In order to understand problems, resources, and ways of improving TB epidemic situation, it is important to analyze stafng of TB Services.

Subjects and Methods. The number of phthisiologists, full-time and employed positions of phthisiologists in 2011-2020 was assessed based of Federal Statistical Surveillance Form no. 30, and for the period of 2005-2014, Form no. 17 was additionally used. The number of phthisiologists was calculated as the ratio of the number of phthisiologists (Form no. 30) to the population at the end of the reporting year multiplied by 10,000. The physician workforce capacity was additionally analyzed based on audit reports of on-site visits in 10 regions of the Russian Federation (RF) in 2021.

Results. As of late 2020, the stafng level with physical persons amounted to 52.5%, the shortage of personnel was more than 4,000 phthisiologists. The provision of the population with phthisiologists ranged from 0.49 (2014) to 0.47 per 10,000 population (2020). In 2011-2020, the coefcient of part-time employment varied from 1.6 to 1.7, exceeding the regulatory value (no more than 1.5) but for 2019. The sampling analysis in 10 regions of the Russian Federation demonstrated that the proportion of phthisiologists of retirement age among physicians was 37.2%. In 2011-2020, the number of tuberculosis patients per one phthisiologist position  decreased from 19.0 to 7.8, the number of patients with multiple drug resistant tuberculosis - from 2.7 to 2.1. There is a significant decrease in the number of staff positions and occupied positions of phthisiologists providing medical care in out-patient settings (by 14.0%), while the number of phthisiologists in in-patient facilities remained the same.

Conclusion. Challenges in stafng of TB Services are as follows: shortage of personnel, high level of phthisiologists working part-time, insufcient stafng of out-patient and polyclinic services, high proportion of physicians of pre-retirement and retirement age and insufcient level of professional competence of young specialists.

The objective: to investigate the relationship of polymorphic variants of genes of xenobiotic biotransformation metabolism enzymes (NAT2 (590G>A (rs1799930)), CYP2E1 (9896C>G (rs2070676)), ABCB1 (3435T>C (rs1045642)), GSTM1 (E/D), GSTT1 (E/D) with the risk of pulmonary tuberculosis.

Subjects and Methods. Within the framework of this study, a population sample of unrelated 1081 individuals of Slavic nationalities (mainly Russians) living in the territory of Kursk Oblast was used.

Results. The del/del (D/D) GSTM1 genotype was associated with an increased risk of developing tuberculosis, while carrying the del/del (D/D) GSTT1 genotype was associated with a lower risk of developing the disease. Polymorphism 3435T>C ABCB1 (TC genotype) was associated with increased susceptibility to pulmonary tuberculosis in the codominization model, while TT+TC genotypes had the same association in the dominance model.

The objective: to determine possibility of prescribing and safety of various anti-tuberculosis drugs and their combinations as part of a therapeutic or preventive course of anti-tuberculosis therapy (ATBT) in patients with end-stage chronic kidney disease (CKD) receiving hemodialysis replacement therapy in the settings with high prevalence of drug resistant strains of Mycobacterium tuberculosis.

Subjects and Methods. 42 patients receiving hemodialysis replacement therapy were followed-up by Central Tuberculosis Research Institute: of them, 31 (73.8%) had active tuberculosis and 11 (26.2%) had residual post-tuberculous changes in the respiratory organs. During the follow-up, the nature and severity of adverse reactions to anti-tuberculosis drugs were assessed.

Results. In the patients with end-stage CKD suffering from respiratory tuberculosis, drug resistant strains prevailed – 68.2%. Some of adverse events developed when taking anti-tuberculosis drugs were as follows: deterioration of uremia in 20.5% of cases, cardiovascular complications – in 17.9%, and neurotoxic reactions – in 15.4%. Progression of uremia occurred more often in the followed-up patients taking anti-tuberculosis drugs versus hepatotoxic reactions (p = 0.02). When treating tuberculosis patients with end-stage CKD, isoniazid was discontinued due to adverse events in 12.8% of cases and pyrazinamide in 12.8% of cases, other drugs were discontinued less frequently. Compilation of individual regimens of anti-tuberculosis drugs with the consideration of drug susceptibility testing results, contraindications, and concomitant diseases made it possible to provide an adequate anti-tuberculosis therapy for patients with end-stage CKD with tuberculosis infection in 92.9% of cases for a period of more than 6 months.

The objective: to assess the impact of tuberculosis (TB), chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) on the quality of life (QOL) and the need to manage each disease to improve the physical and mental components of QOL.

Subjects and Methods. A simple prospective study included 80 patients, men – 53.9%, women – 46.1% who were divided into 3 groups: Group 1 – COPD (n = 35), median age [Me (25.0; 75.0 )] 56.0 (54.0; 60.0) years old, Group 2 – COPD + TB (n = 25), 58.0 (56.0; 59.0) years old, Group 3 – COPD + TB + CHF with preserved ejection fraction (n = 20), 60.0 (57.0; 64.0) years old. QOL was assessed using the SF-36 questionnaire. There were no statistically signifcant differences between the compared groups in terms of COPD severity and TB forms.

