The objective: to determine main directions for improving the epidemiological control over socially important infectious diseases (tuberculosis, HIV infection, viral hepatitis B and C) based on the study of epidemic signs and its determinants from 2010 to 2021.

Subjects and Methods. The main Rosstat Forms no. 8, 33, 61, 4, 2, 12, C51 were studied. Epidemiological and statistical analysis and content analysis of publications were applied. Calculations and graphical data analysis were performed using Microsoft Excel 10.0 software package.

Results. Epidemiological trends of socially important infectious diseases differ: in tuberculosis, acute hepatitis B and C, there is a decrease in morbidity and mortality; in chronic viral hepatitis B and C, there is stabilization with a slight decrease in morbidity rates (both chronic viral hepatitis B and chronic viral hepatitis C) and mortality (from chronic viral hepatitis B). Mortality caused by chronic viral hepatitis C increased, while HIV morbidity and mortality stabilized. Measures for improving the system of epidemic control over socially important infections include the timely detection of the disease, early start of etiotropic therapy, increase in the coverage with preventive examinations and vaccination, improvement of detection in the families exposed to infections and infection control activities in such families, and health education of the population.

The objective: to develop the procedure for etiological diagnosis of infectious coxitis (IC) depending on the patient's HIV status.

Subjects and Methods. The data of medical records of 97 patients with signs of IC were analyzed. Patients were divided into group depending on their HIV status.

Results. The time required to diagnose IC was identified, and it made 7.35 ± 1.30 months for HIV-positive patients, and 6.25 ± 0.90 months for HIV negative patients (p > 0.05). The procedure was developed to be implemented when a patient complained of pain in the hip joint. Patients with HIV infection and suspected IC should undergo computed tomography (CT) of the hip joints, and HIV-negative patients should have CT done if the hip joint X-ray is not informative. The use of CT in the HIV+ Group reduced the diagnostic time from 9.4 ± 1.3 to 5.3 ± 1.3 months (p = 0.680), in the HIV- Group – from 8.7 ± 1.2 to 3.8 ± 0.6 months (p = 0.02). The reason why diagnosis took that long was the rare use of invasive methods at the outpatient stage. Thus, puncture of the hip joint was performed in the HIV+ Group in 2.7% of cases, in the HIV- Group – in 10%. Trepanobiopsy performed in a hospital made it possible to establish the etiology of IC in all patients. The diagnostic efficacy of microbiological tests in case of tuberculous coxitis made 48.64% in the HIV+ Group and 30.0% in the HIV- Group, in case of nonspecific coxitis it was 32.43% and 30.0%, respectively.

The objective: to assess the state of oxygen-dependent blood processes in patients with Beck's sarcoidosis.

Subjects and Methods. Parameters of blood oxygen transport function and free radical lipid oxidation, as well as the content of nitrogen monoxide and hydrogen sulfide gas transmitters were assessed in the blood of 75 patients (41 women; 34 men) with Beck's sarcoidosis, stage 2 (the pulmonary mediastinal form).

Results. In the pulmonary mediastinal form of sarcoidosis versus healthy individuals, there was a decrease in the degree of blood oxygen saturation from 65.4 (60.6; 67.8) to 41.50 (36.0; 49.8), p < 0.05, %, partial oxygen pressure from 40.0 (38.0; 47.0) to 23.0 (18.3; 29.0) mmHg, p < 0.05, and blood pH increased. A decrease in the index of hemoglobin affinity to oxygen p_50real (26.80 (24.70; 31.40), p < 0.05, versus healthy individuals 28.2 (27.9; 29.1) mmHg) was revealed. The level of diene conjugates increased in plasma by 86.4% (p < 0.05) and malondialdehyde increased in erythrocytes by 139.2% (p < 0.05), while the following parameters decreased: α-tocopherol (by 42.7 %, p < 0.05), retinol (by 41.9%, p < 0.05), reduced glutathione (by 30.4%, p < 0.05), and ceruloplasmin (by 22.3%, p < 0.05) in plasma. There was an increase in the concentration of nitrogen monoxide (from 15.42 (14.48; 17.71) to 17.09 (7.04; 25.09), mmol/L) and a decrease in hydrogen sulfide (from 29.01 (25.21; 37.03) to 13.08 (8.63; 20.46), mmol/L) in the blood in case of this pathology.

