Objective — to study genetic control activation of cytokines in the blood of patients with pulmonary multi-drug resistant tuberculosis (MDR TB).
Materials and methods. Under our supervision were 140 patients with infiltrative pulmonary tuberculosis (PT) and 30 healthy donors. Patients have been divided into two groups, with and without pulmonary MDR TB. Were studied areas of interleukin genes IL-2 polymorphism T330G, IL-4 — C589T and IL-10 — G1082A using the polymerase chain reaction and the level of cytokines (IL-2, IL-4 and IL-10) were studied in venous blood by ELISA method.
Results and discussion. Before the treatment PT patients showed significant increase of IL-2 and decrease in concentration of IL-4 and IL-10 in comparison with healthy. After the two-month of standard therapy there were a significant decrease of IL-2 and IL-4, IL-10 was significantly increased. MDR TB patient group had significantly lower concentration of IL-4, IL-10 and significantly higher concentration of IL-2 than in patients without MDR TB both before chemotherapy and after 2 months of treatment. The low level of secretion of IL-4, IL-10 and high changes in IL-2 significantly associated with the mutational homozygote and heterozygote polymorphism of C589T — IL-4, G1082A — IL-10 and T330G — IL-2 genes in patients with infiltrative PT. Among group of MDR TB patients is significantly more distinctive the heterozygous genotype polymorphism of cytokine genes.
Conclusions. The heterozygote genotype and mutational polymorphism homozygote of genes determines the level of production of these cytokines, is a significant factor of prediction of the development of pulmonary tuberculosis and further chronization of the process. Activation of heterozygous genotypes of higher represented cytokine gene polymorphisms was significantly more distinctive for pulmonary MDR TB.

Keywords: multi-drug resistant tuberculosis, cytokines, gene polymorphism, immunity, interleukins.

The algorithm of modeling of tuberculosis of undefined localization in HIV-positive people necessarily involves the identification of intoxication syndrome, probably nonspecific reactions and at least one of key diagnostic criteria (virage of tuberculin Mantoux test with 2 tuberculin units and/or a positive response to antimycobacterial therapy with positive outcome against on the background of antiretroviral therapy. At the same time thorough examination, primarily of the thoracic and abdominal cavities, particularly the lungs and lymph nodes, shows no signs of tuberculous lesions.

Keywords: HIV, algorithm, modeling of tuberculosis of undefined localization.

Objective — was the assessment of accessibility and adressability of labour migrants to health care services and the identification of risk factors causing the TB morbidity.
Materials and methods. 1207 labour migrants including 98 with pulmonary TB were investigated.
Results and discussion. Republic of Moldova reports the biggest incidence of tuberculosis and the biggest rate of migrants among European Region countries.  «Hard-to-reach features» of migrants were confirmed by the low aviability for health care, low awareness about their health state. TB vulnerability of migrants was confirmed by the association of multiple exogenous conditions worsened by TB contact.
Conclusions. Migration is a specific risk factor that damaged the health state of the moldova population, necessiting the implementation of urgent TB screening procedures for ensuring a high accessibility to health care serive of this hard to reach group. 

Keywords: Tuberculosis, migration, risk factors, health care.

HIV-infected patients with multidrug-resistant tuberculosis (MDR TB), including extensively drug-resistant tuberculosis (XDR TB), reveal a significant increase in the frequency of XDR TB from 8.7 % in patients with newly diagnosed tuberculosis to 40.9 % in patients with retreatment and up to 45.0 % of patients with retreatment failure.
In HIV-infected patients with MDR TB, including XDR TB, the level of resistance of MTB to the first and second-line anti-TB drugs is only slightly dependent on the previous treatment, with the exception of ofloxacin (unlike other fluoroquinolones) and kanamycin/amikacin.

Keywords: HIV, multi-drug resistant tuberculosis, extensively drug-resistant tuberculosis, drug susceptibility profile.

