Tuberculosis and Lung Diseases最新文献

The results of sanatorium treatment were analyzed in 156 children and adolescents aged 11-17 years at high risk for tuberculosis. All the patients had been long infected with Mycobacterium tuberculosis with hyperergic tuberculin sensitivity; they had comorbidity and were susceptible to frequent respiratory diseases. A course of percutaneous low-intensity laser irradiation was incorporated as a new method into a complex of prophylactic treatment. The time course of changes in tuberculin sensitivity, serological values, and clinical data were estimated. The proposed treatment regimen was shown to have some advantage over the conventional treatment one.

Metabolic disturbances were corrected using the oral specialized formula Nutrien-phthisio (ZAO "Company Nutritec", Russia) in 53 patients with pulmonary tuberculosis and concomitant diseases. In the whole group, tuberculosis was first detected in 21 patients; 32 had a chronic process. Chemotherapy was discontinued in all the patients due to the intolerance phenomena caused by comorbidity (erosive gastritis, gastroduodenal peptic ulcer, hepatitis B and C, chronic pyelonephritis) in 24 patients, by adverse reactions in 19, and by a combination of both factors in 10. The criteria for objectively monitoring the efficiency of nutritional support (in combination with specific treatment) were body mass index, general blood analysis, by taking into account the percentage and absolute count of lymphocytes and the protein metabolism from the serum levels of total protein, albumin, and transferrin. The study determined clinical and laboratory indications for the use of Nutrien-phthisio and the favorable impact of nutritional support on the course of a tuberculous process and concomitant diseases.

Due to the implementation of the International Bank for Reconstruction and Development (IBRD) loan project "Prevention, diagnosis, treatment of tuberculosis and AIDS", a "Tuberculosis" component that is an addition to the national tuberculosis control program in 15 subjects of the Russian Federation, followed up by the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences, the 2005-2008 measures stipulated by the Project have caused substantial changes in the organization of tuberculosis control: implementation of Orders Nos. 109, 50, and 690 and supervision of their implementation; modernization of the laboratories of the general medical network and antituberbulosis service (404 kits have been delivered for clinical diagnostic laboratories and 12 for bacteriological laboratories, including BACTEC 960 that has been provided in 6 areas); 91 training seminars have been held at the federal and regional levels; 1492 medical workers have been trained in the detection, diagnosis, and treatment of patients with tuberculosis; 8 manuals and guidelines have been prepared and sent to all areas. In the period 2005-2008, the tuberculosis morbidity and mortality rates in the followed-up areas reduced by 1.2 and 18.6%, respectively. The analysis of patient cohorts in 2007 and 2005 revealed that the therapeutic efficiency evaluated from sputum smear microscopy increased by 16.3%; there were reductions in the proportion of patients having ineffective chemotherapy (from 16.1 to 11.1%), patients who died from tuberculosis (from 11.6 to 9.9%), and those who interrupted therapy ahead of time (from 11.8 to 7.8%). Implementation of the IBR project has contributed to the improvement of the national strategy and the enhancement of the efficiency of tuberculosis control.

Drug resistance among yeasts and mycelial fungi remains a serious problem when therapy for deep mycoses is chosen. The generic variety of fungal cultures obtained from the sputa of 148 patients with various bronchopulmonary diseases in 1998-2008 was assessed. Most (n = 113) isolates were yeasts of the genus Candida and 39 isolates were mycelial fungi of the genus Aspergillus. The fungi of the genera Geotrichum, Rhodotorula, Saccharomyces, Kluyveromyces, Penicillium, Cryptococcus, and Mucor were much less common. The sensitivity of the obtained Candida isolates was monitored. It has been found that in the past decade there has been reduced sensitivity to azole drugs, such as ketoconazole, clotrimazole, fluconazole, and itraconazole. At the same time, the sensitivity of yeast cultures to pimafucin has increased. Comparison of the sensitivity of cultures of various genera has shown that the azole drugs are much less active against Aspergillus than Candida. The sensitivity of mycelial fungi to lamisil and pimafucin is higher than that of yeasts.

Clinical and X-ray changes were comparatively studied in new-onset tuberculosis patients excreting susceptible Mycobacterium tuberculosis (MBT) and mutidrug resistant (MDR) MBT. Eighty tuberculosis patients who had not received antituberculous drugs were followed up. Before chemotherapy, sputum was tested in all cases, by using the TB-biochip system, to determine drug susceptibility of MBT. According to the results of microchip diagnosis, the patients were divided into 2 groups: 1) patients with primary MRD MBT (a study group) and 2) those with MBT susceptible to all drugs (a control group). A chemotherapy regimen involving a combination of reserve drugs was given in Group 1 while Group 2 received standard regimen 1 that comprised basic series drugs. The timely use of the adequate therapy regimen in patients with MDR tuberculosis could achieve a high efficiency of therapy in a short period in terms of the bacterial excretion rate in 97.5 and 100% and in the terms of the decay cavity healing rate in 92.5 and 97.5% in Groups 1 and 2, respectively At the same time after termination of a 6-month course of therapy, both groups showed a preponderance of minimum residual changes as scars (37.5 and 45.0%) and fibrous foci (52.5 and 50.0%).

The development of a biopsychosocial model of disease acquires a great practical value for modern phthisiology, which presupposes an in-depth study of the psychological and social constituents of disease as important factors of therapy optimization and an increase in the efficiency of the rehabilitative measures being implemented. The problem of psychological causes and factors associated with the occurrence of a tuberculous process in children and adolescents has been inadequately developed in phthisiology. A psychodiagnostic study was conducted in 90 patients from Moscow pediatric tuberculosis facilities. The children and adolescents with respiratory tuberculosis were ascertained to have the personality characteristics distinct them from their somatically healthy coevals: tenderness, responsibility, honesty, diligence, deliberate observance of generally accepted moral rules and regulations, inclination to moralize, anxiety, irritability, infantilism, low frustration tolerance, dependence, sensitivity, and a need for support. The revealed psychological features enhance the pathogenicity of stressors, lead to the tension of adaptive mechanisms and may contribute to the development of the disease. Psychocorrective measures aimed at expanding the behavioral range and molding self-regulation skills in these patients should be developed within the complex rehabilitation system for children and adolescents with respiratory tuberculosis, which will aid in enhancing the efficiency of their psychoemotional adaptation and preventing the recurrences of the underlying disease.

The specific features of the pathogenesis of lung tuberculomas were studied in 302 patients among the indigenes and newcomers in the Far-North. The predominant formation of caseous foci from the tuberculous infiltrate located in the lung tissue in most cases was ascertained to be the specific feature of the development of lung tuberculomas under the conditions of a Far- North region, in Yakutia in particular. Tuberculoma formation shows a peculiar combination of evolving foci of acute specific pneumonia with a torpid inflammatory process, which contributes to the formation of multiple and large tuberculomas in the presence of significant pneumosclerosis. At the same time, homogeneous tuberculomas most commonly formed in both newcomers and indigenes.

A procedure for intraoperative ultrasound revision of the mediastinum was applied to 40 patients. An intraoperative mediastinal ultra- sound study, by using sterile 0.9% NaCl solution, could improve the imaging of an operative wound in a restricted space and determine the pattern and extent of a tumorous process, which directly affected treatment policy.