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By taking into account the present requirements for the equipping of the laboratories, the authors have drawn up the minimum standard list of equipment, as well as a list of additional equipment for the specialized bacteriological laboratory of a tuberculosis-controlling institution, which performs microbiological studies for the diagnosis and control of chemotherapy for tuberculosis. The specifications and characteristics of the baric types of equipment used to fit out the laboratories under the present conditions are described. Equipping the laboratories in accordance with the draw-up lists is shown to ensure a qualitative, effective, and safe work. Recommendations on how to supply the laboratories with equipment, to make the optimal choice, and to use consumables for tests are given.

The major available indicators of the efficiency of laboratory service activities in diagnosing tuberculosis, including those widely used in international practice and Russian traditional tuberculosis statistical data, are analyzed. The optimal criteria for assessing the quality and efficiency of work of the clinical diagnostic laboratories of the general health network and the bacteriological laboratories of a tuberculosis service in the detection, diagnosis, and chemotherapy monitoring of tuberculosis have been developed. The recommended levels of the indicators, which are to be achieved by well working laboratories, if a well-implemented tuberculosis-controlling program is available, are defined.

Drug resistance (DR) in Mycobacterium tuberculosis (MBT) has been monitored in the Republic of Mariy El. It has been established that there is a considerable prevalence of drug-resistance strains even among new cases. There is a gradual rise in the level of MBT DR, including multiple DR (MDR). In 2000 and 2006, the rates of primary MBT DR were 26.7 and 31.5% (including those of MDR were 10.2 and 13%), respectively. The proportion of strains resistant to 4 major antituberculous drugs (I, R, S, E) of the number of DR cultures increased from 19% in 2003 to 35% in 2005, which suggests the situation of high strain with the prevalence of DR tuberculosis in the Republic of Mariy El.

The authors have revealed the acutest problems of laboratory tuberculosis diagnosis service in the Russian Federation. They have made their conclusion on this issue and developed the following recommendations: to continue the reorganization of Russia's laboratory tuberculosis diagnosis service; to reconstruct and repair laboratories; to provide them with up-to-date equipment; to make a full-scale training of laboratory workers; to standardize the procedures of microbiological tests for tuberculosis; to organize bacteriological tuberculosis service monitoring in Russia, including monitoring of tuberculosis-controlling facilities; to develop and officially approve a number of normative documents (current standards for the time spent on working operations and criteria for estimating the load on the personnel performing the procedures of a study, new staff lists for laboratories, the level and structure of salaries in the laboratory's personnel).

The experience of researchers of the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences, in the pilot areas of Russia has made it possible to perfect approaches to improving a bacteriological diagnosis of tuberculosis in general health care facilities. A decisive role in enhancing the effectiveness of detection of patients with tuberculosis by the Ziel-Nielsen test is played by the following factors: training of laboratory personnel; provision of laboratories with high-grade equipment and reagents; introduction of the methods and techniques unified and approved by the Ministry of Health of the Russian Federation; regular supervision of jurisdictional laboratories; outside control of the quality of studies. Proper organization of examination of patients, including an effectual selection of patients to be examined, the observance of the established frequency of their examination, and provision of the required quality of a taken sample greatly affect the efficiency of a microscopic diagnosis of bacillary patients. In addition, the centralization of performed microbiological tests for tuberculosis in the most trained, certified, and licensed large laboratories exercising a centralized control of the quality of microbiological studies is optimal.

The practice of the researchers of the Central Research Institute of Tuberculosis in Russia's experimental areas yielded approaches to improving the microbiological diagnosis of tuberculosis in both specialized and general health care facilities. A decisive role in enhancing the efficiency of microbiological identification of patients with tuberculosis is played by the following factors: laboratory staff training, provision of laboratories with qualitative equipment and reagents, introduction of unified methods and those approved by the Ministry of Health of the Russian Federation, regular supervision of jurisdictional laboratories, and outside test quality control. The efficiency of microbiological diagnosis of bacillary patients primarily depends on the expediency of formation of groups of patients under study, the observance of the frequency of examinations, and the assurance of the quality of collected materials. With this, the centralization of microbiological tests for tuberculosis at the most trained, certified, and licensed large laboratories that exercise a centralized control over the quality of microbiological tests.