Objective — еxogenous risk factors were studied at 142 new pulmonary TB cases with treatment default comparing with 105 succesfully treated patients under DOTS strategy.
Materials and methods. The high TB incidence (104.6/100.000 in 2012) and low treatment succes rate (62 % in 2012) is mainly due to a high default (7.8 % in 2012) and failure rate (3.5 % in 2012) and characterise the epidemiological situation in Republic of Moldova.
Results and discussion. According to predictible value, high risk factors for default were: male sex, economic disadvantaged state, single civic status, codependence, previously released from detention; medium risk factors — low education level, extrem poverty.
Conclusions. Social, educational support and withdrawl techics must be implemented to all patients exposed to risk factors for enhancing tuberculosis treatment result. 

Keywords: TB risk factors, treatment, epidemiology of TB risk.

Objective — to explore and examine the state of the colon microflora in patients with pulmonary tuberculosis according to the range of sensitivity of Mycobacterium tuberculosis to anti-TB drugs and HIV status.
Materials and methods. The study included 40 patients with newly diagnosed pulmonary tuberculosis with preserved sensitivity of Mycobacterium tuberculosis to anti-TB drugs (group 1), 50 patients with MDR tuberculosis (group 2) and 30 patients co-infected with HIV/tuberculosis with preserved sensitivity of Mycobacterium tuberculosis to anti-TB drugs (group 3) and 30 healthy controls  as a control group (group HC), who were conducted the bacteriological examination of the contents of the colon cavity.
Results and discussion. Results of the study according to appropriate category before the etiotropic treatment showed a high incidence of the colon dysbiosis in patients with pulmonary tuberculosis in all study groups that manifested as deficiency or complete elimination of obligate microorganisms and and contamination of mucous membrane of the colon with opportunistic bacteria. The most profound changes in microbiota were observed in patients with MDR tuberculosis and co-infection of HIV/TB.
Conclusions. Dysbiosis colon is a common pathology in patients with pulmonary tuberculosis, which determines the necessarity of prescribing pre- and probiotics for these patients for the correction of existing dysbiotic changes in the colon and prevention of their progression.

Keywords: tuberculosis, dysbiosis, microbiocenosis.

To identify the features of clinical course of community-acquired pneumonia (CAP) at the patients with chronic comorbid disorders and assessment of outcome the prospective study of 438 patients (213 male (48.6 %), mean age — (56.1 ± 17.9) years) was performed. According to presence of chronic comorbidity and level of its control all patients were divided into 4 groups: no chronic diseases (79 persons), with controlled co-morbidities (115 people), with uncontrolled concomitant diseases (120 people) and complicated co-morbidities (124 people). Clinical presentation of CAP at the patients without chronic disease, with controlled or uncontrolled concomitant disease without functional failure characterized by mild (to 88.6 %) or moderate disease (39.2 %) with moderate intensity of respiratory symptoms, mainly cough (more than 90 %), segmental infiltration of lungs, rare complications. In the case of decompensation of cardiovascular and respiratory diseases, labile blood glucose in diabetes melitus patients had severe onset, with the presence of severe dyspnea (72.6 %), lobal infiltration of the lungs, needed urgent help (in 57.3 % of cases), often accompanied by deterioration of the patient after the start of treatment (20.2 % vs. 8.7 %) and exudative pleurisy (31.5 %). Availability decompensation of chronic diseases related to the develop­ment of functional failure worsens and complicates the course of emergency. In the case of controllable chronic disease patients with NP do not differ from those without comorbidity.

Keywords: community-acquired pneumonia, comorbidity, clinical symptoms.

