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Search Results: 1 - 10 of 87609 matches for " I Fedorin "
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The Directly Observed Therapy Short-Course (DOTS) strategy in Samara Oblast, Russian Federation
Y Balabanova, F Drobniewski, I Fedorin, S Zakharova, V Nikolayevskyy, R Atun, R Coker
Respiratory Research , 2006, DOI: 10.1186/1465-9921-7-44
Abstract: The purpose of this study was to implement a DOTS programme in the civilian and prison sectors of Samara Region of Russia, describe the clinical features and outcomes of recruited patients, determine the proportion of individuals in the cohorts who were infected with drug resistant TB, the degree to which resistance was attributed to the Beijing TB strain family and establish risk factors for drug resistance.prospective study2,099 patients were recruited overall. Treatment outcomes were analysed for patients recruited up to the third quarter of 2003 (n = 920). 75.3% of patients were successfully treated. Unsuccessful outcomes occurred in 7.3% of cases; 3.6% of patients died during treatment, with a significantly higher proportion of smear-positive cases dying compared to smear-negative cases. 14.0% were lost and transferred out. A high proportion of new cases (948 sequential culture-proven TB cases) had tuberculosis that was resistant to first-line drugs; (24.9% isoniazid resistant; 20.3% rifampicin resistant; 17.3% multidrug resistant tuberculosis). Molecular epidemiological analysis demonstrated that half of all isolated strains (50.7%; 375/740) belonged to the Beijing family. Drug resistance including MDR TB was strongly associated with infection with the Beijing strain (for MDR TB, 35.2% in Beijing strains versus 9.5% in non-Beijing strains, OR-5.2. Risk factors for multidrug resistant tuberculosis were: being a prisoner (OR 4.4), having a relapse of tuberculosis (OR 3.5), being infected with a Beijing family TB strain (OR 6.5) and having an unsuccessful outcome from treatment (OR 5.0).The implementation of DOTS in Samara, Russia, was feasible and successful. Drug resistant tuberculosis rates in new cases were high and challenge successful outcomes from a conventional DOTS programme alone.Since the 1990s the World Health Organization Directly Observed Therapy Short Course (DOTS) management strategy has become the internationally recommended approach for tubercul
Barriers to sustainable tuberculosis control in the Russian Federation health system
Atun,R.A.; Samyshkin,Y.A.; Drobniewski,F.; Skuratova,N.M.; Gusarova,G.; Kuznetsov,S.I.; Fedorin,I.M.; Coker,R.J.;
Bulletin of the World Health Organization , 2005, DOI: 10.1590/S0042-96862005000300015
Abstract: the russian federation has the eleventh highest tuberculosis burden in the world in terms of the total estimated number of new cases that occur each year. in 2003, 26% of the population was covered by the internationally recommended control strategy known as directly observed treatment (dot) compared to an overall average of 61% among the 22 countries with the highest burden of tuberculosis. the director-general of who has identified two necessary starting points for the scaling-up of interventions to control emerging infectious diseases. these are a comprehensive engagement with the health system and a strengthening of the health system. the success of programmes aimed at controlling infectious diseases is often determined by constraints posed by the health system. we analyse and evaluate the impact of the arrangements for delivering tuberculosis services in the russian federation, drawing on detailed analyses of barriers and incentives created by the organizational structures, and financing and provider-payment systems. we demonstrate that the systems offer few incentives to improve the efficiency of services or the effectiveness of tuberculosis control. instead, the system encourages prolonged supervision through specialized outpatient departments in hospitals (known as dispensaries), multiple admissions to hospital and lengthy hospitalization. the implementation, and expansion and sustainability of who-approved methods of tuberculosis control in the russian federation are unlikely to be realized under the prevailing system of service delivery. this is because implementation does not take into account the wider context of the health system. in order for the control programme to be sustainable, the health system will need to be changed to enable services to be reconfigured so that incentives are created to reward improvements in efficiency and outcomes.
