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Tuberculosis of the central nervous system has a large proportion among all extrapulmonary tuberculous lesions forms and is an urgent and socially significant problem, despite the development and availability of modern diagnostic methods (radiation diagnostics, cerebrospinal fluid PCR) and treatment. A high disability and mortality level in tuberculous meningoencephalomyelitis is often caused by an untimely clinical diagnosis, which may be associated with an atypical clinical picture of the disease, as well as insufficient information content of the results of instrumental and immunological examination. The authors present a case of tuberculous meningoencephalomyelitis in a female patient without concomitant HIV infection, in the absence of manifestations of visceral, including pulmonary, tuberculosis throughout the disease. Despite the fact that the tuberculous nature of the nervous system lesion was suspected at the initial neurological examination stage, the diagnosis was complicated by the lack of laboratory confirmation by a positive PCR test for Mycobacterium tuberculosis during repeated cerebrospinal fluid studies. Nevertheless, due to the dramatic development of the situation (progressive deterioration of the patient's condition, confusion of consciousness deepening to the coma level) and the direct threat to the life of the patient, it was decided to prescribe anti-tuberculosis therapy «ex juvantibus», which led to a rapid neurological symptoms regression and, ultimately, almost complete neurological deficits recovery. The case is atypical because tuberculous damage to the nervous system (in the form of a positive PCR test for Mycobacterium tuberculosis) was confirmed only on the third day of anti-tuberculosis therapy, and microbiological confirmation of tuberculosis invasion was established only on the 12th day from the start of specific therapy (the 23rd day of illness).

The pathogenetic relationship between pulmonary tuberculosis and lung cancer in their concurrence is now still the subject of discussion., Objective: To study the pathogenetic relationship between pulmonary tuberculosis and lung cancer., Material and Methods: The investigators examined surgical material from 51 patients (41 men) aged 41-73 years (mean age, 63.7 years) with pulmonary tuberculosis concurrent with lung cancer. They also studied tumors, tuberculous caverns, infiltrates, and foci with surrounding macroscopically intact lung tissue, as well as fibrotic changes by histological, histochemical and immunohistochemical examinations., Results: Previous tuberculosis can be considered as a risk factor for lung cancer. Central cancer was more common in patients with inactive, chronic tuberculosis with a predominance of fibrotic processes in the root of the lung and in its hilar zones. Fibrous-cavernous tuberculosis and cavernous tuberculosis were more frequently concurrent with central cancer; peripheral tumors mainly occurred in infiltrative tuberculosis and tuberculomas., Conclusion: The findings suggest that in a number of cases, cancer and tuberculosis may be anatomically close, developing in the same anatomical unit - the lung. However, this does not indicate an unambiguous etiopathogenetic relationship between pulmonary tuberculosis and lung cancer. The relationships between pulmonary tuberculosis and lung cancer are much more complex and do not fit into the simple scheme of cause-and-effect relations.

The article describes 143 cases of exudative pleuritis of unknown origin in patients who were diagnosed and treated with any minimally invasive surgical procedures: pleural puncture (PP), video-assisted thoracoscopy (VATS) with biopsy of the pleura. A different diagnostic methods (cytological, microbiological, histological) used in various diagnostic surgical procedures are analyzed in detail and calculated diagnostic sensitivity, specificity, and accuracy of each method. Based on the analysis of cytological, histological and microbiological studies in the performance of VATS concluded relatively high, comparable with the method of open pleural biopsy, diagnostic efficiency, the sensitivity of this method in the scheme of the diagnostic algorithm of EP of unknown origin.

A case report of central pontine and extrapontine myelinolysis in the combination with spinal cord damage is presented. The authors analyze literature data on this problem and discuss the pathogenesis and diagnostic issues of myelinolysis.

Aim: To assess an efficacy of diagnostic and curative bronchoscopy in patients with purulent-destructive pulmonary diseases., Material and Methods: Diagnosis and treatment of 34 patients with purulent-destructive pulmonary diseases including small-focal destruction (14) and lung abscesses (19) were analyzed. 33 patients underwent diagnostic fibrobronchoscopy (FBS) with brush and transbronchial biopsy. Curative endoscopy included bronchial tree sanation, peribronchial administration of antibiotics (5) and transbronchial drainage of abscess (14)., Results: Atrophic bronchitis and cicatricial deformity of the 2-3rd segmental bronchi were revealed in 81.8% and 15.2% respectively. Transbronchial biopsy confirmed malignant neoplasms (15.2%) and pulmonary tuberculosis (6.1%). Peribronchial administration of amikacin in patients with small-focal pulmonary destruction and transbronchial drainage of abscesses accelerated pulmonary tissue repair and complete recovery., Conclusion: Transbronchial biopsy in patients with destructive pulmonary diseases verifies pathological process and excludes malignant and specific pulmonary damage. Complex use of endoscopic methods is associated with positive clinical result in all patients with pulmonary destruction.

