The objective: to evaluate the effectiveness of inhaled surfactant therapy in the integrated treatment of severe COVID-19 pneumonia in a multicenter prospective clinical trial of surfactant-BL.

Subjects and methods. 122 patients with severe COVID-19-associated pneumonia treated in two treatment centers were enrolled in the study. All of them received antiviral, anticoagulant and anti-inflammatory therapy. 56 patients also received inhalation therapy with surfactant-BL (OOO Biosurf, St. Petersburg, Russia) at a dose of 1 mg/kg 2-3 times a day. The remaining 66 patients received no surfactant-BL inhalation. When included into the study, all patients were divided into two groups based on severity of the condition at the time of inclusion: 62 people (Group I) needed oxygen inhalation through a face mask with the flow of 6-8 L/min for hypoxemia correction (27 received surfactant therapy and 35 did not); other 60 patients (Group II) required non-invasive respiratory support (constant positive airway pressure, non-invasive mechanical ventilation, high-flow oxygen therapy), of them 29 received surfactant therapy, while 31 patients did not.

Results. In Group I, switching to invasive mechanical ventilation was required for 3/27 (11.1%) patients who received surfactant therapy, and 10/35 (28.6%) who received no surfactant therapy (p = 0.085); lethality made 3/27 (11.1%) and 9/35 (25.7%) (p = 0.131), respectively. In Group II, among those who received surfactant therapy, 5/29 (17.2%) were switched to invasive mechanical ventilation and 18/31 (58.1%) among those who did not receive it (p = 0.001); lethality made 5/29 (17.2%) and 18/31 (58.1%) (p = 0.001), respectively. In the pooled group of 122 patients with severe COVID-19-associated pneumonia, 8 (14.3%) of 56 patients who received surfactant died, and 27 (40.9%) of 66 died among those who did not receive it, (p = 0.001).

Conclusion: Inhalation surfactant therapy can reduce the frequency of switching patients to mechanical ventilation and statistically significantly reduce lethality caused by severe pneumonia associated with SARS-CoV-2. 

The objective of the study: to perform comparative assessment of life quality (LQ) associated with health of children and adolescents suffering from tuberculosis, both HIV negative and HIV positive.

Subjects and methods. In 2017-2019, the cross-sectional epidemiological study was conducted in Pediatric Department of Samarkand Regional TB Dispensary, the study was aimed to assess life quality associated with health in 70 children and adolescents at the age from 5 to 18 years old. 35 of them had tuberculosis and HIV infection (TB/HIV Group), 35 had tuberculosis and negative HIV status. Pediatric Quality of Life Inventory – PedsQL was used to assess the life quality.

Conclusion. The combination of HIV infection and tuberculosis has a more pronounced effect on the physical and mental functioning of patients and worsens the life quality of children and adolescents to a greater extent than tuberculosis. 

The objective of the study: to assess changes of epidemiological indicators for TB/HIV co-infection in the Udmurt Republic (UR) and the Russian Federation (RF) from 2008 to 2017 and make the prognosis for the next 5 years.

Subjects and methods. The main epidemiological indicators for TB/HIV infection were retrospectively analyzed, the data were taken from annual reports of Republican TB Dispensary, Regional Center for AIDS and Infectious Diseases and Federal Research Institute for Health Organization and Informatics by the Russian Ministry of Health.

Results. From 2008 to 2017, the incidence of respiratory tuberculosis both in the Russian Federation and in the Udmurt Republic decreased by 43.0%. While the incidence of HIV infection among the population of the Udmurt Republic increased by 148.5%, in the Russian Federation by 79.7%. From 2011 to 2017, the TB/HIV incidence increased in the UR by 76.6%, in the RF by 48.2%. The mortality of tuberculosis patients died of HIV infection increased by 147.6% in the RF, and by 400% in the UR. Trends in forecasts for investigated indicators of TB/HIV co-infection in the Udmurt Republic and the Russian Federation demonstrate their further growth. 

The objective: to assess the safety and medical cost effectiveness of different LTBI treatment regimens in children and adolescents.

Subjects and methods. 205 children in the age from 6 to 17 years old with latent tuberculosis infection were included in the study: The main (prospective) group included 31 children who were treated with isoniazid and rifapentine (HRpt). The comparison (retrospective) group included 174 pediatric patients: 128 patients received the regimen consisting of isoniazid and pyrazinamide (HZ), 14 patients received isoniazid and rifampicin (HR), and 32 patients received isoniazid and ethambutol (HE).

Results. When using the HRpt regimen, the treatment was well tolerated; adverse events (eosinophilia) were documented in 6.5% of children. The medications were taken once a week and it allowed reducing the frequency of treatment interruptions for non-medical reasons. The overall cost per patient was lower with the HRpt regimen than with the other three LTBI treatment regimens. 

The objective: to assess the methods and time of detection of tuberculosis and HIV infection in children with the co-infection, epidemiological risk factors to develop tuberculosis and effectiveness of preventive measures.

Subjects and methods. 75 children in the age from 0 to 14 years old were enrolled in the study. The TB/HIV Group included 25 children with TB/HIV co-infection. The TB Group included 50 HIV negative children with tuberculosis, they made a comparison group.

Results: out of 25 children with TB/HIV, only 18 (72%) were aware of perinatal exposure to HIV. HIV infection was confirmed in 11/25 (44%) children during the first months of life, in the remaining 14/25 (56%) it was confirmed later, the latest at 13 years old. In 4 children, HIV infection was detected during examination for tuberculosis. In the TB/HIV Group, in 14/25 (56%) children were exposed to tuberculosis in their families as well as 35/50 (70%) in the TB Group. The positive result of a sputum test of the index case was registered in 7/14 (50%) children of the TB/HIV Group and 19/35 (54.2%) children of the TB Group. Of 25 children of the TB/HIV Group, 17 children (68%) were vaccinated with BCG, and in 9 of them the vaccination was not done properly. 

