Phthisiology
Year of manufacture: 2004
Format: PDF
Quality: OCR
educational literature for medical students
Description: Phthisiology is a section of clinical medicine and a medical specialty that studies only one infectious and socially dependent disease - tuberculosis. The lungs are most often affected by tuberculosis. However, all other organs and tissues of the human body can be affected.
The increase in morbidity and mortality from tuberculosis in Russia and many countries determines the relevance of the problem and attracts everyone's attention. In 1998, the Russian government adopted a Federal program for urgent measures to combat this disease. Doctors of various specialties are encouraged and obliged to update the knowledge in phthisiology acquired during their student years. Commissions and programs to combat tuberculosis are being created in the regions of the country, the Russian Ministry of Health is making important decisions, and the media are sounding the alarm. The World Health Organization (WHO) establishes a large office in Moscow with a special representative for anti-tuberculosis work. The State Duma adopts and the President of the Russian Federation signs Law No. 77 of the Federal Law “On preventing the spread of tuberculosis in Russia” on June 18, 2001. On December 25, 2001, the Government of the Russian Federation issued a Decree on examinations of the population to detect tuberculosis, on the procedure for dispensary and statistical monitoring of patients with tuberculosis and its spread. On March 21, 2003, the Minister of Health of the Russian Federation issued Order No. 109 “On improving anti-tuberculosis care to the population,” which, based on scientific data, Russian and international experience, regulates the basic principles of the work of health authorities and institutions for the prevention, detection and treatment of tuberculosis.
To prevent tuberculosis, its spread and successful treatment, preventive measures and timely, as early as possible, detection and treatment of patients are necessary. The decisive role in the timely identification of patients with tuberculosis is played by doctors to whom a sick person first turns. These are general practitioners, family doctors, pediatricians, therapists, surgeons, neurologists, dermatologists, obstetricians-gynecologists, pulmonologists, urologists, ophthalmologists, as well as specialists in radiation, endoscopic and laboratory diagnostics.
All doctors, regardless of their specific medical specialty, need to know the basics of phthisiology! Every doctor should be able to promptly predict the possibility of tuberculosis in a patient, examine him and, if necessary, refer him to an anti-tuberculosis institution.
Now let's get to the point - a consistent presentation of the basics of phthisiology.
"Phthisiology »
A COMMON PART
Historical sketch
The causative agent of tuberculosis
Pathogenesis and pathological anatomy of tuberculosis
- Primary infection with Mycobacterium tuberculosis and latent course of tuberculosis infection
- Clinically evident tuberculosis
- Morphology of local changes
Anatomical and physiological information about the respiratory organs
- Larynx
- Chest wall
- Pleura
- Lungs and bronchi
- Pulmonary and bronchial arteries
- Lymphatic system of the lungs
- Main symptoms
- Questioning, physical methods
- Tuberculin diagnostics
- Microbiological studies
- Radiation diagnostic methods
- Endoscopy
- Puncture of the pleural cavity
- Biopsy of pleura, lungs and lymph nodes
- Blood and urine examination
- Assessment of respiratory and circulatory functions
TO classification of tuberculosis
Primary tuberculosis
Disseminated pulmonary tuberculosis
Focal pulmonary tuberculosis
Infiltrative pulmonary tuberculosis
Caseous pneumonia
Pulmonary tuberculoma
Cavernous and fibrous-cavernous pulmonary tuberculosis
Cirrhotic pulmonary tuberculosis
Tuberculous pleurisy
Tuberculosis of the larynx, trachea and bronchi
Pulmonary tuberculosis in combination with other diseases
- Tuberculosis in HIV-infected patients and patients with acquired immunodeficiency syndrome
- Pulmonary tuberculosis and pneumoconiosis