Aim: to determine whether the activity of tuberculous inflammation is associated with different clinical forms of drug-resistant pulmonary tuberculosis., Subjects and Methods: The material taken from 310 patients operated on in 2010-2015 were retrospectively examined. The patients underwent economical lung resections of limited extent (typical and atypical ones of up to 3 segments) for circumscribed forms of tuberculosis with bacterial excretion. A study group consisted of 161 (51.9%) patients with drug-resistant variants of pulmonary tuberculosis. A control group included 149 (48.1%) patients with preserved susceptibility of Mycobacterium tuberculosis to anti-TB drugs. The activity of specific changes in tuberculosis was morphologically evaluated in accordance with the classification proposed by B.M. Ariel in 1998., Results: The highest activity of fourth-to-fifth degree specific inflammation, including that outside the primary involvement focus, was obtained in the drug-resistant pulmonary tuberculosis group due to the predominance of patients with cavernous and fibrous-cavernous tuberculosis versus those in whom the susceptibility to chemotherapeutic agents was preserved. A macroscopic study showed that the primary lesion focus had a median size in one-half of the all the examinees; but large tuberculomas, caverns, and fibrous caverns over 4 cm in diameter were multiple and detected in the drug-resistant pulmonary tuberculosis group. Multidrug resistance was observed in more than 60% of the patients with fibrous-cavernous pulmonary tuberculosis, extensive drug resistance was seen in those with cavernous tuberculosis, which is an aggravating factor. The data obtained from the morphological study of the intraoperative material can specify the clinical form of tuberculosis and evaluate the efficiency of preoperative specific therapy. The highest activity of specific inflammation was observed in patients with multiple drug-resistant pulmonary tuberculosis, the prevalence of third-to-fourth degree specific changes was seen in those with multiple and extensively drug-resistant tuberculosis., Conclusion: The findings suggest that the activity of tuberculous inflammation is associated with different clinical forms of drug-resistant tuberculosis and with a spectrum of drug resistance.

The poly-morbidity is an actual problem of clinical medicine. The chronic hepatitis and tuberculosis are among widespread socially significant diseases while their relationship needs further investigation. The purpose of study is to analyze rate of occurrence, structure and clinic а chronic hepatitis taking course in comorbidity with tuberculosis of various localizations. The technique of continuous sampling was applied to carry out cohort randomized single-staged study analyzing rate structure and clinic of chronic hepatitis in 1189 patients with tuberculosis including pulmonary (n=1125), extra-pulmonary (n=24), abdominal (n-40) localizations. The chronic hepatitis is established in 45% of all cases and in half of cases out of them at the stage of exacerbation (53.2%) when the disease is presented by viral (59.6%) predominantly hepatitis C, alcoholic (25.7%), non-alcoholic (9.8%) and medicinal (4.9%) steatohepatits. The chronic hepatitis associates with pulmonary tuberculosis 3.4-1.7 times more often than with extra-pulmonary and abdominal tuberculosis. The chronic hepatitis is characterized by minimal and moderate activity of inflammation. The chronic hepatitis in case of abdominal tuberculosis manifests more expressed alterations of all laboratory syndromes of hepatitis. The medicinal hepatitis was established only in case of pulmonary tuberculosis. The chronic hepatitis С and B progresses in a comorbide way, is characterized by little symptoms, cytolysis with 2.3-2.8 standards of ALT, AST, minimal parenchymatous jaundice and cholestasis with activity of GGTP 2.86 of standards, mesenchymal inflammation in 3.1-3.4 times more often in case of its comorbidity with extra-pulmonary and abdominal tuberculosis. The alcoholic steatohepatitis is characterized by higher cytolysis, predominance of activity of AST over ALT, more expressed parenchymatous jaundice and cholestasis. The non-alcoholic steatohepatitis is characterized by poly-morbidity with diabetes mellitus type II also, cardiovascular pathology, steatosis of liver, the lowest parameters of markers of cytolysis, mesenchymal inflammation, jaundice, cholestasis and normal values of markers of hepatic cellular inadequacy. The medicinal hepatitis is characterized by increasing of asthenia, nausea, development of jaundice, skin itching, hepatomegaly,cytolysis, cholestasis, hyper-bilirubinemia against the background of specific poly-chemotherapy., Competing Interests: The authors declare no conflict of interest.

Definition of the most important factors and their combination, causing the disturbances of heart rhythm in patients with the pulmonary tuberculosis and diabetes, now attracts more and more attention. For this purpose, extensively used the capabilities of multifactorial analysis, which allowed to evaluate the distribution of the pathological factors and their interaction with each other. The objects of the study were complex examination the data of 90 patients with pulmonary tuberculosis and diabetes (insulin-dependent diabetes-27, non-insulin- dependent diabetes-63). In the mathematical processing of the instrumental methods we analyzed the results of echocardiography, indicators of respiratory function and the results of the Holter ECG monitoring. The use multifactorial mathematical analysis has allowed to establish the most significant pathogenetic factors and their combinations, causing disrhythmogenesis. In patients with pulmonary tuberculosis and diabetes with a combinations of right ventricular hypertrophy with a tendency to pulmonary hypertension and respiratory function parameters most commonly observed ventricular arrhythmias. On the occurrence of supraventricular arrhythmia mainly influenced by pulmonary hypertension and left ventricular hypertrophy.

