The article describes historical aspects of foundation and development of TB services in Moscow Region and stages of development and reorganization of Moscow Regional Clinical TB Dispensary. It presents the results of improvement of tuberculosis prevention and early detection, organization of treatment of tuberculosis patients for the last 3 years.

The objective: to assess the possibility of tuberculosis elimination in Moscow Region by 2035.

Subjects and Methods. For the study, Federal Statistical Surveillance Form No. 8 Information on Active Tuberculosis cases, and Form No. 33 Information on Tuberculosis Patients for 015-2023 were selected, rates were calculated for the average annual population in the region. Changes in tuberculosis incidence in Moscow Region were analyzed.

Results. Based on results of the study on possibility to eliminate tuberculosis in Moscow Region by 2035, it has been found that if the current epidemic situation persists, it is only possible to achieve the mortality target. To achieve the target results for other rates, additional measures to prevent tuberculosis among the population are needed.

The objective: to assess results of TB medical units reorganization aimed to optimize development of TB services.

Subjects and Methods. The article presents results of TB services reorganization in Moscow Region from 2015 to 2023.

Results. Effective coordination and organizational and methodological management allowed improving the quality of dispensary follow-up over patients, enhancing efficiency of inpatient medical care, complying with uniform requirements to diagnosis and treatment of tuberculosis patients which ensured the achievement of target rates.

The article describes the experience of implementing control over quality and safety of medical activities and passing the stages of voluntary certification under System On Quality and Safety of Medical Activities in 2020-2022 in 3 clinics and 12 branches of Moscow Regional Clinical TB Dispensary. Obtaining a certificate of voluntary certification by National Institute of Quality confirms the leading position of Moscow Regional Clinical TB Dispensary and served as a basis for founding Regional Center for Organization of Internal Control of Quality and Safety of Medical Activities.

The objective: to test the TREC/KREC DNA levels in children with various manifestations of tuberculosis infection.

Subjects and Methods. A prospective, cross-sectional study was conducted in 2022-2024. Observation Group consisted of 115 children aged 6 (5; 7) years, of them 25 were diagnosed with tuberculosis, 63 were diagnosed with latent tuberculosis infection, 27 were not infected with Mycobacterium tuberculosis (conditionally healthy).

Results. Findings of the study were as follows: among children with LTBI and a positive response to TRA, only 18.2% had the high TREC DNA concentration which corresponded to the level in the children ill with tuberculosis (t = 0.971; p = 0.342), there was a direct relationship between the TREC DNA and KREC DNA levels in children with LTBI; in 21.2% of children the level was low and indicative of immunodeficiency. If the positive response to TRA persisted in children for two years or more, there was a decrease in the average TREC DNA level, which was statistically significant compared to that in children with TRA+ for less than 2 years. Taking into account the results obtained, the TREC DNA level in children with LTBI can be considered as an additional criterion to assess activity of tuberculosis infection and can be an evidence to justify preventive anti-tuberculosis therapy if studied further. We also found a direct correlation between the TREC and KREC DNA levels in children with LTBI, r = 0.48 (by Spearman). When the positive response to TRA persisted for more than two years, a statistically significant decrease in the TREC DNA level was noted versus the results in children with the first positive response to TRA (t = 2.965; p = 0.005).

Conclusion. Taking into account the results obtained, the TREC DNA level in patients with various manifestations of tuberculosis infection can be considered as an additional criterion of infection activity, which will allow differentiated approach to preventive treatment being an important evidence to justify anti-tuberculosis therapy.

The objective: to evaluate risk factors for tuberculosis relapse development during stabilization of the COVID-19 situation.

Subjects and Methods. 165 patients over 18 years of age were enrolled in the observational comparative study, those patients were followed up due to respiratory tuberculosis relapses in 2021-2023. Risk factors for early and late relapses that occurred during the pandemic (2021-2022) and post-pandemic (2023) periods were analyzed. They included age, gender, accommodation, social status, imprisonment, smoking, alcohol and substances abuse, comorbidities, clinical forms of tuberculosis, presence of cavities, bacterial excretion, and drug resistance of Mycobacterium tuberculosis.

Results. The data obtained confirmed the assumption that the COVID-19 pandemic had led to changes in social and medical-biological risk factors for tuberculosis relapse.

The objective: to evaluate the effectiveness of various methods for the main bronchus stump closure when performing pneumonectomy for destructive pulmonary tuberculosis.

Subjects and Methods. Treatment results of 1211 tuberculosis patients from 1958 to 2022 were studied. The patients were treated in three clinical phthisiopulmonary centers. All of them underwent pneumonectomy with closure of the main bronchus stump by different methods.

Results. We studied results of using different methods for suturing the main bronchus during pneumonectomy. For this purpose, the incidence of early fistulae of the bronchial stump and mortality from bronchopleural complications were assessed. The worst result was observed when using a mechanical suture (21.7% and 8.3%, respectively), the combination of polyspast-circular ligature with mechanical suture improved the effectiveness (2.3% and 4.6%, respectively), and the best result was demonstrated by the stump-free method of bronchus closure offered by D.B. Giller et al. (0.3% and 0.1%, respectively).

