The objective: to predict lethal outcomes in patients with COVID-19 based on the result of chest computed tomography (chest CT) using a semi-quantitative visual scale of the pulmonary parenchyma lesion.

Subjects and methods. Inclusion criteria: patients who underwent chest CT from March 2 to May 1, 2020, inclusively, upon referral of a general practitioner due to suspected community-acquired pneumonia caused by COVID-19. Chest CT was performed in 48 medical organizations providing primary medical care to the adult population in Moscow. Exclusion criteria: patients whose chest CT was not assessed by CT 0-4 score; patients who were not confirmed as COVID-19 positive.

In the Russian Federation, CT 0-4 score is recommended to be used for assessment of the extent of lung parenchyma lesion in cases with suspected COVID-19.

Data on fatal outcomes were received on May 4, 2020 inclusive.

Results: data of 13,003 patients from the Unified Radiological Information Service were retrospectively included in the study according to inclusion and exclusion criteria. The test aimed to detect a trend of directional changes in the proportion of deceased patients among various categories using CT 0-4 score demonstrated a statistically significant result (p < 0.0001). The chance of a lethal outcome increases directionally from CT-0 to CT-4. The test for deviations from the linear trend also provided p < 0.0001, i.e. when moving to higher scores (CT-3 and CT-4), there was an accelerated increase in the risk of death. Analysis of overall survival using the Cox regression model showed that the assessed factors (age and CT 0-4 score) were statistically significantly associated with the time to death from COVID-19 (p < 0.05). The risk of death increased with age, on average, 8.6% for every 5 years (95% CI 0.8-17.0%). When transferring from one category of CT to the next one, the risk increased by 38% on the average (95% CI 17.1-62.6%). There was no statistically significant association of gender factor with overall survival (p = 0.408).

The visual score of CT 0-4 recommended for use in the Russian Federation to assess lung parenchyma lesions according to chest CT data, is a predictor of a lethal outcome in patients with COVID-19. CT 0-4 score is convenient for practical use.

The objective: to study changes in the structure of mortality from tuberculosis and HIV infection in Russia from 2000 to 2017.

Subjects and methods. The data of the Federal State Statistics Service on the mortality of the Russian population from tuberculosis and HIV infection (standardized ratio per 100,000 population) for 2000-2017 were studied. Data on the structure of patients with TB/HIV co-infection were obtained from Form no. 61 of the federal statistical monitoring for 2017.

Results. In Russia, there has been a steady decrease in the mortality rate from tuberculosis, the value of which in 2017 reached 5.9 per 100,000 people. At the same time, the average values of the mortality rate from tuberculosis have shifted towards the older age groups reaching maximum values in the age group of 45 years and older. On the contrary, the analysis of mortality from HIV infection (2006-2017) detected its unprecedented increase from 1.6 to 12.6 per 100,000 population. The maximum concentration of mortality from HIV infection was observed in young age groups (35-44 years old). The increase in mortality from HIV infection was accompanied by a change in the structure of mortality from infectious diseases: the proportion of tuberculosis decreased from 79.1% (2000) to 27.4% (2017), and the proportion of HIV infection increased from 0.1% ( 2000) to 57.2% (2017). Currently, in Russia, mortality from HIV infection in young age groups has taken a leading position in the structure of causes of death from infectious diseases, displacing mortality from tuberculosis.

The objective: to assess the effect of parenteral viral hepatitis on the manifestations of respiratory tuberculosis and the nature of surgical interventions for tuberculosis.

Subjects and methods. An ambispective observational study was conducted with a continuous sampling of 475 respiratory tuberculosis patients over 18 years old who underwent surgical interventions. The patients are divided into two groups: the group of RTB+PVH consisted of 92 patients with concurrent respiratory tuberculosis and chronic parenteral viral hepatitis; the group of RTB included 383 patients with respiratory tuberculosis and no parenteral viral hepatitis.

Results. It was found that compared with RTB group, in RTB+PVH group (regardless of the type of hepatitis virus), a chronic course of tuberculosis was registered significantly more often (42.4%; p = 0.005; OS = 2.0); more often bacillary excretion was documented (68.5%; p = 0.035; OR = 1.7), including those with multiple and extensive drug resistance (52.4% of cases with positive sputum tests, p = 0.048; OR = 1.8). Radical (69.6%; p = 0.05; OS = 1.7) and small-scale surgical interventions (64.1%; p = 0.037; OS = 1.8) were significantly less frequently performed in RTB+PVH patients; and such patients often developed postoperative complications (8.7%; p = 0.009; OS = 2.9).

The objective: to assess the level of vitamin D and parameters of phosphorus-calcium metabolism in children with latent tuberculosis infection.

