Представляю Вашему вниманию семейство ранорасширителей Omni-Tract. Более чем тридцатилетний опыт работы американских конструкторов позволил на сегодняшний день создать простой и удобный в эксплуатации инструмент, использующийся практически во всех хирургических направлениях: урология, педиатрия, сосудистая хирургия, онкология, общая хирургия и многих других
Современный подход к подготовке врача-уролога: от «образования на всю жизнь» ...Игорь Шадеркин
Министерство здравоохранения и социального развития РФ
ФГУ «НИИ Урологии Росмедтехнологий»
Современный подход к подготовке врача-уролога: от «образования на всю жизнь» к «образованию через всю жизнь»
Аполихин О.И., Абдуллин И.И., Казаченко А.В.
МОСКВА 2010
14. Сравнение ближайших результатов биполярной и монополярной ТУР предстатель...Игорь Шадеркин
Сравнение ближайших результатов биполярной и монополярной ТУР предстательной железы
В.В.Лысенко. В.М. Ходос, А.М. Чайка
Одесский государственный медицинский университет
Одесса, 2010
Представляю Вашему вниманию семейство ранорасширителей Omni-Tract. Более чем тридцатилетний опыт работы американских конструкторов позволил на сегодняшний день создать простой и удобный в эксплуатации инструмент, использующийся практически во всех хирургических направлениях: урология, педиатрия, сосудистая хирургия, онкология, общая хирургия и многих других
Современный подход к подготовке врача-уролога: от «образования на всю жизнь» ...Игорь Шадеркин
Министерство здравоохранения и социального развития РФ
ФГУ «НИИ Урологии Росмедтехнологий»
Современный подход к подготовке врача-уролога: от «образования на всю жизнь» к «образованию через всю жизнь»
Аполихин О.И., Абдуллин И.И., Казаченко А.В.
МОСКВА 2010
14. Сравнение ближайших результатов биполярной и монополярной ТУР предстатель...Игорь Шадеркин
Сравнение ближайших результатов биполярной и монополярной ТУР предстательной железы
В.В.Лысенко. В.М. Ходос, А.М. Чайка
Одесский государственный медицинский университет
Одесса, 2010
13-16 мая 2009 года в Солине состоялася конференция «Уроонкология» Польской ...Игорь Шадеркин
13-16 мая 2009 года в Солине состоялася конференция «Уроонкология» Польской Ассоциации Урологов.
В конференции приняло участие около 210 врачей. Из них 6 участников из Украины.
Были прочитаны доклады на следующие темы:
1.Лечение рака мочевого пузыря.
2.Онкоурология
3. Организация системы здравоохранения в Польше
4.Мочекамення болезнь
5.Молекулярная биология
6.Оперативная урология
7. Лапароскопия в урологии
8. Роботы в урологии
Гости посетили окрестные городки и поселки, проведены экскурсии.
13-16 мая 2009 года в Солине состоялася конференция «Уроонкология» Польской ...Игорь Шадеркин
13-16 мая 2009 года в Солине состоялася конференция «Уроонкология» Польской Ассоциации Урологов.
В конференции приняло участие около 210 врачей. Из них 6 участников из Украины.
Были прочитаны доклады на следующие темы:
1.Лечение рака мочевого пузыря.
2.Онкоурология
3. Организация системы здравоохранения в Польше
4.Мочекамення болезнь
5.Молекулярная биология
6.Оперативная урология
7. Лапароскопия в урологии
8. Роботы в урологии
Гости посетили окрестные городки и поселки, проведены экскурсии.
Bovine tuberculosis: Occupational hazard in Abattoir workersiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Candida is the most common cause of fungal infection worldwide and 4th most common cause of blood stream infections in hospital setting.
Associated with 47 % mortality rate.
17 different species identified till yet.
Most common among them are C. albicans, C. glabrata, C. parapsilosis and C. tropicalis.
Candida usually develops on mucous membranes ( mouth , genitals etc).
Candida in blood stream it is known as candidemia.
When it passes from blood stream to other body parts(eyes, kidney, liver and brain etc) it is called invasive candidiasis.
