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    Π’ΡƒΠ±Π΅Ρ€ΠΊΡƒΠ»Π΅Π· Ρƒ взрослых ΠΈ Π΄Π΅Ρ‚Π΅ΠΉ Π² Π‘Π΅Π²Π΅Ρ€ΠΎ-Π—Π°ΠΏΠ°Π΄Π½ΠΎΠΌ Ρ„Π΅Π΄Π΅Ρ€Π°Π»ΡŒΠ½ΠΎΠΌ ΠΎΠΊΡ€ΡƒΠ³Π΅: Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠ° эпидСмиологичСских ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»Π΅ΠΉ ΠΈ ΠΊΡ€ΠΈΡ‚Π΅Ρ€ΠΈΠΈ ΠΈΡ… ΠΎΡ†Π΅Π½ΠΊΠΈ

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    The epidemic situation is monitored by numerous rates that may not reflect it objectively which will subsequently lead to higher incidence rates and severe forms of tuberculosis in both adults and children in the regions with the most unfavorable situation.The objective: to evaluate epidemiological rates for tuberculosis in the Northwestern Federal District to identify the most significant, and assess the epidemic situation in the region using these most significant rates.Subjects and Methods. We analyzed the main epidemiological rates of pediatric tuberculosis according to federal statistics (Forms 8 and 33) in 11 districts of the Northwestern District in 2019-2021. Annual figures were obtained from open demographic data of the state statistics (https://www.fedstat.ru). Statistical analysis was pe`rformed using the free software R (v.3.5.1) and the commercial Statistical Package for the Social Sciences (SPSS Statistics for Windows, Version 24.0, IBM Corp., 2016). Hierarchical cluster analysis and k-means clustering were used with the selection of the lowest and highest values of rates. A formula is proposed for calculating the coefficient of full coverage with preventive screening (COP) for tuberculosis of the population which allows adjusting the analyzed epidemic rates taking into account the maximum coverage of the population with preventive screening and determining the accuracy of previous analysis.Results. According to the data obtained, in 2017 and 2018, Vologda Oblast and Nenets Autonomous Okrug were epidemically favorable regions, while in 2020 and 2021 Kaliningrad, Leningrad