Tuberculosis Research Institute Research Articles

Machine learning algorithms to predict treatment success for patients with pulmonary tuberculosis.

Despite advancements in detection and treatment, tuberculosis (TB), an infectious illness caused by the Mycobacterium TB bacteria, continues to pose a serious threat to world health. The TB diagnosis phase includes a patient's medical history, physical examination, chest X-rays, and laboratory procedures, such as molecular testing and sputum culture. In artificial intelligence (AI), machine learning (ML) is an advanced study of statistical algorithms that can learn from historical data and generalize the results to unseen data. There are not many studies done on the ML algorithm that enables the prediction of treatment success for patients with pulmonary TB (PTB). The objective of this study is to identify an effective and predictive ML algorithm to evaluate the detection of treatment success in PTB patients and to compare the predictive performance of the ML models. In this retrospective study, a total of 1236 PTB patients who were given treatment under a randomized controlled clinical trial at the ICMR-National Institute for Research in Tuberculosis, Chennai, India were considered for data analysis. The multiple ML models were developed and tested to identify the best algorithm to predict the sputum culture conversion of TB patients during the treatment period. In this study, decision tree (DT), random forest (RF), support vector machine (SVM) and naïve bayes (NB) models were validated with high performance by achieving an area under the curve (AUC) of receiver operating characteristic (ROC) greater than 80%. The salient finding of the study is that the DT model was produced as a better algorithm with the highest accuracy (92.72%), an AUC (0.909), precision (95.90%), recall (95.60%) and F1-score (95.75%) among the ML models. This methodology may be used to study the precise ML model classification for predicting the treatment success of TB patients during the treatment period.

Diagnosis of Drug Resistance of M. tuberculosis in the Regions of the Siberian Federal District

The objective: to assess possibilities for timely diagnosis of drug resistance of M. tuberculosis in the regions of the Siberian Federal District (SFD) with a high burden of drug resistant tuberculosis.Subjects and Methods. The retrospective analysis included federal and sectorial statistical reporting data (Form no. 33, Form no. 8, Form no. 30, Form no. 7-TB, Form no. 8-TB), forms of non-recurrent statistical surveillance VR-5MLU, Form no. 68, data from Visit Reports by specialists of Novosibirsk Tuberculosis Research Institute by the Russian Ministry of Health for 2021 – 9 months of 2023.Results. All laboratories of TB units in the regions of the Siberian Federal District are equipped with equipment for rapid molecular genetic diagnosis of M. tuberculosis, however, the majority of laboratories have no possibility to conduct rapid molecular genetic DST to fluoroquinolones. In a number of regions no DST to levofloxacin and moxifloxacin is performed. Susceptibility testing to linezolid and bedaquiline is conducted extremely rarely. Susceptibility testing to delamanid is performed in single cases and only in one region. To achieve treatment effectiveness rates defined in Edict no. 19 by Russian Ministry of Health dated February 07, 2023, it is necessary to equip TB units with modern equipment for rapid DST, organize an uninterrupted supply of consumables, as well as train laboratory personnel in the shortest possible time.

Integrated Approach in the Treatment of a Patient with Tuberculosis of the Lungs and Tracheobronchial Tree

Introduction. According to the World Health Organization data for 2021, there is an increase in the incidence of tuberculosis (TB) worldwide. There is also an unfavorable growth trend in drug-resistant TB. One of the complications of the tuberculosis process is tuberculosis of the tracheobronchial tree, which has tended to grow in recent years. Many studiesindicate the incidence of bronchial tuberculosis from 10 to 40 %, taking into account the level of endoscopic service.The purpose of the study to demonstrate the high effectiveness of an integrated approach in the treatment of a patient with tuberculosis of the lungs and tracheobronchial tree.Methods. The materials of the study were: the outpatient card of the advisory department of the Central Tuberculosis Research Institute, the medical history of the inpatient patient and the results of a comprehensive examination.Results. The presented clinical example demonstrates the high effectiveness of an integrated approach in the treatment of a patient with a widespread tuberculosis process using anti-tuberculosis chemotherapy, inhalation and pathogenetic therapy. By 4 months of treatment, pronounced positive clinical and laboratory dynamics was observed, significant resorption of focal infiltrative changes in the leſt lung was achieved radiologically, and endoscopically, infiltrative tuberculosis of the trachea, leſt main bronchus and leſt upper lobe bronchus was cured.Conclusion. This clinical observation demonstrates the need for an integrated approach in the management of this category of patients and shows the high effectiveness of the treatment.

