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The paper analyzes the data available in the literature on the prevalence of smoking and its impact on different systems of the human body. Basic documents of the World Health Organization on smoking control policy are presented.

Tuberculous meningitis (TM) develops more frequently in unvaccinated or inadequately vaccinated infants (28 cases of 34), in contact infants (26 of 34 cases). Within the first year of life TM is especially aggressive. Late diagnosis and treatment leave significant residual neurological changes or result in lethal outcomes.

Because of deterioration of epidemiological situation by tuberculosis, individuals from tuberculous infection foci and social risk group require special care. It is important to integrate efforts of phthisiatric and general therapeutic and prophylactic services in detection of tuberculosis in children and adolescents, to create controlled conditions for conduction of antituberculous measures.

The paper analyzes patient contingents at one of the largest tuberculosis hospitals in Russia in 1995 to 1998. Ti has been ascertained that there has been an increase in the number of patients transferred from general hospitals from 9.7 to 27.4%. Patients with caseous pneumonia and intrathoracic lymph node tuberculosis have doubled.

The prevalence of insulin-dependent diabetes mellitus (IDDM) and noninsulin-dependent diabetes mellitus (NIDDM) among adults in two Moscow okrugs was studied. It was 0.218 and 1.678%, respectively, the latter form being encountered 7.7 times more frequently. Patients with pulmonary tuberculosis followed at tuberculosis control dispensaries (n = 69,012) were found to have diabetes mellitus in 236 cases (120 with IDDM and 116 with NIDDM). The prevalence of IDDM among the tuberculosis control dispensary patients was 1.7%, which was 8 times greater than that in the general population. That of NIDDM was 1.68%, which did not significantly differ from that in the population. Epidemiological analysis showed that there was a highly significant association of tuberculosis with diabetes mellitus in the population. The risk for IDDM was 3.6% in patients and exceeded that in the population while the risk for NIDDM in the population was the same as that in the population. Analyzing the distribution of immunogenetic HLA-1 and HLA-2 markers showed that patients with tuberculosis concurrent with IDDM were intermediate between a group of patients with isolated tuberculosis and isolated IDDM.

Dispensary record group VIII for patients with sarcoidosis was introduced in Moscow in 1994 and a center based on the Moscow Research Production Center?? was set up to diagnose and treat such patients. In addition to advisory work, the sarcoidosis center performs organizational and methodological functions. A scheme of subgroup (A, B, and C) distribution of Group III patients by the activity and pattern of sarcoidosis has been developed to have unique follow-up methods. The diagnosis made in the patients and their dispensary registration, the efficiency of treatment, and their movement by subgroups are checked up. This system of a center-dispensary interaction revealed a dynamics in sarcoidosis incidence and prevalence in the city in 1994-1997. Evidence is provided for that it is expedient and timely to organize a follow-up of patients with sarcoidosis particularly when the share of paid medical services is increasing.

The tuberculosis mortality rate is largely determined by the organization of early identification of patients with this disease in the general population. At present the volume of prophylactic surveys has reduced, but, nevertheless, they are the method of choice in detecting tuberculosis in time. Since the prevalence of tuberculosis greatly differs in different populations, prophylactic examinations must be differential in relation to the risk of disease or epidemiological hazards. Increasing the coverage of prophylactic examinations of risk groups by 10% allows one to increase the identification of patients with tuberculosis by 1.6 times in them, that by 8.0% enhances it by 1.9 times. Since the socioeconomic conditions have changed and the logistics is poor, the most effective existing actions should be taken.

The present-day poor epidemiological conditions are marked by an increase in tuberculosis detection rates (1.43%) with low coverage (28.0%) of the population with preventive fluorographic surveys and a high proportion (39.0%) of young patients (aged 18-39 years) among new cases. The shares of advanced and acute forms of tuberculosis were 7.2 and 11.4%, respectively. A decay phase was detected in 50.6%, 52.6% of patients isolated bacteria. In children, tuberculosis morbidity increased by 28.6% mainly among the unregistered extrafamilial contacts. Most patients (75.8%) detected upon their referral to the polyclinics and general hospitals had a high proportion of extrapulmonary tuberculosis. Thus, the above trends of morbidity show its high potential level.

