Risk factors of antituberculosis treatment failure

Department of Pneumophthisiology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaThe Republic of Moldova reports the highest incidence of tuberculosis (114,3/100 000) and the lowest level of succes in its treatment (52,3%) among the european region countries. In most of the patients (90%), the antituberculosis treatment failure is correlated with social risk factors (low social and economic status, problematic social-epidemiological categories of the population) and biological ones (young age, male sex, some physiological conditions, associated deseases). Clinical risk factors (the heavy clinical forms with chronic evolution), therapeutic risk factors (the empiric treatment of multidrug-resistant tuberculosis, treatment interruptions, the individualisation of the standard treatment) and administrative risk factors (interrupted supplying, suboptimal treatment quality, the presence of expired drugs, bad storing conditions) prevail in the regions with the defficiencies in the management of the heath care system. The combination of the risk factors is aqcuiring more importance than the threat of just one risk factor. The study of the risk factors before the beginning of the tuberculosis treatment is important for taking the risk reduction measures and increasing the succes rate

Clinical and immunological predictive factors for antituberculosis pulmonary treatment failure

Department of Pneumophtysiology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chiril Draganiuc Institute of Phtysiopneumology, Chisinau, the Republic of MoldovaAbstract Background: The Rrepublic of Moldova reports the biggest incidence of tuberculosis and the lowest success treatment rate among European region countries. In the most of patients the antituberculosis treatment failure is correlated with social risk factors (social, economical low status, social-epidemiological category of the population) and biological (young age, male sex, some physiological conditions, associated diseases). Clinical factors (extensive forms, chronic evolution, immune disturbances), therapeutical factors (treatment errors and interruptions, individualised regimens) and administrative factors (interrupted supplying, suboptimal drug quality) prevail in regions with defficiencies in heath care delivery. Risk factors association is more evident than the severity of one risk factor. Clinical and immunological assessement is important before initiation of the treatment for establishing risk reduction measures and increasing success rate. Material and methods: The study was conducted on 201 cases with treatment failure and 105 with successfuly ended treatment. Cases were investigated according to national standards and local specific immune procedures. Results: High clinical risk factors were revealed: late detection, extensive and bilaterally localised tuberculosis, lung tissue destructions and dissemination, complications, comorbidities; as well as high immune risk factors were established: low cellular resistance, high degree of intoxication, low preimmune resistance. Conclusions: The study at least of high clinical and immune risk factors must be performed before the treatment initiation for increasing the treatment success rate

Intensive phase efficacy of injected drugs – isoniazid and rifampicin in the treatment of patients with lung tuberculosis and hepatobiliary pancreatic comorbidities

Background: One of the most important tuberculosis control action represents the effective anti-tuberculosis treatment. The standard regimens are associated with high level of side effects, especially at patients with hepatobiliary and pancreatic co-morbidities. Material and methods: There were studied clinical and laboratory indices of a total number of 60 new pulmonary tuberculosis cases, with proved hepatobiliary and pancreatic comorbidities, distributed in the 1st study group, consisted of 30 patients treated with the standard anti-tuberculosis treatment, all drugs being administrated orally and the 2nd control group, consisted of 30 patients, treated with the standard anti-tuberculosis treatment with injected forms of first line anti-tuberculosis drugs isoniazid and rifampicin. Results: The clinical improvement of the patient’s general state under the influence of intravenous use of isoniazid and rifampicin was confirmed by a lower expressiveness of intoxication and bronchopulmonary syndroms, as well as by a better radiological dynamics and higher rate of microscopic convertion at the end of intensive phase of the tuberculosis treatment. Biochemical disturbances due to tuberculosis treatment were less evident at the patients treated with intravenous isoniazid and rifampicin, confirmed by a better rehabilitation of mathematic indices of endogenous intoxication. Conclusions: Assessing the differences between the clinical and laboratory tolerance of tuberculosis drugs according to the way of administration, it was proved the importance of individualization of the standard treatment at patients with hepatobiliary and pancreatic disorders by intravenous use of isoniazid and rifampicin in intensive phase of the treatment, for improving the therapeutical effectiveness

The socio-economic risk factors of tuberculosis in conditions of a high migration in trans-border region