60 patients were observed with chronic destructive pulmonary tuberculosis which was diagnosed rhythm disturbance and conduction of the heart. It should be noted that the most frequently occurred among patients with heart rhythm disturbances in the form of sinus tachycardia (27.4%) and sinus arrhythmia (24.2%). Almost half of the patients (48, 1%) in the electrocardiogram (EKQ) were diagnosed disturbance of intraventricular conduction. The disturbance of atrioventricular conduction noted in 33.3% of cases. As a result of Halter ECG monitoring sunpeventricular disturbances are diagnosed most frequently and take place in 63,6% of cases. Ventricular arrhythmias were diagnosed in 12% of patients. Conduction of the first of degree atrioventricular block transitory character was noted in 55.6% of cases. Intraventricular blockades of Hiss right branch were determined in 44.4% of cases. The most frequently (41.6%) among the associated with rhythm disturbances and cardiac conduction diagnosed a rare combination of supraventricular monotypic extrasystole with first class ventricular extrasystole.

Objective: to characterize the morphological features of inflammation and the degree of myeloperoxidase expression in the lung of patients who died from HIV-associated tuberculosis (TB)., Material and Methods: Autopsy lung tissue specimens from 229 patients with HIV-associated TB were examined. A comparison group consisted of dead TB mono-infected patients (n = 30). Dead HIV/TB co-infected patients were divided into subgroups: 1) 50 patients with Stage 4A-4B and a CD4(+)-lymphocyte count of more than 200 cells/µl; 2) 54 with Stage 4B-4C and a CD4(+)-lymphocyte count of 100 to 200 cells/µl; 3) 125 with Stage 4C-5 and a CD4(+)-lymphocyte count of less than 100 cells/µl. Histological and immunohistochemical examinations of lung slices were performed using antibodies to myeloperoxidase (MPO)., Results: The predominant types of an inflammatory response were revealed according to the level of CD4+ lymphocytes. The lungs in Subgroup 1 showed a predominant typical granulomatous response (82%). Subgroup 2 exhibited an exudative-productive inflammatory response (57.4%) while Subgroup 3 displayed an alterative necrotic type (92.8%). Subgroup 3 showed the most marked reduction in lymphocyte numbers in the areas of inflammation, which was accompanied by a significant increase in the relative density and other morphometric parameters of MPO-positive macrophages and granulocytes in the inflammatory infiltration zones and alveolar walls., Conclusion: The identified changes in the lungs suggest that there is a decline in the magnitude of a delayed type hypersensitivity reaction, a progression of alterative necrotic processes as CD4(+) lymphocytes decrease in the systemic blood flow, and an increase in the proportion of functionally immature macrophages in the areas of inflammation, which reflects a substantially impaired local immune response to the persistence of M. tuberculosis in HIV infection.

Aim: To identify predictors for the poor outcome of infiltrative pulmonary tuberculosis (IPTB)., Subjects and Methods: The social, epidemiological, and medical risk factors and clinical features of IPTB were assessed in 130 first detected patients. The findings were classified using a cluster analysis and then a variance analysis, followed by the ranking of its results., Results: The primarily diagnosed disseminated destructive process with respiratory and cardiopulmonary failure, excretion of both resistant and multi-resistant pathogenic bacteria had a strong impact on the poor outcome of tuberculosis (TB) in the first detected patients. Its outcome was also influenced by a set of social factors, such as poor material living conditions, stay in corrective labor facilities, and a lack of education. The unfavorable outcome of TB was significantly due to organizational factors, such as bad habits; refusal to undergo fluorography during a few years; and a medical factor as comorbidities., Conclusion: Based on the identified factors, the authors formulated recommendations for working with the first detected IPTB patients at risk for a poor disease outcome.

Objective: To analyze cellular and subcellular disorders in the lung in the presence of HIV-associated tuberculosis., Material and Methods: The investigators made a comprehensive morphological examination of 25 autopsy specimens from patients who had died from HIV-associated tuberculosis. Lung pieces from the foci of caseous necrosis at its boundary and adjacent lung segments and from macroscopically intact perifocal pulmonary segments were microscopically explored. Plain stains and Ziehl-Neelsen histobacterioscopy were used for light microscopy. An immunohistochemical study was conducted using tuberculosis mouse monoclonal antibodies (clone 1.1/3/1, Vector). Seven early autopsy specimens (1-2 hours after statement of biological death) were investigated ultrastructurally. Ultrathin sections were contrasted with Reynolds' lead citrate and looked through a Libra-120 transmission electron microscope (Germany). Semithin sections were stained with toluidine blue., Results: HIV-associated tuberculosis is a disease accompanied by dual aggressive infection. Impaired blood-air barrier integrity gives rise to structural and ultrastructural changes primarily in type I alveolocytes that are responsible for physiological gas exchange and detoxification. Type I alveolocytes have been noted to be in close contact with plasmocytes that are most ultrastructurally preserved and at the same time display the phagocytic and detoxifying functions being redistributed, which is necessary to keep cells viable and which is a characteristic sign of this comorbidity. This redistribution is due to severe damage to macrophages that are unable to ensure complete mycobacterial phagocytosis; thereby the plasma cells partly assume this function, as supported by ultrastructural examination. Severe destruction of granulocyte organelles and partial and complete cell necrosis with its preceding apoptotic changes were established. A study of vessels in the microcirculatory bed has indicated that the ultrastructural changes in the endothelial cells are polymorphic, which is characteristic of an exudative-inflammatory response of lung tissue., Conclusion: Cellular and subcellular changes, the pattern of intercellular relationships, and necrotic and apoptotic cell rearrangements, which are in one way or another involved in the pathophysiological processes maintaining definite hemostasis, are an important component in the pathogenesis of HIV-associated tuberculosis.