Monitoring the Cardiotoxic Effects of Bedaquiline in Older Children and Adolescents with Multiple and Extensive Drug Resistance

The objective: to evaluate expanded monitoring of cardiovascular disorders in older children and adolescents with multiple drug resistant tuberculosis receiving bedaquiline (Bq) as a part of anti-tuberculosis therapy.Subjects and Methods: A cohort retrospective-prospective study (2015-2021) was conducted, which included 36 patients aged 13-17 years old who received Bq. The prospective part included 19 patients (Main Group), they underwent extended monitoring (EM) of cardiotoxic reactions; this extended monitoring program was developed in Central Tuberculosis Research Institute. The retrospective part included 17 patients (Control Group), in whom cardiotoxic reactions were assessed using standard monitoring recommended by the Russian Society of Phthisiologists at that time. The relationship between the studied risk factor (monitoring by standard ECG) and the outcome (Bq discontinuation) was assessed using the Pearson χ2 test.Results. Prolongation of the QTc interval > 0.440 ms was noted in 17.6% of cases in Control Group and it was regarded as a cardiotoxic effect of Bq, the drug was discontinued. In Main Group, prolongation was noted in 47.3% of cases which was considered a functional disorder of the cardiovascular system according to EM, the drug was not discontinued, χ2 = 3.896; p = 0.049. EM can be used in older children and adolescents with multiple drug resistant respiratory tuberculosis, which will make it possible to safely include Bq to chemotherapy regimens.

Specific Features of the Course and Treatment of Respiratory Tuberculosis in Women during Pregnancy and Postpartum Period. Perinatal Outcomes

The objective: to study specific features of the respiratory tuberculosis course and effectiveness of its treatment during pregnancy and postpartum period, and to evaluate the impact of tuberculosis on perinatal outcomes.Subjects and Methods. In 2010 - 2022, a retrospective-prospective case-control study enrolling 164 patients of reproductive age was conducted in Central Tuberculosis Research Institute. Two groups were formed: Case Group included 82 pregnant women with respiratory tuberculosis; Control Group included 82 non-pregnant patients with respiratory tuberculosis.Results. In both groups, new cases of respiratory tuberculosis were notified more often versus relapses. Distinctive features of respiratory tuberculosis in pregnant women versus the non-pregnant were as follows: the predominance of the proportion of extensive drug resistant M. tuberculosis – 55.5% versus 31.7% (p<0.05), respectively; lower frequency of lung tissue destruction – 18.3% versus 32.9% (p≤0.05); higher incidence of cavities - 80% and 40.7% (p≤0.05) and complications of respiratory tuberculosis – 25.6% versus 12.2% (p≤0.03), respectively. The high effectiveness of respiratory tuberculosis treatment such as relief of clinical symptoms and sputum conversion was achieved at the end of the intensive therapy phase both in Case Group and Control Group. Longer time until sputum conversion and lower rate of cavity healing were reported in the patients from Case Group. In 75.6% of pregnant women from Case Group there was a delivery with favorable perinatal outcomes.

