[Therapy and Rehabilitation of Patients with Pulmonary Tuberculosis and Different Treatment Adherence].

The pulmonary tuberculosis process as dependent on the disease form and the therapy efficacy with the use of Cycloferon in the treatment scheme were investigated. The study had two stages. At the first stage the data concerning 358 patients with primary pulmonary tuberculosis and infiltration (93 patients) or degradation (89 patients) and 176 patients with pulmonary fibrocavernous tuberculosis were analysed. At the second stage the efficacy of the treatment schemes applied to the patients with pulmonary fibrocavernous tuberculosis was compared. The etiotropic therapy intensive phase was applied to all the patients. Moreover, 56 patients (group 1) under the therapy and rehabilitatinon were treated with Cycloferon in a dose of 0.25 administered intramuscularly twice a week (not less than 16 injections for the course), 60 patients (group 2) were treated with Omega 3, 30 patients (group 3) were given the standard complex (vitamins and tonics), 30 patients (group 4) were under the etiotropic therapy alone. The following additional factors promoting progression and aggravation of the tuberculosis process were confirmed: degradation at the time of the disease diagnosis, high resistance of the pathogen to antituberculosis drugs, low adherence to the treatment, social desadaptation and especially psychofunctional state of the patients. The use of Cycloferon in the schemes of the intensive phase treatment of the primary fibrocavernous tuberculosis resulted in reduction of the intoxication signs, bacteria isolation, positive dynamics of the cavity healing, lower lung infiltration and consequently high frequency of the treatment positive outcomes (94.1 ± 3.33%).

[Immunomodulator Intensification of Etioropic Therapy in Patients with Advanced Pulmonary Tuberculosis].

The study was aimed at possible increase of the therapy efficacy in patients with advanced tuberculosis by including immunomodulators to the treatment schemes. The data concerning 6034 patients with advanced tuberculosis, mainly fibrocavernous tuberculosis of the lungs, were analysed. Four groups of the patients were randomized. In group 1 the management of the patients included etiotropic therapy and some treatment and rehabilitation measures with the use of Cycloferon. The group 2 patients in addition to the etiotropic therapy and some treatment and rehabilitation measures were given Omega-3. In group 3 the management included the etiotropic therapy and some treatment and rehabilitation measures. In group 4 the etioropic therapy was used alone. The analysis showed that 3419 patients had primary pulmonary tuberculosis, 340 patients had relapsing tuberculosis and 2275 patients had long-term process. The etiotropic therapy efficacy was estimated after an intensive phase of not more than 3 months. In the cases with Mycobacterium tuberculosis drug resistance and some other unfavourable factors it was estimated after a 5-month intensive phase. The results confirmed that inclusion of immunomodulators to the treatment schemes allowed to increase the therapy efficacy and the patients' adherence to the treatment, as well as to shorten the period of the bacteria carriage. Thus, the use of Cycloferon in the schemes of the treatment of the patients with fibrocavernous pulmonary tuberculosis allowed to shorten the period of the pathogen carriage (as well as the drug resistant forms) in 94.1 ± 3.33% of the patients in spite of concomitant diseases. The effect of Cycloferon in such cases was likely due to both its direct immunoprotective action and the improvement of the general state of the patients and their higher adherence to the treatment.

[Effectiveness of immunomodulating therapy of pulmonary tuberculosis with cycloferon].

Cycloferon was used to treat newly diagnosed, recurrent and long-standing pulmonary TB. The dose of 7,5 g combined with antibacterial therapy caused no complications. The effectiveness of this therapy based on the generally-accepted criteria was significantly higher than standard treatment but varied depending on the character of pathological process. It is recommended to use cycloferon in the intense phase of the basal treatment.

[Topical aspects of organization of tuberculosis monitoring at the level of a subject of the Russian Federation (in case of the Belgorod Region)].

The paper shows how a tuberculosis monitoring system is under development at the level of the Russian Federation subject--the Belgorod Region. The tuberculosis monitoring system allows an effective control of both tuberculosis-controlling measures determined by the existing normative documents and orders and supplementary measures to enhance the effectiveness of tuberculosis control in the region. Tuberculosis monitoring should be further improved at the regional region by the sections: outpatient visit, antiepidemic measures in the foci; children's sanatorium work, cohorts to be examined by a physio pediatrician.

[Immunological correction in progressive pulmonary tuberculosis].

The authors used their immunological correction method to treat 154 patients with progressive pulmonary tuberculosis. Of them, 38 patients received standard antituberculosis therapy (Group 1), 39 had additionally paravasal lymphotrophic immunological correction (Group 2), and 38 took antituberculous drugs in accordance with individual regimens (Group 3), and 39 patients were treated by individual regimens during immunological correction (Group 4). After termination of the basic course of chemotherapy, clinical cure was achieved in 61.1, 76.3, 72.2, and 94.7%, respectively (p < 0.05). During the basic course, mortality was 11.1, 5.3, and 5.5% in the first three groups. By taking into account the immunological status of patients with caseous pneumonia, disseminated, and multicavernous pulmonary tuberculous lesion, immunological correction is indicated early in the basic course of therapy.

[Penitentiary tuberculosis as an object of simulative manifestations].

