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Background. The only method of treatment that can change the natural course of allergies is allergen-specific immunotherapy, which allows reducing the sensitivity of the child’s body to the causative allergen and decreasing the activity of chronic inflammation. The evidence base for the effectiveness of allergen-specific immunotherapy in the treatment of bronchial asthma (BA) has significantly expanded recently. However, the truly important results remain too limited to make clinically useful conclusions about the efficacy of sublingual allergen-specific immunotherapy (SLIT) in people with BA and further evidence is needed. The purpose of the study is to evaluate the effectiveness of SLIT as an additional treatment for atopic BA of varying severity in children sensitized to house dust mites. Materials and methods. The main group consisted of 80 children with BA aged from 5 to 17 years, they were divided into three groups according to the severity of the disease: group 1 — 20 children with mild intermittent asthma, group 2 — 30 children with mild persistent asthma, group 3 — 30 children with moderately severe persistent asthma. Thirty practically healthy children without BA were also examined as a control group. For SLIT, a sublingual ORALTEK spray produced by Inmunotek (Spain) was used, a mixture of house dust mite allergens Dermatophagoides pteronyssinus 50 %/Dermatophagoides farinae 50 %, 1 ml of the solution contains 30,000 IU of natural allergen extract. To assess the effectiveness of the treatment, we conducted an analysis of the total score of clinical manifestations of asthma and allergic rhinitis and the degree of asthma control according to the Asthma Control Test. We also analyzed the state of cellular and humoral immunity in the dynamics of therapy. These indicators were evaluated within 1 month before the beginning and a month after the end of the one-year course of therapy. To assess the validity and reliability of the obtained results, statistical data processing was carried out using Microsoft Excel 2016 and Statistica for Windows 10 programs. The Student’s t-test was applied to assess the reliability of the results. The difference between the compared values was considered statistically significant at p < 0.05. Results. The results of the statistical analysis confirmed a significant improvement in the control indicators of patients who received SLIT: reduction in the total score of clinical manifestations, the frequency of clinical symptoms and the use of emergency drugs (p < 0.05). By the end of the study, the dynamics of a decrease in these indicators compared to the data before the start of treatment (according to the above list) was as follows: in patients of group 1 — 82.5, 91.8, 94.5 %, in patients of group 2 — 80.5, 88.4, 92.7 %, in patients of group 3 — 76.7, 85.3, 91.2 %. After treatment with the addition of SLIT to the basic therapy, a reliable increase in IgE and sIgA was observed, an increase in the spontaneous proliferative response of T-lymphocytes to the mitogen in all three groups to the level of the controls, a probable decrease in eosinophilic inflammation and an improvement in indicators of the cellular and humoral immunity (p < 0.001). Conclusions. The prescription of SLIT to children with mild intermittent BA, mild persistent BA and perennial allergic rhinitis, moderate persistent BA and perennial allergic rhinitis provides an opportunity to obtain stable control of the disease, reduces the number of visits to the doctor and justifies the wide use of this method in clinical allergy practice.

Background. Since the onset of the coronavirus disease 2019 (COVID-19) epidemic until January 1, 2024, more than 5.5 million confirmed cases of COVID-19 have been detected in Ukraine according to official data, approximately 6 % of them among children under 18 years old. Aim: to improve the management of newborns based on studies of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with different course. Materials and methods. Eleven newborns (7 boys and 4 girls) diagnosed with SARS-CoV-2 confirmed by polymerase chain reaction were observed. Disease progression, results of laboratory and instrumental studies were analyzed. Results. An analysis of clinical data and the results of laboratory and instrumental investigations are presented, as well as treatment outcomes in newborns with confirmed COVID-19. It was found that in all cases, children were infected from mothers with SARS-CoV-2. The frequency of clinical symptoms is provided, revealing discrepancies between respiratory symptoms and changes identified on lung ultrasound. Most children exhibited anemia, elevated D-dimer levels in the blood, yet experienced a mild course of the disease. The average duration of illness prior to hospitalization was 3.70 ± 1.48 days, with a hospital stay of 4.01 ± 1.22 days. An exception was in case of patient N., characterized by a severe condition necessitating prolonged oxygen therapy, mechanical ventilation, and administration of remdesivir. This particular case is detailed in the article. Conclusions. In most infants under one month of age observed in this study, the course of ­COVID-19 caused by SARS-CoV-2 was characterized by symptoms such as lethargy, hyperthermia, nasal congestion, diarrhea, and changes detected only through laboratory and instrumental stu­dies: anemia, abnormalities in the coagulation system, and increased lung parenchymal density. Ho­wever, the disease course in infants of this age can also be very severe, with lung parenchymal involvement, pneumonia, COVID-19-associated coagulopathy, complicated by generalized bacterial infection, as presented in the clinical case.

Background. The purpose was to study the prognostic role of some phenotypic factors in the effectiveness of tuberculosis chemoprophylaxis in children at present stage. Materials and methods. To study the role of phenotypic factors in predic­ting the effectiveness of tuberculosis chemoprophylaxis, an analysis was performed of dermatoglyphic indicators, gender, and the inactivation phenotype of isonicotinic acid hydrazide (IAH) in 76 children with tuberculin skin test conversion who underwent a 3-month course of preventive therapy with isoniazid. Dermatoglyphics of fingers and palms was determined according to the standard method [5]. The dynamics of skin sensitivity to tuberculin PPD-L according to the Mantoux test with 2 tuberculin units was used as a criterion for the effectiveness of chemoprophylaxis. According to the latter, the examinees were divided into two groups: the first one consisted of 52 children in whom the size of a wheal decreased by 4 mm or more after the end of a course (effective chemoprevention); the second one included 24 patients in whom skin sensitivity to tuberculin increased or remained at the previous level or decreased by a wheal size for 3 mm or less (ineffective chemoprevention). Results. The conducted statistical analysis revealed a significant difference in 7 indicators between the groups (p < 0.05). Determination of their prognostic informativeness made it possible to rank the prognostic significance of phenotypic signs, namely: the size of the atd angle on the left palm (J = 1.7), the number of ulnar loops on the right hand (J = 1.4), the type of IAH inactivation (J = 1.3), the number of whorls on the right hand (J = 1.2), the total number of whorls (J = 1.1), the atd angle on the right palm (J = 0.7), the number of whorls on the left hand (J = 0.5). The correlation analysis between the dermatoglyphic indicators and the type of IAH inactivation showed that there are reliable connections between them (p

Background. In the context of coronavirus diseases 2019 (COVID-19) pandemic associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a significant number of cases resembling Kawasaki disease in children have been reported worldwide and eventually termed “multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2”. Objective: to compare the clinical presentation, laboratory fin­dings, and instrumental examination data in children with Kawasaki-like MIS-C phenotype and MIS-C with a shock phenotype with cases, which met the US Centers for Disease Control and Prevention criteria. Materials and methods. The article presents the results of a retrospective analysis of the disease histories in 20 children aged 2.5 to 16 years with a Kawasaki-like MIS-C phenotype and with MIS-C with a shock phenotype associated with SARS-CoV-2 infection who were hospitalized in the MNPE “Kyiv City Children’s Clinical Hospital 2” in 2002–2021. Results. Patients were divided into 2 groups according to symptoms and pathological conditions. Group I included children with clinical signs similar to the Kawasaki disease (n = 8). They were classified as those with Kawasaki-like MIS-C phenotype. Complications such as coronary artery dilatations and aneurysms occurred only in this group. Group II consisted of patients (n = 12) who were classified as those with MIS-C with a shock phenotype. Children in this group had a higher number of involved organ systems, were more likely to have shock, pleuritis, peritonitis, and a higher prevalence of abdominal pain. Furthermore, they exhibited elevated levels of leukocytes and neutrophils (p = 0.043; p = 0.047), along with a higher neutrophil-to-lymphocyte ratio (p = 0.05), compared to the patients with Kawasaki-like phenotype. Conclusions. Our results suggest that multisystem inflammatory syndrome associated with SARS-CoV-2 in children is characterized by a wide range of clinical, laboratory and instrumental signs. Moreover, our findings highlight that children with features that correspond to MIS-C with a shock phenotype tend to have a more severe course of the disease and a higher rate of complications.

