Intervention Review

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Low level laser therapy for treating tuberculosis

  1. Vasiliy V Vlassov1,*,
  2. Andrey G Reze2

Editorial Group: Cochrane Infectious Diseases Group

Published Online: 20 JAN 2010

Assessed as up-to-date: 19 OCT 2009

DOI: 10.1002/14651858.CD003490.pub2

Database Title

Additional Information

How to Cite

Vlassov VV, Reze AG. Low level laser therapy for treating tuberculosis. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD003490. DOI: 10.1002/14651858.CD003490.pub2.

Author Information

  1. 1

    Moscow, Russian Federation

  2. 2

    Moscow Medical Academy, Department of Family Medicine, Moscow, Russian Federation

*Vasiliy V Vlassov, PO Box 13, Moscow, 109451, Russian Federation. vlassov@cochrane.ru.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 20 JAN 2010

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ARTICLE TOOLS

Summary (56K)Standard (171K)Full (179K)
 

Background

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Differences between protocol and review
  17. Index terms

Low level laser therapy as a treatment for tuberculosis has been the subject of published studies since the early 1990s (Vlassov 2002). It has been used to treat pulmonary tuberculosis (Badalov 1990) and extrapulmonary tuberculosis (Iagafarova 1998) caused by drug sensitive and multiple-drug-resistant mycobacteria (Bhagwanani 1996; Lomachenkov 1998), and people who have tuberculosis in addition to an underlying medical condition such as endobronchitis (Shesterina 1991). The mechanism of action of low level laser therapy in treating tuberculosis is not known, but it has been hypothesized that it involves the modulation of "information exchange between the human body and universe" or have anti-inflammatory, immunomodulatory, and anaesthetizing action within the human body (Illarionov 1998).

A variety of different laser devices have been used for treating tuberculosis. They include gas lasers, such as the helium-neon laser and the nitrogen laser, and semiconductor lasers, such as the diode pulse beam arsenic-gallium laser. The devices typically deliver 2 mW to 200 mW, with the power density typically ranging from 0.05 W/cm2 to 5 W/cm2 (Alt Med 2002). The laser therapy may be applied externally, such as to acupuncture points or surfaces of the body close to the internal organs affected by tuberculosis (anatomical projections of affected areas), or internally, such as to the blood or to the lung cavities or to bronches. Short external applications (usually less than one minute) are described as stimulating, while longer applications (greater than five minutes) are described as relaxing (Van Breugel 1992; Illarionov 1998). The lasers may be used in conjunction with an invasive procedure such as a bronchoscopy.

The main treatment for tuberculosis is a course of antituberculous drugs taken over a period of at least six months (WHO 1999). This lengthy treatment course can make it difficult for people to adhere to the full course and can increase the frequency of cases where the Mycobacterium tuberculosis bacteria, which cause tuberculosis, develop resistance to the antituberculous drugs (Yew 1999). Lasers seem to be mainly used for treating tuberculosis in countries of the former Soviet Union and India in the belief that they may reduce the length of the treatment or increase the frequency of cure (Vlassov 2002).

This Cochrane Review summarizes evaluates the available evidence on the role of low level laser therapy as an adjunct to antituberculous drugs for treating tuberculosis.

 

Objectives

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Differences between protocol and review
  17. Index terms

To compare low level laser therapy plus antituberculous drugs with antituberculous drugs alone for treating tuberculosis.

 

Methods

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Differences between protocol and review
  17. Index terms
 

Criteria for considering studies for this review

 

Types of studies

Randomized controlled trials.

 

Types of participants

People with tuberculosis affecting any organ. Diagnosis proven by a positive sputum smear or culture, or both, or through the examination of x-rays.

 

Types of interventions

 

Intervention

Low level laser therapy used specifically for treating tuberculosis plus antituberculous drugs.

 

Control

Antituberculous drugs.

Antituberculous drug regimens and other baseline treatments must be identical for both groups. We excluded laser therapy used for coagulation, evaporation of tissues, drying of wounds or surfaces of organs, and photoactivation of drugs.

