"CTRI Bulletin"
#4,(5),2018.
CTRI BULLETIN №4 (5) 2018
Journal Information: Read
Chief Editor: Ergeshov A.E.
Year of foundation: 2017
ISSN (Print): Browse
Publisher site: http://critub.ru
http://tb-bulletin.ru
CONTENT
| 1) | Non-tuberculous mycobacterial pulmonary disease: clinical recommendations by the British Thoracic Society (According to: BTS guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). Thorax. 2017. DOI: 10.1136/thoraxjnl-2017-210927) Translation by Zaitseva A.S. | 6 | ||
| 2) | Thienopyrimidines – new donors of nitric oxide with high activity against Mycobacterium tuberculosis Salina E.G., Kiarelli L.R., Paska M.R., Makarov V.A. | 18 | READ MORE | |
| 3) | Effectiveness of treatment of multi- and extensively drug resistant TB associated with chronic obstructive pulmonary disease Chernikov A.Yu., Zemlyanskikh L.G. | 24 | READ MORE | |
| 4) | A new approach to immunodiagnostics of TB in patients with late-stage HIV-infection Dudchenko A.V., Karpina N.L., Averbakh M.M. | 31 | READ MORE | |
| 5) | The outcomes of standard and modified chemotherapy regimen III in treatment of local forms of TB in children Evseeva N.I., Gubkina M.F., Yukhimenko N.V., Petrakova I.Yu., KhokhkovaYu.Yu. | 38 | READ MORE | |
| 6) | Prevention of mediastinal hernia after pneumonectomy in patients with fibro-cavitary pulmonary TB complicated by multi- and extensive drug resistance Ergeshova A.E., Bagirov M.A., Komissarova O.G., Karpina N.L., Penagi R.A., Chitorelidze G.V. | 46 | READ MORE | |
| 7) | Effectiveness of immunological methods in the complex diagnostics of TB in patients with the terminal stage of chronic renal failure Gordeeva O.M., Telepnev M.V., Panteleev A.V., Shabalina I.Yu., Larionova E.E., Chernousova L.N., Lyadova I.V., Karpina N.L. | 51 | READ MORE | |
| 8) | Effectiveness of the monoclonal antibody-based enzyme immunoassay (EIA) for mycobacterial antigen detection in TB patients’ samples in the automated ВАСTEC MGIT culture system Avdienko V.G., Andrievskaya I.Yu., Kozlova I.V., Babayan S.S., Smirnova T.G., Larionova E.E., Chernousova L.N., Gergert V.Ya. | 58 | READ MORE | |
| 9) | The role of a School for pulmonary TB patients in establishing a therapeutic alliance between an attending physician and a patient in order to promote adherence to treatment Khomova N.A., Tashpulatova F.K., Belotserkovets V.G., Dolgusheva Yu.V., Sultanov S.A. | 68 | READ MORE | |
| 10) | Psychological support to a teenager with destructive pulmonary TB with extensive drug resistance and concomitant diabetes mellitus during hospital treatment Akhtyamova A.A., Zolotova N.V., Khiteva A.Yu. | 75 | READ MORE |
NON-TUBERCULOUS MYCOBACTERIAL PULMONARY DISEASE: CLINICAL RECOMMENDATIONS BY THE BRITISH THORACIC SOCIETY (According to: BTS guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). Thorax. 2017.
