The mutations associated with resistance to rifampicin and isoniazid studied in the genome of M.tuberculosis isolated from 3,144 patients with pulmonary tuberculosis from the clinical and consulting departments of the Central TB Research Institute for the period 2011 - May 2018. The obtained results compared with the spectrum of mutations described for the worldwide population of resistant M.tuberculosis according to TBDReaMDB. The uniqueness of the world population of M.tuberculosis was shown on the specific genetic markers of resistance. The prevalence of MTB strains with the combination of mutations leading to a high level of resistance to rifampicin (rpoB 531 Ser-> Leu) and isoniazid (katG 315 Ser-> Thr(1)) were shown for Russian population of M.tuberculosis. These mutations did not adversely affect the transmissibility of the pathogen. The prevalence of these mutant variants was higher than in other regions of the world. The obtained results allow to make a conclusion about the unfavorable epidemiological situation related to the spread of MDR tuberculosis in the Russian Federation.

The aim of the study was to optimize the radiation diagnosis and differentiation of disseminated pulmonary tuberculosis (DTL) by studying the ray lung semiotics using multislice computed tomography (MSCT), radionuclide diagnostics (RND) with the use of a radiopharmaceutical (RFP) 99mTc-technetril and identifying the most informative for disseminated tuberculosis MSCT- RIA criteria. Materials and methods. The analysis of MSCT data was performed in 67 patients who had X-ray signs of pulmonary dissemination. The study was conducted on a multislice computer tomograph Somatom Emotion 16 from Siemens. 23 patients underwent a radionuclide study with a 99mTc-technetril radiopharmaceutical on the Nucline Spirit gamma camera in the planar and single-photon emission computerized tomography (SPECT) mode. The statistical processing of the data was carried out using the MicrosoftExcel software package. The reliability of the differences between the qualitative indices of the compared groups was determined using the 2 criterion. Results. The distribution of foci of dissemination according to MSCT using the high resolution algorithm (HRCT) was characterized by localization of dissemination foci in the structures of the primary, secondary pulmonary lobe, perivascular and peribronchial, involvement of pleura piles of various degrees and reactive changes in the intrathoracic lymph nodes (VGLU). In 55.7% of cases, foci with DTL were distributed in intralobular structures, lobular septa and endobronchial. In 86.3%, fragmentary infiltration of axial interstitium was noted. There was also marked infiltration of pleura sheets involving extrapuleural fat tissue in 50.7% of cases. Hyperplasia of the intrathoracic lymph nodes was established in 12.5% of cases. According to planar and SPECT studies in 21.0%, the prevalence of dissemination by CT correlated with accumulation of RFP in the lungs according to planar research and topically - in VGLU according to SPECT. In 81.8% of cases of hyperplasia of lymph nodes revealed by CT, there was an accumulation of RFP by SPECT. In 42.1% of cases of limited dissemination, according to CT, there was a diffuse accumulation of RFP following the results of planar scintigraphy. Conclusion Interpretation of the obtained data, taking into account the level of damage to the structural units of the lung with the definition of activity and prevalence in the application of different radiotherapy techniques, allows to optimize the diagnosis and differential diagnosis of disseminated pulmonary tuberculosis.