The objective: to assess effectiveness, safety and pharmacoeconomic feasibility of using a dispersible fixed-dose combination (isoniazid 150 mg, rifampicin 150 mg, pyrazinamide 375 mg) in patients with respiratory tuberculosis and preserved susceptibility of Mycobacterium tuberculosis (MTB) to anti-tuberculosis drugs.

Subjects and Methods. A post-registration observational study was conducted to assess treatment effectiveness of pulmonary tuberculosis in 60 adult patients with drug susceptible tuberculosis. In Main Group, patients received the fixed-dose combination (isoniazid 150 mg, rifampicin 150 mg, pyrazinamide 375 mg), while in Control Group, patients were treated with the regimen consisting of single anti-tuberculosis drugs.

Results. Sputum conversion rate made 76.7% by the end of the intensive phase (60 doses) when replacing isoniazid, rifampicin and pyrazinamide with the dispersible fixed-dose combination, while with the standard choice of drugs, it was 66.7%. The incidence of adverse reactions was 7-fold lower when using the investigational drug which contributed to a high level of adherence and high effectiveness of therapy. Pharmacoeconomic analysis convincingly demonstrated advantages and economic benefits of the dispersible fixed-dose combination (isoniazid 150 mg, rifampicin 150 mg, pyrazinamide 375 mg), which was more costly than the combination of single drugs.

The objective: to compare effectiveness and safety of isonicotinoylhydrazine-O,N' iron (II) sulfate dihydrate with the drug of isonicotinic acid hydrazide group in the complex therapy of patients with drug susceptible tuberculosis and HIV infection.

Subjects and Methods. In 2020-2021, 40 patients with HIV infection and drug susceptible respiratory tuberculosis with a positive sputum test were examined in Moscow Regional Clinical TB Dispensary as a part of the post-registration observational study. The subjects were randomized into two groups – Main Group (MG) and Comparison Group (CG). Isonicotinoylhydrazine-O,N' iron (II) sulfate dihydrate was administered to the patients from MG as a part of regimen 1 of chemotherapy (instead of isoniazid). The effectiveness and safety of the investigational drug and comparator were evaluated. The primary effectiveness criteria included resolution of clinical symptoms of intoxication and sputum conversion. The secondary effectiveness criterion was positive X-ray changes. The safety criterion was the absence of adverse reactions.

Results. During the study period, no adverse reactions were registered when isonicotinoylhydrazine-O,N' iron (II) sulfate dehydrate was used, as well as isoniazid. Good tolerability was noted as well as high compliance to treatment by patients. Thus, both in terms of effectiveness and safety, isonicotinoylhydrazine-O,N' iron (II) sulfate dihydrate is comparable to isoniazid as part of anti-tuberculosis chemotherapy for patients with drug susceptible tuberculosis and concurrent HIV infection.

The objective: to assess effectiveness and safety of the surfactant as part of comprehensive anti-tuberculosis therapy in pulmonary tuberculosis patients depending on the drug resistance pattern and HIV status.

Subjects and Methods. 184 patients with pulmonary tuberculosis were enrolled in the study, of them 130 (70.7%) were men and 54 (29.3%) were women. All patients were randomized into Main Group (MG) and Control Group (CG). Surfactant therapy was added to comprehensive anti-tuberculosis therapy of the patients from Main Group. Additionally, each group was divided into subgroups based on HIV status.

Results. The addition of surfactant therapy to comprehensive anti-tuberculosis therapy increases effectiveness of treatment improving such parameters as sputum conversion and cavity healing regardless of drug susceptibility pattern including patients with concomitant HIV infection. At the same time, the agent used for surfactant therapy demonstrated good tolerability.

The objective: to evaluate treatment results in MDR TB patients when delamanid is added to the treatment regimen.

Subjects and Methods. 91 patients with multiple drug resistant pulmonary tuberculosis were included in the study, of which 36 people (39.6%) were HIV positive. Patients were divided into four comparison groups depending on HIV status and inclusion of delamanid in the treatment regimen. Groups receiving delamanid included only patients in whom bedaquiline or linezolid had been discontinued due to adverse reactions.

Results. The results of treatment of MDR TB when delamanid is added to the chemotherapy regimen during the intensive phase, indicate its high effectiveness and safety including HIV positive patients.

The objective: to evaluate state of extracellular matrix markers and their tissue inhibitors during development and formation of clinical phenotypes of COPD, in patients facing the high risk of developing exacerbations.

Subjects and Methods. 96 COPD patients (73% men and 27% women) were examined. Patients were randomized into the following groups: Group 1 included 40 COPD patients with bronchitis phenotype; Group 2 included 38 patients with emphysema phenotype; and Control Group consisted of 18 practically healthy subjects. All patients underwent a comprehensive clinical and laboratory examination. Levels of matrix metalloproteinases (total MMP-9 and MMP-2) and their tissue inhibitors TIMMP1 and TIMMP2 were determined by ELISA.

Results. The development of COPD, regardless of the clinical phenotype of the disease, is accompanied by pronounced expression of extracellular matrix markers MMP-9 and MMP-2. Regardless of the COPD clinical phenotype, elevated activity of metalloproteinases is accompanied by inhibition of production of TIMMP2 and dysfunction of the MMP-9/TIMMP1 antiprotease system. In COPD patients with MMP-2 level of 214 ng/ml, the formation of bronchitis phenotype can be predicted, while with MMP-2 level of 214 ng/ml or more, the formation of emphysema phenotype can be predicted.