Pediatric tuberculosis is a health problem of special significance because it is a marker for current transmission of tuberculosis in society. The research aimed at analyzing the peculiarities of detection and course of pediatric extrapulmonary tuberculosis (EPTB) taking into account the profile of drug resistance. A retrospective study of medical charts of children with EPTB (n = 47; 1st group) and pulmonary tuberculosis (PTB) (n = 49; 2nd group) aged 0-15 for 2013-2020 has been conducted. 2 subgroups with EPTB were identified separately: resistant (EPRTB) (n = 23) and sensitive (EPSTB) (n = 24). Results and discussion. The frequency of EPTB was 9.8%. Tuberculosis of peripheral LN (40.5%), CNS (27.7%), bones and joints (23.4%) was significantly more often diagnosed, than other lesions. Almost half of children with EPTB had a miliary distribution. In 44.7% of children with EPTB contact with a patient with tuberculosis was not established. EPRTB was significantly more common among children under 1 and up to 3 years of age than EPSTB. The resistance to combination of HR (73.6%) was found more often than to HRES (10.5%), HRS, H and Z (5.3% each; p<0.01). In 73.9% of children with EPRTB was detected when seeking medical care, in 13.0% the time to diagnosing lasted 6 months. Among children with EPRTB, gradual course was more frequent and in 47.8% intoxication syndrome was dominating. 78.3% of children with EPRTB were not vaccinated. Conclusion. The above indicates the need to intensify preventive measures against tuberculosis among children, especially at risk groups, make monitoring of contacts and their treatment.

Objective — to analyze the peculiarities of detection and course of various clinical forms of extrapulmo­nary tuberculosis (EPTB), the profile of drug resistance of the Mycobacterium tuberculosis (MBT) among children of different ages. Materials and methods. We retrospectively analyzed the medical data of 47 children aged 0 to 14 with local forms of EPTB, hospitalized in the pediatric department of Lviv TB hospital from 2013 to 2020. Children were divided into groups: up to 1-year-olds (19 children; group I), 2—9 year-olds (19 children; group II) and 10—14-year-olds (9 children; group III). Results and discussion. It was found that children under 1 year of age were more likely to live in rural areas than in urban areas (78.9 vs. 21.1 %; p < 0.01). Resistant forms were diagnosed among 49.0 % of children. Among children of the first year of age this number reached 73.7 %, which is probably more often than among children aged 2—9 (26.3 %; p < 0.01). The numbers of multidrug-resistant TB (MDR-TB) and the risk of MDR-TB among children under one year of age were 35.7 and 28.6 %, respectively. The most common clinical form of EPTB was TB of peripheral lymph node (PLN) regardless of age (40.4 %). Only TB of PLN and TB of meningeal and CNS were found among children under 1 year of age. Among children aged 2—9, TB of PLN and TB of bone and joints were probably more common than all other localizations. TB of bones and joints among children aged 10—14 was more common than TB of eyes and skin. The proportion of TB of meninges and CNS in group I was probably higher compared to groups II and III (p1 < 0.01; p2 < 0.05). At the same time, TB of bones and joints among children of groups II and III was diagnosed significantly more often than in group I (p1 < 0.01; p2 < 0.05).In 89.4 % of cases EPTB was combined with pulmonary TB (PTB). Among children under one year of age, miliary PTB was diagnosed probably more often than other clinical forms (p < 0.05). Bilateral lesions were probably more common among children under one year of age than in children aged 10—14 (77.8 vs. 28.6 %; p < 0.05). Unilateral lesions were more common among children aged 10—14 than in children up to one year of age (22.2 vs. 71.4 %; p < 0.05). Children under 1 year of age and 2—9-year-olds were significantly more likely to be diagnosed with EPTB when seeking medical care than during examination of contact persons (63.2 vs. 26.3 %; 68.4 vs. 31.6 %; all p < 0.05) and during the preventive examination (10.5 % and 0; all p < 0.01). Also, EPTB was found more often among children aged 10—14 (66.7 vs. 0; p < 0.01). It was found that only 36.8 % of children of group I, 42.1 % of children of group II and 33.3 % of children of group III were sent to a specialized hospital after visiting the clinic.Patients under 1 year of age and 2—9-year-olds compared with children aged 10—14 were significantly more likely to have a combination of clinical manifestations of intoxication and bronchopulmonary syndromes (47.4 and 31.6 % vs. 0; p1 < 0.05; p2 < 0.01). At the same time, intoxication syndrome was significantly more common among children aged 10—14 than among children under one year of age (88.9 vs. 26.3 %; p < 0.01). Lack of vaccination was significantly more common among children under one year of age than in the following age groups (94.7 vs. 57.9 and 44.4 %; both p < 0.05), and the proportion of ineffective vaccinations was significantly higher among children aged 10—14 than in children under 1 year of age (55.6 vs. 5.3 %; p < 0.05). Conclusions. These data indicate the need to intensify preventive TB measures among children of different ages, as well as the need for enhanced control over vaccination, regular screening, monitoring of contacts among the adult population and their controlled treatment.

Pediatric tuberculosis (TB) is a serious infectious disease that affects many children worldwide and is more likely to be extrapulmonary than adult TB. The purpose - to analyze the profile of drug resistance of Mycobacterium tuberculosis and clinical features of extrapulmonary resistant (EPR) TB among children from Lviv region, Ukraine. Materials and methods. We analyzed all cases of EPR TB (n=23) and extrapulmonary sensitive (EPS) TB (n=24) among 478 medical charts of children, who were hospitalized in the Lviv Anti-TB hospital during 2013-2020. Results. It was found out that EPR TB was diagnosed significantly more often at the age of 1 year and up to 3 years old than EPS TB and significantly less often - among children aged 4-7 years. The children with EPR TB were significantly more likely to live in rural areas and they were significantly more likely to be from families with less than 2 children, compared to EPS TB. The children with EPR TB were more often diagnosed with meningeal and central nervous system (CNS) TB, less often - with TB of the bones and joints, only they had TB of the intestine, compared to EPS TB. Miliary pulmonary TB and the predominance of bilateral process were more common at EPR TB. Among children with EPR TB, rifampicin-resistant TB was significantly more common found than the risk of multidrug-resistant TB (MDR-TB) and monoresistant TB. The resistance profile of MDR-TB showed that 17.4% are resistant to the combination of HR (H-isoniazid, R-rifampicin), 8.6% - to HRES (E-ethambutol, S-streptomycin), 4.3% - to НRS. Among 43.5% of children with EPR TB the contact with a TB patient was not established. At the same time, only a third of children who had came into contact with bacterial exсretors were under dispensary observation and only about 9% received chemoprophylaxis. Conclusions. In order to prevent the development of EPR TB, it is necessary to improve TB prevention measures among the most vulnerable segments of the population. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

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The article is devoted to the issues of the cultural aspect of teaching the Latin language, optimization, and effectiveness of the study of the Latin language in order to update the methodological paradigm. The relevance of the article is due to the emergence of new priorities of higher medical education, the transition from a qualification approach in professional medical education to a competency-based one, where the emphasis is shifted from the "assimilation of knowledge" to the formation of "competences» that ensure professional terminological literacy of a specialist, as well as the need to find and develop optimal theoretical methods and practical methods, the use of modern innovative technologies and online methods aimed at improving educational outcomes, including in distance learning conditions. The cultural approach to teaching the Latin language is able to give new impulses that will positively influence the spiritual development, upbringing, and training of a new type of specialists - educated, competent, creative individuals who have the skills of self-education and are able to quickly respond to changes in the professional environment.