Problemy tuberkuleza i boleznei legkikh最新文献

The authors studied the efficiency of material incentives in the amount of 300 rubles for each case to medical workers of the general health care network for early detection and to those of tuberculosis facilities for effective treatment us in 2001-2007. Due to the tuberculosis-controlling measures made in these years with the mechanism of material incentives to medical workers being introduced, the tuberculosis situation stabilized and the major epidemiological indices, such as morbidity, mortality, and prevalence, decreased by 1.3, 2.2, and 1.7 times, respectively. The higher fluorographic coverage of the population and the introduction of microscopy at the general health care facilities resulted in that the number of new cases of fibrocavernous tuberculosis from 5.6 to 0.7% and, on the contrary, the proportion of bacteria-excreting subjected among the new cases of pulmonary tuberculosis increased from 18.4% in 2000 to 45.2% in 2007 or by 2.5 times (p < 0.001). The results of treatment of the new cases became better. Thus, there were increases in the rate of bacterial discharging cessation from 67% in 2000 to 84.5% in 2007 (p < 0.001), that of cavity closure from 59% in 2000 to 75.2% in 2007 (p < 0.001), and that of transfer to diagnostic registration group III from 23.1% in 2000 to 32.4% in 2007 (p < 0.01). Thus, introduction of the material incentives to the medical workers of the general health care network and tuberculosis facilities had a positive impact on the quality of diagnosis and the efficiency of treatment in patients with tuberculosis.

The indices of life quality were estimated by the Seattle questionnaire in 140 patients aged 19 to 79 years who had chronic obstructive pulmonary diseases (COPD). The results of the study determined the lower life quality indices in patients with COPD according to a number of social factors: domicile, occupation, number of family members, living conditions, and medical care.

The impact of disease and treatment on the mental status of patients with infiltrative pulmonary tuberculosis was studied. The study included 39 patients, chemotherapy in whom was complicated by the development of adverse reactions and 33 patients who had no adverse reactions. In new cases of tuberculosis, anxiety and personality disorders before chemotherapy were ascertained to be a response to first diagnosed tuberculosis and forced long-term in the inpatient setting. The development of adverse reactions caused by antituberculous agents during therapy was accompanied by impairments in psychological adaptation processes, the preservation and worsening of anxiety and personality disorders, which determines it necessary to include additional drug and psychotherapeutic correction methods into a package of therapeutic measures in tuberculosis.

The results of therapy were comparatively analyzed in 103 patients with destructive pulmonary tuberculosis receiving collapse therapy (artificial pneumothorax (n=42), pneumoperitoneum (n=57), artificial pneumothorax + pneumoperitoneum (n=4) and 99 control patients. Collapse therapy substantially increases the efficiency of treatment of new cases of destructive pulmonary tuberculosis: bacterial discharge cessation was achieved in 95.6%; decay cavities were closed in 90.2% (72.4 and 61.6% in the controls, respectively). With artificial pneumothorax, decay cavities closures occurred more frequently and earlier: after an average of 3.5 +/- 1.3-months of therapy; with pneumoperitoneum it did following 4.5 +/- 1.0 months. Early loose pleural adhesions do not preclude the formation of a gas bubble and the collapse of an afflicted lung portion.

The major available indicators of the efficiency of laboratory service activities in diagnosing tuberculosis, including those widely used in international practice and Russian traditional tuberculosis statistical data, are analyzed. The optimal criteria for assessing the quality and efficiency of work of the clinical diagnostic laboratories of the general health network and the bacteriological laboratories of a tuberculosis service in the detection, diagnosis, and chemotherapy monitoring of tuberculosis have been developed. The recommended levels of the indicators, which are to be achieved by well working laboratories, if a well-implemented tuberculosis-controlling program is available, are defined.

Visceral pleural pathomorpholodical changes were studied in 50 patients. Group 1 included 25 patients with isolated tuberculous pleurisy; Group 2 consisted of 7 patients with tuberculous exudative pleurisy in the presence of a specific process in the lung; a comparison group comprised 18 who had not died from diseases of the lung and pleura. The exudative productive type of specific pleural inflammation was prevalent in 15 (60%) and 4 (57.1%) patients, respectively. In Group 1, the pleural thickness was 144.0 +/- 3.3 microm, which was 8.3 times greater (p < 0.01) than that in the comparison group (17.35 +/- 4.78 microm). In Group 2, the visceral pleural thickness was 151.1 +/- 3.4 microm, which was 8.7 times greater (p < 0.01) than that in the comparison group and 1.05 times greater than that in Group 1. The study has established that in both Group 1 and Group 2, exudative pleurisy is accompanied by early visceral pleural fibrosing with a tendency to be more pronounced in Group 2 patients, which raises the question as to whether it is necessary to use resolution therapy at the early stages of treatment, to inject isoniazid lymphotropically, and to apply physical methods to prevent pleural cavity obliteration.

The state-of-the-art of care given in the inpatient departments of tuberculosis facilities (TF) in the Kemerovo Region is analyzed. Large municipal TFs have been reorganized as interregional ones with their adjacent areas being assigned. Indications for hospitalization have been formulated. Continuous supply with antituberculous drugs (ATDs) is ensured. Strict monitoring of the use of each dose of ATDs has been made. Schools for tuberculosis patients have been set up. The posts of a psychologist and a social worker have been introduced. Compulsory hospitalization of bacteria-excreting patients is used by the decision of the court. As a result of the work done, queue to be admitted to the TFs of the Kemerovo Region has been eliminated; the treatment time has been optimized. The informative value of simple sputum smear microscopy against acid-resistant mycobacteria has significantly increased. The rate of premature treatment discontinuity has reduced. The efficiency of inpatient treatment has enhanced.