Tuberculosis (TB) is a very common disease worldwide including India. Tuberculosis of the female genital tract is
common enough to be found in 1% of women with DUB (Sutherland 1949) and in 4% of adolescent with excessive
menstrual loss (Sutherland 1953). The commonest site of involvement is the fallopian tubes (90e100%). The next
common site is endometrium (60%). The infection is from the tubes either by lymphatics or direct spread through
continuity. Symptoms vary according to the severity site and stage of the disease. Anti tuberculosis chemotherapy is the mainstay of tt. Initially drugs are used for 2 months. These are isoniazid, rifampicin, pyrazinamide and ethambutal. Treatment is continued for another 4 months with isoniazid and rifampicin.
Социальная программа и план поездки на КубуИгорь Шадеркин
VIII конгресс Профессиональной ассоциации андрологов России III российско -кубинский Форум по андрологии, 7-15 апреля 2013 года
Социальная программа и план поездки
Туберкулез придатка и яичка
Новосибирский НИИ туберкулеза Росмедтехнологий
Кульчавеня Е.В.
Д.м.н., профессор
Главный научный сотрудник
ФГУ ННИИТ Росмедтехнологий
Руководитель отдела урологии
urotub@yandex.ru; www.urotub.uroweb.ru
6. Наш первый опыт лазерной эндопиелотомии, эндоуретеротомииИгорь Шадеркин
Наш первый опыт лазерной эндопиелотомии, эндоуретеротомии
ГУ "дорожная больница" ГП «Одесская железная дорога"
Центр эндоскопической, лазерной хирургии и дистанционной литотрипсии.
Малярчук Д.А. Малярчук А.И.
19. Лікування „камяної доріжки” у хворих, що перенесли еухл на курорті Труска...Игорь Шадеркин
Лікування „камяної доріжки” у хворих, що перенесли еухл на курорті Трускавець
Автори
О.Б. Прийма, Я.В. Фецяк., В.М. Питлик
Доповідач кандидат медичних наук, доцент Прийма Олег Богданович
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
4. Although TB is
very old disease
(first cases are
dated back to the
times of pharaohs),
it is not absolutely
clear still now.
5. The World Health Organization
recognized TB as a global problem
and emphasized, that TB kills more
young and adults than any other
infectious disease; TB kills more
women than any single cause of
maternal mortality
WHO report 2006
6. African region has the highest estimated incidence
rate (356 per 100,000 habitants) but the absolutely
highest number of TB patients lives in the most
densely populated countries of Asia.
Bangladesh, China, India, Indonesia and Pakistan
together account for half of the new cases arising
each year.
The worldwide estimated incidence of new cases
is 139 per 100,000 on average (9.2 million).
WHO report 2008
9. In countries with low incidence of TB lymphonodal TB
predominates in structure of extrapulmonary TB.
6% 6%
17% CNS
bone&joint
UGT
50% lymponodal
21%
abdominal
Germany
5% 5%
11% 13% 2%
20% 18%
6%
13%
12%
41% 54%
USA Macedonia
10. Structure of extrapulmonary TB
Russian Federation
11%
bone&joints
26%
8%
UGT In countries with
17%
lymph. nodes severe epidemic of
eyes TB, Urogenital
38%
others tuberculosis is the
Tunis most common form
10% of extrapulmonary
9%
35% TB and the second
14%
common form of TB
as whole
14%
18%
11. Male Genital TB seems to be a rare
disease. Nevertheless, 77% men
died from tuberculosis of all
localizations had prostate
tuberculosis, mostly overlooked
during life time. Actually, this
means in Russia about 19000
men yearly.
Kulchavenya E, 2007
19. TYPES OF
MYCOBACTERIA
• M. tuberculosis human (M. tuberculosis) –
causes disease in 80-85%.
• M. tuberculosis bovis (M. bovis) – causes
disease in 10-15%, mostly in contacted with
infected animals.
• M. tuberculosis avium (M. avium) – causes
disease in 1-5%.
• М. tuberculosis africanus (M. africanum) –
causes disease in up to 90% in habitants of
South Africa (initially resistant to tyoacetazon).