and Novgorod Oblasts were regarded as favorable regions that were steadily improving their performance. Regions with unfavorable tuberculosis situation include Pskov Oblast, St. Petersburg and the Komi Republic. At the same time, the first two regions occupy this position stably from 2017 to 2021. The use of the coefficient of low coverage with screening for tuberculosis made it possible to determine that Murmansk Oblast, St. Petersburg, Leningrad and Pskov Oblasts in 2020 and 2021 are prognostically unfavorable regions despite a decline in official tuberculosis rates. The data obtained correlate with a high percentage of positive tests with the tuberculosis recombinant tuberculosis allergen (TRA) in children in the regions mentioned above.Conclusions. The analysis of the data clearly demonstrates the possibility of determining the epidemically most favorable or unfavorable regions using four rates: coverage with preventive screening, incidence in the adult population, incidence in children aged 0 to 17 years, and tuberculosis mortality. Cluster analysis using these rates, calculation of rates using the developed coefficient of low coverage with screening for tuberculosis, and analysis of positive results of TRA test in children allows identifying the most epidemically unfavorable regions, despite the decrease in some rates that can be regarded as favorable.ΠœΠΎΠ½ΠΈΡ‚ΠΎΡ€ΠΈΠ½Π³ эпидСмичСской ситуации проводится с ΡƒΡ‡Π΅Ρ‚ΠΎΠΌ большого числа ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»Π΅ΠΉ, ΠΊΠΎΡ‚ΠΎΡ€Ρ‹Π΅ ΠΌΠΎΠ³ΡƒΡ‚ Π½Π΅ совсСм ΠΎΠ±ΡŠΠ΅ΠΊΡ‚ΠΈΠ²Π½ΠΎ ΠΎΡ‚Ρ€Π°ΠΆΠ°Ρ‚ΡŒ Π΅Π΅, Ρ‡Ρ‚ΠΎ Π² ΠΏΠΎΡΠ»Π΅Π΄ΡƒΡŽΡ‰Π΅ΠΌ ΠΏΡ€ΠΈΠ²Π΅Π΄Π΅Ρ‚ ΠΊ ΠΏΠΎΠ²Ρ‹ΡˆΠ΅Π½ΠΈΡŽ уровня заболСваСмости ΠΈ появлСнию тяТСлых Ρ„ΠΎΡ€ΠΌ Ρ‚ΡƒΠ±Π΅Ρ€ΠΊΡƒΠ»Π΅Π·Π° ΠΊΠ°ΠΊ Ρƒ взрослого насСлСния, Ρ‚Π°ΠΊ ΠΈ Ρƒ Π΄Π΅Ρ‚Π΅ΠΉ Π² Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ нСблагоприятных Ρ€Π΅Π³ΠΈΠΎΠ½Π°Ρ….