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The analysis of publications concerning the impairment of fertility in the patients presenting with congenital adrenal cortical hyperplasia was focused on the reduction of the degree of estrogenization. It included the data on the course of sexual development and the outcomes of feminizing plastic procedures in the girls suffering this disease depending on the degree of its compensation and the date of onset of the treatment.

The results of the systemic antimicrobials (AM) consumption and expenditures assessment in the departments of surgery of multi-profile hospitals in different regions of the Russian Federation and the Republic of Belarus in 2009-2010 based on retrospective collection and analysis of the data from the hospital expenditure notes using ATC/DDD methodology are presented. The average AM consumption and expenditure rates in the above mentioned departments varied from 24.9 DDD/100 bed-days to 61.7 DDD/100 bed-days depending on the department profile, with beta-lactams (cephalosporins and penicillins) share in the consumption being as high as 70-90%, followed by fluoroquinolones and aminoglycosides. Only 55-70% of the consumed AM belonged to the drugs of choice, whereas the improper AM consumption and expenditure rates amounted up to 10-18%. The study outputs can be used for the budget allocation and AM distribution improvement in the departments of surgery, as well as for the development and efficacy control of the local antimicrobial stewardship programs.

The authors review the publications devoted to the problem of health quality in the children born through assisted reproductive technologies. The data on the state of somatic and psychic health of such children are discussed. The main lines of investigations into the possible consequences of extracorporeal fertilization and its modifications are proposed. Special attention is given to the problem of comparability of different studies, the relevance and reliability of conclusions based on their results.

We report on the results of experiments on polarization switching in a ferroelectric TGS crystal during injection of electron beams from a scanning electron microscope under a surface layer. A series of models reflecting the polarization switching dynamics of a ferroelectric crystal under the action of an injected charge is constructed. The implementation of these models is based on the principles of evolution of domain structures taking into account analysis of possible polarization switching mechanisms for ferroelectric samples. A mathematical model developed using these principles demonstrates qualitative similarity of model current pulses and those obtained experimentally in the injection mode.

Scanning electron microscope (SEM) ability to control focused electron beam allows studying materials, which are highly responsive to external exposure. Active modes of SEM investigation based on specific responses are suggested. A modification of electron beam induced current mode for domain imaging in TGS-crystals is suggested. A focused electron beam can be used as a local heat source for SEM images due to pyroelectric effect. The peculiarities of a SEM domain structure image caused by electrical and thermal factors are considered.

New modes of visualization of ferroelectric domains in the SEM were developed. The crystallographic contrast on a-c domains in PbTiO3 single crystals was observed due to channeling of electrons. It was possible to observe domains in a PZT-family of ceramics through a thin conductive gold electrode using increased accelerating voltage (to 15 kV). The electron stimulated polarization current mode is based on variation of the polarization under action of a probe penetrating through a metal electrode. Barkhausen jumps were used for creating a map of domains.

The domain structure of TGS crystals was investigated by means scanning electron microscope in the electron beam induced current mode. The injection of the charge under the electrode creates electric fields and causes an intensive polarization reversal. Polarization switching current of TGS samples was studied simultaneously.

