Проблема отказов от иммунодиагностики туберкулеза: результаты многоцентрового социологического исследования

The objective: to study the reasons for the refusal of legally authorized representatives of children to conduct mass immunodiagnosis of tuberculosis using a representative sample of population and to outline possible ways to change this negative situation.Subjects and methods: A cross-sectional multi-center study was conducted. In 8 regions of the Russian Federation, the survey was conducted in 1,059 legally authorized representatives of children refusing to undergo mass immunodiagnostics of tuberculosis. The following main reasons for refusal were found out: fear of side effects and complications (32.6%), distrust in the quality of the test (29.7%), lack of understanding of the need to examine a child for tuberculosis. 72.2% of respondents demonstrated poor awareness of the problem of tuberculosis – they denied this problem or associated it with a different social environment, which was fertile ground for negative information received through various channels. To solve this problem, it is necessary to intensify health education in various groups of the population, including work with religious communities. Additional resources can be used such as targeted social advertisements, which will allow covering with health education propaganda of 33.1% of people who do not want to receive information about tuberculosis, expanding the regulation for the use of alternative methods of screening for tuberculosis.The authors state that they have no conflict of interests.Цель исследования: на репрезентативной выборке изучить причины отказа законных представителей детей от проведения мероприятий по массовой иммунодиагностике туберкулеза и наметить возможные пути корректировки данного негативного явления.Материалы и методы: одномоментное многоцентровое исследование. В 8 субъектах Российской Федерации проведено анкетирование 1 059 законных представителей детей, отказывающихся от мероприятий по массовой иммунодиагностике туберкулеза. Установлено, что основными причинами их отказа явились: страх побочных реакций и осложнений (32,6%), недоверие качеству теста (29,7%), отсутствие смыслового мотива обследования ребенка на туберкулез. У 72,2% респондентов установлена недостаточная информированность о проблеме туберкулеза ‒ ее отрицание или смещение в иную социальную среду, что явилось благодатной почвой для негативной информации, получаемой по различным каналам. Для решения данной проблемы необходимо активизировать санитарно-просветительскую работу с различными группами населения, в том числе работу с религиозными общинами. Дополнительными ресурсами могут быть: использование тематической целевой социальной рекламы, которая позволит вести санитарную пропаганду среди 33,1% лиц, не желающих получать информацию о туберкулезе, расширение нормативной базы для применения альтернативных методов обследования на туберкулез.Авторы заявляют об отсутствии у них конфликта интересов

Medical management of Acute Radiation Syndromes:Immunotherapy by Antiradiation Immunoglobulin G .

Immunoglobulins is an important part of Acquired Immunity and participate in such important immunological processes as recognition, regulation and elimination of foreign antigens. At the present time, Intravenous Immunoglobulins are used for an efficient therapy for immune deficiency syndromes, thrombocytopenias, inflammatory reactions, modulation of autoimmunity and a wide range of hematologic disorders. Traditionally, the treatment of Acute Radiation Syndromes (ARS) includes supportive therapy, cytokine therapy, blood component transfusions and stem cell transplantation. However, results of treatment of ARS remain limited and in cases of severe radiation injury insufficient. Studies of therapy effects of Anti-radiation Immunoglobulin G in vivo have established that specific antibodies to Radiation Toxins of SRD group can be important, effective part of medical management of ARS and can play a significant role in neutralization of radiation induced toxicity. Multiple-organ failure at Acute Radiation Syndromes is a major cause of mortality after high doses of gamma irradiation. Radiation Toxins of Specific Radiation Deteminant group(neuro-toxic, neuro-vascular-toxic, entero-toxic, hemato-toxic) play an important role in development of Acute Radiation Syndromes and development of multi-organ involvement and multi-organ failure. Radiation Toxins possess high toxic properties. Radiation Neurotoxin isolated from lymphatic system of irradiated animals (with a clinical picture of cerebral radiation syndrome) and injected to healthy animals in toxic doses 0.03 mg/kg, 0.5 mg/kg, 10.0 mg/kg, 15.0 mg/kg had initiated development of acute failure of blood circulation and breathing ventilation. Death of laboratory animals had occurred within 5 min-3 days after injection of toxic doses of Radiation Neuro-Toxin and depended on a concentration and a type of active substance of Radiation Toxins. Hyper-immunization of non-irradiated animals by non-toxic doses of Radiation Toxins were provided. The immunoglobulin fraction of pooled hyperimmune anti-radiation plasma was separated. Immunoglobulines to Radiation Toxins were used for a treatment of Acute Radiation Syndromes and the efficacy of this bio-pharmaceutical agent was initially evaluated. Therapeutic application of Specific Anti-radiation Immunoglobulin had significantly diminished mortality rate at Acute Radiation Syndromes and was much more effective compare with natural immunoglobulins preparations and irradiated forms of natural irradiated immunoglobulins

Antiradiation vaccine : immunoprophylaxis of acute radiation syndromes - radioprotective efficiency.

