Questionnaire survey in 236 doctors and 584 patients has shown that provision of social and psychological support to tuberculosis patients is very limited despite the significant demand for it, which provides negative impact on treatment and rehabilitation results. The article presents various possible actions aimed to improve this situation.

Goal of study: to assess the Charlson comorbidity index in those suffering from chronic obstructive pulmonary disease (COPD).

Materials and methods. 207 patients suffering from COPD smoking for a long period of time (the smoker index of 240 and time of smoking of 40 packs/years were enrolled into the study. SCORE risk charts were used for evaluation of cardiovascular risk. The respiratory function was evaluated by the multi-module unit of MasterLab/Jaeger type. Charlson comorbidity index was used to assess comorbidity.

Results. Charlson comorbidity index made 4.49 ± 1.50 scores in the studied group, those with very high cardiovascular risk made 68.9%. The confident correlation has been found out between total cardiovascular risk and Charlson comorbidity index. Direct moderate correlation has been found out between comorbidity index and rates of packs/years. Confident correlations have been found between comorbidity index and VC (r = -0.39, p < 0.005), comorbidity index and RV (r = 0.46, p < 0.05). 

Specific features of psychological state were studied in 295 pulmonary tuberculosis patients with satisfactory tolerance to anti-tuberculosis medications and 75 patients poorly tolerating the treatment.

Before the treatment start the patients who later demonstrated adverse reactions to treatment were diagnosed with more intense neurotic and hypochondriac personal features, destructive reactions and higher level of emotional tension and frustration – all the above promote dysregulation of the host adaptation. The research demonstrated the need to consider psychological aspects when studying the tolerance to anti-tuberculosis chemotherapy. 

In order to define specific constitutional features of the children infected with tuberculosis 222 children in the age from 1 to 14 years old have been examined: 106 children with active tuberculosis; 54 children with remaining post-tuberculosis changes; 62 children infected with tuberculous mycobacteria. The following types of diatheses were identified: lymphohypoplastic, allergic, neuroarthritic, exudative-catarrhal. It has been found out that among those with active tuberculosis the children suffering from lymphohypoplastic and neuroarthritic diatheses prevail (17.0 ± 3.7%), and allergic diathesis is less common (10.4 ± 3.0% cases). Children with lymphohypoplastic diathesis have a complicated course of tuberculosis (27.8 ± 10.6%) and more intensive intoxication syndrome (55.6 ± 11.7%). The frequency of allergic diathesis is higher in the children with remaining post-tuberculosis changes (29.6 ± 6.2%) and those infected with tuberculosis (33.8 ± 6.1%) compared to children with active tuberculosis (10.4 ± 3.0%).

Time period required for diagnosis in those with suspected pulmonary tuberculosis was analyzed; diagnostic value of immunological tests done in 70 patients (diaskintest and QuantiFERON®TB Gold) was studied and the results were presented. As a result of this comprehensive examination 20 patients were diagnosed with tuberculosis and 50 patients were diagnosed with non-tuberculosis diseases. The analysis has proved high sensitivity of diaskintest – 75%, QuantiFERON®TB Gold – 90% and their specificity is 86 and 84% respectively. The factors associated with positive results of both tests have been detected.

The level of uric acid in blood serum was investigated in 134 new patients suffering from multiple drug resistant pulmonary tuberculosis (78 men and 56 women). The tests were performed by admission to hospital and then repeated in 1, 2, 3, 4, 5, 6, 7 and 8 months of treatment. Prior to chemotherapy the increased uric acid level was observed in 28.2% of men and 37.5% of women. During treatment with pyrazinamide uric acid level increased in this category of patients in 1 month after treatment start and further it went down; however it was above normal during the whole course of treatment. Monitoring of uric acid level in the patients with initially normal rates has shown that the primary increase of uric acid was observed during the whole course of chemotherapy (8 months) and more often during the first 2 months of treatment both in men and women.

Goal of the study: to evaluate the test with tuberculous recombinant allergen (TRA) in the patients with effective treatment course due to tuberculosis, to investigate the impact of clinical, epidemiological and social factors on persistence of active tuberculosis.

Materials and methods. Patients were divided into 2 groups basing on time period after completion of the main treatment course. Group I – 32 patients (up to 6 months), group II – 63 patients (more than 6 months).

Results of the study. Results of TRA tests in Group I remained positive in 34.4% of patients and in Group II - 23.8%. The average size of the induration in Group I made 10 mm(95% CI 6.5-13.3), in Group II – 13 mm (95% CI 8.4-19.7) Patients from Group I had positive results of TRA test more often in case of initial infiltrate form of pulmonary tuberculosis and bacillary excretion. In patients from Group II the positive TRA results correlated with presence of concurrent conditions and exposure to a tuberculosis case in the past. Positive results were confidently more often observed in lonely patients in both groups. TRA test can be a valuable tool to evaluate the risk of tuberculosis relapse after completion of the main treatment course. 

Tuberculosis mortality was analyzed basing on regional differentiation in the Russian Federation in 1975-2014. Stable differences between regions when distributing this rate and its changes through time were evaluated as per two geographical regions. One of them was described by a spatial gradient pointing at the increase of the rate along the geographical axis from the north to the south. The second direction complied with the differentiation gradient presenting the increase in tuberculosis mortality in the direction from the west to the east. The article also demonstrates certain advantages and limitations of this spatial distribution analysis of generalized tuberculosis mortality rates.

Goal: to investigate specific methods of tuberculosis control teaching to students of Pediatric and General Medicine Department at Phthisiology and Pulmonology Department of Siberian State Medical University subordinated to the Russian Ministry of Health.

Materials and methods. Main training curricula and teaching programmes for professional lines of 31.05.01 on General Medicine and 31.05.02 on Pediatrics, students' questionnaires.

Results. The article presents the experience of self-tuition of students while preparing to practical training in tuberculosis control in order to enhance the efficiency of mastering this topic, to form positive motivation to have training and productive activities, to develop the skills of information collection and its compilation for public presentation; it describes the task teachers face when implementing Federal State Educational Standard of Higher Education.

Conclusions. It is necessary to optimize the training in order to enhance the self-tuition of students when preparing for practical training in tuberculosis control; new forms of training are to be introduced. 

Sclerosing pneumocytoma is a rare tumor. Most frequently it occurs in women at the age from 30 to 50 years old. Prevalently sclerosing pneumocytoma is a tumor with a single localization at the periphery of the lung. However sometimes diffuse lesions of both lungs can develop, when indurated foci of the tumor are located in the lung tissue. The article presents the clinical case of diffuse sclerosing pneumocytoma in 57-year-old female patient. Marginal excision has been performed for diagnostics of the disease. The set of immunohistochemical stains with monoclonal antibodies was used for accurate identification.