Background. The issue of sarcopenia is becoming increasingly relevant for children, yet its relationship with phase angle (PA) of bioimpedance analysis remains incompletely understood. Objective: to investigate the relationship between phase angle and body composition in children aged 8 to 14 years. Materials and methods. Data from bioimpedance analysis, correlation, and regression analysis were utilized. Results. During the study, it was found that in girls, PA correlates with body fat (BF) and skeletal muscle (SM and sarcopenic index (SI)) content, with correlation coefficients of 0.36, 0.43, and 0.34, respectively. Additionally, regression analysis showed that SI plays a significant role in determining PA in girls, explaining 18.18 % of the variance. In boys, a positive correlation between PA and SI was also observed, with a correlation coefficient of 0.63, and SI played a key role in determining PA, explaining 40.39 % of the variance. It was also found that SM content has a weaker but statistically significant impact on PA in both genders, explaining 14.70 % of the variance in girls and 7.17 % in boys. Total body mass also showed a weak but statistically significant correlation with PA in girls and boys. Further analysis revealed that the relationship between PA and body composition was significant, particularly in the H-L plane, where PA was more dependent on skeletal muscle content, indicating the importance of considering this parameter when assessing the physiological status of children’s bodies. Conclusions. The results of this study underscore the importance of phase angle as a marker for assessing body composition in children. The identified positive association between PA and body composition suggests a potential usefulness of PA in determining sarcopenia and musculoskeletal health. For further clinical use of PA in clinical practice, standardization of measurement methodo­logy and creation of reference databases are necessary

The literature review deals with the problem of metabolic dysfunction-associated fatty liver disease that is poorly studied in pediatric gastroenterology. Until recently, primary hepatic steatosis not associated with alcohol intake was defined as non-alcoholic fatty liver disease. Given the unity of the pathogenetic mechanisms underlying primary steatosis, associated steatohepatitis, liver fibrosis with metabolic disorders, such as visceral obesity, insulin resistance, meta-inflammation of adipose tissue, it was proposed to change the terminology. The authors present data on modern nomenclature definitions, etiological factors, prevalence, criteria of metabolic disorders and meta-inflammation associated with this nosology and specific to childhood. Metabolic dysfunction-associated fatty liver disease and nonalcoholic fatty liver disease are characterized by the development of hepatosteatosis. However, a distinguishing feature of metabolic dysfunction-associated fatty liver disease is the presence of metabolic disorders in a patient. It is believed that the use of the term “metabolic dysfunction-associated fatty liver disease” in clinical practice allows doctors to make a diagnosis more reliably and more accurately modify the patient’s lifestyle. Much attention is paid to the description of the heterogeneity of metabolic dysfunction-associated fatty liver disease in clinical practice, and a concise list of therapeutic options for metabolic dysfunction-associated fatty liver disease in childhood is presented.

Irritable bowel syndrome (IBS) is diagnosed accor­ding to the Rome IV criteria for functional gastrointestinal di­sorders. It is estimated that 10–15 % of older children and adolescents suffer from IBS. IBS causes abdominal discomfort and pain and can worsen quality of life in children. The article provides an analysis of changes in ideas about pathogenetic mechanisms, approaches to the diagnosis and treatment of IBS in children. Once the diagnosis of IBS is made, it is important to explain to the pa­rents and children that there is no serious underlying disease. This reassurance may be effective treatment in many cases. Lifestyle modifications, stress management, dietary interventions and probiotics may be beneficial in some cases. Although there is limited evidence for efficacy of pharmacological therapies such as antispasmodics, laxatives, and antidiarrheals, they play a positive role in severe cases.

Background. The relevance of the study is due to the frequent occurrence of Lyme disease (neuroborreliosis) in the spring-autumn period. Official record of Lyme disease in Ukraine has been conducted since 2000, although the first cases were identified in the 1990s. From 2001 to 2023, the incidence of Lyme borreliosis in Ukraine increased almost by 35 times. Materials and methods. The authors conducted a retrospective analysis of statistical data on Lyme borreliosis morbidity from 2000 to 2023 and the most common cases of infectious pathology in children during this period. As pediatric infectious disease specialists, the authors present a clinical case recently observed in the pediatric infectious unit in Poltava. Results. The diagnosis of Lyme borreliosis is made based on a characteristic clinical picture and a serological confirmation. The latter is crucial in the diagnosis of Lyme borreliosis and includes 2 stages. The first stage is the assessment of immunoglobulin M and G titers by the immunofluorescence assay (IFA). If the result is negative, further investigation is conducted within the first 30 days of symptoms onset by repeated IFA 4–6 weeks after the initial test. If the analysis is conducted ≥ 30 days after the onset of symptoms, further examinations are not carried out, and an alternative diagnosis should be suspected. In case of a doubtful or positive IFA result, the diagnosis is further confirmed by the Western blotting (the second stage). The authors present a case report of a 6-year-old girl M., hospitalized in the pediatric infectious unit of the CE “Municipal Clinical Hospital 1” (Poltava) in March 2023 with a diagnosis of Lyme disease (systemic tick-borne borreliosis), early disseminated stage, myalgia, arthralgia, subacute course, moderate severity. Acetonemic syndrome. Stage 1 deficiency anemia. Metabolic cardiomyopathy. Speech development delay. Conclusions. Therefore, it is crucial to recognize Lyme disease with a progressing or remitting disseminated form, as specific therapeutic approaches exist that are effective for this disabling condition.

A rare case of severe septicemia with meningitis that developed as a result of infection with non-pathogenic Neisseria weaveri, which is better known as the commensal of the dogs’ oral cavity, is described in a child aged 7 years. The disease began acutely with fever up to 39 °C and vomiting. Later, these symptoms were accompanied by delusions, psychomotor agitation, sharp pallor of the skin and convulsions. Subsequently, the skin became cyanotic, hemorrhagic rashes appeared throughout the body. With the abovementioned symptoms, the patient was admitted to the intensive care unit of infectious clinical hospital with the diagnosis of meningococcal infection, infectious toxic shock syndrome type 1. As a result of the bacteriological examination of mucus taken from the nasopharynx and cerebrospinal fluid, meningococcus was not detected. However, blood samples contained gram-negative diplococci identified by Vitek-2 and VT2 NH ID cards as Neisseria weaveri. The uniqueness of the case is that in a typical clinical picture of generalized meningococcal infection with hemorrhagic rashes and meningitis, which was accompanied by shock, bacteriological blood tests identified a “zoonotic” type of Neisseria weaveri. As a result of the treatment, clear positive dynamics and eventual recovery of the child on the 14th day of illness were observed. The above case proves that recognition of this microorganism is of clinical importance, and non-pathogenic Neisseria weaveri should be considered as a pathogen that can cause severe septicemia with meningitis and shock manifestations, even without a history of a dog bite. The issue of the role of Neisseria weaveri in the development of the disease in children requires further study and an interdisciplinary approach with the involvement of infectious disease specialists, epidemiologists, immunologists, and microbiologists.

Background. The article deals with the relevant problems of infectology pediatrics — viral pneumonias. Viral infections can be the cause of numerous disorders of the body, but respiratory complications are the most common, especially in preschool children. The purpose is to present the clinical and paraclinical features and treatment of pneumonia caused by common viral pathogens in preschool children based on a generalization of the available literature. Materials and methods. Modern domestic and foreign literary sources on clinical and paraclinical diagnosis and treatment of pneumonia caused by common viral pathogens were reviewed and analyzed. Web of Science, Scopus, PubMed, Google Scholar databases were studied to search for literature sources. When determining the recommendations, a new, 11th revision of the International Classification of Diseases and the results of prospective and retrospective studies conducted in recent years were taken into account. Results. Modern epidemiological and etiological data on viral pneumonias in children are presented, their terminology base is updated, which contributes to the consolidation of this diagnosis in pediatric practice. In the context of the problem, based on the analysis of the results of a multicenter retrospective examination, differences in clinical manifestations, laboratory parameters, and imaging results in pneumonia caused by common viral pathogens are presented. Clinical predictors for the presence of mycoplasma co-infections and secondary bacterial infection are highlighted. Wider implementation of modern methods of etiological diagnosis is recommended because of the risk of a high rate of co-infections in children with viral pneumonia. The issue of pneumonia treatment in preschool children is considered. Conclusions. The results of the analysis justify the existence of a significant dependence between the types of the pathogen and the features of viral pneumonia course in preschool children, increase the effectiveness of differential diagnosis in various clinical phenotypes and the assessment of laboratory activity of the disease. These data, with a high degree of probability, can ensure the choice of the optimal initial therapy, predict the disease course, and solve the issue of the need for hospitalization.

