The review shows the results of metabolomic studies in pulmonology. The key idea of metabolomics is to detect specific biomarkers in a biological sample for the diagnosis of diseases of the bronchi and lung. Main methods for the separation and identification of volatile organic substances as biomarkers (gas chromatography, mass spectrometry, and nuclear magnetic resonance spectrometry) used in metabolomics are given. A solid-phase microextraction method used to pre-prepare a sample is also covered. The results of laboratory tests for biomarkers for lung cancer, acute respiratory distress syndrome, chronic obstructive pulmonary disease, cystic fibrosis, chronic infections, and pulmonary tuberculosis are presented. In addition, emphasis is placed on the possibilities of metabolomics used in experimental medicine, including to the study of asthma. The information is of interest to both theorists and practitioners.

В противотуберкулезных учреждениях сконцентрированы наиболее эпидемически опасные пациенты – больные туберкулезом легких, которые выделяют в окружающую среду большое количество микобактерий туберкулеза (МБТ): в суточном количестве мокроты больного туберкулезом может находиться свыше 7 млрд МБТ [16]. При отсутствии эффективной вентиляции после выделения из макроорганизма микобактерии в течение нескольких часов могут находиться в воздухе в виде частиц аэрозоля, оседающих затем на поверхности различных объектов, на которых могут накапливаться в значительном количестве, превышающем минимальную дозу заражения [5, 38, 49]. Длительный контакт восприимчивого к этой инфекции человека с объектами (посудой, одеждой, мебелью и другими предметами и поверхностями), загрязненными патогенными микобактериями, может привести к заболеванию туберкулезом [32, 33, 38, 52]. Усугубляет эпидемическую ситуацию высокий уровень распространения в РФ возбудителя туберкулеза с множественной (МЛУ) и широкой лекарственной устойчивостью [41, 48].

Таким образом, в противотуберкулезных учреждениях сотрудники, пациенты и посетители подвергаются риску заражения нозокомиальным туберкулезом [7, 8, 20, 28, 31, 38].

In Russia, the accounting of tuberculosis, including multidrug-resistant tuberculosis, is intricate and contains a great deal of data allowing for different interpretation. The modifications of existing forms engender numerous defects in filing them out, which drastically reduces the validity of analytical information and levels off a positive effect off when obtaining additional information. The existing federal statistical tuberculosis reporting forms need modification and adequate and instructional support. The tracking (cohort) follow-up and monitoring system-based methodological approaches to federal and branch reporting require unification. A unified electronic register of tuberculosis patients must serve as a source of additional information.

The follow-up study of the course of tuberculosis in 274 HIV-infected patients has established patterns in the development of its generalization with a consequential change of pulmonary, lymphogenous, and hematogenous stages. The periods of evolving generalization vary directly with the baseline level of CD4 lymphocytes when tuberculosis is detected. Generalized hematogenous tuberculosis develops with the lower level of CD4 lymphocytes and generalized lymphogenous tuberculosis does with their steady-state level. In the lymphogenous stage, Mycobacterium tuberculosis (MBT) spreads from the primarily involved intrathoracic lymph nodes along the lympathic routes to the nearest regional lymph nodes that are supraclavicular, subclavian, lateral cervical and axillary ones. MBT simultaneously penetrates along the lymphatic vessels accompanying the large vascular trunks into the lymph nodes of the retroperitoneal space and abdomen. Specific splenic involvement that may be a marker of the onset of a hematogenous MBT break is intermediate in the initial stages of hematogenous generalization.

The clinicoeconomic efficiency of Stage 1 chemotherapy (CT) using different organizational forms of treatment was comparatively evaluated in 172 patients with new-onset pulmonary tuberculosis. The main reasons for ineffective CT were discontinued treatment (27.1 to 10.5%) and a fatal outcome (13.8% at an around-the-clock hospital). Home hospital treatment showed the lowest rate of discontinued and refused treatments (10.5%). The cost of Stage 1 CT (90 bed-days) at an around-the-clock hospital was 49,339 rubles. The highest clinicoeconomic efficiency of Stage 1 CT was noted during home hospital treatment: the rate of discontinued treatment was 2.3-2.5 times lower than that at a day hospital and around-the-clock hospital and the cost of ceased bacterial discharge verified by sputum microscopy was 8,501 rubles, which was 6.2 times less than that at an around-the-clock hospital and almost less than that at a day hospital.