Rates of Latent Tuberculosis in Health Care Staff in Russia
Francis Drobniewski ,Yanina Balabanova,Elena Zakamova,Vladyslav Nikolayevskyy,Ivan Fedorin
PLOS Medicine , 2007, DOI: 10.1371/journal.pmed.0040055
Abstract: Background Russia is one of 22 high burden tuberculosis (TB) countries. Identifying individuals, particularly health care workers (HCWs) with latent tuberculosis infection (LTBI), and determining the rate of infection, can assist TB control through chemoprophylaxis and improving institutional cross-infection strategies. The objective of the study was to estimate the prevalence and determine the relative risks and risk factors for infection, within a vertically organised TB service in a country with universal bacille Calmette-Guérin (BCG) vaccination. Methods and Findings We conducted a cross-sectional study to assess the prevalence of and risk factors for LTBI among unexposed students, minimally exposed medical students, primary care health providers, and TB hospital health providers in Samara, Russian Federation. We used a novel in vitro assay (for gamma-interferon [IFN-γ]) release to establish LTBI and a questionnaire to address risk factors. LTBI was seen in 40.8% (107/262) of staff and was significantly higher in doctors and nurses (39.1% [90/230]) than in students (8.7% [32/368]) (relative risk [RR] 4.5; 95% confidence interval [CI] 3.1–6.5) and in TB service versus primary health doctors and nurses: respectively 46.9% (45/96) versus 29.3% (34/116) (RR 1.6; 95% CI 1.1–2.3). There was a gradient of LTBI, proportional to exposure, in medical students, primary health care providers, and TB doctors: respectively, 10.1% (24/238), 25.5% (14/55), and 55% (22/40). LTBI was also high in TB laboratory workers: 11/18 (61.1%). Conclusions IFN-γ assays have a useful role in screening HCWs with a high risk of LTBI and who are BCG vaccinated. TB HCWs were at significantly higher risk of having LTBI. Larger cohort studies are needed to evaluate the individual risks of active TB development in positive individuals and the effectiveness of preventive therapy based on IFN-γ test results.
Performance of the Genotype? MTBDRPlus assay in the diagnosis of tuberculosis and drug resistance in Samara, Russian Federation
Vladyslav Nikolayevskyy, Yanina Balabanova, Tatyana Simak, Nadezhda Malomanova, Ivan Fedorin, Francis Drobniewski
BMC Clinical Pathology , 2009, DOI: 10.1186/1472-6890-9-2
Abstract: We performed an evaluation of the GenoType? MTBDRplus assay (HAIN Lifescience GmbH, Germany) on a total of 168 sputum specimens from individual patients at a public health laboratory in Central Russia, as a model of a middle income site in a region with high levels of drug resistance. Phenotypic drug resistance tests (DST) were performed on cultures derived from the same sputum specimens using the BACTEC 960 liquid media system.Interpretable GenoType? MTBDRplus results were obtained for 154(91.7%) specimens with readability rates significantly higher in sputum specimens graded 2+ and 3+ compared to 1+ (RR = 1.17 95%CI 1.04–1.32). The sensitivity and specificity of the assay for the detection of rifampicin (RIF) and isoniazid (INH) resistance and MDR was 96.2%, 97.4%, 97.1% and 90.7%, 83.3%, 88.9% respectively. Mutations in codon 531 of the rpoB gene and codon 315 of the katG gene dominated in RIF and INH resistant strains respectively. Disagreements between phenotypical and molecular tests results (12 samples) could be explained by the presence of rare mutations in strains circulating in Russia and simultaneous presence of resistant and sensitive bacilli in sputum specimens (heteroresistance).High sensitivity, short turnaround times and the potential for screening large numbers of specimens rapidly, make the GenoType? MTBDRplus assay suitable as a first-line screening assay for drug resistant TB.Emergence of multidrug resistance tuberculosis (MDRTB, i.e. resistance to at least rifampicin (RIF) and isoniazid (INH) in conjunction with increasing rates of HIV infection worldwide makes the rapid detection of TB drug resistance a key factor in patients' management and care. Rapid (within 1–2 days) diagnosis of MDRTB in clinical specimens allows the commencement of an appropriate TB treatment regimen earlier and helps to prevent transmission of drug resistant TB bacilli.The WHO estimates current MDRTB rates in new and previously treated cases globally at 2.9% and 15.3% re
Popov V.N.,Eprintsev A.T.,Fedorin D.N.,Leonova Yu.A.
