Search

The objective: to evaluate the efficacy and safety of various anti-tuberculosis therapy regimens for multiple drug resistant (MDR) and extensive drug resistant pulmonary tuberculosis in the intensive phase of treatment lasting for 8 months minimum.Subjects and Methods. A single-center cohort prospective-retrospective clinical study was conducted, which included 166 patients aged 18 to 70 years with active pulmonary tuberculosis and proven MDR of Mycobacterium tuberculosis, who received chemotherapy according to regimens IV and V. The treatment regimen of patients in Group I (n = 96) included modern anti-tuberculosis drugs (TBdrugs) – bedaquiline, linezolid, respiratory fluoroquinolone (levofloxacin, moxifloxacin, sparfloxacin), cycloserine, pyrazinamide, and perchlozone at a dose of 8-10 mg/kg, 1 time per day after meals during the intensive phase of treatment, that was at least 8 months. Patients from Group II (n = 70) received a respiratory fluoroquinolone (levofloxacin, moxifloxacin, sparfloxacin), aminoglycoside (amikacin), cycloserine, pyrazinamide, ethambutol, and prothionamide.Results. After 3 months of treatment, symptoms of intoxication disappeared in 22 (81.5%) patients in Group I, and only 41 (61.2%) in Group II (p = 0.04; TTF). In patients of Group I versus Group II, the body temperature returned to normal within a shorter time: 2.8 and 4.3 weeks, respectively (p < 0.05). By the end of the intensive phase of treatment (8 months), sputum conversion confirmed by culture was observed more often in patients of Group I compared to Group II (85 and 80%, pχ2 = 0.003). Adverse events (AE) caused by TB drugs in Group I were observed significantly more often versus Group II: gastroenterological adverse events (pχ2 = 0.05), cardiac adverse events (pTTP = 0.05), and endocrinological adverse events (pTTP = 0.05). Neurotoxic AEs tended to develop more often in Group I (pTTP = 0.06). Ototoxic AEs were more frequently observed in Group II where the treatment regimens included aminoglycosides (pχ2 = 0.05). To maintain adequate chemotherapy regimens IV or V over long-term treatment, MDR tuberculosis patients need continuous monitoring of AEs, intravenous administration of two or three TB drugs, and timely therapy to manage manifestations of AEs.

The objective: to study the frequency, structure and impact on the surgery outcome of intra- and postoperative complications after lung resections for fibrous-cavernous tuberculosis.Subjects and Methods. A retrospective cohort analysis of intra- and postoperative complications was performed in 847 patients who underwent surgery for fibrous-cavernous pulmonary tuberculosis. Their influence on the surgery outcome was determined in accordance with the modified Russian classification of surgical errors assessment by R. M. Satava and the Accordion classification for severity of surgical complications. It has been established that the most dangerous complications that adversely affect the result of the operation are the following: injury to the cavity, vessels of the root of the lung and systemic circulation, empyema of the pleural cavity, exacerbation of tuberculosis, and pulmonary heart. These complications caused an unfavorable outcome in all 47 patients with such an outcome and led to a fatal outcome in 22 (78.6%) patients out of 28 deceased patients. Additions to the Accordion classification of postoperative complications are proposed taking into account the specific features of surgeries for tuberculosis.

The Eurasian (née European) Modern Pollen Database (EMPD) was established in 2013 to provide a public database of high-quality modern pollen surface samples to help support studies of past climate, land cover, and land use using fossil pollen. The EMPD is part of, and complementary to, the European Pollen Database (EPD) which contains data on fossil pollen found in Late Quaternary sedimentary archives throughout the Eurasian region. The EPD is in turn part of the rapidly growing Neotoma database, which is now the primary home for global palaeoecological data. This paper describes version 2 of the EMPD in which the number of samples held in the database has been increased by 60 % from 4826 to 8134. Much of the improvement in data coverage has come from northern Asia, and the database has consequently been renamed the Eurasian Modern Pollen Database to reflect this geographical enlargement. The EMPD can be viewed online using a dedicated map-based viewer at https://empd2.github.io and downloaded in a variety of file formats at https://doi.pangaea.de/10.1594/PANGAEA.909130 (Chevalier et al., 2019).

