The review of the recommendations "Tuberculosis among children" according to general sections with the point on the methods of diagnosing and increasingly on five chemotherapy regimens which are formed depending on mycobacteria's drug sensitivity. Special attention is paid to treatment regimens of the drug-resistant tuberculosis and chemotherapy schemes including new anti-tuberculosis drugs - Bedaquiline and Linezolid in combination with fluoroquinolone. The criteria of the prescription of short chemotherapy regimens that weren't applied previously to cure tuberculosis with multi-drug resistance of the pathogen were presented. Clinical guidelines were developed and introduced into practice to help medical practitioners and provide an appropriate anti-tuberculosis medical treatment in particular clinical cases.

In 2020 the world faced new infectious disease which required unprecedented epidemic measures. The pandemic of COVID-19 can affect the spread and courses of other diseases including tuberculosis infection. The analysis of the publications in online databases Medline, PubMed and Scopus was conducted following the description of the accompanying pathologies of the patients suffering from new coronavirus infection from December 2019 to October 2020. 32 articles presenting information about 152,000 COVID-19 patients having accompanying pathology were chosen. More often such pathologies as arterial hypertension (21.2 %), diabetes (12.1 %), chronic lung diseases (4.2 %) and oncology diseases (0.3 %) were found. The combination of COVID-19 and tuberculosis was registered by different authors in 0.3-8.3 % cases, more often in countries with high level of tuberculosis (China and India).

Tuberculosis is still a pressing issue in Russia. Due to this fact timely vaccination of tuberculosis patients is highly important in order to protect them from accompanying infectious diseases. Evaluation data on clinical and immunological effectiveness of the vaccine against pneumococcus, flue, diphtheria, lockjaw, hepatitis B, measles, epidemical parotitis and other infections is presented. The safety of using mono-combined vaccines, and also their coimmunization in different body parts of the infected with tuberculosis mycobacteria is underlined. Modern views on conjugate and adjuvant vaccines which help to save vaccine-induced immunity for a long time are highlighted. Despite on the lack of data on tuberculosis patients' vaccination against SARS-COV-2, the authors' opinion is that theoretically there is no reason for exemption of this contingent from immunization with that vaccine and also immunization according to national immunization calendar in the period of current epidemics.

Issues on the effectiveness of stenotic esophagus cancer and the ways of multimodal approach to the therapy of such kind of pathology are being discussed. The possibility of the intraluminal surgery (photodynamic therapy and stenting) as an alternative to operative treatment is discussed. It allows to improve the quality and to prolong life of the patients having stenotic cancer of the upper part of the digestive tract.

The lecture is devoted to the current approaches to diagnosing and treating tuberculosis of bones and joints among children. Issues of the evidentiary standards of the diagnosis "tuberculosis of bones and joints" and peculiarities of the skeletal-related event of anti-tuberculosis immunization are discussed. It is highlighted that according to WHO's recommendations tuberculosis can be considered as diagnosed, but not proved and also as diagnosed and verified. Diagnosis is considered verified when it has bacteriological proof. The specific character of the bone disorder can be diagnosed only by testing material from lesion. The surgical treatment of the tuberculosis of joints and bones among children should be as close as possible to the moment of diagnosing. After surgery chemotherapy is conducted taking into account verification of the pathogenic strains and its drug sensitivity. Thus tuberculosis of joints and bones among children requires two-level proof of the diagnosis, its stage-by-stage verification and syndrome-nosologic support.

Objective: The assessment of the level of interferon-у (IFN-y) production after stimulation by specific antigens in case of a polymorphic variation of (T-1488C) IFNG gen among children.

Methods: From 2014 to 2018 prospective cross-sectional study of 160 children under 18 years old was conducted. 81 of them had tuberculosis, 72 - latent tuberculosis infection and 16 - non-infected.

Results: It was determined that polymorphic variation of (T-1488C) IFNG gen is connected with tuberculosis and its heterozygous genotype can be considered as a marker of a high risk of a disease.

Conclusions: Polymorphic variation of (T-1488C) IFNG gen is associated with the different level of immune response against separate specific antigens - according to the assessment of the level of induced IFN-y which decreased in case of heterozygous and homozygous genotype for an allele C. The existence of homozygous genotype for an allele T was associated with the high level of IFN-y production after specific stimulation among the children having latent tuberculosis infection.

Objective: To estimate the effectiveness of the preventive tuberculosis treatment among children having autoimmune systemic diseases who get immunosuppressive therapy.

