Наукові праці. Кафедра фтизіатрії та пульмонології
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Item Functional state of the liver in pulmonary tuberculosis in the dynamics of pathogenetic treatment with a complex of amino acids(2023-02) Shevchenko, Olga; Todoriko, Lilia; Pohorielova, Olha; Semianiv, Ihor; Ovcharenko, Irina; Shevchenko, Rostislav; Yeremenchuk, Inga; Pidverbetska, Olena; Toderika, YanaThe aim: To investigate the in!uence of prescribing a complex of amino acids in pathogenetic therapy in patients with pulmonary tuberculosis on liver function. Materials and methods: The study included 50 patients with drug susceptible TB and 50 patients with drug-resistant TB (multidrug-resistant and extensively drug-resistant). Results: The study included 50 patients with drug susceptible tuberculosis (TB) and 50 patients with drug-resistant TB. When comparing biochemical pa-rameters characterizing liver function in patients with drug-susceptible TB after 1 month of anti-tuberculosis therapy, it was found that patients receiving additional therapy with a complex of amino acids had a lower level of bilirubin, p<0.05. After 60 doses, patients receiving additional therapy with amino acids had signi"cantly lower bilirubin levels alanine aminotransferase (ALT) and aspartate aminotransferase (AST), p <0.05. When comparing the biochemical parameters characterizing liver function in patients with drug-resistant tuberculosis after a month of anti-tuberculosis therapy, signi"cantly higher protein level was found in the groups of patients receiving additional therapy with amino acids, as well as signi"cantly lower ALT level, AST and creatinine p<0.05. Conclusions: The additional appointment of the complex of amino acids in the pathogenetic therapy of patients with pulmonary tuberculosis makes it possible to reduce the severity of hepatotoxic reactions manifested by the main parameters (AST, ALT, total bilirubin) and to increase the protein-synthetic function of the liver, which allows us to recommend their appointment to improve the tolerance of anti-tuberculosis therapy.Item Ferritin, IL-6 and human-beta-defensin-1 as prognostic markers of the course severity and treatment effectiveness of pulmonary tuberculosis(2023-06) Shevchenko, Olga; Todoriko, Lilia; Matvyeyeva, Svitlana; Ovcharenko, Irina; Shvets, Olga; Pohorielova, OlhaCurrent methods of investigation in TB patients, namely sputum microscopy, culture, and molecular genetic methods, although well-studied, have a number of disadvantages, such as low sensitivity, long time required to obtain results, or high cost. Because of this, the search for alternative diagnostic tools and methods for predicting the course and effectiveness of treatment in patients with tuberculosis becomes relevant. In this study, ferritin, interleukin-6 (IL-6), and human-beta-defensin-1 (HBD-1) were selected for comparison of prognostic performance. Objective — to investigate the dynamics of ferritin, IL-6, and human-beta-defensin-1 levels against the background of the intensive phase of pulmonary tuberculosis therapy and to identify the most effective marker for predicting the effectiveness of treatment. Materials and methods. 100 patients with pulmonary tuberculosis and 20 healthy individuals were included in the study. Examination of patients was carried out according to the current standards of providing medical care to tuberculosis patients. In addition, the patients' fasting blood ferritin, IL-6 and HBD-1 levels were determined at the beginning of treatment and after 60 days. Healthy individuals from the control group had a single determination of ferritin, IL-6 and HBD-1 blood levels on an empty stomach. Results and discussion. At the beginning of treatment, the ferritin level was significantly lower (95.95 ± 8.68) ng/ml in patients who later effectively completed the intensive phase of anti-tuberculosis treatment than in patients with ineffective intensive phase of treatment (152.27 ± 8.85) ng/ml. The same trend persisted after 60 days: in the effective intensive phase — (123.87 ± 13.39) ng/ml, in the ineffective one — (239.76 ± 12.91) ng/ml, p < 0.05. In effective intensive phase of antituberculosis treatment, the level of IL-6 was significantly lower. Thus, at the beginning of treatment, it was (82.59 ± 6.89) pg/ml in patients with an effective intensive phase of treatment and (146.42 ± 8.04) pg/ml in patients with ineffective intensive treatment phase. After 60 days, it was (48.88 ± 4.19) pg/ml