Background. Recently, there has been an increase in the prevalence of the autonomic nervous system (ANS) dysfunction and, against this background, motility disorders of the upper digestive tract (UDT), which, in turn, is the basis for the formation of chronic pathology of the digestive organs in children. The purpose was to improve the treatment of children with ANS dysfunction by studying the type of motility disorders of the UDT and prescribing therapy schemes depending on the type of disorders. Materials and methods. The article presents the results of clinical and anamnestic, laboratory, instrumental and psychological research of 109 children aged 6–16 years with autonomic dysfunction. Results. All surveyed children were divided into two representative groups: group I (main one, n = 87) — patients with autonomic dysfunction and impaired motility of the UDT who by type of motor function were divided into two subgroups: IA — with the acceleration of this function (n = 18) and IB — with its slowdown (n = 69); group II (comparison one, n = 22) — children with autonomic dysfunction without motility disorders of the UDT. In order to treat patients in subgroup IA, they, in turn, were divided into two therapeutic subgroups: IA1 — only basic therapy for autonomic dysfunction, and IA2 — in addition to basic therapy for autonomic dysfunction, correction of motility disorders of the UDT was performed. Patients of subgroup IB were also divided into two subgroups: IB1 — only basic therapy for autonomic dysfunction, and IB2 — in addition to basic therapy for autonomic dysfunction, correction of motility disorders of the UDT was conducted. The effectiveness of treatment for autonomic dysfunction syndrome has been proven, taking into account the type of motility disorders of the UDT. Different treatment regimens were proposed for children with ANS dysfunction without disorders and with the presence of motility disorders. The use in the comprehensive treatment of children with autonomic dysfunction syndrome of drugs that affect the motor function of the upper alimentary canal significantly increases its effectiveness during treatment for 30 days (89.0 versus 57.0 % when motor function slows down). Conclusions. The effectiveness of the comprehensive treatment for autonomic dysfunction has been proven, taking into account the type of motility disorders of the UDT. It reliably reduces the risk of recurrence of clinical manifestations of gastrointestinal pathology in children.

Pediculosis and varicella, common in children, typically pose no significant diagnostic or treatment challenges. However, the ongoing full-scale war in Ukraine has led to severe humanitarian consequences, including mass migration and health care infrastructure damage. Under such conditions, standard treatment modalities, including isolation and hygiene measures, may be impracticable. These challenges underscore the need for adapting patient management strategies to crisis conditions. We report a case of a previously well 10-year-old female, presenting with pediculosis capitis and varicella co-infection, complicated by folliculitis. Pediculosis had been detected by the parents one week before the onset of varicella, and they self-administered a topical anti-pediculosis agent based on clearol and dimethicone once. On the 12th day of varicella infection, we found purulent rash elements on the scalp, severe pruritus, and presence of lice eggs and nits. Considering the evidence of folliculitis on the scalp, which complicated the use of external pediculicides and hygienic procedures, the case necessitated a tailored treatment approach. This included oral cefuroxime for bacterial superinfection, and two doses of oral ivermectin for pediculosis 200 mcg/kg one week apart, along with chloropyramine hydrochloride for pruritus management. The strategy resulted in elimination of head lice infestation with no adverse events. This case illustrates the critical need for updated clinical protocols and health care provider education on optimal treatment practices, especially in crisis contexts. The coexistence of varicella with a pediculosis infection precipitated a secondary bacterial infection requiring systemic antibacterial treatment. Clinical research provides evidence of oral ivermectin effectiveness in pediculosis treatment when topical pediculicides cannot be utilized. To mitigate varicella complications and control epidemic processes, integrating varicella vaccination into the national immunization schedule is recommended. Moreover, for cases with varicella and ectoparasitic infections, systemic treatment with antiviral and antiparasitic agents like acyclovir and ivermectin should be considered to minimize the risk of superinfection. The registration of oral ivermectin for pediculosis treatment by state health authorities is advocated to formalize its use in clinical practice.

Background. Today, an important task for children’s allergology is to improve the treatment of children with bronchial asthma in order to prevent the severe course of the disease, disability and mortality of patients. The purpose was to study the effect of vitamin D supplementation in the prevention and treatment of exacerbations of bronchial asthma in children. Materials and methods. The research group is 164 children with bronchial asthma. The level of 25(OH)D was evaluated by the electrochemiluminescence method on the Elecsys 2010 analyzer (Roche Diagnostics, Germany) according to the Cobas system test. The level of interleukin (IL) 4, IL-10 was assessed using sets of reagents for enzyme immunoassay. For the clinical assessment of patients, the level of bronchial asthma control was determined, and clinical analysis of disease exacerbations was conducted. Results. As a result of the comparison of the initial level of 25(OH)D in the blood serum of patients, after the use of 2,000 IU of vitamin D3 for 6 months, after the summer and after taking cholecalciferol in increased doses (4,000 IU) for 2 months, a significant difference was found between the indicators according to the Friedman test (λ2 = 41.211; p < 0.05). A positive clinical dynamics of bronchial asthma was observed in children in whom exacerbations were detected against the background of an infectious process, compared with children who had exacerbations against the background of other factors. Also, in this category of patients, after long-term intake of vitamin D with different dose regimens, a significant difference was found (p < 0.05) when comparing IL-10 and IL-4 indicators. Conclusions. Children with bronchial asthma exa­cerbation against the background of infectious processes can be recommended a year-round use of cholecalciferol, except for summer, with different dose regimens, including high daily doses (4,000 IU).

Pectus excavatum is the most common congenital chest wall deformity. It creates cosmetic defect, affects the psycho-emotional state and causes functional disorders the organs of mediastinum and lungs. From the beginning, clinical symptoms may not be noticeable, but as a child grows, the deformity progresses, becomes asymmetric and spreads to the ribs, irreversible spine di­sorders occur, cardiopulmonary system dysfunctions increase, and a psychological complex of physical inferiority is formed. The article discusses the main clinical manifestations of pectus excavatum, diagnostic features, and indications for choosing treatment method. The proposed algorithm is based on the synthesis of the knowledge of related specialists about the scope of necessary exa­minations, the joint participation of a multidisciplinary team in making a clinical diagnosis, determining the most rational tactics, and choosing modern treatment methods for a specific patient.

Background. Inflammatory bowel diseases (IBD) develop in childhood more often, last throughout life, and their frequency is rapidly increasing in industrialized countries. Most researchers identify vitamin D (VD) as a key regulator of gastrointestinal homeostasis, an innate immune response and a biomarker for the activity and severity of IBD. The purpose was to determine the frequency of vitamin D deficiency and its relationship with the course of inflammatory bowel diseases in children. Materials and methods. The study included 36 patients: 13 with IBD (main group) and 23 children of the comparison group with irritable bowel syndrome and functional abdominal pain. The average age of children was 13.09 ± 2.28 years, with a median of 14.5 years; 63.6 % were boys. Patients with IBD were evaluated for clinical disease manifestations, disease localization (Paris Classification) and disease activity (PCDAI/PUCAI). Irritable bowel syndrome and functional abdominal pain were diagnosed based on the Rome IV Criteria. Serum 25-hydroxyvitamin D (25(OH)D) was assessed by the electrochemiluminescence method (Elecsys Vitamin D total, Cobas). Results. Severe IBD prevailed among the examined children (61.5 %). There was no significant difference in overall body weight and height between the groups, which may be due to the short duration of IBD. However, children with IBD showed a tendency to lower physical development indicators. Significant differences in hemoglobin, erythrocyte sedimentation rate, C-reactive protein, number of platelets, fecal calprotectin were observed among the studied groups (p < 0.05). The concentration of VD in the blood of the examined children ranged from 39.9 to 10.8 ng/ml, with an average of 21.8 ± 5.8 ng/ml. In 76.9 % of patients with IBD, blood concentration of VD reduced, while only 21.7 % children in the comparison group had its level below the norm. Children with IBD were characterized by significantly lower levels of VD in the blood (average of 16.7 ng/ml). Lower levels of VD were associated with female sex, Chron’s disease (CD) and ulcerative colitis (UC), as well as disease duration of more than 3 years and disease severity. There was an inverse correlation between VD and the degree of IBD activity (CD: r = –0.33; p = 0.01; UC: r = –0.38; p = 0.01) and the severity of the course (CD: r = –0.35; p = 0.01; UC: r = –0.36; p = 0.01), the levels of C-reactive protein (CD: r = –0.39; p = 0.01; UC: r = –0.37; p = 0.01) and fecal calprotectin (CD: r = –0.42; p = 0.01; UC: r = –0.46; p = 0.01). Conclusions. In most children (76.9 %) with inflammatory bowel diseases, the concentration of VD in the blood is significantly lower than in those with functional gastrointestinal disorders. Lower vitamin D levels were associated with female sex, Crohn’s disease, and ulcerative colitis, as well as disease duration of more than 3 years, activity level, and severity, supporting the role of vitamin D as a possible predictor of severity of these diseases in childhood.