Journal of Stress Physiology & Biochemistry , 2005,
Abstract: Photosynthesis and respiration participates in energy production by plants undo different light conditions. It looks quite important to provide a balanced regulation of these processes. It was show in presented study that succinate dehydrogenase activity drops down in intact leaves undo intensive light/ There is no direct influence of light to purified enzyme. It was found that low concentrations of ATP (2 - 5 mkM) activated succinate dehydrogenase (SDH) but concentration more than 30 mkM inhibit it. Presented data supports idea that enzyme regulation is provided by oscillations of cell metabolites concentrations.
Analysis of undiagnosed tuberculosis-related deaths identified at post-mortem among HIV-infected patients in Russia: a descriptive study
Yanina Balabanova, Vladimir Tchernyshev, Igor Tsigankov, Svetlana Maximova, Natalya Mikheeva, Ljudmila Fedyukovitch, Sergey Kuznetsov, Ivan Fedorin, Francis Drobniewski
BMC Infectious Diseases , 2011, DOI: 10.1186/1471-2334-11-276
Abstract: We conducted a retrospective analysis of errors leading to death of HIV-positive patients in general health care hospitals in Togliatti, Russia, in 2008. All (n = 29) cases when tuberculosis was established at autopsy as a cause of death were included.Median length of hospital stay was 20 days; in 11 cases the death occurred within the first 24 hours of admission. All cases were known to be HIV-positive prior to admission, however HAART was not initiated for any case, and no relevant tests to assess severity of immunosupression were performed despite their availability. No appropriate diagnostic algorithms were applied to confirm tuberculosis. Major gaps were identified in the work of hospital and consulting physicians including insufficient records keeping. In almost all patients earlier regular HIV-relevant tests were not performed due to poor compliance of patients, many of whom abused alcohol and drugs.We conclude that introduction of prompt and accurate diagnostics tests, adequate treatment protocols and intensive training of physicians in management of AIDS and TB is vital. This should include reviewing standards of care for HIV-positive individuals with accompanying social problems.Tuberculosis (TB) remains a serious public health threat and economic burden in the Russian Federation with escalating rates of multi- and extensive drug resistance (MDR and XDR) against a background of poor infection control and active spread of resistance strains [1,2]. At the end of the 1990s, the HIV-epidemic emerged and is now spreading fast across the country with the number of registered cases being close to half a million by the end of 2009 [3]; the number of HIV-TB co-infection cases is increasing and according to national data TB is one of the most common causes of death of HIV-infected patients [4,5]. Due to the recent nature of the epidemic and the poor availability of antiretroviral drugs until recent years [6], Russian physicians have relatively limited experience of
Survival of Civilian and Prisoner Drug-Sensitive, Multi- and Extensive Drug- Resistant Tuberculosis Cohorts Prospectively Followed in Russia
Yanina Balabanova,Vladyslav Nikolayevskyy,Olga Ignatyeva,Irina Kontsevaya,Clare M. Rutterford,Anastasiya Shakhmistova,Nadezhda Malomanova,Yulia Chinkova,Svetlana Mironova,Ivan Fedorin,Francis A. Drobniewski
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0020531
Abstract: A long-term observational study was conducted in Samara, Russia to assess the survival and risk factors for death of a cohort of non-multidrug resistant tuberculosis (non-MDRTB) and multidrug resistant tuberculosis (MDRTB) civilian and prison patients and a civilian extensive drug-resistant tuberculosis (XDRTB) cohort.