Methods: A cohort study of 59 participants under 17 years old was conducted. They got treatment for their rheumatic diseases in specialized medical institutions and were sent for phtisiatrician consultation because of the high risk of tuberculosis progression. Thanks to the doctor's scheme of actions and according to the screening results the preventive anti tuberculosis therapy was prescribed. Then the frequency of active tuberculosis progression was estimated.

Results: There is a high level of effectiveness of the preventive anti-tuberculosis measures among children who get immunosuppressive therapy: there were no cases of active tuberculosis.

Conclusions: Preventive anti-tuberculosis measures developed for children getting immunosuppressive drugs allow reducing the risk of active tuberculosis progression significantly.

Objective: To estimate epidemiological factors of the tuberculosis progression among children and teenagers under current conditions.

Methods: Epidemiological indicators on tuberculosis in Moscow region for the period from 2014 to 2019 have been analyzed according to the forms of Federal Statistic Survey.

Results: There is a decrease of tuberculosis disease rate in Moscow region among children and teenagers. The increase of preventive examination coverage by 1.6 times when tuberculosis was identified allowed to take timely preventive measures and to reduce the morbidity among children and adults living in the outbreaks of the infection by 11.8 times. The enhance of the effectiveness of preventive measures is due to the introduction of the sample of tuberculosis recombinant allergen. It increased the commitment of the parents to the preventive treatment of the children and teenagers up to 92.9 %.

Conclusions: Early and timely detection of tuberculosis and working in the outbreaks of tuberculosis infection preserve relevance under the conditions of tuberculosis disease. High risks of tuberculosis progression among children and adults defined contacts with a person discharging bacteria, also multiple drug resistance of the mycobacteria and the availability of the outbreak formed by patients having co-infection HIV+tuberculosis.

Objective: The analysis of the age and gender patterns of the linear parameters of the spleen of children and adolescents on the basis of intravital imaging.

Methods: Sizes of spleens on the level of the middle of bodies' vertebras Th_XI-L_III were defined on computer tomograms of abdomens of 75 children and adolescents divided into 4 groups (early childhood, first childhood, second childhood, and adolescence).

Results: There was a growth of the long axis of the spleen on the level of Th_XII among boys from 2^nd and 4th age groups, among girls - only in the 4^th group. The reliable difference of this parameter on the level of L_I was observed only among boys from the 2^nd group. The long axis of the boys turned out to be bigger than girls' on the level of Th_XII in 1^st and 2^nd groups. With age a significant growth of the diameter of the organ was defined among girls from the 4^th group on levels of Th_XII and L_I. The reliable increase of this parameter was noticed among boys from the 2^nd group on the level of Th^XII and from the 4^th group on levels of Th_XII and L_I. The differences in the average indexes of the diameter of the organ between girls and boys were defined in the 2^nd group on the level of Th_XII. Significant increase of the diameter of spleen was defined among boys from 2^nd and 4th groups in comparison with previous age periods.

Conclusions: Among boys the size of the spleen significantly increased statistically in groups of 1^st childhood and among adolescents. Among girls the reliable increase of the long axis and diameter of spleen was registered among adolescents. There was no reliable increase in height in any group (in comparison with previous ages). The long axis of spleen was significantly bigger among boys, than among girls in early and 1^st childhood age, spleen diameter - in 1^st childhood age. The reliable differences in the indexes of the height of spleen between girls and boys within age groups weren't identified.

Objective: To estimate factors influencing healing of the pulmonary tumor cavitation in case of valve bronchial block (VBB) among patients having tuberculosis and low motivation to take anti-tuberculosis medicines.

Methods: 135 patients having destructive tuberculosis and low motivation for treatment were studied according to factors influencing the effectiveness of VBB. Depending on the results two groups of patients were defined: patients with healing (n=78) and patients whose pulmonary tumor cavitation stayed at the same level (n = 56).

Results: The method turned out to be the most effective for patients having the duration of the disease for less than 2 years, upper-lobe localization of tuberculosis process with the pulmonary tumor cavitation up to 2 cm, bacteriologically proven, having HIV co-infection with the concentration of CD4⁺-lymphocytes in blood in the amount of more than 250 cells per microliter and committed to antiretroviral therapy and also among patients with the periodic anti-tuberculosis chemotherapy take offs after treatment restarting.

