The articles presents materials of the three defended and approved doctor’s dissertations, devoted to individual approaches to children ill with tuberculosis and having the risks of developing tuberculosis depending on social conditions, state of the host, cellular and molecular-genetic levels. The options of working with children and adolescents being within the studied categories, basing on the innovative computer technology have been o|ered. The examples are given how the innovative approaches have been introduced into the practical works of pediatricians and TB pediatricians.

The articles presents results of associative study of pulmonary tuberculosis and 17 genes with the wide competence field, which products are informative in relations to development of multi-factorial diseases of various etiology. The biggest number of associations was found out to the gene of NOS3 (in particular with rs1799983) – they were registered as associations with pulmonary tuberculosis in general (p = 0.003), and with its clinical forms (p = 0.006), tissue destruction level (p = 0.029), endophenotypes (0.002 ≤ p ≤ 0.033 for various clinical manifestations). The following combinations of genotypes of VNTR/rs1799983 are generally associated with studied pathology (gene of NOS3), rs3746190/rs11575926 (gene of IL12RB1), rs909253/rs1800629 (gene LTA/TNF). Moreover the following polymorphous variants of genes are associated with qualitative and quantitative signs of pulmonary tuberculosis: TNF, LTA, TNFRSF1B, IL12RB1, IFNGR2, ADRB2, IL4R, GNB3. The associative study of genes of GNB3, PPP3R1, GATA4 with tuberculosis was conducted for the first time.

The article contains morphological evaluation of the activity of tuberculosis disease in patients with various drug resistance patterns basing on the tests of surgical specimens of 310 patients, who underwent pulmonary resections (up to 3 segments). The analysis included complications and relapses after surgery in patients with various degree of morphological activeness of tuberculous changes at the moment of surgery. The frequency of complications and relapses among patients with drug resistant and drug susceptible tuberculosis was confidently di|erent – 18.01 and 6.71% respectively. But the patients manifesting the high degree of morphological activity of tuberculous changes at the moment of surgery, in total had complications and relapses with the same frequency both for drug resistant and drug susceptible tuberculosis (36.7 and 33.3% respectively).

The prospective analysis was conducted covering urodynamic testing of 20 patients su|ering from active tuberculosis spondylitis having neurogenic disorders of urination and preparing for reconstructive surgery. The obtained data allowed detecting functional disorders which can cause irreversible changes of the upper and lower urinary tract, to complicate the post-surgery recovery and the consequent rehabilitation of these patients. The authors point out at certain limitations in using of one component of urodynamic testing – evaluation of evacuation capacity of the urinary bladder due to the existing neurologic disorders and spinal instability in the area of tuberculous lesion.

261 tuberculosis patients mainly su|ering from the pulmonary forms were enrolled into the comparative study of the pattern and prevalence of mutations in the genes of katG, inhA, ahpC and rpoB M. tuberculosis among urban and rural population. The testing was conducted with use of biological microchips and the set of reagents TB-Biochip, Russia. It has been found out that among tuberculosis patients constantly living in urban settings the multiple drug resistance is registered confidently more often compared to rural citizens – 38.6% against 23.2% respectively and the unfavorable pattern of mutations is detected in the genes of katG and rpoB, simultaneous multiple and concurrent mutations in 2-3 genes prevail. This requires development of additional measures of control over transmission of drug resistant strains of M. tuberculosis among urban population.

The study presents the analysis of drug susceptibility of tuberculosis mycobacteria isolated from pulmonary tuberculosis patients by the moment of their registration in 2013 on the territory of Vladimir region. Totally 574 pulmonary tuberculosis patients were registered. Of them 432 were new cases, 78 relapses and other cases (in particular treatment failures and defaults) made 64 persons. All the groups demonstrated the increase of multiple drug resistance: in 101 (28.5%) cases of all infectious patients who had drug susceptibility tests done. Among new cases and relapses – 69 (25.9%) and 24 (46.2%) isolates of tuberculosis mycobacteria respectively.

The purpose is to identify the leptin and adiponectin content in blood regarding their receptor expression in the soft tissue of the hip in case of chronic obstructive pulmonary disease with the signs of osteporosis.

80 COPD patients and 76 healthy persons were examined. Receptor expression to leptin and adiponectin in the vessels was tested by immune-fluorescent technique in 30 patients.

Control leptin and adiponectin expression was presented in skin, subcutaneous fat and cross-striped muscles. In case of COPD leptin and adiponectin expression was identified in skin and subcutaneous fat. In control cases and COPD leptin expression was identified in endothelium and myocytes achieving confident reduction at stages II and III. Adiponectin expression in control cases and in stage I was detection only in adventitia. In stages II and III stages adiponectin is expressed in myocytes and endothelium. Receptor expression to leptin and adiponectin repeats their content in blood. The correlations between leptin and adiponectin and their expression with body mass index and mineral bone density have been found out.

The detected changes confirm the contribution of adiponectin to re-modeling of muscle and bone tissue in case of COPD. 

The study investigated the distribution of polymorphous variants of genes regulating cellular cycle – p53 G215C, Bax G248A and Bcl-2 C938A in lung cancer patients and healthy donors with the purpose of obtaining new fundamental knowledge on the role of above polymorphisms in the lung cancer development. The statistically significant di|erences were found out in the distribution of polymorphous variants of genes regulating cellular cycle in the compared groups; relative risks of cancer development were calculated for those carrying of polymorphous variants of genes of p53 G215C, Bax G248A and Bcl-2 C938A.

