Risk factors and algorithms to identify hepatitis C, hepatitis B, and HIV among Georgian tuberculosis patients.

OBJECTIVES: To determine prevalence, risk factors, and simple identification algorithms for HIV, hepatitis B, and hepatitis C co-infection; factors that may predispose for anti-tuberculosis therapy-induced hepatotoxicity. METHODS: We recruited 300 individuals at in-patient tuberculosis hospitals in three cities in Georgia, administered a behavioral questionnaire, and tested for antibody to HIV, hepatitis C (HCV), hepatitis B core antigen (anti-HBc), and the hepatitis B surface antigen (HBsAg). RESULTS: Of the individuals tested, 0.7% were HIV positive, 4.3% were HBsAg positive, 8.7% were anti-HBc positive, and 12.0% were HCV positive. In multivariable analysis, a history of blood transfusion, injection drug use, and prison were significant independent risk factors for HCV, while a history of blood transfusion, injection drug use, younger age at sexual debut, and a high number of sex partners were significant risk factors for HBV. Three-questionnaire item algorithms predicted HCV serostatus 74.1% of the time and HBV serostatus 85.2% of the time. CONCLUSIONS: Treatment of tuberculosis patients in resource-limited countries with concurrent epidemics of HCV, HBV, and HIV may be associated with significant hepatotoxicity. Serologic screening of tuberculosis patients for HBV, HCV, and HIV or using behavioral algorithms to identify patients in need of intensive monitoring during anti-tuberculosis therapy may reduce this risk.

High prevalence of hepatitis C virus but not HIV co-infection among patients with tuberculosis in Georgia.

SETTING: Tuberculosis (TB) and hepatitis C virus (HCV) infection have emerged as major public health problems in former Soviet republics. OBJECTIVE: To determine the prevalence and risk factors for the human immunodeficiency virus (HIV) and HCV co-infection among patients with TB in Georgia, a cross-sectional study was carried out at hospitals in four Georgian cities. RESULTS: Of 272 hospitalized patients with TB, 61 (22%) were found to be HCV-seropositive and three (1%) were HIV-seropositive. The median age of those with TB was 35 years (range 18-74 years); 74% were male. In multivariate analysis, risk factors for HCV co-infection included previous incarceration (OR 4.6, 95%CI 1.9-10.8), history of receiving a tattoo (OR 2.6, 95%CI 1.2-5.7), previous diagnosis of a sexually transmitted infection (OR 7.2, 95%CI 1.4-37.8), and age 26-45 years (OR 2.1, 95%CI 1.0-4.6). CONCLUSION: HCV co-infection was common among hospitalized patients with TB in Georgia. Incarceration and receiving a tattoo, a common practice among inmates in Georgian and former Soviet correctional facilities, were important independent risk factors associated with HCV infection among those with TB. Further studies are needed to assess the impact of the high prevalence of HCV co-infection on treatment outcomes, including tolerability and risk of anti-tuberculosis drug induced hepatotoxicity.

Efforts of identifying the place of tb infection and bcg vaccination in the hygiene hypothesis of allergy.

Hygiene hypothesis of allergy proposed by D. Strachan in the 1980s is still urgent. The goal of the study was the identification of association between BCG vaccinations and TB infection and bronchial asthma and other allergic manifestations and defining the nature of such association. The study engaged students of the Tbilisi secondary school #4, born in 1990-1998. The study was carried out using International Study of Asthma and Allergies in Childhood questionnaire and tuberculin test. The obtained data was statistically processed using computer software Epi-info (Version 3.3.2. Atlanta, USA). The conclusions of the study are as it follows: 1. There is no statistically reliable association between BCG vaccination and prevalence of Bronchial asthma, as well as other allergic manifestations. This makes doubtfull involvement of anti-TB immunization in hygiene hypothesis. 2. Incidence of bronchial asthma and other allergic manifestations among TB infected individuals is twice lower in comparison with non-infected persons. Despite this fact due to non-representativity of the material such inverse association is not statistically reliable.

Risk for tuberculosis infection among internally displaced persons in the Republic of Georgia.

