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33. Banavalicer J., Bose M. Drug susceptibility study of MBT isolates from treatment failure patients of pulmonary tuberculosis // Intern. J. Tuberc. and Lung Dis. - 2001. - Vol. 5, 11. - Suppl. 1. - P. 82.

34. Forssborn M., Sagebie D., Hauer B., Loddenkemper R. Drug-resistant tuberculosis in Germany // Intern. J. Tuberc. and Lung Dis. - 2001. - Vol. 5, 11. Suppl. 1. - P. 83-84.

188 ISSNͲߠίȠ.2013.80..1..1 35. Marcos A. Espinal, Dr. PH. Sang Jac Kim, Pedro J. Suar et all. Standart Short-Course Chemotherapy for Drug-Resistant Tuberculosis Treatment Outcomes in 6 Countries // JAMA. - 2000. - Vol. 283, 19. - 2537-2545.

36. Miskinis K., Kaminskaite A. Treatment outcomes of multidrug resistant tuberculosis // The Europen respiratory Journal. Abstracts ERS Annual Congress.

Geneva, Switzerland. - 1998. - P. 368.

37. Pomerantz BJ, Cleveland JC Jr, Olson Hk, et all. Pulmory resection for multi-drug resistant tuberculosis // J. Thorac Cardiovasc Surg. 2001;

121:448-453.

38. Udwadia Z., Almeida D., Rodrigues C. Fluoroquinolone resistant tuberculosis in Bombay. Germany // Intern. J. Tuberc. and Lung Dis. - 2001. - Vol. 5, 11. - Suppl. 1. - P. 79- 39. WHO. Global tuberculosis control. - 2012.

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ISSNͲߠίȠ.2013.80..1..1 Yu.V. Prosvyetov, S.M. Kudylchak, N.O. Skorokhodova, A.Yu. Gusarova Research advisor: head of the department, doctor of medical sciences, professor Yu.V. Prosvyetov Department of Tuberculosis and Pulmonology SI Zaporizhia Medical Academy of Post Graduate Education Ministry of Health of Ukraine MODERN METHODS OF TREATMENTS OF CHEMORESISTANT PULMONARY TUBERCULOSIS (REVIEW) In 1995 our country declared an epidemic of tuberculosis (TB). During these years, starts to increase the frequency of patients with drug-resistant parasite to anti TB drugs. Treatment of multiresistant TB is a difficult problem because of the limited range of anti-TB drugs, the high cost of drugs second series of poor tolerability and two-year duration of treatment. Cure rate of new cases according to the report Global Tuberculosis Control 2012 is 85%, and in respect of multiresistant tuberculosis this figure rises by 48 and 33%.

During the course of chemotherapy treatment interruption patients is 11.3%, which is tied to social factors and poor tolerability of anti-TB drugs.

Significant role in lung pathology plays a breach in the system of immunological reactivity and surfactant system. In cases where pulmonary macrophages fall into a state of depression by bacteria, waste handling processes of catabolism of surfactant, a threat of persistent infection of the lungs. Inhaler use of surfactant reduces treatment time affected the lungs. Inclusion in the complex treatment of patients with pulmonary TB chemoresistant of plasmapheresis and heparin improves the efficiency of complex treatment of a specific process.

Given the situation with multi-TB antibiotic therapy often requires completion of pathogenic agents, particularly with a view to the good tolerability of second-line anti-TB drugs, improving overall health, immune system, metabolism, more rapid regression of the pathological process and its symptoms, as well as to decrease in the average cost of treating these patients.

In the department of pulmonary tuberculosis 3 Municipal Institution Zaporizhia regional clinical TB dispensary Zaporizhia Regional Council patients receiving treatment for category 4 in the intensive phase of arginine hydrochloride was administered intravenously for 10 days. In patients with decreased symptoms of intoxication, upgraded functional indices of liver.

Treatment of patients with chemoresistant pulmonary tuberculosis at present is one of the most important and the most difficult problems of tuberculosis. Despite the fact that the problem of increasing the effectiveness of treatment of patients with chemoresistant pulmonary tuberculosis h received considerable attention, the effectiveness of treatment these patients is poor and needs improvement.

Key words: chemoresistant pulmonary tuberculosis, pathogenetic treatment.

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Heyman // Pediatrics. -2006. Vol. 118 (3). P. 1279-86.

12. Treatment of Infectious Mastitis during Lactation: Antibiotics versus Oral Administration of Lactobacilli Isolated from Breast Milk / Arroyo R., Martin V., Maldonado A. (at all.) // Clin Infect. Dis. 2010. Vol. 50 (12). P. 1551-1558.

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Y. I. Reshetilov, I. I. Redko, N. N. Prosenko, E. Y. Vasilchenko, L. F. Kuznesova, T. V. Bogoslav, N. A. Kolyada CHALLENGES OF LACTOSE THERAPY OF THE CHILDREN AND ADOLESCENTS FROM THE POSITION OF FAMILY DOCTOR The article demonstrates modern conception of the mechanisms and causes of disease in children and adults. Are discussed the features of the clinical course of the disease in newborns, infants and adults. Are presented diagnostic methods for differentiation of various types of lactase deficiency between adults and children.

