Problemy tuberkuleza i boleznei legkikh最新文献

The results of survey of 750 patients from a general somatic hospital of the penitentiary system, including 288 patients with respiratory diseases, were analyzed. The detection rate of tuberculosis was 12.8% among all the patients and 32.6% among those with respiratory diseases. In the convicts, tuberculosis developed in most cases within the first 1-2 years of their imprisonment and, in short spaces of time, it was frequently accompanied by the significant clinical manifestations, quite often with the acute onset of the disease. Tuberculosis was mainly detected on prophylactic fluorography. Among the clinical forms, there was a predominance of infiltrative and focal tuberculosis and exudative pleurisy.

Objective: to develop a procedure for calculating needs for antituberculous drugs (ATD).

Materials and methods: A unified E-form (UEF) was developed as an "Excel" file with the underlying invariable formulas and coefficients for the computer-based calculation of ATD needs in any subject of the Russian Federation. The needs were estimated using the average number of tablets (capsules, vials) of each ATD required per man/course, by taking into account the conventional chemotherapy regimens, the duration of chemoprophylaxis, antirecurrent courses, ATD test therapy, a treatment regimen for complications due to BCG vaccination. Information on the inventory of ATDs at the end of the previous year and their estimated deliveries from various sources was additionally considered. Data to be filled in the UEF were obtained from the reporting documents: 1) TB Form No. 2 "Information on patients registered for treatment" approved by Order No. 50 "On Consummation of Recording and Reporting Documents as to Tuberculosis Monitoring" issued by the Ministry of Health of the Russian Federation on February 13, 2002; 2) Form No. 030-4/y "Tuberculosis Patient Follow-Up Schedule"; and 3) Form No. 33 "Information on Patients with Tuberculosis" approved by Regulation No. 80 issued by the Russian Statistics Agency on November 11, 2005. The filled-in UEFs were obtained from 82 subjects of the Russian Federation.

Results: among all the contingents of antituberculosis dispensaries, who were given ATDs, the absolute majority was the persons receiving chemoprophylaxis. Only 18.3% received chemotherapy for active tuberculosis. Of them, 56.8 and 15.3% were treated in accordance with chemotherapy regimens 1 and 3, respectively. The regimes (2B and 4) using second-line agents were given least frequently (7.1 and 7.1%, respectively). Comparing the data from Form No. 33 and those obtained on filling in UEF showed with a fair degree of assurance that the treatment of patients with a chronic tuberculous process had been incompletely registered. Personified registration of patients with multidrug Mycobacterium tuberculosis resistance should be performed in order to have objective information on the scope of required medical aid and the real calculation of needs for second-line ATDs. For unified calculation of needs for ATDs for chemotherapy, it is necessary to introduce a standardized approach to its performance at different dispensaries. By taking into account that ATDs are purchased and dispensed free of change, one should have a responsible attitude to consuming drugs, determining indications for their usage, and filling the UEF. TB Form No. 2 "Information on patients registered for treatment" and Register No, 03-TB/y "Register of patients with tuberculosis" should be improved, by adding data on the number of patients receiving chemoprophylaxis, antirecurrent courses, test therapy, and treatment of complications due to

The paper presents the diagnostic features of 95 cases with complicated forms of abdominal tuberculosis (AT). The latter has been found to be concurrent with disseminated progressive pulmonary tuberculosis in 97.3% of cases. HIV infection is present in 25.2% of the patients. In 42.1%, a complication of AT is its first onset. The late diagnosis of AT in the phase of development of complications is due to its asymptomatic course at the early stage, the similarity of clinical manifestations with various nonspecific abdominal diseases, the low informative value of radiodiagnostic techniques, and scanty bacterial excretion. In this connection, AT is detectable in 92.6% with the development of acute surgical abdominal pathology requiring emergency diagnostic laparoscopy and surgery. Among all acute surgical abdominal diseases, complicated abdominal tuberculosis ranks third, which in the presence of any abdominal symptoms, particularly those concurrent with pulmonary tuberculosis needs examination for abdominal tuberculosis. Various surgical interventions (more commonly right-sided hemicolectomy, enterectomy, and abdominal abscess lancing) were made in 92 patients with complicated abdominal tuberculosis. There were intraoperative complications, such as perforated tuberculous intestinal ulcers (54.7%), ileus (30.5), abdominal and retroperitoneal abscesses (11.6%), as well as other rare complications, such as intestinal hemorrhage, perforated tuberculous gastric ulcer, and splenic abscess (3.2%). In 42.1% of cases, surgery was ineffective and it was followed by the development of recurrent complications that required surgery. In HIV-infected patients, AT ran more severely. Overall mortality in patients with AT was 47.4%, that in patients with and without HIV infection was 58.3 and 43.7%, respectively.

The authors propose a phthisiological care-adjusted standard of the diagnosis, treatment, prevention of antibiotic-associated diarrhea. They have developed a standard-driven algorithm of expert assessment of the quality of medical aid to this group of patients.

Two hundred and eighteen Mycobacterium tuberculosis-infected children and adolescents aged 4 to 18 years were examined. Whether the patients and their relatives had a history of allergic reactions was ascertained. A complex of diagnostic studies is of great value in verifying the presence of concomitant allergic diseases. The rate of allergic reactions in the child's history does not itself determine the likelihood of development of allergic states. The Mantoux (tuberculin) test in allergic children does not lead to an exacerbation of the underlying disease at remission. The remission manifestations of paraallergy are noted in 15.8% of the patients with allergic diseases and in 42.9% of the children having allergic reactions in the history. This supports the quality of a follow-up and treatment by an allergist, as well as an adequate response to a Mantoux test with 2 TE of PPD-L in the bulk of allergic children. The use of antihistamines as preparation for the test allows an inference about true infection and the sensitivity to tuberculin in both the most of allergic patients and persons with a history of allergic manifestations.

The results of examination and treatment were studied in 3637 new cases of pulmonary tuberculosis. A total of 1879 cases were detected at prophylactic examinations (Group 1) and 1758 cases were identified when they resorted to doctors for complaints (Group 2). Circumscribed and benign existing forms of tuberculosis were prevalent in patients at prophylactic examinations. At the same time tuberculosis was accompanied by destruction in a third of cases and by bacterial excretion in half the cases. On applying to the physicians for complaints, the patients were found to have mainly a process with destructions and bacterial excretion and the proportion of acutely progressive forms of tuberculosis was also considerable. In Group 1, treatment showed a much higher efficiency than in Group 2. Deaths from tuberculosis among the new cases were frequently observed in Group 2 and much less frequently in Group 1. Their cause was generally acute tuberculosis.