in patients with an effective intensive phase of treatment and (142.89 ± 9.11) pg/ml in patients with ineffective intensive treatment phase, p < 0.05. The level of HBD-1 was higher when the intensive phase of antituberculosis therapy was ineffective, as when measured at the beginning of treatment (effective intensive phase — (18.71 ± 3.31) pg/ml, ineffective intensive phase — (32.79 ± 8.31) pg/ml), as well as when measured after 60 days (effective intensive phase — (19.93 ± 3.58) pg/ml, ineffective intensive phase — (42.92 ± 12.99) pg/ml, p < 0.05). Conclusions. Levels of ferritin, IL-6 and HBD-1 are significantly increased in tuberculosis patients compared to healthy individuals, which allows them to be considered as markers of tuberculosis inflammation. Higher concentrations of these markers, both at the beginning of treatment and after 60 doses, are predictors of failure of antituberculosis therapy. The strongest relationship between the studied markers and parameters of the severity of the tuberculosis process is observed in the study of HBD-1, which allows us to consider it as the most effective marker of the severity of the course among presented ones.Item Human-beta-defensin-1: prognostic marker of tuberculosis severity and treatment effectiveness in pulmonary tuberculosis(Wiadomości Lekarskie, 2021-08) Pohorielova, Olha; Shevchenko, OlgaThe aim: Was to investigate human-beta-defensin-1 level in blood serum depending on tuberculosis severity and treatment effectiveness. Materials and methods: 100 patients with pulmonary tuberculosis and 20 healthy persons were included to the study. HBD-1 level was measured by ELISA in all the healthy persons and in all the patients at the treatment onset and at the end of initial phase of treatment. Additionally, the patients were examined with chest X-ray, sputum microscopy and culture, blood test and blood biochemistry. Results: HBD-1 level was higher in patients with tuberculosis (21.5 ± 2.9 μmol/L) compared with healthy individuals (8.9 ± 2.5 μmol/L). A positive correlation of middle strength was found between the size of lung lesion and the level of HBD-1 and between the level of HBD-1 and the massiveness of bacterial excretion. We found weakly negative correlations between the level of HBD-1 at the beginning of treatment and parameters of life quality rated on sf-36 scale. Patients with initially high level of HBD-1 had preservation of bacterial excretion, as well as signs of inflammatory activity. In patients with an effective intensive phase of treatment, the initial level of HBD-1. Conclusions: The larger pulmonary tuberculosis lesion, as well as the more pronounced clinical manifestations lead to the higher level of HBD-1. The possibility of using humanbeta-defensin-1 as a prognostic marker of treatment effectiveness is confirmed by the fact that human-beta-defensin-1 level prevails at the beginning of treatment in patients with subsequently non-effective intensive phase of treatment.Item Dynamics of life quality in patients with pulmonary tuberculosis against the background of the appointment of an essential amino acids complex(2021) Shenchenko, Olga; Pohorielova, OlhaObjective — to investigate the dynamics of life quality in patients with pulmonary tuberculosis against the background of the appointment of an essential amino acids complex. Materials and methods. The study included 100 patients with pulmonary tuberculosis who received treatment and diagnosis in accordance with the WHO recommendations and current state protocols. The patients were divided into 3 groups: group 1 (n = 50) did not receive additional complex of amino acids in pathogenetic therapy; group 2 (n = 25) received a complex of amino acids in tablet form for 30 days; group 3 (n = 25) received injectable amino acids complex for 10 days and then was transferred to tablet form for 20 days. At the beginning of treatment, after 30 days and after 60 days, the patients were interviewed using the SF-36 questionnaire. Also, the patients were measured the level of Human-beta-defensine-1 in the blood plasma by ELISA at the beginning of treatment. Results and discussion.Item Vitamins B1 and B12 deficiency as a predictor of tuberculosis severity and peripheral nervous system damage(Inter Collegas, 2020) Schvets, Olga; Schevchenko, Olga; Piskur, Zoryana; Stepanenko, Ganna; Pohorielova, OlgaIt is known that vitamin status plays one of the leading roles in the normal functioning of the immune system. Vitamins deficiency leads to weakening of immunity and can provoke occurrence of severe infectious diseases, including tuberculosis. The purpose of the study was to investigate the role of vitamins B1 and B12 deficiency as a predictor of tuberculosis severity and development of peripheral nervous system damage. Materials and methods. 