DOI: 10.1136/thoraxjnl-2017-210927)
| Article 1. | Page 6. |
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| ARTICLE TITLE: | Non-tuberculous mycobacterial pulmonary disease: clinical recommendations by the British Thoracic Society (According to: BTS guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). Thorax. 2017. DOI: 10.1136/thoraxjnl-2017-210927) |
| AUTORS: | Translation by Zaitseva A.S. Central TB Research Institute, Moscow, Russia |
| DESCRIPTION OF ARTICLE: | Submitted as of 01.09.2018 In 2017 the British Thoracic Society published the new guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). The full text is available in the November 2017 issue of Thorax or at https://www.brit-thoracic.org.uk/standards-of-care/guidelines/bts-guidelines-for-non-tuberculous-mycobacteria/. We have summarized the key recommendations. Since the publication of the British Thoracic Society (BTS) Guideline on the ‘Management of opportunistic mycobacterial infections’ in 2000, our understanding of the epidemiology, microbiology and management of non-tuberculous mycobacterial-pulmonary disease (NTM-PD) has advanced. The incidence and prevalence of NTM-PD are increasing and are most likely explained by improved clinician awareness and enhanced detection methods, as well as a variety of changing environmental, mycobacterial and host factors. Technological advances in molecular microbiology have revolutionised our understanding of NTM taxonomy, and it is now appreciated that species and subspecies often differ in their pathogenicity and treatment response. While there remains a dearth of contemporary randomised controlled trial data to inform practice, the Guideline Development Group has sought to combine the best available evidence with clinical experience to create a pragmatic management guideline. |
| FOR CORRESPONDENCE: | Central TB Research Institute 2, Yauzskaya alley, 107564, Moscow Anna S. Zaitseva, Senior Researcher, Department of Differential Diagnosis of TB and Extracorporeal Treatments, Head of Therapeutic Department No. 4 Tel.: +7 (499)785-90-31, Е–mail: anyasyls@yandex.ru |
Thienopyrimidines – new donors of nitric oxide with high activity against Mycobacterium tuberculosis
| Article 2. | Page 18. |
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| ARTICLE TITLE: | Thienopyrimidines – new donors of nitric oxide with high activity against Mycobacterium tuberculosis |
| AUTORS: | Salina E.G.,1 Kiarelli L.R.,2 Paska M.R.,2 Makarov V.A.1 1A.N. Bach Institute of Biochemistry, Federal Research Center “Fundamentals of Biotechnology”, Moscow, Russia 2University of Pavia, Pavia, Italy |
| DESCRIPTION OF ARTICLE: | Submitted as of 14.06.2018 The original compounds thienopyrimidines exhibit considerable activity against M. tuberculosis cells in vitro, including dormant forms. We have previously found that thienopyrimidines are the chemical precursors of the more active compounds formed in the M. tuberculosis cell under the action of thioredoxin-like protein Rv2466c, but the mechanism of this activation remained unclear. The analysis of enzymatic activation products of the most active compound TP053 under the action of Rv2466c revealed the production of nitric oxide (NO) during a series of reduction reactions. NO is known to be characterized by a toxic effect on the cell, damaging the DNA and inhibiting the biosynthesis of proteins and lipids. |
| KEYWORDS: | thienopyrimidines, nitric oxide, NO donor, dormant forms, M. tuberculosis, thioredoxin-like protein, prodrug. |
| FOR CORRESPONDENCE: | A.N. Bach Institute of Biochemistry, Federal Research Center “Fundamentals of Biotechnology” of the Russian Academy of Sciences 33, Build. 2, Leninsky Prospekt, 119071, Moscow, Russia Elena G. Salina, Candidate of Biological Sciences, Senior Researcher, Laboratory of Biochemistry of Stresses in Microorganisms Tel.: +7 (905) 578-96-68 E-mail: elenasalina@yandex.ru |
Effectiveness of treatment of multi- and extensively drug resistant TB associated with chronic obstructive pulmonary disease
| Article 3. | Page 24. |
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| ARTICLE TITLE: | Effectiveness of treatment of multi- and extensively drug resistant TB associated with chronic obstructive pulmonary disease |