 

Types of outcome measures

 

Primary

  • All-cause death.
  • Time to become sputum negative (smear or culture conversion, or both) for mycobacteria or frequency of conversion at two, five, six, or eight months.

 

Secondary

  • Time to resolution of fever (or frequency of resolution of fever).
  • Time to resolution of infiltration of lungs on x-ray* (or frequency of resolution).
  • Time to lung cavity closure on x-ray* (or frequency of closure).
  • Measure of lung function, such as forced vital capacity (FVC).

*X-rays must have been evaluated blindly and by no less than two specialists.

 

Adverse events

  • Serious adverse events (leading to death, requiring hospitalization, or withdrawal from treatment).
  • Other adverse events.

 

Search methods for identification of studies

We have attempted to identify all relevant trials regardless of language or publication status (published, unpublished, in press, and in progress).

 

Databases

We searched the following databases using the search terms and strategy described in Appendix 1: Cochrane Infectious Diseases Group Specialized Register (October 2009), CENTRAL (The Cochrane Library 2009, Issue 4), MEDLINE (1966 to October 2009), EMBASE (1974 to October 2009), CINAHL (1982 to October 2009), Science Citation Index (1945 to October 2009), PEDro (1929 to October 2009 ), LILACS (1982 to October 2009).

 

Other sources

We searched the electronic catalogue of the Central Medical Library in Moscow (1988 to April 2009) using the search terms tubercul* and laser*, the website of the National Centre for Science Information at the Indian Institute of Science (15 April 2002), handsearched the journal journal Probl. Tuberk. Bolezn. Legk. (2000 to April 2009), where most relevant articles were published in previous years. We used Google (July 2009) to search the Internet with the search terms tuberculosis and laser, and, for the Vlassov 2002 version, handsearched the proceedings of all relevant conferences available in the Central Medical Library and the private literature collections of two specialists in the field. We contacted relevant organizations and researchers for the original version.

 

Researchers and organizations: unpublished and ongoing trials

For the original version of the review (Vlassov 2002), we contacted individual researchers working in the field and organizations including the Centre of Advanced Technology (India), the International Union Against Tuberculosis and Lung Disease (IUATLD), and the Central Tuberculosis Research Institute (CTRI) of the Russian Academy of Medical Science.

 

Reference lists

We also checked the reference lists of all studies identified by the above methods.

 

Data collection and analysis

 

Selection of studies

Both authors independently screened the results of the literature search to identify potentially relevant studies, although only the first author screened the Russian language studies. We examined the full text of any potentially relevant articles before making a decision on their eligibility, and resolved differences in opinion through discussion. We attempted to contact the authors of studies where there was ambiguity.

 

Data extraction and management

Both authors independently extracted data from the included trial.

 

Assessment of risk of bias in included studies

Both authors independently assessed the risk of bias in trials. We assessed the generation of allocation sequence and concealment of allocation as adequate, inadequate, or unclear according to Juni 2001; described who was blinded to the intervention; and assessed the percentage of randomized participants included in the analysis of a primary outcome measure, with 90% or more considered as adequate. We resolved differences through discussion and attempted to contact the trial authors for clarification where needed.

 

Data synthesis

We were unable to do any data analyses. We will refer to the methods described in the protocol should we need to conduct analyses in future updates.

 

Results

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Differences between protocol and review
  17. Index terms
 

Description of studies

See: Characteristics of included studies; Characteristics of excluded studies.

Of eight potentially relevant studies, we excluded seven studies, six conducted in Russia and one in Azerbaijan, for the reasons described in the 'Characteristics of excluded studies', and included one randomized controlled trial (Puri 2003).

Puri 2003 was conducted in New Delhi, India and enrolled 130 participants for an evaluation of the gallium-arsenide laser in the treatment of pulmonary tuberculosis. All participants received the same basic antituberculosis drug regimen in addition to either the laser treatment or sham laser treatment. Those receiving the laser had daily treatment for 10 days and were either admitted to hospital or attended the outpatient clinic. The treatment was external with the location guided by chest radiographs. Further details are provided in the 'Characteristics of included studies'. The participants in the sham irradiation control group used the same machine without switching it on.

