The objective: to study delays in provision of medical care to pulmonary tuberculosis patients above 15 years old with laboratory confirmation of the diagnosis before and during the COVID-19 pandemic in Dushanbe, Tajikistan.

Subjects and Methods. A retrospective cohort study was conducted among new pulmonary tuberculosis patients above 15 years old with laboratory confirmation of the diagnosis registered by TB Control Centers in Dushanbe in 2019–2021. Information was collected from medical records, medical databases, and patient questionnaires. Two types of delays were detected during the provision of medical care: delays related to the patient (defined as >14 days between onset of tuberculosis symptoms and the first visit to a health unit); delays related to health system (defined as >3 days from the first visit to TB unit to the initiation of tuberculosis treatment).

Results. Of the 472 patients enrolled in the study, 276 were registered during the COVID-19 pandemic (2020–2021) and 196 patients were registered before the pandemic (2019). Frequency of delays was similar (83% vs 82%, p=0.8) during and before the COVID-19 pandemic. The frequency of delay related to health system was statistically significantly lower during the pandemic versus the period before the pandemic (34% vs 44%, p=0.023). The median duration of delays associated to the patient before the pandemic (60 days, IQR: 15–541) and during the pandemic (60 days, IQR: 15–360, р=0.6) was also similar as well as delays related to health system (before the pandemic – 7 days, IQR: 4–336) and during the pandemic (7 days, IQR: 4–225, р=0.6).

Conclusion. Contrary to the expected result, no significant difference in delays related to the patient before and during the pandemic was found, and the frequency of delay related to health system during the pandemic significantly reduced compared to the period before the pandemic.

The objective: to assess the stability of circulation of S genotype and S-like strains of M. tuberculosis (MTB) in the Republic of Sakha (Yakutia) over a 12-year period and perform their phylogenetic identification relative to the L4.4 Euro-American subline.

Subjects and Methods. Between 2009 and 2022, 513 MTB strains isolated from pulmonary tuberculosis patients were studied using molecular genetic methods. 92 isolates belonging to S genotype or having an S-like genetic profile were found. Whole-genome sequencing of five strains of S genotype that circulated in the territory of the Republic of Sakha (Yakutia) in 2020-2022 was carried out. A global phylogenetic analysis was performed and evolutionary relationship of the obtained genomes was determined, a RT-PCR test was developed for the rapid detection of S genotype strains.

Results. In the territory of the Republic of Sakha (Yakutia), there is a stable circulation of S and S-like MTB genotypes belonging to the L4.4 Euro-American subline, the L4.4.1.1 subtype. The evolutionary model has confirmed the previously stated hypothesis that the spread of the S genotype among the indigenous population of Yakutia is associated with mass exposure to the Russian settlers which started from the beginning of the 17th century.

Conclusion. Spread of MTB strains of the L4.4 Euro-American subline, L4.4.1.1 subtype, among the indigenous populations of New Zealand, Canada and Yakutia in the 17th-19th centuries is very similar.

The objective: to analyze results of surgical treatment of the patients with spontaneous pneumothorax.

Subjects and Methods. Medical records of patients with spontaneous pneumothorax (SP) who were treated in Surgical Thoracic Department of Ryazan Regional Clinical Hospital from 1998 to 2021 were retrospectively analyzed. The article describes the experience of treatment of 738 cases of spontaneous pneumothorax within one medical center. The evolution of tactics and principles of surgical treatment over a 23-year period is presented. The incidence of spontaneous pneumothorax and efficacy of different surgical options were analyzed. The recurrence of spontaneous pneumothorax was recorded in the following cases: after pleural cavity drainage – in 19.7%, after videothoracoscopic resection of bullous parts of the lung in combination with subtotal parietal pleurectomy – in 2.1%.

The objective: to evaluate the efficacy of chemotherapy regimens for isoniazid resistant pulmonary tuberculosis (Hr-TB): short-course regimen consisting of 4 components (non-injection) and the regimen consisting of 5 components (standard regimen).