The present clinical and social characteristics of new cases with pulmonary tuberculosis show some features. The clinical characteristics of patients in 1995 to 1997 indicate an increased number of patients with disseminated, frequently bilateral processes and acute tuberculosis which is largely associated with the decline in preventive fluorographic surveys of the population including those who have contacted bacteria-isolating patients. There were 61.3% with pulmonary symptoms among those who visit physicians and 62.1% among those from the foci of tuberculous infection. Social aspects of the study demonstrate that there is a great number of young patients (56.4% of those under 39-49 years) and a high proportion (81.1%) of able-bodied patients among both males and females. There was an increase in the proportion of patients having higher education (43.7%) and a decrease in laboring patients (21.4%). This is most likely to be associated with the fact that many patients did not work by the profession they had been trained. There was a higher proportion (43.0%) of the patients having different poor working conditions and patterns. In these years, the patients' financial position deteriorated. It was slightly better in the employed than in the unemployed. However, in both groups the bulk of the patients had income per head in the family at the subsistence level or lower (56.2 and 21.6% in the unemployed and employed, respectively. These data were assessed by the guidelines made by the State Statistics Committee of the Russian Federation and the RF Ministry of Labour. It should be noted that the nutritional quality did not correspond to the optimal composition ratio of dietary foods and it was characterized by the high content of less valuable foods, carbohydrates, low levels of protein and vitamins. Poor social aspects in characteristics of patients were undoubtedly to be associated with a greater number of patients with severe, frequently progressive forms of tuberculosis although they had received specific chemotherapy.

To form contingents of pulmonary tuberculosis patients with isolated drug-resistant Mycobacteria tuberculosis (MBT) strains, chronic patients having the disease for more than 3 years (50.3%) head the list, new cases (36.9%) detected in the past 3 years (1994-1996) rank second, next are those with relapsing tuberculosis (12.8%) identified in 1994-1996. The ratio of the above group of patients with isolated drug-sensitive MBT species is 23.3, 68.8, and 7.9%, respectively.

Despite unfavorable socioepidemiological conditions, there are potentials of reducing tuberculosis morbidity in the epidemic foci of children and adolescents (by more than 3.5 times). For this, all the children and adolescents from the foci of infection should be thoroughly examined and followed up and educational and preventive measures including intensified antituberculosis propaganda should be made in these foci.

Three hundred and eighty new cases of pulmonary tuberculosis were examined and the characteristics of a tuberculous process studied in different social groups (industrial and office workers, unemployed) in relation to methods of detection of the disease: on referrals or prophylactic examinations. There was a considerable reduction in the proportion of patients whose disease was detected on prophylactic examinations, and in the families of patients with tuberculosis. The tuberculous process detected on referrals was characterized by its higher prevalence and a qualitatively more severe form (caseous pneumonia, fibrinous-cavernous, and cavernous processes). A decay phase and bacterial isolation were more frequently noted.

While contacting a patient with bacillar tuberculosis, neonates and their mother are at risk for the disease, which makes it necessary to make up a programme that involves emergency antituberculosis measures. Among them primary specific drug therapy in all children in contacts, which may prevent tuberculosis in them, is highly effective.

Disability was analyzed in 270 patients with pulmonary tuberculosis detected in 1995-1997. Today the level of disability and its associated expenses on payment of allowances due to the working incapacity of patients with pulmonary tuberculosis are more and more determined by different poor social factors, such as the specific features of the labour market, unemployment, lower living conditions of most patients with this disease.

A total of 5532 homeless persons were examined. The affection with pulmonary tuberculosis was 10.9%. The disease was first detected in 2.53% of the examinees. Relatively curable types of pulmonary tuberculosis were encountered in 70.2% of patients. A system of social and antituberculous measures should be set up for this population group.

