The objective: to compare changes in markers of hemostasis and fibrinolysis during the course of treatment in new patients with pulmonary tuberculosis (TB), who suffered from COVID-19 and no COVID-19.

Subjects and Methods. 50 new patients with pulmonary tuberculosis were enrolled in a retrospective study, of them 25 new pulmonary tuberculosis patients had a history COVID-19 (TB/COVID-19 Group) and 25 new pulmonary tuberculosis patients had no COVID-19 (TB Group). The state of hemostasis and fibrinolysis was assessed at four checkpoints: at admission to hospital for treatment and after 1, 2, 3 months of tuberculosis treatment. To assess the relationship between the detected changes and systemic inflammation, C-reactive protein (CRP) was additionally tested.

Results. It was found that new pulmonary tuberculosis in both groups was associated with hypercoagulative shift in the hemostasis system. The incidence of patients with hypercoagulable shift decreased during the course of tuberculosis treatment in both groups. At the same time, the hypercoagulable shift leveled off significantly slower in TB/COVID-19 Group versus TB Group. Inflammatory response persisted in TB/COVID-19 Group throughout the follow-up.

Conclusion. A hypercoagulability shift persisted in new pulmonary tuberculosis patients who had suffered from COVID-19 before and during tuberculosis treatment. This factor requires monitoring of hemostasis and fibrinolysis systems in such patients and, if necessary, pharmacological therapy should be used.

The objective: prevention and relief of hepatotoxic reactions to antituberculosis drugs in patients with infiltrative destructive pulmonary tuberculosis with multiple, pre-extensive and extensive drug resistance.

Subjects and Methods. Clinical and laboratory data of 160 patients receiving antituberculosis drugs and additionally morpholinium-methyl-triazolyl-thioacetate (Thiotriazolin) (TTZ Group) or Phosphogliv (Comparison Group (CG)) were comparatively analyzed.

Results. After 4 months, TTZ Group showed a decrease in frequency of toxic reactions to antituberculosis therapy, suppression of cytolysis and cholestasis syndrome as evidenced by decreased levels of ALT and AST enzymes, alkaline phosphatase, normalization of bilirubin levels and its fractions, and improved liver protein-synthetic function. In TTZ Group, normalization of the antioxidant defense system and free radical oxidation (FRO) was achieved, while in the comparison group, FRO rates did not show positive changes. Patients in TTZ Group showed more pronounced resorption of infiltration, healing of destruction sites, decrease in the frequency of bacterial excretion 4 months after the start of treatment versus Comparison Group.

The objective: to study clinical and epidemic characteristics in children with newly diagnosed post-tuberculosis changes.

Subjects and Methods. Medical records of 78 children with newly diagnosed post-tuberculosis changes were analyzed; all those children were followed up by Voronezh Regional TB Dispensary in 2021.

Results. Children aged 8-11 years, 35/78 (44.8%) prevailed among the study subjects, no infants (0-3 years) were enrolled in the study. 24/78 (31%) children were exposed to a tuberculosis case. Most children (93.6%) were immunized with BCG-M but postvaccine scar was detected in only 48% of them. 37/78 (47.4%) patients had a hyperergic response to tuberculosis recombinant allergen. After detection of post-tuberculosis changes, 56/78 (71.8%) children received preventive treatment of tuberculosis, while 22 patients had no preventive treatment since their parents gave no consent.

The objective: to evaluate clinical effectiveness and safety of short-course chemotherapy regimens in patients with drug-resistant tuberculosis based on a systematic and meta-analytic study.

Subjects and Methods. A systematic search for scientific publications published between 01.01.2018 and 01.10.2023 was conducted in PubMed and eLibrary. Sixty-six studies were selected using the keywords “treatment of drug-resistant tuberculosis, randomized clinical trials”. By a manual review, 7 publications meeting required parameters for meta-analysis were identified.

Results. A single-group meta-analysis of the effectiveness of short-term chemotherapy regimens demonstrated the following: a favorable outcome can be achieved in 80.9% of cases; an unfavorable outcome occurs in 19.4%; sputum culture conversion by 8 weeks of chemotherapy is achieved in 74.6% of cases; SAEs were registered in 15.1% of patients, grade 3 and higher SAEs- in 39.5% (based on 4 publications).

The objective: to study treatment effectiveness of respiratory tuberculosis complicated by pleural empyema.

