The reorganization of Moscow phthisiatric service in in 2012 results in a large outpatient network formation with common tasks and a vertical management, the quality of detection and diagnosis of the TB due to the introduction of more accurate methods; continuity at the stages of the treatment process, increasing of the coverage of risk groups with chemoprophylaxis, preventive and anti-relapse treatment. The aim of the study: to assess the TB pathomorphosis based on the study and comparison of its clinical forms.

Materials. 41,430 TB patients admitted to a multidisciplinary round-the-clock specialized hospital from 2005 to 2020 were examined.

Results. The proportion of generalized TB was increased in from 1298 cases (5.5%, 95%CI 5.2–5.8%) in period I (2013–2020) to 1724 (9.6%, 95%CI 9.2–10.1%) – in II (2005–2012). At the same time, among the isolated forms of pulmonary TB, disseminated cases began to be registered less frequently – 1444 cases (8.1%, 95%CI 7.7–8.5%) vs 2830 (12.0%, 95%CI 11.5–12.4%), focal – 452 (2.5%, 95%CI 2.3–2.8%) vs 873 (3.7%, 95%CI 3.5–4.0%), fibrous-cavernous 1383 (7.7%, 95%CI 7.3–8.1%) vs 2600 (11.1%, 95%CI 10.7–11.5%). On the contrary, the share of infiltrative TB increased from 2643 (11.2%, 95%CI 10.8–11.6%) to 2895 (16.2%, 95%CI 15.7–16.7%). In the structure of extrapulmonary TB as part of the generalized process, abdominal, lymphatic and genitourinary TB continued to dominate with increasing their shares in in the last eight years. The number of isolated genitourinary TB cases was decreased from 1028 (4.4%, 95%CI 4.1–4.7%) in the first period to 334 (1.9%, 95%CI 1.7–2.1%) in the second one. The number of other extrapulmonary TB cases decreased slightly. The incidence and prevalence of TB among Moscow residents decreased by 57.3%.

Conclusion. Thus, the variability of the structure of TB consists in the growth of its generalized forms in recent years, a decrease in the proportion of isolated extrapulmonary TB cases without changing their structure.

The organization of temporary COVID-19 observators is one of the strategic directions of work in the face of the threat of the import and spread of COVID-19, which was carried out by the Government of the City of Moscow in the social and medical spheres. The article summarizes the practical results of the organization of a temporary COVID-19 observatory, in which medical supervision was provided by employees of the Moscow City Scientific and Practical Tuberculosis Control Center of the Moscow City Health Department. In order to separate contact with COVID-19 patients and COVID-19 patients in mild and asymptomatic form who do not have the possibility of isolation at home, a temporary observatory was organized on the basis of the Sanatorium. Artem (Sergeev) at the State Unitary Enterprise of the city of Moscow «Medical Center for Managing the affairs of the Mayor and the Government of Moscow». The observatory was organized during the period of restrictive measures to reduce the spread of COVID-19. In order to separate contact with COVID-19 patients and COVID-19 patients in mild and asymptomatic form who cannot self-isolate at home, a temporary observatory was organized on the basis of the Sanatorium. Artyom (Sergeev) at the State Unitary Enterprise of Moscow «Medical Center for Managing the Affairs of the Mayor and the Government of Moscow» during the period of restrictive measures to reduce the spread of COVID-19. In the expanded temporary observatory for COVID-19 on the basis of the sanatorium, medical care was provided to 2,783 patients. The average follow–up period was 13.8 days (95%CI 13.6–14.0).

Aim. Study and evaluation of the methods of work of TB dispensaries in St. Petersburg during the COVID-2019 pandemic.

Methods. We used the medical documentation of TB dispensaries in St. Petersburg.

Results. As a result of the implementation of a complex of anti-epidemic measures within anti-tuberculosis institutions and the use of new tactics for diagnosing tuberculosis, treating and dispensary observation of patients at home, the trend of a gradual decrease in the incidence of tuberculosis in St. Petersburg, as well as an increase in the detection of concomitant diseases in patients with tuberculosis, has been preserved. In some cases, taking into account the side toxic effect of anti-tuberculosis and antiviral drugs, it was necessary to resort to temporary (for the duration of COVID-19 treatment) cancellation of anti-tuberculosis therapy. Termination of courses of anti-tuberculosis drugs in the category of patients with primary tuberculosis, representing an epidemic danger, was noted in 7.2% of cases.

Conclusion. The applied new methods and approaches of anti-tuberculosis activities are feasible, effective, can be implemented in a short time and do not require increased logistics and staffing.