ЦСль исслСдования: ΠΎΡ†Π΅Π½ΠΊΠ° эпидСмиологичСских ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»Π΅ΠΉ ΠΏΠΎ Ρ‚ΡƒΠ±Π΅Ρ€ΠΊΡƒΠ»Π΅Π·Ρƒ Π² Π‘Π΅Π²Π΅Ρ€ΠΎ-Π—Π°ΠΏΠ°Π΄Π½ΠΎΠΌ Ρ„Π΅Π΄Π΅Ρ€Π°Π»ΡŒΠ½ΠΎΠΌ ΠΎΠΊΡ€ΡƒΠ³Π΅ для выявлСния Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ Π·Π½Π°Ρ‡ΠΈΠΌΡ‹Ρ…, Π° Ρ‚Π°ΠΊΠΆΠ΅ эпидСмичСской ситуации Π² Ρ€Π΅Π³ΠΈΠΎΠ½Π΅ с ΠΏΡ€ΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ Π·Π½Π°Ρ‡ΠΈΠΌΡ‹Ρ… ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»Π΅ΠΉ.ΠœΠ°Ρ‚Π΅Ρ€ΠΈΠ°Π»Ρ‹ ΠΈ ΠΌΠ΅Ρ‚ΠΎΠ΄Ρ‹. Π‘Ρ‹Π» ΠΏΡ€ΠΎΠ²Π΅Π΄Π΅Π½ Π°Π½Π°Π»ΠΈΠ· основных эпидСмиологичСских ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»Π΅ΠΉ ΠΏΠΎ Ρ‚ΡƒΠ±Π΅Ρ€ΠΊΡƒΠ»Π΅Π·Ρƒ Ρƒ Π΄Π΅Ρ‚Π΅ΠΉ ΠΏΠΎ Π΄Π°Π½Π½Ρ‹ΠΌ Ρ„Π΅Π΄Π΅Ρ€Π°Π»ΡŒΠ½ΠΎΠΉ статистики (Ρ„ΠΎΡ€ΠΌΡ‹ β„– 8 ΠΈ β„– 33) Π² 11 ΠΎΠΊΡ€ΡƒΠ³Π°Ρ… Π‘Π΅Π²Π΅Ρ€ΠΎ-Π—Π°ΠΏΠ°Π΄Π½ΠΎΠ³ΠΎ Ρ€Π΅Π³ΠΈΠΎΠ½Π° Π·Π° ΠΏΠ΅Ρ€ΠΈΠΎΠ΄ с 2019 ΠΏΠΎ 2021 Π³. Π•ΠΆΠ΅Π³ΠΎΠ΄Π½Ρ‹Π΅ ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»ΠΈ ΠΏΠΎΠ»ΡƒΡ‡Π΅Π½Ρ‹ ΠΈΠ· ΠΎΡ‚ΠΊΡ€Ρ‹Ρ‚Ρ‹Ρ… дСмографичСских Π΄Π°Π½Π½Ρ‹Ρ… государствСнной статистики (https://www.fedstat.ru). БтатистичСский Π°Π½Π°Π»ΠΈΠ· проводился с использованиСм свободной ΠΏΡ€ΠΎΠ³Ρ€Π°ΠΌΠΌΠ½ΠΎΠΉ срСды вычислСний R (v.3.5.1) ΠΈ коммСрчСского ΠΏΠ°ΠΊΠ΅Ρ‚Π° ΠΏΡ€ΠΎΠ³Ρ€Π°ΠΌΠΌΠ½ΠΎΠ³ΠΎ обСспСчСния Statistical Package for the Social Sciences (SPSS Statisticsfor Windows, вСрсия 24.0, IBM Corp., 2016). ΠŸΡ€ΠΈΠΌΠ΅Π½ΡΠ»ΠΈΡΡŒ иСрархичСский кластСрный Π°Π½Π°Π»ΠΈΠ· ΠΈ кластСризация ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΎΠΌ k-срСдних с Π²Ρ‹Π±ΠΎΡ€ΠΎΠΌ Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ Π½ΠΈΠ·ΠΊΠΈΡ… ΠΈ высоких Π·Π½Π°Ρ‡Π΅Π½ΠΈΠΉ ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»Π΅ΠΉ. ΠŸΡ€Π΅Π΄Π»ΠΎΠΆΠ΅Π½Π° Ρ„ΠΎΡ€ΠΌΡƒΠ»Π° расчСта коэффициСнта ΠΏΠΎΠ»Π½ΠΎΠ³ΠΎ ΠΎΡ…Π²Π°Ρ‚Π° профилактичСским обслСдованиСм (ПОН) Π½Π° Ρ‚ΡƒΠ±Π΅Ρ€ΠΊΡƒΠ»Π΅Π· насСлСния, ΠΊΠΎΡ‚ΠΎΡ€Ρ‹ΠΉ позволяСт ΡΠΊΠΎΡ€Ρ€Π΅ΠΊΡ‚ΠΈΡ€ΠΎΠ²Π°Ρ‚ΡŒ Π°Π½Π°Π»ΠΈΠ·ΠΈΡ€ΡƒΠ΅ΠΌΡ‹Π΅ эпидСмичСскиС ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»ΠΈ с ΡƒΡ‡Π΅Ρ‚ΠΎΠΌ максимально ΠΏΠΎΠ»Π½ΠΎΠ³ΠΎ ΠΎΡ…Π²Π°Ρ‚Π° насСлСния ПОН ΠΈ ΠΎΠΏΡ€Π΅Π΄Π΅Π»ΠΈΡ‚ΡŒ ΠΏΡ€Π°Π²ΠΈΠ»ΡŒΠ½ΠΎΡΡ‚ΡŒ ΠΏΡ€ΠΎΠ²Π΅Π΄Π΅Π½Π½ΠΎΠ³ΠΎ Ρ€Π°Π½Π΅Π΅ Π°Π½Π°Π»ΠΈΠ·Π°.