This article is written to update tuberculosis (TB) experts in the Russian Federation about the most recent data on the global TB situation, the progress in global TB care and control efforts, the challenges ahead, and the response expected by all countries. In particular, the article will detail the new End TB Strategy that the World Health Organization (WHO) is promoting for the new era of the Sustainable Development Goals 2016-2030 after the World Health Assembly approved it in a resolution during its 2014 meeting. The Russian Federation, with its extraordinary resources and knowledge needs to contribute to the roll-out of the new Strategy, both nationally and internationally. For this, the Ministerial Conference called by the Russian Federation Government to be held in Moscow on 16-17 November 2017 will play a crucial role in calling for the political attention necessary at the highest governmental levels in all high-burden countries, with an ultimate aim to raise the struggle against TB in the heads-of-state agenda.

Goal of the study: to evaluate tuberculosis epidemic situation in Azerbaijan in 2011-2015.

Materials and methods. The following tuberculosis rates were analyzed and compared: incidence, prevalence and mortality for 5 years (2011-2015) basing on the data of official statistic reporting (Form no.8 and Form no. 20) for 2011-2015.

Results. During 5 years (2011-2015) tuberculosis incidence decreased by 22.2%, prevalence by 20.3%, mortality by 7.3%, tuberculosis incidence in children by 28.5% and prevalence by 35.6%. These positive changes resulted from strengthening and optimization of tuberculosis care in the Republic. 

In Russia tuberculosis patients are detected during preventive mass screening and by self referral to medical units with clinical signs of the disease.

Goal of the study: to compare pulmonary tuberculosis patients detected during mass screening and by self referral to medical units with clinical signs of the disease.

Materials and methods: Data about 446 pulmonary tuberculosis patients treated in Republican TB Dispensary of Saransk in 2012-2014 were retrieved from Rosttsat Forms no. 8 and 33 and Russian Ministry of Health Reporting Forms (Edict 50). Statistica software was used for data processing.

Results. Among 446 pulmonary tuberculosis patients detected in 2012-2014, the part of those detected during mass screening made ¾ out of total number, and those detected by self-referral made ¼, however the latter group of patients was significantly more dangerous from epidemiological point of view, since among them the part of those with long period of the disease before treatment start was higher, the positive sputum tests were more often observed as well as pulmonary cavities and primary MDR compared to the patients detected during mass screening.

The obtained results point out at the need to focus on mass screening in the targeted groups of population concentrated around sources of infection. 

Goal of the study: to define the interaction procedure between phthisiologists and neurosurgeons when managing local tuberculosis of central nervous system in HIV-infected patients.

Materials and methods. Histological, mycobacteriologic and X-ray features of CNS tuberculosis were studied in 73 died and 5 operated HIV-infected patients.

Results. Stepwise treatment of the patients with local HIV-associated tuberculous lesions of brain includes conservative treatment with the search for the causative agent in all available biological liquids, and should the therapy fail then the decision is made about biopsy for diagnosis confirmation and sensitivity testing and the consequent decision about surgery aimed to remove the lesion. The surgery can be performed only after the relevant anti-bacterial treatment in compliance with drug sensitivity data till perifocal edema is not visible on the brain images. 

Goal: to evaluate the life quality of patients cured of pulmonary tuberculosis. All patients had spirometry done. The life quality was assessed with the help of St. George's Respiratory Questionnaire (SGRQ) for respiratory function evaluation. Average values for all questions of St. George's Respiratory Questionnaire was lower compared to those healthy even in the patients with normal respiratory function. Data of St. George's Respiratory Questionnaire had statistically confident correlation with spirometry rates, high co-efficient of test-retest correlation and agreement. Therefore St. George's Respiratory Questionnaire is a true and reliable tool for life quality evaluation of patients cured of pulmonary tuberculosis. The main factors providing impact on life quality were respiratory function disorders and severity of dyspnea.

Goal of the study: to evaluate the clinical efficiency of anti-influenza vaccination, erdosteine and pulmonary rehabilitation for prevention of exacerbations in COPD patients.