Subjects and Methods. Treatment outcomes of 208 patients treated at Krasnoyarsk Regional TB Dispensary were analyzed. The most often, the course of tuberculosis was complicated by pleural empyema in the patients with disseminated and fibrous cavernous pulmonary tuberculosis – 163 patients (78.4%). On the side of empyema, tuberculous lesions in the lung tissue were total in 179 (86.1%) patients, of whom 128 (61.5%) had totally affected contralateral lung as well. In terms of extent, total (56.7%) and subtotal (28.8%) empyema prevailed. Bronchopleural fistula was found in 168 (80.7%) patients. 111 (53.4%) patients received conservative treatment of empyema, in 73 (32.2%) patients, pleural cavity drainage with aspiration of gas and purulent contents was applied, and 30 (14.4%) patients received combined treatment (at the first stage – conservative or pleural cavity drainage, and at the subsequent stage – surgical treatment).  

Results. Complication of pulmonary tuberculosis by pleural empyema significantly deteriorates the prognosis of the disease outcome: complete clinical effect was achieved only in 29.3% of patients, with the mortality rate of 20.2%. The main predictor of unfavorable treatment outcome is total pleural empyema with bronchopleural fistula, and the most effective treatment method is the combination of conservative therapy and surgery. However, due to disseminated tuberculous lesions, insufficiency of external respiration function, comorbidities, and asocial behavior, surgery was possible in no more than 20% of patients. At the same time, 92.3% of patients referred for medical help late, 62.7% of patients had a history of early discharge from hospital for gross violation of hospital rules.

The objective: using artificial intelligence algorithms to develop a method for assessing the support function of the spine in infectious spondylitis based on sagittal balance and segmental instability parameters.

Subjects and Methods. 249 patients with infectious spondylitis were included in a retrospective study, all of them were admitted to National Medical Research Center of Phthisiopulmonology and Infectious Diseases from 2020 to 2022. The etiology of the spinal inflammation was determined by microbiologic and pathomorphologic tests of biological specimens from the focus of spinal destruction.

Results. Patients were divided into the groups of those with tuberculous spondylitis (n=114) and those with non-specific spondylitis (n= 35). The frequency of neurological complications and severity of destruction according to Pola classification and Asia-IMSOP scale were assessed in the groups; statistical and correlation analysis of the parameters of pathologic instability of vertebral segments and global sagittal balance was performed. Severe types of support dysfunction taking into account the summarized data of sagittal balance deviations and segmental instability, were diagnosed in 45.7%. A classification has been developed that details and specifies using mathematical parameters, types and degrees of impairment of the support function, taking into account both global sagittal balance data and segmental disorders.

The objective: to evaluate efficacy of treatment of concurrent (viral and drug-induced) liver injuries in patients with HIV-associated tuberculosis using a multicomponent solution for infusions containing succinic acid.

Subjects and Methods. The prospective comparative study included 122 patients with HIV-associated tuberculosis and concurrent chronic hepatitis C and B, distributed in 3 groups depending on the clinical and biochemical activity of (viral and drug-induced) liver injuries and the nature of therapy. Group 1 included 48 patients with minimal activity of concurrent liver injury, Group 2 included 38 patients, and Group 3 included 36 patients with moderate clinical and biochemical activity. Patients in Groups 1 and 2 received intravenous administration of the solution of inosine + meglumine + methionine + nicotinamide + succinic acid (Remaxol, OOO NTFF POLYSAN) for 10 days, in Group 3, patients had detoxification therapy (glucose-saline solutions, sterofundin) and ursodeoxycholic acid.

Results. Against the background of infusions of the solution of inosine + meglumine + methionine + nicotinamide + succinic acid in patients of Groups 1 and 2 there was a more pronounced decrease of ALT in 3.6-3.8 times vs. 1.9; AST – in 2.6-2.7 times vs. 2.4; TB – in 3.7 times vs. 1.6; DB – in 3.3 times vs. 1.8; GGT – in 5.7 times vs. 4.9 in Group 3.

Conclusion. The obtained results demonstrate the efficacy of the solution of inosine + meglumine + methionine + nicotinamide + succinic acid in treatment of concurrent (viral and drug-induced) liver injuries with minimal and moderate clinical and biochemical activity in patients with HIV-associated tuberculosis.

The objective: to evaluate the diagnostic effectiveness of computed tomographic navigation (CTn), bronchoscopic navigation (BN) in transbronchial biopsy (TBB) of peripheral lesions in the lungs.

Subjects and Methods. An analysis of CT navigation data during bronchoscopy (BS) of 201 patients (Ctn Group) with peripheral lung formations (area of interest) was carried out. The advancement of bronchoscope to the area of interest during bronchoscopy was performed under CT navigation with VBN playing the major role. Comparison was made to the group (CG) of 195 patients in whom no CT navigation was used.