The objective: to evaluate the effectiveness of the medication containing a 7% NaCl solution and 0.1% sodium hyaluronate in patients with destructive pulmonary tuberculosis and multiple/extensive drug resistance (MDR/XDR) and inflammatory changes in the tracheobronchial tree. Subjects and methods. A prospective randomized controlled study was carried out, which included 69 patients with destructive pulmonary tuberculosis and MDR/XDR and respiratory complaints and changes in the tracheobronchial tree detected by fibrobronchoscopy. All patients underwent a complete clinical and functional examination, and by analyzing the questionnaires, the mMRC dyspnea index was calculated, the CAT test was performed, and the response to treatment was assessed using the Likert scale. The patients were randomly divided into two groups. The main group included 30 patients; in addition to anti-tuberculosis therapy, through a nebulizer, they received inhalation with the solution containing 7% NaCl and 0.1% sodium hyaluronate, 5 ml 2 times a day for 10 consecutive days, 20 inhalations. The control group (39 people) received individual chemotherapy according to the resistance profile with standard mucolytic treatment. The examination was carried out before the course with the mucoactive drug (visit I), then at the end of the course – after 10 days (visit II) and after 30 days (visit III) from the moment of inclusion in the study. The significance of differences (p) was determined at p

The objective of the study: to identify the frequency of various species of non-tuberculous mycobacteria (NTM) isolated in the patients of TB services in Siberian Region during 2014-2018, to determine the correlation between rates of resistance to different antibacterial drugs.Subjects and methods. PCR hybridization on strip strips (Hain Lifescience GenoType Mycobacterium CM / AS) was used to genotype 475 NTM isolates of patients from various TB hospitals inSiberia. Drug susceptibility was tested by minimum inhibitory concentrations (MIC) on culture with serial micro-dilutions in a liquid medium using TREK Diagnostic Systems kits. 64 panels were used for slow-growing mycobacteria (SLOWMYCO), 46 - for fast-growing ones(RAPMYCO). Data processing was performed using the APL of 3.5.1 and the data analysis software of Rstudio, version 1.1.442.Results of the study1. Tomsk Region differs from the other considered regions ofSiberiadue to higher frequency of M. intracellulare among isolates identified by PCR hybridization. In other regions, M. fortuitum prevails among isolated.2. Incomparison with the reference data (CLSI M62, 2018), differences in the MIC of some NTM species isolated from patients in Siberia and theFar Eastwere observed, most likely related to the regional characteristics of these isolates.3. HTM isolates resistant to moxifloxacin are also resistant to linezolid, trimethoprim, and ciprofloxacin.4. Fast-growing clarithromycin resistant HTM isolates are predominantly sensitive to moxifloxacin, ciprofloxacin, and trimethoprim.

The objective of the study: to evaluate the efficacy and safety of treatment of tuberculosis patients with pre-extensive drug resistance and extensive drug resistance (XDR-TB) with regimen V using new anti-tuberculosis drugs including continuous treatment with bedaquiline.Subjects and methods. The treatment efficacy and safety were assessed in 39 patients treated with regimen V. Of them, 17 (43.6%) suffered from fibrous cavernous tuberculosis, 31 (79.5%), and 9 (23.1%) were HIV positive.Results. Treatment efficacy: 32 (82.0%) were cured, 1 (2.6%) was treatment failure, 4 (10.2%) did of non-tuberculosis, 2 (5.1%) defaulted from treatment. 23 (69.7%) patients took bedaquiline for the entire course of chemotherapy (the average duration made 19.3 months). Of them, 22 (95.6%) were cured, 1 (4.4%) had treatment failed. It was observed that the drug was well tolerated.Adverse events resulted in the cancellation of drugs were documented in 9 (23.1%) patients. After sputum conversion, 30 (76.9%) patients were treated using hospital-substituting technologies, including 10 of them who were treated under direct observation by video. Post-treatment follow-up is carried out in 28 out of 32 (2 changed their place of residence, 2 died of non-tuberculosis) of the treated patients, the average duration of follow-up have made 11.7 ± 6.3 months, the patients are relapse free.