Despite the improvement of epidemiological indicators for tuberculosis, the reservoir of specific nosology is preserved. With the involvement of the child in the educational system, the range of his communication increases and, together with it, the probability of infection of the child with ILD and the disease with primary forms of tuberculosis increases. Objective: to characterize the structure of clinical forms of tuberculosis in children 4-11 years for the period 2001-2015 in the Omsk region. Materials and methods. The study is retrospective, with the inclusion of 609 children aged 4 to 11 years who received inpatient treatment from 2001 to 2015. The structure of clinical forms of tuberculosis was compared with the allocation of extrapulmonary forms in a temporal aspect. In the comparative periods there were no significant gender differences, the inhabitants of the village prevailed. Results and discussion. The structure of clinical forms of tuberculosis in patients aged 4-11 years is represented by tuberculosis of respiratory organs up to 92-98% of cases in preschool children and 89-92% of cases in children 7-11 years old and with time the proportion of TBL decreased, and the proportion of PTC increased, at the level of 3-7%. Isolated extrapulmonary tuberculosis was registered less frequently, mainly the urinary system suffered, children aged 4-6 years were ill with isolated forms at a frequency of 1% to 9% of cases. The generalized form of the process among children aged 4-6 years increased from 2% to 7%, and among 7-11 years - from 3% to 7% of all cases of tuberculosis, more often there was a combined lesion of organs with pulmonary tissue. Conclusions. On the territory of the region in the period from 2001 to 2015 in children 4-11 years old with tuberculosis, tuberculosis of the respiratory organs prevailed in the structure of clinical forms, and extrapulmonary tuberculosis did not lose its importance and from the moment of introduction into practice CT influenced the structure of the generalized form of the process.

Despite the fact that there are many normative documents, it is necessary to clarify them for the diagnosis of community-acquired pneumonia in each specific case. Therefore, the task of this work was to determine the priorities in laboratory technologies for the microbiological diagnosis of community-acquired pneumonia on the basis of laboratory practical work, the analysis of regulatory documentation and the description of clinical cases.

Goal. To study the results of treatment for newly diagnosed tuberculosis in patients with different HIV status. Materials and methods. A retrospective study of all new TB cases among adults (n = 1036) registered in 2013-2014: 664 patients with HIV-free tuberculosis (TB) and 372 patients with HIV (HIV) and TB. Results. The average age of the patients was 39 ± 13 years; of men was 63.8% (n = 661). The median number of CD4-lymphocytes was 185 cells / jl (0-2064 cells / jl). most patients with HIV and (69.8%, n = 260) did not receive antiretroviral therapy. TB in HIV-1 and more often than in patients without HIV and was detected by treatment (74.7%, n = 278 vs. 49.4%, n = 328) (P <0.001), and among the clinical forms more often disseminated TB (43.1%, n = 156 vs 15.8%, n = 103) (P <0.001). Bacteriovenectomy by any of the methods for HIV and / or TB was detected more often than in patients without HIV without TB (72.1%, n = 261 vs 54.7%, n = 356) (P <0.0001), including number when sowing on dense nutrient media (64.1%, n = 232, vs 46.0%, n = 299) (P <0.001). For HIV and TB with preserved drug sensitivity, it was less common (31.9%, n = 67 vs 50.9%, n = 137) (P <0.001), and with primary multidrug resistance (MDR) 1.5 times more often than with monoinfection (51.4% and 33.5%, respectively) (P <0.001). In the absence of data on drug resistance, patients were treated with drugs of the main series. Treatment of MDR TB was conducted 64.4% (n = 58) in patients with TB and 42.6% (n = 46) with HIV and / or TB patients; in the remaining cases, MDR preparations of the reserve were not assigned because of refusal, lack of commitment or obtaining information about drug resistance after death. Cure for HIV / TB was less frequent than with monoinfection of TB (38.2% vs 61.7%) (P <0.001), and the share of deaths from all causes in HIV-TB was significantly higher (40.9% % vs 12.1%) (p <0.001). The conclusion. In patients with HIV, tuberculosis in most cases was detected during treatment, they were more often registered with bacterial excretion and primary MDR, and the effectiveness of treatment for HIV and / or TB was significantly lower than in patients with negative HIV status, mainly due to high mortality.

The article presents the results of a clinical and epidemiological study to identify risk factors for the lethal outcome of tuberculosis, which occurs in the context of HIV infection, in patients in the treatment facilities of the penitentiary system. In a research, the Machine learning methods based on creation of optimal partitioning signs space and recognition methods were applied. It is with high reliability allowed to determine the predictive factors of hospital mortality to a patient with tuberculosis that occurs against the background of HIV infection, which became: drug use, weight loss, chronic, extensive and acutely progressive forms of the tuberculosis process, tuberculosis recurrence, pulmonary destruction, tachycardia, arrhythmia, fever, hepatomegaly, splenomegaly, lymphadenopathy, HIV viral load, CD4 count, hemoglobin , level of ESR, lymphocytes, ALT, ASAT, total bilirubin, creatinine, the presence of bacterial excretion, the presence of parenteral hepatitis, diabetes, HIV-associated diseases.

