 36-56% of retreatment cases had interrupted in-patient treatment. In multivariate analysis, independent predictors of treatment interruption included: male gender (odds ratios (ORs) 1.5-2.3), age group 25-50 years (ORs 1.5-1.7), alcohol abuse (ORs 1.8-4.0), imprisonment history (ORs 1.3-2.5), unemployment (ORs 1.1-2.8), being a retreatment case (ORs 1.3-2.5), and having severe forms of TB (1.4-4.0); factors protective from interruption included urban residence (ORs 0.7-0.9) and having concomitant diseases (ORs 0.6-0.8). Based on the Lipeck model, new TB cases from the four regions were divided into low, high, and very high risk groups. Proportions of TI were approximately 20-35% in the low risk group, approximately 60-75% in the high risk group, and approximately 75-85% in the very high risk group (except Orel). CONCLUSIONS: We have described the independent predictors of patient TI, and a predictive rule for the in-patient TB treatment phase interruptions has been developed. Treatment interruption is a significant obstacle in the success of the National Tuberculosis Control Program in Russia. Interventions targeted at the high risk groups should be implemented in order to prevent in-patient treatment interruption.

[EXPERIENCE WITH THE NEW SKIN TEST DIASKINTEST® USED TO DIAGNOSE RESPIRATORY TUBERCULOSIS IN CHILDREN AND ADOLESCENTS IN A TUBERCULOSIS UNIT].

Seventy-two patients aged 4 to years, who had first detected X-ray changes in the lung or intrathoracic lymph nodes and had received no antituberculous drugs before study, were examined to estimate the sensitivity and specificity of the new skin test Diaskintest® (recombinant CFR-10--ESAT-6 protein produced by Escherichia coli BL21(DE3)/pCFP--ESAT). According to the results of examination and treatment, the patients were divided into 3 groups: 1) 52 patients with active respiratory tuberculosis; 2) 7 patients with residual changes after spontaneously cured tuberculosis; 3) 13 with nontuberculous diseases. By comparing the results of the skin tuberculin test (Mantoux test with 2 TE PPD-L) and Diaskintest®, the mean size of an infiltrate and the percentage of hyperergic, negative and doubtful reactions were estimated in each group, which allowed evaluation of the sensitivity and specificity of the new skin test Diaskintest® versus the conventional skin tuberculin test. The sensitivity of Diaskintest® (Group 1) was 96.2%; false-negative responses with doubtful results being kept in mind were 3.8% (2 patients with limited tuberculous lung lesion). Diaskintest® was the most sensitive in patients with infiltrative pulmonary tuberculosis, in those with disseminated processes or lung tissue decay, as the hyperergic reaction to Diaskintest® just in these cases was more than 80.0%. Its specificity (Group 3) was 84.6%; false-positive results were seen in 15.4%. Determining the activity of first detected posttuberculosis changes--Ghon's focus (Group 2) indicated that Diaskintest® was of more informative value than the Mantoux test with 2 TE PPD-L since its speci- ficity in this case (a negative result) was 100.0%, and that of the Mantoux tuberculin test was 14.3%. The high sensitivity (96.2%) and specificity (84.6%) of the new skin test Diaskintest® permit its use in the comprehensive examination of patients with clinical and radiological signs in a specialized hospital, contributing to the shorter duration of differential diagnosis in difficult diagnostic cases. Diaskintest® enables one to rule out the activity of the process with a high assurance in patients with first detected post-tuberculosis changes.

[THERAPEUTIC AND DIETARY CORRECTION OF PROTEIN-ENERGY DEFICIENCY WITH A DRY PROTEIN COMPOSITE FORMULA IN PATIENTS WITH PULMONARY TUBERCULOSIS IN A TUBERCULOSIS HOSPITAL].

The time course of changes in the degree of tuberculous intoxication syndrome (scores), body mass deficiency (body mass index), routine clinical X-ray data on 300 first detected patients with tuberculosis treated at the Regional Clinical Tuberculosis Hospital (n = 160) and the clinic of the I. M. Sechenov Moscow Medical Academy (n = 140) was assessed to evaluate the efficiency of using a dry protein composite formula in the package of therapeutic measures in inpatients with pulmonary tuberculosis. A study group included 200 patients whose basic diet comprised the dry protein composite formula DISOO Nutrinor. A control group consisted of 100 patients receiving standard antituberculosis treatment and basic diet without using the above formula. In the vast majority of study group patients (n = 152), intoxication symptoms substantially reduced 1.6 months after the start of treatment whereas this occurred noticeably later (following 2.5 months) in the control group (n = 80). Better positive changes in weight gain were found during dietary therapy with the dry protein composite formula in the study group than in the control group. During correction of a dietary protein component, the monthly body weight gain in the study group was 2.2 kg on average greater than that in the control group. The study group patients were also found to have a more significant resolution of infiltrative and focal lung changes on control X-ray studies than the control patients. Also, the study group patients showed a trend for more frequent cessation of bacterial excretion than did the controls. The rate of adverse reactions to chemotherapy was 5% (10 subjects) in the study group and thrice higher than that in the control group (15%, 15 subjects) in the control group. The findings prove the efficiency and urgency of correction of protein-energy deficiency in patients with active pulmonary tuberculosis, by supplementing the dry protein composite formula to the basic diet.

[THE FREQUENCY OF ADVERSE REACTIONS TO ANTITUBERCULOUS AGENTS IN FIRST DETECTED PATIENTS OLDER THAN 18 YEARS WITH PULMONARY TUBERCULOSIS AND THE FACTORS INFLUENCING THEIR DEVELOPMENT].

The study was conducted at Omsk Regional Clinical Tuberculosis Dispensary Four in 2003-2007. The frequency of adverse reactions was studied in 485 patients aged 18 to 84 years. Adverse reactions were found to complicate chemotherapy in 67.8% of cases; 2.5% of the patients developed 2 types of adverse reactions or more. The bulk (67.1%) of adverse reactions developed within the first 2 months of chemotherapy and was associated with treatment regimen I. Age older than 60 years, comorbidity, the asymptomatic course of the disease are the major factors predisposing to their development. The development of adverse reactions substantially lowers the efficiency of treatment in new cases of tuberculosis.

[CORRECTION OF METABOLIC DISTURBANCES IN PATIENTS WITH PULMONARY TUBERCULOSIS AND CONCOMITANT DISEASES].

Metabolic disturbances were corrected using the oral specialized formula Nutrien-phthisio (ZAO "Company Nutritec", Russia) in 53 patients with pulmonary tuberculosis and concomitant diseases. In the whole group, tuberculosis was first detected in 21 patients; 32 had a chronic process. Chemotherapy was discontinued in all the patients due to the intolerance phenomena caused by comorbidity (erosive gastritis, gastroduodenal peptic ulcer, hepatitis B and C, chronic pyelonephritis) in 24 patients, by adverse reactions in 19, and by a combination of both factors in 10. The criteria for objectively monitoring the efficiency of nutritional support (in combination with specific treatment) were body mass index, general blood analysis, by taking into account the percentage and absolute count of lymphocytes and the protein metabolism from the serum levels of total protein, albumin, and transferrin. The study determined clinical and laboratory indications for the use of Nutrien-phthisio and the favorable impact of nutritional support on the course of a tuberculous process and concomitant diseases.