The objective of the study: to identify the frequency of various species of non-tuberculous mycobacteria (NTM) isolated in the patients of TB services in Siberian Region during 2014-2018, to determine the correlation between rates of resistance to different antibacterial drugs.

Subjects and methods. PCR hybridization on strip strips (Hain Lifescience GenoType Mycobacterium CM / AS) was used to genotype 475 NTM isolates of patients from various TB hospitals inSiberia. Drug susceptibility was tested by minimum inhibitory concentrations (MIC) on culture with serial micro-dilutions in a liquid medium using TREK Diagnostic Systems kits. 64 panels were used for slow-growing mycobacteria (SLOWMYCO), 46 - for fast-growing ones(RAPMYCO). Data processing was performed using the APL of 3.5.1 and the data analysis software of Rstudio, version 1.1.442.

Results of the study

1. Tomsk Region differs from the other considered regions ofSiberiadue to higher frequency of M. intracellulare among isolates identified by PCR hybridization. In other regions, M. fortuitum prevails among isolated.

2. Incomparison with the reference data (CLSI M62, 2018), differences in the MIC of some NTM species isolated from patients in Siberia and theFar Eastwere observed, most likely related to the regional characteristics of these isolates.

3. HTM isolates resistant to moxifloxacin are also resistant to linezolid, trimethoprim, and ciprofloxacin.

4. Fast-growing clarithromycin resistant HTM isolates are predominantly sensitive to moxifloxacin, ciprofloxacin, and trimethoprim.

Objective: to study and compare the level of homocysteine with the results of coronary angiography in patients with myocardial infarction (MI) and concurrent chronic obstructive pulmonary disease (COPD).

Subjects and methods. 246 patients with MI were examined. In 137 (55.7%) people, MI developed on the background of COPD, while in 109 (44.3%) patients MI was a single condition. Comparison groups consisted of 55 somatically healthy individuals and 50 patients with COPD. Enzyme immunoassay was used for testing homocysteine levels in plasma samples.

Results. Stenoses of only one coronary artery (CA) with hyperhomocysteinemia were rare in patients in both groups (3.5% in patients with myocardial infarction and 3% in patients with myocardial infarction and concurrent COPD), multivessel diseases of CA statistically significantly prevailed. Lesions of 3 vessels or more were detected statistically significantly more often in patients with hyperhomocysteinemia with myocardial infarction and concurrent COPD. Among patients with myocardial infarction with hyperhomocysteinemia, patients with CA narrowing by 50-75% prevailed, and among patients with myocardial infarction with COPD and hyperhomocysteinemia, patients with CA narrowing by 75-99% and complete occlusion were statistically significantly more frequent. That is, in patients with myocardial infarction, concurrent COPD and hyperhomocysteinemia, more pronounced lesion of CA was observed, which was manifested by multivascular lesions, greater severity of occlusion and higher frequency of complete stenosis of CA.

Organization of day care centers at TB dispensaries has become a promising trend of directly observed treatment of tuberculosis patients.

The objective of the study: to analyze the activities of a day center by TB dispensary for the period of 12 years.

Subjects and methods. Two groups of people were compared: patients with TB/HIV co-infection (n = 232) and HIV negative tuberculosis patients (n = 665).

Results. HV positive patients had tuberculosis of chest lymph nodes 3.8 times more often. Destructive changes in the lungs were found equally often in both groups in about a quarter of patients. In patients with TB/HIV co-infection, viral hepatitis was diagnosed statistically significantly more often than among HIV negative tuberculosis patients (82.3% versus 11.3%; p < 0.01). Tuberculosis treatment efficacy in HIV positive patients was identical in the day center and in-patient units. Treatment of patients in a dayhospital of TB dispensary has allowed increasing the duration of directly observed treatment of tuberculosis.

The objective: using double-site enzyme immunoassay (ELISA) to evaluate the specificity of the antigens of digestive and chemically modified cell walls (CW) of M. tuberculosis.

Subjects and methods. Hyperimmune sera of mice were obtained against modified CW antigens; immunoglobulins of different subclasses were isolated from them. With their help, 152 Bactec cultures with mycobacterial and non-mycobacterial growth from patients with lung diseases were tested by ELISA.

Results. When CW was treated with proteinase K (prK), the protein content decreased by 10 times, and upon hydrolysis of NaOH, by more than 30 times. In immunoblotting, there was a narrowing of the spectrum of recognized antigens by the sera of hyperimmune mice (compared with whole CW), which indicated a decrease in their immunogenicity. Modification of WC of M. tuberculosis disavows 54 kDa antigen, causing a strong IgG1 subclass response.