The paper presents the results of a 5-year follow-up of simulative manifestations of tuberculosis at penitentiaries. The high rate of use of penitentiaries as an object of these manifestations has been established, predominantly relapse aggravation of process activity being observed when treatment is continued. The causes of simulative manifestations are diverse; along with a qualitative physical examination, they should be borne in mind by a phthisiatrician in order to make a timely diagnosis.

[Limited epidemic of tuberculosis among young socially dysadapted individuals].

Two epidemic outbreaks of tuberculosis were observed among young socially dysadapted individuals at a juvie. They were liquidated, by chiefly implementing social preventive measures and by introducing new chemotherapy regimens.

[The scope and efficiency of inpatient tuberculosis treatment].

There is evidence for the necessity of reorganizing the indications and volumes of antituberculosis care in the tuberculosis hospitals, as shown by the example of one of the subjects of the Russian Federation. The optimum variant of this reorganization lies in the formula of reduction-consolidation-profiling-efficiency by the quality criteria and, when the regional features are kept in mind, is attainable and its alternative is currently absent.

[Need for correction of the normative-legal base for implementation of a federal program and programs of the subjects of the Russian Federation for Tuberculosis Prevention under the conditions of expected stabilization of the epidemic situation]. / O neobkhodimosti korrektsii normativno-pravovoi bazy ispolneniia natsional'noi programmy i programm sub"ektov Rossiiskoi Federatsii po preduprezhdeniiu tuberkuleza v usloviiakh ozhidaemoi stabilizatsii épidemiologicheskoi situatsii.

Evidence is provided for that there is a need for making additions and amendments in Federal Law No. 77 "On Prevention of the Prevalence of Tuberculosis in the Russian Federation". Amendments are aimed at improving the legal base to increase the financing of governmental programs, at organizing the prevention and treatment of tuberculosis, at optimizing labor in specialized health care services. The authors propose to support the initiative of the Kursk Branch of the Russian Society of Phthisiologists for appealing to the State Duma of the Russian Federation to submit a legislative initiative in amending the law.

[Prospects in the search for new biological agents to prevent tuberculosis]. / Perspektivnost' poiska novykh biopreparatov dlia profilaktiki tuberkuleza.

Six biological specimens, including BCG obtained from Mycobacterium tuberculosis or animal tissues in accordance with an original procedure were studied. Their protective efficiency in tuberculosis infection was evaluated by the magnitude of allergic reactions and by pathological tissue changes 5 months after animal immunization and infection. The drug PKP-3 was found to be most effective and its further study is promising.

[The risk group in the contingents of a correction institution: the structure and procedure for its observation]. / Gruppa riska v kontingentakh ITU: struktura i taktika ee nabliudeniia.

Studies were made of the structure of individuals with residual pulmonary changes who were at corrective labour institutions. Among them, the incidence of active tuberculosis is 16-21 times greater than that of reactivation among the other populations. It is these persons who should be regarded as a risk group and regular prophylactic measures should be used in them.

[Features of anti-tuberculosis aid to prisoners]. / Osobennosti protivotuberkuleznoi pomoshchi bol'nym, nakhodiashchimsia v mestakh lisheniia svobody.

Characteristic features of medical care of tuberculosis patients staying at places of their confinement are considered on the basis of the examination data collected during a year. Inpatient treatment was primarily indicated for subjects with pulmonary tuberculosis (66%), including 31.9 per cent of the newly diagnosed. It is recorded that the percentage of patients with fibrocavernous process was rather high (13.7%), while those suffering from concurrent conditions and excreting drug-resistant tubercle bacilli made up 41.2 and 45.9 per cent; respectively. Some measures are recommended to optimize sufficiently provided medical care and treatment efficacy.

[Tuberculosis in persons subjected to obligatory fluorographic examinations]. / Tuberkulez u lits, podlezhashchikh obiazatel'nomu fliuorograficheskomu obsledovaniiu.

The results of the examination of the tuberculosis cases detected during 7 years among the annually screened population are given. Still, with 43.6% incidence of the destructive forms 55.3% of the cases were detected between the prophylactic examinations. Further employment was recommended in 33.7% of those cured from tuberculosis. It is concluded that the existing early tuberculosis detection approach is not effective any more and has to be improved. First of all, the responsibility for implementing of medical instructions needs to be stimulated.

[What type of curriculum in phthisiology should there be for medical students?]. / Kakoi byt' uchebnoi programme po ftiziatrii dlia studentov meditsinskogo vuza?

Reconstruction in public health requires further improvement of medical personnel training by using more perfect curricula and methods of teaching. Different curricula on phthisiology are discussed in regard to disease pathomorphism and organization of personnel activity. It is advisable that the main attention should be paid to mastering differential diagnosis by medical students during their individual work.

[The phthisiotherapist under today's conditions]. / Kurator-ftiziatr v sovremennykh usloviiakh.

Efficiency of the activities of medical curators in tuberculosis dispensaries is discussed in connection with reconstruction of public health care. An improvement of the quality of prophylactic arrangements, introduction of centralized control of treatment and observation of patients and other organizational innovations made the activity of the curators unnecessary at the present stage. It is proposed to discuss the possibility of performing organizational and methodological measures by indications in regional dispensaries according to contracts with preserving the system of centralized control.