International Union for Circumpolar Health Ministry of Public Health and Social Development of RF Russian Academy of Medical Sciences Siberian Branch of Russian Academy of Medical Sciences Siberian Branch of Russian Academy of Sciences Medical Polar Fund “Science” The Northern Forum

Abstracts

Seminar Infection Diseases in Arctic

The clinical course of tuberculosis disease in the extreme north is characterized by an early fibrosis of the lung tissue. As a result, the complete involution of tuberculous inflammation and the healing of caseation cavities can never be achieved within scheduled durations of treatment in the majority of patients. In these cases surgery is a priority option for further treatment.

In Yakutia for the last 5 years an annual average proportion of active tuberculosis patients who consulted their surgeons for possible appointment to surgery has been 36.6-40.1%. Among them 40.6-46.0% had indications for surgery. Surgical operations could be performed only in 46.8-48.6% of the appointed patients. The most common reasons for cancellation of surgery were: presence of concomitant disease (10.9%), reasonless (related to non-adherence) refusal of a patient to undergo operation (7.6%), as well as reasoned refusal (4%). Interestingly, if the prescribed operations were nevertheless done, intensive treatment (involving patient’s commitment) soon afterwards proved highly beneficial to the outcome in 6-6.5% of the cases. The degree of “shortfall” in the use of surgery among active tuberculosis patient population was on the average 42-53.2%. Most of these cases would subsequently become chronic patients.

Bearing in mind the above overall rates, proportion of surgically rehabilitated cases in this patient population made up 8.6-10.2%, proportion of surgically rehabilitated fibrous-cavernous cases – 20.6-29.5%. These rates proved better than average national rates by a factor of 2-2.5. Surgical bed turn-over increased from 3.5 to 4.2, and percentage of radical surgeries with broadened indications rised from 24.7% to 37%. Pleurpulmonectomies alone increased from 1.8% to 6.5%.

Also, we used a novel indicator – proportion of surgically rehabilitated tuberculosis patients in relation to patients with clinically efficient outcome. This indicator had increased from 16.0% to 20.1%, i.e. surgery was used in every fifth clinical recovery.

Further improvement of cure rates requires dividing newly identified patients from chronic patients, with surgical treatment focused preferably on newly identified and young, employable chronic patients.

Note. Abstracts are published in author's edition

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Last update: 06-Jul-2012 (11:52:05)