Background. The article presents modern data about the prevalence and peculiarities of the course of acute respiratory viral infections in a childhood based on retrospective analysis of medical records. The purpose of this article was to analyze the epidemiology and features of acute respiratory viral infections in children based on the retrospective analysis of medical records, and reports of the Public Health Center. Materials and methods. Extracts from the medical charts of inpatients with acute respiratory pathology and statistical reports of the work of the ENT department of Ivano-Frankivsk Regional Children’s Clinical Hospital for 2017–2022, which included 1,177 patients, were carefully studied. Results. The clinical features of acute respiratory infections in children hospitalized to the ENT department were as follows: age over 3 years (89 %), frequent admissions to the hospital (> 4 times a year) at the age of 4–5 years, nasal congestion (87.0 %), headache (72.0 %), body temperature above 37.9 °С (37 %), purulent nasal discharge (20 %), cough (15.6 %), general weakness (12.3 %). The average duration of the disease before hospitalization was 8.0 ± 0.2 days, and after hospitalization, it was 7.0 ± 0.1 days. It was found that those hospitalized had mostly ENT pathology, which initially was more likely to be viral (75.0 %); moreover, predominantly girls were affected (45 %), χ2 = 15.7, p < 0.05. At the same time, the proportion of combined forms of ENT diseases with a complicated course was 25 %, and boys were more likely to be affected (60 %), χ2 = 18.9, p < 0.05. Pansinusitis, on the other hand, occurred more often against the background of secondary chronic pathology (70.0 and 30.0 %, p < 0.05), χ2 = 32, p < 0.05. During all years of observation, the age group of 3 years and older prevailed among hospitalized children with acute respiratory infections. Most patients were admitted to the hospital in a condition of moderate severity. In all children hospitalized during the reporting period, we have found signs of respiratory syndrome such as nasal congestion and anosmia, sore throat, cough, purulent nasal discharge, as well as symptoms of intoxication: general weakness, headache, fever. ­Conclusions. The obtained data require further study and observation in the dynamics in order to stratify risk factors for the development of IgA-vasculitis in a childhood.

Background. The growing number of children with diabetes creates a global economic problem, including a financial burden on the country’s health care system and economic stress for families of children with diabetes. The purpose was to assess the effectiveness of medical care for children with diabetes in different regions of Ukraine over the last 20 years (2002–2021) of peacetime. Material and methods. The article presents the results of statistical evaluation and epidemiological analysis of data from the Center for Medical Statistics of the Ministry of Health of Ukraine on the rates of disability, hospitalization, and inpatient care among the pediatric population in 2002–2021. Statistical processing of the results was carried out using MS Excel, XLSTAT-Pro. Results. During 2002–2021, an increase in the rate of primary disability due to diabetes mellitus was highest among adolescents — by 4.1 times and lowest among primary schoolchildren — by 3.4 times; among children 0–6 years old, it increased by 3.6 times. The proportion of children with disabilities due to diabetes as of 2017 is 12 % among the age group of 0–6 years, and 25 % in adolescents (15–17 years). In 2013–2021, the hospitalization rate among children with diabetes increased from 1.27 to 1.35 per 1,000 of the relevant population, and the average length of hospital stay decreased by 19 %. The rate of mortality due to diabetes complications among hospitalized children varies and does not have a specific trend (in 2021, it was 0.02 per 100 in-patients). Conclusions. The analysis of the efficiency of medical care for children with diabetes during 2002–2021 in the context of increasing prevalence and incidence of diabetes showed stable trends towards a huge increase in the level of primary and general disability, a slight increase in hospitalization rates, and a decrease in the average length of hospital stay. These results call for a detailed study of the causes, control, and revision of protocol documents for the management of such patients.

The problem of coronavirus disease (COVID) requires further study and generalization because the pathogenetic mechanisms are not fully elucidated, and the clinical data are varied. Therefore, it is necessary to accumulate data about the features of coronavirus disease in patients of different age groups in order to enrich the clinical experience. The treatment and diagnosis outcomes were used to make a conclusion about clinical manifestation in pediatric COVID patients. The data were extracted using PubMed/MEDLINE and Google Scholar databases. Generally, important components of coronavirus disease pathogenesis are viral tropism for cell host, cytokine storm, endothelial dysfunction, hemodynamic instability, and dehydration. These pathogenic ways lead to multiorgan injury, so clinical signs of coronavirus infection might be different. It depends on a system that suffers from coronavirus. However, pediatric COVID infection can be mild with respiratory signs, or it can be a multisystem inflammatory syndrome. On the other hand, there are typically laboratory features of coronavirus disease, including a significant rise in inflammatory and coagulation markers such as C-reactive protein, procalcitonin, fibrinogen and D-dimer. Moreover, coronavirus has displaced other expected etiological factors of some acute upper and lower respiratory tract infections and caused acute stenosis laryngitis, bronchiolitis, or pneumonia. Interestingly, coronavirus might be a cause of Kawasaki disease, therefore, physicians should pay attention to all clinical and laboratory signs in children in order to make a clear decision about diagnosis and treatment. The benefits of this study consist in presentation of pediatric COVID features. Modern knowledge will allow to choose necessary diagnostic test in time. General practitioners will be able to refer the patients to hospital before complication arise.

Background. The purpose was to evaluate the peculiarities of microcirculation (MC) according to biomicroscopy data in respiratory diseases in children on a model of acute bronchitis. Materials and methods. The paper presents data on the study of MC in children with acute bronchitis (n = 30) compared with healthy individuals. The state of microcirculation was evaluated using nail bed biomicroscopy and by qualitative and semi-quantitative indicators. Results. In children with acute bronchitis compared to healthy persons, a number of changes were noted: in the arterioles — an increase in tortuosity, in the venular parts — the phenomena of sludge and spasms, in the capillaries — a decrease in the number of functioning microvessels and changes in their shape, slowing blood flow and sludging of red blood cells. Conclusions. Digital nail bed biomicroscopy in children is an accessible, simple and informative method for studying the state of MC in acute respiratory diseases. In acute bronchitis, even with a mild course, there are changes in the MC pattern at the level of all microvessels, with a predominance of changes in the capillaries.

Biliary sludge can occur when taking medicines (oral contraceptives, cephalosporins, octreotide, furosemide, clofibrate, morphine, calcium preparations, etc.). In particular, 30–40 % of ceftriaxone, which is widely used in pediatric inpatient practice, is excreted with bile, 5–15 % of all side effects of the drug are due to biliary sludge. The mechanism of ceftriaxone-associated biliary sludge is due to the fact that ceftriaxone competes with bilirubin for albumin, which induces an increase in unconjugated bilirubin in the blood. The drug enters the bile in the form of a divalent anion, binds to calcium in ceftriaxone-calcium complexes with inclusions of cholesterol monohydrate crystals and bilirubinate granules. In patients taking cephalosporins, when complaints from the gastrointestinal tract appear, ultrasound screening is mandatory. Children with a family history of gallstone disease and risk factors should undergo ultrasound screening on the 10th day and 1 month after treatment with cephalosporins, even in the absence of complaints. The administration of ursodeoxycholic acid leads to a significant regression of clinical symptoms of biliary sludge and objective ultrasound signs in 2/3 of children after 2 months.

Background. Seasonal allergic rhinitis shows a constant upward trend not only among the adults but also in the children’s population. A significant percentage of patients have a moderate and severe course of the disease, which leads to a significant deterioration in their quality of life. Since the pathogenesis of allergic rhinitis is represented by a complex cascade of immunological reactions involving a number of cytokines that play a role in the development of allergic inflammation of the upper respiratory tract, the priority direction of our work was an in-depth study of the pathogenetic mechanisms of this disease. The purpose was to investigate the levels of interleukin-33 (IL-33) and its suppression of tumorigenicity 2 (ST2) receptor in the blood serum of children with hay fever, depending on the age and severity of the disease, followed by the determination of correlations of these indicators with various clinical and immunological parameters of seasonal allergic rhinitis. Materials and methods. Forty-two patients aged 6–17 years with seasonal allergic rhinitis and 26 healthy children (controls) took part in the study. Severity of nasal and extra-nasal symptoms of allergic rhinitis was determined using a visual analog scale. Skin prick testing was performed according to generally accepted standards during remission using a standard pollen panel. Quantitative measurement of serum indicators of interleukin-33 and ST2 was carried out by the method of solid-phase enzyme immunoassay. A mandatory condition for conducting the study was the presence of written informed consent from the parents. Results. The study of serum levels of IL-33 and ST2 showed statistically higher concentrations in the group of children with a severe course of seasonal allergic rhinitis, a direct correlation of medium strength between content of the above cytokines in children with a mild SAR (τ = 0.65; p < 0.05) and a strong dependence in patients with moderate (τ = 0.76; p < 0.01) and severe (τ = 0.80; p < 0.05) course. When comparing the mean values of IL-33 and ST2, no significant changes were found depending on age and the presence of mono- or polysensitisation among patients with allergic rhinitis. In children with seasonal allergic rhinitis and concomitant bronchial asthma, there was a statistically significant tendency towards a more severe course of the disease with correspondingly higher values of IL-33 and ST2 compared to patients with isolated seasonal allergic rhinitis. Conclusions. The obtained results of the immunological study made it possible to emphasize the diagnostic significance of IL-33 and its receptor ST2 as potential biomarkers in the development of allergic inflammation in pediatric patients with seasonal manifestations of rhinitis.

