The objective: to evaluate the clinical and economic efficiency and impact of mass fluorography screening of the population on tuberculosis mortality and rates of timely tuberculosis detection in four federal districts of the Russian Federation with different levels of tuberculosis detection and coverage of the population with fluorography mass screening.

Subjects and Methods. Analytical materials of the Federal Center for Monitoring of Tuberculosis Transmission Control in the Russian Federation posted on official websites were used. The rates were analyzed by applied statistics methods. All statistical calculations were performed with 0.95 significance.

Results. A correlation analysis was performed between the coverage, effectiveness of tuberculosis detection by mass fluorography screening of the population and main rates reflecting the epidemic situation and timeliness of tuberculosis detection in the Russian Federation and its four federal districts. There was no correlation between the detection effectiveness and main markers of timeliness of tuberculosis detection. It was found out that against the background of increased costs for mass fluorography screening, its implementation did not provide significant positive results in reducing tuberculosis incidence and mortality which indicated their low clinical and economic efficiency.

The objective: to assess the safety and compliance with new regimens for preventive treatment of drug susceptible and drug resistant tuberculosis.

Subjects and Methods. The study was carried out in Almaty, the Republic of Kazakhstan; 182 patients from the groups facing the high risk of developing active tuberculosis received preventive tuberculosis treatment with new regimens: 71 patients were treated with isoniazid and rifampicin for 3 months (3 HR), 55 - with isoniazid and rifapentine for 1 month (1 HR), 56 - with levofloxacin for 6 months (6 Lfx).

Results. During treatment with regimens 3 HR, 1 HP, 6 Lfx, no adverse events of severity degree 3-4 developed , while adverse events of severity degree 1-2 were rare and relieved. The patient-oriented approach to the organization of preventive chemotherapy made it possible to achieve high treatment completion rates: in the group receiving 3 HR, it was 97.2% of cases, in the group receiving 1 HP - 96.4%, and in the group receiving 6 Lfx - 82.2%.

The objective: to study prevalence and patterns of mutations in the katG, inhA, ahpC, rpoB genes associated with Mycobacterium tuberculosis (MTB) resistance to isoniazid (H) and rifampicin (R) in patients with various clinical manifestations of pulmonary tuberculosis (TB).

Subjects and Methods. 441 sputum samples collected in tuberculosis patients were tested using biological microchips. Tests were carried out in Group 1 - patients with confirmed bacterial excretion (n = 256) and in Group 2 (n = 185) - patients without bacterial excretion. The same patients were enrolled in Group 3 - patients with acute progressing tuberculosis (n = 52) and Group 4 (n = 99) - patients with localized tuberculosis.

Results. In Group 1, DNA of Mycobacterium tuberculosis was found in 79.3% of patients, in Group 2 - in 57.8%. Among all samples, mutations in the genes encoding resistance to isoniazid were detected in 15.5%, resistance to rifampicin - in 58.1%. Resistance to isoniazid was more often caused by mutations in the katG gene (49%) versus the inhA (29%) and ahpC (4.2%) genes. We found 13 most common types of mutations in the rpoB gene associated with resistance to rifampicin. The dominant mutations in both groups were Seu531->Leu mutations - 19.7% in Group 1 and 24.3% in Group 2. In Group 1, mutations in the katG gene (53.7%) were observed more often than mutations in the inhA gene (27.7%). In Group 3, mutations in the katG gene were registered in 30.8%, in the inhA gene - in 25%. There were no statistically significant differences in patterns of mutations in the katG, inhA, ahpC, rpoB genes between Groups 1, 2 and 3, 4. Thus, patients without bacterial excretion and patients with localized tuberculosis are a hidden dangerous reservoir of tuberculous mycobacteria with multiple drug resistance to rifampicin and drug resistance to isoniazid.

The objective: to assess the prevalence of latent tuberculosis infection (LTBI) among risk groups in the adult and pediatric population in Siberian and Far Eastern Federal Districts.

Subjects and Methods. Federal and sectoral statistical reporting data (Forms No. 33, 8, 30) for 2018-2021 from Siberian and Far Eastern Federal Districts were retrospectively analyzed. Also, additionally collected data on TRA testing in 2021 in the pediatric and adult population registered as Group VIA of Dispensary Follow-up were analyzed.

