Tuberculosis and Lung Diseases最新文献

The reliability of a statistical mortality rate due to pulmonary tuberculosis was analyzed in 10 Russian Federation's subjects having the least rates. It was shown that its reliability might be objectively assessed by a method for complex analysis of the rates reflecting the population coverage of prophylactic examinations, the proportion of tuberculosis patients identified at their visits to health care facilities, and the pattern of patients with new-onset pulmonary tuberculosis. The reliability of this rate is mainly influ-enced by the prophylactic examination coverage of the population at increased risk for tuberculosis. Underidentification of patients with pulmonary tuberculosis leads to a discrepancy in the actual and statistical deaths from pulmonary tuberculosis with its underestimated values.

The efficiency of complex treatment for destructive pulmonary tuberculosis by surgery was analyzed on 2 groups of the Russian Federation's subjects selected by ranking results. The use of surgical interventions in the complex treatment of pulmonary tuberculosis patients with decay cavities was shown to enhance its efficiency and to promote the prevention of infection spread. This resulted in a reduction in the proportion of patients with destructive tuberculosis among the first detected patients, in the contingents of patients with chronic tuberculosis, and in the proportion of patients detected from their referrals to medical institutions.

To enhance the efficiency of extrapleural thoracoplasty in patients with fibrocavernous tuberculosis, the authors propose that the oper-ation should be supplemented by cavern ligation, thus inducing a more significant irreversible collapse only in the cavernous area. The above procedure has been used to operate on 164 subjects with the caverns being located in the upper lobe or the upper lobe and sixth segment of one lung. Decay cavity closure was achieved in 110 (67.1%) patients; bacterial excretion cessation was seen in 77 (76.2%) of 101 patients with 3.1% mortality. Long-term results were observed in 135 subjects. Clinical resolution was stated in 113 (83.7%) patients; 9 (6.7%) subjects died from progressive tuberculosis or postoperative complications. Analysis of the results of the proposed operation ascertained that its efficiency is little related to cavern sizes and noticeably decreases during a progressive tuberculous process.

Right ventricular diastolic function, pulmonary hemodynamics, and peripheral endothelial vasoregulatory function were studied in patients with chronic cor pulmonale during complex treatment over time. The study confirmed the vasodilatory effect of ozone therapy and amlodipine during standard therapy, which appeared as lower blood pressure and better right ventricular diastolic function.

The investigation was undertaken to study the thymus in healthy individuals and patients with asthma. Ninety-five asthmatic patients (34 men and 61 women) aged 15 to 70 years were examined. The thymus was examined by Doppler ultrasonography. In healthy individuals aged 19 to 58 years (mean age 33 years), the thymus weighed from 1.4 to 5.5 g; its mean weight was 3.2 ± 0.4 g. In the asthmatic patients, the sizes of the thymus were on an average increased: its length was up to 35.6 ± 0.9 mm (20.8 ± 1.6 mm in healthy individuals); the width was up to 33.2 ± 0.8 mm (19.7 ± 1.7 mm in healthy individuals); the anteroposterior size was up to 18.7 ± 0.8 mm (14.6 ± 1.2 mm in healthy individuals). The mean weight of the thymus was as high as 12.2 ± 1.0 g, i.e. its mass was 4 times greater than that in the healthy individuals from the control group.

The authors discuss the problem associated with the severe, persistent course of drug-induced liver disease slightly responsive to traditional treatment in patients receiving antituberculous therapy. The objective of the study was to reveal the essence and causes of drug-induced liver damage characterized by its severe, persistent course, evident clinical and laboratory manifestations, and a weak response to traditional therapy and to develop diagnostic principles. The severe, persistent course of drug-induced liver disease slightly responsive to traditional therapy was shown to be caused by a few competitive pathological processes occurring in the liver rather than failures in the therapeutic and diagnostic process. Prognostic criteria for the severe, persistent course of drug-induced liver disease slightly responsive to traditional therapy have been developed. A diagnostic algorithm is proposed.

Problems in the delivery of antituberculosis care to the pediatric population of Moscow are analyzed. Databases are set up by the statutory forms available in the city's tuberculosis dispensaries and by additional analytical tables from pediatric therapeutic-and-prophylactic institutions, such as children's local polyclinics. In Moscow, there was a reduction in the vaccination coverage of healthy neonatal infants at their discharge from maternity hospitals and departments over a number of years (88.0% in 2008 and 90.3% in 2005). The proportion of non-vaccinated neonates due to their parents' refusal was as high as 3.2% of the annual cohort to be vaccinated at maternal hospital discharge. A more alarming situation is established in children's polyclinics where the share of parents' refusal of tuberculosis vaccination was 60.5% (44.5% in 2005) of all the children who were registered in the children's polyclinics and remained unvaccinated at the end of the year. The low number of contacts per bacteria-excreting person registered in the Moscow dispensaries (2.7% in.2008, 2.5% in 2007, and 2.0% in 2004) suggests that phthisiatricians and epidemiologists did inadequately active work in the foci of tuberculosis infection. Migrants with tuberculosis and socially disadapted persons living in the megapolis are an uncontrolled reservoir of infection. In 2008, there was a surge in the number of tuberculosis children who had been non-vaccinated with BCG vaccine for various reasons--the annual growth rate was +2.96. The possible ways out of the established situation are considered. The authors propose to actively involve not only general practitioners and local pediatricians, but also public organizations into prophylactic work with children. Major attention and resources should be directed to work in the foci of tuberculosis infection; it is necessary to differentiate the use of preventive chemotherapy in children, by taking into account the results of evidence-based medicine to identify the most likely risk factors for the development of the disease.

The course of tuberculosis and efficiency of combination antituberculous and antiretroviral therapy were analyzed in 30 patients with late-stage HIV infection. The acute progressive course of tuberculosis was found to reduce the role of prophylactic fluorographic examination in this category of patients. Various diagnostic mini-invasive surgical procedures proved to be of great informative value (91.7% sensitivity) in the diagnosis of atypical tuberculosis. During the intensive phase, combination antituberculous and antiviral therapy with its high adherence yielded good clinical results: the median CD4 lymphocyte increase was 65 cells/µl; the therapy was acknowledged to be effective in treating the tuberculous process in 76.7% of the patients; mortality was 6.7%.

The study was undertaken to enhance the efficiency of therapy in patients with drug-resistant pulmonary tuberculosis, by correcting homeostasis by efferent therapy. The results of examination and treatment were analyzed in 140 patients aged 18 to 65 years with destructive pulmonary tuberculosis treated at the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences. According to the treatment modality, the patients were divided into 2 groups: 1) 73 patients in whom therapeutic plasmapheresis was used as efferent therapy to treat drug intolerance and endotoxicosis (a study group); 2) 67 patients who had no therapeutic plasmapheresis (a control group). The use of small-volume plasmapheresis in patients with drug-intolerance destructive pulmonary tuberculosis favored a rapid and prolonged hepatic function recovery in 100% of cases, which made it possible to continue antituberculous therapy (ATT) and to determine a good treatment outcome as a whole. When toxic and allergic reactions to antituberculous drugs occurred in patients with drug-resistant fibrocavernous tuberculosis during treatment, the use of efferent detoxification techniques yielded a significant correcting effect, halved the duration of ATT discontinuation, and indirectly contributed to a 2.5-fold reduction in the level of bacterial excretion in the study group patients as compared with the controls (49.3% versus 19.4%). Furthermore, pulmonary infiltrate resolution was twice more frequently observed in the patients receiving plasmapheresis during etiotropic therapy than that in the controls (50.7% versus 28.4%).