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The paper summarizes the results of studies into the pathological anatomy and pathomorphism of pulmonary tuberculosis in Yakutia, which have been conducted by the Department of Anatomy, Yakutsk State University Medical Institute, over 36 years. A morphological comparative analysis of autopsies of individuals who died from different forms in the pre-antibacterial and antibacterial periods and surgical materials were used as a major source of data. More than 1,000 autopsies made it possible to define a wide range of behavioral patterns and the morphological features of pulmonary tuberculosis under the extreme climatic conditions of the Far North. These findings have made a significant contribution to the development of the new scientific school Northern Phthisiology.

The paper presents the results of comparison of the rates of tuberculosis morbidity in children as a whole, in the foci of tuberculosis, in follow-up Group VI and the frequency of using sanatory care for preventive purposes in Russia in 1999. A role of available sanatoria in preventing tuberculosis is found to be in sufficient. By using the best areas as an example, the volume of required work with children at risk for tuberculosis and the rational use of sanatory care are substantiated.

The paper presents the results of typing by HLA classes I and II antigens in 55 patients with tuberculosis and 85 healthy Tyvians in the Erza District. Republic of Tyva. HLA I and II antigens were determined serologically and polymerase chain reaction, respectively. Tyvian patients with pulmonary tuberculosis had HLA B7 antigen more frequently and HLA B12 antigen less frequently than the controls. The findings suggest that pulmonary tuberculosis is associated with HLA-DRB1 14(6) specificity in this district of the Republic of Tyva. These data may be useful in forming groups at risk for pulmonary tuberculosis in the district under study.

The paper deals with 4-year work of a tuberculosis dispensary that serves over 1 million residents of Moscow. It presents the causes of late detection of tuberculosis, the specific features of the socioeconomic status and those of the clinical picture of the disease in relation to the "channel" of detection, as well as the structure of identification of Mycobacterium tuberculosis resistance in new and old cases of tuberculosis and also analyzes the efficacy of treatment by the DOTS methods in new cases of pulmonary tuberculosis who have complete a full 6-month treatment course.

The paper summarizes the results of the multidisciplinary epidemiological survey made in the past decade in the Russian Federation. Reasons for the higher incidence of tuberculosis among children and the influence of different factors on epidemiological indices were established. The paper clearly shows how the incidence and infection rates of tuberculosis in children are indicative of its total epidemiological situation in the general population in the country. Against this background, the pattern of new-onset tuberculosis mainly confirms the quality of work of general therapeutical and tuberculosis controlling services on active detection and prevention of the disease.

The paper considers drug resistance in Mycobacterium tuberculosis (MBT) in the Barents region of Russia and Norway. Along with a rise in tuberculosis morbidity, there has been recently an increase in the number of patients isolating MBT that are resistant to antituberculous agents. The most dangerous trend is an increase in MDR of MBT strains. In the north-west of Russia there are high MBT drug resistance rated as compared to Norway. There are differences in the determination of drug resistance by the absolute concentration method and by the BACTEC method.

The paper proposes a principle of following up patients from tuberculosis facilities, which is based on the patients' need for treatment rather than on the duration of monitoring of cure stability. The proposed scheme of dispensary registration may focus phthisiologists' attention on the patients who really need a follow-up. The use of the scheme in tuberculosis facilities will enhance the efficiency of treatment in patients and reduce the rate of tuberculosis reactivation in patients registered as risk group ones.

The paper shows a poor prognosis of tuberculosis spread among HIV-infected patients in Russia for the years immediately ahead. Recommendations are given how to organize a tuberculosis controlling care to patients with HIV infection by taking into account its stages by aspects, such as prevention, diagnosis, medical examination, and treatment.

The paper provides the data of comprehensive epidemiological and clinical studies made at the Clinic of Tuberculosis in Children and Adolescents. Research Institute of Phthisiopulmonology, I. M. Sechenov Moscow Medical Academy, Ministry of Health of the Russian Federation, in the past 15 years and dedicated to extrapulmonary tuberculosis in children and adolescents with tuberculosis. Due to the specific features of manifestations of extrapulmonary tuberculosis in childhood and adolescence and to the existing system of prevention and early detection of the disease in children and teenagers in the Russian Federation, the number of children with severe generalized extrapulmonary tuberculosis is not on the rise despite that the epidemiological situation has aggravated in the past 15 years. The clinical features of most common forms of extrapulmonary tuberculosis are shown and measures for their monitoring proposed.

The paper shows how to detect an epidemiological chain of spread of tuberculosis in the Barents Sea Region. RFLP typing of Mycobacterium tuberculosis strains may serve as an important tool in detecting an infection source and drawing up epidemiological chains of tuberculosis spread. Cross infection may occur in tuberculosis cure hospitals, which shows it necessary to delimit fluxes of tuberculosis patients into health care facilities.

