The paper covers the content and significance of social preventive measures to control tuberculosis in the Armed Forces of the Russian Federation. Due to their recent reforms, the Armed Forces have taken new twists and military service has itself undergone drastic changes. A reduced call-up military service period, mainly a regional principle for recruitment, improved living, service, and resting conditions for the militaries, their better nutrition and food quality, improved military clothing, etc. have been an important contribution to social prophylaxis. In the past 6 years, only the above changes have caused tuberculosis morbidity to be reduced by more than 55% among the conscript servicemen. This is indicative of the importance of social measures. At the same time, all directions for tuberculosis control remain relevant among the militaries under the present conditions.

The paper presents the results of studying the lifestyle of young people from Stavropol and their awareness of tuberculosis prevention. The gender of the respondents, the composition of their families, their attitudes to religion, and the level of their educational institution have been established to affect the young people’s lifestyle. The knowledge of the respondents about tuberculosis depends on their educational institution, region of domicile, and gender.

The paper presents the experience in surgically treating 145 patients with destructive, mainly fibrocavernous pulmonary tuberculosis. All the patients completed treatment. In the preoperative preparation, particular emphasis is laid on the promptest determination of a spectrum of pathogen susceptibility/resistance, individualized chemotherapy, and collapse therapy options. Postoperative complications occurred in 27 (18.6%) patients, fatal outcomes in 4 (2.7%). The former were recorded most frequently after pneumonectomy in 13 (37.1%) cases, the later were seen in 3 (8.6%). Sputum culture conversion was generally achieved in 111 (78%) patients, particularly in 97 (78.2%) patients with multidrug-resistant tuberculosis and in 14 (66.7%) with a broad drug resistance in the pathogen. Out of the 64 patients followed up for more than 3 years, 48 (75.0%) were in clinical and bacteriological remission.

The paper gives indications for remedial osteoplastic thoracomyoplasty, its advances and techniques. It shows the specific features of modified thoracomyoplasty. The results of this surgical intervention are analyzed in 98 patients from the Lung Surgery Department of the National Center of Phthisiology. The clinical efficiency of the operation was noted in 92.8% of the patients.

The paper describes the experience in simulating the epidemic process of tuberculosis in case of the pediatric population of the Irkutsk Region. The model is based on the results of questionnaire surveys of the parents of 439 children. A group of children from low-income families that are in contact with tuberculosis patients (6%) has been ascertained to have the greatest impact on the epidemiological situation of the disease. The group’s contribution to morbidity rates is 60%. Controlled preventive treatment in risk-group children may reduce morbidity rates for children by 45%.

Анализ эпидемических особенностей туберкулеза в современных условиях указывает на многообразие факторов, имеющих существенное значение в развитии этого заболевания. Основным фактором является бактериальное инфицирование, также имеют значение генетическая предрасположенность, сложный и разнонаправленный иммунный ответ, развитие иммунопатологических реакций, характерных для хронических инфекций [1, 2, 14]. В связи с этим закономерным является интерес к изучению иммуногенетических аспектов, в частности механизмов генетического контроля иммунного ответа и возможностей его регуляции с учетом иммуногенетических особенностей индивида [10, 16-19].

In 2013, 3.3 times fewer patients fell ill with tuberculosis in places of imprisonment than in 1999. Among the new registered tuberculosis cases in the facilities of the Federal Penitentiary Service (FPS) in 2013, there were males (93.7%), persons aged 18-44 years (88.3%); about each two patients (47.2%) were 25-34 years old. The timely detection of tuberculosis is due to the registration of its forms with a small extent in a decay phase in only 21.5% of cases (in the subjects of the Russian Federation (41.3%). The achieved positive changes in the number of tuberculosis cases in the places of imprisonment cannot be considered as a steady state. This is associated with the fact that the proportion of tuberculosis patients with HIV infection in the penitentiary facilities was on the rise (21.9% in 2013); the efficiency of treatment in the patients was substantially influenced by multidrug resistance recorded in 77.8% of the patients who died of tuberculosis. The contribution of FPS to the structure of new notified HIV infection cases annually decreased in Russia: 19.4% in 1997; 13.0% in 2013. Since 2007, the places of imprisonment had been annually registering about 10,000 people, with slight variations by years. The men imprisoned in the FPS facilities of Russia made up the majority of the new registered HIV cases (82.8% in 2013). The cause of death in patients with HIV/TB co-infection is mainly HIV infection since the latter has late stages in 82.0%.

The paper considers doctor-patient relationships, compliance in routine practice, and the psychological characteristics of patients with pulmonary diseases.

The paper describes three rare cases of extrapulmonary tuberculosis: placental tuberculosis, tuberculomas of the Fallopian tubes, tuberculosis of the skin and subcutaneous tissue, and Stage 4 obesity. It analyzes the reasons for the untimely detection of extrapulmonary tuberculosis and emphasizes that physicians of all specialties should be always alert to tuberculosis.

The paper describes two clinical cases of progressive focal pulmonary tuberculosis in 11- and 12-year-old children. Chemotherapy regimen III was used because of the absence of bacterial excretion and the mild involvement of lung tissue. Following 4-month therapy, a focal decay appeared in the left lung (C1-2) of the former patient. The female patient was operated on. M. tuberculosis DNA was identified by PCR in her intraoperative specimen; isoniazid and rifampicin resistance was determined. Occult multidrug resistance was a reason for ineffective treatment with first-line drugs. After 6-month chemotherapy, the size of a focus in the right left (C1-2) doubled and a new focal shadow emerged in the lung of the latter patient. The progression was related to the untimely obtained information on a broad drug resistance in the infection pathogen and to the chemotherapy performed by ignoring these data. Chemotherapy correction in view of the data of a drug susceptibility test could provide a positive result in both cases.