Objective was the comparative analysis of general nonspecific adaptive reactions (RANG) and the expresiveness of endogenous intoxication in various forms of pulmonary infiltrative tuberculosis.
Materials and methods. RANG structure, intoxication indices and plasma level of circulating immune complexes were assessed at 374 new pulmonary infiltrative TB cases.
Results and discussion. Standard treatment enhanced RANG structure only in limited forms of pulmonary TB. Despite of concludent diminishing of intoxication indices in both groups, the high level of circulating immune complexes at the end of intensive treatment phase, demonstrated the insuficient immune adaptive and desinstoxication activity of the standard regimen.
Conclusions. The standard TB treatment demonstrated an unsuficient immune restoring action, necessita­ting the association of immune adaptive drugs.

Keywords: Tuberculosis, adaptive reactions, immune reactivity.

Objective — to study the clinical features of tuberculosis (TB) among medical workers of Vinnytsya region for the period from 2007 to 2014.
Materials and methods. Analyzed the occupational structure and clinical characteristics 120 detected over the 8-year period patients medical workers of Vinnytsia region. The analysis of statistical data col­lected on the basis of official indicators of TB services.
Results and discussion. On the relevance of the problem according to the data obtained by analysis of clinical features according to which almost half (48.4 percent) of healthcare workers who become ill on TB, asked for help in connection with the appearance of certain symptoms. Most cases of TB were observed among nurses (55.0 %). 76.7 % of all cases of health workers females, and 28.3 % were working in TB facilities. In clinical the incidence of TB health workers prevailed pulmonary form inflammatory (35.2 %) and disseminated (30.6 %).
Conclusions. So the problem of the incidence of health workers on TV remains relevant and requires further study. This is confirmed by our data, according to which a significant portion of those who fell ill, was discovered by the passive method, a large number of recurrence of TB among health care workers, the prevalence of infiltrative pulmonary and disseminated forms of the disease, and also higher than in the population, the incidence of extrapulmonary TB.

Keywords: tuberculosis, health care workers, medical workers, the incidence, clinical features, Winnytsya region.

Objective — to study the characteristics of comorbid flow and efficiency of the basic treatment of school-age children suffering from bronchial asthma and concomitant chronic allergic rhinitis.
Materials and methods. There were examined 219 school-age children suffering from bronchial asthma (BA) in the first (I) group consisted of 125 children with asthma, and the II group formed 94 patients with asthma and concomitant allergic rhinitis (AR).
Results and discussion. It is shown that asthma with concomitant AR was characterized by more severe, in particular, the proportion of children with severe disease in group I was 21.6 %, and group II — 45.7 % (р < 0.05). It should be noted that before the appointment of the current course of therapy the nature of asthma, comorbid with AR differed worst performers control the disease, and the most expressive positive clinical dynamics in the course of treatment has been achieved in the frequency of daytime and nighttime symptoms, limited physical activity, frequency of exacerbations during the year, reduction of the content of oxidative modification of proteins and metabolites of nitrogen monoxide in exhaled breath condensate, reducing bronchial hyperresponsiveness.
Conclusions. Patients with asthma and concomitant allergic rhinitis compared to children with asthma without concomitant allergic diseases occur more severe inflammation and airway lability, and after a course of basic treatment in these patients is improving indicators of disease control, while full control is achieved only 1/5 of patients (21.4 %), and cases of uncontrolled asthma are saved half of children (50.0 %).

Keywords: bronchial asthma, allergic rhinitis, children.

In chronic pancreatitis patients was found persistent state of oxidative stress on the level of malonic aldehyde, which ran against the lowered levels of antioxidant enzymatic and non-enzymatic composition (p < 0.05). The use of complex treatment of patients with chronic pancreatitis course of dynamic electroneurostimulation on the proposed scheme contributes to a significant regression effects oxidative stress (p < 0.05).

Keywords: chronic pancreatitis, trophological disorders, oxidative stress, antioxidants, dynamic electroneurostimulation.

