Problemy tuberkuleza i boleznei legkikh最新文献

Therapy for pulmonary tuberculosis in patients is complicated by their negative psychoemotional state frequently deteriorated by long inpatient stay. Enhancing the efficiency of rehabilitative measures in phthisiology requires active optimization of the patients' mental state. This problem can be solved by a package of correction measures involving psychological correction with reflex therapeutic normalization of the functional state of the cortical regions of the central nervous system in patients with pulmonary tuberculosis. One hundred tuberculosis patients with decompensated mind, including 60 with OG and 40 with KG, were examined. A noticeable psychoemotional improvement was reliably detected 5 months after complex correction psychological and neuropsychological accompaniments of standard chemotherapy in the OG study.

Forty-seven patients with pleurisy of tuberculous etiology underwent a radionuclide study using the reagent 99mTc-labeled technefit, the result of which was compared with the morphological changes in the pleural biopsy or resection specimens. First-degree pleural resorptive dysfunction (PRD) was ascertained in 27.6% of the patients. Morphologically, there were signs of acute edema of all pleural layers in both the area of inflammation and the proximal portions with reduced vessels in the microcirculatory bed (MCB). These patients had medical treatment. 59.6% of patients had second-degree PRD--circumscribed caseous foci and granulomas were morphologically found in the presence of progressive fibrosis with a small number of vessels in the MCB. 12.8% of patients had third-degree PRD--massive pleural fibrosis with a significant reduction in MCB vessels and lymph capillaries. Active tuberculous inflammation remained mainly in the deep layers of the pleura. Surgical treatment was performed in patients with second-third degree PRD. Thus, comparison of the results of a radionuclide study with morphological changes in the tuberculosis-afflicted pleura made it possible to establish the degree of pleural MCB impairments, to characterize the activity of a pathological process, and to define objectively treatment policy.

The purpose of the study was to obtain information on tuberculosis patients' needs, perception, and expectations from health care as a whole and social backing in order to improve the implementation of a program for enhancing tuberculosis patients' motivation for recovery and treatment. Anonymous voluntary questioning using the standard questionnaire was carried out among new tuberculosis cases registered to be treated in 4 subjects of the Russian Federation (the Oryol, Vladimir, and Belgorod Regions, and the Republic of Mariy-El). Eighty-seven patients who had stopped being treated before the appointed time and 1302 patients who were receiving chemotherapy at the time of questioning were interviewed using the questionnaire. The main reasons for treatment discontinuance in those who stopped treatment before the appointed time were the necessity of earning their living (30%), alcohol consumption (30%), inadequate health education of the patients who considered themselves to be healthy (25%). Most patients (67%) preferred rewards as social backing, products/hot food (41%), and fare (32%). Among the proposed social backing schemes, the most popular ones were those that envisaged small daily rewards (23%) or a large final bonus (21%). The majority (67%) of patients preferred outpatient treatment. Thus, patients with tuberculosis face a great deal of problems that affect their motivation for treatment. To satisfy some of these problems is not the direct duties of an antituberculosis service due to the fact that the manning table lacks appropriate posts and an item of expenses. Therefore additional funds should be allocated from the budgets of a subject of the Russian Federation and/or municipal entities for adequate organization of social backing of patients with tuberculosis to enhance the efficiency of their treatment. Collaboration of antituberculosis services of the Russian Federation's subjects with social organizations and an addiction service along the availability of psychological and legal consultations to patients is the most optimum variant of social backing organization to improve the patients' motivation for treatment.

Data on 104 patients with pneumonia treated at Moscow multidisciplinary hospitals for suspected respiratory tuberculosis (RT) show that general practitioners have lost tuberculosis-diagnosing skills and phthisiological alertness. This is suggested by frequent failures to collect medical historical data, neglect of risk factors for RT, poor orientation in the differential diagnosis of pneumonia and tuberculosis, violation of diagnostic standards of pulmonary tuberculosis, specifically a paucity of sputum microscopic studies and lateral lung X-ray studies. Upgrading the recognition quality of tuberculosis makes it necessary to observe the propedeutic rules for examining and studying a patient, to reveal important anamnestic and clinical data, and to follow instructions. At the same time, there is no need for new equipment and technologies, but it is critically important to increase the level of tuberculosis knowledge in physicians of all specialties and to create motivation for qualitative diagnostic work.

One hundred and thirteen patients with pulmonary tuberculosis and mental disease and 127 tuberculosis patients without mental diseases were studied. Patients with mental diseases were observed to have asymptomatic pulmonary tuberculosis with insignificant expectoration, which made the microbiological diagnosis of tuberculosis difficult. The basic method for detection of tuberculosis is to make a fluorographic study every 6 months, which enables active detection of more than 92% of new cases of tuberculosis as minor forms. The efficiency of treatment for tuberculosis concurrent with mental diseases was high: bacterial discharge ceased in 93.3% of cases, decay cavities closed in 80%, which was associated with the possibility of performing long-term continuous treatment in the inpatient setting.

