Problemy tuberkuleza i boleznei legkikh最新文献

There has been a drastic increase in the incidence of ostitis in children since 2001. Comparison of current tuberculous ostitis (n = 70) and primary pulmonary tuberculosis (n = 60) in infants revealed significant clinical and epidemiological differences. Molecular genetic methods identified BCG M. bovis strain DNA in 13 (46.4%) intraoperative samples and 4 samples of obtained cultures from bone destruction foci. Isolation of BCG cultures and/or verification of BCG M. ovis DNA from the bone lesion focus by polymerase chain reaction is a significant criterion for verification of the BCG etiology of ostitis having a morphological pattern of productive necrotic tuberculosis in children.

Twenty-seven sarcoidosis patients with signs of cardiac damage were examined to study the clinical features of cardiac sarcoidosis and the impact of systemic glucocorticosteroid (GCS) therapy on its course. ECG and echoECG changes were observed in 21 (78%) and 17 (63%) patients, respectively; abnormal perfusion was seen in 25 (93%) patients at single-photon emission myocardial computed tomography using 99mTc-MIBI. Three clusters (clinical types) of patients were identified, which differed in the pattern and degree of cardiac disorders. The use of systemic GCSs in 13 of 20 patients resulted in myocardial perfusion recovery and clinical improvement, the degree and duration of which depended on what cluster it belonged to. Seven GCS-untreated patients had progressive perfusion disorders with subsequent or synchronous clinical deterioration (p < 0.05). The degree and duration of the positive effect of a GCS differed depending on the clinical type of cardiac damage.

Reasons for laboratory misdiagnosis that is observed in general health care network (GHCN) and penitentiaries were studied. The clinical efficiency of the diagnosis of tuberculosis in the GHCN by the Ziehl-Neelsen method is largely determined by three major factors, each of which is fundamentally important in assessing the result. The first factor is the adequacy of making up a cohort of patients having the symptoms of productive cough in the course of 2-3 weeks or more who are to be examined for tuberculosis by laboratory studies. The second is the quality of a diagnostic material. The third is the quality of laboratory specialists' work. The paper shows it necessary to implement programs for the internal control and external assessment of the quality of laboratory studies and to optimize (centralize) the activities of laboratories under the conditions of a regional network.

Routine X-ray examination indicated that the rate of cavernous and fibrocavernous tuberculosis was 21.4 and 25.9%, respectively. Computed tomography (CT) showed that the ratio of patients with cavernous tuberculosis to those with fibrocavernous one changed and was equal to 14.3 and 33.0%, respectively. The number of patients diagnosed as having fibrocavernous tuberculosis increased. According to the traditional studies, the number of patients with one lobe being affected turned out to be higher. Accordingly, that of patients with involvement of the whole lung or two lungs proved to be underestimated at cavitary analogue X-ray study (AXS) or linear tomography (LT). Preoperative X-ray CT detected a larger number of caverns and tuberculomas. While identifying decay cavities in tuberculomas, X-ray CT enhanced the effectiveness of a study from 17 to 36% as compared with the results obtained at AXS and LT that revealed specific changes in the intrathoracic lymph nodes and inoculation foci in the lung. The nature and scope of elective operations were reconsidered from the results of X-ray CT.

The structure of tuberculosis patients with HIV infection who died from any causes, other than tuberculosis, in the Sverdlovsk Region in 2000-2006 did not differ from that of patients with concurrent pathology who died from tuberculosis. The general health care facilities had revealed tuberculosis during life in most patients who died from terminal-stage HIV infection; at death these patients had endstage HIV infection which tuberculosis joined to 4 years or more after HIV infection registration. A fatal outcome in 88.1% of the patients died from the terminal stage of HIV infection was observed within the first year after tuberculosis detection, in half the cases the background disease being generalized tuberculosis at autopsy; every two patients discharged microorganisms during life, drug resistance in the causative agent of tuberculosis was found in every three patients. Half the patients who died from other causes, other than HIV infection and tuberculosis lost their life within the first year after registration of the tuberculous process. Lifetime bacterial discharge was recorded in half the patients; drug resistance of Mycobacterium tuberculosis has developed a third of the patients with comorbidity who died from other causes, other than tuberculosis and HIV infection. The volume of lifetime specialized care for HIV infection to deceased patients with comorbidity had been inadequate. The importance of the problem of notification of cases, when the autopsy background disease was tuberculosis in comorbidity patients not included into the regional tuberculosis morbidity and mortality statistics, will increase with further development of the epidemics of tuberculosis and HIV infection to the Svedlovsk Region.

In 2000 to 2006, one hundred and fifty-eight patients with active nephrotuberculosis, including 24 without obstructive uropathy, 70 with obstruction at the level of the upper ureter third, and 64 with that at the level of the lower ureter third, were examined. It was shown that papillites, pyonephroses, and specific paranephritis were prevalent when a specific process extended to the upper ureter third. Involvement of the lower ureter third resulted in the most significant renal destruction that was bilateral in 75% of cases with a large proportion (51.4%) of complete organ destruction and complications of the underlying disease. The effectiveness of organ-removing operations was higher in ureteritis of the upper third of the ureter and that of reconstructive operations was higher in ureteritis of the lower third. Surgical treatment for nephrotuberculosis in distal obstruction induced no regression of renal failure in 24% of cases, its progression being observed in 8%. Every five patients were reoperated on; more than 29% of the patients underwent bilateral operations; the proportion of organ-removing interventions turn to be highest.

The effectiveness and safety of treatment with vobenzyme supplemented to the standard antibiotic therapy have been compared in 60 patients. Addition of vobenzyme to the standard antibiotic therapy significantly reduces the number and degree of respiratory symptoms has a pronounced effect on the activity of inflammation, leads to a more complete reversal of pulmonary parenchymatous infiltration on a roentgenogram, contributes to the achievement of the maximum efficiency of treatment, and substantially diminishes residual respiratory symptoms of pneumonia economically expediently and safety at a late follow-up.

The results of treatment in patients with tuberculosis are low. Within the first 3-4 months of therapy, lung caverns are closed in 12-26% of patients. The length of tuberculosis inpatient treatment is 79 days, as provided by the state guarantees of rendering free treatment, and the proposals to reduce the number of beds are not substantiated. It is necessary to optimally restructure a bedspace and to bring it into proper sanitary position.

Examining 261 cases of active forms of tuberculosis in children and adolescents in the Samara Region in 1996 to 2004 indicated that 115 (44.1%) had earlier received chemoprophylaxis in the outpatient setting. The specific features of tuberculosis were revealed in this group of patients as compared with the children and adolescents who had never been treated with antituberculous drugs (n = 146): there was a predominance of preschool children; severe, disseminated forms of tuberculosis, detectable from complaints were observed less frequently; clinically cured pulmonary tuberculosis was more frequently characterized by residual posttuberculous changes. Outpatient chemoprophylaxis reduces the severity of the disease, but is not always effective in preventing tuberculosis.

The efficiency of treatment was analyzed in 142 children aged 3-14 years who had local forms of primary pulmonary tuberculosis. Therapy was performed according to regimens 3 and 1, by using individual dosage regimens depending on the extent and severity of a specific process, the presence of complications, and age-related features. In minor tuberculosis, solitary calcifications being detected without signs of the activity of tuberculous infection, the basic course of therapy was 6-8 months; it was performed using 2 drugs in individual cases. In disseminated and complicated processes, eliminated intoxication and visible X-ray inflammatory changes were observed in 58.8-61.7% of children by months 3-4 of treatment, which required a longer intensive phase, by administering 3 drugs in the continuation phase till 6-9 months.