The article describes the changes in the main tuberculosis rates in Khanty-Mansiysky Autonomous Region for the last 10 years. The main areas requiring major efforts and bottlenecks in tuberculosis control are highlighted, and the results achieved in the treatment of multiple drug resistant tuberculosis in this Russian region are presented. The article presents preliminary analysis of treatment efficiency of multiple drug resistant tuberculosis and changes in the epidemics of this most dangerous form of the disease given the introduction and active use of a new generation of anti-tuberculosis drugs.

The article describes the issues of psychological rehabilitation of pulmonary tuberculosis patients and summarizes the practical experience of authors in the establishment of psychological support services in a TB clinic. The presented model of psychological rehabilitation includes the differential use of certain types of psychological care at the various stages of chemotherapy. The elaborated approach incorporates specific features of tuberculosis treatment as well as the specific response of tuberculosis patients and their personal communication detected through clinical and psychological tests.

The objective of the study: modification of the standard IFA method aimed to detect antibodies against tuberculosis, assessment of its efficiency as a screening tool for prediction and diagnostics of tuberculosis in HIV patients.

Subjects and methods. The modification of the standard IFA method aimed to assess the intensity of humoral anti-tuberculosis immune response included measurement of operational dilution of tested sera in order to enhance its diagnostic value. The modified method was used for the examination in the following groups: 85 active tuberculosis cases, 92 HIV patients with no clinical signs of tuberculosis, and 30 healthy donors.

Results: it is possible to use the modified method in HIV positive people in order to detect those with the highest risk of tuberculosis among them; to provide early diagnostics of active tuberculosis, which is especially crucial at the advanced stages of HIV infection. This method cannot replace the classic methods of tuberculosis diagnostics and it is not recommended for mass screening in HIV negative persons.

Every year, a significant number of healthcare workers fall ill with tuberculosis in the Kyrgyz Republic. During the investigated period (2011-2016), 80.8% of all new tuberculosis cases among healthcare workers were registered among nurses, paramedical personnel, and caregivers. Whereby, during the whole period, the part of those who developed tuberculosis in general medical services made 92.8%, while in TB units it was 7.2%.

Goal: to detect specific features of circulation of tuberculosis mycobacteria belonging to various genotypes in Saratov Region, define their clinical and epidemiological value and changes in the transmission during 4 years of monitoring (2014-2017).

Materials. 310 clinical isolates of M. tuberculosis were studied, all isolates were obtained from sputum of new pulmonary tuberculosis patients. The toolkit of Spoligo-Biochip (OOO BIOCHIP-IMB, Moscow) was used for spoligotyping and hybridization on the biological microchips.

Results. It was found out that in 2014-2017 in Saratov Region,11 genotypes of M. tuberculosis were circulating (Bejing, Beijing-like, Haarlem+Ural, LAM, T, Microti, Rus 1, EAI, Canetti, Cas, Manu), of them, Bejing, Beijing-like, Haarlem и T. dominated. The homogeneous genetic structure was typical of Beijing и Beijing-like with large clusters of spoligotypes of (SIT) 1, 265 и 250. Beijing SIT 1 was confidently more frequent in those with severe forms of tuberculosis and bacillary excretion. M. tuberculosis of Haarlem and T genotypes had a higher heterogeneity and lower clusterization. Beijing and Haarlem were the most unfavorable from the epidemic point of view and they were confidently more frequent in patients with lung tissue destruction and bacillary excretion. For 2016-2017, the positive change in tuberculosis epidemics was registered in Saratov Region, namely, the circulation of Beijing decreased while the circulation of T genotype increased.

The article presents the experimental studies results of continuous spectrum pulsed UV light mycobactericidal activity against the laboratory strain of Mycobacterium terrae and clinical strains of Mycobacterium tuberculosis with multiple and extensive drug resistance. A pulsed xenon lamp of a mobile “Alfa-01” unit for air decontamination was used as ultraviolet light source. The experiments showed high activity of pulsed UV light against all studied strains, which does not depend on the distance to the treated surface (up to 4 m). The efficiency of contaminated surfaces disinfection reached 100%. Exposing contaminated objects to pulsed xenon UV lamps’ light leads to multiple molecular genetic changes in DNA macromolecules with complete loss of drug resistance to rifampicin and partial loss of drug resistance to isoniazid.

