The objective of the study: to compare changes in the blood level of C-reactive protein (CRP) during the administration of different formulations of tocilizumab (TCZ) in COVID-19 patients admitted to hospital in real clinical practice.

Subjects and methods. The cohort of 14 patients was included in the retrospective study; they all had a severe course of COVID-19 and were admitted to hospital: 7 patients received had intravenous infusions of tocilizumab and 7 had subcutaneous injections. The indication for tocilizumab prescription was the elevation of CRP blood level by 5 times and more or 2-fold and more elevation of ferritin above the norm. In the group receiving subcutaneous injections with tocilizumab, the proportion of elderly people was bigger and CRP levels were higher versus the group receiving intravenous infusions. The efficacy was assessed by changes in CRP levels on the 1st, 3rd and 7th day after the administration. The study included only the patients discharged from hospital with improvement of their state.

Results. It has been demonstrated that when the patients develop cytokine storm, the use of both formulations of tocilizumab (for intravenous and subcutaneous administration) is effective. When tocilizumab was administered intravenously, the changes in CRP levels (especially at high rates - more than 150 mg/l) were more intense versus subcutaneous administration. The use of these formulations of tocilizumab had the same long-term efficacy: the level of CRP by the 7th day after administration decreased comparably in both groups, the time of complete normalization of this rate did not differ significantly. The different dynamics of CRP level decrease in each specific case could be associated both with the formulation of the drug and other factors that could not be established.

The objective of the study: to compare two approaches to mass screening for tuberculosis infection in children and adolescents in Moscow.

Subjects and methods. Two periods have been assessed. Period 1 (2014), when a pilot screening project was implemented in two stages: Stage 1 -all children and adolescents had Mantoux test with 2 TU PPD-L (1,429,395 people were tested), Stage 2 - a skin test with TRA (tuberculosis recombinant allergen - ESAT protein-6/CFP-10) was used in those with increasing induration as a response to Mantoux test (219,888 people were tested). Period 2 (2019): children from 0 to 7 years old (711,869 children were tested) were screened by the same two-stage scheme, and those 8-17 years old (904,757 people were tested) had the test with TRA only.

Results. It has been demonstrated that the test with TRA can be used as a screening tool and effectively identify patients with a high risk of tuberculosis development. At the same time, the rate of detection of tuberculosis patients, persons with post-tuberculosis changes and latent infection is tens times higher among persons with positive reactions to TRA test versus Mantoux test. The preventive therapy received by those positively responding to TRA test resulted in almost no disease in them. Over the past 7 years, the number of people newly diagnosed with tuberculosis, latent tuberculosis infection (LTBI) and post-tuberculosis changes has decreased. Preventive therapy in those with a positive result of TRA test helps to stop the progression of tuberculosis infection and reduce the pool of LTBI among children and adolescents.

TRA test versus Mantoux test, allows more effective selection patients with a high risk of developing tuberculosis, thus it is possible to carry out additional examination only of this target group and save resources.

The objective of the study: to study changes in MDR tuberculosis incidence and prevalence among patients with HIV infection in the North-Western Federal District and its regions in 2007-2018.

Subjects and methods. The data from FSN Form No. 61 on Information on HIV Infected Patients Contingents for 2007-2018, materials of Federal Research Institute for Health Organization and Informatics by the Russian Ministry of Health, information from tables additionally developed by the authors were used. Epidemiological and statistical methods were applied; the differences between the variables were established by the Fisher coefficient based on the Statistica software.

Results. The increase in the incidence of TB/HIV co-infection is the highest in regions with the low cumulation of HIV infection: Arkhangelsk, Pskov Regions and the Komi Republic. In 2018, MDR TB among HIV patients with HIV was the most prevalent in Leningrad Region (37.7%), the Komi Republic (32.2%) and Novgorod Region (29.3%), while in the Republic of Karelia, there was not a single case of MDR TB detected among HIV patients, in Pskov Region - 2.4% of cases. The efficacy of tuberculosis chemotherapy by regimens IV-V among the MDR TB/HIV cohort was statistically significantly lower than that of the entire MDR TB cohort: 41.4% versus 61.5% (p < 0.04).

The objective: to determine predictors of the development of latent tuberculosis infection (LTBI) and tuberculosis in children and adolescents.

Subjects and methods. A study was carried out, including testing induced IFN-y and assessment of genotypes of the polymorphic variant of IFNG gene (T-1488C) among 310 children under the age of 18. They included children ill with tuberculosis, infected with tuberculous mycobacteria (MTB) and not infected with MTB.