The objective: to investigate the anti-tuberculosis effect of laser photodynamic inactivation (PDI) of M. tuberculosis H37Rv in vitro by methylene blue (MB) in the minimum concentration (1 μg/ml) with laser radiation of 662 nm. Subjects and methods. A comparative analysis of the intensity of growth of Mycobacterium tuberculosis H37Rv after laser irradiation and laser FDI by MB with different doses of light energy was carried out. Results. Laser radiation with a wavelength of 662 nm was found to have an inhibitory effect on the growth of M. tuberculosis H37Rv. FDI of Mycobacterium tuberculosis was first registered in the presence of a minimum concentration of MB (1 µg/ml) which suppressed colony growth by 97 and 93% when they were processed by radiation with a wavelength of 662 nm with the lowest density of doses of light energy (46.9 and 93.75 J/cm2).

The objective of the study: to evaluate the results of lung resections in patients with fibrous cavernous tuberculosis. Subjects and methods. A retrospective analysis was performed in 722 patients who underwent lung resections due to disseminated fibrous cavernous tuberculosis. Results. The efficacy of lung resections as a part of comprehensive treatment of patients with disseminated fibrous cavernous tuberculosis was high and provided achievement of a complete clinical effect (sputum conversion and removal of all cavities) in 82.2% of 722 patients (30 (4.2%) patients with hospital mortality). 272/720 (37.8%) patients suffered from complications in the postoperative period (2 patients died of bleeding during surgery). Pleural empyema (primary and secondary) complicated the postoperative course in 68/720 (9.44%) patients, of them 44 people had a failure of the bronchus stump prior to the development of empyema. Within the 6-month period after the surgery, 22/720 (3.1%) patients had their tuberculosis exacerbated.

The aim of the study was to determine the dose of a virulent strain of Mycobacterium tuberculosis H37Rv that is optimal for modeling experimental tuberculosis granulomatosis in mice and to investigate the effect of the original inductor of the Keap1/Nrf2/ARE system TS-13 (sodium 3- (3'- tert -butyl-4'-hydroxyphenyl) propylthiosulfonate) on animal survival and the dynamics of granuloma formation. Material and methods. Generalized tuberculosis granulomatosis was modeled by a single injection into the tail vein of male BALB/c mice of the 2-month-old M. tuberculosis strain H37Rv at doses of 106, 107 and 108 microbial bodies. Another group of animals on the day of infection with M. tuberculosis (107 microbial bodies) began to receive TS-13 with drinking water (100 mg/kg body weight). Survival was fixed daily; after 5 weeks, mice were euthanized and liver samples were taken for histological examination. Results and discussion. The dose of 107 microbial bodies was found to be the most adequate when modeling in BALB/c mice the tuberculosis granulomatosis caused by the intravenous injection of virulent M. tuberculosis strain H37Rv. At the 36th day after the injection of 107 microbial bodies, mortality was significantly lower in the group of mice receiving the inducer of the signal system Keap1/Nrf2/ARE monophenol TS-13 with drinking water (44 and 15% mice survived, respectively). At the same time, these two groups did not differ in the number and diameter of liver granulomas. The results show a high prospect of studying the role of oxidative stress and the redox-sensitive signal system Keap1/Nrf2/ARE in tuberculosis granulomatosis.

The aim of this study was to assess optimizing effects of antistress neurotechnologies on the clinical course of acute pulmonary tuberculosis. The study was performed in three steps: upon admission before treatment, followed by repeated examination at 2 and 4 months. The patients before study were divided into the two groups: (1) 33 patients received standard antituberculosis drug therapy (SDT) and (2) 35 cases after standard antituberculosis drug therapy accompanied by neurothechnological anti-stress therapy (NAT). Patients from the NAT group received a regular audio-visual-vibrotactile stimulation as additional therapy (2 to 3 30-min sessions per week during 4 months). By the time of hospitalization, the groups did not differ in their general immune state. The percentages of CD3+ , CD4+ , CD8+ , CD16+ , CD19+ as well as indexes of phagocyte activity showed some changes after 2 and 4 months of therapy. The patients from both groups before treatment exhibited lymphocytosis, decreased phagocyte activity, when compared to healthy individuals. By the end of therapy (4 months), the patients from the NAT group showed increased phagocytosis by monocytes (p < 0.01) and granulocytes (p < 0.05) which approached values of healthy control. The study demonstrated also that efficiency of combined therapy was higher in the NAT vs. SDT group: closure of lung destruction cavities was observed in 90.5% of patients from the NAT group vs 45% of patients from the STD group. The results present evidence for combined implementation of neurothechnological anti-stress therapies as a supplementary method for the standard specific drug therapy in primary infiltrative lung tuberculosis.