The paper analyzes the epidemiological indicators of tuberculosis among adults and children in the Republic of Tajikistan in 1994-2003. Despite the fact that the registered morbidity and mortality rates for tuberculosis (TB) have become stable in this country in the past 5 years, its burden has remained tense. Examination using a drug resistance test revealed that in 2009 there were 17 and 60% of patients with multidrug resistant TB among the new and recurrent cases, respectively. There were 68 cases of TB with broad drug resistance in the pathogen and only 10 patients had access to treatment. In 2009-2013, the proportion of HIV/TB patients accounted for 1.3-2.5%. Innovative technologies (GeneXpert, HAINtest, and MGIT) are finding increasing use for diagnosis and differential diagnosis; early detection of tuberculosis by fluorography and tuberculin diagnosis is being established. The efficiency of treatment in patients with tuberculosis with susceptibility and resistance in the pathogen was 88 and 66.7%, respectively.

The investigators retrospectively analyzed the demographic, social, and clinical structure of 197 patients with pulmonary tuberculosis treated at the Novosibirsk Research Institute of Tuberculosis, Ministry of Health, and 50 patients with prostatic tuberculosis and compared the indicators in question. The cohort was established to be considerably heterogeneous; gender differences were found in the pattern of pulmonary tuberculosis. Pulmonary tuberculosis was detected in nearly half (45.7%) of the patients during preventive examinations; bacterial excretion was found in 78.2% of the patients (82.6% of men and 71.1% of women). The patients with prostatic tuberculosis were ascertained to have a higher social well-being than those with pulmonary tuberculosis: the former had higher educational level and they were less prone to practice bad habits.

The paper characterizes drug susceptibility in Mycobacterium tuberculosis isolated from new cases of tuberculosis concurrent with HIV infection. The investigators have studied the spectrum of drug resistance in Mycobacterium tuberculosis isolated from new cases of tuberculosis concurrent with and without HIV infection (172 and 309 clinical isolates, respectively). There are differences in the rate of primary drug resistance to antituberculosis drugs in patients with and without HIV infection (59 and 43.5% of the cases, respectively). The HIV-infected have also shown high rifampicin resistance rates in Mycobacterium tuberculosis (41.7%). The reasons for these differences are as yet unknown and call for further investigation.

To study the clinical efficiency of using mesodiencephalic modulation (MDM) as therapy in the combination treatment of patients with pulmonary tuberculosis, the authors examined two groups: 1) the patients who received a MDM cycle in combination with chemotherapy regimens (a study group); 2) those treated using standard chemotherapy regimens (a control group). By the end of one-month therapy, the study group ceased bacterial excretion twice more often than the control group that exhibited the similar results only by the end of three-month treatment. MDM as therapy produced positive X-ray changes in 76.0% of the cases in the study group and in 44.4% in the control one. MDM used in the combination treatment of patients with tuberculosis makes it possible to reduce the length of hospital stay, the number of round-the-clock beds, and the cost of treating these patients.

A family is a social group that satisfies the most important needs and fulfils diverse functions. Patients with infiltrative pulmonary tuberculosis are not emotionally supported by their family members and hence experience anger and exasperation. The functioning of 30 families of patients with infiltrative pulmonary tuberculosis was psychologically studied using the family environment scale. The findings were compared with those of 100 standard families. Six out of 10 items showed significant differences, the other 4 items also displayed dissimilarities, but the latter were insignificant. The families of patients with pulmonary tuberculosis were dysfunctional. The social climate of the family had established well before infiltrative tuberculosis was diagnosed in its member. The dissimilarities from the standard families are due to the social characteristics of family members, such as low income, alcohol abuse, and imprisonment. The specific features of the social climate of a family provide an explanation for no moral support to the patient.