Conclusions: Such factors as tuberculosis anamnesis for longer than 2 years, 4-7 cm cavitation, remaining mild or abundant bacterioexcretion, wide drug resistance of the pathogen, the level of CD4⁺-lymphocytes in blood less than 250 cells per microliter for HIV co-infected, and total rejection of anti-tuberculosis drugs influence the maintaining of the destructive changes on the basis of VBB.

Objective: To highlight the features of the epidemiological tuberculosis among HIV patients in Primorsky region.

Methods: Statistical data of the epidemiological monitoring, forms of federal monitoring and industry reporting, medical records of the Primorsky Regional Anti-Tuberculosis Dispensary and HIV and infectious diseases prevention center were analyzed.

Results: As a rule HIV-associated tuberculosis was identified during the fourth stage of HIV-infection on the basis of accompanying diseases and most of all in infiltrative form. As a rule at the moment of diagnosing HIV-infection low indexes of CD4⁺-lymphocytes level were registered. It was indicative to severe immunodeficiency. Tuberculosis chemoprevention according to indications among children having HIV was conducted not in all cases. It is connected with multiple refuses and stopping treatment.

Conclusions: Primorsky region is considered to have an unfavorable epidemiological situation in Russia not only according to HIV rate but also to tuberculosis rate. The relevance of the problem of comorbidity of these diseases has increased in recent years.

Objective: The estimation of the epidemiological symptoms of coinfection HIV and tuberculosis in the conditions of high level of both infections spread.

Methods: Retrospective epidemiological analysis of the disease, spread and death rates in case of tuberculosis, HIV-infection and their combined forms among the population of the Irkutsk region in comparison with similar Russian indicators for 16 years was carried.

Results: The dynamics of coinfection HIV/tuberculosis incidence on the regional level corresponded to general Russian intensive increase from 1999 to 2005 and lower progression speed from 2005 to 2014. The spread of HIV-associated tuberculosis both on federal and regional levels had the increasing trend. Mortality rate is characterized by multidirectional: negative rate of growth in Russian Federation and progression in Irkutsk region.

Conclusions: Increased tension of tuberculosis epidemiological situation is shown by quickly increasing disease and death rates of coinfected HIV patients. Undoubtedly such situation requires increased measures of the epidemiological control of socially-significant infections.

Objective: The analysis of the tuberculosis epidemiological process tendencies among children and adolescents (0-17 years old) in one of the biggest regions of the Far East Federal District - in Sakha Republic (Yakutia).

Methods: Epidemiological tuberculosis indicators among child population of the republic from 2000 to 2019 were studied. Two periods were compared: from 2000 to 2009 - it's a period of socio-economic crisis, from 2010 to 2019 - it's a period of a relatively stable epidemic situation.

Results: During the period of epidemiological stabilization disease and tuberculosis primary infection rate among child population of Sakha Republic decreased by two times compared with the period from 2000 to 2009. At the same time infection spread rate reduced by eight times. However tuberculosis disease rate among child population is still exceeding average rate in Russia. The changes of the epidemiological indicators in different administrative districts in Yakutia are uneven.

Conclusion: Tuberculosis epidemiological situation among children population of Sakha Republic (Yakutia) has a stable tendency to improve. It is necessary to give territories different epidemiological characteristics in order to study the causes which influence epidemiological process and to develop anti-tuberculosis programs in order to improve the situation.

Objective: Analysis of the main epidemiological tuberculosis indicators in Primorsky region.

Methods: New epidemiological indicators were studied: tuberculosis disease, spread and death rates on the territory of Primorsky region for the period from 2014 to 2019. Statistical data of Primorsky Regional Anti-Tuberculosis Hospital and Primorsky Regional Medical Information Analytical Centre, National reports and also forms of federal monitoring and industry reporting were used.

Results: Tuberculosis epidemic situation in Primorsky region is still one of the most unfavorable in Russia. Main epidemiological indicators (disease, spread and death rates) significantly exceed average national rates in spite of some decrease. High level of tuberculosis disease rate having multidrug resistance, and also the increase in HIV/Tuberculosis co-infection rate will have a negative influence on the epidemiological situation in the region in the coming years.

Conclusions: In the conditions of current epidemiological situation in order to optimize anti-tuberculosis measures it's necessary to apply complex science-based approach aimed at early diagnosing of tuberculosis patients, increasing diagnostics level, improving treatment and outpatient observation.

Objective: To estimate the expression level of bitter taste buds TAS2R31 in blood serum in different variations of bronchial asthma (BA).