Conclusion. There is a deterioration in the blood oxygen-binding properties in patients with Beck's sarcoidosis, stage 2, and as a consequence, tissue needs in oxygen are not adequately provided by blood circulation. There is an increase in the concentration of nitrogen monoxide and a decrease in hydrogen sulfide, which affects the oxygen transport function of blood which may be important for ensuring the processes of oxygen transfer to tissues. In this pathology, activation of lipid peroxidation and a decrease in the level of antioxidant protection factors of blood were revealed which might be important for the genesis of this disease.

The objective: to evaluate comparative neurotoxicity of combinations of anti-tuberculosis and antimicrobial drugs with different and similar toxic potentials assessing behavioral changes in rats.

Subjects and Methods: non-linear female rats divided in 3 groups were used in this study. For 14 days, the rats received a daily combinations of drugs: Group 1 – Mxf + Lzd + Cs + Pto, Group 2 – Mxf + Bdq + Cs + Z , and Group 3 – Bdq + Lzd + Cfz + Z. Neurotoxicity was assessed by changes in behavioral responses using Open Field Test. The number of crossed squares and racks was recorded which characterized horizontal and vertical activity, also peeping into burrows (exploratory activity), the number of groomings (washing and scratching) and physiological functions were registered.

Results. In rats of Group 1 versus baseline parameters, we observed a significant limitation of horizontal motor activity and a sharp decrease (by 5 times) in exploratory activity, a 2.8-fold decrease in the number of groomings which indicated emotional suppression. In rats of Groups 2 and 3, the decrease in motor and exploratory activity was insignificant but there was a more pronounced emotional depression. The use of the Mxf + Lzd + Cs + Pto combination in which all drugs possessed a neurotoxic potential, led to diverse and profound changes in behavioral responses which indicated a pronounced neurotoxic effect.

The objective: to study specific parameters of detection of fungi of the genus Aspergillus in respiratory organs of pulmonary tuberculosis patients.

Subjects and Methods. In 2019-2021, the samples of sputum or bronchoalveolar lavage of 520 patients above 18 years old with confirmed pulmonary tuberculosis and HIV-negative status were tested for molds. Also, all patients had their sputum or BAL tested for acid fast mycobacteria (AFB), cultures of M. tuberculosis (MBT), and DNA of tuberculous mycobacteria.

Results. Positive culture results for fungi were obtained in 50/520 (9.62%; 95% CI 7.37-12.45, Wilson test) pulmonary tuberculosis patients. Species identification revealed fungi of the genus Aspergillus in 46/50 (92%) of them.

In 37/46 (80.43%; 95% CI 66.83-89.35) patients, a single type (one species of Aspergillus) was identified, in 9/46 (19.57%; 95% CI 10.65-33.17) two types were identified. A. fumigatus (16/37 isolates, 43.24%) and A. niger (13/37 isolates, 35.14%) prevailed among single types of cultures. A. niger + A. flavus (3/9 isolates, 33.33%) was the most frequent combination. The ratio of the effectiveness of methods for detecting fungi such as culture/direct microscopy/galactomannan antigen in serum and BAL was 100/84.78/4.35% and 67.39%, respectively. Thus, BAL is more preferable than serum for detection of galactomannan antigen in patients with tuberculosis.

Only in 8/46 (17.4%) patients, bacterial excretion was detected by culture, which is typical for the active phase of the course of tuberculosis. In the remaining 38 (82.6% 95% CI 69.28-90.91) patients, no tuberculous mycobacteria were detected by culture, which was typical of stabilization and cure of tuberculosis.

The objective: to determine the impact of the COVID-19 pandemic on the structure and course of urogenital tuberculosis (UGTB) in Uzbekistan.