| AUTORS: | Chernikov A.Yu.1, Zemlyanskikh L.G.2 1Oblast Clinical TB Dispensary, Kurskaya Oblast Health Committee, Kursk, Russia 2Kursk State Medical University, Kursk, Russia |
| DESCRIPTION OF ARTICLE: | Submitted as of 03.08.2018 Aim: To study effectiveness of treatment of multi- and extensively drug resistant TB (MDR/XDR TB) associated with chronic obstructive pulmonary disease (COPD). Materials and methods. We conducted a prospective non-interventional comparative randomized study. The main group enrolled 66 patients with MDR/XDR TB associated with COPD diagnosed in 2014-2016. The distribution by COPD types was as follows: type A – 11 (16.7%), type B – 25 (37.8%), type C – 24 (36.4%), type D – 6 (9.1%). The control group enrolled 66 patients with active MDR TB, also diagnosed in 2014-2016, without signs of COPD. All the patients underwent clinical examination, chest CT, spirometry, bronchoscopy, luminescent microscopy of sputum, sputum inoculation onto solid and liquid media, drug susceptibility testing, molecular and genetic studies, evaluation of patient quality-of-life by the St. George’s Respiratory Questionnaire (SGRQ). Results. We established that patients with MDR/XDR TB associated with COPD were commonly detected at patients’ referrals. Cavitary TB prevailed. Sputum positivity was less commonly confirmed by microscopy, and heavy mycobacteria growth was rarely observed on solid media. We established a wide spectrum of resistance to TB drugs. TB treatment caused adverse reactions, which resulted in more frequent treatment interruptions and treatment prolongations up to 24 months. Treatment outcomes demonstrated low rates of sputum conversion confirmed by microscopy or culture, as well as by positive clinical and X-ray dynamics. Most significant results of quality-of life normalization were achieved by “activity” and “influence” scores, while the general rate and “symptoms” scores remained without any significant shifts. Conclusion. Effectiveness of treatment of MDR/XDR TB associated with COPD was lower than that of MDR TB. This was caused by prevalence of more severe types of COPD, development of adverse reactions to TB treatment, the traits of TB pathogenesis in the lung tissue with anatomical changes due to COPD. |
| KEYWORDS: | multi- and extensively drug resistant TB, COPD, quality-of life, treatment effectiveness. |
| FOR CORRESPONDENCE: | Oblast Clinical TB Dispensary, Kurskaya Oblast Health Committee 50A Chernyakhovskogo St., 305000, Kurskaya oblast, Kursk, Russia Alexander Yu. Chernikov, Candidate of Medical Sciences, Pulmonologist Tel.: +7 (471) 237-00-25 Е-mail: ale-cherny@yandex.ru |
A new approach to immunodiagnostics of TB in patients with late-stage HIV-infection
| Article 4. | Page 31. |
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| ARTICLE TITLE: | A new approach to immunodiagnostics of TB in patients with late-stage HIV-infection |
| AUTORS: | Dudchenko A.V., Karpina N.L., Averbakh M.M. Central TB Research Institute, Moscow, Russia |
| DESCRIPTION OF ARTICLE: | Submitted as of 23.07.2018 Objective – to ascertain the significance of lipoarabinomannan (LAM), a mycobacterial cell-wall component, and INFγ-inducible chemokine CXCL-10 (IP-10) in human serum for TB detection in patients with late-stage HIV-infection. Materials and methods. The study enrolled 106 patients aged 18 and older with late-stage HIV-infection, inflammatory intoxication syndrome and newly detected changes in the lungs. LAM and IP-10 were measured by enzyme immunoassay (EIA) irrespective of CD4+ lymphocyte counts. TB infection was established considering microbiology, molecular-genetic, radiology and cytology data. The immune status was evaluated by the levels of CD4+ cells/mcL, CD8+ cells/mcL and the immunoregulatory indexes of CD4+/CD8+. Results. The study enrolled 106 patients. In 63 patients TB was diagnosed (group HIV/TB), in 43 patients TB was not confirmed (group HIV). The level of CD4+ lymphocytes varied from 0 to 1038 cells/mcL. The largest group of patients had the CD4+ level less than 100 cells/mcL – 65 patients (61.3%). CD4+ from 100 to 200 cells/mcL were established in 12 patients (11.3%), CD4+ more than 200 