The article presents the analysis of multiple drug resistant tuberculosis (MDR TB) prevalence among new and previously treated cases in the Kyrgyz Republic in 2016. The part of MDR TB among new cases makes 21.9%, among relapses – 49.2%, and among previously treated cases – 64%. 52.2% of new cases are susceptible to anti-tuberculosis drugs, as 28.1% of relapses and 17.8% of previously treated patients.

The article presents results of multi-dimensional analysis of 83 rates, calculated on the basis of federal and sectoral reports on tuberculosis in 21 regions of Siberian and Far Eastern Federal Districts, which were collected from 2006 to 2016. For statistic processing of data, a distance matrix was used with its consecutive analysis by principal coordinates analysis, which allowed detecting the closest correlations between rates. It has been proved that main factors of successful tuberculosis control are the following: improvement of the organizational quality of treatment and diagnostics, provision with qualified medical personnel, early detection through expansion of coverage of population with fluorography screening. The principal coordinates method also allowed performing a multilateral evaluation of epidemic situation in all regions and defining the ones with the most favorable tuberculosis situation.

The article presents the analysis of outcomes of short course treatment of tuberculosis patients with multiple drug resistance (MDR TB), which was twice shorter compared to standard treatment (9-12 months versus 20-14 months). The efficiency of short-course and standard treatment did not differ significantly in new MDR TB cases and those previously who had limited tuberculous lesions and received no therapy with second line drugs in the past (69.2% versus 68.2%), while the default rate was twice less (13.5% versus 27%, p = 0.03). Economic efficiency of treatment: costs of drugs for short-course treatment of MDR TB were 3 times lower compared to the standard one.

Goal: to detect the best mode of in vitro photodynamic inactivation of M. tuberculosis by Radahlorin.Subjects and methods. The activity of culture of M. tuberculosis, H37Rv strain, photosensitized by 0.00005% Radohlorin was compared and the intensity of growth was assessed after photodynamic inactivation by different doses of light energy with 662 nm wavelength.Results. For the first time, anti-microbial properties of E6 chlorine in the form of medicamental photosensitizer (0.00005% Radohlorin) suppressing museum strain of M. tuberculosis of H37Rv were detected. Photoinactivation of M. tuberculosis depends on the dose and achieves its maximum in 10 minutes of light exposure with light energy of 0.5 W.

The single prospective study was conducted in order to assess clinical efficiency of adding the immune restorative agent of deoxyribonucleat sodium (Derinat) to the current chemotherapy regimens of 102 patients (new cases or relapses) with destructive pulmonary tuberculosis with multiple or extensive drug resistance; the patients were divided into two groups: the main group included 30 patients who were prescribed with intramuscular injections of Derinat, 5 ml, every 24 hours with 48 hours interval, 10 injections in total; and nebulizer inhalations with mixture of Derinat and saline solution in the proportion of 1:1 (2 ml of Derinat and 2 ml of saline solution), once a day, 20 inhalations in total; the comparison group included 72 patients, who had no Derinat prescribed. When compared to the control group, the group of patients treated with the immunomodulator had a shorter period of clinical manifestations elimination, increase in the frequency of sputum conversion (by 28.6% by the 4th month of treatment), reduction in the rate of eradication of bronchial tree mucus inflammations, increase in the frequency of cavity healing (by 20% by the 6th month of treatment).