Presented the results of the analysis of the effectiveness of antituberculous activities and the effectiveness of treatment of patients with tuberculosis, combined with HIV- infection for the period 2010 - 2017 in the Irkutsk region. In order to assess the effectiveness of TB interventions among people with HIV infection in the Irkutsk region, statistical data for 8 years from annual reports and statistical forms were analyzed. During the analyzed period, high effectiveness of antituberculous activities among patients with HIV infection in the Irkutsk region was noted. The key problem is the low adherence of patients with HIV infection to dispensary observation and treatment, and as a consequence, the implementation of preventive measures among them and treatment of tuberculosis. This indicates an unfavorable prognosis of the further spread of tuberculosis among HIV-infected people.

In studying patients with clinical course, diagnosis and treatment of meningitis in conditions of high HIV prevalence, in 20 patients treated in 5 TB unit and 1 branch "Kristall" of Beloyarsky, Sverdlovsk region, in 2018, it was established that patients with HIV infection accounted for 95%, 95% died, generalized tuberculosis was detected in 83% of patients, the immediate cause of death was the progression of tuberculous meningitis in 22% of patients, the severity of the underlying disease, HIV infection in 28 %, progression of mixed infection - in 6%, cryptococcal infection - in 6%. Laboratory characteristics of cerebrospinal fluid do not give 100% information about the etiologic agent. Difficulties in treatment are determined by the lack of antiretroviral therapy, the difficulty of detecting the etiologic agent, the high prevalence of multiple and broadest resistance of mycobacterium tuberculosis (91%) to antituberculosis drugs.

Currently, despite the decline in the incidence and mortality of tuberculosis, the epidemic situation around the world, including in Russia, remains tense for tuberculosis. One of the reasons for this is an increase in the number of patients with HIV infection, which is a risk factor for tuberculosis. The combination of tuberculosis and HIV infection in recent years has turned into one of the most significant and urgent health problems. The review provides data on the prevalence of tuberculosis associated with HIV infection both in the world and in the Russian Federation, and the most comprehensive survey of scientific studies devoted to the study of the clinical and radiological and laboratory manifestations of tuberculosis in patients with HIV infection is presented. In addition, literature data on the efficacy of treatment of tuberculosis in this category of patients are given.

We studied 261 patients with newly detected MDR tuberculosis who were divided into 2 groups. The first group consisted of 164 patients in whom, before hospitalization determined the resistance of M. tuberculosis to rifampicin by the GeneXpert MTB/RIF method. Treatment of this group of patients was initially conducted according to the 4th regimen of chemotherapy (pyrazinamide, kanamycin/amk/capreomycin, fluoroquinolone, cycloserine/terizidone, protionamide, PAS). The second group (the comparison group) included 97 patients in whom MDR was diagnosed by sputum culture method. Prior to receiving data on the drug resistance, these patients received treatment according to the 1st standard chemotherapy regimen (isoniazid, rifampicin, pyrazinamide, ethambutol). After detecting MDR M. tuberculosis (after 2-3 months of treatment) correction treatment with re-registration for 4th regimens were performed. It was found that the new detected MDR tuberculosis in the Stavropol region of Russian Federation is more often detected in men in the form of infiltrative tuberculosis, characterized by the M. tuberculosis positive sputum and destruction in lung tissue up to 2 cm in size. The efficacy of treatment by conversation sputum culture after 3 and 6 months of treatment, as well as to close cavities after 6 months of treatment in the group of patients initially treated with 4 regimens of chemotherapy was significantly higher in comparison with patients initially treated with 1 and then 4 chemotherapy regimens.