Subjects and Methods. A retrospective cohort comparative study of the urogenital tuberculosis structure by clinical data for 2018-2021 was carried out. The data of 2,866 patients with extrapulmonary tuberculosis were analyzed including 1,208 patients with urogenital tuberculosis.

Results. Of the 1,208 patients with urogenital tuberculosis, 327 were registered in 2018, 300 in 2019, 219 in 2020 (the first year of the COVID-19 pandemic), and 362 in 2021. The smallest number of cases registered in 2020 is due to lock-out activities. In 2021, there was a 2-fold increase in the number of patients with co-morbid forms of urogenital tuberculosis versus 2019 (pre-pandemic period). The frequency of detection of Mycobacterium tuberculosis in patients with urogenital tuberculosis in 2021 also increased by 4.3-5 times compared to 2019. The largest number of cases with the co-infection of urogenital tuberculosis and COVID-19 was recorded in 2020 – in 13.2% of identified patients. Concurrent urogenital tuberculosis and encrusting cystitis were observed in 4 (1.1%) patients detected in 2021. The underdetection of urogenital tuberculosis patients in 2020 resulted in the higher proportion of surgeries in 2021.

The objective: to justify the optimal duration of chemotherapy with Lzd and Bdq by evaluating the long-term treatment outcomes in patients with multiple/pre-extensive drug resistant (MDR/preXDR) tuberculosis who interrupted treatment at different time points.

Subjects and Methods. 800 patients with MDR/preXDR tuberculosis were enrolled in the study, they were from all regions of the Russian Federation and they started a course of chemotherapy with regimens containing Lzd and Bdq in 2017-2018. All patients who interrupted their chemotherapy (124) were divided at 4 groups. Group 1-43 patients who received less than 90 doses, Group 2-37 patients who received from 91 to 180 doses, Group 3-39 patients who received from 181 to 270 doses, and Group 4-5 patients who received from 271 to 360 doses of anti-tuberculosis drugs.

Results. In Group 3, the effectiveness of reaching a favorable outcome during observation for 3-4 years made 53.8% in 21/39, which was comparable to the effectiveness of treatment with a 24-month course of chemotherapy (2017 – 58.0 and 2018 – 52.1%). The treatment duration of patients from Group 3 was additionally analyzed, the arithmetic mean of the number of administered doses makes 262 ± 15, which allowed recommending 9-month courses of chemotherapy.

The presented observation describes an example of effective treatment of the patient with disseminated destructive pulmonary tuberculosis with preXDR. The treatment included staged surgery using the original method of anterior mediastinum plasty with a mesh implant.

The treatment resulted in the following outcomes: stabilization of the tuberculous disease, persistent sputum conversion, minimization of overdistension of the only lung, absence of mediastinal pulmonary hernia and no deterioration of respiratory function.

Urethral tuberculosis is a rare disease since the advent of highly effective anti-tuberculosis drugs. The article describes an extremely rare clinical observation of a 34-year-old patient with the transition of tuberculous inflammation from the subcutaneous tissue to the wall of the urethra with intact kidneys. Since the first blood discharge from the urethra, the diagnostic process took 3.5 years, all these years, multiple examinations for tuberculosis were carried out and the results were negative, while the disease progressed. The diagnosis was differentiated between acute purulent anterior subcutaneous paraproctitis and festering pararectal cyst. There were repeated openings of the perineal abscess, no bacterial growth was observed, histological tests revealed chronic purulent inflammation. In view of the persistent recurrent course of perineal abscess, tuberculosis was repeatedly suspected. Acid-resistant mycobacteria were found in the discharge from the fistula by fluorescent microscopy: 10-99 in the sample. Tuberculous mycobacteria were not found in the urine by polymerase chain reaction. The patient was diagnosed with A18.4. Tuberculosis of subcutaneous fat (perineum). Mycobacterium tuberculosis (+). The course of disease was complicated by perineal fistula. With the anti-tuberculosis treatment, the fistulous opening healed within a month.