The objective of this review is to optimize the use of antibiotic therapy for COVID-19 based on the published and our own data. The decision to prescribe antibiotic therapy in case of secondary bacterial pneumonia associated with SARS-CoV-2 should be based on a comprehensive assessment of the results of clinical, laboratory and instrumental examination including the elevated level of procalcitonin (more than 0,5 ng/ml).

To achieve this objective, 48 publications were analyzed.

The objective: to evaluate the variety of adverse reactions to combinations of clofazimine with anti-tuberculosis and antimicrobial drugs with different and similar toxic profiles.

Subjects and Methods: Studies were carried on non-pedigree female rats at the age of 10-11 months. In Group 1, rats received Cfz + Bdq + Mxf + Clr, in Group 2 – Cfz + Bdq + Lzd + Z daily for 14 days. A comprehensive examination upon completion of drug administration included functional (ECG, behavioral reactions), laboratory and pathomorphological assessments.

Results. The combination of Cfz + Bdq + Mxf + Clr had a pronounced cardiotoxicity: it caused QT prolongation up to 0.053 ± 0.002 s and individual fluctuations within ranges up to 20 ms; some rats demonstrated qualitative ECG changes. Hepatotoxic reactions were revealed according to laboratory and morphological parameters, and morphological signs of mild kidney dystrophy were found in most rats. Neurotoxic reactions were manifested as a decrease in motor and exploratory activities. The combination of Cfz + Bdq + Lzd + Z did not cause significant ECG changes; mild signs of hepatotoxicity and nephrotoxicity were observed in single rats, behavioral disorders manifested only as emotional depression of the animals. Significant differences in the variety and degree of adverse reactions are due to the combination of clofazimine with drugs possessing similar cardiotoxic potential – bedaquiline, moxifloxacin, and clarithromycin.

The imbalance in matrix metalloproteinase (MMP)/inhibitors system leads to degradation of extracellular matrix of connective tissue and pathological remodeling forming the morphological basis for respiratory dysfunction.

The objective: to study the relationship between parameters of MMP/inhibitors system in blood and parameters of ventilation and gas exchange disorders in patients with chronic pulmonary tuberculosis (PTB).

Subjects and Methods. Patients with the verified diagnosis of tuberculoma (n = 45) and fibrous-cavernous pulmonary tuberculosis (n = 85) were examined. All patients underwent computed tomography of the chest and assessment of respiratory function. Serum concentrations of MMP-1, -3, -8, -9 and their inhibitors TIMP-1 and α2-macroglobulin (MG) were tested by ELISA (R&D Systems, Minneapolis, MN, USA). Statistica 7.0 and an ANCOVA model were used for statistical analysis which considered the diagnosis and smoking status as factors, and the respiratory function parameters were considered as covariates.

Results. In pulmonary tuberculosis patients, the concentrations of MMP-9 and MMP-8 in the blood correlated with extension of lung parenchyma lesions when compared to tuberculomas and fibro-cavernous tuberculosis, MMP-9 and TIMP-1 with changes in lung volumes (R² = 0.60 and 0.80; p = 0.001), and MMP-8 correlated with functional disorders of gas exchange (R² = 0.60 and 0.80; p = 0.001). Changes in MMP-1, MMP-3, and α₂-MG (R² = 0.60 and 0.80; p = 0.45) did not correlate with extension of lung parenchymal lesions and decreased lung function.

The objective: to identify socio-demographic, clinical and laboratory factors associated with tuberculosis recurrence.

Subjects and Methods. Clinical and laboratory data of 208 TB patients treated at the National Scientific Center for Phthisiopulmonology of the Ministry of Health of the Republic of Kazakhstan were analyzed.

IL-2 to the AlaDH was assessed using test platforms Lionex GmbH (Germany) according to the manufacturer's instructions. SPSS 23.0 software was used for statistical processing of obtained data. To assess the significance of differences in groups, the Pearson Chi-Square test was used. To determine the factors associated with of the tuberculosis relapse, а multiple binary logistic regression analysis was carried out.

Results. Multivariate logistic regression analysis confirmed that male gender (OR = 2.086, 95% CI 1.001-4.350, p = 0.050), drug resistance (OR = 4.910, 95% CI 1.923-12.534, p = 0.001), fibrosis cavernous tuberculosis (OR = 6.362, 95% CI 2.178-18.585, p = 0.001) and low level of sensitized T cells that synthesize IL-2 in response to exposure to the AlaDH antigen in IGRA in vitro (OR = 2.155, 95% CI 1.060-4.379, p = 0.034) were significantly associated with tuberculosis recurrence.