Sclerosing hemangioma of the lung — a benign tumor, first described by A. Libow and DS Hubbel in 1956 synonyms: histiocytoma, pulmonary pnevmotsitoma, sclerosing angioma, sclerosing intravascular bronchoalveolar tumor fibroksantoma, vascular endotelioma, alveolar angioblastoma). This pathology is quite rare, so far described more than 300 observations of SHL. No single view of histogenesis SGL. The paper presents a clinical case of SHL patient 51years, described the used methods of diagnosis, treatment and monitoring of disease dynamics over the long term.

Keywords: sclerosing hemangioma of the lung, diagnosis, differential diagnosis.

Objective — to determine the condition of the nitrogen oxide metabolites (NOx) in patients with the combination of COPD and IHD.
Materials and methods. The increased prevalence of chronic obstructive disease (COPD) and its often combination with ischemic heart disease (IHD) necessitates a thorough study of the pathogenic mecha­nisms of this association for more effective treatment. The study of mechanisms of nitric oxide metabolism with the characteristics of products and the action for nitric oxide to the condition of chronic systemic inflammation in the body of patients with such comorbidity becomes the modern field of research.
The data for the study were 37 patients with a mean age (54.4 ± 3.1 years) with acute exacerbation of COPD (clinical group B, GOLD II), combined with IHD — major group. 23 patients with acute exacerbation of COPD were included in the Ist comparative group and 29 patients with IHD, stable angina pectoris were included in the IInd comparative group. All examined patients were examined for the levels of NOx (stable metabolites of nitric oxides) in the serum and in the condensate of exhaled air (CEA) in compliance with the described techniques.
Results and discussion. Violations of the oxide metabolism in patients with combination of COPD and IHD and COPD without IHD have systemic nature and are increased with degree of pulmonary failure and the severity of endobronchitis.
Conclusions. Increasing the concentration of metabolites of nitric oxide in patients with COPD, combined with IHD and in patients with COPD can be considered as manifestations of nitrosive stress, which is one of components of oxidative stress. In patients with combination of COPD and IHD among all investigated persons, the content of metabolites of nitric oxide in serum and in CEA was the highest that can be seen as a consequence of the most expression of systemic inflammation, which confirms the more severe manifestations of both diseases in patients with such combination. The decrease in the activity of inflammation is an important moment for oppression of the nitrosive stress. For this aim the treatment of patients with investigated comorbidity should be composed with medications having antioxidant properties.

Keywords: chronic obstructive pulmonary disease, ischemic heart disease, metabolites of nitric oxide.

In the article there were obsereved the literature data and own studies on etiology, frequency of prevelence, classification and modern approaches to the treatment of exacerbations of chronic obstructive pulmonary disease (COPD). There was  proved negative impact  frequency of infectious exacerbations of COPD on the course of disease progression, the development of complications and necessity of pathogenic antibiotic therapy.

Keywords: chronic obstructive pulmonary disease, infectious exacerbations, treatment.

The data of retrospective analysis of medical reports of 284 patients with HIV-infection staying in the clinic of the Department of infectious diseases of KhMAPGE on the basis of Kharkov RCIH are presented in the article. It was stated that coinfection with HIV and viral hepatitis C were diagnosed in 27.8 % of cases, HIV and some other viral infections from ТОRCH complex — in 23.6 %, HIV and tuberculosis — in 7 %, HIV and viral hepatitis В (VHВ) — in 1.4 %.

Keywords: HIV infection, tuberculosis, coinfection, VHВ, VHC.

Co-infection tuberculosis/HIV in Kharkov region in 2014 epidemiological analysis shows that the number of males prevails comparing with females in the structure of co-infection tuberculosis/HIV. Prevailed site of tuberculosis in HIV-infected persons is pulmonary tuberculosis (73, 4 %). Tuberculosis is a main secondary disease with HIV-infection and the main cause of death in AIDS stage. This demands mutual coordinated efforts of Phthisiology and anti AIDS services for in time prophylaxis and diagnosis of tuberculosis in HIV-infected persons.

Keywords: tuberculosis, HIV/ AIDS, epidemiology.