The objective of the study: to compare and analyze of quantitative and qualitative tuberculosis epidemiological rates during two periods of time, 8 years each, in the Republic of Armenia, in order to assess the effectiveness of implemented TB control measures.

Subjects and methods. The data of the modified statistical reports of TB dispensaries (Form 33 and Form 61b) for 2002-2017 were used. The rates were broken down into two time periods of 8 years each (Period I – 2002-2009, Period II – 2010-2017).

Results. In Period II compared to Period I, the analysis showed the reduction of the following rates: tuberculosis incidence and prevalence by 1.4 times, mortality by 2.6 times, incidence in children by 2.3 times; the portion of those with fibrous cavernous tuberculosis among new pulmonary tuberculosis cases went down by 55.8% and those with bacillary excretion went down by 54.8% among all detected cases.

However, in Period II versus Period I, the portion of those died within the 1st year after detection of the disease increased by 50.8%, while the following rates remained stable: extrapulmonary tuberculosis incidence (6.1 and 7.6 per 100,000 population), early relapses of tuberculosis ( 3.3 and 3.0 per 100,000 population), and incidence among contacts (1,414.8 and 1,220.7 per 100,000 of average annual number of notified contacts).

The objective: to study the prevalence and ranges of mutations in katG, inhA, and ahpC genes coding resistance to isoniazid, and in rpoB gene coding resistance to rifampicin in patients with pulmonary tuberculosis from different age groups.

Subjects and methods. 253 patients were examined; based on their age they were divided into 3 groups (Group 1 – from 18 to 30 years, Group 2 – from 31 to 60 years, group 3 – from 61 to 80 years). Biological microchips with TB-Biochip reagent kit (Russia) were used.

Results. In Groups 1 and 2, compared to Group 3, mutations were recorded more often simultaneously in katG, inhA, ahpC genes and rpoB genes which meant that multiple drug resistance (MDR) prevailed (32.4 and 36.1% against 13.2%, respectively). In general, mutations in katG gene (including MDR + isolated isoniazid resistance) were also confidently more frequent in Groups 1 and 2 (30.9 and 32.7%) versus Group 3 (10.5%). Similar changes were found in the prevalence of the adverse type of ser 315-> Thr mutation of katG gene, which was registered in 23.5% of cases in Group 1, in 21.8% of cases in Group 2, and in 7.9% – in Group 3. In Group 3, mutations in rpoB gene (including MDR) were less frequently recorded and made 26.5% versus 45.5% in Group 1 and 46.9% in Group 2. There were no confident differences in ranges of mutations in rpoB gene between the examined groups of patients. Thus, a significantly lower level of resistance to isoniazid and rifampicin in elderly and senile tuberculosis patients was found compared to young and middle-aged patients, which was registered at the level of genetic mutations.

The objective of the study: to assess the risk to develop active tuberculosis in HIV infected patients with history of substance abuse taking into account their CD4 count.

Subjects and methods. A retrospective case-control study was conducted with enrollment of 171 patients: HIV Group included 85 persons, while TB/HIV Group – 86 persons. For screening for chronic alcohol/narcotic intoxication, the CAGE questionnaire was used, and tobacco dependence was detected according to the criteria of World Health Organization. CD4 counts were obtained by the retrospective analysis of medical records. The impact of the studied risk factors on the development of tuberculosis was estimated by calculating the odds ratio with the calculation of the 95% confidence interval.

Results. Statistically significant association with the development of active tuberculosis was obtained for all factors studied (tobacco smoking: OR = 8.7, 95% CI 3.6-21.6, p = 0.01; chronic alcohol and narcotic intoxication: OR = 3.5, 95% CI 1.8-6.5, p = 0.001 and OR = 2.5, 95% CI 1.1-5.4, p = 0.026, respectively). In the group of patients with CD4 count above 200 cells/µL, there was a confident effect of smoking and clinically significant substance abuse on the risk to develop active tuberculosis, and the power of their effect increased: for tobacco smoking OR = 12; 95% CI 1,5-98,7, p = 0.012; for drug abuse, OR = 4.8, 95% CI 1.7-13.4, p = 0.002. The tendency of chronic alcohol intoxication providing impact on the risk to develop tuberculosis in patients with CD4 count above 200 cells/μl persisted, but there was no statistically significant relationship in calculating the odds ratio OR = 3.1, 95% CI 3.1–9.6, p = 0.082. The obtained data allow considering people living with HIV and possessing history of substance abuse as a group facing the high risk to develop tuberculosis in need close follow-up aimed to prevent tuberculosis.

Non-specific hyperresponsiveness of the respiratory tract mucosa makes one of the important pathophysiological mechanisms for asthma development; it is characterized by the increased active response of the efferent system to stimuli. When this occurs, it damages the alveoli surfactant which ensures the viability of local immunity of lung tissue. Chronic respiratory failure induces changes in the cardiovascular system. The course of inhalations with a native surfactant reduces the dependence on inhalation corticosteroid.

