The article presents the comparative analysis of various types of thoracoplasty in treatment of tuberculosis patients with big cavities (more than 4 cm).

Subjects and methods: 63 patients were enrolled into the study (each of 3 groups included 21 patients depending on the type of thoracoplasty).

Results. Cavity healing and sputum conversion were achieved faster in the patients who had thoracoplasty by the method offered by the authors with use of the mesh transplant of Surgipro–SPMM-149. This method allowed avoiding mediastinal hernias and provided the highest rate of cavity healing – 81.0 ± 8.6%.

In the Arkhangelsk Region, the prevalence of multiple drug-resistant tuberculosis is one of the highest in the world. In 2016, the portion of multiple drug resistant tuberculosis made 33.1% among new cases and 59.5% among relapses. Using new molecular genetic diagnostic techniques allows reducing the time for diagnostics of tuberculosis and drug resistance and should result in the earlier start of adequate treatment.

The goal of the study is to assess the impact of new diagnostic molecular genetic methods on the time period from the first referral for medical care till the start of MDR-TB treatment. It was assumed that the introduction of molecular genetic tests would lead to early initiation of treatment in MDR TB patients (the research project of the International Union Against Tuberculosis and Lung Diseases and Tuberculosis Control Program of Arkhangelsk Region on The PROVE-IT LPA; Policy Relevant Outcomes from Validating Evidence on Impact of Line Probe Assays).

Subjects and Methods. The results of the diagnostic procedure using cultures were compared with the results of the procedure based on molecular genetic tests aimed to detect MDR-TB. 295 MDR TB patients were enrolled into the study, of them, 163 had culture and 132 had molecular genetic tests.

Results. The use of molecular genetic tests in smear-positive patients (AFB+) resulted in the reduction of the time period before initiation of MDRTB treatment by 50 and 66 days (median) versus culture by BacTAlert and absolute concentration on Lowenstein-Jensen medium respectively (p <0.001).

Patients with a negative smear (AFB-), in whom MDR TB was detected by molecular genetic methods started treatment by 78 days earlier (median) versus patients who had culture (Lowenstein-Jensen, p < 0.001). Despite the significant reduction in the time period, even using molecular genetic methods, it took 24 days for cases with AFB+ and 62 days for cases with AFB- to be notified and start treatment of MDR TB.

The goal of study: to investigate CAT-test in those suffering from chronic obstructive pulmonary disease (COPD).

Subjects and Methods. 53 COPD patients were examined. The studied group included COPD patients with the long history of smoking. The respiratory function was evaluated by the multi-module unit of MasterLab/Jaeger type. The patients were requested to fill in the Beck Depression Inventory. CAT test was used to evaluate the general condition.

Results. As the stages of COPD progressed, the number of CAT scores increased: in the patients with stage 2 of COPD it made 21.30 ± 7.34 and with stage 4 CAT scores made 26.7 ± 10.2. The level of depression was increasing with higher severity of COPD: the maximum number of scores of the Beck Depression Inventory was observed in COPD patients with stage 4 and it made 19.62 ± 11.2, and it was the lowest in COPD patients, stage 2 - 10.68 ± 8.41 The direct moderate association was observed between CAT and the level of depression (r = 0.53, p < 0.05). No true correlation was found between CAT and FEV1 (p > 0.05).

The single prospective study was conducted in order to assess clinical efficiency of adding the immune restorative agent of deoxyribonucleat sodium (Derinat) to the current chemotherapy regimens of 102 patients (new cases or relapses) with destructive pulmonary tuberculosis with multiple or extensive drug resistance; the patients were divided into two groups: the main group included 30 patients who were prescribed with intramuscular injections of Derinat, 5 ml, every 24 hours with 48 hours interval, 10 injections in total; and nebulizer inhalations with mixture of Derinat and saline solution in the proportion of 1:1 (2 ml of Derinat and 2 ml of saline solution), once a day, 20 inhalations in total; the comparison group included 72 patients, who had no Derinat prescribed. When compared to the control group, the group of patients treated with the immunomodulator had a shorter period of clinical manifestations elimination, increase in the frequency of sputum conversion (by 28.6% by the 4th month of treatment), reduction in the rate of eradication of bronchial tree mucus inflammations, increase in the frequency of cavity healing (by 20% by the 6th month of treatment).

The goal of the study is to perform the comprehensive assessment of the efficiency of regional TB services based on the analysis of certain indicators reflecting accessibility and quality of tuberculosis care.

Subjects and Methods. This study used data of medical statistics on tuberculosis and demography. Processing and analysis were performed using Big Data, methods of descriptive statistics, correlation and cluster analysis.

