The article describes the current tuberculosis epidemiological situation in institutions of the penitentiary system including the combination of tuberculosis and HIV infection. The epidemic consequences of increased coverage of people living with HIV infection (PLHIV) with antiretroviral therapy (ART) were analyzed. By 2020, tuberculosis incidence dropped to 621 per 100,000. Tuberculosis mortality dropped to 6.8 per 100,000. The incidence of tuberculosis among PLHIV decreased from 3,490.6 per 100,000 population in 2014 to 2,014.2 per 100,000 population in 2020, while coverage of PLHIV with ART increased from 21.7 to 89.6%. The proportion of TB patients among PLHIV decreased from 10.4% in 2014 to 7.2% in 2020. The proportion of PLHIV among newly diagnosed TB patients remained high (34.4% in 2020). The prevalence of multiple drug resistant tuberculosis decreased to 557.6 per 100,000. Thus, in 2020, the epidemiological tuberculosis situation in the Russian penitentiary institutions continued to improve. The strategy to increase coverage of PLHIV with ART proved to be effective for prevention of tuberculosis in penitentiary settings. Multiple drug resistant tuberculosis presents a serious problem which forms the grounds for introduction of modern treatment protocols with innovative drugs to the Russian penitentiary institutions.

The objective: to develop differentiated approaches to the choice of timing of surgical treatment of intrathoracic lymph node tuberculosis (ITLNTB) in children during the increasing incidence of multiple drug resistant tuberculosis (MDR-TB).

Subjects and Methods. 52 patients of 2-12 years old had their intrathoracic lymph nodes removed at different stages of anti-tuberculosis therapy. All children had massive (more than 10-15 mm) conglomerates in their intrathoracic lymph nodes. Additionally to changes in intrathoracic lymph nodes, 12 people had active tuberculous changes in the lungs or bronchial tuberculosis.

Results. 5 patients were operated before chemotherapy, 35 patients after 2 months of treatment, and 12 patients underwent surgery afterwards. The elective surgery was performed in 51 children, and 1 child had surgery before the start of chemotherapy due to vital indications (the threat of breakthrough of caseous masses into the trachea).

Planned surgical treatment in children with tuberculosis of intrathoracic lymph nodes should be carried out within the following timing: before the start of anti-tuberculosis therapy in the absence of clinical, laboratory and radiological signs of the disease being active; as soon as possible from the start of chemotherapy (it is enough to focus on the results of the first CT control after 2 months of treatment (there should be no tendency to involution of pathological changes) in the presence of minimal signs of tuberculosis activity). The choice of timing of planned surgical treatment is individual and determined by the timing of stabilization of pulmonary changes or the cure of bronchial tuberculosis (after 6, 9, 12 months) in patients with newly diagnosed active tuberculosis of intrathoracic lymph nodes in combination with lung and/or bronchial lesions. The development of life-threatening complications is an absolute indication for emergency surgery.

The objective: to evaluate the prognosis of 4-year survival in patients with chronic obstructive pulmonary disease (COPD) and concomitant obstructive sleep apnea-hypopnea syndrome (OSAHS).

Subjects and Methods. 62 patients with COPD and OSAHS were enrolled in the study, they all had been diagnosed in accordance with the recommendations of GOLD (2017). The clinical and functional examination included assessment of respiratory function parameters and a 6-minute step test, a survey using the validated questionnaire of the dyspnea scale by Medical Research Council (MRC) followed by the calculation of body mass index and the BODE index.

Results. Patients with COPD and concomitant OSAHS demonstrated higher intensity of dyspnea, deterioration of functional obstructive disorders, and lower exercise tolerance. The course of the disease was characterized by multiple exacerbations requiring hospitalization, 77.4% of COPD patients with OSAHS suffered from cardiovascular diseases and 95.2% were obese. Evaluation of the integral BODE index in COPD patients with OSAHS showed that only 35.5% of them had a 4-year survival rate exceeding 57%. A strong inverse correlation was established between the BODE index and the maximum desaturation rate (r = -0.78) and the moderate inverse correlation was established between the BODE index and SaO₂ (r = -0.37). As a result of a 12-year follow-up (2008-2019), mortality in COPD patients with OSAHS was established in 22.2% of cases, mainly among COPD patients with severe OSAHS.

The objective: to compare the effectiveness of endoscopic diagnosis of bronchial tuberculosis in pulmonary tuberculosis patients with different HIV status.

Subjects and Methods. The data obtained during tracheobronchoscopy in 371 respiratory tuberculosis patients from 2018 to 2020 were retrospectively studied. The indication for bronchoscopy was the presence of clinical and radiological symptoms characteristic of bronchial tuberculosis in a pulmonary tuberculosis patient. All patients were divided into two groups: HIV+ and HIV-.