The authentic data on the drug resistance of Mycobacterium tuberculosis can be obtained only provided that standard laboratory procedures and the unified standardized method for determining the resistance are used along with a compulsory outside quality control over the performance of this test. The supervisory activities of the researchers of the Central Research Institute of Tuberculosis (CRIT), Russian Academy of Medical Sciences, made in some regions of Russia included standardization of methods and their implementation quality control allowed them to reveal and to correct main errors in drug resistance testing. In this connection, this made it to record the true level of M. tuberculosis resistance to essential antituberculous agents in the areas investigated by the researchers of CRIT. Analyzing the data on the drug resistance of M. tuberculosis in the above areas leads to the conclusion that 2000 was marked by rather high rates of primary drug resistance; nearly a fourth of all new and prior cases of pulmonary tuberculosis studied for its drug resistance were carriers of a M. tuberculosis resistant to at least one antituberculous agent.

The study was undertaken to assess the role of polymerase chain reaction (PCR) analysis in complex bacteriological studies in diagnosing pulmonary tuberculosis in 197 patients by bacterioscopy, inoculation, and PCR. It was shown that in addition to conventional bacteriological methods, PCR might be used as an additional laboratory study in making a diagnosis in patients with restrictive pulmonary tuberculosis. A combination of cultural inoculation and PCR analysis enhances the sensitivity of bacteriological diagnosis and reduces its duration in oligo- and abacillary patients with tuberculosis. PCR analysis enhances the efficiency of laboratory control over antituberculous chemotherapy.

The studies have showed the frequency and spectrum of drug resistance, determined by the methods of proportions and absolute concentrations, to be virtually equal. This suggests that both methods are of equal diagnostic value. The method of absolute concentrations is rather accurate and similar to that of proportions in sensitivity, by ensuring comprehensive determination of the spectrum of drug resistance. Furthermore, the advantages of this method are its simplicity, accessibility, and cost-efficiency.

The results of determination of drug medium depend on both individual cultural properties of the strains tested and the type of the medium used. The composition of a medium is of significance for some strains: the latter grow in any medium and are characterized by the same spectrum of resistance. However, most drug-resistant strains have higher feeding demands which are not fully met on the lyophilized Löwenstein-Jensen medium. The strains in the lyophilized medium show an incomplete spectrum of resistance and less grow than do those in freshly prepared Löwenstein-Yersen medium.

Clinical examination with immune status assessment of more than 300 healthy persons, who worked in 30-km Chernobyl NPP zone four years after the accident was carried out. The clinical characters of immune deficiency were detected in 6.67% of examined persons and appeared as repeated respiratory diseases. Significant increase in mean level of leukocytes and lymphocytes was revealed. Activation of T-helper link of cell immunity was determined by increase of CD4+ cells in 35.2% of examined persons, that were lower than in people who took part in Chernobyl accident amelioration in 1986. Decrease in content of T-cells and B-cells was observed in 1/4 and 3/4 of persons correspondingly by rosette assays. No changes in serum immunoglobulins level was observed.

Immobilization of proteolytic enzymes on carbon materials depends on the concentration of the protein to be immobilized, the protein/carrier ratio and pH. The kinetics of the proteolytic enzyme adsorption and combined immobilization of proteases and lytic enzymes are considered, and properties of the resultant preparations (temperature and pH optima) and the effect of gamma-sterilization are discussed. Chymotrypsin and terrilytin immobilized on carbon SKN-2P hydrolysed 0.2% solution of casein during 25-27 days with a maximum yield of 50-70%.

When in the experiment on rats the jointly immobilized on a carbonic cloth proteases and lytic enzyme complex were used, the reduced period of the suppurative wound cleaning and healing was noted as compared to that in use of the immobilized on a carbonic cloth proteases and jointly immobilized on a gause proteases and lytic enzyme complex.