- Tuberculosis and chronic nonspecific respiratory diseases
- Tuberculosis and diabetes mellitus
- Tuberculosis and peptic ulcer of the stomach and duodenum
- Tuberculosis and alcoholism
- Tuberculosis and mental illness
- Tuberculosis and cancer
Extrapulmonary tuberculosis
- Tuberculosis of the central nervous system
- Tuberculous meningitis
- Brain tuberculoma
- Tuberculosis of bones and joints
- Tuberculosis of the kidneys and urinary tract
- Tuberculosis of male genital organs
- Tuberculosis of female genital organs
- Tuberculosis of peripheral lymph nodes
- Tuberculosis of mesenteric lymph nodes
- Tuberculous peritonitis
- Intestinal tuberculosis
- Tuberculosis of the eye
- Lupus
Prevention of tuberculosis
- Social prevention
- Sanitary prevention
- Specific prevention of tuberculosis
- Anti-tuberculosis vaccination and revaccination
- Chemoprophylaxis
- Early, timely and late detection of tuberculosis patients
- Organization of identification of tuberculosis patients
- Tuberculosis examination and diagnosis verification
- Chemotherapy
- Anti-tuberculosis chemotherapy drugs
- Monitoring the effectiveness of chemotherapy and assessing treatment results
- Prevention and elimination of adverse reactions
- Drug resistance of the tuberculosis pathogen and chemotherapy methods
- Chemotherapy of pulmonary tuberculosis in inpatient and outpatient settings
- Surgical treatment of pulmonary tuberculosis
- Artificial pneumothorax and pneumoperitoneum
- Pathogenetic and symptomatic therapy
- Spa treatment
- Pulmonary hemorrhage
- Spontaneous pneumothorax
- Acute cor pulmonale
- The role of the general treatment and preventive network
- Specialized anti-tuberculosis service
- State sanitary and epidemiological supervision
- The international cooperation
Reviewers:
A.K. Ivanov, Doctor of Medical Sciences, Professor, Head of the Department of Phthisiopulmonology of the St. Petersburg State Medical Academy named after. I. I. Mechnikova; M. V. Pavlova, Doctor of Medical Sciences, Professor, Head of the Department of Pulmonary Tuberculosis Therapy of the St. Petersburg Research Institute of Phthisiopulmonology of the Federal Agency for High-Technological Medical Care.
All rights reserved. No part of this book may be reproduced in any form without the written permission of the copyright holders.
List of abbreviations
BALL– bronchoalveolar lavage
BCG– Bacillus Calmette Guérin – vaccine strain for the prevention of tuberculosis
VSLU- intrathoracic lymph nodes
GINK– isonicotinic acid hydrazide
GKP– graduated skin test
DOTSK– proper volume of circulating blood
Gastrointestinal tract– gastrointestinal tract
ELISA- linked immunosorbent assay
KP– caseous pneumonia
CT- CT scan
KTL– cavernous pulmonary tuberculosis
LKK– pulmonary hemorrhage and hemoptysis
LU– drug resistance
MBT– Mycobacterium tuberculosis
OKL– main course of treatment
PPD– tuberculin allergen, purified protein derivative
PTD- TB Dispensary
PTK– primary tuberculosis complex
PTP– anti-tuberculosis drugs: H – isoniazid, R – rifampicin, Z – pyrazinamide, E – ethambutol, S – streptomycin, K – kanamycin, A – amikacin, Rb – rifabutin, Pt – prothionamide, Ea – ethionamide, Fq – fluoroquinolones, Cs – cycloserine, PAS – PAS
PCR– polymerase chain reaction
RNGA– indirect hemagglutination reaction
JV– spontaneous pneumothorax
TVGLU– tuberculosis of intrathoracic lymph nodes
THOSE– tuberculin unit
Ultrasound- ultrasonography
FBS– fibrobronchoscopy
FG– fluorography
FCTL– fibrous-cavernous pulmonary tuberculosis
FTL– physiotherapeutic treatment
HNZL– chronic nonspecific lung diseases
COPD– chronic obstructive pulmonary disease
HP– chemoprophylaxis
HT– chemotherapy
CNS- central nervous system
CTL– cirrhotic pulmonary tuberculosis
CV– cavum – cavern
DOTS– Directly Observed Treatment Short Course – WHO program for the detection and treatment of tuberculosis, providing strictly controlled treatment with a relatively short course of chemotherapy
L– lymphangitis
n– necrosis
p– papule
PPD– purified protein derivative – purified protein derivative
RM 2TE– Mantoux test with 2TE
v– vesicle
Preface
Tuberculosis continues to be a social and medical health problem in all countries of the world.
