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Main arrow Archive of previous Issues arrow ╣2 2011 (18) arrow Outcomes of management of pulmonary tuberculosis: comparison between primary pattern and secondary destructive pattern
Outcomes of management of pulmonary tuberculosis: comparison between primary pattern and secondary destructive pattern Print
Thursday, 02 June 2011

Tsybikova E.B.
Federal Public Health Institute, Moscow

The resume. Background: The Millennium has passed, yet pulmonary tuberculosis is still at a rise in Russia, the main reason being low efficiency in management of secondary destructive pulmonary tuberculosis.

The aim of this study was to analyze in a cohort survey the outcomes of management of primary pulmonary tuberculosis and secondary destructive pulmonary tuberculosis in Russian Federation in 2007-8.

Methods: A comparative analysis of outcomes was implemented in two groups: patients with primary pulmonary tuberculosis and patients with secondary destructive pulmonary tuberculosis. The study was carried out through analysis of the data from the cohort survey of RF in 2008. The latter was carried out on the basis of medical registry and accounts produced according to the Order No.50 of 13.02.2204 of the Ministry of Public Health and Social Development. For comparative analysis of the results, an accurate method of Fisher was used when comparing Tables 2X2 through the program EPIINFO, Version 3 (EPOCDC,1988).

The investigation into a structure of the cohort of successfully cured incidental patients with pulmonary tuberculosis was carried out. The patients of this cohort were classified along presence/absence of bacterial excretions assessed with microscopy of sputa.

The Districts of RF were ranged along the total number in 2008 of surgical interventions performed in them for tuberculosis in patients of this cohort. Three categories has been established: Districts with 200-320 operations, Districts with 100-200 operations, and Districts with 50-100 operations.

Results: Comparative analysis proved that efficiency of treatment for incidental destructive tuberculosis was evidently lower than for the primary tuberculosis. The structure of the group of effectively cured patients was dominated by patients in whom the disease was not accompanied by bacterial excretion, while the patients with associated bacterial excretion most frequently failed to be uncured and occasionally died. Lack of surgery in combined treatment for incidental destructive pulmonary tuberculosis is found in half a Districts of RF, and this is a factor negatively affecting the successful outcome.

Conclusions: High mortality rates in patients with primary destructive tuberculosis is determined by two factors: bacterial excretion and low efficiency of their treatment. Patients with associated bacterial excretion most frequently remained uncured and occasionally died. Lack of surgery in combined treatment for incidental destructive pulmonary tuberculosis was a factor negatively affecting the effective treatment and successful outcome.

Key words: incidental pulmonary tuberculosis, destructive tuberculosis, cohort study, efficiency of treatment, surgical intervention, outcomes.

References

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