[Training of physicians-phthisiologists in the Urals Federal Region]. / Podgotovka vrachei-ftiziatrov v Ural'skom federal'nom okruge.

The paper analyzes problems associated with the training and retraining of staff for phthisiological service and general practitioners, such as therapists and pediatricians, in the timely diagnosis of tuberculosis. The authors share their experience in organizing the training of physicians in antituberculosis aspects. Interaction of departments of tuberculosis and a regional research institute of phthisiopulmonology and the use of current educational technologies are required to enhance the efficiency of this work.

[Tuberculosis in older children and adolescents in an industrial region]. / Tuberkulez sredi detei starshego vozrasta i podrostkov v promyshlennom regione.

60 children and adolescents with tuberculosis aged 12-17 years were examined to specify typical features of the infection in present-day social and economic situation and approaches to its early prehospital diagnosis. The majority of the patients were girls infected with M. tuberculosis 2-3 years before the examination, exposed to a single BCG vaccination with one postvaccination mark. Half of the patients were identified by the symptoms, one third by fluorography, the rest by tuberculin diagnosis or contact. A complex of measures is proposed to improve prehospital diagnosis in children and adolescents.

[Tuberculosis in young children not vaccinated with BCG]. / Tuberkulez u nevaktsinirovannykh BTsZh detei rannego vozrasta.

Manifestations of tuberculosis infection were studied in 168 infants aged 3 months to 3 years of whom 32.7% had not been given BCG vaccine at birth and 67.3% received improper vaccination (the postvaccinal skin signs were absent in all patients). In 58.9% of the infants, local tuberculosis ran along with complications: dissemination into the lungs and other organs were detected in 44.4%, bronchopulmonary lesions in 42.4%, destruction of lung tissue in 18.2% and tuberculous extrapulmonary lesions in 28.3% of the infants. Specific changes were located in several organs in 9.1%. Tuberculosis of the intrathoracic lymph nodes and primary tuberculosis complex had a complicated course 2.2 times and 3.2 times more frequently, respectively, in BCG unvaccinated than in vaccinated infants. Acute tuberculosis (tuberculous meningitis, miliary and progressive tuberculosis with fatal outcome) in infancy is common in 75-100% of the unvaccinated children. Hence immunoprophylaxis of tuberculosis in newborns must be developed and improved.

[Characteristics of newly detected tuberculosis in adolescents]. / Kharakteristika vpervye vyiavlennogo tuberkuleza u podrostkov.

Socioepidemiologic and clinico-roentgenologic features of tuberculosis in 107 adolescents were studied. In 33 per cent of the adolescents, the disease was detected on referral to a polyclinic; in 57.5 per cent of them, on planned fluorography; in 5.8 per cent, on examination as contact persons; and in 3.7 per cent, on tuberculin diagnosis. Subjects with secondary forms of tuberculosis constituted the majority among the affected. The proportion of the patients with destructive forms of tuberculosis and the excretors of tubercle bacilli made up 28.4 and 38.6%, respectively. The contact was confirmed in 36 per cent of the adolescents. The disease caused by a primary infection coincided in 9.7 per cent of them, with the rest being infected during their childhood.

[Treatment and outcomes of complicated tuberculosis of the respiratory organs in young children]. / Lechenie i iskhody oslozhnennogo tuberkuleza organov dykhaniia u detei rannego vozrasta.

The main course of tuberculosis chemotherapy was applied to 85 children at the age of 3 months to 3 years. 62.4, 30.6 and 7.0 per cent of the children suffered from tuberculosis of the intrathoracic lymph nodes, primary tuberculosis and miliary tuberculosis, respectively. The children of younger ages were subjected early during the treatment to intensive chemotherapy consisting of intravenous administration of isoniazid in parallel with 2-3 antituberculous drugs applied to 41.2 per cent of the children and of infusion desintoxication therapy applied to 74.1 per cent of the children. The chemotherapy regimen including isoniazid + streptomycin + ethionamide resulted in clinical recovery 10.1 +/- 0.32 months later, in 48.1 per cent of the patients, the tuberculous inflammation completely resolving, in 40.7 per cent it consolidated and in 11.1 per cent it petrificated. 31 patients with the most severe processes were treated, in addition to the above drugs, with rifampicin as rectal suppositories within 87.0 +/- 3.3 days. The clinical recovery was observed in 10.9 +/- 0.22 months (p greater than 0.05); specific inflammation resolution, consolidation and petrification being observed in 41.9, 45.2 and 12.9 per cent of the children, respectively. The morphofunctional indices of T- and B-immunity markedly lowered at the beginning of the treatment returned to normal 3 months earlier in the patients treated with rifampicin.