The objective: to assess treatment outcomes in tuberculosis patients with extensive drug resistance (XDR TB) treated by new anti-tuberculosis drugs in the civilian community of Arkhangelsk Region.
The analysis included all cases of XDR TB registered in the civilian community of Arkhangelsk Region from November 2006 to December 2013; treatment outcomes were assessed in 21 patients who were treated by regimens containing new anti-tuberculosis drugs (bedaquiline, delamanid, linezolid, clofazimine, imipenem with amoxiclav). 16 patients were treated by regimens containing 4 new anti-tuberculosis drugs. 2 patients were treated by regimen IV containing two drugs – bedaquiline, linezolid and bedaquiline, clofazimine; and 3 patients with regimens containing bedaquiline only.
From November 2006 to December 2017, 175 XDR TB patients were registered in Arkhangelsk Region. The effective chemotherapy using new drugs made 57%, and mortality made 4.7%. In-take of new anti-tuberculosis drugs was accompanied side effects of minor and moderate degree.
New anti-tuberculosis drugs are to be studied further in order to work out the most effective regimens for treatment of XDR TB patients.

The article presents the comparative analysis of the microbiological diagnostics algorithm, developed and used in Central Tuberculosis Research Institute and the algorithm of laboratory diagnostics and monitoring of treatment of pulmonary tuberculosis and drug resistant tuberculosis based on modern rapid molecular techniques, developed by the experts of European Laboratory Initiatives jointly with Secretariat of Regional Office for Europe of World Health Organisation (WHO) for countries of the WHO European Region.
It has been proved that despite some differences in these algorithms, the main principles on which they are based and approaches to diagnostics are similar. In both cases, molecular diagnostic tests and culture on liquid media are preferable for primary diagnostics in all suspected cases of tuberculosis. It provides rapid and accurate diagnostics and early detection of drug resistant tuberculosis, which finally enhances treatment efficiency and reduces transmission of tuberculosis

The objective of the study: to study the outcomes of surgical treatment of tuberculosis in HIV patients.
Subjects and methods. Surgery outcomes in 345 HIV patients with respiratory tuberculosis were analyzed; totally, 355 surgeries were performed on them. Minor surgeries (189/355; 53.2%) done due to emergency reasons were performed in 181 patients, mostly in those with severe immune suppression. 164 patients had planned surgeries (166/355; 46.8%) mostly due to tuberculosis and its complications.
Results. In 345 operated patients, post-operative complications related to surgery made 2.0%, complications not related directly to surgery made 1.2%, and lethal outcomes made 0.9%. Surgery resections were successful even in the patients receiving no antiretroviral therapy with severe immune suppression. All 3 lethal outcomes occurred in the patients with CD4+ count below 200 cell/mcl and they made 2.3% among such patients.

Human immunodeficiency virus (HIV) and tuberculosis with multiple drug resistance (MDR TB) are becoming the major problem for national tuberculosis control programs. Conclusions made by various studies investigating the association of HIV infection and multiple drug resistance of tuberculous mycobacteria in tuberculosis patients are not always unambiguous and evident.
The objective: to summarize data on the correlation between HIV infection and MDR TB among new cases through the systematic review of published results of studies.
Research methods. The quality, accuracy and authenticity of the initial data were assessed. Approximating functions of changes in HIV-TB-MDR and TB-MDR were built for new cases basing on the data of 11 selected studies. The general effect of HIV infection impact factor on TB-MDR was assessed for the studies included into the analysis.
Results. Data analysis for the consolidated group of new cases showed that the assessment of the risk of MDR detection was higher in those with TB/HIV co-infection (OR 2.76; 95% CI 2.35-3.24) versus HIV negative tuberculosis patients, which provided the evidence of the existing positive epidemiological correlation between the positive HIV status and MDR TB.

The objective of the study: to investigate the changes in the course of tuberculosis in the patients with different psychological status.
Subjects and methods. The changes in the course of tuberculosis were studied in 249 new pulmonary tuberculosis patients who had in-patient treatment in CTRI. The groups within the study were formed basing on the results of psychological status assessment: Group 1 included patients with favorable psychological status (171; 68.7% of patients) and Group 2 included patients with different psychological disorders (78; 31.3% of patients) (p < 0.001). Among patients from Group 2 women (66; 84.6%) significantly prevailed over men (12; 15.4%) (< 0.001).
Results. It has been found out that groups with different psychological status did not confidently differ in their clinical and X-ray signs before the treatment start. Whereby, in patients from Group 2 versus patients from Group 1, the abnormalities in the results of laboratory tests were registered confidently more often (87.2 versus 75.4% cases) (p < 0.05), as well as multiple drug resistance (58 versus 41.4% of cases) (p < 0.05). The frequency of adverse events caused by anti-tuberculosis drugs was higher in Group 2 versus Group 1 (25; 32.1% and 28; 16.4% of cases) (p < 0.05). After management of adverse events, the number of patients with poor tolerance was still confidently higher in Group 2 (14; 17.9% of cases), compared to Group 1 (11; 6.4%) (p < 0.05). It was found out that the efficiency of in-patient treatment did not confidently differ in the patients with different psychological status.