Results. The existing forms of statistical reporting do not allow performing reliable assessment of LTBI prevalence and effectiveness of preventive measures in both adults and children. In many regions of Siberian and Far Eastern Federal Districts, there is insufficient coverage with LTBI testing. In 2021, the proportion of children aged 0-17 years with LTBI was 1.9% in Siberian Federal District, and 2.2% in Far Eastern Federal District varying from 0.4 to 31.3% in different regions. In 2021, the proportion of LTBI among contacts, both children and adults, made 17.4-19.9%, on average in the Siberian and Far Eastern Federal Districts varying significantly in different regions from 4.8 to 47.6%.

The objective: to study the impact of multiple drug resistant tuberculosis (MDR TB) on the outcomes of comprehensive treatment with surgical resection of fibrous cavernous pulmonary tuberculosis.

Subjects and Methods. A prospective retrospective cohort study was performed; 526 HIV negative patients with unilateral fibrous cavernous tuberculosis who underwent lung resection were enrolled in the study. Patients were divided into two groups: multiple drug resistant tuberculosis - 216 subjects, drug susceptible tuberculosis - 310 subjects. Each group was divided into three subgroups: with the low (MDR TB - 105 subjects; DS TB 221 subjects), moderate (MDR TB - 67 subjects; DS TB - 68 subjects) and high activity (MDR TB - 44 subjects; DS TB - 21 subjects) of tuberculous inflammation.

Results. The chances of adverse outcomes of comprehensive treatment with surgical resections of fibrous cavernous pulmonary tuberculosis are 2.5 times higher in MDR TB Group versus DS TB Group (p < 0.001; χ², OR = 2.5; 95% CI 1.6-3.9). At the time of the surgery, among patients with MDR TB, there were significantly more patients with moderate and high activity of tuberculous inflammation versus DS TB Group (p < 0.001; χ²). When comparing the groups of patients with a homogeneous degree of tuberculous inflammation activity, no significant impact of MDR TB on the outcomes of comprehensive treatment with resections was found. However, the course of the postoperative period differed, in MDR TB Group, pleural cavity empyema (OR = 3.1; 95% CI 1.7-5.5) and tuberculosis exacerbations (OR = 4.7; 95% - CI 2.1-10.7) were significantly more frequent compared to DS TB Group.

The objective: to study morphological changes in tissues after implantation of a bioresorbable material synthesized on the basis of polylactide (PLA) and polycaprolactone (PCL) in various ratios.

Subjects and Methods. Laboratory animals Chinchilla lanigera (n = 12) underwent intrapleural implantation with 2% PLA/PCL 1/1 and 4% PLA/PCL 1/3 materials. Morphometric assessment was carried out in14 and 28 weeks, the animals were withdrawn from the experiment by an anesthetic overdosing.

Results. When studying tissues adjacent to the implant regardless of differences in its composition, similar morphological signs were observed. A fibrous capsule formed around the implants, and it was more pronounced in 4% of PLA/PCL 1/3. In the structure of the implants, we noted the growth of loose and dense unformed fibrous connective tissue with blood vessels with a significant replacement of the bioresorbable polymer material (by 2/3). Lymphocytes, plasma cells, single macrophages, and multinucleated cells were predominantly located at the implant/tissue interface. In all studied samples, no necrosis was observed in the implantation bed and surrounding tissue.

Conclusion. The data obtained confirm the biosafety of biomaterials and demonstrate the potential for their use in surgical treatment of humans.

The objective: to establish the reasons of discrepancy between the preliminary and final clinical diagnoses in patients admitted to TB inpatient unit, to determine ways to improve the diagnosis of tuberculosis at the pre-hospital stage.

Subjects and Methods. We studied 130 medical records of patients (77 HIV negative patients - Group 1, 53 HIV positive patients – Group 2) admitted to the inpatient unit of TB hospital in 2014-2022, in whom tuberculosis (TB) was excluded after examination.