89 patients with pulmonary tuberculosis and 12 healthy persons were included in the study. The patients were examined and treated according to current guidelines of the Ministry of Health of Ukraine. Additionally, the concentration of vitamins B1 and B12 was measured by ELISA in blood serum in all the patients at the treatment onset and in all healthy persons. To find the damage of peripheral nervous system we performed stimulation electroneuromyography of lower limbs. Results. The level of vitamin B12 was 0.19±0.01 nmol/L (median – 0.19 nmol/L) in patients with destruction of the lung tissue and 0.22±0.01 nmol/L (median – 0.21 nmol/L) in patients without destruction, p <0.05. MNCV was 49.25±0.80 mm/s (median – 49.40 mm/s) in patients with destruction of the lung tissue and 53.41±0.99 mm/s (median – 53.10 mm/s) in patients without destruction, p<0.01. SNCV was 43.41±1.14 mm/s (median – 42.05 mm/s) in patients with destruction of the lung tissue and 45.91±0.94 mm/s (median – 46.00 mm/s) in patients without destruction, p<0.05. Conclusions. Pulmonary tuberculosis leads to the disturbances in the metabolism of vitamins B1 and B12, causing their deficiency and the associated violation of impulse conduction along peripheral nerve fibers. More severe tuberculous lesions with destruction of lung tissue and massive bacterial excretion are associated with a more pronounced deficiency of vitamins B1 and B12, as well as decrease of motor and sensory conduction velocity.Item Treatment effectiveness and outcome in patients with a relapse and newly diagnosed multidrug-resistant pulmonary tuberculosis(Medicinski glasnik, 2020-05) Butov, Dmytro; Myasoedov, Valery; Gumeniuk, Mykola; Gumeniuk, Galyna; Choporova, Oleksandra; Tkachenko, AntonStandard treatment effectiveness in patients with newly diagnosed MDR-TB manifested by faster improvement and stabilization of health, earlier sputum culture and smear conversion, higher frequency of cavity closure and achievement of certain clinical and radiographic improvement against the background of fewer cases of treatment failure and a higher number of cured patients compared with MDR-TB relapse.Item Effectiveness of anti-tuberculosis chemotherapy in patients with tuberculosis relapse compared with newly diagnosed patients(2019-11-26) Butov, Dmytro; Gumeniuk, Mykola; Gumeniuk, Galyna; Tkachenko, Anton; Kikinchuk, Vasyl; Stepaniuk, Ruslan; Peshenko, Alexandr; Butova, TetianaAim. To study the effectiveness of anti-tuberculosis chemotherapy in patients with recurrent pulmonary tuberculosis (RTB) compared with patients with the newly diagnosed process. Materials and methods. We examined 285 TB patients, including 126 individuals with RTB (group 1) and 159 patients with newly diagnosed pulmonary tuberculosis (NDPTB) (group 2). All patients were diagnosed with infiltrative pulmonary tuberculosis (TB). Effectiveness of the basic course of antimicobacterial treatment was assessed in accordance with the following data: time required for the normalization of clinical manifestations, smear conversion, cavity healing, disappearance of infiltrative and focal changes in the pulmonary tissue, as well as the final clinical effectiveness of therapy. Results. Disappearance of clinical symptoms was significantly faster in group 2 compared with RTB patients in (2.25±0.11) and (3.40±0.15) months, respectively (p<0.001). Sputum culture conversion was observed after 6 months of treatment in 138 (86.79%) patients with NDPTB and 89 (72.22%) patients from group 1 (p=0.0023). Closure of cavities and disappearance of infiltrative and focal changes in the lungs occurred within 6 months of chemotherapy only in 55 (43.65%) patients with RTB and 93 (58.49%) patients with NDPTB (p=0.0133). Conclusions. Standard treatment for patients with NDPTB is considered successful in case of faster health improvement and stabilization, less pronounced rates of toxic adverse reactions to anti-TB drugs, faster sputum smear and culture conversion and cavity healing, signs of clinical and radiological convalescence, and the reduced number of large residual changes after the treatment compared with RTB.Item Effectiveness of Intravenous Isoniazid