Subjects and Methods. Medical records of 292 pulmonary tuberculosis patients with resistance to isoniazid were retrospectively studied. In 89 patients (Group A), the regimen containing rifampicin, pyrazinamide, ethambutol, and levofloxacin was used – a 4-component non-injection regimen (180±20 doses). In 203 patients (Group B), the regimen containing rifampicin, pyrazinamide, ethambutol, levofloxacin, and amikacin/kanamycin was used - a 5-component standard regimen (270 doses).

Results. The efficacy of treatment of isoniazid resistant pulmonary tuberculosis was similar, while a short-term 4-component (non-injection) regimen is 4.5 times less expensive versus the standard 5-component regimen. Treatment success made 88.8% and 88.2% respectively, p>0.05.

The objective: to develop approaches to selection of optimal chemotherapy regimens in tuberculosis patients with concurrent diabetes mellitus (DM), by studying complications of diabetes mellitus and adverse drug reactions to anti-tuberculosis drugs.

Subjects and Methods. 235 adult pulmonary tuberculosis patients with concurrent diabetes were enrolled in the study. Of them, 123 were men (52.3%) and 112 were women (47.7%), and the age of the patients varied from 19 to 78 years old.

Results. Complications of diabetes mellitus (DM) were reported in 190/235 (80.8%) patients. Encephalopathy occurred most often – in 147/190 (77.3%) patients, diabetic macroangiopathy developed less often - in 41 (21.6%), followed by diabetic retinopathy – in 20 (10.5%), diabetic nephropathy - in 11 (5.8%), ketoacidosis – in 4 (2.1%), and diabetic foot – in 4 (2.1%). Diabetic macroangiopathy was significantly more often observed in men (66.7%) versus women (31.7%); p<0.01, and diabetic nephropathy was more common in women (81.8%) than men (18.2%); p<0.01. As the age of patients and duration of diabetes increased, the incidence of complications of diabetes also increased. Adverse drug reactions (ADRs) to anti-tuberculosis drugs (TB drugs) occurred in 168/235 (71.4%) patients. ADRs to two or more TB drugs were registered in 140/168 (83.3%) patients. The most frequent irreversible ADRs were caused by the following drugs (of the number of patients taking them): aminoglycosides (58.8%), capreomycin (54.5%), PAS (50.0%), ethambutol (100.0%), cycloserine (40.0%), levofloxacin (33.3%), pyrazinamide (23.3%), terizidone (28.6%), prothionamide (26.3%), linezolid (21.4% ), and moxifloxacin (20.0%).

Conclusion. When treating pulmonary tuberculosis in patients with diabetes mellitus, chemotherapy regimens containing aminoglycosides, capreomycin, prothionamide, and pyrazinamide should be avoided. If there is even an initial stage of retinopathy, ethambutol should be avoided. Patients with encephalopathy should be switched from cycloserine to terizidone.

The objective: to study specific features of the respiratory tuberculosis course and effectiveness of its treatment during pregnancy and postpartum period, and to evaluate the impact of tuberculosis on perinatal outcomes.

Subjects and Methods. In 2010 - 2022, a retrospective-prospective case-control study enrolling 164 patients of reproductive age was conducted in Central Tuberculosis Research Institute. Two groups were formed: Case Group included 82 pregnant women with respiratory tuberculosis; Control Group included 82 non-pregnant patients with respiratory tuberculosis.

Results. In both groups, new cases of respiratory tuberculosis were notified more often versus relapses. Distinctive features of respiratory tuberculosis in pregnant women versus the non-pregnant were as follows: the predominance of the proportion of extensive drug resistant M. tuberculosis – 55.5% versus 31.7% (p<0.05), respectively; lower frequency of lung tissue destruction – 18.3% versus 32.9% (p≤0.05); higher incidence of cavities - 80% and 40.7% (p≤0.05) and complications of respiratory tuberculosis – 25.6% versus 12.2% (p≤0.03), respectively. The high effectiveness of respiratory tuberculosis treatment such as relief of clinical symptoms and sputum conversion was achieved at the end of the intensive therapy phase both in Case Group and Control Group. Longer time until sputum conversion and lower rate of cavity healing were reported in the patients from Case Group. In 75.6% of pregnant women from Case Group there was a delivery with favorable perinatal outcomes.

The objective: to evaluate the role of IL-23 in the development of Th17 lymphocytes in patients with different clinical and pathogenetic forms of pulmonary tuberculosis.

