Problemy tuberkuleza i boleznei legkikh最新文献

The paper analyzes the efficiency of vaccination and tuberculin diagnosis in the megapolis on the basis of official reporting forms Nos. 8 and 33 approved by the 11 November, 2005 Resolution of the Russian Statistics Agency and the Moscow tuberculosis monitoring system. It is concluded that refusals to undergo vaccination and tuberculin diagnosis may result in the system crisis of antituberculous care to the pediatric population. For the optimum solution of reducing the rate of refusals to take the drugs prescribed by a physician, the authors propose to use in pediatric antituberculous care the marketing methods that level off the responsibility of the parties in taking a decision whether a medical service is expedient. Under the marketing conditions of medical services, combating the foci of tuberculous infection should be a main line to reduce the prevalence of tuberculosis. Prevention of tuberculosis is most effective with the active interaction of medical services (pediatric phthisiological and primary pediatric care services) and society and with the needs being molded in it (as a market medical service) in the population.

The clinical and pharmacoeconomic effectiveness of the third-generation cephalosporin Ceftriabol versus the original drug Claforan in the treatment of varying community-acquired pneumonia was studied in 60 and 58 patients, respectively. The Russian third-generation cephalosporin Ceftriabol was shown to be as effective as Claforan in treating patients with community-acquired pneumonia. However, in addition to the main--therapeutic effect, Ceftriabol produces a certain economic gain.

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.

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.

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).

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.

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.