Aim: to evaluate the efficiency of immunodiagnostics using skin tests in the differential diagnosis of tuberculosis (TB) in adult patients.
Materials and methods. The study included 4585 patients aged 18 to 86 years old from 2013 to 2018. Among them, 1040 patients diagnosed with TB, 277 patients with TB and HIV coinfection, 104 patients with pulmonary abnormalities of non-tuberculous etiology. The control group (“healthy”) included students, interns and residents of a medical university (n = 3141). All observed underwent intradermal administration of a purified tuberculosis allergen (AT) and recombinant tuberculosis allergen (ATR) simultaneously on two arms.
Results. In 97% (612/631 patients) of patients diagnosed with infiltrative pulmonary TB, concordance of the results of the reaction to AT and ATR was established. In patients with a verified diagnosis of malignant neoplasm, the ATR test was negative in 96.2% (25/26 patients) of cases, the AT test was negative only in 3.8% (1/26 patients) of the tested patients. In patients with pulmonary TB/ HIV coinfection, negative anergy for AT and ATR was identified in 56% (156/277 patients) of patients and was mainly observed in individuals with CD4+ levels below 300 cells/μL. The proportion of negative results of the ATR test among patients in whom TB was ruled out was 95.1% (77/81 patients), while the results of the AT test were negative in only half of the patients – 48.1% (39/81 patients).
Conclusion. Recombinant tuberculosis allergen can be recommended for the differential diagnosis of tuberculosis in adult patients and has a high information value.

Background. To investigate a variety of lung tuberculosis (TB) obtained in IBD-patients with the anti-TNF treatment.
Methods. 832 patients with IBD were screened prior to initiation of anti-TNF treatment and 446 of them – during such treatment. The investigations were performed including tuberculin skin tests.
Results. 77 (28.8%) of 267 patients investigated with Mantoux test with 2 TU PPD-L on screening had positive result. 29 (28.8%) of 777 patients investigated with skin test with a recombinant tuberculosis allergen on screening had positive result. During treatment with anti- TNF-α positive result of Mantoux test was detected in 18 (13%) of 138 patients. Positive skin test with a recombinant tuberculosis allergen was in 28 (6.3%) of 442 investigated patients. During the comparison of both tests, skin test with a recombinant tuberculosis allergen showed higher specificity. Preventive TB therapy received 19 (4.3% of all treated with anti-TNF) patients during the treatment and none of them develop active TB.
Conclusion. It is highly important to carefully monitor patients not only prior to but also during the anti-TNF-α therapy for timely detection of the latent tuberculosis infection using tuberculin skin tests. Preventive TB treatment provided patients with positive results of tuberculin skin tests effectively decrement of the risk of active TB developing during the anti-TNF-α therapy in patients with IBD.

The article describes the study of the anti-tuberculosis activity of Perchlozon® (thioureidoiminomethylpyridinium perchlorate) against Mycobacterium tuberculosis (MBT) with a different resistance profile to primary and reserve anti-TB drugs by in vitro determining the minimum inhibitory concentrations of the drug. The minimum inhibitory concentration (MIC) of the drug was determined on Middlebrook 7H10 agar nutrient medium in the range from 0.5 to 64.0 μg/ml on clinical MBT strains, both susceptible and resistant to the main and reserve anti-TB drugs.
As a result, various Perchlozon® MIC values were obtained, at which inhi-bition of MBT growth was observed. 86.7% of the susceptible M MBT strains (including the M. tuberculosis H37Rv reference strain) stopped their growth in the range from 2.0 to 4.0 μg/ml, 46.7% of MDR- MBT strains stopped their growth in the range from 2.0 to 16.0 μg/ml, and 53.3% MDR- MBT strains stopped their growth in the range from 32.0 to 64.0; 73.3% of XDR- MBT strains stopped their growth in the range from 32.0 to 64.0 μg/ml.
It has been established that the antitubercular activity of Perchlozon® in vitro depends on drug resistance spectrum of the MBT to the first-line and reserve an-ti-TB drugs.

