Tuberculosis in health care workers in Belarus.

SETTING: Tuberculosis (TB), including drug-resistant TB, is a serious problem in Belarus. OBJECTIVES: To determine the prevalence of TB among health care workers (HCWs) along with patient characteristics, treatment outcomes and drug resistance patterns between 2008 and 2012. DESIGN: A retrospective national record review. RESULTS: There were 116 HCWs with TB. Case notification rates were higher among HCWs than in the general population (349 vs. 40/100 000 in 2012). Most HCWs with TB were nurses (n = 46, 40%) or nurse assistants (n = 37, 32%), female (n = 100, 86%) and aged 25-44 years (n = 84, 72%). Most common places of work for HCWs with TB were multidrug-resistant (MDR-) and extensively drug-resistant (XDR-TB) wards (n = 23, 20%), general medical (n = 26, 22%) and non-medical (n = 34, 29%) departments. All HCWs had pulmonary TB, 107 (92%) had new TB and 103 (89%) had negative sputum smears. Of the 38 (33%) with culture and drug susceptibility testing (DST), 28 (74%) had MDR-/XDR-TB. In 109 HCWs evaluated for final treatment outcomes, 97 (89%) were successfully treated, and their results were not affected by DST status. CONCLUSION: This study highlights the high prevalence of recorded TB in HCWs in TB health facilities in Belarus: there is a need to better understand and rectify this problem

ІНФОРМАТИВНЕ ЗНАЧЕННЯ ВІЗУАЛЬНОГО АНАЛІЗУ АРТЕРІАЛЬНОЇ ОСЦИЛОГРАМИ, ЗАРЕЄСТРОВАНОЇ ПІД ЧАС ЗРОСТАННЯ КОМПРЕСІЇ ПЛЕЧА ПРИ ВИМІРЮВАННІ АРТЕРІАЛЬНОГО ТИСКУ

