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The article presents the results of bacteriological monitoring of 483 children aged 3 to 14 years with acute respiratory diseases in Zaporizhzhia and Zaporizhzhia region in 2017. It was found that leading pathogens were Streptococcus pneumoniae (49.4 %) and bacteria of the genus Haemophilus (36.2 %) in the presence of bacterial respiratory infection. The analysis of the antibiotic susceptibility patterns showed that the microorganisms demonstrated the highest sensitivity to the third-/fourth-generation cephalosporins, vancomycin, linezo­lid and levofloxacin. There was noted a high antibiotic resistance of Streptococcus pneumoniae to penicillins (56 % of strains), clindamycin (43 % of strains) and erythromycin (45 % of strains). The isolates of bacteria of the genus Haemophilus most often showed resistance to the ampicillin (58.1 % of strains) and protected penicillins (52 % of strains). On the basis of obtained data, there was substantiated the expediency of ­using cefpodo­xime proxetil, the third-generation cephalosporin, as the star­ting antibacterial drug in the therapy of acute bacterial respiratory infection in children.

Seventy four young children with acute bronchitis (34 — with viral bronchitis and 40 with bacterial bronchitis) were examined using Acute Bronchitis Severity Score, with a bacteriological study of nasopharyngeal aspirate and determination of 25-hydroxyvitamin D (25(OH)D), vitamin D-binding protein, human bactericidal/permeability-increasing protein, catelicidin LL-37, β1-defensin, lactoferrin levels. The influence of various factors on the development of bacterial bronchitis was evaluated with the help of factorial and cluster analysis. It was found that 6 factors were of the greatest importance: the vitamin D supplementation, anemia factor, iatrogenic factor, inflammation factor, immune factor and maternal factor. To develop a prognostic mathematical model of acute bacterial bronchitis occurrence in young children, we used the equations of logistic regression, which included 9 predictors (the day of hospitalization from the onset of the disease, the day of administration of antibiotic therapy from the onset of the disease, the vitamin D and lactoferrin content in the blood serum, the preventive use of vitamin D, the level of hemoglobin and leukocytes in peripheral blood, acute respiratory infections mother have suffered during pregnancy, score for the assessment of the severity of the disease). The method of genetic algorithm was used to select 4 most significant factors: the day of hospitalization from the onset of disease, the day of administration of antibacterial therapy from the onset of disease, the content of vitamin D and lactoferrin in the blood serum. A decrease in the number of factors from 9 to 4 did not lead to a significant change in the predictive qualities of the model, as evidenced by the area under the ROC curve of the logistic regression equation and the evaluation of the discriminating ability of the model with the Gini coefficient. The sensitivity of the model was 88.9 %, specificity — 78.9 %. The analysis confirmed that the state of vitamin D supplementation, early hospitalization, irrational use of antibiotic therapy, immune disorders and the nature of the course of antenatal period made the priority contribution to the development of acute bacterial bronchitis in young children. The detected risk factors and the results of prognostic modeling should be used to identify children, who are at high risk for the development of acute bronchitis of bacterial origin.