Methods: 10 practically healthy people and 51 patients having BA (35 having allergic and 16 - non-allergic form). The concentration of the buds in blood serum was defined using immunoenzyme method.

Results: Bitter taste buds' TAS2R31 concentration in blood serum of the practically healthy people didn't have statistically significant difference from the same in patients having BA. However in case of non-allergic course of disease the level of TAS2R31 was 1.7 times higher than in the event of allergic one. Both BA variations were characterized by inverse correlation of the concentration TAS2R31 and external breath functioning indicators reflecting patency of bronchi of the average and little caliber. In case of allergic BA statistical significance was demonstrated by direct correlation between serum concentrations of the TAS2R31 and general immunoglobulin E, cortisol, factor of tumor-a necrosis. Direct correlation between the level of buds with the increased emphasis on basophilia of the peripheral blood, and also content of macrophages, neutrophils and bronchial epithelium in mucus was found. In case of non-allergic BA such clinical phenomena as medicinal and fungi sensitization, myocardial infarction in anamnesis, conducting glucocorticoid therapy defined statistically significant correlation with the level of buds in blood serum.

Conclusions: Findings provide additional facts to prove hypothesis about negative regulation of the membrane buds TAS2R by plasma soluble taste buds. Further issue development should be directed to matching expression of the membrane and free plasma taste buds TAS2R.

Objective: To estimate the efficiency of the treatment of children having tuberculosis with multi-drug resistant (MDR) pathogen and from outbreaks of MDR tuberculosis.

Methods: Lot Quality Technique was used to include 31 children having MDR tuberculosis and children from the outbreaks of MDR tuberculosis under 15 years old in the study.

Results: The treatment was shortened for children having light forms of tuberculosis and positive process. The length of intensive treatment took 3 months for 15 patients, 4 months - for 6 children, 5 months - 1 child, 6 months - 5 children, and 8 months - for 4 patients. The injectable drug was stopped and four anti-tuberculosis drugs were prescribed in the stage of prolonging treatment. Overall duration of the treatment took 9 months for 12 children, 10 months - for 5 children, 11 months - for 1 child, and 12 months - for 4 children. Therefore short-term courses were conducted in 22 studies (71 %). Average length of the therapy took 295.9 days.

Conclusions: Small prevalence of tuberculosis lesion of the lungs and intrathoracic lymph nodes, age restrictions to prescribe second line anti-tuberculosis medicines and positive dynamics allow to shorten the duration of the treatment for children having MDR tuberculosis and children from the outbreaks of MDR tuberculosis and to achieve positive results.

Objective: To estimate the efficiency of the influence of a combined medicine containing amberic acid on antioxidant status of the warm-blooded organism in the conditions of temperature effect.

Methods: Thermal model of the experiment conducted on 120 white outbred male rats weighting from 180 to 200 grams for the period of 21 days was used. Animals were divided into four groups: intact, control and two experimental. The last got intra-abdominal injections containing 50 or 100 mg/kg of amberic acid.

Results: Everyday thermal impact during 45 minutes fostered an increase in hydroperoxides of lipids (by 32 to 36 %), diene conjugates (by 36 to 38 %) and malonic dialdehyde (by 51 to 59 %) on the background of a decline in activity of the basic components of the antioxidant system. Injection of a combined medicine containing amberic acid contributes to a credible reduction of hydroperoxides of lipids (by 20 to 24 %), diene conjugates (by 20 to 21 %) and malonic dialdehyde (by 28 to 35 %) in blood plasma. Ceruloplasmin content in animal blood of the experimental groups was credibly higher than comparable figure of rats of the control group by 22-35 %, vitamin E - by 16-28 %, catalase - by 22-35 %.

Conclusions: The usage of a combined medicine containing amberic acid in condition of prolonged temperature effect on the organism of the experimental animals leads to stabilizing processes of peroxidation on the background of increase in the activity of the basic components of the antioxidant system.

Objective: The value of the state and dynamics of the tuberculosis epidemiological situation among children and adolescents in Russia in the backdrop of introducing innovation technologies of tuberculosis care.

Methods: Basic tuberculosis epidemiological indicators for the last 20 years in Russia were studied. Forms of federal statistical monitoring #8, #33, and #47 were analyzed. Death rate was defined according to data of the Russian Federal State Statistics Service. Research methods: Epidemiological, statistical, expert evaluation, content-analysis of the literary source and legal acts.