Results. In pulmonary tuberculosis patients with clinical and radiographic findings characteristic of bronchial tuberculosis, the frequency of endoscopic confirmation of bronchial tuberculosis in HIV+ Group was 57/71 (80.3%), in HIV- Group – 138/300 (46.0%), p < 0.01; χ² = 27.06.

Most often, in HIV-positive patients, the infiltrative form of bronchus tuberculosis was detected – 27 (47.4%) patients, and the fistulous form – 23 (40.4%) patients, bronchial lesions in HIV negative tuberculosis patients were mainly infiltrative – 94 (68.1%) or ulcerative – 24 (17.4%).

The frequency of microbiological detection of the causative agent of tuberculosis increased when bronchobiopsy was performed versus sputum microscopy, especially in HIV negative tuberculosis patients (from 39.9 to 91.3%), and among HIV positive patients from 15.7 to 47.4%.

The objective: to evaluate main effects of complex probiotic therapy (CPT) in patients with multiple drug resistant tuberculosis and co-morbid HIV infection (MDR-TB/HIV) with intestinal dyspepsia syndrome (IDS) in the course of anti-tuberculosis treatment.

Subjects and Methods. The study included 53 people with MDR-TB/HIV co-infection and clinically significant dyspeptic syndrome: 28 patients received a 30-day course of complex probiotic therapy and 25 patients received no such therapy. The effect of complex probiotic therapy on the course of dyspeptic and intoxication syndrome was assessed, and differences in hepatoprotective, hematopoietic, and immunogenic functions between the groups were studied. It was found out that patients receiving complex probiotic therapy had more effective relief of cytolysis, weakness and diarrhea, as well as a higher rate of weight gain, faster increase of hemoglobin concentration and CD4+ count. A clinical observation is presented that clearly demonstrates changes of these rates in a patient of TB hospital who received complex probiotic therapy.

The objective: to define hemogram parameters in smokers with COVID-19 and acute coronary syndrome when they are admitted to hospital.

Subjects and Methods. 62 male smokers hospitalized due to acute coronary syndrome (ACS) were enrolled into a case-control study. Group 1 (n = 31) had ASC and COVID-19, Group 2 (n = 31) had ACS and no COVID-19. The groups were adjusted by age, body mass index and the date of hospitalisation. According to the current routing procedures, from September to December 2020, the subjects were referred to different hospitals in Sverdlovsk Region depending on COVID-19 status. Inpatient medical records were used to collect the data. Blood parameters were examined by Mindray BC-5150 (China) automatic hematological analyzer performing complete clinical blood count and differentiating 5 leukocyte subpopulations. Statistical processing was performed using Statistica 13.0. The significance of differences was taken at p < 0.05.

Results. Smoking men with COVID-19 and ACS unlike those GOVID-19 negative had a lower level of diastolic blood pressure, significantly more often were diagnosed with low degrees of hypertension, higher BPD with the same frequency of detection and functional characteristics of chronic heart failure and chronic obstructive pulmonary disease. The hemogram showed a lower level of the number of leukocytes, the percentage of neutrophils, erythrocytes, hemoglobin, hematocrit, the average concentration of hemoglobin in the erythrocyte; a higher level of monocytes, erythrocyte sedimentation rate, and average platelet volume. The above changes can be associated with spesific features of the COVID-19 course.

The article describes a rare case of adenovirus infection complicated by diffuse alveolar hemorrhage in a 29 y.o. immunocompetent patient which developed during a trip to Sri Lanka. The course of the disease was accompanied by severe anemia and respiratory insufficiency, etiology of the disease was confirmed by polymerase chain reaction of pharyngeal swabs and sputum sample. After successful supportive treatment, the patient was discharged on the 13th day of hospital stay to continue treatment in the out-patient settings. This case demonstrates the possibility of severe complications in case of adenovirus infection.

Tuberculosis cutis orificialis is a rare form of cutaneous tuberculosis. The article presents 5 clinical cases of tuberculosis cutis orificialis of the oral cavity and lips that were described in publications. We present our own clinical case of successful treatment of tuberculosis cutis orificialis of the oral cavity, red border of the lips and skin of the lower lip against the background of multiple drug resistant pulmonary tuberculosis in a HIV positive patient. The case was especially difficult due to a long diagnostic search (10 months), severe immunosuppression, and drug resistance of Mycobacterium tuberculosis.

Based on 31 publications the review provides relevant information on epidemiology, etiology, pathogenesis and pathomorphology, clinical, computed tomographic features, diagnostics, and differential diagnosis of bronchiectasis in children. Recommendations for treatment and management of children and adolescents with non-cystic fibrosis bronchiectasis, and prevention of bronchiectasis exacerbations are given from the standpoint of evidence-based medicine taking into account the guidelines of the European Respiratory Society 2021.