The objective of the study: to assess the effect of the course of inhalations with surfactant on the cardiovascular system in patients with hormone-dependent asthma.

Materials and methods: 15 patients with asthma underwent a 70-day course of inhalation with natural surfactant based on a certain regimen (25 mg per inhalation, 21 inhalations in total) in addition to the basic therapy (inhaled corticosteroids and bronchodilators). On the 1st and 70th days of the surfactant therapy course, oscillometry was performed in order to assess macrohemodynamic parameters.

Results. After the course of treatment, pulse pressure was found to increase by 26% compared to the initial level (p <0.05), the cardiac index increased by 16% (p <0.05) and the linear blood flow rate went up by 20% (p <0.05). At the same time, the pulse wave velocity decreased by 15% (p <0.05), while specific vascular resistance went down by 24% (p <0.01). This suggests that clinical remission during surfactant therapy in asthma patients is accompanied by changes in the functional state of the cardiovascular system.

The objective of the study: to evaluate the safety and efficacy of the combination drug of hydroxymethylquinoxalinedioxide + isoniazid lyophilisate within chemotherapy of patients with bronchial tuberculosis complicating pulmonary tuberculosis.

Subjects and methods. Adverse effects of the combination drug were studied in 26 patients with bronchial and pulmonary tuberculosis who had inhalations with hydroxymethylquinoxalinedioxide + isoniazid lyophilisate.

The treatment efficacy of bronchial tuberculosis was compared in Group I (24 patients who received basic therapy for tuberculosis and inhalation) versus Group II (34 patients who received basic therapy only).

Results. Adverse events occurred in 4/26 patients (15.4%, 95% CI 5.5-34.2%) who had inhalations with a solution of hydroxymethylquinoxalinedioxide + isoniazid lyophilisate due to bronchial tuberculosis, 2/26 (7.7 % 95% CI 1.0-25.3%) had to have the drug discontinued.

Treatment efficacy of bronchial tuberculosis was statistically significantly higher in patients from Group I (based on endoscopy data) compared to Group II (after 1 month of treatment, 20/24 (83.3%) and 14/34 (41.2%), respectively; p = 0.001 Fischer’s Exact test; after 6 months 23/24 (95.8%) and 26/34 (76.5%), respectively; p = 0.041 Fischer’s Exact test).

The objective of the study: to evaluate the results of lung resections in patients with fibrous cavernous tuberculosis.

Subjects and methods. A retrospective analysis was performed in 722 patients who underwent lung resections due to disseminated fibrous cavernous tuberculosis.

Results. The efficacy of lung resections as a part of comprehensive treatment of patients with disseminated fibrous cavernous tuberculosis was high and provided achievement of a complete clinical effect (sputum conversion and removal of all cavities) in 82.2% of 722 patients (30 (4.2%) patients with hospital mortality). 272/720 (37.8%) patients suffered from complications in the postoperative period (2 patients died of bleeding during surgery). Pleural empyema (primary and secondary) complicated the postoperative course in 68/720 (9.44%) patients, of them 44 people had a failure of the bronchus stump prior to the development of empyema. Within the 6-month period after the surgery, 22/720 (3.1%) patients had their tuberculosis exacerbated.

The article describes the experience of development and implementation of e-learning courses in the field of phthisiology for specialists of the system of additional professional education at the relevant department of a medical university. It specifies the organizational stages for training of phthisiologists and other specialties during professional development courses using distance learning technologies and assesses the demand for created electronic educational developments within the Moodle distance learning system. 

The article describes a difficult clinical case, when cystic fibrosis was detected in an adult pregnant patient, who had been followed since her childhood due to frequent bronchitis and consequently had a long-term treatment due to unconfirmed pulmonary tuberculosis.

The article describes a clinical case of infiltrative mycobacteriosis of S_1,2,5 and S₆ of the right lung with destruction and dissemination caused by M. avium in a 30-year-old female patient with non-compromised immunity (normal CD4 count).

This suggests that mycobacteriosis cannot be regarded as sufficient evidence of deep immunodeficiency.

M. avium isolated in this clinical case was resistant to clarithromycin and azithromycin which are recommended for preventive treatment of mycobacteriosis in HIV positive patients.

The review analyzes data on the impact of fluoroquinolones and bedaquiline on the cardiac conduction system. The dependence of the cardiotoxic effect of fluoroquinolones on their influence on the potassium channels of cardiomyocytes is presented. The article demonstrates the importance of concomitant factors (potassium level in the blood, concurrent heart disorders, a genetically determined amount of HERG receptors in the myocardium, concomitant drug therapy) in the development of the cardiac toxicity caused by fluoroquinolones and bedaquiline.