Background. Bronchial asthma (BA) in children is on one of the leading places in the morbidity and mortality structure among other allergic and atopic diseases. It can be developed in the form of a monoorganic phenotype (MOPh) or a polyorganic phenotype (POPh) with other nosologies of atopic march (AM): atopic dermatitis (AD) and allergic rhinitis/rhinoconjunctivitis (AR/ARC). This process is genetically determined, with single-nucleotide variants (SNV) of filaggrin (FLG), thymic stromal lymphopoietin (TSLP) and orsomucoid-like protein 3 ­(ORMDL3) genes playing a major role. The purpose of this study was to reveal the impact of rs_7927894 FLG, rs_11466749 TSLP and rs_7216389 ORMDL3 SNV genotype combinations in the deve­lopment of MOPh and POPh of atopic BA in children. Materials and me­thods. One hundred and twenty-one children of the main group and 105 controls took part in the study. The criteria for inclusion into the main group were: age from 3 to 18 years, clinically established and laboratory confirmed diagnoses of MOPh BA, POPh BA + AR/ARC and AD + AR/ARC + BA. The criteria for inclusion in the control group were: age from 3 to 18 years, exclu­ded diagnoses of BA, BA + AR/ARC and AD + AR/ARC + BA. All children underwent swabbing of the oral mucosa and real-time polymerase chain reaction with the obtained material to detect variants of rs_7927894 FLG, rs_11466749 TSLP and rs_7216389 ORMDL3 genotype combinations. The results were processed ­using the following statistical tools: logistic regression analysis with determination of odds ratio (OR) with 95% confidence interval (95% CI), receiver operating characteristic (ROC) analysis with determination of the area under the ROC curve (AUC), sensitivity (Se), specificity (Sp), Pearson’s correlation coefficient (r), Fisher’s ­exact test, Student’s t-test. The significance value was set at p

Мета: покращити моніторинг орфанних та соціально значущих захворювань у дітей на основі використання географічної інформаційної системи (ГІС) і вивчити зв’язок між поширеністю дефіциту гормону росту (ДГР), муковісцидозу (МВ), гострого лімфобластного лейкозу (ГЛЛ), цукрового діабету 1-го типу (Т1ЦД) й еколого-геофізичними факторами навколишньої території. Матеріали та методи. Моніторинг випадків ДГР, МВ, ГЛЛ та Т1ЦД у дітей в Одеській області проводився з 2016 по 2020 роки. Ми зареєстрували дані 862 дітей, серед яких 92 мали ДГР, 54 — МВ, 88 — ГЛЛ і 628 — T1ЦД. У дослідженні використано клінічні та епідеміологічні методи, а також локальну ГІС. Для аналізу даних застосовували локальний медико-соціологічний шар ГІС і накладали його на еколого-геофізичний шар тієї ж ГІС. У дослідженні використано інформацію, отриману при проведенні Чорноморської геофізичної експедиції в Одеській області. Поширеність захворювань аналізували за χ2-тестом. Значення р

Background. The purpose of the work is to study the prevalence of cardiac disorders in hospitalized children with coronavirus disease (COVID-19). Materials and methods. A retrospective, cohort, monocenter study of the medical records of children who underwent inpatient treatment between September and December 2021 at the Kyiv City Children’s Clinical Infectious Disease Hospital was conducted. For our study, we selected the medical records of patients with polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the presence of at least one result of cardiac activity examination by electrocardiography (ECG) and/or echocardiography. The first study of cardiac activity by ECG and/or echocardiography was carried out in the first three days of inpatient treatment. Standard methods of descriptive statistics were used for data processing. Non-parametric statistical methods (Mann-Whitney test, chi-square, Pearson’s exact test) were used for mathematical analysis. The research was carried out in accordance with the Declaration of Helsinki principles. The study was approved by the bioethics committee of the hospital. Results. Among 305 children hospitalized with a diagnosis of U07.1 (2019-nCoV acute respiratory disease), there were selected 195 medical histories of patients aged 15 days to 18 years (median of 5.37 years), who were examined for cardiac activity by ECG and/or echocardiography. The most common changes were rhythm disturbances in the form of sinus tachycardia (20.8 %), bradycardia (11.9 %) and sinus arrhythmia (7.9 %), ventricular conduction disorders (25.7 %), deviation of the electrical axis of the heart (10.9 %) and repolarization disorders (31.7 %). During echocardiographic examination, structural abnormalities in the form of myocardial hypertrophy were detected in 3.1 % of patients, dilated heart chambers in 2 %, and pericardial effusion in 9.2 %. Among the functional changes, we observed: a decrease in left ventricular contractility in 4.1 % of cases, in cardiac output in 28.6 %, and an increase in total peripheral resistance in 41.8 %. Heart rhythm disturbances in the form of sinus tachycardia, deviation of the electrical axis of the heart, a decrease in the amplitude of the ECG waves, repolarization disorders, and pericardial effusion were associated with an increased risk of death in children with COVID-19. Clinical cases of cardiovascular complications in the form of jugular vein thrombosis and infectious endocarditis illustrate the role of the cardiovascular system in the pathogenesis of coronavirus disease. Conclusions. SARS-CoV-2 infection is often associated with damage to the cardiovascular system. In most pediatric patients, this occurs in the form of subclinical changes registered during laboratory or instrumental studies, but the development of manifest forms such as myocarditis, endocarditis, pericarditis, heart attack, coronary disease, thrombotic complications, and heart failure is possible. Using simple non-invasive methods (ECG and echocardiography) during screening, it is possible to diagnose damage to the cardiovascular system, as well as to detect changes in the cardiovascular system, which are subclinical, but can have an important prognostic value regarding the adverse course of the disease in children, which are hospitalized with SARS-CoV-2 infection.

Background. Recurrent and prolonged course of respiratory infections leads to the formation of chronic foci of inflammation, the persistence of viruses, impaired physical and psychomotor development, and a decrease in the child’s immunity. Given the participation of vitamin D (VD) in the regulation of the body’s immune response, the study of its role in the development and course of recurrent respiratory diseases in children remains re­levant. The purpose is to study the effect of vitamin D supplementation on the frequency and course of recurrent respiratory diseases in children. Materials and methods. We examined 52 children with recurrent respiratory infections aged 4 to 10 years. Children were examined before and after VD supplementation according to the study criteria: the average frequency of acute respiratory infection (ARI) episodes per year, the severity of the clinical manifestations of ARI episode, its average duration, the frequency of antibiotic prescriptions and outpatient visits to the doctor. Results. It was found that at the beginning of the exa­mination, the level of 25(OH)D in the blood serum ranged from 11.1 to 29.9 ng/ml, 22 (42.3 %) children had VD deficiency. An analysis of the frequency of ARI episodes per year showed that children with VD deficiency were ill more often than children with a sufficient level of VD (p < 0.001). According to the results of the study, it was found that VD supplementation contributes to a decrease in the frequency of ARI episodes from 8.7 ± 1.7 to 6.8 ± 1.2 times a year (p < 0.001), a decrease in the average number of symptoms of an episode of acute respiratory infections per year from 5.5 ± 0.5 to 4.5 ± 0.5 and their manifestations from 9.2 to 7.41 points (p < 0.001), a decrease in the duration of ARI episode from 6.0 ± 1.7 to 5.7 ± 1.5 days (p = 0.003), as well as a decrease in the number of outpatient visits from 5 to 4 (p = 0.004) and antibiotic prescriptions from 61 to 38 (p < 0.001). Conclusions. VD supplementation improves the course of respiratory diseases in children. The study was carried out in accordance with the Declaration of Helsinki principles. The study protocol was adopted by the ethics committee of the institution indicated in the work. The informed consent of the children’s parents was obtained.

