The objective of the study: to describe the efficiency and safety of new anti-tuberculosis drugs when treating tuberculosis patients with drug resistance.

Subjects and methods. In Belarus, the retrospective and prospective analyses were performed in the cohort of 300 patients with multiple drug resistance and high rates of extensive drug resistance, who were treated with new drugs and drugs which were started to be used for the treatment of tuberculosis. In order to describe the cohort, blocks of variables were used to specify the efficiency and safety profiles of new anti-tuberculosis drugs.

Results of the study. The high level of therapeutic efficiency of new regimens and their fairly favorable safety profile were demonstrated in the cohort.

The objective: to describe the current state of tuberculosis situation before the start of the national healthcare project which is to be implemented till 2024.

Materials. The data from Federal Statistics Forms no. 8, 33, and 61. The number of those died is presented as per the data of Rosstat. Epidemiological rates were calculated as per mid-year population.

Results. In Russia, tuberculosis situation has stabilized and there is a tendency for its improvement, and the changes in main tuberculosis rates provide the evidence of the above. For 10 years (from 2008 to 2017) the following main tuberculosis rates went down: tuberculosis incidence – from 85.1 to 48.3 per 100,000 pop. (by 43.2%); tuberculosis incidence among children from 0 to 14 years old – from 15.3 to 9.7 per 100,000 pop. (by 36.6%); tuberculosis prevalence by the end of the year – from 190.7 to 109.8 per 100,000 pop. (by 42.4%); bacillary excretion in tuberculosis patients – from 80.3 to 46.0 per 100,000 pop. (by 42.7%); tuberculosis mortality – from 17.9 to 6.5 per 100,000 pop. (by 63.7%).

In 2017, tuberculosis incidence among resident population, HIV negative (33.4), was lower than the minimum rate, which was registered in Russia in 1991, when HIV infection provided no significant impact on tuberculosis situation in the country (34.0 per 100.000 pop.). in 2017, tuberculosis mortality (6.5 per 100,000 pop.) which hardly now includes those HIV infected and died of tuberculosis, is lower than the minimum rate documented in 1989 (7.4 per 100,000).

In the long view, the developing HIV epidemics will provide a negative impact on tuberculosis situation given the growing rates of the patients at the advanced stages of HIV infection and the increasing number of patients with multiple drug resistance. HIV infection will not allow achieving a significant reduction of tuberculosis incidence and will result in the growing fatality among tuberculosis patients in the number of the regions of the Russian Federation.

Currently, it is not necessary to concentrate on the number of those examined but to improve the quality of screening in the groups facing a high risk to develop tuberculosis and to consider re-organization of tuberculosis services due to the reduction of tuberculosis incidence.

During 10 years (2018-2027), tuberculosis incidence is to be reduced twice. The program for tuberculosis incidence reduction is to be predicted for each region specifically, considering the current tuberculosis situation and the level of tuberculosis detection organization. In parallel, the effective tuberculosis care is to be provided for those HIV infected.

Valve bronchial block is successfully used for the healing of cavities in tuberculosis patients, including those with HIV infection.

The objective of the study: to investigate factors providing an impact on the healing of destructive changes when using valve bronchial block in the patients with TB/HIV co-infection.

Subjects and methods. Valve bronchial block was used in 68 HIV positive patients as a part of the comprehensive treatment of tuberculosis. Depending on its outcome, 2 groups of patients were identified: those in whom the cavity was healed (n = 38) and those in whom the cavity persisted (n = 30). The factors providing an impact on the efficiency of valve bronchial block in those groups were investigated.

Results. This method was the most effective in the patients who had tuberculous lesions in the upper lobes, with cavities up to 2 cm in diameter, scanty bacillary excretion, CD4 count above 250 cells/mcl, and good adherence to antiretroviral therapy, if it was indicated. The factors providing impact on destruction persistence during the valve bronchial block were the following: cavities from 4 to 7 cm, persisting moderate or massive bacillary excretion, extensive drug resistance, CD4 count below 250 cell/mcl, especially below 100 cells/mcl.

The objective of the study: to investigate the efficiency of treatment of those suffering from chronic obstructive pulmonary disease (COPD) when using laser-ultrasound effect along with traditional therapy.

Subjects and methods. 58 COPD patients were enrolled into the study. The article describes the number of clinical, laboratory and functional rates, parameters of external respiration functions, biomarkers of system inflammation during treatment including the low-intensity laser radiation, exposure to ultrasound and basic medicamentous therapy.