The paper analyzes the results of implementation of the WHO recommendations on detection ad treatment of patients with tuberculosis in 1997-1999. A total of 8901 individuals with symptoms of suspected pulmonary tuberculosis were examined in this period. Sputum smear microscopy revealed acid-resistant bacteria (ARB) in 293 (3.3%) of the patients, including in 167 (57%) with their verification at clinical diagnostic laboratories of general health care units. A therapeutical success was achieved in 81.9% of the new cases of pulmonary tuberculosis who had ARB, in 85.7% of the patients without ARB, and in 72% with recurrent tuberculosis.

The paper proposes procedures for analyzing and predicting the rates of total morbidity due to tuberculosis and the time of its cure. Original procedures for identifying the factors that most substantially influence total tuberculosis morbidity rates (incidence rates) are described. A statistically significant regression equation was derived to predict tuberculosis morbidity in the cities and towns of the Rostov region (the determination rate R2 = 0.95; the mean weighed predictive error is no more than 5%, with 1-2% in the cities). A total approach to statistical assessment of the impact of concomitant diseases on the clinical recovery rates is proposed. Estimates indicated that there is alpha negative statistically significant correlation between the rapidity of recovery and the presence of concomitant pathology (alcoholism). A statistical correlation between the indices of regression of active tuberculosis was assessed. In 96% of cases, transition of active tuberculosis to inactive one can be judged from the values of only two factors. A functional relationship has been derived, which defines the onset of the phase of inactive tuberculosis with accuracy sufficient for practical purposes.

The paper presents guidelines in treating tuberculosis in children from the experience gained in Russia and other foreign countries. Emphasis is laid on the necessity of applying a comprehensive approach to the treatment whose main constituents are sanitary and dietary regimens, etiotropic and pathogenetic therapies, prevention of exacerbations or treatment of concomitant diseases. It is important to use antituberculous agents rationally by determining a standard treatment regimens for patients with various somatic diseases. Of great value is the pattern of organization of a therapeutical process at different stages (institutional treatment at a hospital, day hospital, or sanatorium and outpatient treatment), which secures continuity and accordingly enhances the efficiency of treatment as a whole.

The paper presents the results of elucidation of numerous tuberculosis risk factors. Eight most significant criteria were selected by using the multifactorial analysis. They were used to develop an algorithm for selecting patients in risk groups at the polyclinic. Follow-ups of these groups of patients were shown to enhance the detection rate of tuberculosis, thus greatly reducing material expenditures.

The paper presents the Institute's activities in qualification rating of its staff from January 1994 to September 1998. It analyzes theses prepared and defended by the Institute's researchers and competitors. The activities of the dissertation council are briefly characterized.

The paper summarizes the results of clinical observations of 55 teenagers suffering from active respiratory tuberculosis. It defines risk factors for this disease in adolescents. Emphasis is laid on the current pathomorphology and a great variety of clinical types of tuberculosis. Treatment of tuberculosis is ascertained to be preferred by using the short-term intensive chemotherapy regimen recommended by the World Health Organization, which is intended to cure most patients in the shortest period as compared with existing routine regimens.

The paper deals with organizational measures for detection and treatment of homeless persons with tuberculosis in Saint Petersburg. A total of 1653 homeless tuberculosis patients were followed up in 1991-1997. There was high incidence of tuberculosis in homeless persons (30 detected per 1000 examinees. All agencies, facilities, and services should participate in detecting and treating tuberculosis among homeless subjects. Large-scale solution of this problems requires a package of measures by providing additional funds stipulated by a regional goal-oriented tuberculosis control programme.

The paper summarizes experience in using a new technology of health care provided to patients from antituberculous dispensaries (ATD), which has been developed by the Russian Research Institute of Phthisiopulmonology, Ministry of Health of the Russian Federation. The new procedure was used at the ATD of 114 districts, towns, and cities of 6 Russian administrative regions over 5 years. The areas under study covered more than 7 million adults. The procedure enhances the efficiency of ATD patient service and health care mainly by fixing the optimum time of basic complex therapy of patients with pulmonary tuberculosis (PT), by decreasing the time of recovery by 1-2 years and the follow-up duration for control outpatient groups (III, VII ATD groups), by drastically reducing the number of persons to be medically treated for preventive purposes by 58-70%. The proposed procedure for ATD follow-up care may be useful in the areas of the Russian Federation and requires no material and technical means and resources.

The results of long-term follow-ups of 300 patients with sarcoidosis registered at the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences, were studied. The paper provides a full characterization of the patients by their social status, clinical forms, detection modes, diagnostic methods. The efficiency of treatment was evaluated, as evidenced by the "movement" from group to group (from active group to inactive one). A follow-up makes it possible to correct treatment.