Subjects and methods. 40 children from 3 to 17 years were enrolled in the study, they all had the abnormal reaction to Mantoux test with 2 TU but no clinical, radiological and bacteriological signs of active tuberculosis; 39 of them received preventive treatment for latent tuberculosis infection during the study. The following parameters were tested: blood level of 25-hydroxycholecalciferol (calcidiol, 25(OH)D) (the level of less than 10 ng/ml was considered as pronounce severe deficiency, the level of 11-20 ng/ml as moderate deficiency, 21-29 ng/ml – minor deficiency, above 30 ng/ml – an adequate level of vitamin D); total calcium, and ionized calcium.

Results: 87.5% (14/16) of children from the group of 3-6 years old and 96% (23/24) of children from the group of 7-17 years old were found to have vitamin D deficiency; p > 0.05. The blood level of total calcium and ionized calcium in all children was within the age norm.

The objective: to study clinical manifestations of tuberculosis relapses and their treatment outcomes in patients with HIV infection.

Subjects and Methods. 132 medical records of patients with tuberculosis relapses were analyzed; 69 of them were HIV-positive and 63 were HIV-negative. All of them were admitted to Irkutsk Regional Clinical Tuberculosis Hospital from 2016 to 2019, and then continued treatment of tuberculosis on the out-patient basis. Treatment efficacy was assessed in February 2020.

Results. More severe clinical forms of tuberculosis relapses were typical of HIV patients including generalized forms affecting the central nervous system. Therefore, among these patients, the mortality rate is significantly higher (24.6%) than in tuberculosis relapses with no concurrent HIV infection (6.3%), p ≤ 0.05.

The objective: to study the prevalence of chronic obstructive pulmonary disease (COPD) in adult organized groups, to assess the structure and risk factors of its development.

Subjects and methods. 3,000 people of the organized population working at various enterprises in Tashkent aged 20 to 60 years (1,400 (46.7%) women and 1,600 (53.3%) men) underwent the contemporary pulmonological screening.

Results. The active pulmonological screening aimed to detect COPD among organized groups has been justified; examination of 3,000 people allowed detecting 198 (6.6%) new patients additionally to 65 cases that were already known at the time of screening. The chances of developing COPD increase with the presence of risk factors such as smoking, exposure to toxic substances and chemicals, and recurrent upper respiratory tract infections.

The objective of the study: to evaluate the efficacy of treatment of extensive drug resistant tuberculosis (XDR-TB) in patients with different genotypes in the biotransformation system NAT2 (rs1041983, rs1799930, rs1799931, rs1801280) and CYP2B6 genes (rs3745274).

Subjects and methods. The study involved patients undergoing in-patient treatment at Republican Clinical TB Dispensary in Ufa from 2016 to 2018. XDR TB group included 210 people; the control group included 343 healthy donors. Molecular genetic analysis was performed on DNA samples isolated from peripheral blood leukocytes. Genotyping of polymorphic loci was carried out by kompetitive allele specific PCR (KASP).

Results. It was revealed that polymorphic loci rs1799931 of NAT2 gene and rs3745274 of CYP2B6 gene were associated with the risk of developing XDR TB. Regression analysis detected combinations of the predictor genotypes of rs1799931*G/A × rs3745274*G/T and rs1799931*G/G × rs37455274*(G/G+T/T), that significantly reduce efficacy of XDR TB treatment.

The clinical experience demonstrates the importance of 3D modeling when planning surgical intervention in patients with pulmonary tuberculosis. The 3D model was built up based computed tomography data using Avtoplan software with plug-ins for segmentation of the lung, pathological foci, vascular structures, and bronchial tree. The data obtained during 3D modeling allowed us to plan surgery and the data were fully confirmed during the operation. The 3D model with color mapping reveals syntopy, which is extremely difficult to determine using standard computed tomography and allows the wider use of minimally invasive endoscopic surgical interventions.

The article describes a clinical case of successful treatment of a patient with disseminated bilateral fibrous cavernous tuberculosis and extensive drug resistance, with preserved sensitivity to only one anti-tuberculosis drug; the fifth chemotherapy regimen and pleuropneumonectomy were used.

The article analyzes scientific publications (37 articles) devoted to phthisiology, clinical pharmacology of antimicrobial agents, laboratory methods for evaluating the effectiveness and safety of various regimens of tuberculosis chemotherapy caused by resistant strains of M. tuberculosis.

It tells about prospects for expanding the line of antimicrobial agents for treatment of tuberculosis caused by resistant strains of M. tuberculosis, new approaches to the study and evaluation of the effectiveness of the drug at the stage of preclinical trials using the in vitro HFS-TV model.