Goal of the study: to define the effect of various doses of laser radiation with 662 nm wave on the growth of M. tuberculosis in vitro.Materials and methods. Samples of mycobacterial suspension of M. tuberculosis H37Rv were processed by monopositional light radiation (λ = 662 nm) in six dosing regimens varying in power and duration of the exposure to the light. All samples of mycobacterial suspension of M. tuberculosis were inoculated on the solid nutritional media of Lowenstein-Jensen in triplets for each dose of the exposure to light. Cultures were incubated under 37°С for 90 days with weekly inspection of samples.Results. Continuous irradiation by diffused laser with 662 nm wave provides the most expressed bacteriostatic and bactericidal effects against M. tuberculosis H37Rv under the density of the energy dose of 234.5 and 703.5 of J/sq.cm. Such a dose was obtained through 5 and 15-minute exposure respectively.

Новосибирский НИИ туберкулеза Минздрава России (ННИИТ) имеет богатую историю научных достижений в самых разнообразных областях фтизиатрии, в том числе в исследовании эпидемиологических закономерностей распространения инфекции, в хирургии легочного и внелегочного туберкулеза, разработки новых методов фармакотерапии и фундаментальных исследованиях патогенеза туберкулезной инфекции. В настоящей статье рассмотрены четыре перспективных направления исследований, которые ННИИТ инициировал недавно и уже получил первые результаты: исследование распространения латентной туберкулезной инфекции (ЛТИ) у взрослого населения и ее роли в эпидемическом процессе; изучение малоизученных штаммов M. tuberculosis, таких как B0/W148; исследование механизмов локальной иммуносупрессии в зоне туберкулезного очага, в том числе потенциальной роли мезенхимальных стволовых клеток (МСК), аккумулирующихся в туберкулезных воспалительных инфильтратах; разработка новых лекарственных форм противотуберкулезных препаратов, представленных в виде наноаэрозолей для ингаляционного введения.

Annual statistic forms were analyzed by means of an open cross-sectional single-step cohort study in order to assess the impact of the available infection control on the changes in tuberculosis incidence among medical personnel of TB medical units in Siberian and Far Eastern Federal Districts. A significant negative correlation was found out between the changes in TB incidence in the region and the year when this infection control was introduced, such as time period of a patient's transfer to the relevant ward or out-patient treatment when the result of smear microscopy was received, splitting up flows of patients depending on the microscopy result from treatment – diagnostic rooms, and availability of visual aids on the infection control for patients and personnel. It was demonstrated that the early introduction of administrative measures provided the most significant impact on the reduction TB incidence among the medical workers of TB units.

The article describes three cases of deep venous thrombosis in those suffering from fibrous cavernous pulmonary tuberculosis. The causes of thrombotic complications were analyzed. In all cases the patients had a central venous catheter installed. The state of thrombotic readiness associated with genetic causes as well was confirmed in two patients. Under follow-up by thrombodynamics testing, it was found out that the effective dose of low-molecular heparin was above the estimated dose prescribed according to the instructions. One case had a lethal outcome. Certain actions to be taken by anesthesiologists and emergency physicians are offered in order to minimize the risk of thrombotic complications in pulmonary tuberculosis patients in need of surgery and (or) a venous catheter.

Goal of the study: analysis of drug resistance of certain species of non-tuberculous mycobacteria through testing by minimum inhibitory concentrations on the fluid nutritional media.Materials and method: drug resistance of non-tuberculous mycobacteria was tested by the method of minimum inhibitory concentrations on the fluid nutritional media. 51 strains of non-tuberculous mycobacteria from the species of M. intracellulare, M. avium, M. kansasii, M. gordonae, M. fortuitum, M. abscessus were tested. The minimum inhibitory concentration of the drug for slow-growing non-tuberculous mycobacteria was defined using the panel of 13 drugs (SLOWMYCO) and for the fast-growing mycobacteria – the panel of 15 drugs RAPMYCO Sensititre (Trek Diagnostic System, Thermo Scientific, USA) was used. It was proved that the majority of tested fast growing mycobacteria were resistant to ceftriaxone, cefepime, cefoxitin but susceptible to amikacin; and slow growing non-tuberculous mycobacteria were susceptible to clarithromycin, linezolid and amikacin.

