Tuberculosis is one of the most dangerous social and medical problems. Despite the relative stabilization of some tuberculosis epidemiological rates in general tuberculosis situation remains to be difficult. It can be due low efficiency of existing tuberculosis care organization given the changed social and economic conditions. Therefore the issues of tuberculosis care organization optimization considering the cost effectiveness and compliance with all treatment principles of this disease are actual and crucial.

Одной из наиболее сложных проблем в клинической терапии является дифференциальная диагностика заболеваний, объединенных рентгенологическим синдромом легочной диссеминации, так называемых интерстициальных заболеваний легких (ИЗЛ) [1,7]. ИЗЛ представлены приблизительно 200 нозологическими единицами, что со­ ставляет около 20% всех заболеваний легких [8]. Термин «гранулематозные болезни легких» основан на формировании гранулем при этих заболеваниях, в то время как несколько наиболее грозных заболе­ ваний этой группы, ранее объединяемых названием «идиопатический фиброзирующий альвеолит», вообще не образуют гранулемы. Термин «диффузные паренхиматозные болезни легких» делает акцент на паренхиматозном поражении – альвеолите, который является стержнем и главной ареной развертывания драматических событий.

This article analyzes the ways of treatment efficacy enhancement in drug resistant tuberculosis patients through transfer to the individual treatment regimens basing on the objective laboratory data. The presence of M. tuberculosis population heterogeneity has been demonstrated as per the degree of resistance to different drugs relating individual pharmacokinetic features of the patients. The article includes discussion of technical opportunities for the implementation of such approach, the need for detail evaluation of the germ resistance and limits of effective action of anti-tuberculosis drugs related to their pharmacokinetics and pharmacogenetics.

Treatment outcomes have been studied for 1,372 children with pulmonary tuberculosis of 0-14 years old, notified in 2011 and 2012. It has been found out that the high cure rates (94.5%) are related to a lower number of forms with massive bacillary excretion (7.0%). The lower frequency of some other unfavorable outcomes also makes its contribution (but for the ineffective course of chemotherapy). The massive bacillary excretion increases the risk of chemotherapy failure by 13.2 fold and the risk of lethal outcome by 8.9 times.

This article describes the specific primary disorder of small pelvis organs in the female patient with no tuberculosis in her medical history. Use of this roentgen technique for genital tuberculosis detection and assessment of treatment efficacy enhances the effectiveness of diagnostic activities and allows early detection of this pathology thus reducing the risk of complications which is crucial for pregnancy planning given the young age of the patient.

Регулярная контролируемая химиотерапия – необходимое условие для успешного лечения туберкулеза, предотвращения развития лекарственной устойчивости возбудителя, обеспечения санитарно-эпидемического благополучия населения. Возможность ее проведения зависит, с одной стороны, от наличия достаточного количества ресурсов, включая обеспечение противотуберкулезными препаратами, с другой – от приверженности пациентов к лечению. Приверженность подразумевает соблюдение рекомендаций, предписанных медицинским работником пациенту, включая частоту обследований, прием препаратов, соблюдение режима лечения и т. д. Недостаточный контроль химиотерапии и досрочное ее прекращение – основные причины снижения эффективности лечения [1, 5]. Среди эпидемически опасных впервые выявленных больных, зарегистрирован­ ных в 2011 г., досрочно прекратило курс химиотерапии (КХТ) 7,2%, среди случаев повторного лечения – 14,8%, а среди случаев лечения туберкулеза с множественной лекарственной устойчивостью возбудителя (МЛУ-ТБ) – 20,4% пациентов [3]. Указанная проблема актуальна не только в Роcсии, но и во всем мире. По данным глобального отчета Всемирной организации здравоохранения, прерывают лечение 5% впервые выявленных больных, 12% больных, проходящих повторное лечение, и 28% больных МЛУ-ТБ [8].

The article presents the analysis of immediate and postponed outcomes of surgical treatment of tuberculosis spondylitis in HIV-infected patients; the relative risks of post-surgery complications have been estimated.

The article presents efficiency comparison of Sensititre test system and culture methods of Bactec 960 and Lowenstein-Jensen medium for drug susceptibility testing of tuberculosis mycobacteria.

Cultures of M. tuberculosis of 137 patients have been studied. It has been found out that the part of coinciding results is fairly big for drug susceptibility testing by test system of Sensititre MycoTB and other methods. This system has the advantages related to standard procedures and capacity of drug susceptibility testing (degree) to 12 drugs simultaneously within a short period of time (7-14 days). Drug susceptibility testing of M. tuberculosis by testing system of Sensititre MycoTB is simpler from technical point of view compared to all other systems. Sensititre MycoTB has been tested abroad and in MSPCT and certified and it can be used for the clinical practice. 

208 patients were included into the study. The 1st group included patients with TB/HIV co-infection (n = 116), the second group consisted of tuberculosis patients without HIV infection (n = 92). The results of general blood count and biochemical blood assay before the chemotherapy start were studied. It was found out that the changes in hemogram of the patients with TB/HIV co-infection were most often manifested through leukocytosis, ESR increase and anemia (93.6%). Reduction of the number of leukocytes, lymphocytes, thrombocytes and anemia are observed at the terminal stages. As regards biochemical rates no confident difference was observed.

Mutagenous and mitosis modifying impact of silver nanoparticles has been studied on outbred mice. Nanoparticles were of round shape with dimensions of 5-50 nm, size of generated organic shell of 2-5 nm, the quantity in 1 mcm3 makes 120-270. Metaphasic analysis of mice bone marrow cells was used as a testing technique. The frequency of chromosome aberrations and mitotic index of preparations were accounted. During single intraperitoneal administration of the agent in the dose of 250 mcg/kg the silver nanoparticles demonstrated mitosis stimulating activity. No mutagenous effect of silver nanoparticles by daily administration for 4 days of 25 mcg/kg and single administration in the dose of 250 mcg/kg has been registered, but there is statistically insignificant tendency of aberrant metaphases increase. Consequently silver nanoparticles in the investigated doses demonstrated no mutagenous activity and can be considered safe for mammalian cells.

The purpose of this research is to investigate the activity of adenosine deaminase and its isozymes in pulmonary tuberculosis patients depending on resistance of mycobacteria to anti-tuberculosis agents.

It has been found out that the ADA level on blood plasma is higher in the patients with drug resistant mycobacteria, in the patients with multiple/extensive drug resistant mycobacteria (M/XDR) insignificant increase on enzyme activity has been observed, which can be the evidence of the immune system activity suppression.

It has been shown that in case of drug susceptible pulmonary tuberculosis the increase of general ADA activity in blood plasma is due to increase of activity in both isozymes and in patients with M/XDR mycobacteria the increase of enzyme activity happens due to the increase in ADA2. 

The child was referred for complex in-patient examination after annual fluorography screening which detected interstitial changes in the lungs, the child had been examined including biopsy of bronchi mucosa, and pulmonary sarcoidosis, stage II, was diagnosed.