The article presents information about the possibilities and effectiveness of detecting latent tuberculosis infection in medical university students. The importance of screening examination of persons from the decreed groups for early detection of an increased risk of tuberculosis and the adoption of preventive measures is emphasized. Long-term observations of the results of screening examination of students of medical and pediatric faculties using a skin allergy test with a tuberculosis recombinant allergen (ATP) shows a gradual increase in sensitivity to ATP as a criterion of latent tuberculosis infection (LT). The frequency of detection of LTI and students of the medical and pediatric faculty is the same and amounted to 3.7% and 3.1%, respectively. There are no differences between the students of the medical and pediatric faculties in sensitivity to ATP and the frequency of LTI. However, more often it was hyperergic, which is more important for future pediatricians. The experience of screening examination of adults using a sample with ATP has shown a high incidence of LTI and can be recommended for wider use.

Rationale. It is known that patients with cirrhosis of the liver are more susceptible to tuberculosis due to impaired immunity. In this regard, the diagnosis of tuberculous exudative pleurisy in patients with cirrhosis of the liver is an urgent medical problem.

Purpose. To evaluate the features of detection, differential diagnosis and course of tuberculous exudative pleurisy in patients with liver cirrhosis.

Materials and methods. Based on archived case histories, an analysis was made of clinical, radiological, laboratory and microbiological examination data of 84 patients aged 17 to 82 years with pleural effusion and cirrhosis of the liver.

Results. Hydrothorax in patients with liver cirrhosis had a tuberculous etiology in 21.4% of cases, and in 61.1% of cases tuberculous pleurisy was combined with pulmonary tuberculosis, in 50.0% it was accompanied by the release of mycobacterium tuberculosis with sputum, lethal outcome was observed in 11.1% of patients. For the purpose of early detection of tuberculous pleurisy in patients with liver cirrhosis and hydrothorax, regular fluorographic examinations of patients are necessary, and if tuberculosis is suspected, the use of microbiological and morphological methods for verifying the diagnosis is necessary.

The aim of the study. To identify differences in the course of COPD, which occurred after the cure of tuberculosis in a patient with the formation of residual changes, and COPD, which occurred before the detection of tuberculosis in the patient, after the regression of mycobacterial infection.

Materials and methods. With the help of computer number generation, study groups 1 (patients who did not have a history of COPD before tuberculosis was detected) and 2 (patients with a history of COPD) were identified, 94 patients in each group.

The results of the study. In group 1 patients, there is a decrease in FEV1 in the range of 70-80% in 19.1% and in the range of 60-69% in 40.4% of cases, while in 7.4% there is an absolute increase in FEV1 per 200 ml and a bronchodilation coefficient of more than 12% according to the results of the bronchodilation test, and the ratio of FEV1 /VEL of less than 75% was noted in 69.1% of cases. On CT scans in group 2, bronchiectasis and bullae are more common. Progression of obstruction in the form of a decrease in FEV1 per year by an average of 90-105 ml in 61.7% of cases is observed in group 2 patients. Conclusion. The results obtained do not confirm the data on a more severe course of obstructive disease that developed after the formation of post-tuberculosis changes. Patients who had COPD before the detection of tuberculosis, in the presence of residual post-tuberculosis changes in the lungs, more often demonstrated indicators of the irreversible course of the disease.

Introduction. Features of the course of tuberculosis against the background of chronic non-specific diseases of the bronchopulmonary system in children and adolescents have not been studied enough so far, so the timely detection of tuberculosis in children with chronic bronchopulmonary pathology is an urgent problem.

Purpose of the study. Determination of factors contributing to the development of tuberculosis in children with chronic nonspecific pathology, in order to identify high-risk groups among them.

Materials and research methods. The work was carried out on the basis of the NMIC FPI MOH RUSSIA. The study involved 158 children and adolescents diagnosed with respiratory tuberculosis, respiratory tuberculosis in combination with various forms of chronic nonspecific bronchopulmonary pathology (lung malformations, chronic bronchitis, bronchial asthma). A comparison was made in these two groups of such parameters as anamnestic data, complaints, clinical examination data, and computed tomography results.

Results. The factors for the development of tuberculosis in children with chronic nonspecific diseases of the bronchopulmonary system included pneumonia transferred at an early age, acute respiratory diseases 3 or more times a year, and the early age of children infected with Mycobacterium tuberculosis.

Conclusion. These circumstances increase the risk of developing active tuberculosis in children and aggravate its course. In particular, chronic non-specific lung diseases associated with tuberculosis in some cases aggravate the course of a specific process, which acquires a relapsing course.

The article presents the results of treatment of cicatricial circular stenosis of the bronchus of the 3rd degree with tuberculosis of the respiratory organs in a teenager using a minimally invasive endoscopic technique – balloon dilatation. Bronchial stenoses are a frequent complication of bronchial tuberculosis and are traditionally subject to surgical treatment. Endoscopic methods, which include balloon dilatation, and their timely re-use can achieve a stable positive effect and avoid possible surgical intervention. Conducted under endoscopic control 12 weekly sessions of the procedure for restoring the patency of the left main bronchus (balloon dilatation). A stable positive dynamics obtained due to the expansion of the lumen of the left main bronchus from 2– 3 mm to 5 mm and the restoration of pneumatization of the left lung.