The objective of the study: to investigate diagnostics, course and outcomes of COVID-19 in children and adolescents with tuberculosis in relation to the epidemic control activities.

Subjects and Methods: during the pandemic of coronavirus infection (the first and second waves), 83 patients aged 2 to 17 years (41 children and 42 adolescents) were followed up. 62 (74.7%) children got infected with the novel coronavirus infection among 82 patients treated at the clinic over this time.

Results. COVID-19 has been found to be highly contagious in the group of children staying in the ward, employees working with children and adolescents were the source of infection. Compliance with sanitary and infection control activities allows reducing the likelihood of the viral infection spread in the group of children and adolescents. The respiratory syndrome is not a major sign for the diagnosis of COVID-19 in children and adolescents with respiratory tuberculosis. For the diagnosis of COVID-19, targeted immunological and microbiological tests are important. Most patients with clinical manifestations of the coronavirus infection (79.4% of cases) were diagnosed with a mild course of the disease. Co-infection (tuberculosis and COVID-19) caused no mutual aggravation. No adjustment of chemotherapy was required, and the duration of treatment didn’t increase including short-course chemotherapy regimens with multiple/extensive drug resistant Mycobacterium tuberculosis and in patients after surgery.

The objective: to compare treatment efficacy and relapse rates in patients with isoniazid-resistant tuberculosis treated with 9- and 6-month courses of chemotherapy.

Subjects and Methods. A retrospective cohort study was conducted. The period from 2010 to 2015 was evaluated. The cases of tuberculosis registered on the territory of Arkhangelsk Region were studied. In 2010-2013, all patients with isoniazid-resistant tuberculosis (n = 130) in the region received a 9-month course of treatment. From 2014 to 2015, the duration of treatment for isoniazid-resistant tuberculosis in the region was reduced from 9 to 6 months. The patients (n = 54) received short-course treatment: aminoglycoside or polypeptide (2 months), rifampicin, pyrazinamide, fluoroquinolone, and ethambutol.

There was no statistically significant difference in treatment outcomes of isoniazid-resistant tuberculosis between two regimens: The outcome of effective treatment made 76.2% for the 9-month regimen and 74.1% for the 6-month regimen. The relapse rate per 100 person-years was 0.7 (95% CI 0.1-1.9) for the 9-month regimen and 1.9 (95% CI 0.2-6.7) for the 6-month regimen. This study confirmed the need to decrease the duration of treatment for isoniazid-resistant tuberculosis to 6 months.

The objective: to develop proposals to improve the effectiveness of the tuberculosis immunodiagnosis system in children by analyzing potential losses of patients for registration.

Materials: data from primary medical records of 605 children in 5 regions of Russia, results of the survey in 513 legal guardians and 27 experts.

Results. 13.9% of the children subject for screening were not examined, tests were administered in 1.1% of children who had contraindications to them, errors in the test administration were expected in 1.5% of children, and in 6.2% of children, antihistamine medications were used leading to errors in the detection of tuberculosis infection. In 3.7% of children, results of the test were not assessed, 3.1% of eligible children were not referred to the phthisiologist, and 6.5% were lost to follow-up by the phthisiologist.

Conclusions. The cumulative loss during immunodiagnosis of tuberculosis made 68.7%. The main reasons for the losses are medical exceptions and refusals to have immunodiagnosis of tuberculosis by legal guardians, incomplete follow-up by the phthisiologist, and the use of antihistamines.

To reduce these losses, it is advisable to consider the following: organizing consultation with the phthisiologist at children's polyclinics and large children's groups; legal guardians should be able to have a paid sick leave on the days when the child has an appointment with the phthisiologist; specifying indications for desensitizing therapy and prohibiting it outside the indications; organizing internal and external quality control system for immunodiagnostics.

The objective of the study: to evaluate and compare the predictors of effectiveness of navigation bronchobiopsy – radial endobronchial ultrasound with mini probes (rEBUS) in patients with peripheral pulmonary tumors of tuberculosis and oncological origin.

Subjects and Methods. The effectiveness of rEBUS-guided bronchoscopic biopsies and predictors of this effectiveness were retrospectively analyzed in 152 patients (71 men and 81 women) with pulmonary tumors visualized by chest computed tomography (CT) as peripheral lung masses. All patients were divided into 2 groups according to the verified diagnoses: TB Group included 83 patients with pulmonary tuberculosis without bacterial excretion at the time of bronchological examination; NEO Group included 69 patients with pulmonary neoplasms.