The trial measured a number of outcomes of which the sputum conversion and clinical improvement are relevant to this review; however, no data are available for the latter outcome. Although the trialists did not report adverse events or death as outcome measures, some data were reported that relate to these. The trial report provided information on these outcome measures, but the data were insufficient for analysis. The attempts to contact the author for clarification were unsuccessful. The trial report did not provide details on the group that each of the participants were randomized into or which group those participants that left the trial were from; the only details on group allocation was for the 65 participants who were cured (see Figure 1).

 FigureFigure 1. Flow of participants as reported in Puri 2003

 

Risk of bias in included studies

Puri 2003 was described as a randomized controlled trial, but there is no information on how the allocation sequence was generated. It was also unclear how the allocation was concealed. The participants were blinded to the intervention, but it is unclear if this was the case also for the treatment providers and outcome assessors. In terms of the inclusion of the randomized participants available for the analysis of the time to sputum conversion (a primary outcome measure), the trialists have reported that 53.85% (70/130) of the enrolled participants completed treatment, but we are unsure to which treatment group five of these participants were allocated.

 

Effects of interventions

 

Death from any cause

The trialists reported one death, but it is not clear which treatment group the person was in. No further details were provided.

 

Time to become sputum negative

The trialists did not report the number of participants enrolled into each group, which meant that we do not have the denominators for this analysis. Although the trialists did provide details on the sputum conversion, it was only for the 65 participants reported as cured.

 

Discussion

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Differences between protocol and review
  17. Index terms

The original version of this review included a search for and description of non-randomized studies on low level laser therapy for tuberculosis (Vlassov 2002). Over 3500 participants and 60 researchers from India and countries throughout the former Soviet Union were involved in the 29 studies, which tended to report promising results. Since this time we have continued our search of the literature and have been surprised to find that only one randomized controlled trial has since been conducted. It has been disappointing to find that the description of the methods and results in the trial report meant that we were unable to summarize the findings. Any further studies conducted in this area must be well-designed randomized controlled trials, which should be reported in full to allow the wider scientific community to gain a better understanding of the potential value of this intervention.

 

Authors' conclusions

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Differences between protocol and review
  17. Index terms

 

Implications for practice

The one small randomized controlled trial that evaluated low level laser therapy for treating tuberculosis was poorly reported and does not clarify the potential benefits or harms of this intervention. The use of this intervention is not supported by reliable evidence.

 
Implications for research

Researchers need to focus on conducting well-designed randomized controlled trials to assess low level laser therapy for treating tuberculosis. The trialists must ensure that all participants give their consent, use pragmatic outcome measures including adverse events, and provide a detailed description of any antituberculous drugs used concurrently with the laser therapy (these should be the same in both the intervention and control groups). The trials should be reported in full and preferably conform to the Consolidated Standards of Reporting Trials (CONSORT) statement (Moher 2001).

 

Acknowledgements

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Differences between protocol and review
  17. Index terms

We acknowledge the following support provided for the Vlassov 2002 version of the review: Leonid M Pechatnikov for independently checking the Russian language contributing articles, Carrol Gamble (née Preston) for statistical support, and Bertie Squire and Paul Garner for advice. Harriet G MacLehose contributed to and was an author on previous versions of this review.

 

Data and analyses

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Differences between protocol and review
  17. Index terms

This review has no analyses.

 

Appendices

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Differences between protocol and review
  17. Index terms
 

Appendix 1. Search methods: search strategies for databases

Search setCIDG SRaCENTRALMEDLINEbEMBASEbLILACSbCINAHLbSCIPEDro
1tuberculosistubercul*TUBERCULOSISTUBERCULOSIStubercul*tubercul*tubercul*tubercul*
2TBTBtubercul*tubercul$TBTBTBTB
31 or 21 or 2TBTB1 or 21 or 21 or 21 or 2
4laserlaser1 or 2 or 31 or 2 or 3laserlaserlaserlaser
53 and 43 and 4laserlaser3 and 43 and 43 and 43 and 4
6——4 and 54 and 5————


aCochrane Infectious Diseases Group Specialized Register.
bSearch terms used in combination with the search strategy for retrieving trials developed by The Cochrane Collaboration (Higgins 2005); upper case: MeSH or EMTREE heading; lower case: free text term.