Subjects and Methods. 165 pulmonary tuberculosis patients were examined. Venous blood was used for tests. Mononuclear leukocytes were isolated by centrifugation and monocytes were extracted and transformed into dendritic cells. The concentration of IL-23 in the supernatants of culture suspensions of dendritic cells was determined by ELISA. Immunophenotyping of Th17 lymphocytes (CD4+CD161+IL-17A+ cells) was performed by flow cytometry. Real-time PCR was used to determine the expression of the RORC2 transcription factor gene in lymphocytes.

Results. In patients with infiltrative drug susceptible and drug resistant pulmonary tuberculosis against the background of normal production of IL-23 by dendritic cells, an increase in blood level of Th17 lymphocytes and the level of mRNA of the RORC2 transcription factor gene was registered. The course of disseminated pulmonary tuberculosis (regardless of drug susceptibility and resistance) is associated with pronounced decrease in the concentration of IL-23 in vitro and the absence of response from Th17 lymphocytes.

The objective: to evaluate effectiveness of treatment of infiltrative pulmonary tuberculosis patients with exudative or productive types of the tissue inflammatory reaction when additional immunotherapy with recombinant IFN-γ is used.

Subjects and Methods. 127 infiltrative tuberculosis patients were enrolled in the study, of them 66 had an exudative type of the inflammatory reaction (2 Groups OG-1 and GS-1 were formed), 61 had a proliferative type (2 Groups OG-2 and GS-2 were formed). Patients from OG-1 and OG-2 Groups additionally received different regimens with recombinant interferon-γ.

Result: Comprehensive treatment of infiltrative tuberculosis including intramuscular administration (according to a certain regimen) of recombinant IFN-γ contributes to achievement of pronounced positive changes of clinical and radiological symptoms in patients with both exudative and productive types of the tissue inflammatory reaction. In the groups treated with recombinant IFN-γ, restoration of the cellular immune response, cellular cooperation, normalization of the cytokine profile and increased phagocytosis activity were confirmed by the results of laboratory tests.

The article presents a long-term follow-up of a family nidus of tuberculosis infection demonstrating the incidence among adult contacts including 6 years after taking off the register of dispensary follow-up.

The article describes the follow-up over a clinical case of the patient with COPD, pulmonary hypertension (PH), and history of pulmonary tuberculosis. According to the guidelines, treatment of the patient with PH which developed due to bronchopulmonary pathology was focused on constant bronchodilator therapy to reduce hypoxemia and to achieve additional vasodilating effect on vessels of the pulmonary circulation, as well as on non-invasive high-flow oxygen therapy which inhibited the progression of PH (it prevented mortality).

The article presents the review of 61 publications. The topic is highly relevant due to the fact that clinical trials of drugs and chemotherapy regimens usually enroll adults, while children participate only in a small number of them. Often in clinical practice, anti-tuberculosis drugs are prescribed to children off-label. The frequency of adverse reactions in children varies widely depending on approaches to their reporting. The most severe and frequent adverse events are associated with liver injury. In recent years, clinical trials of fluoroquinolones, bedaquiline, and delamanid were run in pediatric patients with drug resistant tuberculosis demonstrating satisfactory tolerability and safety of these drugs.

Based on an analysis of archive materials, scientific publications and official statistics obtained from 56 sources, the global tuberculosis burden was assessed. In 1918 in Russia, tuberculosis mortality made 360 cases per 100,000 population, exceeding that in other industrial countries: in England this rate was 113.0; in the USA – 148.0; in Switzerland – 201.0; in Italy – 209.0; in France – 226.0; in Germany – 230.0; and in Japan (1920) – 234 cases respectively. Having undergone colossal socio-economic catastrophes like no other country, Russia achieved significant success in the fight against tuberculosis: in 1913, tuberculosis incidence was 733.0 per 100,000 population, tuberculosis mortality was 276.8; while in 2021 these made 31.1 and 4.3 respectively. In 2021, WHO excluded Russia from the list of countries with a high burden of tuberculosis. However, in Russia as well as in the other BRICS countries, the burden of MDR TB and TB/HIV co-infection still remains high, which requires allocation of resources to reduce their spread.