cells/mcL – in 29 patients (27.4%). LAM levels in the serum from HIV/TB patients and the serum from HIV patients significantly differed (13.75 ± 1.5 pg/ml; CI±2.97 and 7.49 ± 0.5 pg/ml; CI±0.96, respectively; p = 0.000163). IP-10 levels in HIV/TB patients were also higher than in HIV patients (2055.88 ± 378.6 pg/ml (CI±742.06 pg/ml) and 956.74 ± 142.8 pg/ml (CI±279.9 pg/ml; Р=0.013747). In HIV/TB patients LAM and IP-10 levels correlated (the correlation coefficient was 0.56), while in HIV patients there was no such correlation. The positive results of the LAM test did not differ in both sputum positive and sputum negative patients (14.46 ± 2.21 pg/ml and 12.74 ± 1.84 pg/ml, respectively). IP-10 levels were higher in sputum positive patients than in sputum negative patients (2713.02 ± 498.15 pg/ml, CI ±478.2 pg/ml and 988.01 ± 319.3 pg/ml, CI ±306.5 pg/ml, respectively, Р=0.012103). We showed negative correlation between levels of LAM and IP-10 in sputum positive patients -0.48 and sputum negative patients 0.75. Conclusion. The measurements of LAM and chemokine IP-10 (CXCL-10) in the blood serum are informative adjunct criteria for TB diagnosis in patients with late-stage HIV-infection. |
| KEYWORDS: | HIV-infection, TB, immunodiagnostics, lipoarabinomannan, chemokine IP-10 (CXCL-10). |
| FOR CORRESPONDENCE: | Central TB Research Institute 2, Yauzskaya alley, 107564, Moscow, Russia Artem V. Dudchenko, Graduate Student Теl.: +7 (499) 785-90-26 E-mail: Dudchenko_07@mail.ru |
The outcomes of standard and modified chemotherapy regimen III in treatment of local forms of TB in children
| Article 5. | Page 38. |
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| ARTICLE TITLE: | The outcomes of standard and modified chemotherapy regimen III in treatment of local forms of TB in children |
| AUTORS: | Evseeva N.I.1, Gubkina M.F.1,2, Yukhimenko N.V.1, Petrakova I.Yu.1, KhokhkovaYu.Yu.1 1Central TB Research Institute, Moscow, Russia 2Russian National Research Medical University named after N.I. Pirogov, Moscow, Russia |
| DESCRIPTION OF ARTICLE: | Submitted as of 30.07.2018 The aim – to evaluate effectiveness of treatment of local forms of TB in children using standard and modified chemotherapy regimen III. Materials and methods. The study enrolled 61 patients with newly diagnosed active TB of intrathoracic lymph nodes and focal pulmonary TB. In all cases TB was localized, sputum negative and uncomplicated. Twenty-seven patients of group 1 received standard chemotherapy regimen III (4 drugs in the intensive phase, 2 drugs in the continuation phase of treatment); 34 patients of group 2 received modified chemotherapy regimen III (3 drugs in the intensive phase, 2 drugs in the continuation phase). Results. Intoxication symptoms disappeared, and blood counts normalized after 3 months of treatment in the majority of patients of the both groups. Positive X-ray dynamics was observed in 7 patients (25.9%) of group 1 and 12 patients (35.3%) of group 2; more commonly after 3 months of treatment, and less commonly after 6 months of treatment: in group 1, 85.7% and 14.3% respectively, in group 2, 75% and 25% respectively (φ=1.00000, р>0.05). There was no difference between the groups in time and frequency of positive clinical, X-ray and laboratory dynamics. In group 2 adverse reactions to TB drugs were reliably less frequent – 17.6±6.5% vs. 44.4±9.7% in group 1 (р=0,036) – and drug withdrawals were 2.5 times less frequent due to lower drug burden in the intensive phase. Conclusion. Modified chemotherapy regimen III was as effective as standard chemotherapy regimen III. Thus, it can be used as an alternative to standard chemotherapy regimen III in treatment of local forms of TB in children. |
| KEYWORDS: | childhood TB, modified chemotherapy regimen, adverse reactions. |
| FOR CORRESPONDENCE: | Central TB Research Institute 2, Yauzskaya alley, 107564, Moscow, Russia Natalia I. Evseeva, Junior Researcher, Child and Adolescent Department Tel.: +8 (499) 785-90-27 E-mail: detstvocniit@mail.ru |
Prevention of mediastinal hernia after pneumonectomy in patients with fibro-cavitary pulmonary TB complicated by multi- and extensive drug resistance
| Article 6. | Page 46. |