Experience of valve bronchial block in pulmonary tuberculosis patients with local inflammatory changes of the bronchial tree

The objective: to study results of bronchial block in pulmonary tuberculosis patients depending on the presence of local infl ammatory changes in their bronchial tree, the frequency and nature of complications in this category of patients.Subjects and Methods. In order to achieve the above objective, in 2018–2019 in Novosibirsk Tuberculosis Research Institute, all patients who had indications for bronchial block were enrolled in the study. 275 tuberculosis patients were divided into 2 groups: Main Group (n=108) consisted of the patients with infl ammatory changes in their bronchial tree, while Comparison Group (n=167) included patients with no such changes. The valve bronchial block was implanted, effi cacy of treatment and complications that developed were evaluated. Results. Effi cacy of valve bronchial blocking did not depend on the presence of local infl ammatory changes in the bronchi, so it can be used without waiting for the relief of infl ammatory changes. The profi le of complications in the groups was comparable.

Surgical treatment of respiratory tuberculosis patients in the Siberian and Far Eastern Federal Districts during the initial period of the COVID-19 pandemic

The objective: to analyze the quality of phthisiosurgical care in the Siberian and Far Eastern Federal Districts monitored by Novosibirsk Tuberculosis Research Institute (NTRI).Subjects and Methods. Statistical reports for 2019 from phthisiosurgical departments of 17 Russian regions within the Siberian and Far Eastern Federal Districts were analyzed. The reports refl ected the initial period of the pandemic.Results. The analysis of the quality of phthisiosurgical care in the Siberian and Far Eastern Federal Districts covered the areas monitored by Novosibirsk Tuberculosis Research Institute, the Russian Ministry of Health. The main performance rates of phthisiosurgical departments of 17 Russian regions are presented for 2019, they demonstrate a positive trend, and their facilities and resources have signifi cantly improved. The trend towards reduction of phthisiosurgical beds is observed in the regions, which may be due to the service centralization and improved access to surgical and high-tech care in federal institutions. Surgical departments possesses substantial reserves for increasing the number of surgeries, one of which is the revision of cohorts.

Parameters of Complete Blood Count and Blood Chemistry during Treatment of Patients with MDR/XDR Pulmonary Tuberculosis with a Short-Course Regimen Containing Bedaquiline, Pretomanid, and Linezolid

The objective: assessment of changes in the parameters of complete blood count, clinical urine tests, and blood chemistry during chemotherapy of patients with MDR/XDR pulmonary tuberculosis receiving the short-course regimen containing bedaquiline, pretomanid, and linezolid (B-Pa-L).Subjects and Methods. 18 patients with MDR/pre-XDR/XDR pulmonary tuberculosis were enrolled into the study. They all received treatment at Central Tuberculosis Research Institute from 2015 to 2022.Results. In the course of chemotherapy of these patients, changes in laboratory test results were noted at different times. Abnormal changes in complete blood count were detected in 10/18 (55,6%) patients during chemotherapy for the 1st time. Hemoglobin levels, erythrocyte and leukocyte counts decreased. Hematuria and bacteriuria were detected by clinical urine test. Proteinuria was observed in almost in half of the patients. Elevated serum potassium level was frequently noted. Blood chemistry demonstrated elevated levels of ALT and AST, which is typical of cytolytic effect on hepatocytes of drugs within chemotherapy. In most cases, all above abnormalities were degree 1 of toxicity and resolved within 2-4 weeks after they were detected. Abnormalities in grade 2-3 of toxicity were mainly observed in patients receiving linezolid at the dose of 1200 mg/day. In most cases, the above abnormalities were detected during the first 4 weeks of chemotherapy.