Materials and methods. 108 patients suffering from COPD of medium severity (average age 50.48 ± 0.88 years old) and receiving standard therapy for their main condition were enrolled into the study. The results were evaluated in 12 months by the software titled Management System for Treatment and Diagnostics of Those Suffering from Asthma and Chronic Obstructive Pulmonary Disease (Pulmosys).

Results. This set of measures demonstrated confidently high clinical efficiency: anti-influenza vaccination, erdosteine and pulmonary rehabilitation compared to standard therapy, and compared to vaccination and pulmonary rehabilitation with standard therapy. Clinical efficiency manifested through confident reduction in the number of exacerbations and admissions to hospital, positive changes in the clinical signs of COPD, confident reduction of the system biomarkers' level, increased tolerance to physical load, and enhancement in the life quality of the patients. 

Goal of the study: to study co-morbidity and risk of post-operative infectious complications in tuberculous spondylitis patients with concurrent non-specific spinal osteomyelitis as per ASA, PITSS scales and Charlson score.

Materials and methods. Surgical treatment of 41 patients with infectious spondylitis was retrospectively analyzed. Patients were divided into 2 groups. Tuberculous spondylitis patients were included into group 1 – 24 (58.5%), and those suffering from non-specific spinal osteomyelitis were included into group 2 (17.0-41.5%) More than half of tuberculous spondylitis patients were HIV positive (13/54.3%) and 16 out of 24 patients (66.7%) had generalized form of tuberculosis. The survival forecast for the patients after surgery was estimated by Charlson score, ASA score was used for evaluation of surgical and anesthetic risks, and risk of postoperative complications was assessed by PITSS (Postoperative infection treatment score for the spine) (2012).

Results. Early and late infectious complications were detected in 4 (9.7%) of patients with ASA at 3-4 scores, Charlson score exceeding 5 and high risk as per PITSS (more than 21 scores). Tuberculous spondylitis patients had Charlson score exceeding 5 and high risk as per ASA (4 scores) more often compared to those suffering from non-specific spinal osteomyelitis. The majority of infectious spondylitis patients (28/57.5%) had medium and high risk of postoperative complications development as per PITSS. HIV positive tuberculous spondylitis patients had two fold risk of postoperative complications development compared to those HIV negative (χ2 = 4.53, OR = 2.76, p = 0.0012). 

In case of mycobacterial infection the granulomatous infiltration foci contain the significant amount of mesenchymal stem cells (MSC), which functional phenotype and respective function in anti-tuberculosis immune defense remain unknown.

Goal of the study: to characterize the MSC phenotype, formed by their interaction with BCG of M. bovis and to evaluate the changes in this phenotype caused by the action of inhibitors and stimulants of immune regulatory action.

Materials and methods: MSC retrieved from bone marrow of mice were cultured with the presence and absence of BCG of M. bovis and/or poludanum TLR3 agonist; and the effect of two latter on the production of pro- and anti-inflammatory cytokines was evaluated by enzyme multiplied immunoassay. Flow cytometry and radioactive testing were used to evaluate the impact of cultured BCG fluid and poludanum-conditioned MSC on the proliferative and apoptotic activity of splenocytes. The inhibitors of indoleamine 2,3-dioxygenase (IDO), cyclooxygenase-2 (COG-2) or NO synthase were added to certain cultures alone with BCG and poludanum, and the contributions of IDO, COG-2 and NO to BCG and poludanum-induced response were assessed.

Results. Pro-inflammatory polarization of MSC under the action of BCG and poludanum was demonstrated. Pro-inflammatory MSC phenotype correlated to their anti-apoptogenic and growth-stimulating actions on the splenocytes. It was demonstrated that IDO and NO restrained BCG-induced polarization and conversely COG-2 promoted BCG-induced pro-inflammatory polarization of MSC.

Conclusions. 1. MSC actively participate in the formation of immunologic anti-mycobacterial resistance. 2. Targeted regulation of IDO and NO production can be feasibly applied for formation of anti-tuberculous vaccinal immunity and control mycobacterial infection. 

The article presents the clinical case of thyroid tuberculosis, diagnosed during thyroidectomy in the female patient suffering from nodular toxic goiter. Doctors are to be made aware about the rare localization of tuberculosis for its timely detection.