Proven the effectiveness of the modern non-invasive method of diagnosis of this pathology is the breath test, which allows adults to diagnose in same time violations in the metabolism of carbohydrates, proteins and fats. Are discussed the problems of the disease treatment in children and adults. Proven therapeutic effectiveness of the preparation of lactase, "Mamalac" as a substitution fermentotherapy in the treatment of the disease in children, adults, which allows to preserve the high level of consumption of lactase and reduce the amount of amental therapy. The purpose of lactase in the dose of 7 mg (700 units) per 100 ml of expressed breast milk in newborns helped preserve the natural feeding, significantly reduce the excretion of carbohydrates with faeces and eliminate the clinical manifestations of the disease to 1 days of the disease. The purpose of lactase, for older children and adults in a dose 198 ISSNͲߠίȠ.2013.80..1..1 of 300 mg (3000 units) during each meal which included dairy products, allowed to maintain consumption of lactase. Key words: infants, lactose, therapy, Mamalac Key words: infants, children, adolescents, enzyme therapy, lactose therapy, Mamalac.

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A.S. Sementsov, A.V. Vysotsky *, V.V. Voytkov * Department of Radiology, SI "ZMAPE MH Ukraine" *Kherson EDO USE INTERVENTIONAL ULTRASOUND IN EVALUATION OF INFLAMMATORY COMPLICATIONS AFTER JOINT PROSTHESIS Determining the location and nature of the inflammatory complications of large joints after installation of implants and various metal is an actual problem of modern orthopedics and traumatology.

The purpose of the study - the development and implementation of new methods of diagnosis and highly informative assessment of inflammatory complications after the installation of the large joints and metal implants.

The intervention was carried out in an outpatient setting with the use of specialized puncture needles and needles for spinal puncture.

The indications for surgery was considered the presence of implants signs of inflammatory complications.

Noted the almost complete agreement between the results obtained in the study of material obtained by puncture under ultrasound guidance, with the results of bacteriological tests intraoperation.

ISSNͲߠίȠ.2013.80..1..1 Significant complications after the intervention was not observed. In the subsequent surgical treatment of patients examined differences in the location and extent of inflammation was observed.

Using this method makes it possible to quickly and accurately in the preoperative period to determine the amount of the forthcoming operational benefits, assign adequate, the most effective antibiotic therapy, predict outcomes.

Key words: Interventional Ultrasound, prosthetic joints, inflammatory complications 614.2:616-082:616. .. , .. 㳿

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3. Woolf S.H., Batissa R.N., Anderson G.M., Logan A.G., Wang E. Assessing the clinical effectiveness of preventive maneuvers: analytic principles and systematic methods in reviewing evidence and developing clinical practice recommendations. A report by Canadian Task Force on the Periodic Health Examination. J. Clin Epidemiol.-1990;

43:891-905.

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Y.M. Stepanov, I.Y. Skyrda SI "Institute of gastroenterology NAMSU" ATTITUDE OF THE HEALTHCARE INSTITUTIONS TO THE MANAGEMENT OF THE MEDICAL CARE QUALITY IN GASTROENTEROLOGICAL PATIENTS Quality of medical care and its organization is the most important problem in health organization. However, there is no agreement of opinions between experts in definition of concept "quality of medical social service".

Authors have surveyed of healthcare manager's opinions in different city health care institutions in Ukraine. Necessity and way of implication system of medical care quality provision and evaluation at the municipal level was investigated.

Sociological study among the chief physicians, their assistants, heads of the departments etc. was performed with original questionnaire. Results indicate healthcare managers understand necessity of quality provision system implication in medical institutions use. However, results indicate necessity of all ranges healthcare managers' professional development in provision, management and enhancement of service quality.

Key words: medical services, quality of medical social services, healthcare managers.

210 ISSNͲߠίȠ.2013.80..1..1 UDC: 616.12-005.4:612.017.1]-002-07.

Fushtey I.M., Podsevahina S.L., Palamarchuk A.I.

State Establishment "Zaporozhye medical academy of postgraduate education of Ministry of Health Care of Ukraine" INFLUENCE OF PERINDOPRIL ON VASOMOTOR ENDOTHELIAL FUNCTION AND INFLAMMATION MARKERS AT PATIENTS WITH ISCHEMIC HEART DISEASE Keywords: ischemic heart disease, vasomotor endothelial function, cytokines, perindopril.

Cardiovascular diseases win first place in structure of death rate and physical inability of the population of Ukraine. During last years, followersof a "vascular" direction in the atherogenesis theory develop the inflammatory concept which essence consists that inflammatory process in wall of arteries is the central part of a pathogenesis and an atherosclerosis morphogenesis. In favour of such point of view suggests presence of elements of an inflammation in the form of cellular reactions in the field of atherosclerotic damages and hyperplasic reactions with an outcome to fibrosis [2,4].