Results. It was found that the main predictors of LTBI development were biomedical factors, for LTBI progression - social factors. The marker of the high risk to develop tuberculosis (OR = 4.667, 95% CI 1.24-17.62; p = 0.008) for both primary (47.5%) and secondary (65.0%) genesis of the disease and its unfavorable course is the heterozygous IFNG genotype (T-1488C). The probable risk of tuberculosis progression in this variant is found to be at the level of 74.07% (95% CI 63.54-82.43%).

At the early stage, LTBI markers were specific proteins: ESAT6, Rv2660c. The ESAT6-CFP10 hybrid protein was identified as a marker of active tuberculosis infection.

The objective: to study treatment efficacy in new pulmonary tuberculosis patients depending on the genotypes of M. tuberculosis in the Republic of Sakha (Yakutia).

Subjects and methods. The authors studied the clinical course and outcomes of 312 bacteriologically confirmed new pulmonary tuberculosis cases among patients admitted to hospital in 2010-2014. Molecular genetic tests included deletion analysis of RD105 and RD207 regions of DNA of the pathogen followed by MIRU-VNTR genotyping at 24 loci.

Results. In the Republic of Sakha (Yakutia), the Bejing and S genotypes are of epidemic importance, these genotypes prevail among drug resistance mycobacteria. Tuberculosis caused by the Bejing genotype had multiple (MDR) and extensive drug resistance (XDR) in 30.6% of cases, its subtype CC2/W148 - in 85.3%. The S genotype was accompanied by MDR/XDR in 69.7% of cases, subtype S256 - in 78.9%. The treatment of patients was highly efficient according to the criteria of sputum conversion (92%) and cavities healing (89.4%). The lowest rates were observed in case of tuberculosis caused by the Bejing and S genotypes due to their subtypes CC2/W148 and S256. Clinical cure of new pulmonary tuberculosis caused by the Bejing genotype was achieved in 73.4% of cases, by subtype CC2/W148 - in 41.2% with a significantly higher proportion of treatment failures and lethal outcomes of tuberculosis than in other subtypes of this genotype. With the S genotype, the clinical cure was achieved in 72.7% of patients, with no significant difference in the incidence of unfavorable outcomes in patients with subtype S256.

The objective of the study: to study the radiological and morphological parallels in respiratory sarcoidosis (RS).

Subjects and methods. 121 patients with respiratory sarcoidosis were enrolled in the study, their ages varied from 21 to 66 years, they all were examined in 2007-2019. The analysis of radiological manifestations of sarcoidosis was assessed according to the main parameters (symmetry of the lesions, the size of the intrathoracic lymph nodes, the presence of dissemination, pneumofibrosis). The extended morphological testing of biopsy specimens was carried including evaluation of the quantitative and qualitative composition of granulomas.

Results. The chest computed tomography revealed a discrepancy between the radiation signs in respiratory sarcoidosis and the staging theory by Wurm. Changes in the lung parenchyma and swelling of the mediastinal lymph nodes were found in all patients at stages I-III. The components of the cellular elements of the inflammatory infiltrate did not differ at different stages of respiratory sarcoidosis. However, as the radiological changes progress, the number of granulomas increased and there was a direct correlation between the number of granulomas in the biopsy specimen and the X-ray staging by Wurm (r = 0.24; p <0.05), while the frequency of granulomas with necrosis also increased (r = 0.39 ; p < 0.05).

The article describes 3 clinical cases of tuberculous pleurisy in pulmonary sarcoidosis patients who received courses of glucocorticosteroid therapy in the past. In all cases, the tuberculous etiology of pleurisy was confirmed by microbiological detection of the pathogen in exudate or biopsy specimens.

The objective of the study: to summarize current data on the use of low-dose computed tomography (LDCT) for lung cancer screening (LCS).

Subjects and methods: Relevant articles published from 2016 to 2019 were searched for the following key words: lung cancer screening, low-dose computed tomography, ultra-low-dose computed tomography. The search was performed in the open databases of PubMed, Google Scholar, Elibrary. 23 Russian and 778 English publications were found. Among them, relevant publications with high citation indices were selected.

Results. By 2019, there have been significant changes in the methodology of LDCT in LCS, and these changes can be considered as one of the priority state areas of modern health care. The article considers the main and potential additional goals of screening for lung cancer, the parameters of inclusion into lung cancer risk groups according to the data of various global studies. It describes data on the recommended maximum permissible doses of radiation exposure in different countries and the economic efficiency of screening. In addition, the technical requirements for a computed tomography scanner in LCS and methods for interpreting LDCT have been systematized.