The efficacy of albendazole (400 mg taken once), mebendazole (100 mg taken once), and metronidazole (0.5 g thrice daily for 7 days) was evaluated when treating ascariasis, enterobiosis, and blastocystosis, respectively, in patients with HIV infection and in those with pulmonary tuberculosis. Metronidazole-resistant lambliasis was treated with exdisten (5 mg four times for 10 days) in 30.4% of the patients with HIV infection and in 43.3% of those with tuberculosis. Most HIV infected patients received antiretroviral therapy (ARVT). All the tuberculosis patients took isoniazid, ethambutol, pyrazinamide, rifampicin, and streptomycin. Efficiency was monitored by triple coproscopy at an interval of 5-7 days and by additional examinations using the method of Ritchii et al. There was parasitological cure (decreased infection rate for blastocystosis) and clinical improvement as positive changes in symptoms, such as nausea, weakness, headache, weight loss, and others, in all the patients with concomitant ascariasis, enterobiosis, and lambliasis. ARVT and antituberculosis drugs were observed to be better tolerated in all cases.

The efficacy ofreamberin, remaxol, S-adenosyl-L-methionine (ademethionine) and 5% glucose solution was estimated in the treatment of patients with tuberculosis of the respiratory organs and drug hepatotoxicity signs confirmed by higher activity of liver indicative enzymes and nitrogen oxide levels. Remaxol showed a pronounced positive effect on the cytolytic syndrome signs, evident from lower activity of alanine aminotransferase and aspartate aminotransferase. At the same time ademethionine was superior to remaxol in the effect on the cholestatic signs and inferior in the effect on the cytolytic signs. By the effect on the activity of alanine aminotransferase and aspartate aminotransferase, reamberin was inferior to remaxol and superior to ademe-thionine, its effect on the cholestasis markers level vs. the other drugs being superior only to that of 5% glucose solution. As compared to reamberin, ademethionine and 5% glucose solution, remaxol promoted higher integral indices of the host antioxidant protection (total antioxidant capacity and total antioxidant status), that partially explained the drug pronounced hepatoprotective effect.

Interferon inductors of various chemical groups, belonging to antivirals, and induction of several types of endogenous interferon in blood serum are described. Cycloferon was shown efficient in the complex treatment of chronic hepatitis C, tuberculosis in HIV-infected subjects, arbovirus diseases, influenza and acute respiratory virus infections.

The aim of the work was to study the frequency and severity of disturbances of external respiration in patients with post-tuberculosis changes. They were found in 46.9% of the patients that recovered after tuberculosis which suggests the necessity of spirometric observation during the rehabilitation period, optimization of medicamental therapy and education of the patients.

In the article, with 72 patients, taken as an example, with tuberculosis of respiratory organs the authors present their clinical experience with using various methods of surgical correction of the hemithorax volume (by means of extrapleural, intrapleural extra-intrapleural correcting thoracoplasties and diaphragm plasty) during performing resections on the lungs and/or pleura. Substantiation is given to the necessity of correcting hemithorax volume in patients with tuberculosis of respiratory organs in performing resections of great volume.

Molecular factors of pathogenesis of the eosinophilic blood reaction under pulmonary tuberculosis are analyzed in the article. It has been established that the key cytokine providing the development of hemic eosinophilia in patients with pulmonary tuberculosis is IL-5. IL-5 plasma concentration turned out to be increased only in patients with eosinophilia. Increase of eotaxin was determined in patients with tuberculosis despite of the presense of eosinophilia. One-directional nature of the defined changes in eotaxin concentration might be explained by dual properties of this chemokine: on the one hand, eotaxin mediates long-term presence of eosinophils in blood; on the other hand, it initiates the process of adhesion of eosinophilic leucocytes to vascular endothelium with their further migration to the focus of granulomatous inflammation. The established increase in number of IL-5R-positive eosinophils presents one more mechanism which explains the basis of long-term presence of eosinophils in peripheral blood in patients with pulmonary tuberculosis.

The effect of trental on hemostasys system depending on the degree of heart failure was studied in patients with fibrocavernous pulmonary tuberculosis complicated by chronic pulmonary heart disease. Established the desirability of placing trental in the treatment regimen of patients with fibrocavernous pulmonary tuberculosis and compensated CPHD in order to correct violations of the microcirculation and prevention of circulatory decompensation.

Tuberculosis of intrathoracic lymph nodes in part of patients is complicated by the break of molten caseous node in the lumen of the bronchus lumen and obstruct it with thick caseous masses and granulation tissue. The severity of state in children is determined by the caliber of the affected ones. Recovery of the right primary bronchus patency in 10-month child succeeds in rigid bronchoscopy.