Tuberculosis is a classic example of an infectious disease linked with social determinants of the health. The survey includes information about the risk factors, socio-economical status pulmonary tuberculosis patients from a high tuberculosis burden trans-border region: Chisinau and Balti city and Western Ukraine Chernivtsi region

The role of the immunocorrective activity of the medicine BioR in the patients after a failed anti-tuberculosis treatment

Department of Pneumophthisiology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaTuberculosis is a multi-pathogenetic disease, its treatment response is influenced by the degree immune disturbances. An acute progressive evolution with extensive destruction and dissemination provokes the lowest treatment results, which in most cases are influenced by a heterogeneous immune response. The immunological data obtained before and after the treatment of 54 new pulmonary TB cases have been compared with the data of 50 healthy individuals. By a blind selection 27 TB patients have been included in the control study group and have been treated with the standard antituberculosis treatment and immunocorrecting medicine BioR. The immune indices of 27 cases treated only with standard antituberculosis treatment have been compared with the control group. The associated antituberculosis treatment have reduced the severity of the immune defficiency, reduced the increased immune globulin level, increased the organism’s sensibilisation to bacteriological and micobacteriological antigens, reduced the intoxication indices. Despite the immuno-regulatory activity of the medicine BioR, the comprehensive TB treatment in general has not improved the treatment results, as one course of treatment is insufficient for a complete immune rehabilitation and the involvement of other factors, influencing the treatment outcomes is required

Clinical and immunological correlation in patients with anti-tuberculosis treatment failure

Department of Pneumophtysiology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Tuberculosis is a multipathogenetic disease, the treatment response of which is influenced by the degree of the immune disturbances. The acute progressive evolution of this disease with extensive destructions and dissemination causes the lowest treatment results and in most of the cases is influenced by the heterogeneous immune response. Material and methods: Clinical and immunological data obtained before and after a standard antituberculosis treatment of 54 new pulmonary TB cases with the failed treatment and of 34 new pulmonary successfully treated TB cases have been compared with the data of 50 healthy individuals. Results: It has been established that despite the similar distribution of patients by gender and age in the groups and the similar prevalence of risk factors among the patients (active smoking, alcohol consumtpion, associated diseases) the patients with treatment failure had much longer hospitalisation period due to the persistance of clinical signs (cough, expectorations, chest pain, hemotysis, dyspnoea, asthenia, anorexia, weight loss, fever, night sweats), which have been directly correlated with the severity of the immune disturbances. The patients with antituberculosis treatment failure have had the severe deficiency of all lymphocytes, T subpopulations, the increased level of lymphocytes B, the increased level of all types of immune globulines, the less evident sensibilisation to bacterial antigens (staphylococcus, streptococcus, pneumococcus) and micobacterial antigens; the intoxication indices have increased and the preimmune resistance indices have reduced. Conclusions: All the immune disturbances revealed can be considered as the predictors of antituberculosis treatment failure. On the contrary, the successfully treated patients have had less evident immune disturbances of cellular, humoral and preimune resistance, and some of the indices have returned to a normal level due to the antituberculosis treatment

Dynamics of adaptive response and immune reactivity under the influence of adaptogenic drugs in pulmonary tuberculosis

Chiril Draganiuc Institute of Phthysiopneumology, Department of Pneumophthysiology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Tuberculosis is a multifactorial disease, with the evolution and response to treatment being determined by the interaction between the genotype of M. tuberculosis and the human genotype. Immunological adaptogenic treatment is an important pathogenetical treatment of tuberculosis. BioR medicine obtained from the biomass of Spirulina platensis exhibits an antioxidant activity and immunomodulator activity. Extract of Eleuterococc increases the body’s resistance, diminishing the level of the body stress syndrome. The aim of the research was the comparative analysis of adaptive reactivity and immune resistance in the patients with pulmonary tuberculosis treated with immunomodulator drug BioR versus extract of Eleuterococ. Material and methods: adaptive reactivity and immune resistance indices were analyzed in a total number of 113 patients hospitalized in clinical subdivisions of Chiril Draganiuc Institute of Pneumophthysiology. Results: Both drugs showed a high adaptogenic capacity, a high efficiency on the level of immune reactivity, although it was appreciated that the immune modulator drug BioR is more efficient than Eleuterococ extract associated medicine to antituberculois treatment of patients with pulmonary tuberculosis. Conclusions: The combination of adaptogenic drugs: extract of Eleuterococ and BioR with anti-TB treatment enhances its efficacy, demonstrated by normalizing of the adaptogenic reactions, also enhancing the immune and preimmune resistance indices. Both drugs can be recommended for inclusion as immune modulators in the standard anti-TB treatment with the aim to ensure high therapeutical effectiveness

Ambarzumyan type theorem for a quadratic Sturm-Liouville operator

We consider a quadratic Sturm-Liouville problem. In this paper, some uniqueness theorems are extended to the case in which the governing second-order ordinary differential equation contains both q(x) and p(x) instead of only q(x) . It is shown that if the spectrum is the same as the spectrum belonging to the zero potential, then the functions q(x) and p(x) are zero.Bu çalışmada bir kuadratik Sturm-Liouville problemi ele alındı. Bazı teklik teoremleri, içerisinde sadece değil hem hemde bulunduran ikinci mertebeden adi diferensiyel denklem olması durumuna genişletildi. Spektrum eğer sıfır potansiyeline ait olan spektrum ile aynı ise, ve fonksiyonlarının sıfır olduğu gösterildi

Differential diagnosis of the pulmonary infiltrate in actual epidemiological state of tuberculosis

Department of Pneumophtysiology, Nicolae Testemiţsanu State University of Medicine and Pharmacy, Chiril Draganiuc Institute of Phthysiopneumology, Chisinau, the Republic of MoldovaBackground: Tuberculosis (TB) is a big challenge for public health in the Republic of Moldova, with an incidence recored on the third place among high TB-burden countries. Pneumonia is a distinct nosologic entity included in the frame of respiratory pathologies with an impact on public health, showing a high risk for a poor outcome. Material and methods: The conducted study was retrospecitive, selective and descriptive realised on a sample of 194 patients (study group – 125 patients with pulmonary tuberculosis and reference group – 65 patients with community acquired pneumonia). Results: It was established that younger age, urban overcrowding, harmful habits, disadvantageous economic status, sigle matrmonial status, epidemiological high risk conditions characterized patients with tuberculous pulmonary infiltrate. Old age, comorbidities, reduced availability of highly qualified medical care, characterized patients with non-specific pulmonary infiltrate. Conclusions: Complex approach to patients with pulmonary infiltrative opacities, indivudalised according to social, demographic, epidemiological and biological features must be performed appropriately, considering the severity of the epidemiogical situation of tuberculosis in the Republic of Moldova

Analysis of risk factors for default and failure treatment among patients with pulmonary tuberculosis under DOTS strategy

Department of Pneumophtysiology, Chiril Draganiuc Institute of Phtysiopneumology, Nicolae Testemitanu State University of Medicine and Pharmacy Chisinau, the Republic of MoldovaBackground: The biggest incidence of tuberculosis (114.3/100.000) in the Republic of Moldova correlates with the lowest success treatment rate (52.3%), the biggest default rate (10.9%) and failure rate (3.5%) in new pulmonary TB cases among European region countries. Material and methods: We studied social, economical, epidemiological risk factors and case-management features of a total amount of 457 pulmonary tuberculosis cases, distribuited in 1-st study group, consisting of 201 cases who failed the anti-tuberculosis treatment, 2-nd study group, consisting of 142 cases, who defaulted the treatment, and a control group of 105 successfully treated patients under Directly Observed Treatment Short Course Chemotherapy. Statistic evaluation was performed using T Student criteria and Odds Ratio, calculated through the two by two table. Results: According to the predictible value, high risc factors for failure were: chronic alcohol consumption, detention releasing and for default were: male sex, economic disadvantage, single civil state, chronic alcohol consumption, detention releasing. Conclusions: Default and failure antituberculosis treatment refers to the patients belonging to economicaly and social disadvantaged groups, with harmful habits (alcoholosm, drug injection using, active smoking), low living conditions, belonging high risk epidemiological groups. Migrations, homelessness and detention releasing imperil the continuing of antituberculosis treatment, predisposisng to failure and default of the antituberculosis treatment. Social, educational support and withdrawl techniques for harmful habits must be implemented to high risk groups to minimise the risk of non-adherence to the disease