The outcomes of treatment of 110 homeless patients with tuberculosis admitted to Moscow City Clinical Hospital No. 7 in 1993-1996 were followed up. All homeless persons have various concurrent diseases, such as alcoholism, chronic nonspecific diseases of the lung, diseases of the cardiovascular system, kidney, liver, etc., which require their treatment by physicians of different disciplines. Good results of treating the homeless may be obtained when rehabilitative services are used and hospital treatment is performed for at least 4 months. All homeless patients who admitted to general hospitals are to be physically, roentgenologically, and bacterioscopically examined whether they have tuberculosis.

Tuberculosis was detected in 2.2% of migrants from Baku, whereas among those applying for medical and social care to the charity organization "Physicians without Boundaries" this value is 4 times higher: 8.6%. These results necessitate the development of a complex of antituberculosis measures adapted to new marginal risk groups-migrants. The principal purpose of these measures should be to make specialized medical care as available as possible for this group.

Homeless patients with tuberculosis form a special group. Being out of therapeutical-and-prophylactic institutions sight and violating elementary sanitary regulations, they are, from an epidemic standpoint, the most dangerous part of a tuberculosis reservoir. Tuberculosis morbidity rates in the homeless are extremely high and tens times as great as those among other populations. The existing system for detecting tuberculosis among the homeless is not very effective. Much better results are achieved by nongovernmental philanthropic institutions where homeless persons apply to for medical and social aids. About half the homeless patients with tuberculosis were referred to Tuberculosis Hospital 11 of the International Organization "Physicians Without Boundaries". The patient's personality is, in general, the most vivid terms, characterized as asthenic; with low intelligence and constitution; asocial, aggressive, and being a carrier of the motive of acquired helplessness. This group of patients needs not only medical efforts, but sociolegal and sociopsychological rehabilitation. The activities of Tuberculosis Hospital 11 wherein a room of social aid and rehabilitation has been functioning since 1995 may be an example of a comprehensive approach to tackling the problem of homeless patients with tuberculosis.

Incidence rate of tuberculosis was ascertained in medical and paramedical staff of antituberculosis institutions (ATI) for adults. For the period 1987-1993 tuberculosis developed in 38 subjects, i.e. 4 times more frequently than in the rest adult population of Russia. The physicians catch the infection 1.2 times less frequently than paramedical personnel. The highest morbidity was observed in the staff of clinical, bacteriological and pathological laboratories. The course of tuberculosis in ATI staff is favourable due to early detection and long-term treatment but is characterized by frequent attendant diseases, resistance and intolerance to antibacterial drugs. Preventive treatment of ATI staff in a special sanatorium enhances their resistance to M. tuberculosis infection and reduces this infection prevalence in tuberculosis contacts.

The authors present 6-year follow-up results for 884 new cases with destructive respiratory tuberculosis. The patients were from a high risk group by social, disease form and associated disease criteria. The majority of the cases (90%) were detected at diagnostic x-ray outpatient examinations. There is a rise in destructive tuberculosis detection rate in general hospitals. Treatment response rate for destructive tuberculosis may be assessed as high: bacterial discharge ceased in 90.5%, caverns closed in 86.5%, 39.2% were cured within 3 years, 33.3% improved, chronic forms developed in 10.9%, lethal outcomes occurred in 16.6% of treated patients. For 6 years the number of complete responses did not grow much.

The problem of pediatric tuberculosis is viewed in terms of its connection with social and medical setting, epidemiological situation in adult tuberculosis. To correct negative trends in tuberculosis prevalence in children efforts should be made to eliminate the infection foci, to promote conditioning of population, to introduce new programs of health care for mothers and children.

Thanatogenesis of pulmonary tuberculosis has been studied on autopsy material gained in tuberculosis hospitals of Moscow from 1972 to 1992. The leading cause of lethal outcomes was progressive fibrous-cavernous tuberculosis (71.6% in 1992). Disseminated tuberculosis mortality rose two-fold (14.2% in 1992). Death rate for infiltrative tuberculosis reaches now 5.56%. Tuberculous patients die of the progressive disease in 54.94%, of respiratory distress and cardiac insufficiency in 32.72%. Progressive tuberculosis proved to combine with nontuberculous diseases in 71.87% of the cases.