Comprehensive analysis of research outcomes from selected Indian Council of Medical Research Institutes

Background: Given the importance of the ICMR in shaping the research landscape in India, it is essential to understand the research outcomes produced by the various ICMR institutes over the years. Aim and Objectives: This study aimed to analyze the research outcomes from the top six selected Indian Council of Medical Research (ICMR) institutes over a period of 33 years, from 1989 to 2021. Materials and Methods: The six ICMR institutes analyzed were the National Institute for Research in Reproductive Health, the National Institute for Research in Tuberculosis, the National Institute of Cholera and Enteric Diseases, the National Institute of Malaria Research, the National Institute of Nutrition, and National Institute of Virology. Results: A total of 8174 research outcomes were identified, including research articles, review articles, and meeting abstracts. The study analyzed the relative growth rate and doubling time, document types, top journals and research areas, and collaborations and funding agencies associated with these outcomes. The study found that there was a steady growth in research productivity over the years, although a decline was observed in 2021, possibly due to the COVID19 pandemic. The study also identified specific institutes that had the maximum number of publications in certain fields, such as immunology. Conclusion: The study's findings can provide valuable insights for policymakers, funding agencies, and researchers interested in understanding the research landscape and trends in India..

Primary drug resistance of M. tuberculosis according to the Center of Excellence of the WHO Network of Supranational Reference Laboratories of the CTRI in 2016–2021

ntroduction. Culture research and testing of Mycobacterium tuberculosis (MBT) for drug susceptibility in the Russian Federation is carried out with uneven qual-ity, which distorts the idea of primary drug resistance (DR). Aim. To study the primary DR of MBT to the main combinations of anti-TB drugs for 2016–2021 according at the Center of Excellence of the WHO Supranational Reference Laboratories Network at the Central Tuber-culosis Research Institute. Methods. Data on drug sus-ceptability and frequency of resistance to the main com-binations of anti-TB drugs (in accordance with updated definitions) of MBT isolated before treatment were stud-ied in 966 new TB cases from 69 regions of the Russian Federation examined at the Center of Excellence of the WHO Supranational Reference Laboratories Network at the Central Tuberculosis Research Institute from 2016 to 2021. Results. The rate of any primary drug resistance to rifampicin was 46.2%; 95% CI [43.0–49.3], MDR — 45.8%; 95% CI [42.6–48.9], pre-XDR — 24.2%; 95% CI [21.5–27.0], XDR — 5.4%; 95% CI [3.3–8.0]. Over time, there was a decrease in primary MDR MBT from 48.7% in 2016 and 54.9% in 2017 to 36.8% in 2021. The frequency of pre-XDR did not change during the observation peri-od. There was a statistically significant increase in the incidence of primary XDR from 2.1%; 95% CI [0.4–11.1] in 2016 and 0.0% in 2017 to 11.0%; 95% CI [6.1–19.1] in 2021 (p=0.03). Conclusion. The rate of primary MBT drug resistance to the main anti-TB combinations, ac-cording to our study, significantly exceeds the overall figures for Russian Federation. This suggests that the situation with MDR, pre-XDR, and XDR tuberculosis in the Russian Federation is much more alarming than we see from the regular reports, while the quality of local microbiological diagnostics on is insufficient

Экспедиция Московского научноисследовательского института туберкулеза Министерства здравоохранения РСФСР в Калмыцкую АССР в 1963 г.

Introduction. From July to October of 1963, a medical expedition of Moscow Tuberculosis Research Institute (RSFSR Ministry of Health) was working in the Kalmyk ASSR. Goals. The article seeks to introduce into scientific circulation some data on the tuberculosis surveys conducted across the Kalmyk ASSR. Results. The work is the first to examine the efforts undertaken by scientific associates affiliated to the mentioned TB research institute and physicians of Radiology Institute aimed at investigating tuberculosis epidemiology and rendering organizational, methodical, and therapeutic assistance in tuberculosis control. The paper also publishes the Expedition Report prepared by its leader — Dr. B. Varsava, then a senior researcher at Moscow Tuberculosis Research Institute. The expedition examined ca. 10,000 residents of Yustinsky District (Kalmyk ASSR), the identified TB patients received qualified medical treatment, while attached medical professionals of the Republic undertook additional training.