Background. The implementation of modern ICT in health care practice makes it possible to improve prevention, diagnosis, early rehabilitation and treatment of cardiovascular system (CVS). According to the World Health Organization each year cardiovascular diseases (CVD) cause the death of 17.5 million persons; it is 31% of all deaths worldwide). High blood pressure is a major risk factor for heart attacks. The current instrumental diagnostics of CVS disorders by ultrasonic Doppler examination, ultrasound scanning and digital optical capillaroscopy, MR angiography, mathematical analysis of cardiac rhythm, Holter monitoring (and other methods) contribute to improving the diagnosis and treatment of CVS diseases. However, «rejuvenating» of vascular disorders that lead to profound disability, indicates that today there is an urgent need in fundamental studies on cardiovascular system, changes in cases of pathological conditions, effective technologies for early detection and treatment of vascular pathology. Materials and methods. Arterial oscillogram obtained using monitor of blood pressure and heart rate, which records the value of pressure pulse changes in cuff when measuring blood pressure and export information through an external  interface of data exchange to personal computer. Further analysis of the obtained data and creating of arterial oscillogram was conducted by computer programs developed by the authors. The results of our research are based on assessment during 2012-2017. 626 people - volunteers were divided into 2 groups. The first group consisted of 480 healthy males (27 %) and females (73 %), aged 18 - 22 years, who study in the medical and pedagogical universities of Ternopil, Ukraine. Results. The authors suggested morphological criteria of oscillograms evaluation, defined standards of normal findings; developed the ICT methods of value oscillogram evaluation, differentiated 5 levels of deviations from the norm, which are compared with 5 types of health level gradation established in electrocardiography. Morphological oscillogram analysis enables visual evaluation of vessels condition before compression and their oscillatory ability to counteract compression increase by the cuff when measuring blood pressure. The nature of pulsation will help the doctor to examine pulsation rhythm, cardiac function, and condition of the autonomic nervous system, blood pressure and neuro-reflex effects on the blood vessels state, differentiate functional and organic causes of changes in them. The use of the suggested morphological criteria of value oscillogram evaluation to estimate health condition will help the doctor to take appropriate decisions both during primary examination, and for monitoring the effectiveness of treatment. Conclusions. So, the suggested information technology enables medical professionals to expand information on cardiovascular system of patients, promote early revealing of premorbid and donozological state and help to plan diagnostics and therapy. They will be useful for general physicians, paediatricians, cardiologists, neurologists, researchers, in sports medicine. General physicians (or other users) in the presence of electronic sphygmomanometer and the software will be able to monitor CVS state and peripheral vessels according to the suggested criteria.Внедрение современных информационно-коммуникационных технологий (ИКТ) в практику здравоохранения позволяет улучшить профилактику, диагностику, раннюю реабилитацию и лечение сердечно-сосудистой системы (ССС). Известно, что заболевания ССС относятся к наиболее распространенным заболеваниям человечества. В значительной степени благополучие кровообращения зависит от состояния сосудов - «периферийного сердца». Одним из методов его оценки является артериальная осциллография (АО). В работе представлены результаты исследований, базирующихся на анализе 1640 АО, зарегистрированных с помощью электронного тонометра ОАО 41-2 при измерении АД. Для морфологического анализа АО предложено использовать такие критерии: а) форма всей осциллограммы; б) характер отдельных пульсаций в различных фазах компрессии. Исследования позволили выявить различные виды сосудистой реакции на компрессию плеча во время измерения АД в состоянии покоя (на левом и правом плече), после воздействия различных факторов и в процессе восстановления после них. Использование предложенных авторами методов морфологического анализа АО, их оценка и клиническая интерпретация значительно повышают информативность процесса измерения АД.Відомо, що захворювання серцево-судинної системи відносяться до найбільш поширених захворювань людства. Особливо насторожує «помолодшання» судинних катастроф, що призводять до глибокої інвалідності. Значною мірою благополуччя кровообігу залежить від стану судин - „периферійного серця". Одним із методів його оцінювання є артеріальна осцилографія (АО). Представлені дослідження базуються на аналізі 1640 АО, зареєстрованих за допомогою електронного тонометра ВАТ 41-2 під час вимірювання АТ. Для морфологічного аналізу АО пропонується використовувати такі критерії: а) форма всієї осцилограми; б) характер окремих пульсацій у різних фазах компресії. Дослідження дали можливість виявити різні види судинної реакції на компресію плеча під час вимірювання АТ у стані спокою (на лівому та правому плечі), після впливу різноманітних чинників і в процесі відновлення після них. Використання запропонованих авторами методів морфологічного аналізу АО, їх оцінка та клінічна інтерпретація значно підвищують інформативність процесу вимірювання АТ

Optima TB: A tool to help optimally allocate tuberculosis spending.

Approximately 85% of tuberculosis (TB) related deaths occur in low- and middle-income countries where health resources are scarce. Effective priority setting is required to maximise the impact of limited budgets. The Optima TB tool has been developed to support analytical capacity and inform evidence-based priority setting processes for TB health benefits package design. This paper outlines the Optima TB framework and how it was applied in Belarus, an upper-middle income country in Eastern Europe with a relatively high burden of TB. Optima TB is a population-based disease transmission model, with programmatic cost functions and an optimisation algorithm. Modelled populations include age-differentiated general populations and higher-risk populations such as people living with HIV. Populations and prospective interventions are defined in consultation with local stakeholders. In partnership with the latter, demographic, epidemiological, programmatic, as well as cost and spending data for these populations and interventions are then collated. An optimisation analysis of TB spending was conducted in Belarus, using program objectives and constraints defined in collaboration with local stakeholders, which included experts, decision makers, funders and organisations involved in service delivery, support and technical assistance. These analyses show that it is possible to improve health impact by redistributing current TB spending in Belarus. Specifically, shifting funding from inpatient- to outpatient-focused care models, and from mass screening to active case finding strategies, could reduce TB prevalence and mortality by up to 45% and 50%, respectively, by 2035. In addition, an optimised allocation of TB spending could lead to a reduction in drug-resistant TB infections by 40% over this period. This would support progress towards national TB targets without additional financial resources. The case study in Belarus demonstrates how reallocations of spending across existing and new interventions could have a substantial impact on TB outcomes. This highlights the potential for Optima TB and similar modelling tools to support evidence-based priority setting

