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 study the clinical effectiveness of chemotherapy using bedaquiline (Bdq) and delamanid (Dlm) in children and adolescents with multidrug-resistant (MDR) and extensive drug resistant (XDR) pulmonary tuberculosis of lungs (TBL). Materials and methods. A retrospective cohort analysis of the medical records of 40 patients with pulmonary tuberculosis (TB) with MDR/XDR was conducted in order to study the clinical effectiveness of chemotherapy with Bdq and Dlm. Among 40 patients were 25 (62.5 %) children aged 0 to 14 years and 15 (37.5 %) — teenagers aged 15 to 17; there were 18 (47.5 %) boys, 22 (52.5 %) girls. The patients were divided into two groups: the first group — 25 children and the second group — 15 teenagers. Microbiological research in children and adolescents included: detection of Mycobacterium tuberculosis (MTB) in sputum by smear microscopy, sowing of material on Levenstein—Jensen medium, typing of isolated mycobacteria on BACTEC MGIT 960, determination of the drug susceptibility test of strains of MTB to antituberculosis drugs (ATBDs) of first- and second-line, as well as molecular genetic research of sputum, in particular by GeneXpert MTB/RIF/Ultra and linear probe analysis. All children and adolescents received an individualized treatment regimen depending on the resistance of MTB to ATBDs or on the resistance of MTB at the source of infection. Results and discussion. Among the examined children (25), who were prescribed Bdq and Dlm, almost half (44.0 %) were aged from 0 to 4 years, 12.0 % — from 5 to 8 years and 44.0 % — from 9 to 14 years. Patients aged 17 years (46.7 %) prevailed among teenagers (15). MDR/RIF-TB was diagnosed in 10 (40.0%), XDR-TB determined in 3 (12.0 %) and risk of MDR-TB (RMDR-TB) — in 12 (48.0 %) children who were prescribed a new treatment regimen with Bdq and Dlm. At the same time, MDR-TB diagnosed 1.7 times more often, XDR-TB 2.8 times more often and RMDR-TB 3.3 times less often among adolescents compared to children.The primary tuberculous complex found in 12 (48.0 %) children, TB damage of lung and bone — in 4 (16.0 %), TB of the intrathoracic lymph nodes — in 3 (12.0 %), TB of the lungs and central nervous system — in 2 (8.0 %) and infiltrative TB of the lungs — in 3 (12.0 %). The infiltrative pulmonary TB was observed 7.5 times more often and the disseminated form 3.3 times more often in adolescents than in children.All children didn’t excretion of MTB after the two months of treatment with Bdq and Dlm. However, non-bacterial excretion in all adolescents was achieved within 3 months of chemotherapy (CT). Significant positive X-ray dynamics were found in 23 (92.0 %) children and 12 (80.0 %) adolescents during 9 months of CT. Lung changes remained in 2 (8.0 %) children and 3 (20.0 %) adolescents after 9 months of treatment. However, in both children and adolescents resolution of infiltration, densification of focies and formation of fibrosis in the lungs were confirmed radiologically at the end of the course of treatment. Conclusions. Among 21 (84.0%) children and 10 (66.7 %) adolescents were cured at the end of the course of complex treatment with the use of Bdq and Dlm. Treatment was completed 2 times more often in adolescents than in children (33.3 vs. 16.0 %, p < 0.05). The success of the treatment at the occurrence of new ATBDs was established in all children and adolescents. In addition, among 84.0 % children and 73.3 % adolescents the treatment ended with the formation of small residual changes.

The spread of respiratory diseases has become a topical issue of modern medicine. The prevalence of the diseases caused the rising rates of disability and mortality among people affected by respiratory diseases. The clinical course of respiratory diseases includes the disorders of general and local adaptive and protective mechanisms and cell-mediated connections. Objective — to determine the interleukin profile of serum and bronchoalveolar lavage for the verification of chronic obstructive pulmonary disease (COPD) or bronchial asthma in patients with pulmonary tuberculosis or pneumonia with bronchial obstruction syndrome. Materials and methods. 67 patients affected by chronic obstructive pulmonary disease and 33 patients diagnosed with bronchial asthma who were hospitalized in the Pulmonology Lviv Regional Diagnostic Center during 2015—2020, were examined. The patients were verified with a non-complicated tuberculosis without any destructive changes evident in the lungs (the first or third clinical category of patients), the community-acquired pneumonia with the bronchial obstruction syndrome. Pro-inflammatory interleukins IL-1β, IL-2, IL-6, TNF-α and anti-inflammatory IL-4 in serum and bronchoalveolar lavage were revealed during the lobar and tertiary bronchi fiber-optic bronchoscopy. Results and discussion. The interleukins misbalance was evident: the decrease in IL-1β and IL-2 and the increase in IL-6 and TNF-α by 4.5 times as compared to the unaffected donors was revealed in the patients with chronic obstructive pulmonary disease. The significant decrease in IL-4 was revealed pointing at the high probability of the severe and prolonged COPD and leading to frequent exacerbation and compilations of the disease. By contrast, the patients diagnosed with bronchial asthma showed higher IL-1β and IL-2 as compared to the unaffected patients; the level of IL-6 was higher as compared to the COPD patients, while TNF-α was lower. The patients with bronchial asthma showed higher IL-4 than the unaffected donors and the patients with COPD. Conclusions. The intensity of interleukins expression (especially pro-inflammatory) revealed the level of inflammation based on the acute-phase proteins in the proteolytic-antiproteolytic balance, which may be also used as the additional criteria for the differential diagnostics and justification for the treatment optimization.