Problems of anti-tuberculosis therapy in patients on hemodialysis

The objective: to determine possibility of prescribing and safety of various anti-tuberculosis drugs and their combinations as part of a therapeutic or preventive course of anti-tuberculosis therapy (ATBT) in patients with end-stage chronic kidney disease (CKD) receiving hemodialysis replacement therapy in the settings with high prevalence of drug resistant strains of Mycobacterium tuberculosis.Subjects and Methods. 42 patients receiving hemodialysis replacement therapy were followed-up by Central Tuberculosis Research Institute: of them, 31 (73.8%) had active tuberculosis and 11 (26.2%) had residual post-tuberculous changes in the respiratory organs. During the follow-up, the nature and severity of adverse reactions to anti-tuberculosis drugs were assessed.Results. In the patients with end-stage CKD suffering from respiratory tuberculosis, drug resistant strains prevailed – 68.2%. Some of adverse events developed when taking anti-tuberculosis drugs were as follows: deterioration of uremia in 20.5% of cases, cardiovascular complications – in 17.9%, and neurotoxic reactions – in 15.4%. Progression of uremia occurred more often in the followed-up patients taking anti-tuberculosis drugs versus hepatotoxic reactions (p = 0.02). When treating tuberculosis patients with end-stage CKD, isoniazid was discontinued due to adverse events in 12.8% of cases and pyrazinamide in 12.8% of cases, other drugs were discontinued less frequently. Compilation of individual regimens of anti-tuberculosis drugs with the consideration of drug susceptibility testing results, contraindications, and concomitant diseases made it possible to provide an adequate anti-tuberculosis therapy for patients with end-stage CKD with tuberculosis infection in 92.9% of cases for a period of more than 6 months.

Mycobacterium tuberculosis Lineages Associated with Mutations and Drug Resistance in Isolates from India.

ABSTRACTCurrent knowledge on resistance-conferring determinants in Mycobacterium tuberculosis is biased toward globally dominant lineages 2 and 4. In contrast, lineages 1 and 3 are predominant in India. In this study, we performed whole-genome sequencing of 498 MDR M. tuberculosis isolates from India to determine the prevalence of drug resistance mutations and to understand the genomic diversity. A retrospective collection of 498 M. tuberculosis isolates submitted to the National Institute for Research in Tuberculosis for phenotypic susceptibility testing between 2014 to 2016 were sequenced. Genotypic resistance prediction was performed using known resistance-conferring determinants. Genotypic and phenotypic results for 12 antituberculosis drugs were compared, and sequence data were explored to characterize lineages and their association with drug resistance. Four lineages were identified although lineage 1 predominated (43%). The sensitivity of prediction for isoniazid and rifampicin was 92% and 98%, respectively. We observed lineage-specific variations in the proportion of isolates with resistance-conferring mutations, with drug resistance more common in lineages 2 and 3. Disputed mutations (codons 430, 435, 445, and 452) in the rpoB gene were more common in isolates other than lineage 2. Phylogenetic analysis and pairwise SNP difference revealed high genetic relatedness of lineage 2 isolates. WGS based resistance prediction has huge potential, but knowledge of regional and national diversity is essential to achieve high accuracy for resistance prediction.IMPORTANCE Current knowledge on resistance-conferring determinants in Mycobacterium tuberculosis is biased toward globally dominant lineages 2 and 4. In contrast, lineages 1 and 3 are predominant in India. We performed whole-genome sequencing of 498 MDR M. tuberculosis isolates from India to determine the prevalence of drug resistance mutations and to understand genomic diversity. Four lineages were identified although lineage 1 predominated (43%). The sensitivity of prediction for isoniazid and rifampicin was 92% and 98%, respectively. We observed lineage-specific variations in the proportion of isolates with resistance-conferring mutations, with drug resistance more common in lineages 2 and 3. Disputed mutations (codons 430, 435, 445, and 452) in the rpoB gene were more common in isolates other than lineage 2. Phylogenetic analysis and pairwise SNP difference revealed high genetic relatedness of lineage 2 isolates. WGS based resistance prediction has huge potential, but knowledge of regional and national diversity is essential to achieve high accuracy for resistance prediction.