The objective of the study: to assess efficiency of comprehensive treatment of destructive pulmonary tuberculosis patients with extensive drug resistance using valve bronchial block.

Subjects and Methods. Treatment outcomes in 60 patients with destructive pulmonary tuberculosis and extensive drug resistance were analyzed, the age of patients varied from 18 to 60 years old. The main group included 30 patients who had valve bronchial block along with treatment by third line drugs, the comparison group included 30 patients who had the same treatment but with no valve bronchial block. Pneumoperitoneum was used in both groups, should there be indications for it. The significance of difference was defined by χ2 test, the difference was considered significant with p < 0.05.

Results of the study. When valve bronchial block was used, positive X-ray changes were observed in 22 (73.3%) patients versus 13 (43.3%) patients in the comparison group (p < 0.05), cavities were healed in 9 (30.0%) patients versus 2 (6.7%) (p < 0.05 with Yates' correction), tuberculosis progressed in 1 (3.3%) patient versus 10 (33.3%) in the comparison group (p < 0.01 with Yates' correction). The bacillary excretion persisted in fewer cases: the one confirmed by smear was persistent in 3 (10.0%) patients from the main group versus 9 (30%) from the comparison group (p > 0.05), and the one confirmed by culture – in 5 (16.8%) patients versus 18 (60.0%) respectively (p > 0.01).

The significance of lipoarabinomannan (LAM) level in blood serum for the confirmation of tuberculosis was analyzed in 106 patients at the advanced stages of HIV infection. In 63 of 106 (59.4%) persons tuberculosis was diagnosed based on clinical signs. Patients with co-infection (HIV/TB) had confidently higher level of LAM in their blood serum versus HIV patients (13.75 ± 1.5 pg/ml; CI ± 2.97 and 7.49 ± 0.5 pg/ml; CI ± 0.96, respectively; Р = 0.000163). In general, sensitivity of the test of LAM level in blood serum of HIV patients made 85.7%, and specificity made 79.1%. It was found out that in TB/HIV patients, LAM level in blood serum was not influenced by such factors as extent of tuberculous lesions in respiratory organs (a positive result of LAM test in case of disseminated and local respiratory lesions was in 86% (37/43) and 85% of cases (17/20) respectively) and bacillary excretion (a positive result of LAM test in case of bacillary excretion and without was in 89.2% (33/37) and 76.9% (20/26) of cases respectively). The part of positive results when performing LAM test was in 87.5% of cases (54/63), while results of skin test with tuberculous recombinant allergen were positive only in 14.4% (9/63). The presented results allow concluding than it would be sensible to test LAM level in blood serum in the patients at the advanced stage of HIV infection. The informativeness of LAM test increases depending as the immune deficiency progresses and it becomes a valuable diagnostic tool at the level of CD4 < 200 cells per mcl.

The objective of the study: to study the specific features of pulmonary tuberculosis in diabetes patients based on the autopsy data.

Subjects and methods: Autopsy protocols of pulmonary tuberculosis cases (N=1045) were studied, among them there were some patients with concurrent diabetes (N = 34).

Results: the part of those with concurrent tuberculosis and diabetes made 3.3% among died respiratory tuberculosis patients. Women confidently prevailed among those with concurrent tuberculosis and diabetes (38.2% versus 15.3% in the group of patients without diabetes, p = 0.0003). Respective the form of tuberculosis, the differences were not significant, as well as the frequency of acute progression. Co-morbidity in the patients with diabetes according to comorbidity index was more frequent (diabetes was not included) versus patients without diabetes (p = 0.000225). The main cause of death in both groups was pulmonary heart disease.

The article presents the analysis of a number of publications devoted to psychosomatics of tuberculosis in PubMed/Medline for the period from 1946 to 2016. The majority of publications devoted to this issue were published indicates after the war, and after that period researchers paid less attention to this topic. An opinion is expressed that this descending number of publications indicates of some problems in the field of socially oriented preventive medicine.