The results of treatment of 81 patients, suffering tuberculosis and operated in emergency for an acute surgical diseases of the abdominal cavity organs, are adduced, in 29 of them--nonspecific diseases of nontuberculosis genesis were diagnosed. In 52 patients the indication for emergency operation performance were complications of abdominal tuberculosis (perforation of the tuberculosis ulcers of small intestine--in 37, the tuberculosis mesadenitis--in 15), of them in 34--pulmonary tuberculosis was in inactive phase, that's why the HIV presence was supposed. In 26 patients the diagnosis was confirmed, basing on serologic analysis data. The presence of intraabdominal catastrophe, caused by abdominal tuberculosis complications on inactive pulmonary tuberculosis background witnesses with 85.3% probability the HIV-infectioning of the patient.

The article covers results of "case-control" study concerning clinical and epidemiologic aspects of tuberculosis in asbestosis patients, in connection with dust load. Findings are that the patients having asbestosis complicated with tuberculosis demonstrated total dust load (both in general dust weight and overall accumulated dose of respirable fibers of chrysotile asbestos) decreased with statistical significance, and therefore prevalence of tuberculosis among asbestosis patients decreased 5 times, in spite of growing prevalence of tuberculosis in Russia. Now the disease shows no progressive forms, light and medium course, lower prevalence of bacterioexcretion, longer survival of the patients. Trend of morbidity among the patients having asbestosis complicated with tuberculosis supports epidemiologic situation of tuberculosis in the country. Some workplaces remain with increased concentrations of chrysotile-containing dust, thus in future the patients having asbestosis complicated with tuberculosis could get occupational malignancies.

Clinical and roentgenologic manifestations of cancer of lung developing from residual tubercular changes in 32 patients of elderly and senile age were analysed. Clinical and roentgenologic and laboratory criteria of diagnosis of the associated process were determined. Causes of the late diagnosis of cancer of lung were disclosed; it was caused by the low level of work at the medical institution following up the patients suffering from tuberculosis and having residual changes, namely, lack of regular preventive X-ray examinations which occurs in 3/4 patients with the associated process. We came to the conclusion that patients of the elderly and senile age with residual tubercular changes should be referred to the risk group of developing cancer of lung and it's necessary to display oncology alarm to them.

Blastocystis hominis and nonpathogenic enteric protozoa were diagnosed in 300 patients with pulmonary tuberculosis mainly of its infiltrative form and 500 with Stages II and III HIV infection; the patients received antituberculosis therapy (ATT) and antiretroviral therapy (ART), respectively. Control groups included 200 Tashkent dwellers and 350 patients with various noninfectious diseases of the gastrointestinal tract. Triple coproscopy was made. B. hominis was significantly more frequently detected in patients with pulmonary tuberculosis and those with HIV infection than in healthy individuals: in 53.6 +/- 2.9, 42.2 +/- 2.2, and 18.0 +/- 2.5, respectively (P < 0.01). Only did the tuberculosis or HIV-infected patients show a high intensity of B. hominis infection, which was accompanied by recurring diarrhea and nausea. The high activity of alanine aminotransferase and aspartate aminotransferase was observed in 20% of the patients with tuberculosis + blastocytosis; that of alkaline phosphatase was seen in 25%. The tuberculosis or HIV-infected patients were more frequently found to have Chylomastix mesnili, Jodamoeba butschlii, and Endolimax nana. The specific features of intestinal colonization seem to reflect changes in local immunity; the drugs included into ATT and ART have no substantial effects on the viability of protozoa.

Outcome of treatment of 102 patients co-infected with HIV and tuberculosis hospitalized at Second Municipal Tuberculosis Hospital (St. Petersburg) is analyzed. The median period of follow up was 8 weeks. In order to select the optimum treatment scheme, all patients were divided into three groups (I-III). Group I (51 patients) received, in addition to antituberculosis medications, cycloferon 600 mg tablets on alternate days. Group II (16 patients) received alpha and gamma interferons (Interal injection, 3 MU and Ingaron injection, 500,000 on alternate days) in combination with antituberculosis medications. Control group III (35 patients) received antituberculosis treatment plus placebo. Assessment of the outcome of TB treatment upon 8 weeks of follow up showed a remarkable improvement of clinical and immunological conditions in the patients who received interferons and cycloferon.

The article presents literature review on modern data regarding cardiovascular system lesions in patients with bronchopulmonary diseases and tuberculosis. To detect these changes is of great importance for an assessment of a functional condition of an organism as a whole.

In two subjects of the Russian Federation, the Orlovskaya and Tulskaya Oblast, on the basis of the study of 303 death cases of tuberculosis patients died in 2006, it is established that the actual system of collecting and processing statistic data does not provide the validity of tuberculosis mortality indicators. The most part of errors is explained by the erroneous selection and coding of initial causes of death. The directions of enhancing the validity of mortality indicators at the expense of continuous education of physicians to apply ICD-10 and the implementation of new technologies (software package ?Natality and mortality monitoring? and educational computer program "RUTENDON").