The significant increase in the main epidemic indicators over the past 15 years in Russia is associated not only with a significant deterioration in the socio-economic situation in the country, but also with a change in the properties of Mycobacterium tuberculosis - increased reactogenicity and drug resistance of MTB to major chemotherapy drugs.
High MTB infection in children, diversity in the structure of tuberculosis incidence in all age groups of the population, untimely diagnosis, complicated course and increasing relapses of the disease pose a number of serious problems for general practitioners and TB specialists.
Increasing the level of knowledge of doctors of all specialties on the most important issues of prevention and active detection of tuberculosis among children, adolescents and adults can significantly improve their health. Basic knowledge of the population about tuberculosis can also play an important role in the fight against this infection.
The proposed reference book on phthisiology gives pediatricians, therapists, phthisiatricians, and general practitioners an orientation in epidemiology, methods for diagnosing respiratory tuberculosis and extrapulmonary tuberculosis, methods of treatment and prevention of this disease. Special sections on the combined pathology of nonspecific and specific diseases in adults and the principles of their diagnosis are also given. Attention is paid to the issues of tuberculosis and HIV infection, tuberculosis in young children, adolescents and elderly patients.
This reference book presents a set of radiographs on tuberculosis in children, adolescents and adults, which provide information about the nature of changes in the respiratory system and extrapulmonary lesions in patients.
Familiarization of outpatient and hospital doctors with the main sections of phthisiology can give a positive result in organizing rational work to prevent the disease and increase the effectiveness of its treatment, which will allow us to hope for a more positive epidemic prognosis.
Section 1
General questions of phthisiology
Epidemiology of tuberculosis
Tuberculosis is a chronic infectious disease of the granulomatous type, caused by Mycobacterium tuberculosis and characterized by various phases of the course. The outcome of the disease depends on the level of individual resistance of the body and the social environment in which the patient lives.
Tuberculosis accompanies the history of mankind, but in different countries it has distinctive epidemic indicators. After a decrease in the levels of MTB infection, the incidence of active forms of tuberculosis and mortality from them until the 90s. XX century, in the last decade of the last century and in the XXI century. In many countries of the world there has been an increase in the main epidemic indicators of tuberculosis.
In Russia since the 90s. XX century The levels of MBT infection in children and adolescents, morbidity, morbidity and mortality have clearly increased in all age groups of the population.
One of the most important epidemic indicators reflecting the prevalence of infection is infection(or infection) with MBT in children. Thus, in the last decade, this figure has increased in St. Petersburg by 5–6 times and amounted to: among children aged 14 years in different areas of the city – 35–45%; in adolescents – 50–55; for preschoolers – 15–18%.
In the Leningrad region, MBT infection in children aged 14 years was 60%; the infection rate of fifth-year students at the State Pediatric Medical Academy of St. Petersburg is 75–80%.
In the northern and eastern territories of the Russian Federation, MBT infection in children aged 14 years has been at least 50–60% in the last decade. These are alarming figures, as they characterize an unfavorable epidemic situation.
Infection is determined using the tuberculin diagnostic method in children and adolescents, and children who react positively to tuberculin using the Mantoux test with 2TE are taken into account, if this reaction is not a consequence of BCG vaccination. Per 100 examined, the number of children reacting positively to the Mantoux test with 2TE provides information about the level of infection in a specific age group. Indicators of MTB infection in children in the Russian Federation (more than 60% at 14 years of age) reflect the presence of a large “reservoir” of tuberculosis infection.
The annual spread of tuberculosis infection among the population clearly reflects infection risk indicator, which characterizes the effectiveness of treatment, preventive and anti-epidemic measures.
