In Russia, the downward trends in tuberculosis transmission are leveled by the growing HIV infection spread. In order to improve the situation, it is necessary to know the strengths and weaknesses of tuberculosis control activities among people living with HIV. The objective of the study: the comprehensive assessment of the effectiveness of activities aimed to control the spread of HIV/TB co-infection in North-West Russia. Subjects and methods. The authors used epidemiological and clinical-diagnostic methods, ranking, correlation analysis, and expert assessment. The epidemiological and clinical analyses were based on the reporting forms of Rosstat on tuberculosis and HIV, data from analytical reports on monitoring visits and data from the questionnaires developed by the authors, for 2007-2017. The correlation between the studied parameters was assessed using Spearman's rank correlation. Results. In North-West Russia, the main tuberculosis control activities among people living with HIV, including logistical support and provision of personnel (Spearman's rank ratio (-0.32177), p < 0.05), a set of preventive measures aimed at the coverage with antiretroviral therapy, preventive treatment and screening for tuberculosis in HIV-positive people (Spearman's rank ratio (-0.03226), p > 0.05) did not provide any statistically significant impact on the spread of HIV/TB co-infection, which indicated of their imperfection and inequality. Conclusion. In the North-West of Russia, the system aimed to control the spread of HIV/TB co-infection requires some optimization.

The objective of the study: to analyze the efficacy of extrapleural plombage with silicone plug (EPSP) in those suffering from destructive pulmonary tuberculosis with multiple/extensive drug resistance (M/XDR) and to assess EPSP impact on pulmonary functions and blood gases. Subjects and methods. 34 patients with chronic persistent destructive pulmonary tuberculosis who underwent EPSP were enrolled in the study. 23 were men and 11 were women at the age from 18 to 54 years old (the median age made 36.29± 10.2 years). MDR was diagnosed in 31/34 (91.2%) patients, and of them, 22/31 (70.0%) had XDR. A high profile life long breast implants with texturized coating causing no rejection by the host were used for extrapleural plombage. Results. 18 patients who underwent EPSP as a single surgery had their cavities healed in the operated lung in 100% of cases (95% CI 96.3-100%). There were no lethal outcomes. 1/18 (5.6%) patient suffered from a late complication (empyema) related to EPSP. Postponed outcomes of tuberculosis treatment (effective course of treatment after EPSP) were favorable in 13/16 (81.3%; 95% CI 57.0-93.4%) patients. In 11 patients with disseminated destructive tuberculosis who had EPSP combined with resection or collapse surgery, 12/12 (100%; 95% CI 75.8-100%) had their cavities healed in the operated lung; 2/12 patients needed additional bronchial valve block. Surgeries for EPSP resulted in no lethal outcomes or complications. In 5 patients with destructive tuberculosis relapse in the only lung, EPSP was used to stop the progress of the disease due to poor efficacy of chemotherapy. The impact on cavities healing in the operated lung was achieved in 4/5 (80.0%; 95% CI (37.6-96.3%) patients. The complication after EPSP was observed in у 1/5 (20.0%) patient and resulted in the lethal outcome. 3/5 patients had favorable postponed outcomes. After EPSP, ventilation and gas exchange functions deteriorated in 32% of patients, while in 28% of patients, they improved. The intensity of change was moderate or significant. The most dynamic and informative indicators were the vital capacity of the lungs and the partial tension of oxygen in oxygenated blood (PaO₂ ).

The objective: to study the efficacy of etiological verification of tuberculosis in case of systemic inflammation syndrome in HIV patients. Subjects and methods. 116 HIV patients were examined; all of them were admitted to hospital due to systemic inflammatory syndrome (SIS). In order to diagnose tuberculosis, clinical, bacteriological, and instrumental examinations were performed. Specimens of venous blood were used for the detection of tuberculous mycobacteria by RT-PCR and culture. Results. More than half (64.6%) of cases of systemic inflammatory syndrome in the examined HIV patients was due to tuberculosis onset. The degree of immunity suppression (considering CD4 count) in SIS patients with tuberculosis onset and various HIV-associated pathologies was not statistically significantly different. The frequency of MTB DNA detection by RT-PCR in venous blood in case of verified tuberculous sepsis (non-academic term) in TB/HIV patients made 29.3%, and taking into account positive results of blood culture in 5 patients with no MTB DNA found in the blood, the efficiency of diagnosis of tuberculosis in blood specimens reached 33.3%, while efficiency of blood cultures for MTB made 36.0%, with 100% specificity. Repeated PCR tests and blood cultures performed in some patients allowed increasing the total efficiency of blood tests.