OBJECTIVE: To determine the prevalence of tuberculosis (TB) infection and disease among internally displaced persons residing in Tbilisi, Republic of Georgia. DESIGN: Residents of eight refugee hostels were screened for TB infection using a tuberculin skin test (TST) and a symptom questionnaire. Participation was voluntary. TST-positive individuals were referred for chest radiography. Subjects with cough, fever, or night sweats of > 2 weeks duration provided sputum for acid-fast bacilli (AFB) microscopy and culture. RESULTS: Of approximately 4000 potential subjects (internally displaced persons), 988 (24.7%) participated in the screening program. Of these 988, 931 (94.2%) who had a TST placed returned at 48-72 hours to have the skin test examined; 447 (48.0%) were TST-positive (> or = 10 mm induration). In multivariate analysis, risk factors for a positive TST included male sex, ever having received BCG, history of close contact with a case of active tuberculosis, and living in one specific refugee hostel. Risk for a positive TST was greater among subjects > 20 years old, but there was no difference between age groups over the age of 20 years. Five patients with active TB were identified through the screening program, giving a case rate of 537 per 100,000 population. CONCLUSION: Tuberculosis infection and disease were common in this group of internally displaced persons. Screening was a useful mechanism of case finding among this high prevalence population.

Tuberculosis control in the Caucasus: successes and constraints in DOTS implementation.

SETTING: The pilot projects for tuberculosis (TB) control, supported by the World Health Organization (WHO) and based on the WHO recommended control strategy, directly-observed treatment, short-course (DOTS) in the Caucasian countries (Armenia, Azerbaijan, Georgia). OBJECTIVE: To evaluate the results 2 years after the implementation of the pilot projects. METHODS: Analysis of data on case detection, sputum conversion and treatment outcome reported quarterly to the WHO from the Ministries of Health in each country. RESULTS: Since the establishment of the project, 1330, 764 and 4866 new cases and relapses, respectively, of TB have been detected in the pilot areas of Armenia, Azerbaijan and Georgia. In Armenia and Azerbaijan, respectively 46% and 57% of all cases were smear positive, whilst in Georgia, the corresponding figure was only 12%. After 3 months' treatment, 93% of new smear-positive patients had become smear-negative. The sputum conversion rate for relapses and other retreatment cases (failure, treatment interrupted) was 85%. In Armenia, 78.1% of new smear-positive patients were treated successfully (cured or completed treatment). The corresponding percentages for Azerbaijan and Georgia were 87.9% and 59.6%. Treatment success rates among retreatment cases was generally low, at respectively 46%, 64%, and 35%, in Armenia, Azerbaijan, and Georgia. CONCLUSION: The results of the implementation of the WHO TB control pilot projects in Armenia, Azerbaijan and Georgia suggest that the DOTS strategy is feasible in emergency situations in general, and in the Caucasus in particular.

Cigarette smoking among school teachers in Tobago.

Tobago, until lately, was considered a society with a low prevalence of cigarette smoking. Recent surveys, however, showed an increasing smoking prevalence among school children. To assess whether teachers in Tobago can be credible role models for their pupils, we carried out a cross-sectional survey on their smoking-related attitudes and behaviour in 2002. We distributed anonymous, structured questionnaires to teachers of all 52 primary and secondary schools in the island and conducted structured observations in schools. Of 579 teachers present during the survey, 559 (97%) returned a completed questionnaire; 8.6% of the male and 2.4% of the female teachers reported to be current cigarette smokers; slightly higher proportions had ever been daily smokers. Teachers were well aware of the harmful effects of smoking. Significantly more non-smokers than current smokers were in favour of strict school smoking regulations. The vast majority of the teachers perceived anti-smoking education as their duty. None of the schools had dedicated smoking rooms for teachers, and we found no cigarette butts in or around teachers' rooms. In Tobago, teachers have a lower reported prevalence of cigarette smoking than their pupils. Thus, most teachers can be credible role models with regard to smoking prevention and should be encouraged to become more active in school-based preventive activities.

[Rapid immunoenzyme diagnosis of influenza in patients with various allergoses and bronchial asthma]. / Immunofermentnaia ékspress-diagnostika grippa u bol'nykh razlichnymi allergozami i bronkhial'noi astmoi.