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| ARTICLE TITLE: | Prevention of mediastinal hernia after pneumonectomy in patients with fibro-cavitary pulmonary TB complicated by multi- and extensive drug resistance |
| AUTORS: | Ergeshova A.E., Bagirov M.A., Komissarova O.G., Karpina N.L., Penagi R.A., Chitorelidze G.V. Central TB Research Institute, Moscow, Russia |
| DESCRIPTION OF ARTICLE: | Submitted as of 01.08.2018 We analyzed the outcomes of anterior mediastinum plastic surgery for prevention of mediastinal hernia after pneumonectomy in 30 patients with fibro-cavitary pulmonary TB complicated by multi- and extensive drug resistance. The comparison of surgery outcomes in 17 (56.7%) patients, who underwent pneumonectomy followed by anterior mediastinum plasty, and 13 (43.3%) patients, who underwent pneumonectomy without additional interventions or with delayed extrapleural thoracoplasty on the opposite side, demonstrated that the former group had smaller shift of the mediastinal organs according to chest X-ray data and fewer heart and bronchopulmonary disorders. Thus, we proved the advantages of a new surgery treatment, i.e. anterior mediastinum plasty after pneumonectomy. |
| KEYWORDS: | fibro-cavitary TB, multi- and extensive drug resistance of Mycobacterium tuberculosis, pneumonectomy, anterior mediastinum plasty. |
| FOR CORRESPONDENCE: | Central TB Research Institute 2, Yauzskaya alley, 107564, Moscow Anush E. Ergeshova, Surgeon, Surgery Division no. 2, Surgery Department Tel: +7 (903) 597-14-73 E-mail: dr.akhachatryan@mail.ru |
Effectiveness of immunological methods in the complex diagnostics of TB in patients with the terminal stage of chronic renal failure
| Article 7. | Page 51. |
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| ARTICLE TITLE: | Effectiveness of immunological methods in the complex diagnostics of TB in patients with the terminal stage of chronic renal failure |
| AUTORS: | Gordeeva O.M., Telepnev M.V., Panteleev A.V., Shabalina I.Yu., Larionova E.E., Chernousova L.N., Lyadova I.V., Karpina N.L. Central TB Research Institute, Moscow, Russia |
| DESCRIPTION OF ARTICLE: | Submitted as of 01.08.2018 Given the growing prevalence of chronic renal failure (CRF) in the terminal stage, CRF/TB comorbidity is becoming an interdisciplinary sociomedical and economic challenge, since both patients on replacement therapy and kidney transplant recipients are at high risk for TB. TB diagnosis in CRF patients in the terminal stage is rather complicated, and suppression of cell-mediated immune response can reduce informativity of immunological tests. Aim: to evaluate the diagnostic value and potentials of immunological methods of pulmonary TB diagnostics in patients with the terminal stage of CRF. Materials and methods. We studied 37 patients with CRF in the terminal stage, who referred to the Central TB Research Institute to ascertain the diagnosis due to newly-detected changes in the lungs and/or unspecified intoxication syndrome in 2010-2018. The studies verified pulmonary TB in 18 out of 37 (48.6%) patients with the terminal stage of CRF (group 1). Non-specific pulmonary diseases were diagnosed in 19 (51.4%) patients (group 2). All the patients underwent immunological tests: the Mantoux test with 2 TU PPD-L, the skin test with recombinant tuberculosis allergen (RTA), T.SPOT.TB, lymphocyte subpopulation studies. Results. The analysis of the immunological methods revealed that sensitivity of T.SPOT.TB was 38.8%, and its specificity was 100%. The determination of percentage and absolute numbers of CD4 lymphocytes showed that the respective rates did not differ between TB patients with positive and negative results of T.SPOT.TB. Sensitivity of the Mantoux test with 2 TU PPD-L was 38.8%, and its specificity was 100%. Sensitivity of RTA was 33%, and its specificity was 100%. Conclusion. The immunological tests (the Mantoux test with 2 TU PPD-L, RTA test, T.SPOT.TB) can be used as adjunct methods for TB diagnostics in patients with the terminal stage of CRF, based on their specificity (100%) and sensitivity (38.8%, 33%, 38.8% respectively). However, the immune status of patients with the terminal stage of CRF requires further investigations. |