The objective of the study: to analyze the frequency and patterns of drug resistance of Mycobacterium tuberculosis (MTB) according to the results of microbiological tests of surgical specimens of the patients who underwent surgery due to tuberculosis, and to compare them with the results of sputum tests done in the pre-operative period. Subjects and methods. The data of surgical specimens from 170 patients operated due to tuberculosis were analyzed. The surgical specimens were sent for histological and microbiological tests (detection of MTB DNA and rifampicin resistance by GeneXpert, culture on solid media with drug sensitivity testing). Results. The molecular genetic testing of surgical specimens by GeneXpert was highly effective for detection of rifampicin resistance; in 97.8% of cases, there was a match with the results of sputum culture with consecutive DST performed before the surgery. Molecular genetic tests of surgical specimens allowed detecting MTB DNA in 66.1% of patients in whom no MTB or MTB DNA was detected in sputum and bronchial washings prior to the surgery, and of them in 28.2% of cases, rifampicin resistance was detected, which was unknown before the surgery. These data allowed prescribing adequate chemotherapy immediately after surgery.

The objective of the study: to compare the clinical and X-ray signs of tuberculosis in HIV positive and HIV negative children, to identify factors that are more common in HIV infected children in the region with a high prevalence of both infections. Subjects and methods. 264 children with tuberculosis, and 41 children with HIV infection and tuberculosis undergoing inpatient treatment were enrolled in the study, which was the retrospective study of medical records. The patients underwent standard clinical and X-ray examinations, and microbiological tests. Results. Disseminated forms of tuberculosis (39.1%), tuberculous meningoencephalitis (4.9%) were more frequent in the HIV positive children, while in HIV negative children, it made 1.9 and 0.4% respectively. Among HIV positive children, 34% had several sites of tuberculosis, and 19.5% suffered from generalized forms. In HIV positive children, tuberculosis was more often detected in the infiltration phase, it was accompanied by severe intoxication symptoms, while when taking anti-tuberculosis therapy in combination with ART, they had more rapid positive changes.

87 isolates of M. tuberculosis isolated from tuberculosis patients in the Novouralsk municipality in 2013-2016 were studied. It was found out that a high percentage of isolates had multiple drug resistance: 66 and 85.3% among newly diagnosed and previously treated patients, respectively. Genotyping allowed revealing the dominance of isolates of the Beijing family, both among newly diagnosed (75.5%) and previously treated patients (85.3%), with 52.8 and 67.6% of isolates, respectively, belonging to the Beijing B0/W148 variant. MIRU-VNTR-typing detected nine isolates of the Beijing B0/W148 family with an atypical number of repeats in the QUB26 locus (two). A high rate of tuberculosis with concurrent HIV (39.1%) was noted, while in groups of tuberculosis patients with various HIV statuses, no difference was detected in the ratio of multiple drug resistant pathogens and belonging to the Beijing genotype (BeijingB0/W148). The article demonstrates the possibility of using genotyping technologies to confirm/deny the epidemiological relationship between patients and search for previously unknown mechanisms of tuberculosis infection transmission.

The review analyzed the studies and meta-analyses devoted the treatment of multiple drug resistant tuberculosis in combination with antiretroviral therapy as a possible risk factor of adverse events and the worst outcomes of therapy. In total, the analysis included 18 sources from the Russian and English databases. Most of the studies did not reveal a confident relation between the simultaneous use of antiretroviral and anti-tuberculosis therapy with second line drugs and increased frequency of adverse events. At the same time, in the largest studies, as well as studies devoted to certain adverse events, the authors managed to prove the existence of such a connection. Data on the structure of adverse events also significantly differed in the results obtained by various authors. Most trials were conducted in African countries with a high prevalence of HIV infection.

The article describes the course and nature of the disease, as well as causes of death of Maxim Gorky, the famous Russian writer. The data from his medical history and autopsy are given. Discussion of the nature of the disease is based on the letters of the writer, the memoirs of contemporaries, and conclusions of doctors who observed Maxim Gorky till the last days of his life.