Clinical case of chemoresistant tuberculosis in the patient with tuberous sclerosis: difficulties of diagnosis, features of the course and treatment.

In the practical activities of a modern doctor, significant difficulties are noted in the diagnostics and proper management of patients with hereditary diseases due to the limited coverage of the population by genetic researches. For a long time, the patients with a variety of complaints are observed by doctors of various specialties, and the therapy often has little effect due to a lack of understanding of the true causes of pathological changes. The situation is complicated by case of a combined course of a hereditarily caused disease and some other disease of an infectious, non-infectious or tumor nature. The aim of the research was to study the characteristics of clinical manifestations, course of tuberculosis with resistance to anti-TB drugs in a patient with a rare hereditary disease from the group of phacomotoses - Bourneville-Pringle disease or tuberous sclerosis. This disease has a wide range of clinical manifestations, accompanied with the development of benign neoplasms in various organs and systems, damages to the skin, brain, organs of vision, lungs, kidneys, heart, as well as the musculoskeletal and endocrine system. It leads to development of various infectious and non-infectious pathologies in these organs. The article covers a 4-year period of observation of a young patient with late diagnosed tuberous sclerosis, suffering from pulmonary tuberculosis and tuberculosis of urinary system, includes the initial diagnosis of a specific disease, the course, the dynamics against received treatment and the development of relapse with the formation of resistance to anti-TB drugs. The difficulties in the management of tuberculosis in this patient were in the detection of numerous neoplasms and changes in the internal organs, in particular in the kidneys and lungs, which characterized tuberous sclerosis, on the one hand this contributed to untimely diagnosis of tuberculosis, and on the other hand – worsening the course and the progression of a specific process, as well as an unfavourable prognosis for recovery

ОРГАНІЗАЦІЯ НАВЧАЛЬНОГО ПРОЦЕСУ НА КАФЕДРІ ФТИЗІАТРІЇ ДЗ “ДНІПРОПЕТРОВСЬКА МЕДИЧНА АКАДЕМІЯ МОЗ УКРАЇНИ”

The aim of the work – to analyze the methods and ways of training to improve teaching Phthisiology, which applied at the Department of Tuberculosis of State Establishment “Dnipropetrovsk Medical Academy of Ministry of Health of Ukraine”.The main body. In the conditions of an unfavorable epidemic situation and providing advantages to outpatient models of treatment of tuberculosis patients in Ukraine, there is a need to improve the teaching of the material of Phthisiology discipline to medical students at the departments of higher educational institutions.Typical educational plans and academic programs allocate a limited number of hours for mastering the discipline, so the teachers of the Department of Phthisiology of the State Establishment “Dnipropetrovsk Medical Academy of Ministry of Health of Ukraine” have improved the approaches and methods of teaching tuberculosis giving preference to independent classroom and extra-curricular work for students. Therefore, teachers of the Department of Phthisiology of Dnipropetrovsk Medical Academy conduct a constant search for modern methods of teaching discipline, which will contribute to improving the learning of theoretical and practical material. During practical classes, interactive techniques are used in the form of role-plays, discussions, group work, and auxiliary material that encourages students to study discipline. Students are pleased to participate in the discussion of various situational tasks, which allow them deepening their clinical thinking and evaluate the learned theoretical material. Self-study workshops for 4-year students have been developed for individual work, which include clinical problems with X-rays, tests of varied degrees of difficulty, tasks, drawings and crossword puzzles. Tasks require the student to find answers in additional literature, that improving the knowledge of the subject.Conclusion. Increasing the interest of medical students to the study of the Phthisiology discipline will improve the quality of medical care for patients in the future.Мета роботи – проаналізувати методи та засоби навчання, направлені на поліпшення викладання предмета “Фтизіатрія”, які застосовуються на кафедрі фтизіатрії ДЗ “Дніпропетровська медична академія МОЗ України”.Основна частина. В умовах несприятливої епідемічної ситуації та надання переваг амбулаторним моделям лікування хворих на туберкульоз в Україні виникає необхідність вдосконалювати викладання навчального матеріалу студентам-медикам на кафедрах вищих навчальних закладів.Типовий навчальний план і навчальні програми виділяють обмежену кількість годин для оволодіння дисципліною “Фтизіатрія”, віддаючи перевагу самостійній аудиторній та позааудиторній роботі студентів. Тому викладачі кафедри фтизіатрії ДЗ “Дніпропетровська медична академія МОЗ України” проводять постійний пошук сучасних методів викладання дисципліни, які сприятимуть покращенню засвоєння теоретичного і практичного матеріалу. Під час практичних занять застосовуються інтерактивні методики у вигляді рольових ігор, дискусій, роботи в групах, та допоміжний матеріал, який заохочував студентів до вивчення дисципліни. Студенти із задоволенням беруть участь в обговоренні різних ситуаційних задач, що дозволяє поглибити їх клінічне мислення та оцінити засвоєний теоретичний матеріал. Для індивідуальної роботи розроблені практикуми з самостійної роботи для студентів 4 курсу, які включають клінічні задачі з рентгенограмами, тести різного ступеня складності, задачі, малюнки та кросворди. Завдання вимагають від студента пошуку відповідей у додатковій літературі, таким чином покращуючи знання з предмета.Висновок. Підвищення зацікавлення студентів-медиків у вивченні дисципліни “Фтизіатрія” поліпшить якість надання медичної допомоги пацієнтам у майбутньому