| KEYWORDS: | diagnostics of pulmonary TB, the Mantoux test with 2 TU PPD-L, skin test with recombinant tuberculosis allergen, T.SPOT.TB, chronic renal failure, dialysis, kidney transplantation. |
| FOR CORRESPONDENCE: | Central TB Research Institute 2, Yauzskaya alley, 107564, Moscow Olga M. Gordeeva, Junior Researcher, Clinical Diagnostic Department Tel.: +7 (499) 785-90-26 E-mail: hobbetxe@mail.ru |
Effectiveness of the monoclonal antibody-based enzyme immunoassay (EIA) for mycobacterial antigen detection in TB patients’ samples in the automated ВАСTEC MGIT culture system
| Article 8. | Page 58. |
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| ARTICLE TITLE: | Effectiveness of the monoclonal antibody-based enzyme immunoassay (EIA) for mycobacterial antigen detection in TB patients’ samples in the automated ВАСTEC MGIT culture system |
| AUTORS: | Avdienko V.G., Andrievskaya I.Yu., Kozlova I.V., Babayan S.S., Smirnova T.G., Larionova E.E., Chernousova L.N., Gergert V.Ya. Central TB Research Institute, Moscow, Russia |
| DESCRIPTION OF ARTICLE: | Submitted as of 15.09.2018 For the recent 20 years MPT64 has been the most significant mycobacterial antigen for laboratory diagnosis of TB. We evaluated effectiveness of Mycobacterium tuberculosis detection by monoclonal antibody-based enzyme immunoassay (EIA) using monoclonal antibody pairs against mycobacterial antigens: MPT63, Rv0009, LpqH, MPT83, Ag85B, pstS/phoS, PstS1. We studied 224 M. tuberculosis cultures from pulmonary TB patients, 38 cultures of non-tuberculous mycobacteria, and 120 cultures of non-specific microflora. The highest diagnostic effectiveness (97.35%) was established for EIA detecting antigen MPT64 used as a comparison antigen. Effectiveness was also high for detecting antigens MPT63 (95.95%), Rv0009 (94.85%), LpqH (91.18%), MPT83 (94.23%), 24kDa (93.33%), Ag85B (93.41%) and PstS1 (94.30%). At the same time, specificity of detecting antigens MPT63 (99%) and MPT83 (98.1%) was higher than that of detecting comparison antigen MPT64 (97.5%). Sensitivity of diagnostics by MPT64 (97.17%) was somewhat lower than by antigen Ag85B (98.22%). These results demonstrate that paired monoclonal antibody-based EIA designed for detecting specific mycobacterial antigens is a promising tool, which can be further developed and used as adjunct for studying M. tuberculosis cultures. |
| KEYWORDS: | monoclonal antibodies, Mycobacterium tuberculosis, Nontuberculosis mycobacteria, “capture” ELISA, diagnostic efficacy. |
| FOR CORRESPONDENCE: | Central ТВ Research Institute 2, Yauzskaya alley, 107564, Moscow, Russia Vadim G. Avdienko, Candidate of Medical Sciences, Senior Researcher, Immunology Department Tel.: +7 (499) 780-49-97 E-mail: vg_avdienko@mail.ru |
The role of a School for pulmonary TB patients in establishing a therapeutic alliance between an attending physician and a patient in order to promote adherence to treatment
| Article 9. | Page 68. |
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| ARTICLE TITLE: | The role of a School for pulmonary TB patients in establishing a therapeutic alliance between an attending physician and a patient in order to promote adherence to treatment |
| AUTORS: | Khomova N.A.1, Tashpulatova F.K.2, Belotserkovets V.G.3, Dolgusheva Yu.V.3, Sultanov S.A.2 1Scientific Research Institute of Public Health and Health Organization, Tashkent, the Republic of Uzbekistan 2Tashkent Pediatric Medical Institute, Tashkent, the Republic of Uzbekistan 3Republican Specialized Scientific and Practical Medical Center for Phthisiology and Pulmonology named after Sh.A. Alimov, Tashkent, the Republic of Uzbekistan |
| DESCRIPTION OF ARTICLE: | Submitted as of 12.07.2018 The aim of the present study was to evaluate the level of compliance of pulmonary TB patients, develop and assess effectiveness of educational and informational programmes for inpatients. We studied 75 patients under treatment in a therapeutic department of the Republican Specialized Scientific and Practical Medical Center for Phthisiology and Pulmonology, Uzbekistan. We created a School for pulmonary TB patients and developed lectures for informative, psychological and motivation purposes. We observed that the School for TB patients aided to increase patients’ adherence to treatment and improve interactions between an attending physician and a patient. After attending the School, the number of compliant patients twice increased, and the number of non-compliant patients fell to zero. During the study we practically reduced to zero such a phenomenon as egrotogenia (negative influence of one patient on another). |