The time course of changes in the degree of tuberculous intoxication syndrome (scores), body mass deficiency (body mass index), routine clinical X-ray data on 300 first detected patients with tuberculosis treated at the Regional Clinical Tuberculosis Hospital (n = 160) and the clinic of the I. M. Sechenov Moscow Medical Academy (n = 140) was assessed to evaluate the efficiency of using a dry protein composite formula in the package of therapeutic measures in inpatients with pulmonary tuberculosis. A study group included 200 patients whose basic diet comprised the dry protein composite formula DISOO Nutrinor. A control group consisted of 100 patients receiving standard antituberculosis treatment and basic diet without using the above formula. In the vast majority of study group patients (n = 152), intoxication symptoms substantially reduced 1.6 months after the start of treatment whereas this occurred noticeably later (following 2.5 months) in the control group (n = 80). Better positive changes in weight gain were found during dietary therapy with the dry protein composite formula in the study group than in the control group. During correction of a dietary protein component, the monthly body weight gain in the study group was 2.2 kg on average greater than that in the control group. The study group patients were also found to have a more significant resolution of infiltrative and focal lung changes on control X-ray studies than the control patients. Also, the study group patients showed a trend for more frequent cessation of bacterial excretion than did the controls. The rate of adverse reactions to chemotherapy was 5% (10 subjects) in the study group and thrice higher than that in the control group (15%, 15 subjects) in the control group. The findings prove the efficiency and urgency of correction of protein-energy deficiency in patients with active pulmonary tuberculosis, by supplementing the dry protein composite formula to the basic diet.

Metabolic disturbances were corrected using the oral specialized formula Nutrien-phthisio (ZAO "Company Nutritec", Russia) in 53 patients with pulmonary tuberculosis and concomitant diseases. In the whole group, tuberculosis was first detected in 21 patients; 32 had a chronic process. Chemotherapy was discontinued in all the patients due to the intolerance phenomena caused by comorbidity (erosive gastritis, gastroduodenal peptic ulcer, hepatitis B and C, chronic pyelonephritis) in 24 patients, by adverse reactions in 19, and by a combination of both factors in 10. The criteria for objectively monitoring the efficiency of nutritional support (in combination with specific treatment) were body mass index, general blood analysis, by taking into account the percentage and absolute count of lymphocytes and the protein metabolism from the serum levels of total protein, albumin, and transferrin. The study determined clinical and laboratory indications for the use of Nutrien-phthisio and the favorable impact of nutritional support on the course of a tuberculous process and concomitant diseases.

For the purpose to determine the clinic-pathogenetic efficacy of Cycloferon liniment in the combined therapy of parodontitis of patients with focal tuberculosis medical examination and treatment of 40 patients is carried out. It is established, that use of liniment Cycloferon in the combined treatment of patients with focal tuberculosis allows to accelerate process of normalization of lipid peroxidation parameters and antioxidant potential of blood, to decrease infection load (Herpes symplex virus I, Candida albicans, Staphylococcus aureus) in parodontal recess and evidence of local inflammation with reduction of activity of the tumours necrosis factor and interleukin 1beta, that provides acceleration of recuperation processes, lowering the frequency of parodontitis relapses.

To investigate the hemodynamics and myocardic contraction of the heart left ventricle, 61 patients with pulmonary tuberculosis (main group) and 26 healthy subjects (control group) were observed. Higher ultimate systolic and diasystolic volumes of the left ventricle and lower levels of the efflux fraction in the patients with active pulmonary tuberculosis were stated. There was shown inverse correlation of the systemic systolic arterial pressure and the left ventricle efflux fraction with ESR, evident of the tuberculosis intoxication. The most pronounced aggravation of the left ventricle function was recorded in the patients with the most severe tuberculosis process. The impairments in the left ventricle in the patients with active pulmonary tuberculosis were of functional nature. Due to intensive therapy of the tuberculosis, the indices of the left ventricle efflux function improved and the systemic arterial pressure came to normal, along with elimination of the tuberculosis intoxication signs.

Therapy for pulmonary tuberculosis in patients is complicated by their negative psychoemotional state frequently deteriorated by long inpatient stay. Enhancing the efficiency of rehabilitative measures in phthisiology requires active optimization of the patients' mental state. This problem can be solved by a package of correction measures involving psychological correction with reflex therapeutic normalization of the functional state of the cortical regions of the central nervous system in patients with pulmonary tuberculosis. One hundred tuberculosis patients with decompensated mind, including 60 with OG and 40 with KG, were examined. A noticeable psychoemotional improvement was reliably detected 5 months after complex correction psychological and neuropsychological accompaniments of standard chemotherapy in the OG study.