РІВЕНЬ ІНФОРМОВАНОСТІ ТА СТАВЛЕННЯ СТУДЕНТІВ ВИЩИХ МЕДИЧНИХ НАВЧАЛЬНИХ ЗАКЛАДІВ ДО ПРОБЛЕМИ ТУБЕРКУЛЬОЗУ

The aim of the work – determination of the degree of students’ awareness in State Institution “Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine” about various issues of tuberculosis, their attitude to patients with tuberculosis and people who have recovered from tuberculosis, as well as studying students’ views about the relevance of this disease.The main body. We analyzed the questionnaires of 491 students of the 4th year of medical faculties of State Institution “Dnipro­petrovsk Medical Academy of the Ministry of Health of Ukraine” at the age from 21 to 30 years. This questioning was conducted at the first practical lesson, before the beginning of the lecture cycle on Phthisiology. The majority of respondents (93.9 %) have considered the problem with tuberculosis in our country relevant and important for their future practical activities. 77.6 % of fourth-year students have noted the importance of social risk factors for the development of tuberculosis. Students have been well-oriented in the main symptoms of the disease and the ways of transmission of the infection, but have showed insufficient knowledge in the methods of detection, diagnosis, treatment of patients. In addition, students have had of fear of becoming ill while on the cycle.Conclusions. The analysis has showed insufficient awareness of students of higher medical schools about issues of tuberculosis, low motivation to study the discipline. Students have poorly informed about methods of detection and diagnosis of the disease, its initial symptoms, high-risk groups and so on. Misunderstandings of relevance of the problem of tuberculosis and prejudiced, inhuman attitude to the patient can contribute to the formation of low doctor’s alertness to this disease in the future and prevent them from implementing the basic principles of TB control – timely detection and prevention of the disease.Мета роботи – аналіз сучасного стану та досвіду викладання педіатрії англомовним студентам 4-го та 5-го років навчання на кафедрі педіатрії № 2 Харківського національного медичного університету.Основна частина. Викладання педіатрії англомовним студентам вимагає високого рівня професійної підготовки, педагогічної майстерності та вільного володіння англійською мовою. Для підвищення якості підготовки іноземних студентів на кафедрі проводиться постійний пошук та впровадження сучасних інноваційних технологій, регулярне оновлення методичних матеріалів, створення навчальних посібників та підручників з урахуванням міжнародних стандартів надання медичної допомоги дітям.Висновок. Зменшення кількості студентів у групах та лекційних потоках, удосконалення матеріально-технічної бази (комп’ютеризація, розвиток фантомних класів тощо) дозволить поліпшити якість навчання та оволодіння практичними навичками

Analysis of tuberculosis incidence among health workers in the Dnepropetrovsk region.