Time period required for diagnosis in those with suspected pulmonary tuberculosis was analyzed; diagnostic value of immunological tests done in 70 patients (diaskintest and QuantiFERON®TB Gold) was studied and the results were presented. As a result of this comprehensive examination 20 patients were diagnosed with tuberculosis and 50 patients were diagnosed with non-tuberculosis diseases. The analysis has proved high sensitivity of diaskintest – 75%, QuantiFERON®TB Gold – 90% and their specificity is 86 and 84% respectively. The factors associated with positive results of both tests have been detected.

Goal: to evaluate the efficiency of peribronchial lymphotropic therapy in pre-operative preparation of the patients with the instable or complicated course of pulmonary tuberculosis.Materials and methods. Intermediate treatment outcomes of 99 pulmonary tuberculosis patients who had continuous pre-operative preparation have been analyzed. During chemotherapy peribronchial lymphotropic therapy was used in 53 patients, and inhalations of anti-tuberculosis drugs were used in 46 patients.Results. The average duration of treatment in both groups made 3.5 months. Use of peribronchial lymphotropic therapy during the pre-operative period in the most severe patients allowed achieving results comparable with inhalation treatment of pulmonary tuberculosis patients belonging to less severe category.

Efficiency of tuberculosis control measures was comprehensively evaluated in the Russian regions (totally 21 regions) within Siberian and Far Eastern Federal Districts by means of ranging the sets of indicators. Three sets of indicators were used; these indicators reflected the epidemic situation and main rates of operation in the territories upon the outcomes of 2015. Totally 34 indicators were analyzed. The situation varies in different regions of Siberian and Far Eastern Federal Districts, the analyzed indicators significantly differ in the regions depending on the annual results, which first of all witnesses of differences in the quality and efficiency of tuberculosis control activities. Ranging as per indicators' set demonstrates the correlation between the epidemic situation and quality of tuberculosis control activities and stability of their level.

Introduction of electronic case histories to medical units including TB units is one of the factors allowing enhancing quality of medical care provision. Use of the electronic case histories provides conditions for information transparency improvement in a medical unit: financial, statistic and medico-technological. Information contained in the electronic case history is important and required both for internal and external use. Use of electronic case histories contributes to reduction of labor costs of workers in medical units, provides fast access of medical personnel to information, formalizes data, provides preservation, invariance and reliability of the information entered into electronic case history during the whole period of storage, regulates the access rights and confidentiality, personifies data and allows unifying health data of all Russian population into one pool.

The retrospective cohort study was aimed to evaluate treatment outcomes of 476 patients suffering from multiple and extensive drug resistance, to detect risk factors of unfavorable outcomes and to assess the impact of surgical resections on treatment outcomes. 71.8% of patients were cured, in 22.7% treatment failed, and 5.5% died during treatment. Main predictors of the unfavorable outcome were destructive changes in the lungs (Odds ratio (OR) 10.0; 95% CI 2.4-41.9), more than 2 segments of the lungs affected by tuberculosis (OR 6.8; 95%- CI 3.9-11.9), positive results of sputum smear microscopy (OR 3.1; 95% CI 2.0-4.9), pre-XDR of M. tuberculosis (OR 1.9; 95% CI 1.3-2.9), concurrent HIV infection (OR 3.3; 95% CI 1.3-8.2), addiction to alcohol and/or substances (OR 4.8; 95% CI 3.1-7.5), treatment interruption (OR 7.3; 95% CI 4.6-11.8), prescription of non-standard chemotherapy regimens (OR 2.2; 95% CI 1.4-3.4), low income (OR 3.4; 95% CI 2.1-5.5), incarceration (OR 2.2; 95% CI 1.3-3.6). Regarding statistical significance the use of surgical resections was related to the reduction of the risk of unfavorable outcomes also among the patients with treatment failure predictors.

The homeostasis state in the peri-operative period was studied in 31 pulmonary tuberculosis patients. It was found out that the volume of peri-operative blood loss was not related to the presence of increased fractional thromboplastin time and hyperfibrinolysis. The following factors were found to be related to intra-operative blood loss: pulmonary surgery in the past; combination of signs – 2A or 2B group of dispensary follow-up, MDR/XDR TB, bacillary excretion, presence of fibrous cavernous pulmonary tuberculosis in the infiltration state, lesions in 10 segments and more. The formulas of linear regression were o`ered allowing predicting the volume of blood loss and duration of the stay in the intesive care department.