Π Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚Ρ‹ исслСдования. Богласно ΠΏΠΎΠ»ΡƒΡ‡Π΅Π½Π½Ρ‹ΠΌ Π΄Π°Π½Π½Ρ‹ΠΌ, Π² 2017 ΠΈ 2018 Π³. эпидСмичСски благоприятными Ρ€Π΅Π³ΠΈΠΎΠ½Π°ΠΌΠΈ Π±Ρ‹Π»ΠΈ Вологодская ΠΎΠ±Π»Π°ΡΡ‚ΡŒ ΠΈ НСнСцкий Π°Π²Ρ‚ΠΎΠ½ΠΎΠΌΠ½Ρ‹ΠΉ ΠΎΠΊΡ€ΡƒΠ³, Ρ‚ΠΎΠ³Π΄Π° ΠΊΠ°ΠΊ Π² 2020 ΠΈ 2021 Π³. ΠšΠ°Π»ΠΈΠ½ΠΈΠ½Π³Ρ€Π°Π΄ΡΠΊΠ°Ρ, ЛСнинградская ΠΈ НовгородскиС области расцСнСны ΠΊΠ°ΠΊ благоприятныС Ρ€Π΅Π³ΠΈΠΎΠ½Ρ‹, ΠΊΠΎΡ‚ΠΎΡ€Ρ‹Π΅ ΡΡ‚Π°Π±ΠΈΠ»ΡŒΠ½ΠΎ ΡƒΠ»ΡƒΡ‡ΡˆΠ°ΡŽΡ‚ свои ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»ΠΈ. К нСблагоприятным Ρ€Π΅Π³ΠΈΠΎΠ½Π°ΠΌ относятся Псковская ΠΎΠ±Π»Π°ΡΡ‚ΡŒ, Π³. Π‘Π°Π½ΠΊΡ‚-ΠŸΠ΅Ρ‚Π΅Ρ€Π±ΡƒΡ€Π³ ΠΈ РСспублика Коми. ΠŸΡ€ΠΈ этом ΠΏΠ΅Ρ€Π²Ρ‹Π΅ Π΄Π²Π° Ρ€Π΅Π³ΠΈΠΎΠ½Π° Π·Π°Π½ΠΈΠΌΠ°ΡŽΡ‚ Π΄Π°Π½Π½ΡƒΡŽ ΠΏΠΎΠ·ΠΈΡ†ΠΈΡŽ ΡΡ‚Π°Π±ΠΈΠ»ΡŒΠ½ΠΎ с 2017 ΠΏΠΎ 2021 Π³. ΠŸΡ€ΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ коэффициСнта Π½ΠΈΠ·ΠΊΠΎΠ³ΠΎ ΠΎΡ…Π²Π°Ρ‚Π° ПОН Π½Π° Ρ‚ΡƒΠ±Π΅Ρ€ΠΊΡƒΠ»Π΅Π· ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΠ»ΠΎ ΠΎΠΏΡ€Π΅Π΄Π΅Π»ΠΈΡ‚ΡŒ, Ρ‡Ρ‚ΠΎ ΠœΡƒΡ€ΠΌΠ°Π½ΡΠΊΠ°Ρ ΠΎΠ±Π»Π°ΡΡ‚ΡŒ, Π³. Π‘Π°Π½ΠΊΡ‚-ΠŸΠ΅Ρ‚Π΅Ρ€Π±ΡƒΡ€Π³, ЛСнинградская ΠΈ Псковская области Π² 2020 ΠΈ 2021 Π³. ΡΠ²Π»ΡΡŽΡ‚ΡΡ прогностичСски нСблагоприятными Ρ€Π΅Π³ΠΈΠΎΠ½Π°ΠΌΠΈ, нСсмотря Π½Π° сниТСниС ΠΎΡ„ΠΈΡ†ΠΈΠ°Π»ΡŒΠ½Ρ‹Ρ… ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»Π΅ΠΉ ΠΏΠΎ Ρ‚ΡƒΠ±Π΅Ρ€ΠΊΡƒΠ»Π΅Π·Ρƒ. ΠŸΠΎΠ»ΡƒΡ‡Π΅Π½Π½Ρ‹Π΅ Π΄Π°Π½Π½Ρ‹Π΅ ΠΊΠΎΡ€Ρ€Π΅Π»ΠΈΡ€ΡƒΡŽΡ‚ с высоким ΠΏΡ€ΠΎΡ†Π΅Π½Ρ‚ΠΎΠΌ ΠΏΠΎΠ»ΠΎΠΆΠΈΡ‚Π΅Π»ΡŒΠ½Ρ‹Ρ… ΠΏΡ€ΠΎΠ± с Π°Π»Π»Π΅Ρ€Π³Π΅Π½ΠΎΠΌ Ρ‚ΡƒΠ±Π΅Ρ€ΠΊΡƒΠ»Π΅Π·Π½Ρ‹ΠΌ Ρ€Π΅ΠΊΠΎΠΌΠ±ΠΈΠ½Π°Π½Ρ‚Π½Ρ‹ΠΌ (АВР) Ρƒ Π΄Π΅Ρ‚Π΅ΠΉ Π² ΠΎΠ±ΠΎΠ·Π½Π°Ρ‡Π΅Π½Π½Ρ‹Ρ… Π²Ρ‹ΡˆΠ΅ Ρ€Π΅Π³ΠΈΠΎΠ½Π°Ρ….Π’Ρ‹Π²ΠΎΠ΄Ρ‹. ΠŸΡ€ΠΎΠ²Π΅Π΄Π΅Π½Π½Ρ‹ΠΉ Π°Π½Π°Π»ΠΈΠ· Π΄Π°Π½Π½Ρ‹Ρ… наглядно дСмонстрируСт Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡ‚ΡŒ опрСдСлСния эпидСмичСски Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ благоприятных ΠΈΠ»ΠΈ нСблагоприятных Ρ€Π΅Π³ΠΈΠΎΠ½ΠΎΠ², ΠΈΡΠΏΠΎΠ»ΡŒΠ·ΡƒΡ Ρ‡Π΅Ρ‚Ρ‹Ρ€Π΅ показатСля: ΠΎΡ…Π²Π°Ρ‚ ПОН, ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»ΡŒ заболСваСмости взрослого насСлСния, ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»ΡŒ заболСваСмости дСтского насСлСния Π² возрастС ΠΎΡ‚ 0 Π΄ΠΎ 17 Π»Π΅Ρ‚ ΠΈ ΡΠΌΠ΅Ρ€Ρ‚Π½ΠΎΡΡ‚ΡŒ ΠΎΡ‚ Ρ‚ΡƒΠ±Π΅Ρ€ΠΊΡƒΠ»Π΅Π·Π°. ΠšΠ»Π°ΡΡ‚Π΅Ρ€Π½Ρ‹ΠΉ Π°Π½Π°Π»ΠΈΠ· с ΠΏΡ€ΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ Π΄Π°Π½Π½Ρ‹Ρ… ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»Π΅ΠΉ, расчСт ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»Π΅ΠΉ с ΠΏΡ€ΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ Ρ€Π°Π·Ρ€Π°Π±ΠΎΡ‚Π°Π½Π½ΠΎΠ³ΠΎ коэффициСнта Π½ΠΈΠ·ΠΊΠΎΠ³ΠΎ ΠΎΡ…Π²Π°Ρ‚Π° ПОН Π½Π° Ρ‚ΡƒΠ±Π΅Ρ€ΠΊΡƒΠ»Π΅Π· ΠΈ Π°Π½Π°Π»ΠΈΠ· ΠΏΠΎΠ»ΠΎΠΆΠΈΡ‚Π΅Π»ΡŒΠ½Ρ‹Ρ… Ρ€Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚ΠΎΠ² ΠΏΠΎ ΠΏΡ€ΠΎΠ±Π΅ с АВР Ρƒ Π΄Π΅Ρ‚Π΅ΠΉ позволяСт Π²Ρ‹ΡΠ²ΠΈΡ‚ΡŒ Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ эпидСмичСски нСблагоприятныС Ρ€Π΅Π³ΠΈΠΎΠ½Ρ‹, нСсмотря сниТСниС ΠΎΡ‚Π΄Π΅Π»ΡŒΠ½Ρ‹Ρ… ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»Π΅ΠΉ, ΠΊΠΎΡ‚ΠΎΡ€Ρ‹Π΅ ΠΌΠΎΠ³ΡƒΡ‚ Π±Ρ‹Ρ‚ΡŒ расцСнСны ΠΊΠ°ΠΊ благоприятныС

    Current possibilities in the diagnosis of intrathoracic lymph node tuberculosis in children

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    Diagnosing tuberculosis in children is very difficult. There are no clear diagnostic criteria for intrathoracic lymph node (ITLN) tuberculosis, the most common form of tuberculosis in children (78%). Current immunological methods used in combination with computed tomography make it possible to characterize a child’s status more clearly and to establish a correct diagnosis. The positive results of immunological tests in the presence of Mycobacterium tuberculosis infection require a set of radiological examination. ITLN tuberculosis is characterized by the fact that one group or more contains single or multiple ITLNs that measure more than 5 cm and differ in structure and density in the presence of positive immunological tests (Diaskintest and QuantiFERON test)
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