The purpose of our study was to conduct a comparative analysis of tuberculosis incidence among healthcare workers in the general medical service departments and anti-tubercular departments in the Dnipropetrovsk region for the period from 2008 to 2017, analysis of the professional, clinical structure of tuberculosis cases for 2015-2017. Despite the decrease in the incidence of tuberculosis inUkraine,  the incidence of morbidity among medical workers in the Dnipropetrovsk region remains unfavorable. Over the past 3 years, 155 employees of health facilities have been infected with tuberculosis, including 134 from the institutions of the general medical profile and 21 employees of the anti-TB clinics. The risk group consists of representatives of scrub staff and nursing staff, as well as auxiliary (other) personnel, regardless of the profile of the medical institution. It was established that the morbidity of the staff of the institutions of the community network and the clinical structure of cases of tuberculosis is unfavorable with a high proportion of destructive changes in the lungs, bacterial discharge, less specific gravity of cases detected during prophylactic examinations

Analysis of tuberculosis incidence among health workers in the Dnepropetrovsk region.

The purpose of our study was to conduct a comparative analysis of tuberculosis incidence among healthcare workers in the general medical service departments and anti-tubercular departments in the Dnipropetrovsk region for the period from 2008 to 2017, analysis of the professional, clinical structure of tuberculosis cases for 2015-2017. Despite the decrease in the incidence of tuberculosis inUkraine,  the incidence of morbidity among medical workers in the Dnipropetrovsk region remains unfavorable. Over the past 3 years, 155 employees of health facilities have been infected with tuberculosis, including 134 from the institutions of the general medical profile and 21 employees of the anti-TB clinics. The risk group consists of representatives of scrub staff and nursing staff, as well as auxiliary (other) personnel, regardless of the profile of the medical institution. It was established that the morbidity of the staff of the institutions of the community network and the clinical structure of cases of tuberculosis is unfavorable with a high proportion of destructive changes in the lungs, bacterial discharge, less specific gravity of cases detected during prophylactic examinations

Medical workers of health care institutions as a risk group for chemo-resistant tuberculosis: analysis of incidence, a clinical case.

The purpose of our study was to analyze the prevalence of morbidity of medical workers of health care institutions and anti-tuberculosis institutions, as well as the analysis of resistance of mycobacterium tuberculosis strains among medical personal of health facilities in the Dnipropetrovsk region. Retrospective analysis for 2015 - 2017 of electronic database of the patients register (TB-manager), outpatient cards and case histories of patients which underwent treatment in pulmonary-tuberculosis and surgical departments of CI «DnepropetrovskRegional Clinical Treatment and Prophylactic Association "Phthisiology"» DRC» was conducted . The incidence of tuberculosis among medical workers in health care institutions of Ukraine remains at a fairly high, stable level (426 cases of tuberculosis in 2016, 389 cases in 2017) on the background of the decrease in the incidence among the general population (59.5 people per 100 thousand population in 2014 and 51.9 per 100 thousand population in 2017 ). In Ukraine among tuberculosis patients – medical workers,  the overwhelming majority are workers of establishments of the general medical network (GMN) - 351 people, while in anti-tuberculosis institutions (ATI) in 2017, 38 cases of tuberculosis were registered. The article presents the clinical case of multidrug-resistant tuberculosis (MDR) in staff member of the pathoanatomical bureau, one of the medical institutions of the city Dnipro

Medical workers of health care institutions as a risk group for chemo-resistant tuberculosis: analysis of incidence, a clinical case.

The purpose of our study was to analyze the prevalence of morbidity of medical workers of health care institutions and anti-tuberculosis institutions, as well as the analysis of resistance of mycobacterium tuberculosis strains among medical personal of health facilities in the Dnipropetrovsk region. Retrospective analysis for 2015 - 2017 of electronic database of the patients register (TB-manager), outpatient cards and case histories of patients which underwent treatment in pulmonary-tuberculosis and surgical departments of CI «DnepropetrovskRegional Clinical Treatment and Prophylactic Association "Phthisiology"» DRC» was conducted . The incidence of tuberculosis among medical workers in health care institutions of Ukraine remains at a fairly high, stable level (426 cases of tuberculosis in 2016, 389 cases in 2017) on the background of the decrease in the incidence among the general population (59.5 people per 100 thousand population in 2014 and 51.9 per 100 thousand population in 2017 ). In Ukraine among tuberculosis patients – medical workers,  the overwhelming majority are workers of establishments of the general medical network (GMN) - 351 people, while in anti-tuberculosis institutions (ATI) in 2017, 38 cases of tuberculosis were registered. The article presents the clinical case of multidrug-resistant tuberculosis (MDR) in staff member of the pathoanatomical bureau, one of the medical institutions of the city Dnipro