The objective of the study is to assess the scope and timing of tuberculosis vaccination in children with perinatal exposure to HIV, to determine the effectiveness of vaccination by the scarsize and results of Mantoux test in 12 month safter vaccination.

Subjects and methods. Documents on vaccination (Form no.063/u) and case histories (Form no.112/u) of 216 children with perinatal exposure to HIV were analyzed. The control group consisted of 100 children of the same age group born by HIV negative mothers. In this study, epidemiological (descriptive-evaluative, andanalytical) and statistical methods of research were applied.

Results. The proportion of children vaccinated against tuberculosis in the maternity ward in the group with perinatal exposure to HIV made 74/196, and in the control group – 82/99, pχ2 < 0.01. The main reasons for the lack of vaccination were the failure to undergo the three-stage preventive chemotherapy of perinatal HIV infection (35%), neonatal pathology and prematurity (42%). No difference was found in the frequency of the vaccination scar formation and results of Mantoux test (in 12 months after vaccination) in children exposed to HIV and children from the control group (p > 0.05).

65.3% of children exposed to HIV developed the vaccination scar and demonstrated post-vaccination allergies (55.3%) in 12 months after vaccination and there was no difference from children of the control group. 

One of the essential problem sisthelack of continuity of medical follow-up and treatment of tuberculosis patients released from the penitentiary units and transferred tocivilian medical services. Mostly it is due to the fact that patients released from prisons are reluctant to continue medical follow up needed for their disease of tuberculosis or risk of its reactivation.

The objective of the study: to find out the predictors of avoidance behavior in tuberculosis patients released from the penitentiary system of Russia resulting in reluctance to continue medical follow-up.

Subjects and methods. During the case-control study, the information about 75 patients was investigated; those patients were detected in the penitentiary system in the period with 2014 2018 and released by the moment when the study was conducted. Ofthem, 62 referred to TB dispensary to continue follow-up and 13 didn't. The following predictors of the failure to continue medical follow-up were found out: the lackofa regular place of residence or foreign citizen ship; tuberculosis with minimal lesions and the negative result of the sputum test; clinically cured tuberculosis at the moment of release (Group III of dispensary follow-up). The regular place of residence, certain concurrent somatic conditions, and virus hepatites contributed to the willingness of patients to continue follow-up in the civilian medical system including due to tuberculosis. 

The objective of the study: To evaluate the clinical and economic efficacy of chemotherapy in patients with newly diagnosed multiple drug resistant tuberculosis (MDR).

Subjects and methods. The number and structure of MDR tuberculosis patients living on the territory of the Republic of Karelia from 2008 to 2017 were studied. The clinical and economic efficacy of treatment of MDR tuberculosis patients was assessed.

Results. In 2011-2017, decrease in the number of MDR patients in the Republic of Karelia was mainly due to enhanced treatment efficacy of new MDR tuberculosis cases. The introduction of social support methods (food parsels) and express drug sensitivity testing to rifampicin using the Gene Xpert MTB/RIF was associated with higher treatment efficacy – from 37.2% (2013) to 58% (2014), the lower rate of treatment defaults, and significant decrease in mortality, as well as reduction of costs for curing of one MDR tuberculosis patient from1.68 million rubles in 2012 up to 0.77 million rubles in 2014. 

The effectiveness of tuberculosis control is associated with efficacy of treatment of TB patients and above all patients with multiple and extensive drug resistance (MDR/XDR MTB). Patients with TB/HIV co-infection providethe significant impact on the situation.

The objective of the study is to assess outcomes of chemotherapy regimens containing bedaquiline in patients with MDR/XDR TB including those with concurrent HIV infection.

Subjects and methods. The efficacy and safety of the regimes containing bedaquiline were assessed in the intensive phase of chemotherapy in 80 patients with MDR/XDR TB: Group1 consisted of 46 patients with negative HIV status (ICD10 code A15-A19); Group 2 – 34 HIV positive patients at the advanced stage with manifestations of a mycobacterial infection (ICD10 code B20.0).

Results. Treatment outcomes in the groups were as follows: the effective treatment was statistically significantly more frequent in Group 1 versus Group 2 (80.4 and 52.9%, respectively, p = 0.0088). Treatment failure was registered in 3 patients from each group; treatment defaults were statistically significantly more frequent in Group 2 compared to Group 1: in 8/34 versus 2/46 (p = 0.011). 3 patients were transferred out in both Group 1 and Group 2 (3/46 and 3/34, p = 0.69). During treatment, only 1 patient from Group 2 developed an adverse event, most likely associated with the in-take of bedaquiline, a heart rhythm disorder (ventricular arrhythmia) and prolongation of QTcF > 450 ms. 

The article presents the review of 62 publications which demonstrated that 1.1-16.7% of patients with pulmonary sarcoidosis develop plural effusion. Data from thoracoscopic examinations with pleural biopsy in sarcoidosis revealed damage to both the visceral and parietal pleura which manifested through hydrothorax, chylothorax, and hemothorax. Among patients with pleural effusions of various etiology, pleural sarcoidosis is detected in 1.5-4.0% of cases. However, pleural effusion in patients with sarcoidosis can also be caused by concomitant diseases (tuberculosis, mycosis, cardiac, renal, and hepatic failures, pulmonary embolism, pneumonia, and oncological diseases). In this regard, it is advisable to perform morphological verification for the etiological diagnosis of pleural effusion in sarcoidosis patients.