The aim of this work was to study the frequency and structure of chronic splanchnopathies and their influence on the outcome of lung tuberculosis. Comorbidity was investigated in 1229 patients attending a regional TB dispensary. Pathogens isolated in 44.5% of the cases included 16.5% drug-resistant strains; certain patients (7%) developed drug resistance unrelated to the presence or absence of somatic pathology. Half of the patients (40.5%) had tuberculosis concomitant with chronic non-specific diseases; each third patient had several such diseases including gastrointestinal disorders in 28.2% and chronic pathology of other organs or systems in 19.4%. Tuberculosis most frequently associated with dysfunction of upper parts of the digestive tract, alcoholic disease, and chronic obstructive pulmonary disease. Although the 99% probability of death from complications of tuberculosis was higher than from complications of concomitant pathology (chi2 = 47.9; p = 0.000), chronic internal diseases increased the likelihood of undesirable outcome of tuberculosis by 8.22%. Practically speaking, each tenth death among patients with tuberculosis was due to complications of a chronic non-specific disease. It means that such chronic conditions accompanying tuberculosis not only require additional therapy but also deteriorate the quality of life and prognosis of the underlying pathology.

A new technique for airtight sealing of bronchial stump was employed for the first time in 5 patients with fibrocavemrnous tuberculosis complicated by pleural empyema. The mechanical stitch was covered with plastic material on a pedicle from a membranous part of the bronchus; it was buried and sealed with the help of penetrating interrupted sutures. Five patients with similar forms of pulmonary tuberculosis comprised the control group. The new method proved to be highly efficient, promoted early healing of the bronchus, and reduced the development ofbronchial fistulas especially in cases complicated by pleural empyema.

One hundred and thirteen patients with pulmonary tuberculosis and mental disease and 127 tuberculosis patients without mental diseases were studied. Patients with mental diseases were observed to have asymptomatic pulmonary tuberculosis with insignificant expectoration, which made the microbiological diagnosis of tuberculosis difficult. The basic method for detection of tuberculosis is to make a fluorographic study every 6 months, which enables active detection of more than 92% of new cases of tuberculosis as minor forms. The efficiency of treatment for tuberculosis concurrent with mental diseases was high: bacterial discharge ceased in 93.3% of cases, decay cavities closed in 80%, which was associated with the possibility of performing long-term continuous treatment in the inpatient setting.

Enzyme immunoassay (EIA) was used to study the diagnostic value of PTAT circulating in the free and attached state as part of serum circulating immune complexes (CIC) in 34 patients with tuberculosis (TB), 38 with concomitant HIV/TB infection, and 92 with HIV infection without active tuberculosis. A humoral immunological response as circulating PTAT and PTAT conjugated in specific CIC depends on both the form and degree of pulmonary tuberculosis and may be employed to diagnose a disease running as both an independent entity and in the concomitant HIV/TB infection. The use of specific CIC yields additional information on the presence and circulation of mycobacterial antigenic components, which should be borne in mind at the early stages of the disease. EIA diagnosis of pulmonary tuberculosis from the significant titer of PTAT is relatively effective at the stages with infiltration and it ascertains destructive changes before their detection on X-ray and tomographic films.

The bacteriological and clinical manifestations of colonic dysbacteriosis were studied in 65 patients with drug-resistant respiratory tuberculosis before treatment with reserve drugs. Colonic microbiological disturbances corresponding to first-, second-, and third-degree dysbacteriosis were detected in 6 (9%), 14 (21%), and 42 (65%), respectively; no evidence of dysbacteriosis was found in 3 (5%) patients. There were characteristic clinical symptoms of dysbacteriosis (tympanism in 80% of the patients, signs of dyspepsia in 73.8%, sensation of abdominal discomfort in 69.2%, stool pattern changes in 65%). The magnitude of dysbiotic disorders was found to be associated with the severity of the tuberculous process (the extent and presence of lung tissue destruction) and the duration of previous standard chemotherapy. Intoxication and severe colonic microenvironmental disturbances were ascertained to have a mutual impact. Gastrointestinal comorbidity in remission did not affect the severity of colonic dysbacteriosis in patients with drug-resistant pulmonary tuberculosis.

Two hundred and forty-three patients with different forms of active pulmonary tuberculosis were examined. The iron intake was estimated by the serum iron (SI) concentrations, total iron-binding capacity (TIBC), unsaturated iron-binding capacity, transferring iron saturation factor (SF), and ferritin (FT) levels. The findings were compared with the values of red blood cells and the systemic inflammatory response assessed from the levels of acute phase reactants (APR). The obtained results were assessed, comparing with the normal range of values separately in male and female patients. Reductions in SI concentrations and TIBC were found to be typical of patients with active tuberculosis. These changes are the components of a systemic inflammatory response and associated with the development of hypochromic anemia. FT, as an ARR, shows heterodirectional changes. The reduction in this index in female patients with pulmonary tuberculosis frequently indicates their susceptibility to the development of true SI deficiency. In males, FT mainly behaves as an APR, which hinders the clarification of the nature of hypochromic anemia. The levels of SI and SF become normal during effective treatment while ineffective treatment deteriorates hypoferremia.

The paper gives data on the prevalence of nonspecific lung disease in patients with pulmonary tuberculosis, the specific features of diagnosis and treatment of their concomitance in 3453 patients with pulmonary tuberculosis. It shows the low detection rate of nonspecific lung diseases in patients with pulmonary diseases. The high error rate has been established in the diagnosis of pulmonary tuberculosis at health care facilities. There is evidence that the use of current therapy for bronchial obstructive syndrome with inhaled cholinolytics and beta2-agonists in patients with pulmonary tuberculosis causes a reduction in the intensity of respiratory symptoms and an increase in forced expiratory volume in one second.