21. Artificial-created
Mycobacteria
• M. tuberculosis BCG – from M.
tuberculosis bovis (vaccine strain)
• M. tuberculosis – resistant to
antituberculous drugs
22. Identification of MBT in urine
is very difficult task, because
mycobacteriuria is inconstant
and scanty, barely perceptible
23. Identification of MBT:
1. Microscopy
ü Light microscopy (stain Ziehl – Neelsen)
ü Fluorescent microscopy
Detection of all acid – fast bacteria
24. Identification of MBT:
2. Culture diagnostic
• At least three, but preferably five, consecutive
early morning specimens of urine should be
cultured, each onto at least two slants
(Lowenstein - Jensen, Finn – II, Middlebrook
7H9-12)
• a plain Löwenstein-Jensen culture medium to
isolate M. tuberculosis
• a pyruvic egg medium containing penicillin to
identify M. bovis, which is partially anaerobic and
grows below the surface of the culture medium
25. Standard technique is positive in 36-44%
of UGT patients only. In study of
Novikov (2004) bacteriological tests were
performed 3 times in one day –
at 8 o’clock, 11 and 13 o’clock.
Positive cultures were on 15% higher
26. Very important is shortest time between
collection of urine and its sowing,
optimal time should be about 40 min.
27. Identification of MBT:
3. Drug susceptibility test
üAbsolute concentration
üMethod of proportions
üMethod resistance ratio
28. Identification of MBT:
• Automated system Bactec MGIT 960 –
Mycobacteria Growth Indicator Tube. This
tube has a fluorescent oxygen sensor.
30. Biochip technology in EIMB:
Manufacturing by photo-
induced copolymerization
plate
with
light robot probes
pin
Gel pads with immobilized probes
50-500 μm
gel pad
31. Identification of M. tuberculosis strains with biochips
Strain sensitive to
rifampicin treatment
Strain with mutation
in 531 nucleotide
resistant to rifampicin
treatment
Ser531 → Leu
POX
32. The concept of the efficiency of
bactericidal therapy for TB
30
25
MIC (mkg/ml)
20
15
10
5
0
Strains of MBT with different resistance
33. • The cornerstone of antituberculous therapy is
multidrug treatment to decrease the duration
of therapy and to diminish the likelihood that
drug-resistant organisms will develop
36. Ranking of TB Drugs
1st-Line Injections Fluoro- Oral 2nd- “3rd line”
quinolones line
1. RIF 5. STM 6. MOXI 9. ETA 13. CLO
5. KAN 6. GATI 9. PTA
5. AMK 7. LEVO
2. INH 5. CAP 10. PAS 14. AMXCLV
8. OFLO 14. IMIPEN
8. CIPRO
3. PZA 11. CYS 15. LNZ
11. TRZ
4. EMB 12. THIA 16. CLARI
Drugs within a table cell are cross-resistant with the other drugs in that cell.
Drugs with the same number are approximately equivalent in efficacy.
37.
38. Rifacomb plus (R+H+Z) Mayrin (E+H+R)
Rifinag (R+H)
Rifater (R+H+Z)
Mayrin P (E+H+R+Z) Rifacomb (R+H+ В6)
41. DRUG RESISTANCE OF
MICROORGANISMS
•The natural or acquired ability of a
microorganism to maintain vital functions
under the action of drugs in the so-called
critical or higher concentrations.
S. Borisov, 2009
42. DRUG RESISTANCE OF
MICROORGANISMS
•Characteristic of all microorganisms
• Is a clinical problem in surgery,
obstetrics and gynecology, and many
sections of Internal Medicine
• In TB has become a worldwide
medical and political problem
S. Borisov, 2009
43. REASONS FOR DEVELOPMENT OF DRUG
RESICTANT M.tuberculosis
• Insufficient volume / duration of
chemotherapy
• Peculiarities of TB process
• Condition of the patient and/or
comorbidity
• Non-optimal therapy
• Drug deficiency
• Behavior of the patient
44. Drug-resistance:
- mono – to one of any antituberculous drugs;
- poly – to more than one of any drugs used
for the treatment of the disease, excluding
isoniazid and rifampicin simultaneously;
- multi-drug resistance (MDR) - MBT are
resistant to at least isoniazid and
rifampicin
45. Multidrug-resistant TB is associated
both with a higher incidence of
treatment failures and of disease
recurrence, as well as with higher
mortality than forms of TB sensitive to
first-line drugs.
