Despite the growing level of tuberculosis cases with extensive drug resistance and failing treatment of such patients, treatment outcomes of extensive drug resistant tuberculosis in the penitentiary system have never been studied. The objective of the study is to investigate treatment outcomes of extensive drug resistant tuberculosis in the penitentiary system of the Russian Federation. It was observed that treatment success of extensive drug resistant tuberculosis was poor (21.4%), which was first of all due to treatment failures (34.5%) and patients transferred out (27.7%). Relatively low mortality (6.0%) was typical of treatment outcomes. In order to enhance treatment effectiveness of extensive drug resistant tuberculosis in the penitentiary system of the Russian Federation, it would be reasonable to expand quality laboratory diagnostics and use of collapse therapy and to introduce the Federal Register of TB cases.

The objective of the study: to assess the efficiency of therapeutic discrete automated plasmapheresis in the management of hepatotoxic reactions, developed in tuberculosis patients with multiple and extensive drug resistance, including those with concurrent viral hepatitis.

Subjects and methods. 136 patients suffering from respiratory tuberculosis with multiple and extensive drug resistance were enrolled in the study. 56 of them had viral hepatitis: 3 (5.4%) patients suffered from hepatitis B, 49 (87.5%) from hepatitis С and 4 (7.1%) had both hepatitis В + С. After the initiation of chemotherapy, out of 56 patients with viral hepatitis, 36 (64.3%) developed hepatotoxic reactions which was statistically significantly more frequent versus 23 (28.8%) patients out of 80 ones without viral hepatitis, p < 0.01. Patients with hepatotoxic reactions were randomly divided into two groups (29 and 30 patients), and plasmapheresis was used to manage drug-induced liver disorders in one of them.

Results. This method was used in 29 patients and it allowed managing hepatotoxic reactions without cancellation of chemotherapy. In the group where no plasmapheresis was used, chemotherapy was temporarily discontinued in 12 (40.0%) out of 30 patients from 6 to 20 days.

The objective of the study: to analyze approaches to chemotherapy in children of the tender age over a 30-year period.

Subjects and methods. 390 children of the tender age (0-3 years old) were included in the study, they all were treated in the hospital due to tuberculosis from 1985 to 2014. Children were divided into 6 groups based on the time period (six five-year periods).

Results of the study. During different periods of time, changes in the regimens of anti-tuberculosis drugs for children in the age from 0 to 3 years old have been related to the valid regulations, making provisions for chemotherapy principles, and parameters of the drug supply to TB units. The increase in the number of drugs in treatment regimens for children of the tender age has been related to the growing frequency of drug resistant tuberculosis and it has promoted the development of a bigger number adverse reactions caused by the drugs.

The article describes one of the topical issues related to the study of social aspects of children tuberculosis that is the justification of substantial criteria of for defining social status of different families. The objective of the study is to compare social features of the families with children and adolescents ill with respiratory tuberculosis based on the differential approach to the assessment of social adaptation of the family.

Social characteristics of families of 239 children and adolescents have been studied, all the children and adolescents were examined and treated in Central Tuberculosis Research Institute in 2016-2017. This differential approach to social status assessment has allowed identifying two groups: functional families (49.4%) and families facing a high social risk (50.6% of cases). When comparing and analyzing two types of families, who had children and adolescents suffering from tuberculosis, it has been found out that those families differed from the social and economic point of view. The features common for certain types of families both with children and adolescents were the parents' level of education and particular employment of fathers. The remaining criteria (family structure, mothers' employment, accommodation, income size) were confidently different in the families of children and adolescents. The article demonstrates the need for a comprehensive analysis of the family in order to define its social status.

Peripheral lymph node tuberculosis is one of the most frequent extrapulmonary localizations.

The objective of the study: to define the place of peripheral lymph node tuberculosis in the structure of extrapulmonary tuberculosis incidence in the neighboring regions with the unfavorable epidemic situation (Siberian and Far Eastern Federal Districts (SFD and FEFD) and the Republic of Tajikistan); to study the structure of this form of tuberculosis.

Subjects and methods. The statistic reports from TB units of SFD, FEFD and the Republic of Tajikistan for 2016-2017 were reviewed. The structure of peripheral lymph node tuberculosis was assessed through a retrospective analysis of medical records of peripheral lymph node tuberculosis patients, notified in the Republic of Tajikistan and Regional Novosibirsk TB Dispensary in 2016 and 2017 in total.

Results of the study. In 2016-2017 in SFD and FEFD, isolated forms of extrapulmonary tuberculosis were diagnosed in 1,227 patients, of them, 166 (13.5%) patients suffered from peripheral lymph node tuberculosis. In SFD and FEFD of the Russian Federation, our study detected no statistically significant changes in the proportion of peripheral lymph node tuberculosis in the structure of extrapulmonary tuberculosis incidence in the patients with positive and negative HIV status.

In the Republic of Tajikistan, the frequency of peripheral lymph nodes tuberculosis among extrapulmonary tuberculosis cases was statistically significantly higher versus SFD and FEFD in the Russian Federation (504/1 386 and 166/1 227 respectively, p < 0.01). In the Republic of Tajikistan, SFD and FEFD of the Russian Federation, tuberculosis of neck lymph nodes was the most frequent in the structure of peripheral lymph node tuberculosis followed by axillary and inguinal localizations. The difference in the frequency of each localization between the compared regions was not statistically significant.

