Development process of the Practical Approach to Lung Health in Kyrgyzstan.

The Practical Approach to Lung Health (PAL) strategy was adopted by the Ministry of Health of Kyrgyzstan to improve the quality of case management of priority respiratory illnesses, including tuberculosis (TB). The process of development and implementation of the strategy is described in the present study. The World Health Organization stepwise framework was adapted and used to initiate the PAL strategy within the Kyrgyzstan primary health care (PHC) system. The process followed 10 steps which included the government decision to support PAL development, and the establishment of a national working group in charge of adapting guidelines, developing training materials and testing the feasibility and impact of the guidelines. On the basis of the test results, the guidelines and training materials were revised and a national PAL implementation plan was developed. The ongoing health sector reform which focuses, in priority, on strengthening PHC services and the assistance from the government of Finland, generated favourable political, technical and financial circumstances for the development and implementation of the PAL strategy.

Feasibility test results of the Practical Approach to Lung Health in Bishkek, Kyrgyzstan.

SETTING: Ambulatory health centres in Bishkek, Kyrgyzstan. OBJECTIVE: To assess the results of training family doctors in Practical Approach to Lung Health (PAL) techniques. DESIGN: Comparison of the results of two surveys, before (baseline) and after (impact) training on PAL guidelines. Both surveys were carried out according to the same protocol. RESULTS: A total of 86 family physicians working in three ambulatory health centres participated in both surveys. Respectively 893 and 992 respiratory patients were registered in the baseline and impact surveys. Baseline survey patients had longer duration of symptoms, were older and had more concomitant health conditions than impact survey patients. Findings suggest that PAL training has resulted in a decrease by one third in referrals to hospital or specialists or for diagnostic tests. Data do not show any improvement in tuberculosis case detection. However, in the impact survey, the number of drugs prescribed per patient decreased by 13.6% and the average cost of prescription of any drug per patient was reduced by 32.2%. CONCLUSION: The study suggests that training in standardised PAL guidelines is likely to reduce referral as well as drug prescription costs for respiratory patients. These findings need to be confirmed by further studies.

[Analysis of mutations of multidrug-resistant M. tuberculosis strains in patients with tuberculosis in the Kyrghyz Republic].

Two hundred and seventy-eight M. tuberculosis DNA samples taken from patients with clinically confirmed pulmonary and extrapulmonary tuberculosis were studied. Mutations of the rpoB, inhA, katG, and ahpC genes were analyzed by using multiple drug-resistant (MDR) biochips. A hundred and twenty-nine (46%) rifampicin- and isoniazid-sensitive strains and 149 (54%) resistant ones were detected. Out of the 149 drug-resistant strains, resistance to one drug (rifampicin or isoniazid) was revealed in 7 (4.7%) and 48 (32.3%) cases, respectively. The strains simultaneously resistant to both drugs were detected in 94 (63%) cases. In the Republic of Kyrghyzstan, patients with drug-resistant pulmonary tuberculosis were observed to have more commonly multidrug-resistant strains (63%) than the strains resistant to one drug (rifampicin or isoniazid). In this republic, the main cause of rifampicin resistance of Mycobacterium tuberculosis is the Ser531-Leu mutation of the rpoB gene in codon 531 and the Ser315-->Thr of the katG gene in codon 315.

[Statistically mapping modeling of the spread of rifampicin-resistant M. tuberculosis strains in different regions of the Kyrghyz Republic].

Mapping modeling of the distribution of rifampicin-resistant tuberculosis was made in different regions of the Kyrghyz Republic. The results of determination of rifampicin resistance in Mycobacterium tuberculosis (MBT) by the biochip test were used to examine 904 MBT DNA samples taken when examining the patients living in different regions of the Kyrghyz Republic: Bishkek (n = 323), the Chui (n = 185), Issyk-Kul (n = 68), Naryn (n = 75), Talas (n = 47), Osh (n = 65), Dzhalal-Abad (n = 90), and Batken (n = 51) Regions. Comparison of the distribution of drug-resistant forms of tuberculosis by different regions revealed that rifampicin-resistant MBT strains were more frequently encountered in the densely populated regions of the republic - Bishkek and the Chui Region. Rifampicin resistance in MBT was caused by mutations in codons 531, 526, 522, 516, 511, 513, 512, and 513 of the rpoB gene. At the same time, there was a predominant selection of MBT with mutations in codons 531, 526, 516, and 511 in the republic. The spectrum of mutant MBT strains occurring in some regions varied. The broadest spectrum of genetic variability was observed in Bishkek and the Chui Region. Thus, Bishkek and the Chui Region are the hot points of concentration of mutant rifampicin-resistant MBT strains.