The aim of the study was a comparative analysis of the features of the course and efficacy of the treatment of pulmonary tuberculosis in patients with different types of diabetes mellitus (DM). 287 patients with pulmonary tuberculosis were examined, which were divided into 3 groups. The first group included 69 patients with pulmonary tuberculosis in combination with type 1 diabetes (DM1). The second group consisted of 87 patients with pulmonary tuberculosis in combination with type 2 diabetes (DM2). The third group consisted of 131 patients with pulmonary tuberculosis without diabetes mellitus. It was found that pulmonary tuberculosis in patients with type 1 diabetes mellitus and in patients without diabetes was predominantly detected at the age of 20 to 39 years, and in type 2 diabetes, on the contrary - over the age of 40 years. A comparative analysis of the clinical forms of pulmonary tuberculosis showed that tuberculum were significantly more frequent among patients with type 1 and type 2 diabetes than those without diabetes. Distraction in lung tissue was observed in most patients in all three groups. In patients with combined DM, cavities with diameters less than 2 cm was more often observed. In patients with tuberculosis without DM, cavities with sizes from 2 to 4 cm were more often detected. M. tuberculosis positive sputum was observed in the majority of patients in all three groups, but significantly more often in patients with DM2. According to the spectrum of drug resistance, compared groups did not differ significantly. Negativation of sputum in 6 months was detected in 77,5% of patients with DM1, in 88,9% of patients with DM2 and 85,7% of patients without DM. Closing the cavity in lung in six month was detected in 38,8% of patients with DM1, in 59,3% of patients with DM2 and 61,0% of patients without DM.

Aim of the study: to compare two surgical tactics for the treatment of bilateral pulmonary tuberculosis. Materials and methods: 189 patients with tuberculous lesions in both lungs underwent lung resections: 91 patients had it done simultaneously on both lungs from the unilateral intercostal-mediastinal access by video-assisted thoracoscopy; 98 patients had resections of the left and right lung done one after another, time period between resections made 20.8 ± 9.4 days on the average. Results. The comparison of two tactics - simultaneous bilateral lung resection from a unilateral access and bilateral consecutive resections - showed the advantages of the first tactic: 97.5 and 85.7% of patients had sputum conversion (p = 0.05, x²); 98.9 and 92.9% of patients had healing of lung cavities (p = 0.04,x²).During simultaneous surgery, the risk of intra-operative blood loss exceeding 300 ml was much lower (OR = 13.57; 95% CI 3.98 - 46.29) as well as the risk of postoperative complications (OR = 3.32; 95% CI 1.04 - 10.61).

Diseases caused by mycobacteria, leprosy and tuberculosis, are widely known for many centuries. However, interest in mycobacteriosis, as an infectious disease of human organs caused by other mycobacteria, was only apparent from the late 50s of the 20th century. Over the years of observation, the number of cases of mycobacteriosis in various regions of the world has increased significantly, including in patients with cystic fibrosis. A key sign of comorbidity in cystic fibrosis is a chronic microbial infection that determines the severity of the course and the prognosis of the disease. In order to identify and identify mycobacteria isolated from patients with cystic fibrosis from 2011 to 2018, sputum was examined from 160 patients with cystic fibrosis and suspected mycobacterial infection. Mycobacteria were secreted in 17 (10.6%) patients with cystic fibrosis, of which non-tuberculous mycobacteria predominated. Thirteen patients were infected with M. abscessus (76.4%), two with M.avium (11.7%), one with M.xenopi (5.8%), one with M. tuberculosis (5.8%). Determination of drug sensitivity of mycobacteria showed that the culture of M.tuberculosis was sensitive to all antituberculosis drugs, and strains of nontuberculous mycobacteria had a different spectrum of drug susceptibility to drugs used for the therapy of mycobacteriosis. Identification of infectious agents will help ensure the timely initiation of adequate treatment, proper monitoring and prevention of the spread of non-tuberculosis mycobacteria among patients with cystic fibrosis .