This indicator is determined by repeating (after a year) the Mantoux test with 2TE and by the number of people with a “turn” of the tuberculin reaction. It is expressed as the number of people infected with MTB during the year per 100 people. An annual risk of infection equal to 1% corresponds to a tuberculosis incidence of about 50 per 100 thousand inhabitants. In St. Petersburg in recent years, this indicator looked like this: for preschool children it was 0.5–1.0%; for schoolchildren – 1.5–2.5% per year.
WHO experts believe that MTB infection in children under 14 years of age is 1% or less and the risk of infection is no more than 0.1% indicate the elimination of tuberculosis as a common disease.
Children and adolescents infected with MTB in most cases remain healthy, and only 10% of those infected with MTB in different regions of the Russian Federation develop various clinical forms of tuberculosis.
Morbidity is the number of newly diagnosed patients with active tuberculosis during the reporting period (year) per 100 thousand inhabitants. Currently, it varies in different regions of the Russian Federation from 45 to 90–120 per 100 thousand population. In the regions of the North-West of the Russian Federation, the tuberculosis incidence rate ranges from 45.6 to 87.1–110.1 people per 100 thousand population.
The incidence of tuberculosis in children in recent years in the Russian Federation as a whole was 19–16 per 100 thousand, but its distribution in different regions ranged from 15 to 110 per 100 thousand. The highest values of this indicator were at all ages in the Kaliningrad region, Karelia, in the North Caucasus, Eastern Siberia, the Far East, the Far North, and the North-West.
Comparing age groups of patients, it should be noted a shift in morbidity rates in groups of early and preschool age (up to 52%) and groups of 18–24 years, 25–34 and 35–54 years. The highest incidence of tuberculosis occurred at the age of 25–34 years, the lowest – at 65 years and older. The incidence of tuberculosis in men is 3.8 times higher than in women. Only at the age of 20–35 years does the incidence of tuberculosis in women increase.
Soreness– the number of all patients with active tuberculosis registered at the dispensary at the end of the year, regardless of the timing of its detection (reporting year and previous years) per 100 thousand population. High morbidity rates reflect an unfavorable epidemic situation, insufficient effectiveness of treatment of patients, and a low level of organizational work of the anti-tuberculosis service.
Mortality– the number of deaths from tuberculosis during the year per 100 thousand population, one of the most informative indicators for assessing the epidemic situation, as it characterizes the prevalence of tuberculosis. In Russia, the mortality rate from tuberculosis has increased over the past 10 years and amounted to 22 per 100 thousand population in 2002. In children, the highest mortality rate occurs at the age of 0–4 years. The mortality rate in places of detention in the Russian Federation is 100 times higher than in Russia. In the countries of Central and Eastern Europe, mortality also increased, but in the same years it was 8 per 100 thousand population.
There is a certain relationship between the annual risk of MTB infection, morbidity, morbidity and mortality from tuberculosis. The International Union Against Tuberculosis suggests assessing the epidemiological situation depending on the indicators listed above (Table 1).
Table 1. Main epidemiological indicators for tuberculosis
Given in table. 1 data indicate that the situation in Russia regarding tuberculosis is predominantly average, but in terms of the level of morbidity and risk of infection it is approaching unfavorable.
The main reasons for the unfavorable epidemic situation in the Russian Federation are the decline in the socio-economic standard of living of the population, the stratification of society and the impoverishment of 25% of the population, mass unemployment, military conflicts, a large flow of refugees from the former republics of Central Asia and Transcaucasia, a high crime rate and the incidence of active forms of tuberculosis among prisoners. Of no small importance are the low level of sanitary culture of the population, the spread of alcoholism, infection and HIV infection.
