The objective of the study: to evaluate the opportunity of using molecular genetic tests to diagnose exudative pleurisy caused by tuberculosis.

Subjects and methods. 98 patients with pleural effusion were examined. 38 patients were diagnosed with pleurisy caused by tuberculosis, 38 patients suffered from non-specific pleurisy, and in 16 patients pleurisy was caused by tumors.

Results. In case of pleural effusion caused by tuberculosis, the classic criteria of exudate (Rivalta test, the ratio of pleural fluid protein and blood serum protein) were not informative. Thus, the result of Rivalta test was positive only in 33.3%, the mean ratio of pleural fluid protein and blood serum protein made only 0.32 ± 0.09. It was found out that the level of lactic dehydrogenase above 1,000 u/l, and the ratio of lactic dehydrogenase level in pleural fluid and its level in blood serum above 3, were rather typical of pleural effusion caused by tuberculosis. And the level of adenosine deaminase in plural fluid above 50 u/l was also more typical of tuberculous pleural effusion. When testing pleural fluid as a diagnostic material, the poor sensitivity was demonstrated by various microbiological tests (the maximum sensitivity did not exceed 42.1%). The most informative and rapid methods aimed at detection and deciding on the treatment tactics included integral morphological and molecular genetic (GeneXpert MTB/Rif) tests of parietal pleural specimens.

The objective of the study: to detect genotypes and frequency of gene alleles of Toll-receptors (Arg753Gln – for TLR2; Phe412Leu – for TLR3; Asp299Gly – for TLR4; Ser249Pro – for TLR6) among respiratory tuberculosis patients in Zabaykalsky Kray.

Subjects and methods. The distribution of genotypes of allele variants of Toll-receptors genes was analyzed in 120 respiratory tuberculosis patients and 30 healthy volunteers with a compatible gender and age distribution. Genomic DNA was isolated from leukocytes of the whole blood. In order to detect polymorphic variants of Toll-receptors genes, real-time PCR was used. The distribution of genotypes as per investigated polymorphic loci was tested for relevance using Hardy – Weinberg equilibrium. The frequency of genotype distribution in the groups was compared by Pearson's chi-square test with Yates's correction for continuity using 4-field contingency tables. The decision of the association between genotypes and the disease was made based on the value of the odds ratio with 95% of confidence intervals. Additionally, to confirm and analyze the correlation force of genotypes and development of tuberculosis based on the principle of mutual contingency, φ test (Kramer test, Chuprov test) was calculated.

Results. Polymorphism of TLR2, TLR3 and TLR6 genes predispose the development of tuberculosis. The following genotypes make the biggest contribution to the formation of predisposition to tuberculosis: Asp/Asp genotype of TLR4 gene (Asp299Gly), Ser/Ser polymorphism of TLR6 gene (Ser249Pro), heterozygous Asp/Gly of TLR4 gene (Asp299Gly) and mutation Pro/Pro polymorphism of TLR6 gene (Ser249Pro). The protective effect against the development of tuberculosis is related to carriage of homozygous Arg/Arg genotype of TLR2 polymorphism, homozygous Phe/Phe genotype of TLR3 gene and heterozygous Ser/Pro polymorphism of TLR6 gene.

The objective of the study: to investigate the parameters of the course of tuberculosis in the suspected source of infection and children who developed tuberculosis after exposure to the infection for different periods of time.

Materials and subjects: totally 136 household nidi of tuberculous infection. Three groups of children were identified with different period of staying in the nidus of infection prior to detection of the disease in a child: Group 1 (33 nidi) – duration of exposure for 6 months and less; Group 2 (67 nidi) – duration of exposure from 6 months to 2 years; Group 3 (36 nidi) – duration of exposure for more than 2 years. The age of children varied from 3 to 14 years old. The sources of infection (136 persons) were patients with bacillary excretion with different results of drug susceptibility tests.

Results. The longer the patients who were the sources of the infection suffered from tuberculosis, the bigger the portion of fibrous cavernous tuberculosis and MDR/XDR TB was: Group 1 – 6.1 and 36.4%; Group 2 – 29.8 and 53.7%; Group 3 – 66.1 and 63.9%. The course of the disease in the children from the compared groups was identical. Regardless of the duration of exposure, the most frequent forms were tuberculosis of chest lymph nodes and focal tuberculosis. Group 1 – 36.4 and 30.3%; Group 2 – 52.2 and 37.3%; Group 3 – 33.3 and 36.1%. All groups had a high level of minor forms of tuberculosis and lesions at the thickening and/or incomplete calcination phase: Group 1 – 45.5 and 51.5%; Group 2 – 82.1 and 76.1%; Group 3 – 69.4 and 63.9%. The majority of cases from Groups 1 and 2 were detected during examination through contact tracing (81.8 and 80.6%). It was observed that the quality of dispensary follow-up for contact tracing was poorer in Group 3, and due to this, confidently fewer children were detected during examination of those exposed – in 58% of cases (p_1-3 < 0,03, р_2-3 < 0,02).

The objective of the study: to study the impact of inhalation with natural pulmonary surfactant on clinical signs and changes in external respiration rate in the patients with partially controlled and uncontrolled persisting asthma, and to assess the chances to reduce dependence of the patients on inhalation glucocorticosteroid (iGCS).

Subjects and methods. 29 patients with partially controlled and uncontrolled persisting asthma were followed up Persisting asthma was diagnosed as per GINA, 2016. The duration of asthma in the patients varied from 1 to 24 years. All patients received iGCS and long-acting bronchodilators or combination drugs containing them. By the enrollment into the study, patients had been receiving this therapy for at least 6 months. According to the study protocol, after examination patients started to receive inhalation with natural pulmonary surfactant and continued the above therapy. Totally, each patient received 21 inhalations (25 mg per inhalation) in accordance with the schedule during 70 days; after the first inhalation with a surfactant, the patients were followed up for 340 days. No adverse events caused by surfactant and other drugs have been registered during this study.

