[Clinical and immunological features of concomitant HIV/tuberculosis infection and HIV infection without tuberculosis].

The clinical and hematological manifestations and functional state of the immune system were comparatively evaluated in patients with concomitant HIV/tuberculosis (TB) infection (n = 84) and in those with HIV infection without tuberculosis (n = 106). The course of concomitant HIV-TB infection was ascertained to differ from HIV monoinfection in a diversity of additional exposures that aggravated the patients' general condition. These included: the parameters of a long proceeding inflammatory process, which were accompanied by the signs of the infection-toxic syndrome, inflammatory changes in the hemogram, by a sharp stimulation of the nonspecific link of immunity. So the comparative analysis of the trend in HIV infection in combination with active tuberculosis and HIV monoinfection revealed a prompter progression of the disease in the former case.

[Antituberculosis humoral immunity in patients with tuberculosis, HIV infection concurrent with tuberculoses].

Enzyme immunoassay (EIA) was used to study the diagnostic value of PTAT circulating in the free and attached state as part of serum circulating immune complexes (CIC) in 34 patients with tuberculosis (TB), 38 with concomitant HIV/TB infection, and 92 with HIV infection without active tuberculosis. A humoral immunological response as circulating PTAT and PTAT conjugated in specific CIC depends on both the form and degree of pulmonary tuberculosis and may be employed to diagnose a disease running as both an independent entity and in the concomitant HIV/TB infection. The use of specific CIC yields additional information on the presence and circulation of mycobacterial antigenic components, which should be borne in mind at the early stages of the disease. EIA diagnosis of pulmonary tuberculosis from the significant titer of PTAT is relatively effective at the stages with infiltration and it ascertains destructive changes before their detection on X-ray and tomographic films.

[Pathomorphism of pulmonary tuberculosis under the present conditions (according to autopsy data)].

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).

[Comparative study of microscopy by the Ziehl Neelsen method, routine fluorescence microscopy, and fluorescence microscopy using a lumin attachment in the diagnosis of acid-resistant mycobacteria].

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.

[Population-based epidemiological study of pulmonary tuberculosis in a number of rural regions of Tatarstan].

The paper presents the results of a population-based, geneticoepidemiological, and immunological study conducted in two regions of Tatarstan. The population-based risks for tuberculosis were established for males and females. Based on the population and family data, the authors calculated the genetic liability to tuberculosis, namely hereditability that is in the range of 0.8 to 1.0 and includes the contribution of nongenetic and environmental factors. Analysis of the results of immunogenetic studies of the northwestern region of Tatarstan has ascertained that patients have an association with the HLA antigen B22, in the Kama Region there is an association with other HLA antigens: B12 and B16. The higher frequency of the HLA antigens B28 and CW1 in healthy individuals as compared with that in patients with pulmonary tuberculosis (PT) suggests the resistance of PT carriers of these antigens for the disease. A study of the distribution of HLA genes by polymerase chain reaction has established the association of the disease with the DR-B1-15 genes in the Kama Region.

[The specific features of formation of a humoral immune response in patients with tuberculosis].

The paper presents the results of studying the time course of changes in tuberculosis antibodies by enzyme immunoassay (EIA) and immune blotting (IB) in 34 patients with pulmonary tuberculosis. In 76.5% of cases, EIA were established to reveal tuberculosis antibodies whose concentration is most pronounced in lung tissue destruction. The detection rate of specific antibodies to Mycobacterium tuberculosis (MBT) structural components by IB was 100%, which was 23.6% greater than that by EIA. The MBT structural components with a molecular weight of 11-20, 21-30, and 101-160 kDa were found to have high immunogenic properties, as suggested by the maximum levels of antibodies and by the marked antigenic proteins of proteins with a molecular weight of 11-20, 21-30, and 41-50 kDa, which showed itself as the generation of the maximum levels of circulating immune complexes with antigens of this specificity.

[Clinical and immunological features of the course of tuberculosis concurrent with HIV infection].

The clinical and immunological features of the course of tuberculosis concurrent with HIV infection were studied in 109 patients. Thirty-eight patients were found to have active tuberculosis to HIV infection; 22 patients were diagnosed to have HIV infection and tuberculosis, and 49 patients developed tuberculosis in the presence of HIV infection. The most acute course of the disease with severe infection-toxic and asthenovegetative syndromes was observed in patients with simultaneous detection of HIV infection and tuberculosis, and, when tuberculosis joins as a secondary disease in the presence of HIV infection, the bronchopulmonary syndrome, body weight loss, lymphoadenopathy, and skin lesion were pronounced at most. The most severe clinical forms of tuberculosis were observed in a group where tuberculosis manifested itself as an opportunistic disease in the presence of moderate and severe immunodeficiency.

[The predictive value of thyroid function in patients with respiratory tuberculosis].

Enzyme immunoassay was used to determine the levels of thyrotropric hormone (TTH), total and free fractions of thyroxine, and triiodothyronine in patients with respiratory tuberculosis. 61.8% of the patients were found to have type 3 euthyroid pathology that was characterized by the elevated levels of thyroxine and triiodothyronine with the unchanged level of TTH and by the absence of clinical manifestations of thyrotoxicosis. The levels of the total and free fractions of triiodothyronine and thyroxine were higher in patients with lung destruction, dissemination, or bacterial isolation than in those without these manifestations. The positive clinical and X-ray changes were followed up by regression of thyroid shifts in patients with the baseline high values of thyroid hormones. Antituberculous drugs did not affect thyroid function.

[Distribution of HLA antigens in patients with tuberculosis and healthy individuals in the Tatar population]. / Raspredelenie antigenov kompleksa HLA u bol'nykh tuberkulezom i zdorovykh lits v Tatarskoi populiatsii.