Application of mobile phone technology as intervention for the management of tuberculosis patients diagnosed through community survey.

The delay in communicating the results to tuberculosis (TB) patients leads to increased rates of initial loss to follow up of treatment. The gap in communication among healthcare providers requires application of new tools that will address the challenges. Mobile phone technologies could be a useful tool in this context for the delivery of information. The objective was thus to evaluate communication by mobile applications such as the WhatsApp Messenger to decrease initial loss to follow up after initial treatment for TB. Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India undertook a community prevalence survey to find the burden of TB. During this survey, mobile phone-based technology (WhatsApp messenger) was employed as an intervention among the healthcare providers and researchers involved for communicating. This was further evaluated for its usefulness by examining the initial loss to follow up and patients initiated on treatment. The study covered four blocks of Thiruvallur district of Tamil Nadu, South India, namely Kadambathur, Poondi, Thiruvalangadu and Periyapalayam. The survey population was around 20,000 from each block, and the average patients diagnosed by community TB prevalence survey were 30 patients from each block. Among the patients diagnosed through this survey, in the first block, only 55 per cent were initiated on treatment; subsequently, with the intervention, the initial loss to follow up was significantly reduced from 45 to zero per cent. After integrating of WhatsApp messenger application for communication among healthcare providers and researchers, the initial loss to follow up among patients being treated for TB was significantly decreased.

Phenomenon of Demikhov. At N.V. Sklifosovsky Institute (1960–1986). V.P. Demikhov and world transplantology in 1968-1969

The article has reviewed the advances of Soviet and world Transplantology in the field of heart and other organ transplantation achieved by the end of the 1960s. It is shown that there were several groups of doctors and scientists who worked in the USSR dealing with the problem of experimental organ transplantation and trying to bring this experience into clinic. The group of surgeons and urologists (B.V. Petrovsky, Y.M. Lopukhin, etc.) from the Research Institute of Clinical and Experimental Surgery and the 2nd MOLGMI named after N.I. Pirogov, which had the greatest administrative resources and technical capabilities, was successfully implementing kidney transplantation into clinic. The staff of the Faculty Surgery Department (V.S. Savelyev and others) of the 2nd MOLGMI named after N.I. Pirogov developed experimental approaches to heart and liver transplantation. Surgeons from the Tuberculosis Research Institute (N.I. Gerasimenko and others) were dealing with in lung auto- and homotransplats in experiment. All those studies were conducted in close contact with the Department of Operative Surgery and Topographic Anatomy of the 2nd MOLGMI named after N.I. Pirogov (G.E. Ostroverkhov) and the Research Laboratory for Organ Transplantation established at that Department (Y.M. Lopukhin). The leading position in heart transplantation in the country belonged to the Vishnevsky Institute of Surgery (A.A. Vishnevsky, etc.). Surgeons of the MMA named after S.M. Kirov (I.S. Kolesnikov, etc.) rendered a great assistance to the Institute. Apart from these institutions, the Organ Transplantation Laboratory (headed by V.P. Demikhov) worked at N.V. Sklifosovsky Research Institute for Emergency Medicine; it had gained a huge experimental experience, but had very modest opportunities to purchase equipment and pharmaceuticals, to conduct laboratory and morphological studies, having practically no prospects for introducing the results of its research into clinic. Meanwhile, the world clinical Transplantation continued to develop successfully, which was reflected in the materials of the 2nd International Symposium on Heart Transplantation held in 1969 in Montreal (Canada).