Diagnostic efficacy in ELISA with Bactec cultures increases with the use of immunoglobulins obtained against antigens treated with proteinase K – 79.14% (Pr.A) and 86.68% (Pr.G), when compared with immunoglobulins against the original drug – 70.69% (Pr.A) and 69.11% (Pr.G). Specificity increases significantly when using IgG1 antibodies after immunization with CW treated with prK (71.92% versus 25.93% in the initial preparation). Thus, new antigens of M. tuberculosis were identified, new antibody preparations for diagnosis in microbiological cultures were created against them.

Purpose: to study tuberculosis situation in children in Kaluga Region in 2014-2018.

Subjects and methods. Tuberculosis incidence in children was analyzed and compared with tuberculosis rates in adults in 2014-2018. The primary infection of children with tuberculous mycobacteria, the structure of Dispensary Groups III and IV were studied. All new tuberculosis cases in children aged 0 to 17 years in 2014-2018 were analyzed.

Results. In 2014-2018, there were mixed trends in tuberculosis incidence in children in Kaluga Region. The rate of tuberculosis incidence growth made 0.9%, which was higher than the growth in the overall incidence rate and indirectly indicated the presence of infection sources among adult population. No statistically significant correlation was found between the overall incidence of tuberculosis and the incidence of tuberculosis with a positive result of sputum test (r = 0.9; p > 0.05), as well as between the incidence of tuberculosis with with a positive result of sputum test and tuberculosis incidence in children (r = -0.48; p > 0.05). This points out at defects in the work of laboratory service as well as a poor detection of children exposed to infectious tuberculosis cases. In Kaluga Region, the average incidence in children registered as contacts of a tuberculosis case made 809.7 ± 306.1 per 100,000 children exposed to tuberculous infection in 2014-2018.

The Moscow Lung Cancer Screening Project was launched inMoscowin 2017 aimed at selective screening for lung malignant neoplasms using low-dose computed tomography (LDCT) in outpatient settings.

The objective of the study: to assess the prevalence of lung cancer predictors, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), detected by selective screening for lung cancer by LDCT inMoscow.

Subjects and methods. A retrospective study included randomly selected LDCT examinations performed as a part of the Moscow Lung Cancer Screening Program. When re-viewing images and protocols, abnormalities such as foci in the lungs, emphysema, coronary calcium were taken into account.

Results. When assessing the prevalence and nature of random findings revealed by screening with LDCT, the following pathologies were found to be the most frequently detected (% of the number of individuals with random findings): coronary artery calcification - 49.3%, thickening of the walls of the bronchi - 34.9%, bronchiectasis - 34.9%, and pulmonary emphysema - 21.6%. In most cases, these findings may have high clinical and/or prognostic significance.

Screening for COPD and coronary heart disease will significantly improve the cost-effectiveness and diagnostic value of ongoing ultra-low-dose lung cancer screening.

The objective of the study: to increase efficacy of minimally invasive interventions in the diagnosis of limited disseminated and focal pulmonary lesions based on 3D-navigation modeling technologies.

Subjects and methods. The informativeness of transbronchial lung biopsy (TBLB) with 3D navigation and traditional TBLB was compared in 50 patients in two groups. Group 1 included 20 patients with stage I and II sarcoidosis in whom a virtual-navigation map was drawn up using 3D modeling to accompany transbronchial lung biopsy. Group 2 consisted of 30 patients with stage I and II sarcoidosis who underwent standard TBLB. The informativeness of TBLB was evaluated by the results of histological tests of biopsy specimens.

The developed software for positioning thoracoports was tested in 30 patients of two groups who were supposed to undergo lung biopsy with a thoracoscopic minimally invasive intervention for disseminated pulmonary lesions of various genesis. The main group (MG) included 10 patients in whom the developed software was used to determine the location points of the thoracoports. The control group (CG) consisted of 20 patients in whom diagnostic surgery was performed as per standard methods.

Results. In the case of disseminated pulmonary lesions, this technology allows increasing the frequency of the presence of diagnostically significant structures in the specimen obtained by TBLB for histological examination (from 56.3 to 90.0%) and reducing the duration of diagnostic thoracoscopic minimally invasive interventions (from 39.75 to 33.50 min.).

The article describes a clinical case of the effective treatment of multiple drug resistant respiratory tuberculosis in the HIV positive patient. The chemotherapy regimen consisted of 5 anti-tuberculosis drugs, including bedaquiline, and 3 antiretroviral (ARV) drugs. The combined use of bedaquiline and ARV therapy did not result in any adverse reactions.

The review analyzes publications devoted to the frequency of renal adverse reactions during tuberculosis chemotherapy. The most significant pathophysiological mechanisms causing development of drug-induced nephrotoxicity are presented. The article describes the specific features of nephrotoxic effect of aminoglycosides, capreomycin, rifampicin, pyrazinamide, fluoroquinolones, and linezolid. The authors concluded that it was necessary to perform clinical and laboratory monitoring of kidney function for the timely detection of nephrotoxic reactions.