Results. In Group 1, all patients were preliminary diagnosed with pulmonary tuberculosis, in Group 2, 29 patients were preliminary diagnosed with pulmonary tuberculosis and 24 patients - with tuberculous meningitis (TM). Primary examination and analysis of medical records caused doubts about the diagnosis of 60 (77.9%) patients in Group 1, and 40 (75.5%) patients in Group 2. When pulmonary tuberculosis was suspected, pneumonia and cancer were most often verified: 33.8% and 27.3% in Group 1, 51.7% and 24.1% in Group 2, the causes of diagnostic errors at the pre-hospital stage included insufficient attention to medical history and clinical manifestations; outcomes of treatment with broad-spectrum antibiotics were ignored; no control radiological examination was performed; diagnostic fibrobronchoscopy, chest computed tomography, consultations of medical specialists were not provided. Often HIV negative individuals 25/47 (53.2%) had false positive results of sputum microscopy. In Group 2, in 24 patients with suspected tuberculous meningitis, the final diagnosis was cerebral toxoplasmosis (41.7%) and mycotic meningitis (25.0%). Poor coverage with neuroimaging, genetic molecular and serological tests led to diagnostic errors.

The objective: to study the efficacy of tuberculosis preventive chemotherapy in HIV infected patients based on the data of AIDS Prevention and Control Center, which is a part of City Infectious Clinical Hospital no. 1, Novosibirsk.

Subjects and Methods. 236 HIV infected patients aged 33-48 years old were enrolled in the study, they all were registered in AIDS Prevention and Control Center, City Infectious Clinical Hospital no. 1, Novosibirsk. All patients were at the stage of secondary diseases (4A, 4B, 4C), and had a pronounced degree of immunodeficiency (CD4+ from 200 to 349 cells/µl), and the ongoing ART was virologically successful. The efficacy of tuberculosis preventive chemotherapy (CTX) was analyzed in 147 patients versus 89 patients who received no tuberculosis CTX due to various reasons. For tuberculosis preventive chemotherapy, a combination drug was used, which contained isoniazid and pyrazinamide, for 3 months with daily intake. The groups of those receiving and not receiving CTX were comparable in terms of the gender, age and degree of immunodeficiency.

Results. In the group receiving CTX within a year after completion of CTX, tuberculosis was diagnosed in 7/147 (4.8%) patients including: focal pulmonary tuberculosis - in 71.4% (5/7), and infiltrative pulmonary tuberculosis - in 28.6% (2/7 patients). In the group receiving no CTX, during the year, 17/89 (19.1%) tuberculosis cases were detected: focal pulmonary tuberculosis – in 29.4% (5/17), infiltrative pulmonary tuberculosis - in 47.1% (8/17), and disseminated pulmonary tuberculosis - in 23.5% (4/17). Disseminated pulmonary tuberculosis was registered only in the group who received no CTX. The relative risk (RR = 0.442 (<1)) when comparing the number of cases in the groups indicates lower likelihood to develop tuberculosis in the patients taking CTX. The odds ratio (OR = 0.212; CI 0.084-0.534) indicates that the chances of developing tuberculosis are higher in the group receiving no CTX.

Conclusion. The use of a combination of isoniazid and pyrazinamide for tuberculosis preventive chemotherapy in HIV infected patients significantly reduces the risk of developing tuberculosis. Patients with severe immunodeficiency who have contraindications to tuberculosis preventive chemotherapy should be followed up jointly with a phthisiologist, the follow-up should include computed tomography for early detection of tuberculosis signs in the lungs.

We present the clinical case of effective treatment of tuberculosis in a patient with disseminated pulmonary and extrapulmonary pre-extensive drug resistant tuberculosis, HIV-infection and other severe opportunistic and concomitant infections. Short all-oral regimen has been used for the treatment. This clinical case demonstrates the clinical efficacy of modern treatment regimens, good compatibility with other drugs and management of adverse events without treatment interruption.

The review presents data from 55 publications describing the relationship between the gut microbiome and tuberculosis. It presents possible mechanisms by which the intestinal microbiota can influence various parts of the immune system.

It describes the effect of anti-tuberculosis drugs on the intestinal microbiome as well as possible prospects for the use of probiotics in the treatment and prevention of tuberculosis.