Results. Low QOL indices were observed in TB + COPD + CHF Group assessed by all scores especially for physical (30 points) and social functioning (35 points) and general health (35 points). After 3 months of therapy aimed to manage all pathological conditions, a positive trend in QOL was achieved in TB + COPD + CHF Group in terms of physical and mental health scores.

Conclusion. QOL in co-morbid patients is determined not only by the quality and severity of individual nosologies but also by their number. Comprehensive therapy improves the general subjective state of the patient that helps to improve adherence to drug therapy thereby increasing the chance of recovery.

The objective: to study the epidemiological rates of tuberculous meningitis (TM) in Smolensk and Kaluga Oblasts in 2015-2020.

Subjects and Methods. 51 medical fles (Form no. 003-u) of patients with TM were analyzed, those patients were treated in in-patient settings in Smolensk and Kaluga Oblasts over a 6-year period (2015-2020).

Results. The proportion of TM signifcantly correlates with the prevalence of HIV in 2 Oblasts (r = 0.953, p = 0.140 and r = 0.978, p = 0.095, respectively), which allows stating that HIV is the main risk factor for the development of TM. Tuberculous meningitis is more common in men (70.6%) of working age (94.1%), unemployed (60.8%), in combination with pulmonary tuberculosis (64.7%). Late diagnosis of TM is registered in ⅔ of cases; patients fail to undergo the mandatory minimum diagnostic examination. Among patients with HIV infection, TM more often develops in men (90%) of working age (100%), who do not have a regular job (80%), against the background of risk factors (drug addiction, hepatitis C, experience of incarceration), duration of HIV infection up to 10 years and recurrence of tuberculosis. Among HIV positive patients, a severe state, generalized forms of tuberculosis, including lung lesions with scanty bacterial discharge in sputum are registered in 100% of cases.

The objective: to increase efcacy of treatment of patients with new coronavirus infection COVID-19 by prescription of Remaxol.

Subjects and Methods: 105 patients with confrmed new coronavirus infection COVID-19 with lung damage from 25 to 50% (CT-2) were examined and divided into 2 groups (Main Group and Comparison Group). All patients received standard treatment; patients from Main Group (55 people) additionally received Remaxol intravenously 200.0 ml No. 10 daily, then No. 5 every other day. Treatment efcacy was assessed between the 3rd and 4th week of the study.

Results: the patients treated with Remaxol showed more pronounced positive changes of clinical and laboratory symptoms (lower frequency of fever, improved state of health, appetite, decreased dyspnea, cough and wheezing, higher level of SpO2, decreased neutrophilia and blood clotting, ferritin levels, a signifcant increase in activity of superoxide dismutase in erythrocytes and a decrease in myeloperoxidase activity in neutrophils) versus patients receiving standard treatment. The CT lung scan after 3 weeks in patients from Main Group showed the transformation of ground-glass areas into impactions according to the consolidation type in 58.2% (32 people), in 52.2% (29 people) there appeared an organizing pneumonia, a decrease in size of impactions was observed in 54.6% (30 people); in Comparison Group ‒ in 24.0% (12 people), 20% (10 people) and 24% (12 people), respectively, in all three comparisons (p < 0.05).

The article describes a clinical observation of the effective treatment of a multimorbid HIV positive patient with multiple drug resistant tuberculosis. It demonstrates modern approaches to treatment and optimal chemotherapy regimens containing bedaquiline. In the treatment of patients with a combination of chronic infectious diseases (tuberculosis, HIV infection, parenteral hepatitis) and oncological pathology (kidney cancer), interdepartmental interaction of specialists (phthisiologists, infectious disease specialists, and oncologists) is needed in order to compile successful treatment regimens taking into account multiple comorbidities and the risk of adverse reactions to drug combinations and choose the right time to perform a successful surgery.

The objective: to identify and systematize social and demographic risk factors for the development and spread of multiple drug resistant tuberculosis (MDR TB) in the Russian Federation (RF) by means of a systematic review of existing publications.

Subjects and Methods. A systematic literature review was performed in accordance with the PRISMA criteria and included studies conducted in the Russian Federation from 2011 to 2021. Out of 2,861 publications, 26 studies were selected and analyzed.

Results. According to the reviewed studies, patients with a history of incarceration, low income, unemployed, homeless, and patients suffering from alcohol and nicotine addiction are more susceptible to MDR TB. It was also found that MDR TB most often affected people of working age with a clear trend towards a younger cohort. The influence of such factors as gender and location on MDR TB risk is not clear due to conflicting data and comparative strength of evidence in publications.

The review analyzes 47 publications describing the process occurring in the human body with involvement of pyridoxine (vitamin B6). The special emphasis is put on the role of vitamin B6 in prevention of adverse reactions to medications or their relief due to a comprehensive effect on many organs and systems.