46. Global epidemiology of
MDR-TB and the role of WHO in
fighting MDR-TB
Prioritized Areas of TB Control in Modern Social and
Epidemiological Environment
28 November - 1 December 2006
Yekaterinburg, Russia
47. Background
458,000 MDR-TB cases
emerge every year
Without treatment
MDR-TB continues to
spread leading to
additional suffering for
patient and communities
With inadequate
treatment or treatment
with poor quality drugs
incurable TB strains can
develop and spread
48. XDR-TB: extensively drug-resistant MBT
XDR: MDR-TB plus resistance
to any fluoroquinolone and, at
least, 1 of 3 injectables (ami,
kana or capreo)
Of 17,690 isolates from 49
countries during 2000-2004
20% were MDR; 2% XDR
XDR found in:
USA: 4% of MDR
Latvia: 19% of MDR
S Korea: 15% of MDR
XDR found in Southern
Africa associated with
HIV
49. In 2008, an estimated
up to 510 000 cases
of MDR-TB
emerged globally.
TDR is coming!
50. MDR is in the whole world,
but mostly – in 3 countries
458,000
700 000
600 000
310,000
500 000
400 000
300 000 161,000
115,000
200 000
34,000
100 000
-
Total China + China India Russia
India +
Russia
51. MDR in Russia 2006 (% among all patients)
63,0
22,3
new-revealed pts chronic pts
M. Vladimirskiy et al. 2006
54. Compared with PTB, EPTB is
negatively associated with multidrug
resistance
(OR 0.6)
Peto HM et al., 2009
55. Mono-, poly and multi-drug resistant MBT
to the basic antituberculous drugs were found in
up to 52.2% in extrapulmonary TB patients
and up to 78.7% in pulmonary TB patients in
Moscow in 2006
Vishnevskyi V et al., 2008
56. Among 98 patients
with PT + UGT 70.0% had
MDR in sputum, but all strains in urine
were susceptible
Nersesyan and Remrzova., 2008
57. There is no reasonable explanation of
this fact, we must take it
for what it is worth
58. There is a very few papers on drug
resistant urogenital tuberculosis
59. Overall drug resistance in UGT was
8.3% (7.4% non-AIDS/11.5% AIDS)
in a tertiary hospital, Valencia
during the years 1993-1996.
Cremades Romero et al., 1998
60. Of 12 MBT isolates in UGT, eight (66.7%)
were found susceptible to all of the
antituberculous agents, while one was
found resistant to isoniazid and ethambutol,
one was resistant to isoniazid and
rifampicin, and two were resistant to only
isoniazid.
Aslan G. et al., 2007
61. Among 83 strains of MBT in UGT patients
17 (20.5%) were resistant:
70
60 rifampicin
64,7 64,7
50
streptomycin
ethambutol
40 isoniazid
kanamycin
30
MDR (R+H)
20 Polyresistance
20,5
10 17
11,8 5,9 11,8
0 Nersesyan and Remrzova., 2008
62. How can we prevent drug resistance?
• Early diagnostic.
• Complex intensive therapy with 4-5
antituberculous drugs for 2-4 months
follow 2-3 drugs for 5-10 months.
• Using pathogenetic therapy.
63. Diagnosis
• Poor knowledge of the doctors and the
population, absence of the pathognomonic
symptoms, non-optimal antibacterial
therapy for non-specific UTI resulted in
late diagnosis of urogenital tuberculosis
with polycavernous complicated forms
68. Diagnosis
• For a correct diagnosis a careful
investigation of the epidemiological history
(contact with tuberculous infection, TB in
history, especially in childhood)
• and special diagnostic algorithms,
including provocative tests, are necessary.