A group of new-onset pulmonary tuberculosis patients has been studied and its social characterization is provided in the paper. Comparison of the 1991-1992 findings with those obtained in 1970-1980 has indicated that social aspects are topical as before and have some specific features in recent years. The most important issues are now living conditions, financial status of the patients, their social lifestyle, refugees and rational employment of tuberculosis patients and disabled persons.

The trends in tuberculosis morbidity for the recent 30 years and factors that caused tuberculosis incidence to rise by 13.5% in 1992 are analyzed. Infiltrative-disseminated, disseminated and fibrous-cavernous tuberculosis were diagnosed in 58.7%, 11.7% and 1.8% of cases, respectively. Destructive lesion was found in 50% of the patients. Tuberculosis mortality reached in 1992 4.6 per 100,000. Measures to control tuberculosis spread in Moscow are suggested.

The results of study of a tuberculosis infection course in different conditions and its association with BCG revaccination are presented. The Moscow region was tentatively divided into 3 groups of regions. Children of Group 1 were not given revaccination at 7 and 12 years, those of Group 2 at 12 years and those of group 3 received revaccination according to the routine techniques at 7, 12 and 17 years. BCG revaccination withdrawal caused no increase in tuberculosis morbidity and tuberculin sensitivity. Tuberculosis detections were unassociated with the frequency of previous BCG revaccination.

The role of the highest tuberculosis risk groups in the enlargement of dispensary contingents increases under conditions of endemic tuberculosis decline while it is less manifest in the epidemiologically unfavourable regions. Risk contingents of polyclinics should be supplemented by a socially unfavourable group of subjects who together with patients having several risk factors and those with severe diabetes mellitus are the most vulnerable with respect to tuberculosis.

Characteristic features of subjects of the VIA registration group (500 children and adolescents) observed by one of the Moscow children's polyclinic from 1983 to 1987 are given. The rate of primary contamination amounted to an average of 0.75% a year. 92.8% of children and adolescents were infected as a result of an unknown contact, while 7.2% of them had contact with relatives suffering from tuberculosis. In case of conversion of tuberculin reactions, hypersensitivity to tuberculin was seen in 12.2% of the patients and a year later in 4.6% the subjects with persistent hyperergy who were then transferred to the VIB registration group. The following risk factors of contaminating and contacting tuberculosis were found: contact with tuberculosis patients; immunization of poor quality or its absence; hypersensitivity to tuberculin; frequent acute respiratory viral infections and chronic diseases; and unfavourable social and living conditions. The number of these factors should be taken into account since with their growth, the rate of hyperergy and risk of developing the disease are higher. More thorough examination and controlled preventive chemotherapy at a sanatorium are required when 2 or more risk factors are available.

Documentation concerning 307 patients with newly discovered respiratory tuberculosis during 1979-1988 was analysed. The mean age of the patients was 40. Respiratory tuberculosis morbidity among adult men was 5.3 times higher than that among women. More benign forms of the disease were revealed in the latter, which insured 100% cure among them. Half the male patients were smear-positive; 3/4, were alcohol abusers; and 1/3 were kept in reformatory institutions before the onset of the disease. Every second of them was single, thus prone to an unhealthy lifestyle and improper nutrition. 4/5 of the tuberculosis-affected men were heavy tobacco smokers with concomitant chronic bronchitis, and the death of 2% of this number was caused by concurrent lung cancer. The follow-up of 248 men from 1 month to 10 years showed that tuberculosis and other causes, including cancer, underlying diseases and fatal injuries, led to the death of 1 (0.4%) and 9.7% of the patients, respectively.

The following 3 forms of an unfavorable course of sarcoidosis were identified and described: 1) infiltrative-and-pneumonic; 2) that taking the course of fibrotic alveolitis; and 3) generalized sarcoidosis with hepatolienal syndrome. Clinical and X-ray pictures of these forms together with therapeutic results and outcomes are given.