Results: Current tuberculosis epidemiological situation among children and adolescents in Russia in the backdrop of introducing screening is characterized by a favorable trend. Tuberculosis morbidity rate among children under 14 years old decreased by 49.4 %, and it decreased by 55.1 % among children from 15 to 17 years old respectively. It led to a decline in tuberculosis disease rate among adolescents. During the last decade there was a decrease in tuberculosis death rate among children from 15 to 17 years old to 0.02, among children under 14 years old to 0.03 per 100,000 population.

Conclusion: The results of the research prove feasibility of using contemporary tuberculosis screening methods of the child population. It helps to significantly improve the quality of diagnosing this infection and tuberculosis epidemiological situation in Russia in general.

Objective: To characterize epidemiology and methods of diagnosing tuberculosis among children under 14 in high-burden areas.

Methods: The data of the epidemic monitoring in Primorsky Regional Anti-Tuberculosis Hospital for the period from 2005 to 2019 was analyzed.

Results: The dependence of the epidemic indicators on the screening methods was proved. From 2005 to 2009 during both mass screening and additional examination of the children in a specialized medical organizations such medicine as tuberculin was used. On average tuberculosis was diagnosed among 37.2 % children during preventive examination. From 2010 to 2014 after introduction of the recombinant tuberculosis allergen (RTA) into anti-tuberculosis organizations practice this indicator had increased up to 56 %. Screening using RTA was introduced in 2014. After that tuberculosis medical detection among children has increased by 1.9 and 1.35 times in comparison with previous periods respectively.

Conclusions: RTA using improves tuberculosis infection screening among children population. It positively influences clinical structure of the first identified tuberculosis.

Continuous medical education (CME) - new format of advanced training for medical specialists which is a continuous process, using innovative technologies (distant, electronic and others), also an opportunity to develop a personal plan of advanced training. It provides knowledge, skills, abilities and competencies essential for the specialists. The article highlights the experience of the integration of CME by the Department of Therapy named after A.I. Dyadyka at the Internship and Post-graduate education Department at M. Gorky Donetsk National Medical University. Such issues as creating educational programs, methodological supply and teaching tools are highlighted. The emphasis was placed on the methods of organizing seminars and practical classes during advanced training courses. Special attention was paid to resource and informational supply including uploading study materials in electronic resource "Information-educational environment".

Objective: The analysis of the features of the daily routine of University students, determined to the usage of electronic means of communication during COVID-19 pandemic period.

Methods: Communication means preferences of the 634 University students were analyzed using questionnaire survey. Their sleep schedules, physical activity, feeding, educational and leisure activities and wellbeing were analyzed.

Results: It was determined that favorite means of electronic study among respondents was smartphone. It turned out to be the only mean of communication among 5.8±0.9 % of examined. Those who studied in the distant format often exceeded hygiene standards of the duration of ongoing work in front of a computer/laptop compared to students focused on traditional learning (39.4±2.2 against 28.5±3.8 %; χ²=5.69, p=0.018), and also those who exceeded night sleep time limit (15.9±1.6 against 6.9±2.1 %; χ²=7.49, p=0.007). Among online students there were less respondents who had one meal a day (9.8±1.3 against 24.3±3.6 %; х2=20.59, p<0.001) and who had meal shortly before sleep (52.2±2.3 against 64.6±4.0 %; χ²=6.85, p=0.009). Those who studied in the distant format more often took strolls than those who attended fulltime classes: 56.7±2.2 against 29.9±3.8 % (χ²=8.32, p=0.004).

Conclusions: Distant education allowed to make educational process ongoing. However this way of studying caused changes in the regular schedule and the reallocation of the time burden. It can't stop influencing health of the younger generation.

Combination of traumas is still socially-significant problem in our country. The lethality rate from rupture of the main bronchus reaches 50 %. The main method of treatment of the traumatic damages of the respiratory tract is surgical. The best results are achieved during early interventions. However diagnostics of the rupture of the main bronchus is hard because of the severity of the patient's condition and the existence of polytraumas. If the rupture isn't defined on time, it can lead to the formation of bronchostenosis or its overall occlusion and loss of the organ. Clinical observation of the surgical treatment of the rupture of the main right bronchus is shown for the patient 34 years old 3 months after trauma. The reconstruction of the airway patency was made by reimplanting of the main bronchus into trachea. Full recovery of the bronchus functioning was noticed in a year after operation.