The causative agent of tuberculosis. Sources and routes of transmission of tuberculosis infection
The causative agent of tuberculosis was discovered by the German scientist Robert Koch in 1882. Mycobacterium tuberculosis (MBT) belongs to the family of radiant fungi - Actinomycetaccae, widespread in nature. The genus of mycobacteria includes more than 150 species of MBT. These are polymorphic rods, slightly curved, 1.5–6.0 µm long and 0.2–0.6 µm wide, resistant to acids, alkalis and alcohol. The pathogenicity of mycobacteria varies. Pathogenic species include: the human species - M. Tuberculosis (MBT), the bovine species - M. Bovis, a closely related species - M. Africanum, which is actually not found in Russia, as well as the causative agent of leprosy - M. leprae.
Mycobacteria are distinguished by a wide variety of forms (polymorphism): they can be filamentous, granular, coccoid, filterable and L-form. L-forms are mycobacteria that have partially or completely lost their cell wall. They arise under the prolonged action of antibacterial drugs, bacteriophages and other factors that interfere with their growth and reproduction. One of the forms of MBT variability is the formation of drug resistance to antibacterial drugs. Primary and secondary drug resistance are distinguished with a frequency of 15–30 and 40–50%, respectively.
Mycobacteria are characterized by viability in the external environment: in dried and liquid sputum - for 2–6 months; in damp soil, running water, dairy products - up to 12 months or more.
Main tank and the source of tuberculosis infection is a sick person who can excrete MBT with sputum, pus, urine, feces, and a sick animal (cattle, then sheep, goats, pigs, cats, etc.).
Routes of infection– aerogenic (90–95%), alimentary (1–6%), contact (through damaged skin) and intrauterine (hematogenous through an affected placenta or the child’s ingestion of infected amniotic fluid).
Risk groups for tuberculosis:
1. Residence in areas of tuberculosis infection:
a) family; b) apartment; c) random; d) occupational contact with a patient with an active form of tuberculosis. The incidence of children in foci of infection is 20 times higher than outside foci.
2. Person's age:
a) early age (0–3 years); b) adolescence (12–18 years); c) old age.
3. Exogenous factors:
a) low level of socio-economic development of society;
b) war; c) hunger; d) mental and physical overload.
4. Endogenous factors:
a) nonspecific respiratory diseases; b) diabetes mellitus; c) peptic ulcer of the stomach and duodenum; d) mental illness; e) AIDS; e) alcoholism.
The outcome of tuberculosis disease depends both on virulence, the severity of the infection during infection, and on the degree of individual resistance of the body to tuberculosis, as well as on the timeliness of treatment.
Clinical classification of tuberculosis
Currently in Russia, the clinical classification of tuberculosis is used, approved by Order of the Ministry of Health of the Russian Federation dated March 21, 2003 No. 109.
The classification consists of four main sections: clinical forms of tuberculosis, characteristics of the tuberculosis process, complications of tuberculosis, residual changes after cured tuberculosis.
Clinical forms of tuberculosis distinguished by localization and clinical and radiological signs, taking into account the pathogenetic and pathomorphological characteristics of the tuberculosis process. The main clinical forms of tuberculosis are:
1. Tuberculosis intoxication in children and adolescents.
2. Respiratory tuberculosis:
1) primary tuberculosis complex;
2) tuberculosis of the intrathoracic lymph nodes;
3) disseminated pulmonary tuberculosis;
4) miliary tuberculosis;
5) focal pulmonary tuberculosis;
6) infiltrative pulmonary tuberculosis;
7) caseous pneumonia;
8) pulmonary tuberculoma;
9) cavernous pulmonary tuberculosis;
10) fibrous-cavernous pulmonary tuberculosis;
11) cirrhotic pulmonary tuberculosis;
12) tuberculous pleurisy (including empyema);
13) tuberculosis of the bronchi, trachea, upper respiratory tract;
14) tuberculosis of the respiratory system, combined with occupational dust diseases of the lungs (coniotuberculosis).
3. Tuberculosis of other organs and systems:
1) tuberculosis of the meninges and central nervous system;
2) tuberculosis of the intestines, peritoneum and mesenteric lymph nodes;
3) tuberculosis of bones and joints;
4) tuberculosis of the urinary and genital organs;
5) tuberculosis of the skin and subcutaneous tissue;
6) tuberculosis of peripheral lymph nodes;
7) eye tuberculosis;
8) tuberculosis of other organs.