Tongue cancer in a patient with pulmonary tuberculosis. Case report

Tuberculosis and malignant neoplasms are a global threat, these diseases claim millions of lives and cause tremendous suffering to people worldwide. Tuberculosis can mask cancer and create preconditions for carcinogenesis. The article presents a clinical case of tongue cancer in a patient with pulmonary tuberculosis. Patient B.N., 45 years old, was admitted to the FSBI Novosibirsk Tuberculosis Research Institute with complaints of a "sore place" on the tongue, pain in the right half of the tongue, enlargement of the submandibular lymph nodes on the right The tongue hurts for about 1,5 years, but over the last 2 months, condition has worsened. The patient noticed an increase in the size of lesion on the tongue and increased pain, especially during meals (he can eat only after pain relief, for which he takes Nimesulide 4 pills a day). In recent days, he felt also epigastric pain for which he didnt visit a doctor. Tongue biopsy was performed, and histological analysis revealed cancer. The patient was diagnosed with fibrous-cavernous tuberculosis of the upper lobe of the right lung, infiltration and seeding phase; mycobacterium tuberculosis (+); broad drug resistance (HRSECmKmPasCsOfl); gastric ulcer (0,5 cm), exacerbation stage; chronic erosive gastritis, exacerbation stage; malignant neoplasm of the floor of the mouth on the right T3(4)N1M1. With this diagnosis, the patient was discharged for further treatment by oncologists. Physicians need to have a high alertness for cancer in patients with tuberculosis, especially those in the high-risk group. A minimum of standard diagnostic procedures will allow you to verify the diagnosis timely.

Evaluation of a new assay for nontuberculous mycobacteria species identification in diagnostic material and cultures

The purpose of the present study was to evaluate a real-time PCR system for 12 nontuberculous mycobacteria (NTM) species identification developed by Central Tuberculosis Research Institute (CTRI; Moscow, Russia) in cooperation with Syntol LLC (Moscow, Russia). NTM cultures (210 strains, 19 species), Mycobacterium tuberculosis complex (MTBC) cultures (21 strains, 2 species), non-mycobacterial microorganisms (18 strains, 13 species) were used for the first stage of the assay evaluation. Clinical samples (sputum, N = 973) positive for smear microscopy and MTBC/NTM DNA by a PCR-based screening assay collected from 819 patients were used for specificity and sensitivity evaluation. Sensitivity for determining the NTM species directly from diagnostic material was 99.71%, with the specificity of 100%. The sensitivity and specificity for NTM species identification in cultures was 99.67% and 100%, respectively. Both sensitivity and specificity for determining MTBC in cultures was 100%.

You are not born a Person, you become a Person

A surgeon working in the northern regions of Yakutia, chief physician, resident physician at the Second Pirogov Moscow ‘Order of Lenin’ State Medical University, surgeon-phthisiologist of Yakutia Institute for Research in Tuberculosis—this is the quality path of Innokenty Vinokurov in his career of a doctor and an innovative surgeon and phthisiologist. This professional development was underpinned by a number of great human qualities such as keen-witted character, strong work ethic, strong will of a northerner, commitment, curiosity, refined perception of the environment, creativity in everything he ever attempted to do. An innovative surgeon, a research scientist, a novelist—Innokenty Vinokurov, who dedicated more than 40 years of his life to healing and serving others, fell victim to the horrible pandemic of the 21st century, which took his life on June 21, 2020.

Strengthening resilience to reduce HIV risk in Indian MSM: a multicity, randomised, clinical efficacy trial