Results. The overall bronchoscopy effectiveness using CT navigation and bronchoscopic navigation was statistically significantly higher versus the cases when they were not used, 95/201 (47.2%) vs. 65/195 (33.3%), χ² =7.98; p<0.01. Bronchoscopy effectiveness in the CTn and CG Groups differed significantly for lesion in the lung measuring >1 to ≤2 cm (46.9% vs. 28.2%; pz=0.008) and lesions ≤1 cm (28.0% vs. 12.9%; pz=0.048). For large lesion >2 to ≤3 cm, the differences did not reach statistical significance. There were significant differences in bronchoscopy effectiveness between the CTn and CG Groups when lesions were localized in the middle (61.2% vs. 35.8%; pz=0.008) and peripheral (32.0% vs. 22.2%; pz=0.048) zones of the lung. With lesions located in the central part and at its boundaries, the differences between the groups were not significant. When CT navigation and virtual bronchoscopy were used, the presence of connection to the bronchus significantly increased the likelihood of successful bronchoscopy (OR=6.35; 95% CI 3.43-11.78) than in the absence of one.

The objective: to study toxicity modifying effects of Coenzyme Q10 in toxic reactions caused by a combination of antituberculosis drugs in the rat experiment.  

Subjects and Methods. 30 non-linear female rats weighing 230-250 g, divided into 3 groups were used in the experiment. Control Group (CG) received 1% starch gel. Experimental Group 1 (EG1) received a combination of 5 antituberculosis drugs: Mxf + Bdq + Lzd + Cs + Z, Experimental Group 2 (EG2) received the same antituberculosis drugs, and additionally Coenzyme Q10 as the drug product of Qudesan, 30 min before the combination of antituberculosis drugs. Doses of antituberculosis drugs and Coenzyme Q10 were equivalent to human therapeutic doses used in the clinic. The manifestation of toxic reactions in rats was evaluated by body weight changes, clinical and biochemical blood parameters, changes in ECG and behavioral reactions in the open field test, and morphological changes in organs and tissues.  

Results. Coenzyme Q10 showed the ability to modify cardio-, hepato-, hematoto- and nephrotoxicity induced by antituberculosis drugs at functional and morphologic levels. It was impossible to assess the neuroprotective effect of Coenzyme Q10 in the dose used due to weakly expressed changes in behavioral reactions in rats after the combination of antituberculosis drugs compared to Control Group.

The objective: to evaluate labor losses due to tuberculosis.

Subjects and Methods. Modeling of annual labor losses due to temporary and permanent disability and death from tuberculosis (TB) was carried out on the basis of official statistical surveillance data.

Results. Labor losses due to temporary disability (TD) and death were found to be decreasing, while permanent disability losses due to the COVID-19 pandemic have been increasing in the last three years. More than ¾ of labor losses are related to disability due to tuberculosis. The average duration of a tuberculosis case with temporary disability is growing, which may be associated with an increasing number of patients with multidrug-resistant tuberculosis and TB/HIV co-infection. It has been found that the number of labor losses and incidence of tuberculosis with temporary disability is strongly associated with prevalence of fibrous cavernous pulmonary tuberculosis and losses due to disability. The proportion of labor losses due to disability is expected to decrease due to the end of the special procedure for its prolongation.

The article presents a clinical observation of a rare case of concurrent tuberculosis and congenital disease (Noonan syndrome) in a 14-year-old child. Noonan syndrome manifested by multiple stigmas of dysembryogenesis, heart defect, delayed physical and sexual development, cryptorchidism, and keel-shaped chest deformity. At the age of 6 years, the boy was exposed to two relatives suffering from tuberculosis with a positive result of the sputum test, he received no preventive treatment. He was diagnosed with tuberculosis at the age of 14 years when infiltrative changes in the lung were detected by X-ray. During diagnosis, it is worth highlighting that the result of Interferon-Gamma Release Assay (IGRA – T-SPOT TB) was positive, while the result of the TRA test was negative. No bacterial excretion was detected during the entire period of the disease, tuberculosis had no specific course and was successfully cured.

The review is based on 43 publications and it presents current information on variants of tuberculosis infection development in humans and preclinical manifestations of tuberculosis. It describes research trends aimed to develop tests to detect various states of interaction between the host and M. tuberculosis. The most epidemically important tests are those that can detect conditions very similar to tuberculosis and predict onset of tuberculosis in a short time allowing more effective and targeted preventive chemotherapy.

The article analyzes 50 publications devoted to diagnostic approaches to detection of sarcoidosis. It highlights that currently diagnosis of this disease is not standardized and thus errors are highly possible to occur. Improved approaches address all aspects of diagnosis, from the distinction of highly specific clinical and radiologic signs of the disease to the choice of lung biopsy method. The use of sarcoidosis biomarkers such as angiotensin-converting enzyme, chitotriosidase, and serum amyloid A is most promising. The possibility of their combination and association with clinical signs of the disease are being studied, and to discover new biomarkers, full-genome studies are being in progress.