[Prevention of noncommunicable diseases in a local therapist's practice: content, problems, solution ways, and prospects].

High-risk and secondary prevention strategies for noncommunicable diseases in primary health care are mainly implemented by local therapists. The large-scale clinical examination of an adult population (a high-risk strategy), which has been launched in the country since 2013 to solve the problems of detecting people with noncommunicable diseases and their risk factors and making a prevention counseling, is simultaneously a mechanism for the formation of a full therapeutic area passport to identify follow-up groups (a secondary prevention strategy). Currently, there is an obviously insufficient follow-up of inadequate quality. The reasons for this situation are a lack of regular training of local doctors in follow-up in addition to staff shortages. Medical teachers and professional communities working on the basis of common guidelines must be attracted to solve this problem. The actual introduction of a local therapist's efficient performance measures, the setting up of special structures in charge of primary care prevention in the health authorities, and the active involvement of medical prevention and health centers (for people at high risk in the absence of proven non-communicable diseases) in this process will be able to enhance the efficiency of a follow-up. Information technologies, including a tele-follow-up, are an important reserve in implementing the high-risk and secondary prevention strategies.

[Effectiveness of the standard mode of chemotherapy for newly-diagnosed patients with destructive pulmonary tuberculosis with bacterial isolation]. / Effektivnost' standartnogo rezhima khimioterapii pri lechenii vpervye vyiavlennykh bol'nykh destruktivnym tuberkulezom legkikh s bakteriovydeleniem.

The authors evaluated the efficiency of a routine drug therapy regimen by the WHO category 1 in treating 149 new cases of destructive pulmonary tuberculosis and bacterial isolation. They used not only the WHO sputum smear negativization criterion, but the data of cultural studies and on lung cavernous closure. The specific features of the approach applied were compulsory cultural studies determining Mycobacterium sensitivities before treatment and compulsory correction of chemotherapy after there was evidence for the sensitivity. Retrospective analysis of 6-month chemotherapy has ascertained that the efficiency of the routine drug therapy regimen largely depends on the baseline extent of infiltrative and destructive changes in the lung and on the baseline resistance of Mycobacteria tuberculosis. They showed a high baseline resistance to streptomycin (20.6%) and streptomycin and isoniazid (33.1%) and a low baseline resistance to ethambutol (5.1%). In these cases, the more optimum regimen was a combination of rifampicin, pyrazanamide, and ethambutol. When Mycobacteria showed multidrug resistance, the routine regimen was ineffective and caused amplification to a larger number of drugs. A modified treatment course using the routine regimen in the intensive phase was developed. If Mycobacterial resistance was present, compulsory correction was made by using reserve agents, pathogenetic treatments, artificial pneumothorax or surgical interventions, which made it possible to abacillate 94.1% of patients by their smears and culture by months 4-5 and to close caverns in 91.3% of cases by months 8-10.