In recent years, there has been a significant expansion of the nomenclature of medicinal preparations of plant origin. To a considerable extent, this is due to the creation of complex pharmaceuticals based on several medicinal plants or, sometimes, on a rather large number of such plants. Besides the popular herbal mixtures and solid dosed medicinal forms prepared from raw plant materials, there is growing interest in liquid preparations of complex composition (extracts, elixirs, etc.). Recently, a new complex preparation for the treatment of disorders of the oral mucous membrane and periodontium was created at the State Research Institute of Medicinal and Aromatic Plants (Moscow). This liquid preparation represents a mixed aqueous-ethanol extract from seven official medicinal plants, including peppermint leaves, macleya herbs, garden sage herbs, common yarrow herbs, camomile flowers, purple coneflower herbs, and pot marigold flowers. The extract possesses antiinflammatory, wound-healing, regenerating, and antimicrobial properties. This curative effect is due to various groups of biological substances present in the composition. Garden sage, camomile, peppermint, and common yarrow contain essential oil; macleya contributes alkaloids of the chelidonine group; purple coneflower yields a complex of phenolcarboxylic acids; and pot marigold gives flavonoids, which are also present in all other plants except for macleya. The final preparation also contains carbohydrates, carotenoids, trace elements, organic and fatty acids, steroids, saponins, and other components [1 – 9]. Obviously, standardization of such a muilticomponent preparation poses a relatively complicated problem, which requires an individual approach. The general quality of the preparation is evaluated according to the State Standard OST No. 91500.05.001-00 [10], stipulating tests for the identity, quantitative content of the total of biologically active substances, dry residue (moisture content), alcohol concentration, heavy metals content, and microbiological purity. Since the preparation includes components obtained from various plants containing specific combinations of biologically active substances, the test for identity involves general qualitative group reactions for terpenoids, alkaloids, and phenolic compounds (flavonoids, phenolcarboxylic acids, etc.) and a TLC check. Flavonoids are detected using the cyanidin reaction. The presence of tannins is checked by a reaction with iron hydroxychloride. The total terpenoid content is detected by the reaction with vanillin solution in concentrated sulfuric acid and by TLC [11]. Prior to this, the terpenoids are isolated by double extraction with an organic solvent and the solvent is distilled off in vacuum at a temperature not exceeding 40°C. A qualitative analysis for terpenoids and alkaloids is performed by TLC.

The composition, the outcomes of treatment and a follow-up were analyzed in 4 954 first detected adult patients with pulmonary tuberculosis and the baseline negative results of a sputum test for acid-resistant mycobacteria, with the involvement of not more than a lobe. The basic course of therapy yielded clinical and X-ray effects in 83.6% of cases. In the late period of a follow-up, the rate of clinical cure was 93.4%; that of death from tuberculosis, formation of chronic incurable forms of the process, and recurrent tuberculosis was 1.4, 0.9, and 0.9%, respectively. Treatment interruption, multidrug resistance, social disadaption of patients, and severe comorbidity were responsible for the poor outcomes of timely detected tuberculosis.

The procedure and results of forced treatment per curiam were analyzed in 584 bacteria-discharging persons registered as Group 1 patients to be examined in the tuberculosis facilities of the Kemerovo Region in 2004 to 2007. If a package of measures for forcing the patient to be treated is ineffective, a phthisiatrician draws up documents for court. By the decision of the court, the patient is conveyed by justice officers to a tuberculosis hospital. Judicial practice provides a means of substantially enhancing the efficiency of treatment in this socially compromised group of patients with predominantly destructive processes. Among those who had voluntarily come to the hospital just before or after sentence pronouncement, bacterial discharge cessation and decay cavity closure were achieved in almost 90% of cases; clinical resolution was observed in two thirds. At the same time, there is a group of patients, in whom the existing system of measures has proven to be ineffective. There are serious gaps in the legislation of the Russian Federation, which impede the bringing of patients with tuberculosis, the homeless in particular, to compulsory hospitalization. Legislation should be perfected in this area.

The clinical and immunological features of the course of pulmonary tuberculosis (PT) were studied in 418 patients with HIV infection. PT developed in the presence of HIV infection in 212 patients (Group 1), active PT was detected before HIV infection in 72 (Group 2), TB and HIV infection were concurrently diagnosed in 134 patients (Group 3). In the region, most patients with TB and HIV infection were found to have a moderately suppressed immune response. There was a high proportion of patients with disseminated TB in Groups 1 and 3 and those with chronic TB in Groups 2. In Groups 2 and 3, fibrocavernous PT was registered several times more frequently.

