The aim of the study. To assess the impact of the COVID-19 pandemic on the main epidemiological indicators of tuberculosis in the Republic of Sakha (Yakutia).

Materials and methods. For a comparative assessment of morbidity and mortality from tuberculosis and similar indicators in the combined pathology of tuberculosis and COVID-19, statistical data of the organizational and analytical department of the State Budgetary Institution of the Republic of Sakha (Yakutia) »Scientific and Practical Center »Phthisiology« named after E.N. Andreev« used. The observation period covers the first half of 2018-2021. For the correct calculation of epidemiological indicators of semi-annual intervals, the method of the coefficient of the annual expression of the population (λ) used.

Results. Polynomial trend lines in absolute values have a steady decline in the incidence of tuberculosis (R2 = 0.8516; p < 0.01), mortality from tuberculosis (R2 = 0.9947; p < 0.05), with an insignificant decrease in the level of coverage of the population with preventive medical examinations (R2 = 0.293; p > 0.05). The decrease in the rate of tuberculosis incidence in various administrative-territorial zones was in the Arctic zone – by 6.8%, in the East Yakut region - by 58.2%, in the West Yakut region – by 39.9%, in the Central Yakut region – by 40.9% and in the South Yakut region – by 2.4%. The highest proportion of the tuberculosis incidence rate (per 100 thousand population) among territorial-administrative zones observed in the Arctic (24.3%) and East Yakut (26.4%) territories. In the West Yakut, Central Yakut and South Yakut zones, the spread of tuberculosis incidence was equivalent. The growth rates of the combined incidence of new coronavirus infection in tuberculosis patients were insignificant (p > 0.05): in 2020 – 22 cases (4.6 per 100 thousand population) and in 2021 – 26 cases (5.3 per 100 thousand population), which amounted to 12.7% and 17.7% of the number of newly diagnosed tuberculosis patients over the same period. Of the patients with tuberculosis with the combined pathology of COVID-19, a complication in the form of viral pneumonitis noted in 31.9% of cases, and of their number, according to the degree of CT 1, in 93.3% of cases.

Conclusion. Anti-epidemic measures to prevent the spread of a new coronavirus infection among the population of the Republic of Sakha (Yakutia) are identical in effectiveness to those in tuberculosis. Various rates of decline of the main epidemiological indicators in the territorialadministrative zones of the republic characterize the effectiveness of both anti-epidemic and anti-tuberculosis measures among the population in the subordinate administrative territories. Limiting the spread of COVID-19 combined pathology among tuberculosis patients and good treatment outcomes indicates the readiness of the tuberculosis service of the republic and phthisiologists to work in new anti-epidemic conditions caused by the COVID-19 pandemic.

The article provides a brief historical background on the development of anti-tuberculosis institutions in Moscow since the end of the XIX century. The main directions of work of anti-tuberculosis institutions after their unification under the auspices of the MNPC of tuberculosis control in 2012 are considered. In the XXI century, the organizational model of TB dispensaries in Moscow has undergone changes and has been adapted to the new epidemiological conditions for tuberculosis and a new infection – COVID-19, rapidly developing information technologies.

It is possible to work in modern conditions as a phthisiologist only if there is a certain set of knowledge and skills in not only phthisiology, but also infectious diseases (HIV, COVID-19, etc.), oncological diseases, pulmonology, possession of modern diagnostic, therapeutic, information technologies that allow for examination, differential diagnosis and treatment of tuberculosis patients in a short time. A phthisiologist, being the organizer of all anti-tuberculosis measures, constantly interacts with other organizations and departments (the Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, medical organizations of the general medical network, educational organizations, etc.); is obliged to apply a personalized approach to each patient, taking into account his multifactorial database of biological and psychosocial characteristics.

The article presents the results of drug susceptibility testing (DST) for anti-TB drugs of 120 strains of Mycobacterium tuberculosis (MBT) isolated from newly detected patients with pulmonary TB before starting chemotherapy. All patients permanently resided in Moscow. DST for the main and reserve drugs revealed that MBT strains were resistant to anti-TB drugs in 50% of cases. Our study showed that bedaquiline has high anti-tuberculosis activity in vitro against sensitive and resistant MBT strains. Investigated MBT strains belonged to different genetic families, but the Beijing strains prevailed (64.2%). A comparative analysis of the results of determining the MIC values of bedaquiline concerning these MBT strains did not reveal a relationship between the results of DST of MBT for anti-TB drugs and their belonging to genetic families. According to the critical concentrations recommended by WHO, all investigated strains were identified as susceptible to bedaquiline.

In order to comparatively assess the amount of costs for the relief of the most common adverse reactions (AE) in different treatment regimens of patients with tuberculosis with multiple and broad drug resistance (MDR and XDR) of the causative agent, an analysis of the frequency, spectrum, severity and cost of relief of all AE developed against the background of chemotherapy of 239 tuberculosis patients with MDR, divided into three groups: I – 82 patients treated in 2011-2015 using only anti-tuberculosis drugs (ATD) of the main and reserve series; II – 77 patients in whom, in addition to these ATD, linezolid was included in the treatment regimen; III – 80 patients treated with linezolid and bedaquiline with ATD of the main and reserve series. The cost–effectiveness analysis used to identify the most economically effective chemotherapy regimen.