The patients came to see the doctor and to be examined 9 times: on day 1, 8, 15, 29, 41, 70, 160, 250 and 340 of the follow-up. During each visit, the clinical state and external respiration were assessed: FVC, FEV1, FEV1/FVC, and PEF.

Results. The positive impact of surfactant therapy was found out: reduction of the frequency of asthma attacks, cessation or reduction of bronchial spasm frequency under moderate physical load. Two-fold and more reduction of iGCS dose was achieved in 19 out of 29 patients (65.5%; 95%CI 47.4-80.1%), and 3 out of 29 (10.3%; 95% CI 3.6-26.4%) patients fully stopped taking iGCS. The subjective data on the state of patients and objective data on the changes in external respiration function showed a confident improvement of the bronchial functions while taking surfactant therapy (day 1-70 of follow-up), and after it (day 71-340 of follow-up).

The article presents the analysis of multiple drug resistant tuberculosis (MDR TB) prevalence among new and previously treated cases in the Kyrgyz Republic in 2016. The part of MDR TB among new cases makes 21.9%, among relapses – 49.2%, and among previously treated cases – 64%. 52.2% of new cases are susceptible to anti-tuberculosis drugs, as 28.1% of relapses and 17.8% of previously treated patients.

The objective: to study the rates of matrix metalloproteinases/inhibitors system in infiltrate pulmonary tuberculosis during changes occurring in the intensive phase of treatment in order to develop a statistic model aimed to predict reparative changes.

Subjects and methods. The test of ELISA (Bender MedSystems, USA) was used to measure the levels of MMP-1, MMP-8,-9. TIMM and α₂-macroglobulin in blood serum of 35 patients with verified infiltrate pulmonary tuberculosis and various reparative changes during the intensive phase of treatment. The extension of infiltrative changes in the lung tissue was calculated (Vitrea, Nodule Analysis). The software of Statistica 10, ANOVA Repeated Measures and multiple discriminant analysis were used.

Results. Infiltrate pulmonary tuberculosis disrupts the balance in MMP/inhibitors system regardless of the character of reparative changes: MMP-9 goes higher and the reference level of TIMM-1 and α₂-macroglobulin persists. The level of MMP-9 significantly goes down but does not become normal in all variants of the disease involution. Persisting high levels of MMP-8 reduces the chances of cavity healing, while the increasing level of MMP-1 promotes resolution of cavities. To predict the character of reparative changes upon the completion of the intensive phase of treatment of infiltrate pulmonary tuberculosis, the combination of levels of MMP/inhibitors with lung tissue changes during the intensive phase of treatment is the most informative.

The objective of the study: to assess the efficiency of valve bronchial block as a part of the comprehensive treatment of destructive pulmonary tuberculosis with concurrent HIV infection

Subjects and methods. Two groups of patients with concurrent destructive pulmonary tuberculosis and HIV infection were formed, both groups were compatible regarding clinical and X-ray data. The main group included 68 patients who agreed to have valve bronchial block. The comparison group included 57 patients who refused to have valve bronchial block.

Results of the study. When managing HIV patients with destructive pulmonary tuberculosis, valve bronchial block increases the chances of sputum conversion (OR = 4.13; 95% CI 3.50-4.75) and healing of cavities (OR = 3.89; 95% CI 3.30-4.48). Valve bronchial block is indicated to tuberculosis patients with concurrent HIV infection even if the immunity is severely suppressed.

The objective of the study: to characterize nidi of tuberculous infection of category I where children are living and effectiveness of tuberculosis prevention activities for the children living there.

Subjects and methods. The degree of the risk of the epidemic breakout was assessed in the nidi of tuberculous infection where 520 children were living, results of skin tests were studied in 122 children from those nidi exposed to tuberculosis patients with no bacillary excretion, 263 children exposed to infectious patients, 112 children exposed to multiple drug resistant tuberculosis. The group of children (42 persons) from tuberculous infection nidi who developed active tuberculosis was also studied.

Results of the study. It was found out that in two third of the nidi, where children were living, TB patients were excreting tuberculous bacilli, and in more than half of cases the source of infection was drug resistant, of which the majority of nidi (68.4%) had MDR MTB and 12.6% – extensive drug resistance. Each fifth case (21.5%) had concurrent HIV infection. In the nidus with a lethal case, 4.6% of children were contacting a case with TB/HIV co-infection and MDR/XDR. The mean age of the children who developed tuberculosis after exposure to the infection made 5.27± 3.17 years old, and 90.5% of cases were children exposed to a tuberculosis case with bacillary excretion, of 36.8% was exposed to an MDR TB case and 10.5% – to XDR TB. The hyperergic result of the test with TRA was confidently more frequent in all the groups versus Mantoux test (p < 0.05). It indicated of the heavy epidemic burden of the tuberculous infection nidus and proved the need to pay very close attention to this group of patients and their neighbors.

In tuberculous infection nidi, where active tuberculosis was registered among children, the anti-tuberculosis activities were investigated and it was found out that their quality including preventive treatment was poor.

The article describes the main issues related to the provision of quality of laboratory tests aimed to diagnose tuberculosis and monitor the efficiency of its treatment in the Russian Federation. It speculates on the organization of laboratory diagnostics at all stages, in the laboratories of TB services. Some high priority activities for certification of laboratories have been offered.