Background. Atopic march (AM) is the progression of atopic lesions (AL) from monoorganic phenotypes (MOPh), usually atopic dermatitis (AD), to a combination with allergic rhinitis/rhinoconjunctivitis (AR/ARC) and bronchial asthma (BA) in the full-scope polyorganic phenotype (POPh) AD + AR/ARC + BA. At the same time, AD is the initial and basic AM MOPh. The basis of AL and AM is the human genotype, in particular, single nucleotide variants (SNV) of genes that predispose to the development of AL phenotypes. Namely, these are SNV of thymic stromal lymphopoietin (TSLP) and orоsomucoid-1-like protein 3 (ORMDL3): SNV rs_11466749 TSLP and rs_7216389 ORMDL3. The purpose of this study was to detect the associations and risks of developing AM POPh AD + AR/ARC and AD + AR/ARC + BA related to baseline MOPh AD and to each other in children with different SNV rs_11466749 TSLP and rs_7216389 ORMDL3 genotypes. Materials and methods. Two hundred and thirty-two children aged 3 to 18 years took part in the study. The main group consisted of 127 patients with 3 studied AM phenotypes: one MOPh AD (n = 58) and two POPh: AD + AR/ARC (n = 43) and AD + AR/ARC + BA (n = 26). The control group included 105 children without AL, suffering from gastrointestinal diseases. All children in the study groups underwent a buccal swab of the DNA material, which then was studied using the real-time polymerase chain reaction with restriction fragment length polymorphism to determine the genotypes of SNV candidates: A/A, A/G, G/G rs_11466749 TSLP and C/C, C/T, T/T rs_7216389 ORMDL3. Pearson’s χ2 criterion and Fisher’s exact test, Bravais-Pearson contingency coefficient (r), logistic regression analysis with determination of odds ratio (OR) with 95% confidence interval (95% CI), receiver operating characteristic (ROC) analysis with calculation of the area under the ROC curve with a 95% CI and operating characteristics — sensitivity and specificity were used for statistical processing. The critical level of statistical significance of the results during testing of all hypotheses was p < 0.05, the tendency to probability was determined at p = 0.05–0.1. Results. The following statistically significant differences were detected in the occurrence of genotypes related to the control group: for POPh AD + AR/ARC: SNV rs_7216389 ORMDL3: C/C — 14.0 %, T/T — 39.5 to 27.6 and 15.2 %, respectively (p = 0.08 and p < 0.05); for POPh AD + AR/ARC + BA: SNV rs_11466749 TSLP: A/A — 77.0 %, A/G — 11.5 to 50.5 and 45.7 %, respectively (p < 0.05 and p < 0.01). Among the phenotypes of the main group, the following statistically significant differences in the genotypes incidence had been detected: AD + AR/ARC related to AD: G/G rs_11466749 TSLP — 9.3 to 1.7 % (p = 0.08), T/T rs_7216389 ORMDL3 — 39.5 to 19.0 % (p

Background. Treatment of epileptic seizures in young children, especially with epileptic encephalopathies (EE), is a difficult task, which is impossible in modern conditions without the use of a personified (precision) therapy. The diagnostic algorithm for EE must include genetic examination by the next-generation sequencing, which makes it possible to prescribe targeted therapy depending on the genetic etiology of the disorder. The article presents the results of own research on the effectiveness and approaches to targeted therapy of genetic epileptic encephalopathies in young children. Materials and methods. Fifty-eight children aged 0–3 years with clinical manifestations of epileptic encephalopathies, onset of seizures in the first year of life and diagnosed genetic etiology were included in the study. Pathogenic variants in genes associated with the development of epileptic seizures were identified in all children using the next-generation sequencing. The study included assessment of neurological status, history collection, evaluation of semiology and seizure type, development and screening for autism spectrum disorders at the age of 18 and 24 months, video-electroencephalography during night sleep, magnetic resonance imaging of the brain, assessment of antiepileptic treatment received by the child. Results. Of 58 children with EE who were prescribed antie­pileptic drugs, 10 (17.2 %) received monotherapy, 40 patients (69 %) received combined therapy with two anticonvulsants, and 8 children (13.8 %) — combined therapy with three or more anticonvulsants. Levetiracetam (31 patients), valproic acid salt preparations (20 cases), topiramate (11 children) and vigabatrin (10 cases) were most used antiepileptic drugs. In all examined patients with EE, we used schemes of targeted (persona­lized) antiepileptic therapy focused on the genetic etiology of the disorder. In children with tuberous sclerosis caused by mutations in the TSC1 and TSC2 genes, vigabatrin (50–150 mg/kg per day) was included in the antiepileptic therapy and showed efficacy in 75.0 % (9/12) of children with infantile spasms. Corticosteroids (adrenocorticotropic hormone or prednisone) were additionally included in the treatment regimen and showed effectiveness in 66.7 % of cases (4/6). In children with mutations in SCN1A gene, combined therapy including valproic acid, topiramate and clobazam, or valproic acid with levetiracetam and corticosteroids was used, which showed effectiveness in reducing the frequency of seizures in 100 % of cases. Conclusions. Epileptic encephalopathies are a heterogeneous group of genetic disorders in young children that are difficult to treat and often have a malignant course. Since standard antiepileptic drugs are often insufficiently effective in epileptic encephalopathies, the use of targeted therapy drugs and alternative treatments such as hormone therapy are extremely important. The goal of treatment for epileptic encephalopathies is not only to control seizures, but also to prevent the development of neurological and cognitive deficits and restore lost functions.

Background. A decrease in the age of onset of rheumatic diseases in children, an increase in the total duration of the disease, the development of persistent functional and organic di­sorders of organs and systems determine the need to study comorbid conditions already in childhood in order to optimize their diagnosis and comprehensive therapy. The purpose was to study the frequency and main patterns for the formation and further progression of comorbidities in children with rheumatic diseases (juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (SLE)). Materials and methods. An analytical review of the literature on the prevalence and diagnosis of comorbid lesions in adult patients with rheumatic diseases and in children was carried out; 250 children aged 3–18 years with JIA and 67 children with SLE with a juvenile onset were dynamically monitored for the presence of comorbid conditions of the cardiovascular system, kidneys, lungs, eyes, bone tissue, blood lipid disorders. Results. The frequency and nature of comorbidity in children with JIA and SLE have been determined. Preservation of the process activity is the main factor in the progression of comorbid pathology and the formation of irreversible damage to organs and systems with the development of their failure and violations of the quality of life of patients. Conclusions. Based on the presented materials, it is possible to develop programs to prevent the formation and progression of irreversible damage to systems and organs that occur under comorbid conditions in children with rheumatic diseases and to effectively socialize these children.

Background. An outbreak of hepatitis of unknown origin in children aged 1 month — 16 years was first reported by the WHO in April 2022. It was accompanied by a high frequency of acute liver failure, and up to 5 % of children required liver transplantation. The purpose of the review was to determine probable etiological factors and mechanisms of acute hepatitis of unknown origin based on a systematic analysis of literary sources. Materials and methods. We conducted a search for studies on cases or case series of acute hepatitis of unknown origin in the PubMed between January 2022 and February 2023. A combination of the following terms was used for the search: “unknown hepatitis”, “hepatitis of unknown origin”, “non-A-E hepatitis”, “hepatitis of unknown etiology” and “children”. Results. According to the search results, 312 publications were found. After the selection, 14 publications were included in the review. A systematic analysis of 1,188 cases of acute hepatitis of unknown origin, which corresponded to the identified case, showed a high variability of causative agents. However, most children were tested positive for adenovirus (almost 57 %), and 14 % of children had a positive PCR for SARS-CoV-2. Among other viruses detected in children, viruses of the herpes family should be noted, especially human herpesvirus 7 (34.2 %), human herpesvirus 6 (20 %), Epstein-Barr virus (18.2 %), cytomegalovirus (9.2 %). Rhinovirus (40.7 %), enterovirus/rhinovirus (28.7 %), parainfluenza virus (15.4 %), streptococcal infection, and other pathogens were also found. Conclusions. Viruses, genetic predisposition and other factors that change the body’s immune response play an important role in the development of an outbreak of severe hepatitis. Systematic analysis has shown that human adenovirus most often acts as a helper for adeno-associated virus 2, which plays a major role in initiating an immune response in genetically predisposed individuals, causing acute hepatitis and acute liver failure. SARS-CoV-2 infection probably also plays a certain role in immune activation and in the development of hyperinflammation, as do other viruses that act as helpers for adeno-associated virus 2. Continued collection of detailed clinical, microbiological, and epidemiological data on probable cases, as well as well-planned and coordinated follow-up studies are necessary to identify risk factors and other etiological factors associated with this disease.

Background. The adverse social situation in Ukraine and an increase in the number of injured children lead to a burden on trauma departments and rehabilitation centers. Looking for simple methods to help detect violations of compensatory mechanisms, one of which is the centralization of blood circulation, and impaired perfusion at the microcirculatory periphery level is of great current relevance. Materials and methods. A comprehensive clinical and functional examinations were applied to 44 children aged 10–15 years, 21 of them had home-related upper extremity fractures (main group), 23 otherwise healthy children served as the control group. All the children underwent the Box and Block Test (BBT), and the perfusion index (PI) from the extremities was recorded. Results. The BBT performance was characterized by a 1.6-fold decrease (p < 0.05) in the affected extremity of children aged 10–15 years under the rehabilitation treatment compared to that of the non-dominant extremity in healthy children and a 1.3-fold decrease (p < 0.05) in the healthy extremity compared to the dominant one. PI decreased to 2.52 ± 0.58 at rest in the main group children who underwent upper extremity rehabilitation treatment for injuries compared to 3.49 ± 0.34 (p < 0.05) in healthy children. PI reduced to 1.57 ± 0.56 in injured children at exercise loads versus 2.93 ± 0.91 (p < 0.05) in healthy children. The dynamics of recovery also differed and amounted to 2.82 ± 0.45 in the main group versus 4.00 ± 0.64 in the control group. Children with PI up to 1.5 ± 0.4 had significantly lower BBT scores at the beginning of exercise training. PI reduction to less than 1.5 allowed predicting a decrease in muscle functions, delayed wound healing, and the need for analgesia. With an increase in PI to 2.40 ± 0.54 during exercise training, children performed BBT better, while those who had a decrease in perfusion up to 0.98 ± 0.20 performed it twice as slowly (p < 0.05). As a study result, an association between the physical exercise load, changes in PI and BBT has been revealed. Conclusions. BBT scores were characterized by a 1.6-, 2.0- and 1.8-fold (p < 0.05) reduction during the first, second and third measurements, respectively, compared to those of healthy children. Characteristic feature of perfusion index was a statistically significant decrease before and during exercise training as well as slow dynamics of recovery. The correlations between perfusion index and BBT have proven the association of the rehabilitation processes and blood flow restoration.

