Biomedical subjects
Publications and source records attributed to L N Rybka.
Tuberculosis cases in Russia doubled from 1991 to 2000, when the incidence reached 90 per 100,000; and Russian TB mortality rates are the highest in Europe. Implementation of WHO-recommended DOTS strategy is in the preliminary stages. The epidemiological data are presented as is the implementation strategy for stabilizing the epidemic.
To execute the tuberculosis control programme in the Ivanovo Region, the authors calculated the cost of detection of a tuberculosis case at patients' referrals to a therapeutical-and-prophylactic institution for medical aid and during prophylactic X-ray fluographic examinations and the cost of tuberculosis cure while treating the patient at a hospital in the intensive treatment phase (2-3 months) and in the outpatient setting or at a day hospital by the intermittent method in the continued treatment phase. The costs calculated were compared with those obtained by early approaches. The cost of detection of a tuberculosis case was 1580.8 for referrals in 1996 and 4000 for X-ray fluographic prophylactic examinations. The costs of hospital tuberculosis cure (85% cure rates) only in the intensive treatment phase (for 2-3 months) and outpatient intermittent treatment (for 2-4 months) with and without meals were 2415.34 and 2142.17 respectively. If the efficiency is equal, the introduction of new approaches to organizing the detection and treatment tuberculosis cases may save 3877.7 for each cured tuberculosis case and 2419.2 for each patient detected.
In 1993-1995, tuberculosis morbidity increased from 37.8 per 100,000 inhabitants to 55.7. The increase was due chiefly due to incidence rates among urban dwellers. In the same period, tuberculosis mortality rose from 10.2 to 55.7 per 100,000. Tuberculosis control strategy has been revised under the conditions of the increasing spread of tuberculosis infections and the Central Research Institute of the Russian Academy of Medical Sciences jointly with the WHO Global Programme Department has developed the programme "Detection of Patients Isolating Mycobacterium tuberculosis by the ??Tsil-Nilsen method and Their Short-Term Chemotherapy". Analyzing the preliminary data available during 2 quarters (Quarter IV, 1995, and Quarter I, 1996) indicated its adequate efficiency.
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The problems of detection and treatment of patients with tuberculosis, which are of paramount importance for today, are presented through the analysis of the tuberculosis epidemic situation in the country and of the sociomedical characteristics of new cases (49% of socially disadapted persons). Of the most significance is the need to promptly identify patients with strains on their referral to the general somatic hospitals for complaints by using 3-multiple sputum bacterioscopy for Mycobacterium tuberculosis by the Ziehl-Neelsen method. The vital problem is also to change chemotherapeutical regimens as more severe progressive types of the disease require more active treatment in the first months after detection especially in the cohort of socially disadapted persons.
By analyzing the present-day tuberculosis epidemiological situation in the country and sociomedical characteristics of new cases, the authors present methods for detecting and treating patients, which are of paramount importance for today. Of the most significance is the need to promptly identify patients with strains on their referral to the general somatic hospitals for complaints by using 3-multiple sputum bacterioscopy for Mycobacterium tuberculosis by the Ziehl-Neelsen method. The vital problem is also to change chemotherapeutical regimens as more severe progressive types of the disease require more active treatment in the first months after detection especially in the cohort of socially disadapted persons.
Screening for tuberculosis has revealed active disease in 30 of 168 examinees. They have arrived in Russia as refugees from Somalia, Afghanistan, Angola and other countries. 24 refugees had pulmonary tuberculosis. Destruction of pulmonary tissues and massive discharge of M. tuberculosis were found in 10, 2 and 1 patients with infiltrative, disseminated and fibrous-cavernous tuberculosis. A specific therapy with 3-4 drugs stopped discharge of the bacteria with sputum. It is stated that refugees from foreign countries may constitute a great epidemiological threat of tuberculosis for contacting Russian population.
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Homeless patients with tuberculosis form a special group. Being out of therapeutical-and-prophylactic institutions sight and violating elementary sanitary regulations, they are, from an epidemic standpoint, the most dangerous part of a tuberculosis reservoir. Tuberculosis morbidity rates in the homeless are extremely high and tens times as great as those among other populations. The existing system for detecting tuberculosis among the homeless is not very effective. Much better results are achieved by nongovernmental philanthropic institutions where homeless persons apply to for medical and social aids. About half the homeless patients with tuberculosis were referred to Tuberculosis Hospital 11 of the International Organization "Physicians Without Boundaries". The patient's personality is, in general, the most vivid terms, characterized as asthenic; with low intelligence and constitution; asocial, aggressive, and being a carrier of the motive of acquired helplessness. This group of patients needs not only medical efforts, but sociolegal and sociopsychological rehabilitation. The activities of Tuberculosis Hospital 11 wherein a room of social aid and rehabilitation has been functioning since 1995 may be an example of a comprehensive approach to tackling the problem of homeless patients with tuberculosis.
Data on tuberculosis morbidity covering the period 1950-1989 are presented: special features of tuberculosis epidemiology for the studied period are emphasized; grouping of the republics is given by tuberculosis morbidity rates and pattern; difficulties encountered in tuberculosis prevention and detection are discussed which can adversely affect the decline of tuberculosis mortality rates.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.