Health-systems efficiency in the Russian Federation: tuberculosis control
Floyd,Katherine; Hutubessy,Raymond; Samyshkin,Yevgeniy; Korobitsyn,Alexei; Fedorin,Ivan; Volchenkov,Gregory; Kazeonny,Boris; Coker,Richard; Drobniewski,Francis; Jakubowiak,Wieslaw; Shilova,Margarita; Atun,Rifat A;
Bulletin of the World Health Organization , 2006, DOI: 10.1590/S0042-96862006000100013
Abstract: objective: to conduct a comprehensive assessment of the case-mix of patients admitted to tuberculosis hospitals and the reasons for their admission in four russian regions: ivanovo, orel, samara and vladimir. we also sought to quantify the extent to which efficiency could be improved by reducing hospitalization rates and re-profiling hospital beds available in the tuberculosis-control system. methods: we used a standard questionnaire to determine how beds were being used and who was using the beds in tuberculosis facilities in four russian regions. data were collected to determine how 4306 tuberculosis beds were utilized as well as on the socioeconomic and demographic indicators, clinical parameters and reasons for hospitalization for 3352 patients. findings: of the 3352 patients surveyed about 70% were male; the average age was 40; and rates of unemployment, disability and alcohol misuse were high. about one-third of beds were occupied by smear-positive or culture-positive tuberculosis patients; 20% were occupied by tuberculosis patients who were smear-negative and/or culture-negative; 20% were occupied by patients who no longer had tuberculosis; and 20% were unoccupied. if clinical and public health admission criteria were applied then < 50% of admissions would be justified and < 50% of the current number of beds would be required. up to 85% of admissions and beds were deemed to be necessary when social problems and poor access to outpatient care were considered along with clinical and public health admission criteria. conclusion: much of the russian federation's large tuberculosis hospital infrastructure is unnecessary when clinical and public health criteria are used, but the large hospital infrastructure within the tuberculosis-control system has an important social support function. improving the efficiency of the system will require the reform of health-system norms and regulations as they relate to resource allocation and clinical care and implementation of
An Integrated Approach to Rapid Diagnosis of Tuberculosis and Multidrug Resistance Using Liquid Culture and Molecular Methods in Russia
Yanina Balabanova, Francis Drobniewski, Vladyslav Nikolayevskyy, Annika Kruuner, Nadezhda Malomanova, Tatyana Simak, Nailya Ilyina, Svetlana Zakharova, Natalya Lebedeva, Heather L. Alexander, Rick O'Brien, Hojoon Sohn, Anastasia Shakhmistova, Ivan Fedorin
PLOS ONE , 2009, DOI: 10.1371/journal.pone.0007129
Abstract: Objective To analyse the feasibility, cost and performance of rapid tuberculosis (TB) molecular and culture systems, in a high multidrug-resistant TB (MDR TB) middle-income region (Samara, Russia) and provide evidence for WHO policy change. Methods Performance and cost evaluation was conducted to compare the BACTEC? MGIT? 960 system for culture and drug susceptibility testing (DST) and molecular systems for TB diagnosis, resistance to isoniazid and rifampin, and MDR TB identification compared to conventional Lowenstein-Jensen culture assays. Findings 698 consecutive patients (2487 sputum samples) with risk factors for drug-resistant tuberculosis were recruited. Overall M. tuberculosis complex culture positivity rates were 31.6% (787/2487) in MGIT and 27.1% (675/2487) in LJ (90.5% and 83.2% for smear-positive specimens). In total, 809 cultures of M. tuberculosis complex were isolated by any method. Median time to detection was 14 days for MGIT and 36 days for LJ (10 and 33 days for smear positive specimens) and indirect DST in MGIT took 9 days compared to 21 days on LJ. There was good concordance between DST on LJ and MGIT (96.8% for rifampin and 95.6% for isoniazid). Both molecular hybridization assay results correlated well with MGIT DST results, although molecular assays generally yielded higher rates of resistance (by approximately 3% for both isoniazid and rifampin). Conclusion With effective planning and logistics, the MGIT 960 and molecular based methodologies can be successfully introduced into a reference laboratory setting in a middle incidence country. High rates of MDR TB in the Russian Federation make the introduction of such assays particularly useful.
Strategy of Ukraine : Economics, Sociology, Law , 2011,
Abstract: The question of origin of failures is considered in a global market, influence of TNK on an origin and functioning of such processes. Analysis of redistribution of development of countries. Рассмотрены вопросы возникновения провалов в глобальном рынке, влияние ТНК на возникновение и функционирование таких процессов. Проанализированы перераспределение развития стран. Розглянуто питання виникнення провал в у глобальному ринку, вплив ТНК на виникнення та функц онування таких процес в. Проанал зовано перерозпод л розвитку кра н.
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