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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.

The paper analyzes whether it is possible to predict a risk for postoperative empyema, by studying a totality of characteristics of a patient, a pathological process, and the properties of MBT in 46 patients with progressive fibrocavernous tuberculosis. It also shows it actual to accomplish this task with a prediction accuracy of 89.5-100%, by simultaneously taking into account both the bacteriological properties of MBT (the magnitude of Mycobacterium tuberculosis excretion and viability) and different combinations of serum biological parameters that reflect the activity of an inflammatory process.

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 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.

Medical and psychological studies have established that the personality of a psychosomatic patient has characteristic specific features that determine his emotional reactions and lead to psychological and physiological destructions. Searching for the specificity of psychogenesis of pulmonary tuberculosis may be guided by the V. N. Myasishchev provisions of psychology of relations and should be aimed at analyzing the patients' significant experiences that cause their prolonged affective tension. This paper defines the tasks of studying the psychological and neuropsychological features of patients with pulmonary tuberculosis and specifies an adequate set of psychodiagnostic procedures to solve the put problems. The findings may provide insight into the specific character of psychogenesis of pulmonary tuberculosis and into a relationship of the psychological traits of patients with this nosological entity to the physiological processes at the somatic and cerebral level.

The paper describes the follow-up and treatment of patients with tuberculosis concurrent with HIV infection in Moscow in 2004-2005. Major epidemiological parameters, such as morbidity, mortality, and prevalence of this comorbidity, are given. Analysis of these indices suggests that the epidemic situation associated with tuberculosis concurrent with HIV infection became worse in the past 2 years. As compared with 2004, in 2005 the number of such patients increased from 294 to 445, including that of first detected patients rose from 123 to 174. In this group of patients, there was a preponderance of young males aged 29 to 39 years. Most patients with this pathology suffered from drug addiction and alcoholism and other concomitant diseases. The bulk of them were unemployed and disabled. In the HIV-infected, the clinical forms of tuberculosis were severe with a predominance of acute and disseminated processes; the rate of drug resistance, including multidrug resistance, was high, which made treatment difficult and resulted in high mortality.

The paper provides the data of analysis of antituberculous care to teenagers in Moscow and characterizes its problems. Emphasis is placed on the tense and unstable situation associated with the detection of the disease in this age group. In the bulk of adolescents, the disease is identifies when they come to see a doctor, including at somatic hospitals. Active tuberculosis detection techniques (tuberculin diagnosis and fluorography) fail to produce adequate effect mainly due to organizational problems (the bulk of teenagers are outside the organized collective bodies or the latter are frequently changed; the detection of tuberculosis in Moscow nonresidents or in whose who enter secondary specialized colleges claims attention). Age-related sociomedical risk factors, such as hormonal rearrangement, comorbidity, a negative attitude towards preventive medical measures, deviant behavior, social family, and dysadaption, are of importance for the development of tuberculosis. A sociomedical portrait of an adolescent with tuberculosis is given. Attention is drawn to the fact that on implementing antituberculous measures, it is a need for an interaction of a tuberculosis-controlling service with general care health network facilities, including those that deal with the problems of social diseases and educational establishments.

The paper presents data on bed reductions at tuberculosis care facilities in the Sverdlovsk Region. These data are compared with those in the neighboring regions. The main topic of the paper is the advantages of a day hospital over those of a day-and-night one. Indications for admission to a day hospital are presented. The 2004 statistical data on the work of a day hospital are given. The paper shows that hospital-replacing technologies are promising in the treatment and rehabilitation of patients with tuberculosis in the Sverdlovsk Region.

The paper describes the most important developmental stages of phthisiomorphology in chronological order, by using as an example the work of the Pathomorphology Laboratory, Central Tuberculosis Research Institute, since its organization. It also shows the stages of phthisiosurgery with the inestimable scientific and practical contribution of the works by L. K. Bogush and his followers from the formation of lung surgery to today's achievements. The authors give examples of the long-term working partnership of surgeons and morphologists in the development of these two disciplines, which was fruitful in deciding many issues of phthisiology.

The paper reviews the development of biochemical studies in phthisiosurgery, by comparing the needs of resuscitation and anesthetic provision of major thoracic operations and the management of the postoperative period. Emphasis is laid on the leading role of biochemical monitoring in the prevention and treatment of postoperative events, such as acute renal failure, metabolic alkalosis, thrombohemorrhagic syndrome, pulmonary thromboembolism, and others. The prospects of further researches dealing with the problems of postoperative pathophysiology are considered in patients with pulmonary tuberculosis.

The paper briefly describes data on the first operations on the lung made in children at the Central Research Institute of Tuberculosis for pulmonary tuberculosis under anesthesia. According to L. K. Bogush's recommendations, the author has first made clinicomorphological and bacteriological comparisons of different pathological tissue from 105 children and adolescents operated on for pulmonary tuberculosis, 81 biopsy specimens being abacillary. Mycobacterium tuberculosis was found in 54.3% of the operative biopsy specimens from the patients long (mean 1.5 to 2 years) treated by antibiotics. L. K. Bogush defined indications for surgical treatment for different clinical forms of pulmonary tuberculosis in children and adolescents. Six hundred and twenty-seven operations were performed in 589 children and adolescents. All types and volumes of lung resections, pneumonectomy, pleuropneumonectomy, pleurectomy, lymphonudulectomy(tomy), and main bronchi occlusion were made. Operations were performed mainly via lateral access, without crossing the ribs.

