Background. In the context of the stabilization of the tuberculosis situation in Russia, including the Tyumen region, work with children at risk (with a latent tuberculosis infection) is of particular importance. In the course of previous studies, a number of problematic issues in the field of organizing phthisiatric care for this contingent were identified. Aim. To substantiate and develop the structure of the regional register of children with latent tuberculosis infection, as well as the algorithm for collecting and registering information included in it. Material and methods. The analysis of domestic and foreign publications, the current regulatory framework in the field of creation and use of registers in medicine and healthcare has been carried out. The study used content analysis, legal, historical and descriptive-analytical methods. Results. The analysis of the literature showed that currently the practice of creating registers in medicine is particularly relevant, but there is no unified definition, classification, tasks and approaches to their management, therefore, the structure of the regional register of children with latent tuberculosis infection, the procedure for collecting and registering information were developed by the authors based on the functions inherent in it. The register is necessary for recording and monitoring of children with latent tuberculosis infection, optimization of medical processes, solving organizational and scientific issues in providing anti-tuberculosis care to this category of patients. The register consists of 8 blocks: identification, follow-up medical care, anamnesis vitae, epidemiological anamnesis, vaccination against tuberculosis, immunodiagnostics, radiation diagnostics, preventive treatment. The functions of filling in the blocks are distributed between the primary health care institutions and the phthisiological service, as well as assigned to certain specialists. Conclusion. The developed data registration algorithm and the structure of the regional register of children with latent tuberculosis infection contain the data necessary for the implementation of the tasks set, operational and retrospective monitoring of the effectiveness of ongoing activities, as well as management decision-making at all levels of providing phthisiatric care to the children's population of the region.
Introduction. Tuberculosis in Russia is one of the primary problems of epidemiology and public health. The purpose: to analyze the epidemic situation of tuberculosis in high-risk groups of children and adolescents in the Tyumen region of Russia. Material and methods. Were analyzed the annual reporting forms No. 33 «Information about patients with tuberculosis» for 2014-2018 in the Tyumen region. Results. According to our research, research materials in the region, WHO recommendations for eliminating tuberculosis by 2035 the need to develop new approaches and practical recommendations for clinical dispensary observation of children with altered tuberculin sensitivity is justified. Discussion. The epidemic situation among children with altered tuberculin sensitivity by 2018 in the districts of the Tyumen region is characterizing by its heterogeneity. In some districts of the region, the number of children with a turn of tuberculin reactions remains high or continues to increase. Such trends can be associated with the incidence of tuberculosis and the presence of patients with open forms of respiratory tuberculosis in these areas. Conclusion. To improve the efficiency of preventing the development of active tuberculosis in Russian children in 2010, a mathematical model of immune response developed in the Tyumen Region based on the study of immunological indices in groups of children with high sensitivity and hyperresponsiveness to the Mantoux tests 2TE samples. The model can be successfully used for diagnostics and assess the characteristics of the course of tuberculosis infection.
The World Health Organization has adopted the global TB strategy for the period of 2016-2035. To achieve its targets, it is necessary to propose and introduce new approaches for the prevention and treatment of latent tuberculosis infection (LTBI) in children and adolescents, as a potential source of active tuberculosis development. In this regard, the use of vitamin D (cholecalciferol) may become promising in combating tuberculosis, since most researchers suppose an adequate level of cholecalciferol to have a positive preventive and therapeutic effect in children with active and latent tuberculosis. So far the use of vitamin D may be appropriate, especially in children not adequately provided with vitamin D. The paper presents the results of the vitamin D levels study before and after prescribing cholecalciferol, as well as the dynamics of the tuberculin skin tests in school-age LTBI children receiving preventive treatment with anti-TB drugs. At the initial examination, a normal level of 25-hydroxycholecalciferol (25(OH)D) was not detected in any child. After 3 months of administration of vitamin D in therapeutic doses, a normal concentration of 25(OH)D was observed in 52% of the children examined repeatedly. Analysis of the tuberculin skin test dynamics showed 47.6% of children to have a negative/doubtful test result after 3 months of treatment with anti-TB drugs and vitamin D. In 9.5% of patients, the size of the papule did not change during treatment. It is important to note that in these children, the 25(OH)D level also did not increase. А vitamin D intake at a therapeutic dosage did not cause hypercalcemia or hypercalciuria in any child. LTBI children are inadequately provided with cholecalciferol. There fore it is necessary to determine the level of vitamin D in the blood, then to prescribe the vitamin D, regardless of the time of year, along with standard therapy for a more effective outcome of LTBI treatment and prevention of active forms of tuberculosis in the future.
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