The experience of interdepartmental interaction in solving the problem of tuberculosis in the Kemerovo Region has been analyzed. The region's administration has strengthened the material-and-technical basis of the service. The advisory tuberculosis council has been set up. Territorial interdepartmental commissions have been organized. The level of an intervention with the general medical network (GMN) has been increased. A qualitative sputum test has been carried out for acid-resistant mycobacteria. The Main Board of the Federal Penal Jurisdiction Service (MBFPJS) and the Board of Internal Affairs are attracted to examine social risk-group persons. Strictly uncontrolled chemotherapy for patients with tuberculosis has been introduced on the basis of GMN at the stage of aftercare and by the forces of the Red Cross Committee. Along with the MBFPJS, continuity has been established in the treatment of patients with tuberculosis. Juridical attraction of bacteria-isolating person to treatment has been introduced. The work done has substantially improved the detection and treatment of patients, but there are problems to be solved.

Measures to improve the organization of microbiological diagnosis of tuberculosis and to upgrade its quality have been implemented in the Kemerovo Region. The regional reference laboratory has been reconstructed in accordance with the international standards. Inter-regional centers for microbiological diagnosis of tuberculosis have been set up on the basis of large tuberculosis treatment facilities. Sputum microscopy centers have been opened on the basis of general medical service. A multileveled system for surveillance of laboratories and their staff training has been established. The work done has significantly improved the coverage of those who are to be studied and the quality of microbiological diagnosis.

The composition and effectiveness of the treatment of patients 159 drug-resistant TB of Mycobacterium tuberculosis. Dominated by common processes (87%), massive bacterioexcretion (74.2%) and multidrug-resistant TB. Full clinical effect achieved in 54.8% (n = 68), including 28.8% (37) by surgical methods.

The results of examination and treatment were analyzed in 23 children with disseminated and miliary tuberculosis. Babies of the first year of life made up more than 1/2. After BCG vaccination, the scar was less than 5 mm in diameter in most cases. Tuberculosis began predominantly gradually; in half the children, it was sever, but without a pronounced temperature reaction. Roentgenologically, it most frequently manifested itself as total dissemination with polymorphic foci. The miliary process was diagnosed in 3 children. The rate of deaths was 13%. A positive clinical effect was achieved in 87% of the patients.

Two hundred and forty eighty deaths from pulmonary tuberculosis were analyzed in adults. The most frequent cause of deaths was progressive tuberculosis, mainly as caseous pneumonia (60.9%) and the less frequent one was a multicavernous process with bronchogenic (28%) and hematogenic (15%) dissemination. The high incidence of specific intrathoracic lymph nodal lesions, which has increased from 10.8% in 1994-1995 to 30.4% in 1997-1999, and a larger number of hematogenic dissemination from 6.7 to 25.6%, respectively, are noteworthy. Progressive tuberculosis was most commonly favoured by the patients' inadequate attitude towards their health: delayed visits to a doctor when they have symptoms of the disease, the absence of fluorographic examinations, treatment errors due to their incompliance.

The paper presents the results of psychological examination in 110 adolescent patients with respiratory tuberculosis and 89 healthy adolescents aged 13 to 17 years. Most adolescent patients were found to be highly anxious personalities, they were all diagnosed as having accentuation of character. The adolescent patients differed from healthy individuals by inadequate communicability, sensitive, liability to accumulation of negative emotions, by bad need for support and feelings to be taken hard, by marked internal strain and yearning for showing his/her individuality. This also had led to the lower behavioral range, made social adaptation difficult, promoted the susceptibility to stress exposure, and increased a risk for a disease. The psychological peculiarities found may be factors that predispose to tuberculosis.

Examination of 37 children and adolescents with long-term subfebrility and other manifestations of intoxication without local pathological changes included blood test (polymerase chain reaction) for M. tuberculosis. Tuberculous bacteriemia was discovered in 16(43.2%) cases. Non-acute onset and long-lasting intoxication, rejection of other reasons, tuberculin sensitivity, reduction or disappearance of the intoxication in antituberculous treatment, negative results of repeated PCR for M-tuberculosis gave grounds to suspect active tuberculosis in 13 children of 16. Clinical and x-ray picture corresponded to tuberculous intoxication in children and adolescents.