Current medical management of Acute Radiation Syndromes does not include immune prophylaxis based on Antiradiation Vaccine. Existing principles for the treatment of acute radiation syndromes are based on the replacement therapy and supportive therapy. A large amount of antigens isolated from bacterias (flagellin and derivates), plants, different types of venoms (honeybees, scorpions, snakes) can produce a nonspecific stimulation of immune system of mammals and protect against of irradiation. But only radiation toxins stimulate a specific antigenic stimulation of antibody synthesis. Active immunization by non-toxic doses of radiation toxins includes a complex of radiation toxins that we call the Specific Radiation Determinant (SRD). Immunization must be provided not less than 30 days before irradiation and it is effective up to three years and more. Active immunization by radiation toxins significantly diminishes mortality rate (100%) and improves survival rate up to 60% compare with 0% survival rate among irradiated animals in control groups. The SRD molecules were isolated from Lymphatic Systems of animals that were irradiated with high doses of irradiation and had clinical and laboratory picture of Cerebral Acute Radiation Syndrome, Cardiovascular Acute Radiation Syndrome, Gastrointestinal Acute Radiation Syndrome and Hematological Acute Radiation Syndrome. Our classification of radiation toxins include 4 major groups: 1.SRD-1, neurotoxic radiation toxins; 2.SRD-2, neurovascular radiation toxins; 3.SRD-3, non-Bacterial Gastrointestinal Radiation Toxins; 4.SRD-4, Hematopietic Radiation Toxins. Radiation toxins possess both toxic and immunological properties. But mechanisms of immune-toxicity by which radiation toxins stimulate development of ARS are poorly understood. We have compared lethal toxicity of radiation toxins and a potential for neutralization of their toxic activity by specific antibodies to radiation toxins. Blocking antiradiation antibodies induce an immunologically specific effect and possess inhibiting effects to radiation induced neuro-toxicity, vascular-toxicity, gastrointestinal toxcity, hematopoietic toxicity and radiation induced cytolysis of selected sensitive to radiation groups of cells. Blocking Antiradiation Antibodies are immunologically specific and can be produced by immunization with different radiation toxins isolated from irradiated mammals. We propose that Specific Antiradiation Antibodies targeted to radiation induced Toxins. Specific Antiradiation Antibodies neutralize toxic properties of radiation toxins. Antiradiation Antibodies in different phases of Acute Radiation Syndromes can compete with cytotoxic lymphocytes and prevent cytolysis mediated by cytotoxic lymphocytes

Differential diagnosis of Acute Radiation Syndromes by Enzyme Immune-Assay (EIA)

Differential diagnosis of Acute Radiation Syndromes by the method of immune enzyme assay is a very efficient tool of biological dosimetry and evaluation of acute radiation disease. We use as biological markers the group of essential Radiotoxins - high molecular weight glycoproteins with specific antigenic properties. A molecular weight of radiation toxins was 200-250 kDa. High doses of radiation induce the formation of radiation toxins in the organs and tissues of irradiated animals. After whole body irradiation, cellular macromolecules and cells and mitochondrial outer and inner wall membranes are damaged by long-lived radiation-induced free radicals, reactive oxygen species and fast, charged particles of radiation. High doses of radiation induce breaks in the chemicals bonds of macromolecules (proteins,lipids,carbohydrates,DNA molecules) and cross-linking reactions via chemically active processes. These processes result in creation of novel modified macromolecules that possess specific toxic and antigenic properties defined by the type and doses of irradiation by which they are generated. After formation, Radiation toxins migrate from irradiated tissues to interstitial fluid and accumulate in the lymphatic and blood transportation system. Radiation toxins isolated from the lymph of irradiated animals are classified as hematotoxic, neurotoxic, and enteric non-bacterial(GI) Radiation Toxins, and they play an important role in development of Hematopoietic, Cerebrovascular, Cardiovascular and Gastro- Intestinal Acute Radiation Syndromes(ARS). Four Groups and Seven distinct Toxins derived from post-irradiated animals have been designated as Specific Radiation Determinants (SRD): SRD-1(Neuro-toxic radiation toxin generated by Cerebrovascular ARS), SRD-2(Vascular-toxic radiation toxin generated by Cardiovascular ARS), SRD-3(Enteric non-bacterial radiation toxins generated by the Gastrointestinal form of ARS), and SRD-4(Hematotoxic radiation toxins generated by hematological, bone marrow form of ARS ). SRD-4 is further subdivided into four groups depending on the severity of the ARS induced: SRD-4/1, mild ARS; SRD-4/2, moderate ARS; SRD-4/3, severe ARS and SRD-4/4, extremely severe ARS. We postulate that the SRD-1 and the SRD-2 radiation toxins produce toxicity for central and peripheral nervous system. Determination of high levels of SRD-1, SRD-2,SRD-3 and SRD-4 in the periferal blood allowed to recognize early periods of Cerebrovascular, Cardiovascular, Gastrointestinal and Hematopoietic forms of ARS. The important goal of an early assessment with Enzyme Immune Assay is the accurate description of the Acute Radiation Syndromes at initial phases. Early and precise differential diagnosis allow doctors to provide an effective medical management of ARS

