«Approved»Dean of the foreign studentsProfessor _______________Yu.G.Poostovyy«____»________________2010

LECTURE TOPICS FOR IV STUDENTS

2010-2011 academic year

№ п/п Topic Content Lecture Day1. Tuberculosis as scientific and

humanitarian challenge.Historical review. Epidemiology,

etiology and pathogenesis.Immunity.

Tuberculosis as scientific medical and humanitarian challenge. Main eras of the tuberculosis investigation. Gippocarat, Avicenna, R.Koch, R.Laennec, W.Roentgen, A.Calmett, C.Geren, A.I.Abricosov, N.I.Pyrogov, Z.Waksmann, K.Styblo.

Incidence and prevalence of the disease in different countries. Different approach of the tuberculosis epidemiology. Descriptive epidemiology. Etiologic epidemiology. Predictive epidemiology. Risk factors.

Pathomorghology of the tuberculosis.Causative agent of the tuberculosis: morphology,

tinctorial properties, resistance in the environment. Mycobacteria types. Variability (L-form, persisting, reversion). Drug resistance (Multidrug resistance (MDR), extensively drug resistance (XDR)).

Sources of the infection and ways of transmission, interaction with the human being. Local and general reaction onto innoculation. Native resistance and antituberculosis immunity. Humoral and cell immunity.

Ph.D M.G.Dolynska

For content module 1,Topic 1.

First day of classes.

2. Case detecting Ways and approaches of case detecting. Risk groups. Risk evaluation. High risk and populational strategy of case detecting.

Clinical examination of the TB patient peculiarities. The most typical complaints, course, anamnestic data, risk factor revealing; social, family and personal history. Physical

Ph.D M.G. Dolynska

For content module 2,Topic 2.

Second day of classes.

examination: palpation, percussion, auscultation significance. Routine laboratory tests. Functional tests.

Etiological (microbiological) tests. Direct microscopy and cultural tests as a “gold standard” of case detecting. Accelerated cultural tests: Middlebrook, BACTEC sets. Polymerase chain reaction (PCR) and ELISA tests. Approach of resistance detecting.

Radiological examination place. Main methods of radiological examination. Plain chest X-ray examination and CT scanning significance. Main radiological syndromes typical for tuberculosis: hilum widening, lung patterns changing, dissemination, limited opacity, ring-like and round shadow.

Screening X-ray examination: different national strategies. WHO recommendation.

Diagnostic algorithms in TB suspicion.Tuberculin test. Tuberculin preparations. Modern

tuberculin probes. Tuberculin test conversion. Differential diagnosis between pos-vaccine immunity and latent tuberculosis.

3. Primary and secondary tuberculosis Primary and secondary tuberculosis pathogenesis. Morphological peculiarities. Typical course of each type.

Early period of the tuberculosis infection. Pre-local tuberculosis. Intrathoracic lymph nodes tuberculosis. Clinical peculiarities, differential diagnosis, complication, residuals. The significance of residuals in secondary tuberculosis development. Chronic primary tuberculosis. Primary tuberculosis peculiarities at different age. Primary tuberculosis in adults.

Miliary tuberculosis pathomorphology. Frequency among immunocompromised and non-immunocompromised patients. Clinical variants. Differential diagnosis. Prognosis.

Tubercle meningitis as generalized type of primary and secondary tuberculosis. Clinical peculiarities, differential diagnosis, complication, outcomes, residuals.

Disseminated tuberculosis. Frequency and pathomorphology. Clinical variants (sub-acute and chronic).

Ph.D M.G.Dolynska

For content modules 3-4,Topics 3-6.Third day of

classes

Clinical peculiarities, differential diagnosis, complication, residuals.

Focal and infiltrative tuberculosis. Pathomorphology, clinical peculiarities. Foci activeness appreciation. Causes of progressing and advanced cases appearance. Clinico-radiological infiltrates types. Residuals.

Caseous pneumonia. Clinico-radiological variants. Differential diagnosis, outcomes, prognosis, residuals.

Tuberculoma, morphological variants. Classification. Clinical course peculiarities. Ways of revealing. Differential diagnosis, management peculiarities. Outcomes, prognosis.

Pleural tuberculosis. Diagnostic peculiarities. Differential diagnosis, outcomes, prognosis, residuals.

Chronic tuberculosis (fibrous-cavernous, cirrhotic). Causes of development. Pathomorphological peculiarities. Variants and clinical course peculiarities. Differential diagnosis, outcomes, prognosis.

Secondary tuberculosis complication. Pulmonary haemorrhage, spontaneous pneumathorax, heart insufficiency, amyloidosis, pleurisy, haematogenic dissemination. Management and prevention. Residual classification.Secondary tuberculosis case demonstration.

4. Tuberculosis treatment:general principles and approach

General principles of antimycobactrial treatment. Historical background.

Antituberculosis drugs: classification, dosage mechanisms of activity. Side effects: treatment and prevention.

Organizational principles of DOTS (Directly observed treatment short course). The five elements of the expanded DOTS framework. Basical treatment regimens. Multidrug resistance (MDR), extensively drug resistance (XDR) management. Second-line drugs. Expanded treatment conception: appropriate antibacterial treatment, hygienic and dietary regimen, pathogenetic measures (desintoxication, hepatotropic therapy, tissue stimulation, collapsotherapy). Surgical treatment.

Recovery criteria.

Ph.D. M.G.Dolynska

For content modules 5,Topics 7.

Forth day of classes

5. Tuberculosis:preventive interventions

Chain of Transmission. Social, medical, sanitary approach. BCG vaccination. National recommendations concern with indication and contraindication. Immunity properties. Vaccination procedure. Post-vaccination period. Complications and safety.Drug preventive courses. Indication, regimen.Sanitary preventive interventions. Hotbed of the tuberculosis infection. Priority of hotbeds. Interventions in hotbeds.Sanitary education methods and significance.

Professor Yu.G.Poostovyy

For content modules 5,Topics 7.

Fifth day of classes.

Approved on chair meeting August, 31 2010 Protocol №1_______

Head of the Phtisiology chair,Professor _______________Yu.G.Poostovyy

Mehodic board head , Professor _______________Yu.N.Kolchin