The incidence of osteoarticular tuberculosis in 15 regions of the Siberian and Far Eastern Federal Districts from 2018 to 2020 was assessed. The incidence of osteoarticular tuberculosis and co-infection of osteoarticular tuberculosis with HIV and osteoarticular tuberculosis with hepatitis B/C was analyzed. Variants of osteoarticular tuberculosis with respiratory tuberculosis, variants of tuberculosis sites in the bone articular system and the most typical neurological disorders in those patients were presented.

The objective: to study a response of the spleen extracellular matrix (ECM) to the liposome-encapsulated dextrazide (LEDZ) administration in the stabilization period of BCG-induced granulomatosis.

Subjects and Methods. A model of generalized tuberculosis inflammation was reproduced by injecting mice with mycobacteria from BCG vaccine (BCG-infected mice). Intact mice served as controls. During inflammation stabilization, the infected mice were dosed with LEDZ by inhalation and intraperitoneal injection, and main ECM components were assessed.

Results. The BCG-infected mice showed a decrease in the structural components of proteoglycans (PGs) but demonstrated elevated profibrotic fractions of hydroxyproline (Hyp), enhanced activity of matrix metalloproteinases (MMPs) and no differences in the content of their tissue inhibitors (TIMPs), that indicated the fibrosis of the organ. Despite the way of LEDZ administration, the level of uronic acids in PGs and activity of hyaluronidases increased but the content of protein-bound Hyp was reduced with no differences in the content of free Hyp versus infected untreated mice. The administration of LEDZ by inhalation reduced content of profibrotic fractions of Hyp but increased galactose in PGs increased to the level of control mice. The intraperitoneal LEDZ administration decreased the protein content in PGs.

The objective: to evaluate main parameters of cellular, humoral immunity and natural resistance in tuberculosis patients with primary and acquired multiple drug resistance; to study the correlation of these parameters with clinical and radiological manifestations.

Subjects and Methods. A prospective study was conducted which included 169 patients with pulmonary tuberculosis, 80 of them were new cases of drug susceptible pulmonary tuberculosis and they made the Comparison Group (CG), and 89 patients suffered from multiple drug resistant tuberculosis and they made the Main Group (MG). The Main Group was divided into 2 subgroups: MG-1 – 40 patients with primary multiple drug resistant tuberculosis; MG-2 ‒ 49 patients who acquired drug resistance of Mycobacterium tuberculosis during treatment of tuberculosis.

The immune assays included the lymphocyte blast transformation reaction (LBTR) to phytohemagglutinin and tuberculin (PPD), immunophenotyping of CD3⁺ and CD19⁺ cells; phagocytic index and phagocytic number were calculated; nitro blue tetrazolium test was used, concentrations of immunoglobulins and antimycobacterial antibodies were determined.

Results. The clinical laboratory data demonstrated a more severe course of the disease in patients with multiple drug resistant tuberculosis, especially in those with acquired multiple drug resistant tuberculosis which was confirmed by the severity of immune deficiencies of the cellular immunity and innate resistance as well as by the overactivity of humoral immunity. The levels of CD3⁺ and LBTR reaction to PPD had a negative correlation with clinical manifestations and radiological features demonstrating the severity of pulmonary tuberculosis in patients with multiple drug resistance, especially in those with acquired multiple drug resistance; and CD19⁺ and antimycobacterial antibodies positively correlated with clinical manifestations and radiological signs.

Conclusions. Parameters of cellular immunity and natural resistance were the lowest in the patients with acquired multiple drug resistance of Mycobacterium tuberculosis versus primary multiple drug resistance and drug susceptible Mycobacterium tuberculosis. Parameters of humoral immunity demonstrated the increased activity to compensate for the insufficiency of cellular immunity regardless of the type of resistance of Mycobacterium tuberculosis.

The article describes a clinical case of comorbid peripheral lung cancer and extraskeletal chondroma of the diaphragm detected in the patient during chest computed tomography performed as a part of examination after renal colic. The X-ray signs of the masses were completely different, and those lesions were immediately identified as two different pathologies.