[Use of biological microchips in the determination of drug-resistance of Mycobacterium tuberculosis to rifampicin].

The present-day problems in tuberculosis control are associated with a difficulty in detecting Mycobacterium tuberculosis (MBT) in due time and in determining its drug sensitivity by conventional microbiological assays. The determination of the drug sensitivity of MBT takes much time from 2 weeks to 3 months, which fails to initiate and perform specific therapy timely. Molecular genetic techniques, including biochip analysis, yield results in 24-48 hours, which solves the problem of choosing and initiating adequate antibacterial therapy in the shortest possible time after tuberculosis is diagnosed. To assess the situation associated with the prevalence of rifampicin-resistant tuberculosis, by using the biochip analysis, the authors have examined 501 patients with tuberculosis who live in the Kyrghyz Republic. Drug resistance has been found in 40.3% of the examinees. At the same time, their primary and secondary drug resistance is 25.7 and 61.8%, respectively. In tuberculosis patients living in Kyrghyzstan, rifampicin resistance of MBT is more frequently due to mutations in 531 (59.2%), 526 (20.8%), and 516 (8.0%) codons in the rpoB gene.

[Clinical course and symptoms of lung tuberculosis in patients with schizophrenia]. / Klinicheskie proiavleniia i techenie tuberkulëza lëgkikh u bolnykh shizofreniei.

Schizophrenics with multiple diseases are shown to have advanced tuberculosis with active bacterial discharge and rapid progression. There is a relationship between tuberculosis and schizophrenia.

[Treatment of patients with pulmonary tuberculosis and mental disorders]. / Lechenie bol'nykh tuberkulezom legkikh, stradaiushchikh psikhicheskimi zabolevaniiami.

In combined treatment of pulmonary tuberculosis and mental disease cessation of bacterial discharge was achieved in 79.5%, caverns closure in 73.8% of patients. The above percentage for chronic destructive tuberculosis reached 51 and 5.8%, respectively. However, positive results did not persist long

[Pulmonary tuberculosis in patients with mental disorders, drug addiction and substance abuse]. / Tuberkulez legkikh u bol'nykh s psikhicheskimi zabolevaniiami, narkomaniei i toksikomaniei.

The clinical manifestations, course and outcomes of pulmonary tuberculosis were studied in 215 patients with concurrent severe mental diseases (112 had schizophrenia and 103 other organic diseases of the central nervous system). The patients had mainly disseminated pulmonary tuberculosis with copious bacilli excretion and destruction. Their clinical manifestations and the course of a specific process were mainly progressive. Fatal outcomes were most common in tuberculosis patients with concurrent drug addiction and toxicomania. It is recommended that patients with mental diseases, narcomania and toxicomania should undergo a prophylactic fluorographic screening twice a year. Treatment of patients with tuberculosis and concurrent mental diseases should be combined and carried out by a psychiatrist (narcologist) jointly with a phthisiatrist.

[Current status and perspectives in hospital treatment of patients with tuberculosis complicated with alcohol abuse]. / Sostoianie i perspektivy statsionarnogo lecheniia bolnykh tuberkulëzom, zloupotrebliaiushchikh alkogolem.

The authors show a rise in the prevalence of tuberculosis among alcoholics. In the past decade, the specific proportion of these two concurrent diseases has reached 30% among the groups registered in the tuberculosis dispensaries. In a great number of patients, the disease was accompanied by bacterial secretion and decay. The therapeutical efficacy of compulsory treatment inpatients who refuse to take drugs has proved to be low. A daytime hospital can be one of treatments of such patients as the second stage of therapy after tuberculosis patients suffering from alcoholism have stayed in a twenty-four-hour hospital.

[Immune status of middle-aged and aged patients with tuberculosis]. / Immunnyi status bol'nykh tuberkulezom u lits pozhilogo i starcheskogo vozrasta.

After examination of 165 tuberculous patient of presenile and senile age, 150 young patients, 65 healthy presenile and senile donors, 56 young healthy donors it was established that young and aged healthy donors differ by some parameters of T-cell immunity (inhibited blast-transformation response to PHA, reduced number of T-helpers, high suppressive activity of induced Con-A. Young tuberculous patients differ from their healthy counterparts by a variety of immunological parameters (low T-lymphocyte and helper count, poor blast-transformation, increased number of T-suppressors and induced ConA suppression, B-lymphocyte count and serum IgG level). Immunological reactivity is the least in aged tuberculous patients. Compared to aged healthy donors they have reduced number of T-lymphocytes, T-helpers, inhibited PHA response and IL-2 synthesis, greater count of T-suppressors, enhanced induced ConA suppression. B-cell immunity was similar in young and aged patients. Antituberculous immunity reactions were weaker than in young patients.