The high level of HIV infection is one of the factors providing negative impact on tuberculosis incidence and prevalence in Sverdlovsk region. The number of those su|ering from the late stage of HIV-infection is steadily increasing and they develop active tuberculosis fast. The purpose of the study is to evaluate the results of using tuberculous recombinant allergen in the procedure of tuberculosis diagnostics in HIV patients. 4144 HIV patients were enrolled into the study, some of them had tests with tuberculous recombinant allergen (diaskintest) and the others had tuberculin tests. Tuberculous recombinant allergen proved to be more sensitive compared to tuberculin in the planned examination of HIV patients with the purpose of tuberculosis detection. In case of positive or hyperergic reaction to tuberculous recombinant allergen active tuberculosis was detected 4.8 fold often in HIV patients compared to the same reactions to tuberculin. The procedure of preventive examination for tuberculosis in HIV patients should include tuberculous recombinant allergen.

52 pulmonary tuberculosis patients with concurrent diabetes and 76 pulmonary tuberculosis patients without concurrent diabetes (control group) were examined. The state of vascular endothelium was evaluated by the content of nitrogen oxide (NO), endothelium-1 (E-1) and antigen of Willebrand factor (WF) in blood serum (plasma). Patients with concurrent condition had more significant changes in their metabolic status of vascular endothelium (endothelial dysfunction) compared to control group. It manifested through significant reduction of NO level, which is negatively correlated to the increase of glycosylated hemoglobin and the loss of the self-regulating ability of the endothelium cells. The latter was documented by development of the negative correlation between rates of NO and E-1 (in the comparison group the correlation was positive). Functional decompensation of vascular endothelium in pulmonary tuberculosis patients with concurrent diabetes was accompanied by the presence of endothelial destructive lesions, documented increase of  WF (in the majority of patients from the control group WF was within the upper limit of the referent rates). In 3 months of complex treatment of patients with concurrent pathology NO level became normal, but E-1 and WF went confidently down but still were above the upper limits of the norm.

Lately the main TB epidemiological rates are becoming stable in Buryatia Republic. In 2013-2014 the e¾ciency of use of perchlozon was studied within integral treatment of pulmonary tuberculosis patients with multiple and extensive drug resistance (MDR and XDR TB). The first group (n = 28) where the combination of standard regimen 4 with perchlozon was used included patients 85.7% of them with chronic tuberculosis with MDR and XDR. The patients from the second group (n = 30) were treated by standard regimen 4. 78.6% of patients treated by regimens with perchlozon had XDR TB with resistance to second line drugs (p < 0.01). The second group was resistant mostly to 3 main drugs – 66.7% of patients, and there were single cases of resistance to fluoroquinolones. The tolerance of perchlozon was not significantly di|erent from tolerance of the second line TB drugs. The treatment allowed achieving positive clinical changes in the patients' state up to complete elimination of intoxication symptoms and reduction of respiratory insu¾ciency with simultaneous X-ray regression of inflammatory changes in the lungs by the moment of transfer to the continuation phase, it was more often observed in the second group in 22 (73.3%) patients compared to 12 (42.9%) of the first group (p < 0.05). In 4 months of treatment the smear converted in 10 (35.8%) patients from the first group compared to 17 (56.6%) patients from the second group. The use of perchlozon in the complex treatment of XDR tuberculosis patients, in whom there is no favorable prognosis of tuberculosis cure, allows confident clinical and X-ray stabilization of the chronic tuberculosis disease in 42.9% and sputum conversion in 35.8% of patients from the 1st group.

Simple prospective study was conducted in order to evaluate the e¾ciency of using the immune reparative agent of deoxyribo sodium nucleinate (derinat) in the integral treatment of 108 new patients su|ering from destructive infiltrate pulmonary tuberculosis, which were divided into two groups: the main group (MG) included 36 patients to whom derinat was prescribed (intramuscular 5 ml 0f 1.5% solution, 10 injections and inhalations through the nebuliser of the solution of derinat with saline soluion in 1:1 proportion, 2 ml of derinat solution and 2 ml o saline solution once a day, course of 20-30 procedures), the comparison group (CG) included 72 patients to whom no derinat was prescribed. The cavity closure was registered by 38.3% more often in the main group compared to the CG where patients had high risk of transformation into fibrous cavernous tuberculosis (OR = 1.222 ± 0.179). The duration of hospital stay in patients treated with derinat was 23 days shorter.

The article describes the rare case of concurrent pulmonary and abdominal tuberculosis with multiple drug resistance with formation of numerous tuberculomas in the immune competent 7 year old child vaccinated with BCG. The diagnostics was di¾cult due to the lack of information on exposure to tuberculosis, normergic sensitivity to tuberculin in Mantoux test with 2 TU PPL-L, negative diaskintest result and absence of pathologic changes in the chest lymph nodes. The di|erential diagnostics with parasitic and oncologic diseases was conducted. Diagnosis of tuberculosis was verified morphologically. The treatment tactics included anti-tuberculosis chemotherapy and staged surgical interventions in the lungs and abdomen.