The fact that genetic factors largely determine susceptibility to different diseases, including those of infectious nature is beyond question now. Tuberculosis is not an exception in this respect. HLA genes that determine different immunological phenomena make a certain contribution to tuberculosis susceptibility. This paper presents the results of typing using the polymerase chain reaction from the specificities of the HLA gene DRB1 in patients with pulmonary tuberculosis and healthy individuals in different regions of the Republic of Tuva. The studies in these regions of Tuva have revealed a significant positive association of tuberculosis with the specificities of HLA DRb1 13(6) and HLA DRB1 14(6). Analyzing 14 families of patients with tuberculosis has shown that HLA haplotypes from the sick parents who carry the specificities of HLA DRB1 13 and/or DRb1 14 are more frequently transmitted to sick children than to healthy ones. High morbidity in the indigenous dwellers of the Republic of Tuva may be associated with these specificities of the HLA gene DRB1, which is due to the national peculiarities of the native population of this republic.

The paper presents the results of the activities of tuberculosis-controlling facilities and the general medical network rendering an antituberculous care to the population of Russia in 2003. The epidemic situation in Russian remains to be of strain. There is stabilization or an insignificant improvement of some indices of tuberculosis-controlling work.

The activities of two federal and regional tuberculosis sanatoriums for children and adolescents were analyzed. The clinical characteristics and the results of the examination and treatment were studied in 510 patients aged 12-17 years who had various manifestations of tuberculous infection. The beds in the sanatoriums were ascertained to occupy irrationally: the proportion of patients with local forms of tuberculosis there is not more than 30%. Guidelines for selection of children and adolescents with tuberculosis from risk groups and for detection of the disease were developed. A proposal was made to set up consultative and diagnostic centers at the sanatorium basis. The paper shows it possible and expedient to treat children and adolescents with new-onset local, non-destructive forms of tuberculosis under the conditions of a sanatorium.

The paper presents the organizational aspects of antituberculous care delivered at penitentiary institutions of the Russian Federation. The priorities of development, including the interaction with civil public health care of Russia and the continuation of tuberculosis-controlling activities jointly with international organizations, are identified.

The paper presents the results of sociohygienic and epidemiological monitoring of 133 children and adolescents from familial tuberculous foci. Primary infection with Mycobacterium tuberculosis (MBT) was detected in 26 (19.5 +/- 3.4) patients and its carriage was found in 60 (45.1 +/- 4.3 per 100 contact children and adolescents). The rate of primary MBT infection and carriage is largely determined by the social personality of a bacterial isolating personality, by the level of his/her sanitary culture, by his/her adequate attitude towards treatment, by the duration and nature of his/her contacts with those who have had contacts with infected persons, as well as by household and sanitary conditions in the focus. The sources of infection were significantly more frequently fathers, the handicapped or unemployed, chronic alcoholics, prisoners, those who had a low level of sanitary culture, who had an inadequate attitude towards treatment and had a resultant generalized destructive process in the lung and a permanent bacterial carriage.

The paper presents a clinical and social characterization of patients (n = 747) who died from tuberculosis in Volgograd during 2000-2002 on the basis of an analysis of all fatal cases. The sociomedical factors influencing the mortality of patients with tuberculosis have been determined and the sociomedical portrait of a patient with tuberculosis has been created.

The paper describes the molecular genetic characteristics of M. tuberculosis (MT) strains isolated from 114 patients with pulmonary tuberculosis in the penitentiary system of the Arkhangelsk Region. The sensibility to the first-line antituberculous drugs was determined by the radiometric technique BACTEC; rpoB gene mutations were identified by Inno-Lipa, genotyping was made by the RFLPA assay and spoligotyping. The spread of MT of the genotype Beijing in the penitentiary system was found to be 76.3%. The high rate (79.8%) of the clustering pattern is indicative of active transmission of tuberculosis. The transmission of the Beijing genotype MBT strains was higher (96.6%) than that of other genetypes (25.9%). A multifactorial analysis has shown that streptomycin resistance is independently associated with the infection with the strain of MBT of the genotype Beijing (p = 0.02); the circulation and active transmission of Beijing among the population present a human health threat and an endemic risk from the spread of drug-resistant pulmonary tuberculosis.

The paper presents the current approaches to organizing and supervising tuberculosis at different levels. The present-day conditions for organizational and methodological measures are analyzed, the concept of supervision is defined and its principles and main elements are described.

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.

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 describes a method for comprehensive analysis of the epidemic situation which is based on the major component technique. The algorithm proposed for comprehensive assessment is highly effective in the retrospective analysis and in the analysis of the current material which includes a great deal of various characteristics that are at first sight occasionally unrelated. The use of the algorithm is shown by the example of analyzing 19 statistical variables that characterize the epidemic situation and different aspects of the work of a tuberculosis-controlling facility in 30 districts of the Novosibirsk Region in a period of 15 years (1985-1999). During processing, the variables fall into two groups: a group of variables that characterize the quality of antituberculosis work and a group of those reflecting the epidemic situation, which were used to divide the districts of the region into several groups.

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 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 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 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 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 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 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 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 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 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 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.