Лазерная терапия во фтизиопульмонологии

Various techniques of use of low intensity lasers like helium-neon, semiconductive, and granate were elaborated as non-drug pathogenic remedy to increase the effectiveness of complex therapy in patients with destructive pulmonary tuberculosis.The helium-neon laser was used endobronchially, intravenously, or acupuncturally in dependence on coupled or complicated pathology (non-specific endobronchitis, bronchial asthma). The semiconductive laser was used epicutaneously or endobronchially at the area of pathologic focus projection. The granate one was used epicutaneously at the area of large vessels. The elaborated techniques of laser therapy were used in complex treatment in 221 patients with destructive pulmonary tuberculosis.The total effectivity of the treatment including combinations of sputum negativation cases and destruction caves closing was increased by laser phototherapy at 18—20% at the moment of dischargement. The same time, the courses of bacterioemission, destruction caves closing, and hospital treatment were restricted at 1.—1.5 months in average.С целью повышения эффективности комплексной терапии больных деструктивным туберкулезом легких в качестве немедикаментозного патогенетического средства разработаны различные методики применения низкоинтенсивных лазеров, таких как гелий-неоновый, полупроводниковый и гранатовый.В зависимости от сочетанной или осложняющей основной процесс патологии (неспецифический эндобронхит, бронхиальная астма) гелий-неоновый лазер применяли эндобронхиально, внутривенно или на акупунктурные точки; полупроводниковый лазер - накожно, на область проекции патологического очага или эндобронхиально; гранатовый — накожно, на область крупных сосудов.Разработанные методики лазерной терапии использованы в комплексном лечении 221 больного деструктивным туберкулезом легких.Общая эффективность лечения, оцениваемая в процентах, исходя из учета комбинации случаев негативации мокроты и закрытия полостей распада на момент выписки из стационара при использовании лазерной фототерапии, повышалась на 18—20%. Одновременно с этим сокращались сроки прекращения бактериовыделения, закрытия полостей распада и стационарного этапа лечения в среднем на 1,—1,5 месяцев

The problem of refusal from immunodiagnosis of tuberculosis: results of a multi-center sociological study

The objective: to study the reasons for the refusal of legally authorized representatives of children to conduct mass immunodiagnosis of tuberculosis using a representative sample of population and to outline possible ways to change this negative situation.Subjects and methods: A cross-sectional multi-center study was conducted. In 8 regions of the Russian Federation, the survey was conducted in 1,059 legally authorized representatives of children refusing to undergo mass immunodiagnostics of tuberculosis. The following main reasons for refusal were found out: fear of side effects and complications (32.6%), distrust in the quality of the test (29.7%), lack of understanding of the need to examine a child for tuberculosis. 72.2% of respondents demonstrated poor awareness of the problem of tuberculosis – they denied this problem or associated it with a different social environment, which was fertile ground for negative information received through various channels. To solve this problem, it is necessary to intensify health education in various groups of the population, including work with religious communities. Additional resources can be used such as targeted social advertisements, which will allow covering with health education propaganda of 33.1% of people who do not want to receive information about tuberculosis, expanding the regulation for the use of alternative methods of screening for tuberculosis.The authors state that they have no conflict of interests