The aim of the study was to investigate the effect on the psycho-emotional state and adherence to treatment in patients with pulmonary tuberculosis of remaxol inclusion in the accompanying therapy regimens.Material and methods. The data from 326 patients (252 men and 74 women) with various forms of pulmonary tuberculosis treated at the Regional Clinical Tuberculosis Dispensary were analyzed; the average age of patients was 41.3±1.6 years. A low level of adherence to treatment, as well as clinical and laboratory signs of grade I hepatotoxicity were revealed in patients receiving a course of etiotropic therapy in the main group (N=72). In this regard, in addition to the psychological support for the main course of treatment, accompanying therapy was prescribed: remaxol 400 ml intravenous drip every other day (course No. 5), after-wards — 1 time a week (course No. 4). Patients in the comparison group (N=254) received standard treatment. In addition to the standard examination, the cytokine profile (the level of IL-1β, 4, 6), TNF-α and IFN-γ) was determined in dynamics according to the indications in patients. The level of adherence to the treatment was also determined in dynamics through testing according to the original methodology.Results. The study revealed that the inclusion of remaxol in the treatment regimens facilitated more pronounced positive dynamics in clinical and laboratory data compared with the standard regimen: a decrease in signs of hepatotoxicosis and a tendency towards improvement in cytokine profile parameters. This contributed to maintaining the etiotropic therapy regimen and improving the well-being of patients, which, in turn, increased the level of adherence and therefore the effectiveness of treatment in patients.Conclusions. The combination of positive effects of remaxol use in patients with pulmonary tuberculosis contributes to an increase in their psycho-emotional state and thereby increases adherence to treatment and its effectiveness.

The aim of the work was to study the effectiveness of remaxol inclusion in treatment regimens designed for patients with comorbid tuberculosis and hepatotoxic response to etiotropic therapy.Materials and Methods. Case histories of 25 patients (21 men and 4 women) with a confirmed diagnosis of tuberculosis infection and hepatotoxic reactions to etiotropic treatment were analyzed. Of these, 9 patients had a comorbid (TB/HIV) pathology and 16 patients had TB/HIV with concomitant diseases. To stop the signs of hepatotoxicity, all patients were prescribed with remaxol: 400 ml intravenously on alternate days (course No. 5), then 1 time per week (course No. 4). In addition to the standard clinical and laboratory examination, all patients underwent follow-up (before and after the course of remaxol) examination of the levels of aspartate aminotransferase and total bilirubin in the blood, as well as the levels of interleukin production (1β, 4, 6 and 10) and tumor necrosis factors (TNF-α and TNF-γ). Standard regimens were used when conducting anti-tuberculosis chemotherapy.Results. It was noted that the presence of a comorbidity aggravates the course of tuberculosis and reduces the effectiveness of etiotropic therapy due to the development of hepatotoxicity. The inclusion of remaxol contributed to a decrease in the severity of hepatotoxic reactions and made it possible to avoid the correction of the main treatment course. The revealed positive dynamic in cytokine profile indicators can be regarded as a mediated immunological effect of the drug and requires further research.

The aim of the study . To analyze formation features of the epidemic situation for tuberculosis (TB) in the context of the COVID-19 pandemic in order to predict the further actions of medical organizations. Materials and methods . The data for the region for the last 5 years (2017–2021) were analyzed, including 1,762 newly diagnosed cases of patients with TB and comorbidities (according to the data of the Regional Public Health Organization «Regional Clinical Anti-Tuberculosis Dispensary»). All cases were verified using standard diagnostic methods, including molecular genetic methods, to determine the resistance of pathogens to antibacterial drugs. Results . It was revealed that the epidemiological situation in the region was multidirectional: thus, during the COVID-19 epidemic, the most pronounced incidence decrease was observed among cases of chronic course hepatitis (by 16.4 times), while among patients with tuberculosis the incidence decreased by 2.75 times, and among patients with acute hepatitis — only by 1.5 times (P<0.05). Among the cases of comorbid infection, the most severe course was observed in patients with combined (TB + HIV) infection: there was both a more severe general condition, and the development of adverse (undesirable) reactions to anti-TB drugs, which required an extension of maintenance therapy. Conclusions . The results of the study showed that against the background of the COVID-19 pandemic in the region, there was no tendency towards a worsening of the epidemic situation, primarily for the more socially significant infection — tuberculosis. At the same time, there was an increase in the number of cases of comorbid pathology, including HIV + TB. In the treatment of patients with comorbid forms of infection, it is necessary to take into account the possibility of developing hepatotoxic reactions and, as a result, the appointment of accompanying drugs with hepatoprotective and detoxification effects in therapy.

The aim of the study was to evaluate the effectiveness of psychological (adherence to treatment) and accompanying drug therapy depending on the form of pulmonary tuberculosis. The results of complex therapy of 326 patients with various forms of pulmonary tuberculosis are considered. All patients received etiotropic treatment, taking into account the sensitivity of the pathogen to anti-tuberculosis drugs, as well as support therapy, including psychological support and, if indicated, hepatoprotective therapy with Remaxol. When analyzing the dependence of the psychoemotional state of patients on the form of the tuberculous process in the lungs, it was noted that high adherence to therapy was observed in one third of patients in all groups (DTL — 26.1%, ITL — 28.6%, FCTL — 32.8% and ATL — 31.8%, respectively, P >0.05). The results obtained may be associated with a high level of resistance of mycobacterium tuberculosis excreted from pa tients: out of 232 patients with low adherence to treatment (NUP and UUP), 97 (36.2%) showed drug resistance of the pathogen to two or more etiotropic drugs, which, in turn, caused prescription of reserve drugs. Thus, the determination of the level of adherence to treatment is justified and is aimed at correcting the psychological support of patients with pulmonary tuberculosis, which makes it possible to increase the effectiveness of therapy in these patients. The appointment of the latter in a number of patients led to the development of hepatotoxic reactions, which served as the basis for the inclusion in the therapy regimens of the accompaniment of Remaxol (intravenous drip of 400 ml, course No. 5–7). Pronounced hepatoprotective (improved transaminase parameters) and insignificant immunoprotective (positive dynamics of the cytokine profile) effects were noted during treatment. The noted changes in the immunogram can be associated with the proven antioxidant and membrane stabilizing effect of succinic acid, which is part of Remaxol. These changes require further research.

The aim of the study was to analyze the features of the organization of therapy for patients with HIV-associated tuberculosis (TB/HIV) and the effectiveness of pharmacotherapeutic approaches under the conditions of penitentiary institutions. Materials and methods: the data on the incidence and effectiveness of specialized medical care for TB/HIV patients were analyzed for a ten-year period in the population of penitentiary institutions of the Federal Penitentiary Service of one of the subjects of the Central Federal District of the Russian Federation. Therapy and examination of patients with TB/HIV was carried out in accordance with regulatory documents and using generally accepted diagnostic methods. The patients consulted the staff of the departments of the FSBEI HE KSMU to verify the diagnosis and correct treatment regimens. Results: the analysis showed that, despite the stabilization of the TB epidemic situation, the epidemiological indicators for comorbid TB/HIV are increasing in the penitentiary health sector, which is due to an increase in the number of HIV-infected patients. In order to intensify the treatment of patients with TB/HIV in the population of the penitentiary system, it is necessary to give priority to social and sanitary prevention, primarily in risk groups — HIV-infected and individuals with residual lung changes. The inclusion of Remaxol in the therapy regimens for TB/HIV patients promotes rapid relief of hepatotoxic reactions and, as a consequence, increases the effectiveness of the primary therapy, which is illustrated by clinical observation.