За даними літератури, провідними ланками патогенезу ХОЗЛ є (1)хронічне персистивне запалення, яке проявляється активацією багатьох клітин з надміром секреції усіх біологічно активних прозапальних речовин; (2) гіпоксія із використанням енергії, зміною основних сигнальних шляхів, надекспресію гіпоксіє-індуцибельного фактору; (3) анемія хронічної хвороби внаслідок дії прозапальних цитокінів, гіпоксіє-індуцибельного фактору. За власними результатами обстеження 470 хворих на ХОЗЛ, про зв›язок запалення та гіпоксії свідчить зменшення оксигенації крові та показників ФЗД. Активація запалення асоціювалась з погіршенням бронхіальної прохідності за кореляційним аналізом. Анемічний синдром у пацієнтів з ХОЗЛ характеризувався істотним збільшенням нейтрофілів, ШОЕ, СРП, загального фібриногену, серомукоїдів та інтегральних гематологічних індексів, а також гіршою оксигенацією крові, нижчими ємнісними та швидкісними показниками ФЗД. Запалення, гіпоксія та анемія – три провідні ланки патогенезу ХОЗЛ, які створюють хибне коло і зумовлюють прогресування хвороби.

УДК 616.36:616.126.32

Клапанні ураження серця становлять значну проблему, однак про їх особливості за умов метаболічно-асоційованої хвороби печінки та її початкової стадії – стеатозу печінки - відомо мало.
Мета роботи - оцінити поширеність стеатозу печінки у пацієнтів з ревматичними вадами, лікованими хірургічно, та особливості структурно-функціональних параметрів серця за його наявності.
Об’єкт і методи дослідження. У стаціонарних умовах обстежено без збільшення обсягу 44 пацієнти з хронічною ревматичною хворобою серця, яким проводилась хірургічна корекція вади (16 чоловіків, 42 жінки, середній вік 54,00±3,69 р.), відповідно їхнім нормативним документам. Проаналізовано антропометричні та клінічні параметри, загальні аналізи крові та сечі, а також стандартні біохімічні показники крові, параметри електрокардіограми, ультразвукових досліджень серця та органів черевної порожнини; результати опрацьовані методами варіаційної статистики.
Результати. У пацієнтів з хронічною ревматичною хворобою серця та набутими вадами серця, що підлягали корекції, мала місце надмірна маса тіла (середній індекс маси тіла 29,1 кг/м2); у 73% з них діагностувався стеатоз печінки. Стеатоз печінки у пацієнтів з ревматичними вадами серця асоціюється з активацією синдрому запалення за загальним фібриногеном, погіршенням вуглеводного метаболізму з гіперглікемією, розширенням правого шлуночка та гіпертрофією міокарда (усі р < 0,05). За кореляційним аналізом, поглиблення стеатозу печінки з порушенням її функцій буде супроводжуватись погіршенням показників структурно-функціональних характеристик серця, схильністю до тромбоутворення, а також ліпідним і вуглеводним дисметаболізмом з активацією системного запалення.
Висновок: стеатоз печінки впливає на структурно-функціональні показники серця, ліпідний та вуглеводний метаболізм, тромбоутворення, активність запалення, тому має враховуватись при веденні пацієнтів з хронічною ревматичною хворобою серця.

Abstract. Valvular heart defects are a significant problem, but little is known about their features in metabolicassociated liver disease and its initial stage - liver steatosis.
Objective: to assess the prevalence of liver steatosis in patients with rheumatic valvular defects treated surgically, and to estimate key differences in the structural and functional parameters of heart in its presence.
Material and methods: 44 inpatients with chronic rheumatic heart disease who underwent surgical correction of the defect (16 men, 42 women, mean age 54.00±3.69 years) were examined. Diagnostic process was held in accordance with available regulations; standart clinical, laboratory and instrumental data were analyzed; the results were processed by the methods of variation statistics; level of significance was taken as р < 0,05.
Results. Patients with chronic rheumatic heart disease with valvular defects were overweight (mean body mass index 29.1 kg/m2); 73% of them were diagnosed with liver steatosis, which has unfavourable influence into treatment result according literature data. Liver steatosis in patients with chronic rheumatic heart disease is associated with the activation of inflammatory syndrome according to general fibrinogen increase, impaired carbohydrate metabolism with hyperglycemia, right ventricle dilatation and myocardial hypertrophy (all p < 0.05). According to the conducted correlation analysis, the deterioration of liver condition with impaired function will be accompanied by worsening of structural and functional characteristics of heart, the tendency to the increased thrombosis and lipid and carbohydrate metabolic disorders together with activation of systemic inflammation.
Conclusions. The liver steatosis affects the structural and functional parameters of heart, lipid and carbohydrate metabolism, thrombosis, systemic inflammatory activity, so it should be considered in the management of such patients.

Aim: To determine the prevalence and to estimate factors associated with food hypersensitivity in young children of the Lviv region in Ukraine.
Methods: A prospective cross-sectional survey study was conducted between 2016 and 2017 in the Lviv region of Ukraine. A specially designed questionnaire about food hypersensitivity of young children developed and validated by M. J. Flokstra-de Blok was used after translation into the Ukrainian language. The questionnaire included 34 questions, grouped into general and detailed information. Parents of children aged 0–3 years were asked to complete the questionnaire at pre-schools and medical institutions.
Results: Among 4,500 distributed questionnaires, 3,214 (71%) were completed and processed. Parents reported that 25% of their young children had food hypersensitivity. According to the survey the most common agents involved in food hypersensitivity in young children were cow’s milk (34%), egg (28%), and wheat (24%). Hypersensitivity to milk occurred in 50% of children in the age group of 1–2 years. Regional differences associated with food hypersensitivity were also found. Namely, in the Carpathians, there was more hypersensitivity to fish (27%) and honey (22%) than in other regions, while
hypersensitivity to soy was detected mostly in Lviv City residents (8.5%). Unknown causes of food hypersensitivity were highly reported (34%) in the Carpathians.
Conclusion: Prevalence and some distinctiveness of food hypersensitivity revealed in four geographic and climate zones as well as in Lviv City have a considerable practical use for formulation of recommendations for children with food hypersensitivity.

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.

UDC 616-002.5-053.2(477.83)

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.