In all patients of both groups, a bronchological examination was performed for diagnostic purposes and included several types of biopsies (a set of biopsies): at least one of the liquid biopsies (bronchoalveolar lavage (BAL) or bronchial lavage) and one tissue biopsy (transbronchial lung biopsy (TBLB) or brush biopsy). Specimens of all types of bronchobiopsy were sent for microbiological and cytological tests, and the TBLB samples were additionally sent for histological examination.

Results. The efficiency of diagnosing bronchobiopsy with rEBUS navigation in TB and NEO Groups was comparable – 81.9% (68/83) and 81.2% (56/69) (p_χ2 > 0.05), respectively. The factors (predictors) that statistically significantly influenced on effectiveness of bronchobiopsy in both groups were the following: signs of draining bronchus on chest CT, visualization of the mass in general during rEBUS, central position of the ultrasound probe in the mass during navigation, localization of the mass in the upper lobe of the right lung versus the lower lobe (summarized in two groups).

Additionally for TB Group, the predictor was the size of the mass exceeding 20 mm.

The effectiveness of cytological and histological verification in NEO Group with brush biopsy and TBLB samples significantly surpassed the effectiveness in TB Group, but the microbiological diagnosis of M. tuberculosis in BAL/bronchial lavage specimens increased the effectiveness in TB Group and made it comparable to NEO Group.

The objective: to study the long-term changes (1991-2020) in tuberculosis mortality in population of Altai Kray and assess the impact of certain categories of citizens on the formation of this rate.

Subjects and Methods: Statistical Forms no. 8, 30, and 33, statistical compilations, and medical scientific publications.

Results. In order to analyze the curves reflecting changes in tuberculosis mortality in Altai Kray and Russia, these curves have been divided into three conventional periods. General trends have been identified but there are some peculiarities: a significant excess of the average longterm value of the rate versus this rate for whole of Russia; this rate increased faster in the conventional period of 1991-2005. Using the statistical method, it has been established that the formation of tuberculosis mortality rate in the population of Altai Kray was influenced by tuberculosis mortality rate in the Federal Penitentiary Service in 1997 and 1998 and in homeless people in 2005-2008.

The article describes a clinical case of tuberculosis pericarditis in a patient with disseminated pulmonary tuberculosis. X-ray examination of the patient revealed a significant increase in the size of the heart shadow, some fluid in the pericardium up to 1 liter was visualized. The etiology of the disorder was verified by detection of Mycobacterium tuberculosis (MTB) by pericardial fluid culture, and drug sensitivity testing of MTB was performed. Thus an effective treatment regimen was developed, tuberculosis pericarditis and disseminated pulmonary tuberculosis were cured. Echo-CG was used for diagnosis and monitoring of the course of tuberculosis pericarditis.

The article describes a clinical case of pulmonary lymphangioleiomyomatosis (LAM) in a 44-year-old female Patient N., who has been suffering from this disease for a long time. It depicts characteristic classic signs of LAM – a progressive course, thin-walled air cavities in the lungs, retroperitoneal lymphadenopathy, and recurrent pneumothoraxes.

Tuberculosis of the tongue is one of the rare localizations of extrapulmonary tuberculosis. The article presents a clinical case of secondary tuberculous glossitis with concurrent multidrug-resistant pulmonary tuberculosis in a 35-year-old HIV-infected patient. Despite relatively rapid verification of the diagnosis, the clinical situation was difficult due to differential diagnosis with nonspecific lesions, unknown HIV status, and detection of drug resistance of Mycobacterium tuberculosis. This case illustrates the step-by-step diagnosis and treatment of tuberculous ulcers of the tongue and lungs. The comprehensive examination with the use of molecular genetic, bacteriological, histological, and X-ray diagnostic tools contributed to the timely prescription of the adequate anti-tuberculosis therapy regimen.

The objective of the study: to analyze the potential use of video observed therapy (VOT) as one of the fields of mobile health care for treatment of patients with tuberculosis, to substantiate prospects of using VOT as an alternative to directly observed therapy including settings with limited health care resources.

Subjects and Methods. The relevant studies were searched for in the following bibliographic databases: MEDLINE/PubMed, EMBASE, LILACS, IMEMR and IMSEAR, and clinicaltrials.gov. 40 publications devoted to video observed treatment of tuberculosis abroad and in Russia were selected. The recommendations of the World Health Organization on the use of digital technology in tuberculosis treatment, in particular video observed treatment have been studied.

Results. The article highlights the advantages of video observed treatment of tuberculosis, the possibility of implementing this approach in different groups of patients taking into account the inclusion and exclusion criteria, assessing effectiveness of its use (improved treatment adherence, higher number of completed observations, better responsibility of patients for the disease and therapy, economic benefits for the health system and the patient). The study speculates on the potential implementation of video observed therapy of tuberculosis in the Russian Federation.