| KEYWORDS: | compliance, TB, treatment, therapeutic alliance, psychology, awareness. |
| FOR CORRESPONDENCE: | Scientific Research Institute of Public Health and Health Organization 38, Prospekt Mirzo-Ulugbeka, Mirzo-Ulugbekovsky raion, 100077, Tashkent, Uzbekistan Natalia A. Khomova, Junior Researcher, Department of Research into Economics and Financial Issues in Health Tel.: +998 (94) 618-94-13 E-mail: elixir_90@inbox.ru |
Psychological support to a teenager with destructive pulmonary TB with extensive drug resistance and concomitant diabetes mellitus during hospital treatment
| Article 10. | Page 75. |
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| ARTICLE TITLE: | Psychological support to a teenager with destructive pulmonary TB with extensive drug resistance and concomitant diabetes mellitus during hospital treatment |
| AUTORS: | Akhtyamova A.A., Zolotova N.V., Khiteva A.Yu. Central TB Research Institute, Moscow, Russia |
| DESCRIPTION OF ARTICLE: | Submitted as of 29.05.2018 The clinical observation demonstrates the presence of specific premorbid emotional personality traits and a specific social behaviour of a teenager with progressive destructive pulmonary TB with extensive drug resistance and concomitant diabetes mellitus. We showed the necessity of continuous psychological support to such a patient during a complex treatment. The personality profile at admission to hospital was characterized by emotional instability, predisposition to anxiety-depressive and destructive behaviour, chronization of negative emotions. The socio-psychological status was characterized by insularity, isolation, elevated criticism of surrounding people and ongoing events. We established high stress load during the two years before hospitalization. The total severity index of the mental state at treatment commencement twice exceeded the normal values. Obsessive-compulsive, anxiety-depressive, phobic disorders prevailed, as well as interpersonal sensitivity, isolation from surrounding people. Psychological assistance to the patient during the complex treatment included several objectives. In the pre-operative period the priority psychological objectives were determined by the necessity to optimize the emotional state of the patient and his adaptation to the new life situation associated with the upcoming life-saving operation followed by chemotherapy. After 5 months of the pre-operative period some positive dynamics in the emotional state of the teenager was observed. One month after the operation psychological distress significantly decreased versus the primary examination. The achieved improvement of the psychological status allowed starting the next stage of the psychological rehabilitation programme; for the next 9 months special measures were taken to change the emotional response and the personal attitude towards the surroundings, which had previously formed the source of the chronic psycho-emotional tense of the patient. After fifteen months of treatment the psychological status of the teenager was characterized by further positive dynamics. The psychological support to the discussed patient during the complex treatment enabled to significantly decrease stress load, improve and stabilize his emotional state. The psychological measures also helped to overcome emotional maladjustment and facilitate personal development of the teenager; he acquired skills of constructive behaviour and interpersonal interactions. |
| KEYWORDS: | TB, teenagers, psychological support, psychological status, personality characteristics. |
| FOR CORRESPONDENCE: | Central TB Research Institute 2, Yauzskaya alley, 107564, Moscow, Russia Almira A. Akhtyamova, Candidate of Psychological Sciences, Senior Researcher, Psychology Team, Child and Adolescent Department Tel.: +7 (499) 785-90-05 E-mail: detstvocniit@mail.ru |