Objective — to study the features of multidrug-resistant tuberculosis of the lungs of respiratory organs in children and adolescents from focuses of chemoresistant tuberculosis infection. Materials and methods. To study the features of the course of multidrug-resistant pulmonary tuberculosis (MDR-TB), an analysis of clinical, X-ray, microbiological, and generally accepted laboratory examinations was conducted in 256 patients (102 children and 154 adolescents), who were divided into two groups The main group included 145 patients with MDR-TB: of them, 67 (42.2 %) children and 78 (53.8 %) teenagers from focuses of multidrug-resistant tuberculosis infection (MDR-TBI). The control group consisted of 146 patients with «chemosusceptible» pulmonary tuberculosis (CS-TB), of which 70 (47.9 %) were children and 76 (52.1 %) were adolescents from focuses of chemosusceptible tuberculosis infection (CS-TBI). Results and discussion. In children with multidrug-resistant pulmonary tuberculosis (MDR-TB), along with classic forms of tuberculosis (primary tuberculosis complex — 14.9 % and tuberculosis of the intrathoracic lymph nodes — 14.9 %), miliary tuberculosis (11.9 %), tuberculosis of the lungs and central nervous system (5.9 %), caseous pneumonia (8.9 %) and fibro-cavernous tuberculosis (4.5 %) were diagnosed. In the case of MDR-TB of the lungs, adolescents were statistically significantly more likely to be diagnosed with infiltrative tuberculosis (29.4 %) and disseminated pulmonary tuberculosis (35.9 %). At the same time, destructive changes were observed 1.6 times more often in adolescents with MDR-TB than in children, especially with multiresistant specific process (70.5 % vs. 43.3 %, p < 0.05).In children with MDR-TB, 3.5 times more often than in chemosusceptible tuberculosis, signs of the progression of a specific process due to lymphogenous and hematogenous dissemination in the form of tuberculosis of peripheral, intrathoracic and mesenteric lymph nodes, miliary tuberculosis were observed in adolescents, along with complications of a specific complications of a non-specific nature were observed: respiratory failure and non-specific catarrhal endobronchitis). In both children and adolescents, the intensity of bacterial excretion is greater in the presence of MDR-TB than in CS-TB. In the foci of multiresistant infection, an almost complete coincidence of the nature of MTB resistance in children with the source of infection was established. However, teenagers are most often found to be resistant to the combination of HRSE (66.1 %), HRESZ (13.6 %), unlike adults and children. Conclusions. The majority of contact children and adolescents with MDR-TB was detected when referring to a general practitioner or a pediatrician (62.3 % of children and 70.5 % of adolescents), which became the main reason for underdiagnosis of tuberculosis in children and adolescents in general. Our studies show the importance of a thorough examination of all contact children and adolescents in focuses of tuberculosis infection: anamnesis studies, tuberculin diagnostics (quantiferon test), clinical, radiological and microbiological examination for the timely detection of tuberculosis or infection and the appointment of appropriate chemotherapy or chemoprophylaxis.

Objective — to investigate the personal attitude of 5th and 6th year students of the medical faculties of Danylo Halytskyi Lviv National Medical University to mixed forms of education, including distance learning, in the context of quarantine of the COVID-19 pandemic and martial law. Materials and methods. A questionnaire was conducted to study the personal attitude of the 5th and 6th year students of the medical faculties of Danylo Halytskyi Lviv National Medical University to the study of curricula in a mixed form of education during the autumn semester of the 2022—2023 academic year. Results and discussion. Among the survey participants, a third (33.7 %) noted that they felt more responsible for their studies, realised the opportunity to be in the learning process, i.  e. noted a change for the better, in general. However, 18.5 % of the respondents indicated a negative change, feeling indifferent. One third of students (39.1 %) rated their level of anxiety as high, and one third (33.7 %) as very high. It has been found that 30.4 % of students are engaged in volunteer activities alongside their studies, and more than half (53.2 %) are employed, including 30.4 % of all survey participants working in the medical field. Among the 6th year students, participation in volunteer activities increased compared to the 5th year students, and 39.7 % were engaged in it, and more 6th year students were also employed — 56.4 %. Among the negative factors for 80.4 % of the surveyed 5th year medical students, the priority was the lack of acquisition and improvement of practical skills, which is obvious. «Technical difficulties» came second. Distance learning had no impact on the desire to acquire knowledge in 72.3 % of students, and 27.7 % said they felt a lack of motivation to study after switching to distance learning. Conclusions. The war and martial law in Ukraine have become a source of stress for all participants in the educational process, so understanding students’ personal attitudes to learning is relevant and necessary in modern conditions. The use of information technology tools increases opportunities for both education and science. During the quarantine caused by the COVID-19 pandemic and martial law in Ukraine, the educational process did not stop, and the distance learning format, according to the vast majority of students surveyed, made it possible to continue studying medicine in relatively safe places.