 

What's new

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Differences between protocol and review
  17. Index terms

Last assessed as up-to-date: 19 October 2009.

DateEventDescription
20 October 2009New search has been performedSources searched up to October 2009 and text updated. Change in second author.


 

History

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Differences between protocol and review
  17. Index terms

Protocol first published: Issue 1, 2002
Review first published: Issue 3, 2002

DateEventDescription
18 August 2008AmendedConverted to new review format with minor editing.
20 February 2006New citation required and conclusions have changed2006, Issue 2: substantive update in which we included one new trial, updated the review authorship, and amended the inclusion criteria to allow only randomized controlled trials (quasi-randomized controlled trials and observational studies are excluded); no longer contains the description of non randomized studies.


 

Contributions of authors

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Differences between protocol and review
  17. Index terms

Vasiliy V Vlassov and Harriet G MacLehose contributed equally to the previous version of the review. Vasiliy V Vlassov and Andrey G. Reze contributed equally to the update of the review

 

Declarations of interest

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Differences between protocol and review
  17. Index terms

Authors declare that they have no conflict of interest.

 

Sources of support

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Differences between protocol and review
  17. Index terms
 

Internal sources

  • Liverpool School of Tropical Medicine, UK.

 

External sources

  • Department for International Development, UK.

 

Differences between protocol and review

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Differences between protocol and review
  17. Index terms

2002, Issue 3: We added "drying of wounds or surfaces of organs" to the types of interventions that are excluded; removed "as an adjunct therapy" from the objective because this is more appropriate since it is not necessarily used in combination with other treatments; and moved the description of non-randomized studies has been moved from the 'Background' into the main review under a separate subheading.

References

References to studies included in this review

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Characteristics of studies
  19. References to studies included in this review
  20. References to studies excluded from this review
  21. Additional references
  22. References to other published versions of this review
Puri 2003 {published data only}
  • Puri MM, Arora VK. Role of Gallium Arsenide laser irradiation at 890 nm as an adjunctive to anti-tuberculosis drugs in the treatment of pulmonary tuberculosis. Indian Journal of Chest Diseases and Allied Sciences 2003;45(1):19-23.

References to studies excluded from this review

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Characteristics of studies
  19. References to studies included in this review
  20. References to studies excluded from this review
  21. Additional references
  22. References to other published versions of this review
Abashev 1997 {published data only}
  • Abashev IM, Kozlova AI. Role of external laser radiation in the multimodality treatment of patients with destructive pulmonary tuberculosis [Rol' naruzhnogo lasernogo oblucheniia v komplexnom lechenii bolnikh destructivnim tuberkulosom legkikh]. Problemy Tuberkuleza 1997, (3):23-4.
Agayev 2004 {published data only}
  • Agayev FF. Effect of endobronchial laser therapy in first discovered destructive pulmonary tuberculosis. Azerbaijan Medical Journal 2004, (2):45-7.
Lovacheva 2006 {published and unpublished data}
  • Lovacheva OV, Shumskaia II, Sidorova NF, Evgushchenko GV, Nikitin AV. Use of endobronchial laser ultraviolet irradiation in the complex treatment of bronchial tuberculosis [Primenenie endobronkhial'nogo lazernogo izlucheniia v komplexnoi terapii tuberkuleza bronkhov]. Probl Tuberk Bolezn Legk 2006, (12):20-4.
Maliev 1991a {published data only}
  • Maliev BM, Selitskaia RP, Kupavtseva EA. Dynamics of the indices of the immune system as affected by endobronchial laser therapy in patients with complicated tuberculosis of the lungs [Dinamika pokazateley immunnoi sistemi pod vliianiem lazeroterapii u patsientov s oslozhnennim tuberkulezom legkikh]. Problemy Tuberkuleza 1991, (9):64-7.
Maliev 2001b {published data only}
  • Maliev BM, Shesterina MV. Lazeri v pulmonologii [Lasers in pulmonology]. Moscow: Tekhnika, 2001:87-107.
Shesterina 1991 {published data only}
  • Shesterina MV, Maliev BM. Helium-neon laser in the complex therapy of patients with lung tuberculosis [Gelii-neonovii laser v komplexnom lechenii bolnikh tuberkulesom legkikh]. Problemy Tuberkuleza 1991, (5):23-5.
Topolnitskii 1992 {published data only}
  • Topolnitskii VG. Vozmozhnosti vnutrivennogo ispolzovaniia gelii-neonovogo lasera vo ftiziatrii [Perspectives of the laser's intravenous use in phthysiatry] [dissertation]. Moscow: Moscow Research & Development Institute for Tuberculosis, Ministry of Health, Russian Federation, 1992.