Клеточная терапия аутологичными мезенхимальными стромальными клетками у пациентов с лекарственно-устойчивым туберкулезом легких

The objective: to evaluate the effectiveness of treatment with autologous mesenchymal stromal cells (MSCs) in patients with drug resistant pulmonary tuberculosis (DR TB).Subjects and Methods. 120 patients with drug resistant tuberculosis aged 18 to 61 years old were enrolled in the study. They all were treated at the Republican Scientific and Practical Center of Pulmonology and Phthisiology from 2009 to 2018. Against the background of anti-tuberculosis treatment, patients (60 people) from Main Group (MG) underwent bone marrow sampling and then intravenous administration of autologous MSCs.Results. The average dose of administered cells was 1x106 per kg of the patient body weight. The average duration of MSC cultivation made 35 days. Treatment effectiveness in MG made 90% versus 71% in Control Group (CG). All patients who were successfully cured of tuberculosis (TB) using autologous MSCs had no tuberculosis relapses during 5 years of follow-up. In Control Group, 8 (19%) cases of relapse were reported. In Main Group versus Comparison Group, the rates indicating healing of cavities and absence of relapse are statistically significantly better.Conclusion. The use of autologous MSCs in patients with drug resistant tuberculosis has shown its high effectiveness.Цель исследования: оценка эффективности применения аутологичных мезенхимальных стромальных клеток (МСК) у пациентов с лекарственно-устойчивым туберкулезом (ЛУ-ТБ) легких.Материалы и методы. В исследование было включено 120 пациентов в возрасте от 18 до 61 года с ЛУ-ТБ, находившихся на лечении в государственном учреждении «Республиканский научно-практический центр пульмонологии и фтизиатрии» с 2009 по 2018 гг. На фоне противотуберкулезного лечения пациентам (60 чел.) основной группы (ОГ) проводился забор костного мозга, а затем внутривенное введение аутологичных МСК.Результаты. Средняя доза вводимых клеток составила 1х106 на кг массы тела пациента. Средняя длительность культивации МСК была 35 дней. Эффективность лечения в ОГ составила 90% в сравнении с 71% в контрольной группе (КГ). У всех пациентов, успешно излечившихся от туберкулеза (ТБ) с применением аутологичных МСК, рецидивов ТБ в течение 5 лет наблюдения не было. В контрольной группе было зарегистрировано 8 (19%) случаев рецидива. В ОГ по сравнению с КГ показатели по закрытию полостей распада и отсутствию рецидива статистически значимо лучше.Заключение. Применение аутологичных МСК у пациентов с ЛУ-ТБ показало высокую эффективность

Rifapentine access in Europe: growing concerns over key tuberculosis treatment component

[No abstract available]Support statement: C. Lange is supported by the German Center of Infection Research (DZIF). All other authors have no funding to declare for this study. Funding information for this article has been deposited with the Crossref Funder Registry

Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study

Objectives Mortality among HIV patients with tuberculosis (TB) remains high in Eastern Europe (EE), but details of TB and HIV management remain scarce. Methods In this prospective study, we describe the TB treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral therapy (ART). Results A total of 105 HIV-positive patients had MDR-TB (including 33 with extensive drug resistance) and 130 pan-susceptible TB. Adequate initial TB treatment was provided for 8% of patients with MDR-TB compared with 80% of those with pan-susceptible TB. By twelve months, an estimated 57.3% (95%CI 41.5\u201374.1) of MDR-TB patients had started adequate treatment. While 67% received ART, HIV-RNA suppression was demonstrated in only 23%. Conclusions Our results show that internationally recommended MDR-TB treatment regimens were infrequently used and that ART use and viral suppression was well below the target of 90%, reflecting the challenging patient population and the environment in which health care is provided. Urgent improvement of management of patients with TB/HIV in EE, in particular for those with MDR-TB, is needed and includes widespread access to rapid TB diagnostics, better access to and use of second-line TB drugs, timely ART initiation with viral load monitoring, and integration of TB/HIV care

RESULTS OF INTRODUCTING THE PRINCIPLES OF INFECTION CONTROL INTO THE PRACTICE OF THE BELARUS REPUBLICAN TUBERCULOSIS SERVICE

Infection control (IC) in tuberculosis facilities is a package of specific measures and technological procedures to reduce the likelihood of tuberculosis transmission. To monitor and assess IC measures is an important component of work of any tuberculosis facility. The health protection in healthcare workers and patients in different healthcare organizations may be compared on the basis of qualitative and quantitative evaluation of the efficiency of tuberculosis IC measures. The major indicators of IC in the healthcare organizations are the incidence of tuberculosis among healthcare workers and that within the first year of their work in the given healthcare organization. An algorithm for IC measures is proposed for tuberculosis facilities

Tuberculosis Drug Susceptibility, Treatment, and Outcomes for Belarusian HIV-Positive Patients with Tuberculosis: Results from a National and International Laboratory

Background. To cure drug-resistant (DR) tuberculosis (TB), the antituberculous treatment should be guided by Mycobacterium tuberculosis drug-susceptibility testing (DST). In this study, we compared conventional DST performed in Minsk, Belarus, a TB DR high-burden country, with extensive geno- and phenotypic analyses performed at the WHO TB Supranational Reference Laboratory in Copenhagen, Denmark, for TB/HIV coinfected patients. Subsequently, DST results were related to treatment regimen and outcome. Methods. Thirty TB/HIV coinfected patients from Minsk were included and descriptive statistics applied. Results. Based on results from Minsk, 10 (33%) TB/HIV patients had drug-sensitive TB. Two (7%) had isoniazid monoresistant TB, 8 (27%) had multidrug-resistant (MDR) TB, 5 (17%) preextensive drug-resistant (preXDR) TB, and 5 (17%) had extensive drug-resistant (XDR) TB. For the first-line drugs rifampicin and isoniazid, there was DST agreement between Minsk and Copenhagen for 90% patients. For the second-line anti-TB drugs, discrepancies were more pronounced. For 14 (47%) patients, there were disagreements for at least one drug, and 4 (13%) patients were classified as having MDR-TB in Minsk but were classified as having preXDR-TB based on DST results in Copenhagen. Initially, all patients received standard anti-TB treatment with rifampicin, isoniazid, pyrazinamide, and ethambutol. However, this was only suitable for 40% of the patients based on DST. On average, DR-TB patients were changed to 4 (IQR 3-5) active drugs after 1.5 months (IQR 1-2). After treatment adjustment, the treatment duration was 8 months (IQR 2-11). Four (22%) patients with DR-TB received treatment for >18 months. In total, sixteen (53%) patients died during 24 months of follow-up. Conclusions. We found high concordance for rifampicin and isoniazid DST between the Minsk and Copenhagen laboratories, whereas discrepancies for second-line drugs were more pronounced. For patients with DR-TB, treatment was often insufficient and relevant adjustments delayed. This example from Minsk, Belarus, underlines two crucial points in the management of DR-TB: the urgent need for implementation of rapid molecular DSTs and availability of second-line drugs in all DR-TB high-burden settings. Carefully designed individualized treatment regimens in accordance with DST patterns will likely improve patients’ outcome and reduce transmission with drug-resistant Mycobacterium tuberculosis strains