Objective: To determine the quantitative changes in the microbiocenosis of the mucous genital tract in women with tuberculosis of the respiratory system against the background of ongoing chemotherapy. Material and methods: 54 women with tuberculosis of respiratory organs were examined at the stage of selection and within 40-150 days of chemotherapy. A standard study was carried out in the clinics of phthisiology and obstetrics and gynecology; specialized study of vaginal microbiota using the innovative test system "Femoflor" (LLC "NPO DNA - technology”, Russia) with PCR - real-time detection of the results and quantitative description of 28 conditionally pathogenic microorganisms. Statistical processing of the results was carried out using the statistical package IBM SPSS Statistics v.21 (2012). Results: After 40-150 days of chemotherapy in the vaginal microbiota, a significant decrease in Lactobacillus spp was established. Enterobacteriaceae, Streptococcus spp., Staphylococcus spp., Sneathia spp., Lachnobacterium spp., Mobiluncus spp., Megasphaera spp., Peptostreptococcus spp. and an increase in Gardnerella vaginalis, Prevotella, Porphyromonas, Candida spp. Conclusion: 1. Women of reproductive age, patients with newly diagnosed respiratory tuberculosis, who are receiving long-term courses of chemotherapy, represent a risk group for the development of vaginal dysbiosis.2. For objective diagnostics of vaginal dysbacterioses, it is necessary to apply molecular genetic methods of research in the form of PCR reaction in real time and quantitative counting of conditionally pathogenic microorganisms. 4.Лечение вагинальных дисбактериозов должно быть индивидуализированным в зависимости от имеющегося спектра условно - патогенных аэробных и анаэробных бактерий. 3. When determining the type of imbalance of a vaginal microbiota, it is important to evaluate the quantitative changes of the following microorganisms: Lactobacillus, Streptococcus spp., Lachnobacterium spp., Megasphaera spp., And Peptostreptococcus spp., Gardnerella vaginalis and Candida spp. 4. Treatment of vaginal dysbacteriosis should be individualized depending on the available spectrum of conditionally pathogenic aerobic and anaerobic bacteria.

The current study was perfomed to investigate the representativeness of the basic and antigen induced levels of specific (IFN-y) and non-specific (IL-6) biomarkers for the diagnosis of tuberculous pleural effusion. Ninety-three samples of pleural fluid from patient with tuberculosis (TP) and non-tuberculosis (Non-TP) pleurisy were examined. Induction of the synthesis IFN-gamma by immunocompetent cells in pleural exudate was carried out by the recombinant protein CFP10-ESAT6 contained in the diagnosticum «DIASKINTEST» by our method (Patent RF, № 2664427; 2017). Serum and pleural fluid IFN-y and IL-6 levels were measured by enzyme-linked immunosorbent assay technique (enzyme-am-plified sensitivity immunoassay kits, Vector-Best reagent kit (Russia). Our results suggested that introduction of M. tuberculosis antigens into the pleural fluids samples of TP group caused a significant increase of the IFN-y levels compared to basic level, which were not observed in the Non-TP group. Detection of IFN-gamma antigen-induced level in pleural fluid is a promising method for the diagnosis of tuberculous pleurisy. We found no significant differences in the basic and antigen-induced levels of IL-6 in patients with TP and Non-TP pleurisy.

The complex analysis of drug resistance indicators of Mycobacterium tuberculosis to anti-tuberculosis drugs for different categories of tuberculosis patients in the Republic of Mari El for the period from 2007 to 2017 was carried out. There is a significant spread of drug-resistant strains of Mycobacterium tuberculosis even among the new cases of tuberculosis. There is a steady increase in the level of primary and acquired drug resistance, especially multi and extensively drug resistance. The presence in the Republic of Mari El of the bacillary nucleus of chronic forms of tuber-culosis with a wide range of resistance was revealed, which creates prerequisites for the growth of primary drug resistance. To improve the epidemiological situation in the region, it is necessary to op-timize the algorithm of microbiological diagnosis of tuberculosis with the inclusion of methods that ensure the rapid testing of drug resistance to the maximum possible range of anti-tuberculosis drugs. This will make it possible to prescribe adequate treatment in a timely manner and prevent the further development of resistance and the spread of drug-resistant strains of Mycobacterium tuberculosis.