Interferon alpha-2b was tested for its effect on therapeutic effectiveness in pulmonary tuberculosis patients with bronchoobstructive syndrome and signs of secondary immunodeficiency. The patients were randomized to 2 groups. The study group (n=35) received rectal interferon alpha-2b, 3 million IU, on chemotherapy days (twice weekly). The total duration of a course of immunochemothery was 4 months or more. The control group (n=35) did not take the immunomodulator. The use of interferon contributed to the normalization of T-cell immunological parameters in 60.6% of the patients and functional parameters in 35.7% and could achieve closure of decay cavities (the only cavity or one of the cavities) in 90.6% of cases (in the control group, these were in 33.3, 20, and 64.3%, respectively).

The results of surgical treatment were analyzed in 205 patients with destructive pulmonary tuberculosis complicated by spontaneous pneumothorax and pleural empyema. The long-term course, extent, and activity of a tuberculous and purulent process in the lung and pleura determined the patients' severe condition and low respiration and cardiac function parameters. After complex preoperative preparation during 3-4 months, surgical treatment was performed in 84.9% of the patients after stabilization of a pneumopleural process and an intervention was made in 15.1% in the active phase of the disease. A good immediate efficiency was stated in 80% of the patients with this pathology, of them this was observed in 70.4% after pulmonectomy and pleuropulmonectomy, in 88.1% after pleurectomy and partial lung resection, and in 89.6 following thoracomyoplasty. The overall hospital mortality was 11.7%.

Data on 104 patients with pneumonia treated at Moscow multidisciplinary hospitals for suspected respiratory tuberculosis (RT) show that general practitioners have lost tuberculosis-diagnosing skills and phthisiological alertness. This is suggested by frequent failures to collect medical historical data, neglect of risk factors for RT, poor orientation in the differential diagnosis of pneumonia and tuberculosis, violation of diagnostic standards of pulmonary tuberculosis, specifically a paucity of sputum microscopic studies and lateral lung X-ray studies. Upgrading the recognition quality of tuberculosis makes it necessary to observe the propedeutic rules for examining and studying a patient, to reveal important anamnestic and clinical data, and to follow instructions. At the same time, there is no need for new equipment and technologies, but it is critically important to increase the level of tuberculosis knowledge in physicians of all specialties and to create motivation for qualitative diagnostic work.

The mechanisms of development of adult respiratory distress syndrome (ARDS) were studied in 6 patients (3 males and 3 females aged 30 to 48 years) with disseminated complicated respiratory tuberculosis associated with thoracic surgical interventions. Spontaneous pneumothorax is shown to be one of the leading risk factors of ARDS in patients after thoracic surgery for disseminated pulmonary tuberculosis. ARDS after operations for disseminated destructive and complicated tuberculosis is a poor prognostic sign to life and the course of the underlying disease and frequently results in a fatal outcome. A more thorough preoperative preparation of these patients, which involves the assessment of indications for and contraindications to surgical intervention from functional criteria, is needed to prevent ARDS.

Digital videotape recording was done in 81 patients with pulmonary tuberculosis involving the upper lobe of one of the lungs during bronchoscopy. Video filming was used to measure the cross-section area of the ostia of all segmental bronchi of the intact and affected lung. The findings suggest that there is some increase in the mean values of the cross-section area of the ostia of the bronchi draining the affected lobe as compared with the similar parameters in patients in whom this lung is intact. The endoscopic signs of diffuse atrophic endobronchitis are also more significantly frequently detected on the ipsilateral side of the involvement.

The impact of disease and treatment on the mental status of patients with infiltrative pulmonary tuberculosis was studied. The study included 39 patients, chemotherapy in whom was complicated by the development of adverse reactions and 33 patients who had no adverse reactions. In new cases of tuberculosis, anxiety and personality disorders before chemotherapy were ascertained to be a response to first diagnosed tuberculosis and forced long-term in the inpatient setting. The development of adverse reactions caused by antituberculous agents during therapy was accompanied by impairments in psychological adaptation processes, the preservation and worsening of anxiety and personality disorders, which determines it necessary to include additional drug and psychotherapeutic correction methods into a package of therapeutic measures in tuberculosis.

One hundred and twenty-three female patients aged 16 to 49 years with pulmonary tuberculosis were examined and followed up. Of them, 83 (67.5%) patients in whom tuberculosis had occurred and run in the presence of iron-deficiency anemia (IDA) made up a study group and 40 (32.5%) patients in whom tuberculosis had occurred without IDA formed a control group. In the women from the study group, the clinical manifestations of the disease had its own peculiarities: a less pronounced temperature reaction, meager expectoration, severe signs of hypoxia (dyspnea), and chest pain and 97% were found to have abnormally shaped red blood cells (poikilocytosis). Inclusion of Tardiferon into complex treatment aids in enhancing the efficiency of treatment for tuberculosis in the presence of IDA, promoting to a greater extent the regression of the clinical manifestations of the disease and the achievement of abacillation than cicatrization.