224 tuberculosis cases with concurrent HIV infection were examined. Nutritional status was defined based on the body mass index (BMI), levels of transthyretin, albumin and total protein in the blood serum. It was found out that tuberculosis patients with concurrent HIV infection had a severe nutritional deficiency, which was confirmed by the confident reduction of BMI, transthyretin and albumin levels in blood serum. Whereby, the intensity of protein and energy deficiency in tuberculosis patients with concurrent HIV infection was associated on the one hand with the specific course of tuberculosis and on the other hand with the course of HIV infection. The most significant reduction of nutritional status was observed in the patients with fibrous cavernous tuberculosis, multiple localizations of tuberculosis, dissemination of tuberculous lesions in more than two lobes, lung tissue destruction and bacillary excretion and extensive drug resistance. It was found out that the most severe protein-energy deficiency was detected if the CD4 count was below 0.35 x 109/L and viral load exceeded 500,000 copies/ml. The dynamic follow-up showed that the effective treatment provided a significant improvement of protein-energy deficiency. Despite it, even in 6 months of treatment, there was no complete recovery of nutritional status. Should the treatment fail, protein-energy deficiency deteriorated, which was proved by the reduction of BMI, transthyretin, albumin and total protein levels.

The objective of the study: to characterize patients who developed tuberculosis in Chisinau in 2015.
Subjects and methods. The retrospective descriptive study was conducted aimed to analyze data of 668 tuberculosis patients diagnosed in Chisinau in 2015.
Results. The social characteristics demonstrated that in 2015 in Chisinau a tuberculosis patient was most often a young man belonging to socially marginalized population with no medical insurance. The analysis of tuberculosis detection methods showed that only 22.3% of patients were detected through regular screening in risk groups. Among tuberculosis patients, new cases made 60.3%, relapses – 21.7%, those after treatment interruption – 10.3%, and those after treatment failure – 5.7%. In 14 (2.0%) patients, tuberculosis was detected post-mortem.
Out of 674 patients with life time diagnosed tuberculosis, pulmonary tuberculosis prevailed – 638 (94.7%), of them, 193 (30.3%) had a positive result of sputum microscopy for acid-fast bacilli, and 187 (29.3%) patients had a positive result of sputum culture by Lowenstein-Jensen or Bactec 960, and the result of Xpert MTB/Rif was positive in 259 (40.6%) patients. Multiple drug resistance was diagnosed in 118/187 (63.1%) patients.
In 12 months, treatment outcomes were assessed in 647 patients: treatment was successful in 393 (60.7%) patients; 80 (12.4%) patients died, and 174 (26.9%) were still on treatment.

The objective of the study: to compare characteristics and the courses of kidney stone disease and kidney stone disease with concurrent nephrotuberculosis.
Subjects and Methods. 100 patients [55/100 ‒ women, 45/100 ‒ men (1.2/1)] with renal tuberculosis and kidney stone disease and 100 patients [67/100 ‒women, 33/100 ‒ men (2/1)] with kidney stone disease only were enrolled into the study.
Results. Сoncrements in the urinary system formed in 82% of patients after renal tuberculosis was diagnosed in them during 3-25 years, mainly against the continuous in-take of anti-tuberculosis drugs. In 18% of patients, cavernous renal tuberculosis was diagnosed only after the kidney resection due to coral calculus. 82% of patients with nephrotuberculosis developed nephrolithiasis at the age of 56-65, regardless of the time for how long they suffered from tuberculosis.
Statistically significant differences were found between the group of patients with kidney stone disease and nephrotuberculosis and the group of patients with kidney stone disease only in the following parameters: age above 60 years old, nephrolithiasis of one kidney, frequency of nephrectomies, formation of coral calculus, increase of fibrinogen level in blood serum, chronic kidney disease. All the above characteristics provide the evidence of a more severe course of kidney stone disease with concurrent nephrotuberculosis.

The article presents a clinical case of a complex differential diagnostics of disseminated pulmonary lesions with a concurrent condition.