12 and 3 children respectively, local inflammatory changes to 25% of cases, movement restriction to 19% of cases. Clinical manifestations of extrapulmonary forms of tuberculosis combined with respiratory tuberculosis were characterized by paraspecific reactions in 84% of children, intoxication syndrome in 76% of cases, local morbidity in 24% of patients, local inflammatory changes in 32% of cases (p = 0.006), peripheral lymph nodes 24% (p = 0.047), expansion of the venous network on the chest in 16% (p = 0.025), limiting movement to 14% of cases. Conclusions. Extrapulmonary tuberculosis in the period 2001-2015. in most cases is represented by a combined lesion of the urinary and pulmonary systems, the clinical picture of which is more pronounced than the isolated extrapulmonary forms. However, in the last period of observation, a number of symptoms began to accompany the disease less often (p <0.050). 12 and 3 children respectively, local inflammatory changes to 25% of cases, movement restriction to 19% of cases. Clinical manifestations of extrapulmonary forms of tuberculosis combined with respiratory tuberculosis were characterized by paraspecific reactions in 84% of children, intoxication syndrome in 76% of cases, local morbidity in 24% of patients, local inflammatory changes in 32% of cases (p = 0.006), peripheral lymph nodes 24% (p = 0.047), expansion of the venous network on the chest in 16% (p = 0.025), limiting movement to 14% of cases. Conclusions. Extrapulmonary tuberculosis in the period 2001-2015. in most cases is represented by a combined lesion of the urinary and pulmonary systems, the clinical picture of which is more pronounced than the isolated extrapulmonary forms. However, in the last period of observation, a number of symptoms began to accompany the disease less often (p <0.050).

The interaction of a complex of socio-economic and medical resource-intensive factors that influence the formation of the situation with tuberculosis in the Kuzbass is considered. The preliminary, objectified selection of indicators from a large set of registered parameters in the epidemic monitoring system allows to prepare an objective description of the epidemic picture in the region for the subsequent in-depth multi-factor analysis of the situation. Determining the nature and power of the influence of social factors on the situation with tuberculosis and the types of health care costs can allow the creation of models for the regression of the epidemic and the management of this process.

The results of monitoring the epidemic situation of tuberculosis+ HIV, the results of diagnosis and outcomes of treatment in prisons of the Russian Federation as of 2017 are presented. The epidemiological situation of tuberculosis in the prisons of the Russian Federation is the most favorable for the last years. The mortality rate from tuberculosis decreased to 9.7 per 100 000. The reasons of this are: prisoners, as a rule, are representatives of marginalized groups of society, characterized by an antisocial way of life, promiscuity, drug use, and low sanitary culture. The reasons of stabilization of epidemic situation on tuberculosis in a combination with a HIV-infection are considered.

Aim: The analysis of work of a home care for patients with tuberculosis in Perm. Materials and methods: The results of treatment of patients with tuberculosis at a home care are shown in this work. Results: This stationary substitution technology was used for residents of remote areas of Perm for controlled treatment of patients with low adherence to treatment, due to social and medical factors. Conclusions: Among patients with bacterial excretion, who evaded treatment in conditions of noctidial hospital, with low adherence to treatment in stationary, under controlled chemotherapy gives an opportunity to get an effectiveness of treatment of a half of the (50%) patients. A high percentage of interruptions from treatment requires further studying of approaches to the provision of medical care at a home care, using measures of social support for tuberculosis patients.