In Primorsky Kray, where TB situation is much worse compared to the overall situation in the Russian Federation, the quality of tuberculosis care differs significantly depending on the municipality. Based on the rates reflecting the burden of tuberculosis and treatment efficiency using hierarchical clustering and k-means, 4 clusters of municipalities were identified having different levels of the above rates. The availability of human resources for tuberculosis care was assessed for each of 4 clusters. It was found out that clusters with a high burden of tuberculosis were characterized by poor human resources availability for all the rates and vice versa. The results of the study allowed concluding that human resources availability for tuberculosis care was a crucial factor providing an impact on the efficiency of TB services performance.

The article presents medical and social parameters of TB/HIV co-infection in the patients living in Novosibirsk Region and the city of Novosibirsk. It is necessary to find some ways to enhance the poor patients' adherence to examinations and treatment on the inter-disciplinary level.

The goal of the study: to investigate treatment adherence in respiratory tuberculosis patients depending on the choice of therapy.

Subjects and methods: retrospective full-design study. The case histories of adult new tuberculosis cases who were treated in TB Dispensary in 2015 were analyzed. The groups were formed based on the intake of combined drugs with fixed doses (1 tablet contained 60 mg of isoniazid, 120 mg of rifampicin, 300 mg of pyrazinamide, 225 mg of ethambutol, and 20 mg of pyridoxine) – Group 1 (n = 38); or separate tablets in the doses as per drug use instructions (isoniazid, rifampicin, pyrazinamide, ethambutol) – Group 2 (n = 78). The groups were compatible as per sex, age, and clinical manifestations of tuberculosis. Patients from Group 1 with the weight of 60 kg received 5 tablets and patients from Group 2 received more than 12 tablets. Patients' adherence to treatment was assessed as per regularity of intake and number of doses during the intensive phase of treatment.

Results. Patients from Group 1 were regularly taking anti-tuberculosis drugs, while in Group 2 there were interruptions of treatment (7-21 days) in 12 (15.4%) patients. In Group, the intensive phase increased up to 90.2 ± 30.6 doses and in Group 2 this increase made 131.6 ± 65.4 doses due to late sputum conversion. In Group 1, sputum conversion was achieved during the first month of treatment in 60% of patients; and in Group 2 – in 10% of cases (p = 0.044). The frequency of transaminase elevation as a side effect was higher in Group 1, but it did not result in discontinuation of drugs.

Thus, the intake of combined medication with fixed doses improved tuberculosis patients' adherence to treatment.

In Dagestan as in Russia in general, tuberculosis situation has been stably improving for the last 15 years, which resulted in the reduction of efficiency and cost-effectiveness of regular screening in the adult population. Due to this it is necessary to relocate tuberculosis control resources from standard mass screening to activities targeted at risk groups. First of all, these risk groups include children and adolescents, the HIV infected, those exposed to infectious cases of tuberculosis, patients with remaining post-tuberculosis changes and diseases increasing the risk of tuberculosis - those addicted to alcohol and substances, suffering from diabetes, peptic ulcer, chronic non-specific pulmonary diseases as well as those living in poor conditions. It is reasonable to perform work aimed at the upgrade of TB services in the regions with favorable TB situation with the incidence below 40 per 100,000 population.

The article presents the evaluation of safety and efficiency of chemotherapy regimens including the new anti-tuberculosis agent of bedaquiline in 21 pulmonary tuberculosis patients with multiple and extensive drug resistance who were treated in Stavropol Regional Clinical TB Dispensary from 2014 to 2017. It was found out that regimens with bedaquiline were satisfactory tolerated, and the attempt to identify the agent causing adverse events within a multi-component chemotherapy regimen failed. The majority of adverse events were reversible, but they required temporary cancellation of chemotherapy in 5 patients with the consequent continuation of treatment with this regimen after adverse events were managed. The evaluation of treatment efficiency with 6-month treatment with bedaquiline showed sputum conversion in 94.4% of cases and healing of cavities in 72.2%.

The goal of the study is to analyze the incidence of tuberculosis in the population of Samara Region, its changes and trends.

Subjects and methods. The data on tuberculosis incidence in the population for 2000-2014 were analyzed, the data were provided by Samara Regional Rospotrebnadzor Directorate. Microsoft Excel was used for data visualization and ArcView 10.0 was used for mapping.

Results. According to the performed analysis, tuberculosis incidence was growing in Samara Region, while in theRussian Federation the average rate was going down. Every year, the incidence among rural population exceeds the average long-term rate for the whole region. The part of notified cases of respiratory tuberculosis makes 93-97%. Three municipal regions, Bezenchuksky, Elkhovsky, and Koshkinsky, had the highest burden of respiratory tuberculosis. For many years, these regions have the highest incidence with a high portion of tuberculosis with a positive result of sputum test. Among towns in the region, Chapaevsk differed markedly with its high incidence of tuberculosis. From 2005 tuberculosis incidence in children has been gowning down. Every year the number of tuberculosis cases with multiple drug resistance and HIV co-infection is increasing.

The article presents a clinical case of effective treatment of a female patient suffering from respiratory tuberculosis with extensive drug resistance. Chemotherapy regimen included 7 drugs, including bedaquiline and perchlozon.