The authors present the results of a comparative microscopic study of 502 sputum smears from the patients of the Republican Tuberculosis Dispensary. Sputum smear microscopy with the Ziehl Neelsen (ZN) method and fluorescence microscopy (FM) using a Mikmed 2 (LOMO) microscope and an Olympus SX microscope with a LED Lumin attachment were compared. The latter allows conversion of a light microscope to a fluorescence one. For 2 months sputum was randomly sampled from patients at the moment of diagnosis and from those who were treated at a clinic. A culture study was used as the gold standard, among other things, to calculate the sensitivity and specificity of different microscopy methods. The sensitivity of ZN microscopy, FM on a Mikmed microscope, FM using the Lumin attachment was 28.5, 52.5, and 72.8%, respectively. The Lumin attachment is a inexpensive, portable device that converts practically all models of light microscopes to fluorescence ones. Its life is as long as 25 years, it requires maintenance and both the routine supply line and a Krona storage battery or similar ones, as well as a solar battery may be used as a source of energy.

The main task of an antituberculosis service is to treat patients with tuberculosis and to follow up needy persons in order to prevent the spread of tuberculosis among the population. However, phthisiatricians are unable to solve some problems without assistance from the government as they are associated with social and behavioral causes--no or partial patient's motivation for treatment. Early therapy discontinuation in patients with tuberculosis, latent or obvious interruption of chemotherapy, patients' use of a partial dose of drugs give the vast majority of Russian phthisiatricians concern. These lower the efficiency of treatment, increase the likelihood of drug resistance in Mycobacterium tuberculosis, and contribute to the chronic pattern of the tuberculosis process, continuously replenishing the pool of untreatable patients with tuberculosis and bacterial discharge. An incompliant tuberculosis patient discharging bacteria may be compulsorily taken to a tuberculosis hospital by the court decision. This is in line with Article 10, the 18 June, 2001 Federal Law No. 77--"On Prevention of Tuberculosis Spread in the Russian Federation". This investigation was undertaken to enhance the effectiveness of involvement of incompliant bacteria-discharging patients with tuberculosis to compulsory examination and treatment. The mechanism of realization of Article 10 of the abovementioned Law was analyzed from the experience of an antituberculosis service of the Ryazan Region (178 writs). At present, it is impossible to fulfill this Article 10 in corpore due to there is an improper legal base that is in no subordinate legislation and actuate sentences for non-implementation of court decisions. Subordinate legislation regulating a compulsory hospitalization procedure by officers of justice should be elaborated. It is necessary to introduce amendments into the base to make patients with infectious tuberculosis who have not carried a court decision on compulsory hospitalization. Tuberculosis facilities should be used to set up social centers for the complex work and treatment of socially dysadapted patients with tuberculosis (including those who have been released from confinement institutions). For this, tuberculosis institutions should be staffed by social workers, psychologists, psychiatrists, lawyers, and narcology experts with the appropriate funds being allocated.

In modern society, there is a rise in the incidence of tuberculosis in all age groups, including children and adolescents. In old age group, a specific inflammation is detectable from Mantoux test results only in every four children. Tuberculous infection is diagnosed in half of cases when they turn to physicians for complains. Disseminated and complicated forms of tuberculosis are more frequently identified in these situations. The immune system has a particular emphasis on the course and outcome of the disease. The authors have established that caseous masses actively form, followed by the stimulation of the adequate cell pathway promoting the limitation of specific inflammation in old-age group children with primary tuberculosis. In secondary forms of tuberculous infection, there is an increase in the level of monocytes where the persistence and multiplication of the causative microorganism, as well as the activation of the humoral pathway inadequate for tuberculous infection are likely to occur, i.e. the infectious agent may be inhibited until activation of the Th-2 pathway of an immune response takes place.

Follow-ups of 39 children aged 3 to 12 years who had various biomedical risk factors of local forms of primary tuberculosis. Difficulties in diagnosing the local clinical forms of primary tuberculosis with minor clinical and X-ray signs are shown. The authors show it necessary to use of a package of clinical, laboratory, and radiation techniques, by applying computed tomography. The latter excluded minor primary tuberculosis in 15.3+/-6.2% of children and confirmed an active tuberculous process in 23+/-6.7%, and referred it as an incomplete regression phase in 10+/-4.8% and assigned residual changes of spontaneous cure of primary tuberculosis in 9 (23+/-6.7%). There was agreement of these conventional radiation studies and computed tomography in 11 (28.12+/-6.2%) children.

Two hundred and forty-three patients with active pulmonary tuberculosis were examined. Their sera were tested for the level of stable nitric oxide (NO) metabolites, by using the Griess reagent after previous reduction of nitrates to nitrites by a copper-impregnated cadmium reducer. The frank active pulmonary tuberculosis was ascertained to follow the lower serum levels of NO metabolites. The serum NO level did not correlate with inflammatory markers, but reduced when the process was recurrent or chronic. By taking into account the role of NO in the performance of the body's different systems, its serum reduction in patients with pulmonary tuberculosis should be probably referred to as the manifestations of metabolic decompensation as the suppressed endothelial NOS activity that determines the level of NO in circulation.