Results. 564 AE episodes were registered in 220 patients (92.1%, 95% CI 87.9–94.9%), without significant intergroup differences (92.7%, 96.1% and 87.5%, respectively, in groups I, II and III, p > 0.05). AE III–IV degrees of severity were observed in 35 patients (14.6%, 95% CI 10.7–19.7%); no significant differences in severity and frequency of individual types of AE were found. The elimination of myelo-, hepato- and cardiotoxic reactions of III-IV severity required the greatest costs. The cost of cupping all AE and the cost-effectiveness ratio were the lowest in group III patients (CER = 28.9 thousand RUB compared to 41.7 thousand rubles and 40.3 thousand rubles in groups I and II, respectively).

Conclusion. Тhe use of tuberculosis chemotherapy regimens with MDR /XDR pathogen with the inclusion of bedaquiline and linezolid requires the lowest total costs for the relief of adverse reactions with comparable effectiveness

The article presents the results of a randomized clinical trial to study the effectiveness of treatment of drug-resistant tuberculosis with the use of the anti-tuberculosis drug thioureidoiminomethylpyridinium perchlorate (Perchlozon, Tpp). The frequency of occurrence and the spectrum of adverse events studied. An in-depth analysis of individual adverse reactions and their causal relationship with various components of the combined treatment regimens carried out. Presented algorithms and recommendations for predicting, preventing, and correcting the most common complications of drug therapy.

Aim. Determining the effectiveness of treatment of pulmonary tuberculosis in combination with HIV infection in a civilian TB institution, depending on gender.

Materials and methods. The object of study is 67, of which 47 are males and 20 are females with pulmonary tuberculosis with HIV infection. Age: from 21 to 69 years.

Results. In the treatment of pulmonary tuberculosis patients with HIV infection in a civilian TB institution, 50% of patients have a statistically significant cessation of bacterial excretion according to the results of microscopy at the 2nd month at the same time and regardless of the patient’s gender; sex, however, statistically significantly faster in men for the entire time of observation in the hospital, closure of the cavity (s) of decay is achieved faster in men - by 2 months and by 3rd in women, normalization of indicators in general a blood test occurs simultaneously, regardless of gender, at the 3rd month.

Despite the introduction of new anti-tuberculosis drugs, the problem of treating tuberculosis patients with a broad drug-resistant pathogen (XDR MBT) remains relevant.

Aim of the study. Тo increase the effectiveness of treatment of this category of patients using an autologous composition based on dendritic cells activated by a specific antigen.

Research materials and methods. А prospective study conducted in 2016-2019 included 52 patients, 36 (69.2%) men and 16 (30.8%) women, average age 43.2 ± 1.5 years. All patients received antituberculosis therapy in accordance with existing regulatory documents and recommendations. The main group consisted of 25 patients (48.1%) who agreed to immunotherapy with the introduction of an autologous composition with activated specific peptides ESAT-6 and SFP-10 dendritic cells against the background of anti-tuberculosis therapy. Statistical processing of the material carried out using the Statistica 10.0 application software package.

Results. In 70.0% of cases (n = 14), there were no adverse reactions to suspension administration in patients of the main group. One patient (7.2%) had a general reaction in the form of tremor, chills after the first injection. In 5 (38.7%) patients on the 8th and 9th administration, a skin reaction was noted at the injection sites in the form of a papule, with a final regression of these changes after 8 weeks. By 18– 24 months of the course, anti-tuberculosis therapy in combination with immunotherapy in the first month of treatment allowed to obtain a positive effect according to clinical, bacteriological and radiological data in 64% of cases. It was not possible to obtain this result during therapy at the previous stages of treatment. In the comparison group, a positive result achieved only in 45.5% of cases.

Conclusion. The results of the study suggest a positive effect of complex treatment with the inclusion of immunotherapy with an autologous composition based on dendritic cells in the most severe contingent of patients with pulmonary tuberculosis with broad drug resistance of the pathogen, even with an ineffective course of chemotherapy at the previous stage in 64% of cases.

The article describes the life-path of Eduard N. Bellendir (1926- 2010), his scientific methodology and the system of ideas about the pathogenesis of extrapulmonary tuberculosis, which developed over half a century of experimental study of this pathology.

To date, HIV infection remains a chronic incurable disease. ART allows HIV-infected children to grow and develop without distinction from their peers without HIV infection, to be socially adapted and realized in society. The quality of ART forms the commitment of an HIV-infected child to treatment. Considering that ART is prescribed for a lifelong continuous course, and RVPs with a fixed combination of doses, with a dosage regimen of 1 time per day are the drugs of choice in pediatric practice.

According to the long-term experience of using Eviplera in adolescents from 12 to 18 years old at the Moscow City Center for the Prevention and Control of AIDS, high virological efficacy of the drug with no effect on lipid metabolism and physical development of patients was noted.

Purpose. Identification of the main epidemiological aspects of socially significant ophthalmopathology in the South Urals.

Materials and methods. The study »Ural Eye and Medical Study« involved 5893 people (80.5%) over 40 years old.

Results. The incidence of blindness and low vision in the study region was 6.4%. The most common cumulative causes of blindness and low vision, i.e. socially significant pathology was cataract, the share of which in the subpopulation of persons with visual impairment was 53.72%, age-related macular degeneration – 6.91%, myopic degenerative maculopathy – 5.05%, diabetic retinopathy – 3.46% and glaucoma – 2.66%. A feature of the UEMS study was the high frequency and rating of myopic maculopathy in the structure of low vision and blindness.