and Ethambutol Administration in Patients with Tuberculosis Meningoencephalitis and HIV Infection(2019-08-31) Butov, Dmytro; Feshchenko, Yurii; Kuzhko, Mykhailo; Gumeniuk, Mykola; Yurko, Kateryna; Grygorova, Alina; Tkachenko, Anton; Nekrasova, Natalia; Tlustova, Tetiana; Kikinchuk, Vasyl; Peshenko, Alexandr; Butova, TetianaBackground. The aim of this study was to investigate the effectiveness of intravenous isoniazid (H) and ethambutol (E) administered in patients with new sputum positive drug-susceptible pulmonary tuberculosis (TB) with tuberculous meningoencephalitis (TM) and human immunodeficiency virus (HIV) co-infection in the intensive phase of treatment. Methods. Fifty-four patients with TB/TM and HIV co-infection were enrolled for this study. Group 1 comprised of 23 patients treated with E and H intravenously, while rifampicin and pyrazinamide were prescribed orally. Group 2 consisted of 31 patients treated with the first-line anti-TB drugs orally. The concentrations of H and E in blood serum were detected using a chromatographic method. Results. A significant improvement in the clinical symptoms and X-ray signs in patients treated intravenously with H and E was observed and compared to group 2. The sputum Mycobacterium tuberculosis positivity was observed during the second month of the treatment in 25.0% of patients from group 1 and 76.1% of the patients from the control group (p=0.003). In addition, nine patients (39.1%) died up to 6 months when H and E were prescribed intravenously compared with 22 (70.9%)in group 2 (p=0.023). Conclusion. In TB/TM with HIV, the intravenous H and E treatment was more effective than oral H and E treatment at 2 months of intensive treatment in sputum conversion as well as in clinical improvement, accompanied by significantly higher mean serum concentrations. In addition, the mortality rate was lower in intravenous H and E treatment compared to oral treatment.Item Efficacy and safety of intravenous chemotherapy during intensive treatment phase in patients with newly diagnosed pulmonary tuberculosis(2018-09-23) Feshchenko, Yurii; Butov, Dmytro; Kuzhko, Mykhailo; Gumeniuk, Mykola; Butova, TetianaIntroduction: The purpose of our study was to examine the efficacy and safety of intravenous chemotherapy during intensive treatment phase in patients with newly diagnosed pulmonary tuberculosis (pulmonary TB). Material and methods: The study involved 92 patients with newly diagnosed pulmonary TB aged between 20 and 68. All patients with newly diagnosed pulmonary TB and chemosensitive tuberculosis were enrolled in the study. The patients were allocated to two groups. The first (control) group of 46 patients received standard chemotherapy orally. The second (main) group consisted of 46 patients who were prescribed isoniazid, rifampin, ethambutol by i.v. infusion, and pyrazinamide orally as a part of the standard treatment. Results: Symptoms of intoxication and chest manifestations in pulmonary TB patients from the second group were eliminated faster than the same symptoms in the group 1. In the group 2, the mycobacterial clearance in sputum smears was achieved more rapidly, and up to 2 months it was reached in 37 patients (80.43%), while in the control group in 25 patients (54.35%),p = 0.0066. Destruction healing and inflitrative change alleviation after 4 months was reached in 38 patients (82.61%) (in control group — 28 (60.87%), (p = 0.0192). No additional negative effects were detected when compared with the control group at any time. Conclusions: Thanks to i.v. chemotherapy, clinical manifestations of the in-patients with pulmonary TB were eliminated faster, severe side effects of anti-TB drugs were not noticed, time of bacterial clearance and healing of destruction was shorter, healing frequency of destructions increased and the of residual changes decreased.Item The function of the thyroid gland in patients with multidrug resistant tuberculosis(2017) Matvyeyeva, Svitlana; Shevchenko, O.; Pogorelova, O.In 30 patients with multidrug resistant tuberculosis, echostructure of thyroid was studied by ultrasound imaging method. Indices of thyroid function: plasma levels of free thyroxin, thyroid stimulating hormone were studied before chemotherapy initiated, at the end of intensive phase and after the treatment finished. Decreasing of thyroid function under antituberculosis chemotherapy was approved. Monitoring and correction of thyroid function during antituberculosis chemotherapy was suggested.