Results. The laser ultrasound therapy as a part of comprehensive treatment of COPD patients allows achieving the maximum effect for the following criteria: excretion of sputum (the amount of sputum produced during 24 hours), the subjective assessment of cough and sputum by visual analogue scale; improvement of peripheral blood rates, reduction of system biomarkers (IL-4, IL-8, TNF-2), improvement of external respiration function and general state of the patients.

The objective of the study: to analyze clinical data of patients staying in a specialized unit for tuberculosis patients with concurrent HIV infection.

Subjects and methods. The case histories of all patients staying in the unit for TB/HIV co-infection of Surgut Clinical TB Dispensary discharged in 2016 were retrospectively analyzed, totally there were 231 such patients.

Results. Tuberculous lesions in the HIV infected patients were more disseminated (pulmonary disseminated tuberculosis was in 51.1% of patients and generalized forms with lesions in the lungs and other organs were in 17.9% of patients additionally). Cavities were diagnosed in 45.5% of pulmonary tuberculosis patients, and bacillary excretion was detected in 60.4% (among HIVnegative patients, registered in the city, those rates made 38.3 and 42.3% respectively). The rate of multiple drug resistance made 9.9% in all pulmonary tuberculosis patients or 44% among the patients with drug resistance, and extensive drug resistance made 1.4 and 6.1% respectively.

Along with anti-tuberculosis chemotherapy, 45.9% of patients received antiretroviral therapy, and 10.0% of them rejected it.

Only 36.7% of patients completed the intensive phase of treatment, 29.7% defaulted from treatment and left hospital at their will, 17.5% died, and the remaining patients were transferred to some other medical units (for surgery or to manage some concurrent condition) or they were discharged from the hospital due to violations of the discipline.

While on treatment, 57.5% of the patients with bacillary excretion had their sputum converted (by culture).

The objective of the study: to evaluate the applicability of the automated system for detection of chest diseases during a regular mass screening of the population through assessment of universe parameters of diagnostic accuracy.

Subjects and methods. A retrospective diagnostic study was conducted. The index-test (the method being studied) implied distinction and analysis of X-ray films using the software based on convolutional neural networks of U-NET type, which were modified and trained for specific purposes. The reference method used was the double revision of the previously classified X-ray films by two qualified roentgenologists with work experience of 8-10 years. Two depersonalized samplings of digital X-ray films were used: Sample 1 (n = 140), the ratio of the norm and pathology made 50 : 50; Sample 2 (n = 150), the ratio of the norm and pathology made 95 : 5.

Results. The following parameters were set up for Samples 1 and 2 respectively: sensitivity ‒ 87.2 and 75.0%, specificity ‒ 60.0 and 53.5%, the prognostic value of the positive result ‒ 68.6 and 8.3%, the prognostic value of the negative result ‒ 82.4 and 97.5%, the area under characteristic curve ‒ 0.74 and 0.64.

Conclusions. The index test can be used only for mass regular screening in the population with low pre-test chances of pathology, which is confirmed by the prognostic value of the negative result (97.5%). This technology was recommended for the semiautomatic formation of pulmonary tuberculosis risk groups for consequent verification of the results by a roentgenologist.

The objective of the study: to study the prevalence of resistance to first line drugs among tuberculosis patients in Astana (Kazakhstan Republic).

Subjects and methods. Data on resistance to first line drugs according to the WHO classification were analyzed, they included sputum test results of 449 patients with bacillary excretion who received in-patient treatment in TB Dispensary in Astana in 2017. Bactec and Hain test were used for drug susceptibility testing.

Results. The study showed that among new tuberculosis patients and relapses, resistance to isoniazid (H) dominated and made 87.4% (76 out of 87) and 91.1% (41 out of 45) of cases respectively. Resistance to H was registered more often versus resistance to streptomycin. H-resistant strains were detected confidently more often than rifampicin resistance: 76/226 (33.6%) versus 18/226 (8.0%) among all new cases (p < 0.01) and 41/133 (26.1%) versus 5/133 (3.2%) of all relapses (p < 0.01).

Among new cases with drug resistant tuberculosis, the frequency of rifampicin resistant strains was compatible with the frequency of resistance to ethambutol. It was found out that the frequency of resistance to pyrazinamide was low.

The performed analysis confirmed that when prescribing treatment to tuberculosis patients it was necessary to investigate the resistance to first line drugs with much detail.