Background: Prediction of myopia progression in children is of practical relevance. Purpose: To develop a prediction table for comprehensive assessment of the risks for progression of acquired myopia in school-age children. Materials and Methods: One hundred and forty-four low myopic children (288 eyes) underwent the examination. Of these, 62 (124 eyes) had progressive myopia, and 82 (164 eyes) had stable myopia. Prediction of the risk of myopia progression in children was performed with the use of the Shigan technique for normalization of strongly intensive measures based on the probabilistic Bayesian approach. Results: Minimal and maximal values for prediction coefficients with regard to the most informative predictors for myopia progression were calculated, and the relevant prediction table was generated. The table included history-, accommodation-, and biometry-related predictors, as well as those related to the phenotypical signs of connective tissue dysplasia (CTD) as follows: history-related predictors: family history of myopia (PCmin, 1.249; PCmax, 4.34) and manifestations of myopia at age under 8 years (PCmin, 1.18; PCmax, 2.67); accommodation-related predictors: habitual accommodative tone ≥ 0.5 D (PCmin, 1.29; PCmax, 7.51), absolute reserve of accommodation < 1.5 D (PCmin, 1.25; PCmax, 4.6), relative reserve of accommodation < 1.0 D (PCmin, 1.3; PCmax, 7.94); ocular biometry-related predictors: corneal diameter > 12 mm (PCmin, 1.31; PCmax, 9.31), axial length of the eye > 25.0 mm (PCmin, 1.31; PCmax, 9.82), anterior chamber depth ≥ 4 mm (PCmin, 1.28; PCmax, 6.22), corneal hysteresis < 11.0 (PCmin, 1.21; PCmax, 3.29), corneal radius of curvature > 8 mm (PCmin, 1.17; PCmax, 2.5), corneal refractive power < 41.5 D (PCmin, 1.17; PCmax, 2.5), peripapillary retinal nerve fiber layer thickness (PCmin, 1.12; PCmax, 1.9), P < 0.05; CTD-related predictors: asthenic habitus (PCmin, 1.67; PCmax, 4.66), scoliosis and other postural anomalies (PCmin, 1.61; PCmax, 4.21), prominent venous network of the skin (PCmin, 1.75; PCmax, 5.97), cardiac valve prolapse and other minor cardiac anomalies (PCmin, 1.6; PCmax, 4.03), anomalies of tooth position and dentition (PCmin, 1.64; PCmax, 4.37), long digits (PCmin, 1.63; PCmax, 4.3), flat foot (PCmin, 1. 49; PCmax, 3.1), hypermobility of the joints (PCmin, 1.46; PCmax, 2.95), hyperelasticity of the skin (PCmin, 1.44; PCmax, 2.84), and congenital gallbladder anomalies (PCmin, 1.52; PCmax, 3.32), P < 0.05. The newly identified range for the risk of progression of myopia was subdivided into 3 equal sub-ranges (low, moderate and high likelihood for the risk, of 30.67-54.47, 54.48-78.27 and 78.28-102.08, respectively). Conclusion: The use of the prognostic table proposed allows easy identification of school-age myopic children at risk for the progression of myopia, with subsequent development of customized diagnosis and treatment plans.

Background. The features of the morpho-functional state of the left ventricular myocardium and common carotid arteries were studied according to echocardiography in children with cystic fibrosis. Materials and methods. 72 children with cystic fibrosis were examined. To determine the preclinical stage of left ventricular diastolic dysfunction, a functional compliance index (FCI) was determined by the method of A.N. Rosenbaum and V.T. Koval (2010). Results. The results of the study showed the development of left ventricular myocardium remodeling in 58 % of patients with cystic fibrosis, among the variants of which eccentric hypertrophy predominated. The revealed changes increased with an increase in the severity of the course of the disease. The analysis of diastolic function of the left ventricle by standard method in the group of patients with cystic fibrosis did not reveal any significant differences from the parameters of the control group. The FCI calculation showed that in 37.5 % of children with cystic fibrosis, which indicated the formation of left ventricular diastolic dysfunction, which progressed in the course of the disease, it decreased with respect to the values of the control group. The most pronounced changes in FCI were found with concentric left ventricular myocardial hypertrophy and with severe disease. Conclusions. The identified morpho-functional rearrangement of the left heart occurred against the background of remodeling and hemodynamic changes at the level of the common carotid artery in children with cystic fibrosis.

A comprehensive survey was carried out in 30 children with community-acquired pneumonia aged 2 months to 3 years old, among them in 18 children the disease was caused by Streptococcus pneumoniae, and in the remaining 12 patients — by Gram-negative flora. All children underwent the evaluation of the severity of the condition using the PRESS scale, according to which it was found that most patients had severe course of pneumococcal pneumonia. The analysis showed that the development of pneumococcal pneumonia in children occurred against the background of a decrease in the serum content of vitamin D metabolites and the activity of antimicrobial peptides, in contrast to pneumonia caused by Gram-negative pathogens. In the blood serum of children with pneumococcal pneumonia, there was detected a decrease in the content of β1-defensins by 2.6 times, LL-37 — by 3.7 times and human bactericidal permeability-increasing protein — by 2.8 times in comparison with the control group (p < 0.05). It has been proved that inadequate activation of antimicrobial peptides against the background of a deficiency of vitamin D metabolites in infants with pneumonia caused by Streptococcus pneumoniae is one of the pathogenetic links leading to a severe course of the disease.