Characteristics of the tuberculosis process given by the localization of the process, by clinical and radiological signs and by the presence or absence of Mycobacterium tuberculosis (MBT) in the diagnostic material obtained from the patient.
Localization and prevalence: in the lungs - by lobes, segments, and in other organs - by location of the lesion.
Phase:
a) infiltration, decay, contamination;
b) resorption, thickening, scarring, calcification.
Bacterial excretion:
a) with the isolation of Mycobacterium tuberculosis (MBT+);
b) without isolating Mycobacterium tuberculosis (MBT–).
Complications of tuberculosis: hemoptysis and pulmonary hemorrhage, spontaneous pneumothorax, pulmonary heart failure, atelectasis, amyloidosis, fistulas, etc.
Residual changes after cured tuberculosis:
1. Respiratory organs:
1) fibrous;
2) fibrous-focal;
3) bullous-dystrophic;
4) calcifications in the lungs and lymph nodes;
5) pleuropneumosclerosis;
6) cirrhosis.
2. Other organs:
1) cicatricial changes in various organs and their consequences;
2) calcification, etc.
First, the main part of the classification is the clinical forms of tuberculosis. Basically, they differ in localization and clinical and radiological signs using pathomorphological characteristics of the tuberculosis process. All clinical forms of tuberculosis are combined into three groups: tuberculosis intoxication in children and adolescents; respiratory tuberculosis; tuberculosis of other organs and systems.
Second part classification includes localization of the process in the lungs or other organs, characteristics of the tuberculosis process based on clinical and radiological signs (infiltration, decay, contamination - manifestations of active tuberculosis; resorption, compaction, scarring, calcification - manifestations of inactive tuberculosis), as well as the presence or absence of Mycobacterium tuberculosis (MBT+ or MBT–).
The third part characterizes possible complications: pulmonary hemorrhage or hemoptysis, spontaneous pneumothorax, atelectasis, etc.
Fourth part takes into account residual changes after cured tuberculosis of the respiratory system or other organs.
Thus, the formulation of the diagnosis should be in the following sequence: main clinical form, localization, phase of the process, bacterial excretion, complications, residual changes.
Clinical forms of respiratory tuberculosis are divided into primary forms that arise in the patient in the early period of infection, and secondary forms that develop against the background of relative immunity to tuberculosis acquired as a result of infection with MBT or the transfer of local forms of primary tuberculosis.
Clinical forms of tuberculosis of the primary period are characterized by the following signs:
1) the appearance soon (1–2–6 months) after the “turn” of tuberculin sensitivity;
2) lymphotropicity of the lesion;
3) development of paraspecific reactions (erythema nodosum, blepharitis, kerato-conjunctivitis, skin tuberculides, arthralgia simulating rheumatoid and collagen diseases);
4) the spread of infection in the body predominantly by lymph-hematogenous route and the tendency to its generalization;
5) tendency to self-healing.
Clinical forms of secondary period tuberculosis are characterized by the following signs:
1) development of the tuberculosis process mainly in the lung (organ damage);
2) a tendency to decay of lung tissue;
3) spread of infection in the lungs mainly through the bronchogenic route.
Primary forms of tuberculosis occur more often in childhood, less often in adolescents (30%) and young adults 18–30 years old (2.5%). Secondary forms occur in adolescence, young adulthood and in the elderly.
Methods for diagnosing tuberculosis
Clinical diagnosis
Various clinical forms of tuberculosis, phases of the disease, the timeliness of their diagnosis, and the patient’s age also determine the uniqueness of complaints, symptoms of the disease, and data from X-ray and laboratory tests. Timely recognition of the disease determines the nature of its course and outcome.