Background. Single nucleotide variants (SNVs) of the ghrelin (GHRL) gene are accompanied by the production of a defective preproghrelin protein, which can lead to the development of obesity and metabolic disorders. The purpose was to study the associations of SNVs of the GHRL gene in children with the development of various obesity phenotypes. Materials and methods. Two hundred and fifty-two obese children aged 6–18 years were examined. The main group (n = 152) was represented by patients with metabolically unhealthy obesity (MUO). The control group (n = 100) included children with metabolically healthy obesity (MHO). Whole genome sequencing (CeGat, Germany) was performed in 31 children of the main group and 21 controls. Serum levels of interleukin-1β were measured using a chemiluminescent immunoassay, interleukin-6 — by enzyme-linked immunosorbent assay (Synevo, Ukraine). Results. The association with the development of MUO was higher for the T allele of SNV rs696217 in healthy individuals (t = 2.31; p < 0.05) and obese patients (t = 2.06; p < 0.05). The GT genotype SNV rs696217 was associated with insulin resistance (r = 0.40; p < 0.05) in the MUO group and inversely correlated with levels of cholesterol (r = –0.45) and low-density lipoprotein cholesterol (r = –0.39) in children with MHO. The TA SNV rs4684677 genotype correlated with IL-6 levels (r = 0.74) in the MHO group and with IL-1β (r = 0.35) in children with MUO, p < 0.05. Prevention of the transformation of MHO into MUO is determined by the T allele SNV rs34911341 (t = 2.29, p < 0.05). Conclusions. The missense variants rs696217 and rs4684677 of the GHRL gene are SNVs highly associated with obesity and the development of metabolic disorders.

Background. Diagnosis of pneumonia is difficult and requires a comprehensive examination. Respiratory acoustics is currently a promising diagnostic method. The purpose was to evaluate the possibility of pneumonia detection by the average signal power, frequency and amplitude of the acoustic signal using the Trembita-Corona acoustic monitoring device. Materials and methods. Onу hundred and ninety-three children aged from 1 month to 18 years were examined. The children were divided into two groups: group I — 98 patients with community-acquired pneumonia, group II — 95 healthy children. All children were examined using the Trembita-Corona acoustic monitoring device. Results. The sensitivity of the method for detecting pneumonia using the acoustic monitoring device Trembita-Corona according to the average signal power in the 4th, 5th and 6th octaves is from 90.8 to 99 %, and the specificity is from 87.4 to 100 %. The sensitivity of the method for detecting pneumonia using the acoustic monitoring device Trembita-Corona according to the frequency of the acoustic signal in the 3rd and 5th octaves is more than 60 %, and the specificity is more than 63 % in the 3rd octave and 100 % in the 5th octave, respectively. The sensitivity of the method for detecting pneumonia using the acoustic monitoring device Trembita-Corona according to the amplitude of the acoustic signal in the 4th, 5th and 6th octaves is 88.9, 99.9 and 86.9 %, respectively, and the specificity is 100 % in the 4th and 5th octaves and 87.4 % in the 6th octave. Conclusions. The acoustic monitoring device Trembita-Corona demonstrates high specificity, sensitivity and positive predictive value and negative predictive value at given prevalence.

Background. The purpose was to analyze and summarize the accumulated short-term and long-term safety data in children with growth hormone deficiency (GHD) treated using recombіnant human growth hormone (rhGH) based on the results of a physical examination, assessment of vital signs, laboratory parameters, and follow-up. Materials and methods. The study was conducted at the Odesa Regional Children’s Clinical Hospital from 2012 to 2022, with 92 children treated for GHD using rhGH at an average dose of 0.033 mg/kg/day. The evaluation of the safety of this therapy was based on assessing the incidence of adverse events (AEs) as a negative consequence of medical care. We analyzed both short-term and long-term outcomes. Results. When studying the short-term safety of rhGH therapy according to physical examination data, AEs were found in 18 (19.57 %) children, including intracranial hypertension (1), arthralgia (1), prepubertal gynecomastia (1), anemia (3), manifestation of latent adrenal insufficiency (3), latent thyroid insufficiency (2), impaired glucose tolerance (7). 20.6 (7.0 ÷ 34.2) % of patients with unacceptable adherence to rhGH therapy reported painful injections compared to 4.3 (–1.6 ÷ 10.2) % of children with acceptable compliance (χ2 = 5.15; р = 0.02). None of the children experienced serious adverse events such as scoliosis progression, slipped capital femoral epiphysis, edema, and impaired vital functions. AEs in terms of hematological and biochemical parameters were usually transient, often in combination with intercurrent diseases, and were not associated with rhGH. In long-term safety, there was no association between rhGH therapy and the risk of cancer, cardiac, and cerebrovascular diseases. Still, three children (3.26 %) had type 2 diabetes, with overweight in one case and obesity in two. Conclusions. In general, in the short-term context, rhGH therapy for children with GHD is safe. The pain at the injection site is a clinically significant AE as a cognitive emotional barrier to the adherence to rhGH therapy. From the point of view of the long-term safety of rhGH therapy, the fact that type 2 diabetes was detected in 3 (3.26 %) children with increased body weight and obesity is essential.

Background. Lyme disease is a common tick-borne infection. Untimely diagnosis and treatment lead to the chronicity of the process with the development of late lesions of various systems and organs and possible disability. The purpose of the study was to develop a program of rehabilitation measures for children with Lyme disease. Material and methods. The research was conducted on the basis of the Ternopil Regional Children’s Hospital. Twenty children, residents of the Ternopil region, who applied to the Ternopil Regio­nal Children’s Hospital for tick bites and, as a result, diagnosed Lyme arthritis, took part in the study. To assess the severity of pain, we used scales and questionnaires for the diagnosis of DN4 neuropathic pain. Laboratory and instrumental studies were performed such as evaluation of the level of malondialdehyde, diene conjugates, superoxide dismutase. Results. Clinical examination of tick-affected children with Lyme disease showed that the most common primary clinical manifestation is a typical skin lesion — erythema migrans. In case of arthritis, all children notice inflammatory changes and pain in the joints. As a result of the conducted studies, the activation of peroxidation in children with Lyme disease was detected (an increase in the level of malondialdehyde and a decrease in superoxide dismutase, diene conjugates). It was shown that combined therapy with the use of magnetic laser therapy leads to the normalization of lipid peroxidation. Conclusions. All children with Lyme arthritis have a pain syndrome of varying severity. In patients with Lyme disease, there is an increase in the activity of lipid peroxidation and a decrease in the functional capacity of the antioxidant defense system. Children who underwent traditional treatment for Lyme arthritis reported a partial normalization of lipid peroxidation as evidenced by a significantly decreased level of diene conjugates compared to controls. In the group of patients who underwent combined treatment for Lyme arthritis (antibacterial therapy + magnetic laser therapy), the activity of antioxidant defense was normalized. Combination of magnetic laser therapy with antibacterial therapy demonstrates an improvement of pain status and faster rehabilitation of children.