The paper deals with the experience of using the antihistamine drug of the 3rd generation levocetirizine (L-Cet, Kusum Farm Ltd.) for the treatment of allergic rhinitis in children. The high effectiveness of the drug, good tolerability and facility are proved that allows re­commend it for the complex therapy of allergic rhinitis in children.

The comprehensive examination included 204 children with community-acquired pneumonia aged 2 months to 3 years. It was found that in young children with community-acquired pneumonia, the main etiologic factor is bacteria Streptococcus pneumoniae (36.8 %). The content of endogenous antimicrobial peptides was identified in the serum of 20 young children with pneumonia and in 17 children in the control group. It is proved that the development of pneumonia in young children occurs on the background of the reduction in the blood serum levels of β1-defensin and cathelicidin LL-37. The lowest values of LL-37 were identified in children with pneumonia caused by Streptococcus pneumoniae. The analysis of the content of vitamin D metabolites in the serum showed that in children with pneumonia, concentration of 25-hydroxyvitamin D was 1.4 times lower compared with healthy children (р < 0.05). Established deficiency of vitamin D metabolites in young children with community-acquired pneumonia serves as an important pathogenetic factor for cathelicidin LL-37 deficiency in the blood serum, which was confirmed by 3.7-times decrease in the percentage of LL-37 compared with vitamin D metabolites in this cohort of patients.

We have investigated the level of antimicrobial peptides in the blood serum of 46 young children with acute bronchitis depending on the etiological factor. It was found that the development of severe bronchitis in 74.3 % of patients is caused by the colonization of the respiratory tract with bacterial flora. The Gram-negative bacteria Haemophilus influenzaе (32.6 %) is a leading etiological factor in the development of acute bacterial bronchitis. It is proved that the development of acute bronchitis in young children occurs due to lower activity of the antimicrobial peptide (human bactericidal/permeability-increasing protein (hBPI)), and is independent of etiologic factor. The activity of lactoferrin in young children is characterized by multi-directional changes depending on the etiological factor. In the presence of bacterial colonization of the respiratory tract, there was not a sufficient activation of lactoferrin synthesis, but in viral bronchitis, levels of lactoferrin were elevated. The content of β1-defensins in the blood serum decreased only in bronchitis caused by Gram-negative bacteria Haemophilus influenzaе. The while in patients with viral bronchitis and children, in which Streptococcus pneumoniae has been detected, the content of β1-defensins was not statistically different from that of the control group. It was found that the lowest values of antimicrobial peptides were registered in bronchitis caused by Gram-negative bacteria Haemophilus influenzaе, in which there was the most severe disease.

Досліджено рівень антимікробних пептидів у сироватці крові 35 дітей з аденоїдитом, асоційованим із гіперплазією ретроназальної мигдалини. Установлено, що в дітей із гіперплазією ретроназальної мигдалини відбувається зниження вмісту в сироватці крові кателіцидину LL-37, сурфактантного білка SP-D, бактерицидного білка, що посилює проникність клітин, та підвищення рівня лактоферину. Доведено, що порушення продукції антимікробних пептидів є одним із патогенетичних факторів розвитку хронічного запалення в носоглотці при гіперплазії ретроназальної мигдалини в дітей. При цьому вираженість даних змін залежить від ступеня гіперплазії ретроназальної мигдалини та максимально проявляється при аденоїдних вегетаціях 3-го ступеня. Фактором компенсації, спрямованим на відновлення адекватної імунної реактивності в дітей із гіперплазією ретроназальної мигдалини, є розвиток гіперплазії піднебінних мигдалин, що необхідно враховувати при плануванні обсягу лікувальних заходів.