The inflammatory process characterized by activation both proliferation endothelial and smooth muscle cells, cytokines formation and growth factors, moleculas of adhesion and anti-inflammatory mediators, plays an important role in development and progressing of an atherosclerosis [5]. The basic link between an inflammation and increase of risk of occurrence of cardiovascular diseases is endothelial dysfunction.

The great interest touches studying of specific markers of an inflammation cytokines which can be prognostically more significant in definition of processes of an inflammation. There is a large cytokines spectrum which effects are connected with inflammation activation. Some of them, for example the tumor necrosis factor (TNF - ), interlejkin-1 (IL1- ), IL-6 possess proinflammatory properties, action of others, in particular IL-4 and IL-10, is connected to anti-inflammatory reactions [8, 10,12].

And if now practically there are no doubts in prognostic role of markers of an inflammation in atherosclerosis development, influence of medications on this process is studied to a lesser degree. Considering a significant role of renin angiotenin-aldosteron systems in endothelium dysfunction development, an atherosclerosis and a cardiovascular pathology, in general [1], series of randomized studies devoted to angiotensin-converting enzyme inhibitors use (ACEI) in treatment of cardiovascular diseases and preventive maintenance of their complications [6, 7,13]. But influence of perindopril on markers of an inflammation and their interrelation with endothelium vasomotion at patients with a stable angina (SA) strains are studied insufficiently.

ISSNͲߠίȠ.2013.80..1..1 The goal of the study was to investigate interrelation between changes of endothelium dependent vasodilatation (EDVD) of brachial artery (BA) and specific markers of an inflammation (TNF -, IL-1, IL-4, Il-6, IL-10) at patients with SA receiving perindopril as basic therapy.

MATERIAL AND METHODS 61 patient of the age (62,14,2) year with verified SA III functional class (FC) of NYHA. There were 59,1 % men and 41,9 % women. All patients received the basic therapy, including nitrodrugs (kardiket 40 mg/day), -adrenoblokers (metoprolol 50 mg/day), aspirin (aspecard 100mg/day), statins (atorvastatine mg/day) and nitroglycerine if necessary. 29 patients (1st group) who in the anamnesis had adverse effects or intolerance to ACEI, received only basic therapy. To 32 patient (2nd group) perindopril (prestarium, Servier, France) was administered (dose 8mg once daily).

Endothelium functional state was assessed by means of an ultrasonic procedure of definition of EDVD of BA according to the common known recommendations published in Guidelines for the ultrasound assessment of endothelial - dependent flow - mediated vasodilatation of the brachial artery (2002) [9] and determining of desquamated endotheliocites (DEC) in peripheral blood according to method of J.Hladovec (1978) [11].

Level of proinflammatory (TNF -, IL-1, IL-6) and anti-inflammatory (IL-4, IL-10) cytokines was determined by means of immunofluorescent assay with use of panels of the conforming reagents (ProCon,St.-Petersburg, Russia). EDVD of BA and levels of specific markers of an inflammation was made right after hospitalization and in 30 days. Statistical analysis of the obtained results was performed by means of program "STATISTICA 6.0".

RESULTS AND DISCUSSION The data which represent endothelium functional state at initial state and on the background of different kinds of therapy are resulted in table 1. Initially diameter of the BA significantly did not differ in groups. Speed of a blood-groove before and after a compression also significantly did not differ. After a compression of the BA indexes variated: diameter of the BA was 4,910,24 mm, the gain has compounded (1,020,06) % that did not answer a normal endothelium vasomotion in reply to decompression (in norm a gain compounds more than 10 %). Indexes of blood flow speed and quotients also were low.

In 30 days of treatment in 1st and 2nd groups BA diameter and blood flow speed in it before compressive probe remained mostly unaltered. After BA compression the gain of its diameter in 1st group has compounded 5,2 %, speed of a blood-flow in it has increased by 21,5 %, and in 2nd group - 9,7 % and on 31,9 % accordingly. Pulsator and resistance indexes in 1st group significantly have not changed, then as in 2nd group their positive dynamics is noted.

If at the first research disorder of EDVD was revealed in 1st group at 85,6 % of patients, and in 2nd - at 86,1 % in a month of basic therapy it was marked at 54, % of patients, and at addition of perindopril - only at 31,4 %. Number of DEC in blood at primary investigation and after a month of standard therapy significantly has 212 ISSNͲߠίȠ.2013.80..1..1 not changed, exceeding level of conditional norm (no more than 5 cells in microliters) at 88,5 % and 71,8 % accordingly. In a month of complex treatment with perindopril administration endotheliaemia level has significantly decreased, though has not reached normal level, exceeding that at 46,1 % of patients ( 0,01).



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