Currently, the health care system of the Russian Federation is going through a stage of rapid development of information technologies. Digital technologies raise the activity of phthisiological service to a higher level and provide new tools to optimize medical care, improve analytical and organizational processes.

One of the effective digital tools is geographic information systems (GIS). It provides a wide range of opportunities for 3-D visualization of objects, phenomena, analytical information about ongoing work processes on a map. GIS allow analyzing statistical data based on data threedimensional distribution and its changes over time. The possibility of displaying various indicators on separate maps allows to form thematic layers. Working with such data layers and layer stacking allows revealing regularities, to draw conclusions about mutual influence of indicators (such as population overcrowding and tuberculosis morbidity, influence of the number of active patients on the total workload of employees of the district phthisiological office, etc.). We proposed the use of GIS estimating package for management and control of the district TB dispensary office. We got a technical possibility to make a complex analysis of statistical and epidemic indicators on the territory of our district. The use of GIS made it possible to process large arrays of digital data associated with community outreach, forecasting changes in the workload of various units and control of resources of medical organization.

Introduction. In connection with the spread of a new coronavirus infection COVID-19 since 2020, measures have been taken in the city of Moscow to widely diagnose the causative agent of COVID-19. A laboratory PCR department was opened in the State Budgetary Healthcare Institution «MNPC for the fight against tuberculosis of the DZM», taking into account the available material and human resources. Purpose of the study: To generalize the experience of organizing the laboratory service of an anti-tuberculosis institution in the city of Moscow during the spread of a new coronavirus infection. Results. Human and material resources have made it possible to maintain the quality and availability of laboratory diagnostics of biological material from patients receiving treatment at the Moscow Regional Research and Practical Center for Combating Tuberculosis, DZM, during the COVID-19 pandemic. In the period 2020-2022 in total, 90,102 studies of biological material (smears) were carried out by RT-PCR in order to detect COVID-19 RNA. Starting from June 2020 to the present, the PCR department of the KDL Clinic 2 has been studying the direct detection of Covid-19 RNA in biological material using molecular genetic methods based on reverse transcription and polymerase chain reaction (RT-PCR) and the identification of specific immunoglobulin classes IgM and IgG to coronavirus antigens in blood serum (plasma) by the method of immunochemiluminescent analysis (ICLA) of both persons receiving treatment at the State Budgetary Institution of Healthcare Center for Combating Tuberculosis Moscow, and employees.

Purpose. Improvement of algorithms of etiologic diagnostics of tuberculous spondylitis in modern realities of mycobacteria drug resistance and combined viral infections.
Materials and methods. Laboratory results of diagnostic materials obtained from 300 patients diagnosed with tuberculous spondylitis were analyzed; patients were divided into groups according to the presence of HIV and hepatitis C virus (HCV): 20% of patients had no viral infections, 8% of patients were infected with HCV only, 6% were infected with HIV only; 66% of patients were infected with both HIV and HCV. The surgical bone material was examined by the classical triad of etiologic diagnostics of tuberculosis – microscopy, culture on solid growth media and molecular genetic methods (PCR).
Results. Molecular genetic methods are the most informative methods for diagnosing tuberculous spondylitis – the detection rate of MBT is 83%(p< 0.001). Thesemethodsshouldbethemainonesinthestudyofbiologicalmaterialfrompatientsdiagnosedwithtuberculousspondylitis, while bacteriological methods should be used to verify the diagnosis. MBTs isolated from patients with co-infections are characterized by a wide spectrum of drug resistance: the presence of HIV in patients with tuberculous spondylitis 4.16 times (95% CI 2.11-7.67) increased the chance that mycobacteria in the focus of lesions are resistant to at least rifampicin and isoniazid, and the presence of HCV – 2.29 times (95% CI 1.364.86). Therefore, if viral infections are present in a patient with TC, he/she should be considered as a patient at risk of MDR/XDR TB and an appropriate chemotherapy regimen should be administered even in the absence of bacteriologic results.

The paper presents data on testing the drug susceptibility of clinical isolates of M. tuberculosis (MTB) to fluoroquinolones and injectable drugs using molecular genetic tests and phenotypic methods. We demonstrated the diagnostic capabilities of the hybridization technologies «TB-TEST and GenoType MTBDRsl v.2 to detect the genetic determinants of resistance in MTB isolates with multidrug and extensively drug resistance (MDR, XDR), as well as in MBT with pre-XDR.

Purpose. To evaluate the effectiveness of anti-tuberculosis chemotherapy regimens with the inclusion of linezolid in children and teenagers.
Materials and methods. The results of treatment of 55 children and adolescents with tuberculosis when using linezolid in anti-tuberculosis therapy regimens were analyzed. Bacterial excretion was detected in 12.7% of patients at the start of therapy. All children and teenagers included in the study received at least 85% of the daily doses of anti-tuberculosis drugs.
Results. All children and teenagers included in the study showed positive clinical and radiological dynamics at different periods of chemotherapy. Cessation of bacterial excretion was registered in all bacterial isolators by the end of the first month of treatment. The frequency of adverse reactions associated with the use of linezolid was 5.4%; all of them were reversible.

Venous thromboembolic complications (VTEC) haven’t lost their status as an important medical and social problem for many decades. There are about 300 thousand people die from VTEC in Russia every year. Another significant problem for our country is tuberculosis. Tuberculosis is one of the most common severe infections in the world, most often occurs as a chronic disease and can induce VTEC due to a variety of synergistically acting factors. Previously published studies examined the interaction between tuberculosis and VTEC, but they were based on the data obtained from countries with a high incidence of tuberculosis and a low prevalence of venous thrombosis. An analysis of the literature has shown that tuberculous inflammation determines all three interrelated components of the Virchow’s triad: endothelium inflammatory damage, venous stasis and hypercoagulability. In addition, treatment regimens for the disease with the inclusion of rifampicin also contribute to the development of VTEC due to the pronounced procoagulant properties of the drug. Another equally important agent that potentiates hypercoagulation is the HIV virus, which affects the endothelium and immunocompetent cells. Currently available epidemiological data indicate that HIV infection is associated with an increased risk of VTEC in 2-10 times compared to the general population of the same age. In this context, tuberculosis and HIV/TB co-infection can be considered as a large reversible risk factor for the development of VTEC and included in the prognostic risk assessment scales for acute venous thrombosis and embolism.

One of the most important problems in phthisiology remains low indicators of the effectiveness of treatment of tuberculosis patients, especially with drug-resistant MBT. This article presents a review of the possibilities of adjuvant therapy in improving the effectiveness of complex anti-tuberculosis treatment. Adjuvant treatment is prescribed in addition to the anti-tuberculosis chemotherapy and is necessary in the work of a phthisiologist. More than one hundred studies were analyzed, proving that the use of the adjuvant Glutamyl-Cysteinyl-Glycinum dinatrium (Glutoxim) in the complex treatment of tuberculosis is safe and effective.

Sergei Evgenievich Borisov 

05.06.1958 – 15.11.2023