The objective of the study: to assess the lipid profile of membranes of peripheral blood mononuclear cells in the pulmonary tuberculosis patients before and after the intensive phase of chemotherapy, including the effect of glycyrrhizic acid.

Subjects and methods. 384 pulmonary tuberculosis patients of both genders in the age from 25 to 60 years old were enrolled into the study: 308 patients were treated by regimen I during the intensive phase of chemotherapy, and 76 had the intensive phase with regimen I and glycyrrhizic acid. The control group included 36 healthy volunteers at the age from 24 to 58 years old.

The lipid profile of mononuclear cell membranes was evaluated in peripheral blood of the patients. Phospholipids were fractioned into classes using continuous-flow thin-layer chromatography. The following fractions were studied: total lysophospholipids, sphingomyelin, phosphatidylinositol, phosphatidylcholine, phosphatidylserine, phosphatidylethanolamine.

Results. Prior to the start of chemotherapy, the changes in the ratio of main classes of phospholipids of mononuclear cell membranes in peripheral blood was documented in pulmonary tuberculosis patients versus those healthy. Chemotherapy resulted in the accumulation of membrane disruptive lysophospholipids with simultaneous reduction of phosphatidylcholine level. Treating patients with glycyrrhizic acid allowed diminishing (p < 0.05) the negative effect of chemotherapy on lipid membranes of mononuclear cells and improving the ratio of main fractions of membrane phospholipids (p < 0.05). When glycyrrhizic acid was added to the chemotherapy regimen, the sputum conversion rate by the 2nd month of the intensive phase increased from 61 to 73% (p < 0.05).

The growing number of people with advanced stages of HIV infection determines the specific course of newly diagnosed tuberculosis cases and relapses and accordingly, it requires a special approach to follow-up of such patients respective their dispensary group.

The objective of the study: to define the specific features of tuberculosis relapses in HIV patients.

Subjects and methods. 205 patients from Sverdlovsk Region were enrolled into a retrospective study. In all the patients, a relapse of respiratory tuberculosis was diagnosed (there were some single cases of combinations with other localizations of tuberculosis). Of them, 104 patients were diagnosed with HIV infection (Group I) and 101 patients were HIV negative (Group II). The groups were compatible respective the age and gender of the patients.

Results. HIV positive patients develop tuberculosis relapses earlier versus the HIV negative ones (in 31.5 ± 3.0 months and 55.1 ± 5.7 months respectively, p < 0.001).

When tuberculosis relapse was diagnosed, 49.0% (95% CI 47.1-77.7) of patients with HIV infection had their CD4 count < 200 cells/mcl, and most often such a low count was observed among the patients who had CD4 count of 200-349 cells/mcl at the moment when tuberculosis was cured. By the time when tuberculosis relapse was diagnosed among HIV positive patients, the level of antiretroviral therapy failure increased and made 31.7%, and there was a tendency (nearly statistically significant) towards the increase of the portion of ARVT courses lasting for less than 6 months.

In case of tuberculosis relapse, HIV positive patients developed disseminated and generalized tuberculosis more often versus HIV negative ones. The most frequent defects of dispensary follow up (dispensary follow-up group III) over the patients cured of tuberculosis, were the lower frequency of X-ray and bacteriological examinations and underestimation of clinical manifestations. It results in the postponed diagnostics of relapse long after its manifestations, less frequent diagnostics of relapses during planned examination, especially in HIV patients.

Probably, it is worth reconsidering the tactics of dispensary follow-up over HIV positive patients with TB history and following them up longer as active dispensary groups. The following could be the additional criteria for dispensary follow-up extension: CD4 count of 200 cells/mcl and lower and laboratory confirmed failing ARVT.

The objective of the study: to detect specific clinical signs of tuberculous exudative pleurisy and define the tactics for doctors from general medical services for its detection in cancer patients.

Subjects and methods. The case histories of 3 patients suffering from tuberculous pleurisy at the age of 57, 58 and 59 years were analyzed; all the patients were examined and treated in Voronezh Regional TB Dispensary in 2000-2012; and earlier (8 months, 2 and 10 years before that respectively) they received combination therapy due to breast cancer.

Results: The specific clinical manifestations of tuberculous pleurisy in the patients who had cancer were the absence of acute courses of the disease and no intense clinical manifestations as well as suppressed sensitivity to tuberculin. Development of pleurisy when there are no changes in the lungs and no mycobacteria are detected in sputum and pleural effusions results in difficulties in diagnostics aimed to define the etiology of pleural effusions. It was found out that the early use of puncture biopsy of parietal pleura allowed diagnosing tuberculosis within a short period of time (5-8 days).

The article presents the review of latest studies devoted to assessment of the eosinophilic inflammation in chronic obstructive pulmonary disease (COPD) and opportunities for differential therapy of stable COPD and COPD therapy during exacerbation. Currently, there is no final definition what threshold blood level of eosinophils can be used for decision making in clinical practice. The only thing found out was that the high blood level of eosinophils could be a predictor of the risk of frequent exacerbations and the effectiveness of treatment with glucocorticosteroids.

The article presents the review of the Russian and international studies devoted to the use of hepatoprotectors during anti-tuberculosis treatment, including methionine derivatives and agents containing succinic acid.