The article examines the main causes of death among prisoners TB patients treated at TB-1 FKU MSCH-59 of the Federal penitentiary service of Russia and the possibility of reducing hospital lethality by early release from prison in because of a serious illness through optimization of SMK expert activities

Purpose of the study: To study the prevalence trends in Moscow of resistant to critically important antibacterial drugs of the most relevant strains of microorganisms isolated from patients with tuberculosis during 2015-2017. A multicentre study was conducted of the prevalence of drug-resistant clinical strains of A.baumannii, Acinetobacter spp, P.aeruginosa, Enterobacteriaceae, E.faecium, S.aureus, H.influenzae, S.pneumoniae isolated in Moscow from patients with pulmonary tuberculosis and bronchopulmonary diseases during 2015-2017. A high level of prevalence of epidemically significant resistant microorganisms that can significantly complicate the course of the main specific process is established. We used classical bacteriological methods of isolating, identifying and setting drug susceptibility tests by disc-diffusion and other methods.

Morphological methods of revealing mineral dust particles in the lungs are considered in the article. It is shown that the features revealed during polarization microscopy are of significant importance in the verification of bauxite, titanium pneumoconiosis, and talc-associated lesions. It is recommended to use scanning electron microscopy to determine the elemental composition of dust on histological sections. It is established that the integrated application of research methods promotes the identification of mineral particles in lung tissue.

The results of the treatment of patient S., 65 years of age, with a diagnosis of rheumatoid arthritis, right coxarthrosis III stage with acetabular prolapse deformations, left knee osteoarthritis III stage with valgus deformity of the left knee joint, complicated by traumatic subtrochanteric right femur fracture are presented.

In the study of vaginal and cervical canal biocenosis in 67% of women with uterine myoma in the vaginal area, the pattern of bacterial vaginosis was revealed, and Ureaplasma urealiticum was detected in 91% of cases. Very often ureaplasmosis is very often combined with bacterial vaginosis. Given the fact that the surgery for fibroids occupies the first place among gynecological operations, it is necessary to conduct a comprehensive treatment of vaginal dysbacteriosis, which leads to postoperative complications, as well as in women of childbearing age in combination with uterine myoma leads to infertility, to early spontaneous miscarriages, etc.

For the purpose of a scientific assessment of the staff potential of medical organizations in a large industrial region providing primary health care (PHC), the capacity of outpatient and out-patient clinics and emergency medical stations, the provision of the population with physicians and nurses and other key indicators, characterizing the staff of the primary health care system for the period 2013-2017 has been studied. In the context of municipalities, the population of the region has been provided with physicians of the main specialties - district therapists and pediatricians. The provision of the population with medical personnel employed in the PHC has slightly increased. High their coefficient of part-time, especially among physicians, continues to be. In the structure of qualification characteristics of employers in medical organizations providing PHC, persons without a qualification category prevail, and their share increases. The growth of the index of the provision of the population of the studied territory with medical employers of PHC in the last five years is largely due to the reduction in the population, while the availability of the most sought-after primary care physicians - district therapists and pediatricians - declined slightly during this time. The magnitude and dynamics of these indicators differ significantly between municipalities, reaching a critically low level in a number of territories.

A sociological assessment was made of the adherence of doctors of the Irkutsk region, the issue of work experience in medical organizations up to three years inclusive, to the chosen profession. Also, the factors determining it, including the motives for choosing a specialty and the place of employment for beginning doctors, were studied. The survey was conducted in medical organizations of the Irkutsk region, where young specialists were concentrated. It was found that the main reasons for choosing a future specialty, as well as for finding new doctors, are the demand for the chosen line of activity, the level of remuneration and social support measures expressed in additional financial support, which, however, young specialists are not satisfied. The results of the questionnaire testify that at the stage of employment with doctors there was poorly organized work on their labor adaptation, including, professional development, supervision or acceptance for the position as an intern. Many of the young specialists performed in the first months of work not reduced, but increased amounts of workload. The level of wages of many beginning doctors remains relatively low, as a result, almost 40% of respondents are not satisfied with the level of wages. It is extremely unfavorable that, according to the most optimistic estimates, approximately every fourteenth of the young professionals surveyed negatively views their current professional activities, and every twentieth plans to change either the place of work or the profession.