69. Diagnosis
Mantoux test is positive in more than 90% of patients,
but it has no value in regions with severe epidemic
situation (China, Russia, India, Africa), where all adults
are infected with MBT and thus all immunocompetent
inhabitants have positive skin tuberculin test
70. Diagnosis
New Diascintest is more effective as it allows to
differentiate a reaction after BCG vaccination
and latent tuberculous infection
Infected with MTB Suffer from TB
72. Susceptibility of E.Coli in out-patient with UTI
in UTIAP–2 Study (n=258) in Russia
100 89,5 89,9 90,7 92,6 93,8
% s u scep tib le str ain s
80 73,3
56,2
60
40
20 8,1
0
nitroxolin ampicillin co-trimoxazol nalidixic acid pipemidic acid
norfloxacin ciprofloxacin gentamicin nitrofurantoin
73. Susceptibility of E.coli (%) in Russia
on ARESC - Study
Antibiotic (n=301)
1.Fosfomycin 99.3
2. Mecillinam 97.3
3. Nitrofurantoin 94.7
4. Ciprofloxacin 87.4
5. Nalidixic acid 82.7
6. Amoxi/clav 83.0
7. Cefuroxime 83.4
8. TMP-SMX 69.4
9. Ampicillin 42.0
Naber et al 2008 Eur Urol 54: 1164-1178
74. XI National Russian Urological Congress approved
a resolution, that all cases of UTI should be
suspected for TB, and first line therapy should
exclude antibacterials affecting MBT
(fluorquinolons, rifampicin, streptomycin or
amycacin). All patients with UTI primary should be
investigated for TB by culture and/or microscopy.
Only after TB is excluded, they may be treated with
fluorquinolons.
78. Table 1. WHO Standard schemes of a chemotherapy
Essential drug Recommended dosage
(abbreviation) (dosage range) in mg.kg
Daily 3 times weekly
isoniazide (H) 5 (4-6) 10 (8-12)
rifampicin (R) 10 (8-12) 10 (8-12)
Pyrazinamide (Z) 25 (25-30) 35 (30-40)
streptomycin (S) 15 (12-18) 15 (12-18)
ethambutol (E) 15 (15-20) 30 (25-35)
thioacetazone (T) 2.5 Not applicable
79. Table 3. Russian Standard schemes of a chemotherapy
Regime Phase
Intensive Continuation phase
I 2HRZE/S 6 H R / 6 H3 R3
II-a 2HRZES+1HRZE 5 H R E / 5 H3 R3 E3
II-б 3 H R Z E [Pt] [Cap] / [K] [Fq] According to sensitivity of MBT
III 2HRZE 4 H R / 4 H3 R3
6HE
IV Not less then 5 drugs Not less then 3 drugs
[Z E Pt Cap / K Fq] [E Pt Fq]
[Rb] [Cs] [PAS] [Rb] [Cs] [PAS]
Length not less then 6 mo. Length not less then 12 mo.
80.
81. Disadvantages of DOTS
• Is aimed on destructive pulmonary
TB
•Doesn't take in account the
features of UGT
•Etambutol is contraindicated in
hematuria
•Streptomycin is contraindicated in
stricture of ureter or urethra,
microcystis
• Resulted in a lot of relapses and
drug resistance
83. One of such antibiotics is
levofloxacin.
Its concentration in prostate
tissue is 4 times higher than in
plasma, and concentration in
the macrophages – in 8-12
times higher.
86. Treatment of MDR TB
Groups Of Drugs How to Use Them
1. Oral first line drugs As many as possible
2. Injectable drugs One best AG
3. Fluorquinolons One best FQ
4. Traditional oral As many as needed
second line drugs
5. Third line drugs Only if necessary
87. Drug resistance of MBT in UGT
occurs rarer than in PTB,
nevertheless
it may be up to 65%.
88. MBT from fistulas (both renal and
genital) by all means are resistant at
least to one antiTB drug.
89. Mono- and poly-drug resistance of
mycobacteria in UGT patients
predominates,
MDR and XDR are less frequent.
90. UroTB with MDR or XDR
mycobacteria requires individual
scheme of the therapy, using not less
than 6-7 drugs simultaneously,
fluorquinolons and reserve drugs.