The article reviews 60 publications and addresses key aspects of concurrent COVID-19 and chronic obstructive pulmonary disease (COPD). It presents data stating that COPD patients have higher expression of the receptor of angiotensin-converting enzyme 2 in the lungs and this may contribute to a greater susceptibility to COVID-19. In COPD, signs of endothelial cell dysfunction and tendency to thrombus formation have been identified which can present the risk of unfavorable outcomes of COVID-19. Cohort study data do not confirm that COPD patients are more susceptible to SARS-CoV-2 infection, but their clinical outcomes of COVID-19 appear to be worse including the need for mechanical ventilation and lethality. There is no clinical evidence about the role of inhaled glucocorticosteroids used to manage COPD in the development and course of COVID-19.

The objective of the study: to determine the place and effectiveness of video-assisted thoracoscopic lung resection (VATS resections) in the differential diagnostic procedure for examination of patients with chest diseases.

Subjects and methods. In 2017-2019, 1,190 patients with suspected respiratory tuberculosis were examined in the differential diagnostic department of TB Dispensary, the Ministry of Health of the Kabardino-Balkarian Republic; 106 (8.9%) needed VATS since it was impossible to verify their diagnosis despite various biopsies. The age of 106 patients varied from 18 to 80 years old, there were 66 men (62.0%), and 40 women (38.0%). The preoperative diagnosis was as follows: single or multiple lung lesions – 83 (76.9%) cases, disseminated lung disease of unknown etiology or interstitial lung disease of unspecified etiology – 25 (23.1%) cases.

In all cases, the surgical specimens were sent for comprehensive tests, including histological tests, microbiological tests (fluorescent microscopy with Ziehl-Nielsen staining, culture for Mycobacterium tuberculosis (MTB) by Bactec, and culture for secondary flora and fungi), and molecular genetic tests to detect MTB DNA.

Results. The diagnostic efficiency when using VATS resections, histological and microbiological testing of surgical specimens made 98.1% (95% CI 93.38-99.48; Wilson's method). Among the diagnosed diseases, pulmonary tuberculosis was confirmed in 47/106 (44.3%) patients, cancer – 37/106 (34.9%), the rest of patients were diagnosed with some other disorders including orphan diseases.

The objective of the study: to establish specific parameters for formation of tuberculosis risk group in HIV positive children of 0-17 years old in order to plan tuberculosis prevention activities.

Subjects and methods. The main statistical rates on tuberculosis, HIV infection and their combination in children of 0-17 years old for 2009-2018 were studied. All new cases of TB/HIV co-infection were analyzed in children of 0-17 years old in Moscow for 2004-2018.

Results. While the incidence of tuberculosis and HIV infection among children has been decreasing in Moscow over a 10-year period (2009-2018), the group with advanced risk to develop tuberculosis due to HIV infection is growing, both due to children born by HIV positive women (by 1.8 times), and children with confirmed HIV infection (by 2.1 times), which is partly explained by intensive migration in the big city.

In the structure of the followed up of children with HIV infection, it has been established that the number and proportion of the following categories tend to grow: children above 8 years old; those at the stage of secondary diseases and advanced stages of HIV infection; and migrants from other regions.

In 2004-2018, the combination of tuberculosis and HIV infection was detected most often among children aged 8-11 years (14/34; 41.2%), who had not previously been tested for HIV infection, and among people who had lived outside of Moscow before the disease was detected (16/34; 47.1%). The most severe forms of HIV/TB co-infection including fatal ones, were also observed among children from the migrant population without regular medical follow-up.

The objective of the study: to evaluate postponed outcomes of comprehensive treatment with use of valve bronchial block in patients with limited fibrous cavernous pulmonary tuberculosis.

Subjects and methods. Treatment outcomes of 97 patients suffering from chronic destructive pulmonary tuberculosis with lesions within one lobe were analyzed. Valve bronchial block (VBB+) was used in 42 patients, and it was not used in 55 patients (VBB-). In addition to anti-tuberculosis chemotherapy, artificial pneumoperitoneum was used in all patients as a part of the treatment.

Results. Postpones treatment outcomes were followed in 83 patients: in 38 from the Group VBB+ and in 45 from Group VBB-. Clinical cure was achieved in 28/38 (66.7%) patients in Group VBB+ and in 16/45 (29.1%) in Group VBB-, p <0.01. A lethal outcome was registered in 2 (4.8%) patients in Group VBB+ and 10 (18.1%) in Group VBB-, p <0.03.

The objective: to study the effect of short course chemotherapy regimens on treatment outcomes in children with drug resistant tuberculosis.

Subjects and methods. In 2017-2019, 31 children at the age from 3 to 17 years old, received short course chemotherapy which lasted for 12-15 months. Children of both genders were enrolled in the study, they all were new pulmonary tuberculosis cases with multiple drug resistance or at risk of MDR, with no history of previous treatment with reserve anti-tuberculosis drugs, and without severe concomitant diseases. Before the treatment was prescribed, all children underwent lung computed tomography additionally to general clinical and laboratory tests.