The most common causes of diagnostic errors are two: lack of phthisiatric alertness and ignorance of the clinical manifestations of tuberculosis. Tuberculosis is characterized by a discrepancy between the satisfactory state of health of the patient and the severity of radiological changes in the respiratory organs and other organs. Symptoms of intoxication and functional disorders of various organs and systems occur in most patients, but their severity is most clearly presented in young children, and somewhat weaker in preschoolers. In younger schoolchildren, the signs of the disease are weakly expressed due to the fact that in the period of 7–11 years, individual resistance to tuberculosis is higher than at other ages. In adolescents (12–18 years old), the symptoms of the disease are expressed differently: from clear manifestations of ill health to moderate ones. Adults with tuberculosis have symptoms of intoxication, the severity of which depends on the clinical form of tuberculosis, the nature of the disease and the timeliness of diagnosis.
Name: Phthisiology. 4th edition
Perelman M.I., Bogadelnikova I.V.
The year of publishing: 2013
Size: 10.98 MB
Format: pdf
Language: Russian
The book "Phthisiology", edited by Perelman M.I., et al., is the fourth revised and expanded edition covering modern issues of tuberculosis. The etiology, pathogenesis of tuberculosis, and the influence of the causative agent of tuberculosis on the human body are described. Much attention is paid in the book to the clinical picture and diagnosis of tuberculosis. Issues of prevention and treatment of tuberculosis are presented.
Name: Phthisiology
Guseinov G.K.
The year of publishing: 2014
Size: 12.51 MB
Format: pdf
Language: Russian
Description: The book “Phthisiology”, edited by Guseinova G.K., examines modern issues of phthisiology science. The main historical stages in the formation of the doctrine of tuberculosis, its epidemiological... Download the book for free
Name: Phthisiology. National clinical guidelines.
Yablonsky P.K.
The year of publishing: 2016
Size: 4.49 MB
Format: pdf
Language: Russian
Description: The book "Phthisiology. National Clinical Guidelines" edited by P.K. Yablonsky examines such basic issues of phthisiology as general concepts of phthisiology and a practical new classification... Download the book for free
Name: Diagnosis and principles of treatment of tuberculosis of bones and joints in children
Mushkin A. Yu., Pershin A. A., Sovetova N. A.
The year of publishing: 2015
Size: 19.46 MB
Format: pdf
Language: Russian
Description: The book “Diagnostics and principles of treatment of tuberculosis of bones and joints in children,” edited by Mushkin A.Yu., et al., discusses the issues of diagnosing tuberculosis of bones and joints in children of various ages... Download the book for free
Name: Multidrug-resistant tuberculosis
Bastian I., Portals F.
The year of publishing: 2003
Size: 6.2 MB
Format: djvu
Language: Russian
Description: Practical guide "Multidrug-resistant tuberculosis", edited by Bastian I., et al., examines historical aspects of anti-tuberculosis service, principles of definition... Download the book for free
Name: Phthisiology
Mishin V.Yu., Zavrazhnov S.P., Mitronin A.V., Grigoriev Yu.G.
The year of publishing: 2015
Size: 30.62 MB
Format: djvu
Language: Russian
Description: Practical guide "Phthisiology", edited by Mishina V.Yu., et al., examines general and specific issues of phthisiology. The etiology, pathogenesis and pathomorphology of tuberculosis is described, methods for identifying it... Download the book for free
Name: Phthisiopulmonology
Brazhenko N.A., Brazhenko O.N.
The year of publishing: 2006
Size: 19.79 MB
Format: pdf
Language: Russian
Description: The book "Phthisiopulmonology", edited by N.A. Brazhenko, et al., examines epidemiology, etiopathogenesis, features of pathological anatomy, clinical picture, forms of tuberculosis, diagnostic principles... Download the book for free
Name: Tuberculosis in Russia
Shilova M.V.
The year of publishing: 2014
Size: 31.11 MB
Format: djvu
Language: Russian
Description: The book “Tuberculosis in Russia”, edited by M.V. Shilova, examines the relevance of the problem of tuberculosis in the Russian Federation. The epidemiology, statistical features, organizational issues of providing anti-tuberculosis treatment are described... Download the book for free
Name: Tuberculosis. Pathogenesis, protection, control
Bloom B.R.