The paper outlines the results of following up 50 infants and preschool children who had contacts on their families. The major sources of infection were equally both their mother and their father. The children were found to have pronounced active processes. The most severe types of tuberculosis were common in infants in whom general, military tuberculosis and tuberculous meningitis along with complicated types in intrathoracic lymph node tuberculosis were detected. There was more commonly a phase of dissemination and decay in infants. Severe types of tuberculosis were encountered in the families having a combination of many unfavourable factors, both medical and social ones. Among the children who had fallen ill, 32% were detected on their visits to polyclinics of upon admissions to general hospitals.

The paper provides the results of follow-ups of 269 patients with pulmonary tuberculosis, 170 and 39 isolated drug-resistant or sensitive Mycobacteria tuberculosis (MT), respectively. Drug resistance to MT was found to lower the feasibility of curing the patients, to prolong their cure, and to slow down the rate of decreasing the cohort of tuberculosis patients registered at the dispensary. In the first 5-years of the follow-up, there were lower death rates due to tuberculosis in a group of patients with drug-resistant MT than in those with drug-sensitive one.

The paper deals with the results of analysis of the clinical types of pulmonary tuberculosis by the examination findings of new cases in 1990 (n = 1623), 1993 (n = 6686), 1994 (n = 7460), and 1995 (n = 9748). The analysis was made by the diagnoses established in patients identified in 12 areas of the Russian Federation. The proportion of clinical types of tuberculosis, the rate of detection of destructive changes in the lung and bacterial isolation were taken into account. Moreover, tuberculosis complications on detection, the dissemination of the process and concurrent diseases were borne in mind in patients with infiltrative tuberculosis. It was found that new cases of pulmonary tuberculosis increased, but the proportion of its clinical forms and patients with destructive changes in the lung and isolated strains remained unchanged in the past 3 years (1993-1995). The vast majority of new cases of tuberculosis (91.9-91.4%) includes patients with treatable diseases in whom a good clinical outcome can be expected.

The paper presents the results of follow-up of 894 patients in 1983 - 1993. The increasing topicality for physiology and the potentialities of making the diagnosis of the disease better are defined, based on the data on the pathogenesis and pathomorphism of tuberculous lymphadenitis and on the results of testing new diagnostic techniques, including cytological and histological studies of sections and imprints, enzyme immunoassay, and polymerase chain reaction.

In recent years, there has been a rise in tuberculosis morbidity among children and adolescents in Russia. Society's social problems which contribute to the accumulation of an uncontrolled infection reservoir that is unknown to the antituberculous service system. The reservoir is formed primarily among children and adolescents who are brought up in socially disadapted, migrants' refugees, or homeless families, among delinquent children and adolescents. The existing complex of antituberculosis measures is under way only among permanent residents. In this connection, antituberculous measures in the above risk groups are to be improved. Some specific proposals are given in the paper.

The paper presents data on primary infection and infection rates of children from contacts with tuberculosis and from the healthy environment. The infection rates of the contacted children is 3.4 times higher, especially in infants and preschool children. It also shows factors predisposing to infection: asocial families when the patient shows his physician's noncompliance, the lack of revaccination in children and drug prevention. In 25.6% of children, infection had been detected before they were found to have contacts with a tuberculosis patient, and examinations of the infected child's environment made it possible to detect an adult tuberculosis patients. By and large, in 1994 the detection rate of tuberculosis in adults among children with primary infection was 7.4 per 1000 examinees in Kazan, which is 10 times higher than that at mass fluorography of the adult population.

The present paper analyzes immunological parameters and the incidence of secondary immunodeficiency (SID) in physicians and medium-levelled medical staff contacting with tuberculous and non-specific infection. Suppressed cell immunity was recorded in 44% of the medical staff of a pulmonary surgical tuberculosis hospital, with increased length of service there was a rise in the number of patients diagnosed as having immunodepression. The clinical manifestations of SID were recorded in 56% in this group and they were most pronounced in a group of long-working personnel. The proportion of persons with immunodepression proved to be twice higher among nurses than among physicians. Nurses are at the highest risk for immunopathological states. This common occurrence of SID among medical staff is an indicator to make an obligatory regular immunological examinations of the staff for the prevention and immunotherapy of SID.

The incidence and causes of pulmonary tuberculosis recurrences were studied in the convicted persons from the corrective-labour establishments of the Saratov Region. There was a specificity of aggravating factors that influenced the occurrence of relapses. The findings are interpreted in the paper.

Examination for M. avium contamination covered 702 specimens of the synanthropic birds of 6 species (hooded crows, daws, rooks, magpies, sparrows, starlings) which was carried out in 13 landscape-epizootic areas of the northern zone of the Low Volga region. Contamination was studied by a serological test (AIT) using the M. avium extract and dry avian tuberculin as an antigen in the parallel tests. It was found that 96 (23%) of the 416 specimens from the right bank of the Volga and 65 (22.72%) of the 286 birds from the left bank were AIT-seropositive. The paper presents methods of study and contamination parameters of birds; the character of distribution of the infected birds by the region of the examination zone is discussed.