The dissertation contains theoretical substantiation and proposals for practical solution of the scientific problem - optimization of diagnosis of patients with firstly diagnosed infiltrative pulmonary tuberculosis, based on assessment of radiological, inflammatory and immunological indicators, their prognostic value in assessing the effectiveness of treatment and development based on their methods effectiveness of therapy.
The global problem of tuberculosis, which has been looming over humanity for millennia, remains relevant today. The current trend of firstly diagnosed pulmonary tuberculosis (FDPT) shows an increase in the number of infiltrative forms, which make up the majority of new cases. This form of pulmonary tuberculosis is associated with a high probability of developing decay cavities, which in turn are closely associated with bacterial excretion and are often an indication for surgery.
Prolonged hospitalization, stigmatization of the disease, alcohol and drug use, smoking, lack of social and material support, side effects of drug treatment, as well as intoxication play a significant role in prolonging the pathological process. In case of slow clinical and radiological dynamics, continuation of bacterial excretion or serious adverse reactions to etiotropic therapy, the duration of the intensive phase of treatment (IF) may be extended to 90 doses by the decision of the Central Medical Advisory Committee (CMAC). Due to the prolongation of IF, the state bears additional economic costs, and the patient has psychological pressure.
The most important criterion of positive dynamics in the treatment of tuberculosis is the fact that the decay cavities are closed. Patients with a lack of timely closure of the cavities are at risk of adverse disease. Identification of predictors of treatment failure and development of methods for predicting the effectiveness of treatment of infiltrative pulmonary tuberculosis are important unresolved issues of tuberculosis. Therefore, the work devoted to determining the features of the most common infiltrative form of tuberculosis and the development of methods for predicting the effectiveness of its treatment is a highly relevant study.
The aim of the study is to predict the effectiveness of treatment of firstly diagnosed infiltrative pulmonary tuberculosis based on the assessment of clinical and radiological picture, indicators of immunoinflammatory status, psychological status of patients, their relationships and dynamics after treatment.
To achieve the goal of the study, the following tasks were identified, which must be solved during the experiment:
1. To study the features of clinical and laboratory parameters and radiological status in patients with firstly diagnosed infiltrative pulmonary tuberculosis before treatment.
2. In patients with firstly diagnosed infiltrative pulmonary tuberculosis to conduct a correlation analysis of baseline clinical and laboratory parameters with radiological changes in the lungs and determine the factors involved in the development of infiltrative pulmonary tuberculosis.
3. Evaluate the dynamics of the parameters of clinical-laboratory and radiological status in patients with firstly diagnosed infiltrative pulmonary tuberculosis after the intensive phase of treatment in 60 doses and to determine the options for treatment effectiveness.
4. In patients with firstly diagnosed infiltrative pulmonary tuberculosis to establish parameters that are predictor-important in predicting the effectiveness of treatment.
5. In patients with firstly diagnosed infiltrative pulmonary tuberculosis to develop methods for predicting the effectiveness of therapy.
Radiation examination included direct and lateral chest radiography at the beginning and end of IF therapy, and additional methods were used as needed: tomography, posterior and targeted radiography or tomography, computed tomography.
Verification of the diagnosis of FDTB was based on the recommendations of the Unified Clinical Protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care "Tuberculosis", the order of the Ministry of Health of Ukraine from 04.09.2014 № 620 "On approval and implementation of medical and technological documents for standardization of medical care for tuberculosis "and the order of the Ministry of Health of Ukraine from 25.02.2020 № 530" On approval of health standards for tuberculosis ".
To assess the psychological state of patients, standardized self-assessment scales (questionnaires) were used, which can be used by general practitioners without the involvement of a psychiatrist and do not require special training. The Spielberger-Hanin scale was used to determine the anxious reactions of the respondents, where both personal and reactive anxiety were distinguished. Depressive states were assessed using the Beck scale.