In an investigation carried out in the allergological clinic of the Tbilisi State Medical Institute in the period between two outbreaks of influenza, the presence of influenza antigen was determined in nasal washings taken from 127 patients with different allergoses and bronchial asthma by means of the enzyme immuno-assay with the use of the type-specific virion antigen of M1-protein. This method was found to be highly sensitive and to have some advantages over traditional methods used for the diagnosis of influenza. In patients with preasthma and different forms of bronchial asthma elevated susceptibility to influenza infection and its unfavorable influence on the clinical course of these pathological conditions were established.

[Lipid extraction from blood plasma and the subsequent administration of the autologous delipidized plasma as a possible agent for treating atherosclerosis (an experimental study)]. / Ekstraktsiia lipidov iz plazmy krovi i posleduiushchee vvedenie v organizm sobstvennoi delipidirovannoi plazmy kak vozmozhnoe sredstyo lecheniia ateroskleroza (éksperimental'noe issledovanie).

A method for the delipidization of blood plasma of rabbits and dogs with diethyl ether with its subsequent reinfusion into the animal's body is described. Triglycerides and cholesterol were mainly extracted from blood plasma, and only 1/3 of phospholipids. In dog experiments the plasma delipidization procedures led to a decrease of the cholesterol content in the overall fraction of atherogenic lipoproteins of low and very low density and an increase of the cholesterol content in antiatherogenic lipoproteins of high density. The lipoextraction procedures are harmless and may be employed for reducing the blood lipid level.

[Blood plasma lipoextraction as a method of lipid removal from atherosclerotic lesions of the aorta in rabbits]. / Lipoékstraktsiia plazmy krovi kak metod udaleniia lipidov iz ateroskleroticheskikh porazhenii aorty u krolikov.

The effect of repeated lipoextraction of their own blood plasma on regression of the atherosclerotic process was studied in rabbits with experimental hypercholesterolemia 2 months after they had been fed cholesterol. The blood plasma cholesterol level at the end of the experiment was lower in the experimental animals than in the controls, whereas the results of morphological examination of the aortic areas involved in atherosclerosis showed that repeated removal of lipids from the blood plasma promotes rapid regression of experimental atherosclerosis in the experimental animals.

[Triglyceride, total cholesterol and lipoprotein fraction cholesterol levels in the blood plasma of elderly and long-lived persons in the Abkhazian SSSR]. / Uroven' triglitseridov, obshchego kholesterina i kholesterina lipoproteidnykh fraktsii v plazme krovi liudei starcheskogo vozrasta i dolgozhitelei Abkhazskoi ASSR.

The results of examination of 21 males and 30 females of the category of elderly and long-lived persons (81--106 years old) indicate the low content in the blood plasma of total cholesterol (173 mg/100 ml), beta-lipoprotein cholesterol (106 mg/100 ml), pre-beta-lipoprotein cholesterol (18 mg/100 ml), and triglycerides (91 mg/100 ml). The average content of these lipid complexes was lower in males than in females. The low concentration of beta- and pre-beta-lipoprotein cholesterol and the large portion of alpha-lipoprotein cholesterol content in relation to the content of total cholesterol in blood plasma are evidence of a favourable proportion of atherogenous and non-atherogenous classes of lipoproteins in blood plasma of elderly and long-lived persons, which is evidently one of the causes of the lower incidence of ischemic heart disease among them and their high longevity.

[Immunologic characteristics of bronchial asthma developing as a result of influenza infection]. / Immunologicheskaia kharakteristika bronkhial'noi astmy, razvivshesia v rezul'tate grippoznoi infektsii.

The patients with atopic and non-atopic bronchial asthma (BA) provoked by influenzal infection and subjects with influenza were examined for immunity by detection of lymphocyte populations and subpopulations with monoclonal antibodies, by study of the cell-mediated immunity with lymphocyte blast transformation, and by investigation of total and allergen-specific (antiinfluenzal) IgE. It has been established that atopic bronchial asthma formed with influenza participation is a typical allergic disease based on allergo-immunologic disorders characteristic of atopic diseases. Non-atopic bronchial asthma provoked by influenza is mainly formed as a result of secondary immune disorders more characteristic of an infection-dependent pathology. The unfavourable effect of influenzal infection on IgE regulation entails excess production of serum IgE and formation of antiinfluenzal reagins in patients with atopic diseases.