Retrospective cohort study was conduced in order to investigate the efficiency of surgical treatment in pulmonary tuberculosis patients residing in the region with high prevalence of the disease. Two groups of patients were enrolled comparable regarding the course of the disease, presence of surgery indications, living in Altai Republic, who had been examined by TB surgeon (totally 185 persons). 110 patients enrolled into the first group included and 75 patients were enrolled in the control one. While analyzing the results it was found out that surgery allowed achieving sputum conversion in 90.7% of patients in the main group, and among those who refused surgical treatment conversion rate made 66.1% Destructive changes were eliminated in 90.8% in the main group while in the control group cavity healing was achieved only in 56.3% of patients (p = 0.0001, χ2 ).

В г. Новосибирске, в Доме ученых Академгородка, с 18 по 20 июня 2014 г. прошла юбилейная научно-практическая конференция «Эффективное решение проблем туберкулеза: от научной идеи до медицинской практики», объединившая 353 участника.

The paper characterizes the laboratory service that carries out microbiological tests to diagnose tuberculosis in 12 and 9 subjects of the Siberian and Far Eastern Federal Districts, respectively.The efficiency of tuberculosis detection was evaluated by light microscopy of Ziehl-Neelsen- stained smears during primary health care for the population. There were changes in the efficiency of detection using different microbiological diagnostic methods in the bacteriological laboratories of tuberculosis facilities in 2008 to 2012.Emphasis is laid on the topical moments in laboratory service work, which require further improvement and optimization.

The level of patient satisfaction with the result of the medical services received is one of the important aspects of assessment of the quality of medical care. The rendered medical care that meets the expectations and requirements of patients determines the level of their satisfaction. Insufficiently high patient satisfaction with the quality of medical services is today a problem not only for the Institute, but also for whole Russia’s public health care. The elements of market mechanisms as a quality management system are being introduced to solve intricate problems to achieve the effective work of the public health care system under limited resources. Annual assessment of the level of satisfaction of the Institute’s patients, users of medical services, and calculation of the satisfaction index make it possible to estimate changes in the activity of the Novosibirsk Research Institute of Tuberculosis and its strengths and weaknesses and to elaborate a strategy for continuous medical care quality improvement.

A retrospective cohort study was performed to reveal risk factors for fluoroquinolone resistance in M. tuberculosis during treatment of 463 patients with multidrug-resistant (MDR) tuberculosis (TB) in the Novosibirsk Region. The factors associated with an increased risk were the extent of a TB process within > 2 lung segments (OR 1.39; 95% CI, 0.87-2.21), abundant bacterial excretion (OR 2.32; 95% CI, 1.54-3.5), primary aminoglycoside/capreomycin resistance in M. tuberculosis (OR 3.35; 95% CI, 1.80-6.24), concomitant alcohol/drug dependence (OR 1.46; 95 CI, 0.76-2.80), renal dysfunction (OR 4.60; 95% CI, 1.28-16.51), deviations from the standard polychemotherapy of MDR TB (OR 3.17; 95% CI, 1.58-6.34), fluoroquinolones used in doses lower than the recommended one (OR 5.23; 95% CI, 2.27-12.10), discontinuation of a polychemotherapy cycle (OR 5.70; 95% CI, 2.97-10.93), rural residence (OR 2.0; 95% CI: 1.14-3.51), and being in prison (OR 2.0; 95% CI, 1.14-3.51). Resection surgery (OR 0.48; 95% CI, 0.2-1.13), in-hospital intensive-phase polychemotherapy (OR 0.43; 95 CI, 0.27-0.63), and parenteral administration of anti-TB drugs (OR 0.40; 95% CI, 0.18-0.86) were associated with risk reduction.

The paper describes complexities and errors in the management of a patient with pulmonary tuberculosis with broad drug resistance in М. tuberculosis and concurrent type 1 diabetes mellitus. It shows the need for long-term multimodality treatment involving adequate chemotherapy and additional methods in this category of patients.