The study of clinical and X-ray manifestations of the disease in 270 patients has shown that the incidence of disseminated tuberculosis with its acute onset and marked clinical manifestations has greatly increased. It is difficult to make a diagnosis of recently more frequent tuberculosis of the intrathoracic lymph nodes in adults due to acute clinical manifestations resulting from nonspecific inflammation with frequent abscessing at the site of atelectasis in lobar and segmental bronchopulmonary lesions, due to late detection of meagre bacterial isolation, to frequent involvement sites in 3, 4, and 5 segments. Acute generalized disseminated tuberculosis generally follows obscure clinical manifestations from extrapulmonary inflammation in 2-4 months. Acute miliary tuberculosis has frequently accompanied by bacterial isolation and frequently destructions.

Autoptic findings of 120 patients with respiratory tuberculosis indicate that under the present-day conditions, the prevalent cause of death was a progressive tuberculous process as caseous pneumonia (89% of cases), which is much higher than our previous findings (42.9% in 1989 versus 66.% in 1994). Caseous pneumonia chiefly resulted from fibrous-cavernous tuberculosis, less frequently from an independent entity or manifestations of disseminated tuberculosis. Fibrous-cavernous tuberculosis, the major clinical form in the deceased, was frequently associated with specific involvement of intrathoracic lymph nodes (10.8% of cases) and also complicated by the hematogenic generalization of the process (6.7%) and specific pericarditis (5.0%). Progressive tuberculosis resulted in its later detection in a third of cases and irregular treatment in two thirds.

To meet the requirements of insurance medicine to be introduced in this country, special medical and economical standards as regards tuberculosis have been developed for antituberculosis services. The standards summarize and systematize the minimum preventive and treatment measures to be provided for the population of the districts and regions. Criteria of the treatment quality have been formulated. The patients of the antituberculosis institutions have been grouped by curability, follow-up duration, operability. The standards are to help in granting licences, opening credits for treatment and prophylactic institutions and in controlling their activities under insurance medicine.

The first results are given of the elaboration of the specific features of antituberculous measures control in the general medical network under conditions of the budget-insurance medicine. The clinico-economic standards have been compiled, which are the obligatory programs of actions of medical prophylactic establishments as well as the required final results (quality standards). Systematization of the tasks of antituberculous work and methods of their solution for feldsher's station is presented as an example. A characteristic is given to the approaches to quality standards compilation A preliminary determination of a necessary volume of knowledge concerning tuberculosis is given as well as the list of the practical skills that a general practitioner should master. The documents elaborated make the basis for the medico-prophylactic establishments to be accredited, for certification of doctors and the evaluation of their work by the insurance companies.

To increase the efficiency of antituberculosis measures, some efforts have been taken to improve on the basis of economic methods of management the structure of district tuberculosis control service financing and activities. The network of antituberculosis institutions is centralized into big tuberculous associations and ++inter-district dispensaries. ++Clinico-statistical groups, including the quality standards and the models of end results, i. e. the lists of indicators and their standard values, were developed to support mutual financial operations and quality evaluation efforts of the current activities. The amount of material incentive of the medical personnel directly depends on the quality of its work. In this way a material incentive of every medical worker, structural unit, institution and service as a whole is ensured in bringing up the effectiveness of the antituberculosis activities. Initial positive results have already been obtained.

The pKa values of a number of alkaloids in water or in aqueous ethanol have been measured by the potentiometric titration method: nuphleine — 4.59, 6.98; brevicolline — 5.17, 8.02; chelidonine — 6.40; sanguinarine — 7.32; chelerythrine — 7.53; stepharine — 8.48; d-pseudoephedrine — 9.49. For nuphleine and brevicolline, each of which has two nitrogen atoms capable of protonation, assignments have been made of pKa values to the corresponding atoms on the basis of the results of UV spectroscopy.

For analyzing the herb plume poppy a spectrophotometric method has been developed which is distinguished by a high productivity thanks to the absence of a stage of chromatographically separating the combined alkaloids. The error of a single determination is ±5.07%.