Problemy tuberkuleza i boleznei legkikh最新文献

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.

The age and sex structure, social status, and the clinical forms of tuberculosis were studied in 1289 new cases of tuberculosis in the rural population of the Yaroslavl Region. In 1997-2006, rural tuberculosis morbidity in the region increased from 36.5 to 59.0 per 100,000. Over the decade, the overall rise in the number of tuberculosis patients identified in the region was responsible for 61.5% by rural patients. Among the patients identified, relatively young able-bodied persons (aged 18-49 years) accounted for 61.2%. Comparatively, there was the highest increase in the number of new tuberculosis cases among 18-39-year-old women over the decade. Over time, the patients showed a considerable increase in the social group of the able-bodied unemployed, which lowered the efficiency of mass prophylactic surveys for tuberculosis. The proportion of disseminated processes and caseous pneumonia increased in the pattern of clinical forms. In the rural population, the morbidity rate of respiratory tuberculosis in the decay phase rose from 15.8 to 28.9 per 100,000. The findings suggest that the problem of rural tuberculosis worsened in the Yaroslavl Region.

The authors have earlier demonstrated that CBA/N mice bearing nonsense mutation in the btk gene encoding B cell Bruton's thyrosine kinase after CG vaccination develop no protective response against subsequent M. tuberculosis H37Rv challenge. Adoptive transfer approaches are applied to show that this defect is determined by lymphoid cells and B lymphocytes play an essential role in its expression. In addition, experiments on CBA/N-xid mice with crude mixtures of soluble mycobacterial antigens suggest that the processing of live BCG could be impaired in the antigen-presenting cells of these mice.

Intraoperative (n = 290) and autoptic (n = 246) materials obtained from tuberculosis hospitals in 2005-2007 were examined to study the pathomorphism of pulmonary tuberculosis. The study revealed an increase in the number of patients with acute pulmonary tuberculosis. Fibrocavernous tuberculosis halved as compared to the 1980s. Incapsulated pulmonary tuberculosis is prevalent in the phthisiosurgical material (more than 70% of cases). The leading cause of pulmonary tuberculosis was progression of a specific inflammatory process while cardiopulmonary failure and visceral amyloidosis became rare causes of death. The higher incidence of poorly progressive pulmonary tuberculosis in males (they accounted for 85% of the number of death cases) was associated with concomitant and aggravating diseases, such as alcoholism, drug addiction, and HIV infection (68.5% of cases).

DST was ascertained to have a high sensitivity in virtually all patients with tuberculosis and a positive reaction was first noted in the infected. With stabilization and regression, the response to DST was much less pronounced than that in clinical and primary infection (that to the Mantoux test being more evident). DST showed its use as a marker of active tuberculosis not only in its local forms, but also in latent tuberculous infection. This makes it possible to apply DST when preventive treatment is performed. The agent may be used to monitor the progress of treatment. DST has a high specificity--healthy individuals had a negative response to DST while the Mantoux test was positive in many cases. The high specificity of DST was suggested by the fact that the persons vaccinated with (this caused BCG ostitis) had a negative reaction to DST while the Mantoux test was positive in all cases BCG-vaccinated BCG. The findings warrant the use of DST for the differential diagnosis of tuberculosis and BCG-associated complications and the possibility of differentiating postvaccinal and infection allergy in children and adolescents.

The efficiency of treatment was evaluated in 2 groups of new tuberculosis cases discharging drug-resistant Mycobacterium tuberculosis. The authors' method of retrosternal lymphotropic administration of drugs was used in the complex of treatment in a study group of 96 patients; a control group (n = 93) received only combined chemotherapy. The treatment method showed a high efficiency in the treatment of new cases of destructive pulmonary tuberculosis, including acutely progressive forms and caseous pneumonia. Bacterial discharge cessation and decay cavity closure were increased by 26.9% and 27.2%, respectively. The abacillation rate increment was 32.9% for acutely progressive processes and 41.2% for caseous pneumonia. The authors show the efficiency of the method in treating bronchial or laryngeal tuberculosis and the expediency of applying the retrosternal procedure during preoperative preparation.

The paper gives data on the prevalence of nonspecific lung disease in patients with pulmonary tuberculosis, the specific features of diagnosis and treatment of their concomitance in 3453 patients with pulmonary tuberculosis. It shows the low detection rate of nonspecific lung diseases in patients with pulmonary diseases. The high error rate has been established in the diagnosis of pulmonary tuberculosis at health care facilities. There is evidence that the use of current therapy for bronchial obstructive syndrome with inhaled cholinolytics and beta2-agonists in patients with pulmonary tuberculosis causes a reduction in the intensity of respiratory symptoms and an increase in forced expiratory volume in one second.