The paper presents the results of a study of the distribution of Class I HLA antigens in an ethnic Tatar group (in patients with pulmonary tuberculosis and healthy individuals) in 4 districts of Tatarstan. It has been ascertained that an association with HLA-B22 antigen exists in patients with active pulmonary tuberculosis.

[Problems of drug-resistant tuberculosis in the Republic of Tatarstan]. / Problema lekarstvenno-ustoichivogo tuberkuleza v Respublike Tatarstan.

The prevalence of drug-resistant tuberculosis in the Republic of Tatarstan was studied. Among the bacillary patients with tuberculosis, those who isolated drug-resistant Mycobacterium tuberculosis were 54.4%; primary drug resistance was detected in 31.5% of the patients. In the pattern of drug resistance, multidrug resistance was predominant (47.3-75.4%) in all the categories of patients. Whether the blood bacteriostatic activity (BBA) could be used to correct a chemotherapy regimen in patients with tuberculosis was studied. A direct relationship between the level of BBA and a clinical effect was found in new cases of patients. When BBA was low, the treatment regimen required correction in order to achieve the higher level of BBA. There was no relationship between the level of BBA and the results of treatment in patients with chronic tuberculosis. The low values of BBA seen in the use of reserve drugs cast any doubt on the expedience of their use in chronic tuberculosis.

[Awareness of patients of tuberculosis dispensaries and their attitude to therapeutical process]. / Uroven' informirovannosti patsientov protivotuberkuleznykh dispanserov i otnoshenie ikh k lechebnomu protsessu.

The awareness of tuberculosis was studied among patients of tuberculosis dispensaries. A survey indicated that as high as 2.3% of the patients with tuberculosis gave right answers to all the questions of a questionnaire. 61.8% of the respondents answered the bulk of the questions. The latter can be arbitrarily considered to be aware of their disease. The persons who are unaware of tuberculosis are more commonly males with a below-secondary educational level, patients above 50 years, the unemployed, and low class. More than half of such patients are not sure that they will be able to recover, which makes them refuse treating. Better awareness can enhance the results of treatment and the outcomes of the disease.

[Immune defense in hormone-dependent bronchial asthma]. / Immunnaia zashchita pri gormonal'no-zavisimoi forme bronkhial'noi astmy.

The study was undertaken to examine the clinical and immunological features of hormone-dependent bronchial asthma. Long-term corticosteroid therapy was found to have a pronounced immunodepressive effect on both lymphocytic subpopulations and opsonophagocytosis. The sequelae of immunological disorders are lower anti-infective defense, which contributes to a more severe course of the disease generally running in the presence of chronic obstructive bronchitis. The use of immunomodulators, extracorporeal techniques, which favours to reduce the adverse immunosuppressive effect of long-term therapy, is an alternative to corticosteroid dosage increment.

[Physician-patient relations in tuberculosis]. / K probleme vzaimootnosheniia vracha i bol'nogo pri tuberkuleze.

The "rating design" procedure was first used to examine 168 patients with tuberculosis. The image of an ideal doctor as perceived by patients was studied and it was compared with the traits of a practitioner by sex, age, residence, marital status, social class, disease duration, hospital stay, etc. It is shown that there is a great discrepancy of these images, which requires psychohygienic work with phthisiologists in order to create partner relations during treatment.

[Classification of destructive pulmonary tuberculosis into groups according to quantitative and qualitative characteristics with the aim of developing differentiated treatment methods]. / O razdelenii destruktivnogo tuberkuleza legkikh na gruppy po kachestvennoi i kolichestvennoi kharakteristike s tsel'iu razrabotki differentsirovannykh metodov lecheniia.

The results of observation of 1196 new cases of destructive pulmonary tuberculosis are analyzed. The qualitative and quantitative characteristics identified its 5 categories which greatly differed in the frequency and time of decay cavity closure and outcomes of chemotherapy: pulmonary tuberculosis with minimum destruction, restrictive destructive tuberculosis, disseminated destructive tuberculosis, disseminated destructive tuberculosis, tuberculomas with decay, and fibrocavernous pulmonary tuberculosis. Comparing the efficiency of 3 combined treatment regimens led to the conclusion that it was necessary to develop the methods of differential therapy of destructive pulmonary tuberculosis in relation to its qualitative and quantitative characteristics.

[Psychosomatic relationships in sarcoidosis]. / Psikhosomaticheskie sootnosheniia pri sarkoidoze.

The procedure developed by the Bekhterev Leningrad Research Institute was used to define the attitude towards the disease in 40 patients with sarcoidosis. A harmonic attitude towards the disease was detected only in 20% of cases. There was a relationship between the magnitude of clinical manifestations of sarcoidosis and the type of an attitude towards the disease. Hyperneurotization was observed in 50% of female patients with sarcoidosis. The study showed it necessary to perform psychotherapy for sarcoidosis on an individual basis to improve their psychoemotional status and to reach a better mutual understanding between the patient and the medical staff.

[Treatment of patients with pulmonary tuberculosis with regard to their personality traits and attitude to disease]. / Lechenie bol'nykh tuberkulezom legkikh s uchetom osobennostei ikh lichnosti i otnosheniia k bolezni.

Experimental psychological examination was made in 149 patients with pulmonary tuberculosis. Most patients with tuberculosis were ascertained to have mental disorders which increase in chronic alcoholism or progress to chronic destructive tuberculosis. As high as 21.2% were found to show a harmonic attitude towards the disease. The other patients had inadequate disease responses in combination with a low sanitary education. Psychotherapy makes it possible to eliminate mental disorders, to form an adequate disease attitude and to keep to the necessary treatment duration. This enhances the efficiency of tuberculosis treatment.