Additional references

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Characteristics of studies
  19. References to studies included in this review
  20. References to studies excluded from this review
  21. Additional references
  22. References to other published versions of this review
Alt Med 2002
  • Alternative Medicine. Laser. www.geocities.com/altmedd/laser.htm (accessed 21 January 2002).
Badalov 1990
  • Badalov RK, Tsym VF. Use of laser therapy in combined treatment of pulmonary tuberculosis in children and adolescents [Primenenie laserterapii v komplexnom lechenii tuberkuleza legkikh u detei i podrostkov]. Problemy Tuberkuleza 1990, (2):41-3.
Bhagwanani 1996
  • Bhagwanani NS, Bhatia GC, Sharma N. Low level nitrogen laser therapy in pulmonary tuberculosis. Journal of Clinical Laser Medicine and Surgery 1996;14(1):23-5. [MEDLINE: 184]
Higgins 2005
  • Higgins J, Green S, editors. Highly sensitive search strategies for identifying reports of randomized controlled trials in MEDLINE. Cochrane Handbook for Systematic Reviews of Interventions 4.2.5 [updated May 2005]; Appendix 5b. www.cochrane.org/resources/handbook/hbook.htm (accessed 1 October 2005).
Iagafarova 1998
  • Iagafarova RK, Gamzakov RV, Manicheva OA. Evaluation of complex therapy efficiency for urogenital tuberculosis [Otsenka effektivnosti komplexnoi terapii tuberkulesa mochepolovikh organov]. Problemy Tuberkuleza 1998, (2):38-40.
Illarionov 1998
Juni 2001
Lomachenkov 1998
  • Lomachenkov VD, Kuprikova IM, Riazhechkina LA, Pochtennyi IT, Pavliunina AD. Inhibitory effects of electric UHF field and magnetic infrared laser irradiation on Mycobacterium tuberculosis [Ingibiruiuschee deistvie electricheskogo polia UVCh i magnito-infrakrasno-lasernogo izlucheniia na mikobakterii tuberkulesa]. Problemy Tuberkuleza 1998, (4):53-5.
Maliev 1991b
  • Maliev BM. Endobronchial use of different lasers in the complex treatment of patients with complicated thoracic tuberculosis [Endobronchialnoe ispolsovanie razlichnikh laserov v komplexnom lechenii bolnikh oslozhnennimi formami vnutrigrudnogo tuberkulesa]. In: Shesterina MV editor(s). Ispolzovanie laserov vo phthiziopulmonologii. Moscow: Moscow R&D Institute for Tuberculosis, Ministry of Health of RSFSR, 1991:14-20.
Maliev 2001a
Moher 2001
  • Moher D, Schulz KF, Altman DG, for the CONSORT Group. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 2001;357:1191-4.
    Direct Link:
Van Breugel 1992
  • Van Breugel HH, Bar PR. Power density and exposure time of He-Ne laser irradiation are more important than total energy dose in photo-biomodulation of human fibroblasts in vitro. Lasers in Surgery and Medicine 1992;12(5):528-37. [MEDLINE: 1406006]
    Direct Link:
WHO 1999
  • World Health Organization, Communicable Diseases Cluster. What is DOTS? A guide to understanding the WHO-recommended TB control strategy known as DOTS. Geneva: World Health Organization, 1999.
Yew 1999
Summary (56K)Standard (171K)Full (179K)