[Hypolipidemic activity of substances structurally close to penphenone in rats and mice]. / Gipolipidemicheskaia aktivnost' veshchestv, strukturno blizkikh penfenonu, u krys i myshei.

Effect of substances, structurally related to penphenone (2-phenyl-3-methyl-3-hydroxypentanic acid sodium salt), was studied on the main patterns of lipid metabolism in blood of rats and mice, as well as on lipoprotein spectra of rat blood serum. All the compounds studied exhibited hypolipidemic effect, decreasing concentration of total cholesterol, cholesterol of alpha-lipoproteins and triglycerides in rat blood. The effect was less distinct in mice. 2-phenyl-3,4-dimethyl-3-hydroxypentanic acid sodium salt possessed the most pronounced hypolipidemic effect. A decrease in content of beta-and pre-beta-lipoproteins as well as of alpha-lipoproteins was observed after electrophoretic separation of blood serum lipoproteins in polyacrylamide gel in animals treated with the compound.

[Protective platelet features in fibrocavernous tuberculosis]. / Zashchitnye osobennosti trombotsitov pri fibrozno-kavernoznom tuberkuleze.

Light and electron microscopy was used to study platelets in acute and chronic pulmonary tuberculosis. The structure of platelets was demonstrated to be altered depending on the pattern of a tuberculous process. The ratio of alpha-granules, dense glanules, mitochondria, and lysosomes was also changed. The role of platelets in an immunological process was studied. The redistribution of glanules in the platelets finds its new reflection in the light of the psycho- and neutropic actions of the granules contained.

Protective characteristics of platelets in tuberculosis.

We demonstrated specific changes in platelet structure in different types of tuberculous process, in particular, shift in the proportion between alpha-granules, dense granules, different disorders in the mitochondrial and lysosomal apparatus, etc. The role of platelets in immune process is studied. Redistribution of alpha-granules in platelets finds a new interpretation in light of psycho- and neurotropic effects of their contents. Adhesion and aggregation processes and granule release from platelets are regulated by the content of serotonin and cyclic nucleotides in these cells.

Erythrocyte structure and function in fibrocavernous tuberculosis and tuberculous meningitis.

Erythrocyte disintegration processes are more pronounced in meningeal tuberculosis, which is associated with a shift in isoform spectrum of hemoglobin, catalase inhibition, and a sharp aggravation of lactoacidosis. The severity of erythrocyte disintegration cannot serve as a criterion of differential diagnosis of tuberculosis severity.

[Effect of ethirazol and parmidine ofn the development of experimental atherosclerosis in rabbits]. / Vliianie etirazola i parmidina na razvitie éksperimental'nogo ateroskleroza u krolikov

Experiments on rabbits which received cholesterol in food for 3-4 months showed an inhibitory effect of ethirazol (bis-methylamide-1-ethyl-pyrazol-3,4-bicarbonic acid) and parmidine (piridinolcarbamate, 2,6-bis-hydroxymethylpiridine bis-n-methylcarbamate) on the development of experimental atherosclerosis: there proved to be a reduction of accumulation of total cholesterol in the aorta and of its atherosclerotic affection. At the same time the blood serum cholesterol, triglycerids and phospholipid content was not significantly changed by these drugs.

[Effect of chronic stimulation of rats with intact and deafferented hypothalamuses on lipid metabolism and the adrenal cortex]. / Vliianie khronicheskogo razdrazheniia krys s intaktnym i deafferentirovannym gipotalamusom na lipidnyi obmen i koru nadpochechnikov

Chronic irritation of the falsely operated rats and those with the deafferentated hypothalamus led to reduction of total blood cholesterol and the accumulation of triglycerides in the liver. Dexamethasone administration was accompanied by an increase of blood cholesterol and triglycerides and the triglyceride accumulation in the liver. The action of dexamethasone was more pronounced in the animals with the deafferentated hypothalamus. The rate of 11-oxycorticosteroid secretion into the adrenal vein is reduced in the latter.