Results. The chemotherapy regimen for each child consisted of 4-6 drugs selected individually with the consideration of resistance pattern of the child or suspected index case. In all cases, the combination of drugs included fluoroquinolones (levofloxacin or moxifloxacin). Amikacin (67.7%), aminosalicylic acid (80.6%) and prothionamide (74.2%) were frequently prescribed. 54.8% of children received pyrazinamide and 48.4% – cycloserine. Given the limited lesions, only 16.1% of children received linezolid and 9.7% of children received bedaquiline. The main chemotherapy course made 13.2 ± 0.5 months (from 12 to 15 months depending on the form of tuberculosis and changes during treatment). The duration of the intensive phase made 4.8 ± 0.3 on the average. 2 (6.5 ± 4.4%) of 31 children developed adverse events requiring the cancellation of the drugs causing them.

Conclusion. This study has demonstrated satisfactory tolerability and good efficacy of these short course regimens for treatment of multiple drug resistant tuberculosis. No relapses of tuberculosis were reported.

The objective of the study: to determine the burden of tuberculosis with concurrent HIV infection in Dushanbe and the prevalence of multiple drug resistant tuberculosis, to assess the treatment efficacy of drug susceptible and drug resistant tuberculosis depending on the HIV status of patients.

Subjects: A cohort retrospective study was carried out assessing results of examination and treatment of all patients (1,838 people) registered for tuberculosis treatment from 01.06.2016 to 25.12.2019 in Dushanbe.

Results. Among new tuberculosis cases, MDR is more often registered in HIV positive patients versus HIV negative patients (OR 2.3, 95% CI 1.1-4.9, p = 0.03). The chances of successful treatment of tuberculosis in HIV negative patients were higher versus HIV positive patients as well as in drug susceptible tuberculosis (OR 4.7, 95% CI 3.1-7.4; p < 0.000) versus drug resistant tuberculosis (OR 2.5, 95% CI 1.1-75.7; p = 0.03). The chances of tuberculosis cure did not differ statistically significantly among patients with different HIV status for both drug resistant and drug susceptible tuberculosis.

The objective of the study: in Tomsk Region, to establish the frequency of multiple drug resistance (MDR) of mycobacterium tuberculosis (MBT) in new tuberculosis patients with the reference to their HIV status and to assess their treatment outcomes.

Subjects and methods. The presented results were obtained from a retrospective cohort study of 788 new tuberculosis patients who were registered for MDR TB treatment at Tomsk Phthisiopulmonology Medical Center from January 2017 to April 2019.

Results. In Tomsk Region, the level of primary MDR reaches 31.3% in patients with TB/HIV co-infection, while in HIV negative tuberculosis patients, this rate is 24.2%. The incidence of primary MDR/XDR MTB reaches 40% among deceased patients with TB/HIV co-infection. Treatment efficacy in MDR/XDR TB patients with associated HIV infection is low – the effective treatment was achieved only in 7.3% of them. In general (excluding the data on MTB drug resistance and antiretroviral therapy), treatment efficacy of tuberculosis patients with HIV infection is significantly lower versus HIV negative tuberculosis patients: 37.7% and 61.9%, respectively, OR 0.38 [0.28; 0.50], p = 0.001.

The article describes a clinical case of treatment of multiple drug resistant tuberculosis in the patient with type 1 diabetes mellitus who had received a kidney transplant (from his mother) 3 years before tuberculosis was diagnosed due to diabetic nephroangiosclerosis and the development of end-stage chronic renal disease. Pulmonary tuberculosis developed while taking immunosuppressive drugs, it manifested by an infiltrate with destruction of lung tissue in the upper lobe of the left lung, infiltrative tuberculosis of the left upper lobe and segmental bronchi, bacterial excretion confirmed by microscopy and culture. The strain of tuberculosis was resistant to 5 drugs including isoniazid and rifampicin. The chemotherapy regimen included pyrazinamide, capreomycin, levofloxacin, ethionamide, cycloserine, and paraaminosalicylic acid. Glomerular filtration rate was monitored every month. The full course of anti-tuberculosis chemotherapy (556 doses) was effectively completed, glomerular filtration by that time was 77.0 ml/min. Stable sputum conversion was achieved (confirmed by sputum culture), the cavity was healed, and some areas of pneumosclerosis and single solid foci persisted.

The review analyses 61 publications on the use of delamanid, a new drug for the treatment of drug resistant tuberculosis. It presents information about pharmacokinetic parameters, efficacy and safety, as well as the place of delamanid in the combination therapy of multiple drug resistant tuberculosis. It tells about specific parameters of delamanid use in children and HIV patients.