The year of publishing: 2002
Size: 26.36 MB
Format: djvu
Language: Russian
Description: The book "Tuberculosis. Pathogenesis, protection, control" edited by Bloom B.R., examines issues of clinical phthisiology. The issues of etiopathogenesis, clinical picture, early diagnosis of extrapulmonary...
Name: Phthisiology
Perelman M.I., Koryakin V.A.
The year of publishing: 2004
Size: 7.48 MB
Format: pdf
Language: Russian
In the study guide presented to you, the material presented consists of two parts. The first presents general issues of the historical stages of the development of phthisiology as a science, epidemiological indicators of morbidity, mortality, etiopathogenetic aspects, and pathomorphological manifestations of tuberculosis. Specific diagnostic techniques for identifying this pathology are shown. The second part of the book contains a description of the clinical picture and treatment of various forms of tuberculosis.
Name: Phthisiology. 4th edition
Perelman M.I., Bogadelnikova I.V.
The year of publishing: 2013
Size: 10.98 MB
Format: pdf
Language: Russian
Description: The book "Phthisiology", edited by Perelman M.I., et al., is the fourth revised and expanded edition covering modern issues of tuberculosis. The etiology, pathogenesis of tuberculosis, ... Download the book for free
Name: Phthisiology
Guseinov G.K.
The year of publishing: 2014
Size: 12.51 MB
Format: pdf
Language: Russian
Description: The book “Phthisiology”, edited by Guseinova G.K., examines modern issues of phthisiology science. The main historical stages in the formation of the doctrine of tuberculosis, its epidemiological... Download the book for free
Name: Phthisiology. National clinical guidelines.
Yablonsky P.K.
The year of publishing: 2016
Size: 4.49 MB
Format: pdf
Language: Russian
Description: The book "Phthisiology. National Clinical Guidelines" edited by P.K. Yablonsky examines such basic issues of phthisiology as general concepts of phthisiology and a practical new classification... Download the book for free
Name: Diagnosis and principles of treatment of tuberculosis of bones and joints in children
Mushkin A. Yu., Pershin A. A., Sovetova N. A.
The year of publishing: 2015
Size: 19.46 MB
Format: pdf
Language: Russian
Description: The book “Diagnostics and principles of treatment of tuberculosis of bones and joints in children,” edited by Mushkin A.Yu., et al., discusses the issues of diagnosing tuberculosis of bones and joints in children of various ages... Download the book for free
Name: Multidrug-resistant tuberculosis
Bastian I., Portals F.
The year of publishing: 2003
Size: 6.2 MB
Format: djvu
Language: Russian
Description: Practical guide "Multidrug-resistant tuberculosis", edited by Bastian I., et al., examines historical aspects of anti-tuberculosis service, principles of definition... Download the book for free
Name: Phthisiology
Mishin V.Yu., Zavrazhnov S.P., Mitronin A.V., Grigoriev Yu.G.
The year of publishing: 2015
Size: 30.62 MB
Format: djvu
Language: Russian
Description: Practical guide "Phthisiology", edited by Mishina V.Yu., et al., examines general and specific issues of phthisiology. The etiology, pathogenesis and pathomorphology of tuberculosis is described, methods for identifying it... Download the book for free
Name: Phthisiopulmonology
Brazhenko N.A., Brazhenko O.N.
The year of publishing: 2006
Size: 19.79 MB
Format: pdf
Language: Russian
Description: The book "Phthisiopulmonology", edited by N.A. Brazhenko, et al., examines epidemiology, etiopathogenesis, features of pathological anatomy, clinical picture, forms of tuberculosis, diagnostic principles... Download the book for free
Name: Tuberculosis in Russia
Shilova M.V.
The year of publishing: 2014
Size: 31.11 MB
Format: djvu
Language: Russian
Description: The book “Tuberculosis in Russia”, edited by M.V. Shilova, examines the relevance of the problem of tuberculosis in the Russian Federation. The epidemiology, statistical features, organizational issues of providing anti-tuberculosis...