SummaryBackgroundMen who have sex with men (MSM) in India are extremely marginalised and stigmatised, and therefore experience immense psychosocial stress. As current HIV prevention interventions in India do not address mental health or resilience to these stressors, we aimed to evaluate a resilience-based psychosocial intervention in the context of HIV and sexually transmitted infection (STI) prevention.MethodsWe did a multicity, randomised, clinical efficacy trial in Chennai (governmental tuberculosis research institute) and Mumbai (non-governmental organisation for MSM), India. Inclusion criteria were MSM, aged 18 years or older, who were at risk of HIV acquisition or transmission, defined as having any of the following in the 4 months before screening: anal sex with four or more male partners (protected or unprotected), diagnosis of an STI, history of transactional sex activity, or condomless anal sex with a man who was of unknown HIV status or serodiscordant. Participants were required to speak English, Tamil (in Chennai), or Hindi (in Mumbai) fluently. Eligible individuals were randomly assigned (1:1) to either a resilience-based psychosocial HIV prevention intervention, consisting of group (four sessions) and individual (six sessions) counselling alongside HIV and STI voluntary counselling and testing, or a standard-of-care control comprising voluntary counselling and testing alone. The primary outcomes were number of condomless anal sex acts with male partners during the past month (at baseline and 4 months, 8 months, and 12 months after randomisation), and incident bacterial STIs (at 12 months after randomisation). Resilience-related mediators included self-esteem, self-acceptance, and depression. Recruitment is now closed. This trial is registered with ClinicalTrials.gov, NCT02556294.FindingsBetween Sept 4, 2015, and June 28, 2018, we enrolled 608 participants; 305 (50%) were assigned to the psychosocial intervention condition and 303 (50%) were assigned to the control condition. 510 (84%) of 608 men completed an assessment at 4 months after randomisation, 483 (79%) at 8 months, and 515 (85%) at 12 months. 512 (99%) of 515 men had STI data from the 12-month assessment. The intervention condition had a 56% larger reduction in condomless anal sex acts (95% CI 35–71; p<0.0001) from baseline to 4-month follow-up, 72% larger reduction (56–82; p<0.0001) from baseline to 8-month follow-up, and 72% larger reduction (53–83; p<0.0001) from baseline to 12-month follow-up, compared with the standard-of-care control condition (condition by time interaction; χ2=40.29, 3 df; p<0.0001). Improvements in self-esteem and depressive symptoms both mediated 9% of the intervention effect on condomless anal sex acts. Bacterial STI incidence did not differ between study conditions at 12-month follow-up.InterpretationA resilience-based psychosocial intervention for MSM at risk of HIV acquisition or transmission in India was efficacious in reducing condomless anal sex acts, with evidence for mediation effects in two key target resilience variables. HIV prevention programmes for MSM in India should address mental health resilience to augment reductions in the risk of sexually transmitted HIV.FundingNational Institute of Mental Health.

Psychological factors influencing the formation of therapeutic cooperation in pulmonary tuberculosis patients undergoing in-patient treatment

The objective of the study: the comparative study of psychological characteristics of pulmonary tuberculosis patients with different levels of therapeutic cooperation during in-patient treatment.Subjects and nethods. 318 pulmonary tuberculosis patients aged 18-60 years old were enrolled in the study; they all underwent in-patient treatment in Central Tuberculosis Research Institute in 2017-2019, of them 195 (61.3%) were women and 123 (38.7%) were men. In all patients, the level of therapeutic cooperation was studied using the specially designed questionnaire; psychological characteristics were assessed using certain psychodiagnostic methods.Results. It was found that the proportion of patients with a high level of therapeutic cooperation (44.3% of cases) significantly prevailed versus patients with low (29.6% of cases) (Pearson χ2 = 9.4; p &lt; 0.01) and moderate level of cooperation (26.1% of cases) (Pearson χ2 = 15.02; p &lt; 0.001). A comparative study of the psychological characteristics of pulmonary tuberculosis patients demonstrating different levels of therapeutic cooperation allowed identifying psychological prognostic parameters of therapeutic cooperation, the main of which were the severity of suspicion, negative affective states (irritability, aggressiveness), distrustful-skeptical style of interaction, confrontation with others, as well as the level of quality life, primarily the emotional and social aspects of functioning. The detected psychological differences are considered as targets of psychological work focused on the formation of appropriate therapeutic cooperation during in-patient treatment.