The aim: to study the results of surgical treatment of tuberculous pyonephrosis. In 2004–2019 12 patients with tuberculous pyonephrosis underwent nephrureterectomy. Neighboring organs involvement was inherent for all of them, inner and outer fistulas formation detected in 75%. The disease mainly manifested symptoms without evidence of kidney damage. Renal-intestinal fistulas were revealed during surgery in 5 patients. Good long-term outcome of treatment could be achieved mainly by radical surgical intervention.

Aim: to study the prevalence of pathological changes in the ureter wall in urinary tuberculosis (UTB) based on multifocal ureter biopsy.
Methods. The results of morphological findings of 186 patients with ureteral strictures were studied. The first group included 48 (25.8%) patients with UTB without spreading to the ureter, the second group consisted of 64 (34.4%) with the involvement of the ureter. The third was 74 (39.8%) pa-tients with ureteral strictures of non-specific origin.
Results. Specific ureteral strictures led to the development of chronic renal failure 1.5 times more often than in patients with UTB without ureteritis and almost 4 times more than in the group of patients with non-specific strictures (p < 0.05). Bladder tuberculosis was detected only in patients of the 2nd group (more than 1/3), purulent paranephritis was registered in 4.7% of them. Ureteropyeloscopy with multifocal biopsy of the ureter wall revealed total fibrotic changes in 72.7%, focal – in 27.3% of patients of the 2nd group. In the first case, regression of urinary retention during treatment was not observed, in the second it was achieved using endoscopic correction.
Conclusion. Ureteropyeloscopy with multifocal biopsy of the ureter for UTB can reveal the nature and prevalence of fibro-inflammatory changes in its wall. In case of focal lesion, endoscopic approach may be the final step of surgery. In advanced fibro-inflammatory changes, ureteric replacement is indicated.

The article presents two clinical cases of improving urination in patients with neurogenic bladder areflexia of tuberculous spondylitis origin by the electrical stimulation of the sacral spinal cord segments with a high-frequency current.

We were analyzed the functional state and quality of life in 9 patients with benign prostatic hyperplasia after embolization of the prostate arteries in the immediate postoperative period, up to 3 months. In the examined patients, the volume of the prostate gland decreased by 53.3% from the initial within 3 months of observation, the volume of residual urine decreased by 36.5% from the initial level. Positive dynamics of urine flow rate over 3 months was also noted, and the associated IPSS and QoL values decreased correspondingly in a similar way. As our first experience with the use of EAP in patients with BPH showed, this treatment method is less traumatic and effective in eliminating infravesical obstruction. This technique is an alternative to open adenomectomy, which is especially important for debilitated patients with a high risk of anesthesiology benefits.

The stages of elaboration of doctrine tuberculosis clinical “masks” are presented. Pathogenesis and pathological development of paraspecific reactions in tuberculosis patients (by literature) are explained. Clinical case demonstrate the essential necessity of the tuberculosis clinical “masks” knowlege.

Presented the case of successful treatment of tuberculosis patient with multidrug resistant M. tuberculosis and diffuse toxic goiter. The difficulties of diagnostic and management are analysed until surgery as the ending stage of treatment.

Steroid tuberculosis in rheumatoid arthritis patients is a difficulty in treatment. We present a clinical example of a successful cure of a patient with steroid destructive tuberculosis developed against the background of uncontrolled treatment with steroid drugs rheumatoid arthritis. When the initial immunodeficiency with a sharp decrease in neopterin level was detected, glutamyl-cysteinyl-glycine dinatria was included in the treatment. Chemotherapy is organized according to the spectrum of drug resistance, including using bedaquiline. There was good tolerance of treatment. The decay cavity is closed after 5 months. Immune status indicators have improved, including neopterin. Against the background of anti-tuberculosis treatment, no deterioration in the course of rheumatoid arthritis was observed. Clinical recovery of tuberculosis with small residual changes has been achieved.

The article presents an analysis of literature data on epidemiology, morphogenesis, and clinical manifestations of skin tuberculosis. The classification and algorithm of diagnostic measures for this localization of the disease are given. The role and place of morphological methods in the diagnosis of skin tuberculosis at the present stage is discussed. Based on the historical heritage and the anatomical features of skin lesions, their forms, the authors describe in detail the biopsy technique.