Background. An increase in life expectancy of patients with cystic fibrosis contributes to the formation of severe patho­logy of the hepatobiliary system, leading to the development of fatal biliary cirrhosis. The purpose was to prospectively assess the predictive value of a combination of serum liver enzymes, ultrasound liver parameters and transient elastography for diagnosis of clinically significant liver fibrosis. Materials and methods. We enrolled 108 children aged 0–17 years with cystic fibrosis. The fibrosis stage was determined using transient elastography on FibroScan® 502 (Echosens, France). The activity of enzymes (alanine transaminase, aspartate transaminase, alkaline phosphatase, gamma-glutamyl transferase, lactate dehydrogenase-5), ultrasound parameters of the liver at different stages of liver fibrosis have been investigated. Results. Liver fibrosis of varying severity was detected in 29.6 % of patients with cystic fibrosis (liver elasticity ranged from 5.9 to 49.0 kPa). Li­ver cirrhosis was observed in 14.8 % of children with cystic fibrosis. The dependence of an increase in the activity of alkaline phosphatase, gamma-glutamyl transpeptidase, lactate dehydrogenase-5 and an enlargement of the left lobe of the liver, a reduction in the k ratio of the sizes of the right and left lobes of the liver on the degree of fibrosis F1-F4 (р < 0.05) was found. Conclusions. The combined use of transient elastography FibroScan with increased activity of the alkaline phosphatase, gamma-glutamyl transpeptidase, lactatе dehydrogenase-5 and changing of ultrasound liver parameters could be used for early diagnosis of hepatobiliary lesions in cystic fibrosis. The age of a patient with cystic fibrosis over 6 years old, male gender and the presence of ΔF508 deletion in the genotype have a high positive predictive value for liver fibrosis and cirrhosis.

Background. An imbalance of the autonomic nervous system, or a syndrome of autonomic dysfunction, is a pathological condition characterized by a violation of the autonomic regulation of the functions of internal organs, blood vessels, and metabolic processes. This is a polymorphic pathology in which various organs and systems in children suffer, but the dominant role in the clinical picture is given to the cardiovascular disorders that is manifested by an increase of blood pressure. The purpose of the study: to assess the state of the autonomic nervous system and the level of anxiety in children with primary hypertension. Materials and methods. Forty-three children of high school age were examined. The main group included 21 children with a confirmed diagnosis of primary hypertension, and the control group — 22 children with a normal blood pressure level. The state of the autonomic nervous system was assessed using the Wayne A.M. questionnaire. The level of anxiety was evaluated according to the State-Trait Anxiety Inventory (STAI). Results. Evaluation of the level of anxiety revealed that the average level of reactive anxiety in children of the main group on the STAI was 37.3 points, which indicated a moderate level, while in the children of the control group it was low (26.6 points). The average level of personal anxiety in children of the main group was 42.6 points, which actually indicated an increase in the general level of anxiety, in the control group this indicator was low and amounted to 28.7 points (p < 0.005). Conclusions. In children with hypertension, autonomic dysfunction with a predominance of sympathicotonia is more likely to be observed, which indicates a deep pathogenetic connection between an increase in blood pressure and disorders of the autonomic nervous system. Children with hypertension probably have a higher level of personal anxiety compared to those with normal blood pressure, which must be taken into account in the treatment and prevention of this disease.

Aortopulmonary window (APW) is a congenital heart defect characterized by the presence of an abnormal connection between the pulmonary artery and the proximal part of the aortic arch directly above the level of the semilunar valves. It is one of the rarest cardiac defects (frequency of 0.2–0.6 %). APW occurs as an isolated cardiac lesion or in association with other anomalies such as coarctation of the aorta, interrupted aortic arch, tetra­logy of Fallot, and atrial septal defect or patent ductus arteriosus. Treatment of APW comprises surgical correction of the defect, which should be performed immediately after diagnosis in order to prevent the development of pulmonary hypertension. Postoperative complications after surgical correction of APW occur rarely and depend on the association of this defect with other congenital heart defects, especially with an interrupted aortic arch. In this article, we present a retrospective analysis of patients with APW for 2003–2022, who were examined at the Lviv Regional Children’s Hospital OHMATDYT, and 2 clinical cases of APW in 2- and 10-month-old boys.

Background. Atypical hemolytic uremic syndrome (aHUS) is an extremely rare but life-threatening di­s­order in children since it may cause acute kidney injury. Patients with aHUS are at risk of recurrence. Hence, in this paper, we present a case of a 9-year-old boy with aHUS relapse. The child was admitted to the emergency department on the fifth day of illness with main complaints of facial puffiness and decreased urine output. Based on the medical history, the patient developed the second episode of aHUS after 6 years of complete recovery from the first episode. There was no preceding diarrheal illness, instead, the clinical manifestation of both aHUS episodes was triggered by a respiratory tract infection. The results of diagnostic studies performed during the first episode of aHUS were as follows: stool tests for Esche­richia coli and Shiga toxins were negative; a complement assay showed no abnormalities; ADAMTS13 activity and anti-complement factor H antibodies were normal. The results of the kidney ultrasonography and biopsy were consistent with the diagnosis. Family history was remarkable for aHUS in a younger sibling confirmed by molecular genetic testing, in particular, a pathogenic variant in the CD46/MCP (membrane cofactor protein) gene in the heterozygous state has been identified. Physical examination revealed paleness, facial swelling, moderate hypertension, and oliguria. Laboratory findings demonstrated hemolytic anemia, thrombocytopenia, significant azotemia, a severe reduction in the glomerular filtration rate, a high level of aspartate aminotransferase, insignificant electrolyte imbalance, and proteinuria. Supportive treatment included fluid and electrolyte management, fresh frozen plasma, furosemide, and dexamethasone. The child commenced acute hemodialysis due to severe acute kidney injury. Conclusions. A recurrence of aHUS is characterized by severe renal failure requiring acute hemodialysis. Viral infections are potential triggers of aHUS. A relapsing course of the disease and a family history of aHUS indicate the importance of genetic screening, as familial aHUS should be considered.

Background. Chronic tonsillitis is the most common disease among children and adolescents in the structure of pathology of the ENT organs. Untimely diagnosis and irrational treatment lead to decompensation of chronic tonsillitis and the development of lesions of many organs and systems of the child’s body of tonsillogenic origin. The aim of the work was to study the clinical features and ultrasound changes of the palatine tonsils in adolescents with chronic tonsillitis. Materials and methods. We have examined 47 children aged 13 to 17 years suffering from chronic tonsillitis: group I — 27 patients with compensated chronic tonsillitis, group II — 20 patients suffering from decompensated chronic tonsillitis. The control group consisted of 16 practically healthy children, representative in terms of age and gender. We used clinical methods, ultrasonography of the palatine tonsils, and statistical methods. The study was approved by the Institutional Bioethics Committee and it conforms to the principles outlined in the Declaration of Helsinki. Results. According to the results of an ultrasound examination of the palatine tonsils in children with chronic tonsillitis, the main changes were an increase in their transverse dimensions by more than 15 mm, deepening of lacunae, thickening of the capsule, fibrous changes. In addition, in patients with tonsillogenic lesions of the cardiovascular system and a decompensated form of chronic tonsillitis, the pathological signs of the disease according to ultrasound were more significant and were manifested by unclear contours, increased echogenicity, heterogeneous hyperechoic structure, diffuse fibrous and cystic changes of the palatine tonsils. Conclusions. Ultrasonography of the palatine tonsils is a non-invasive, painless, accessible and informative method for studying the structure of the tonsils in normal and pathological conditions. It allows for a more thorough assessment of their changes in compensated and decompensated forms of chronic tonsillitis.

Background. The purpose of the work was to determine the level of S100β protein in children with COVID-19 and to investigate the correlation of this neurobiomarker with the severity of COVID-19 and the age of the patients. Materials and methods. We conducted a retrospective, cohort, observational, post-registration study. We examined 88 children aged 1 month to 17 years with laboratory-confirmed COVID-19 who underwent inpatient treatment at the Kyiv City Children’s Clinical Infectious Diseases Hospital (Kyiv, Ukraine) in 2021–2022. Children were divided according to the course of the disease into two groups: the control group, which had a complicated course of COVID-19, and the main group without complications. We also made a division by age groups: 0–12 months, 1–6, 6–10 and 10–17 years. The main laboratory indicators, data of anamnesis and objective examination were taken into account. During the comprehensive routine examination of the patients on the first day of their stay in the hospital, the blood serum was collected for further examination for the level of S100β neurobiomarker by enzyme immunoassay. CanAg S100 EIA kit (Fujirebio) with a working measurement range of 1–3500 ng/L for S100β marker was used. The research was carried out in accordance with the Declaration of Helsinki principles. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of parents and children was obtained. In the study, we used statistical research, analytical methods, and the method of empirical research. Results. When comparing the main and control groups by age, the age of patients from birth to 12 months was a significant indicator (44.8 % in the main group vs. 23.3 % in controls), p = 0.049. When conducting a study on S100β correlation with D-dimer, a linear correlation was found (r = 0.141; 95% CI –1... 0.311; p < 0.1), as well as a negative linear correlation with prothrombin index (r = –0.204; 95% CI –1... 0.0131; p = 0.03) and age (r = –0.184; 95% CI –1... 0.0077; p = 0.04). Conclusions. A correlation between S100β neurobiomarker, age and severity of COVID-19 was revealed. Higher indicators were noted in the group of patients with a complicated course of the disease. A tendency towards a higher level of protein S100 at a younger age was revealed, as well as a linear relationship of neuromarkers with prothrombin index and D-dimer.

Background. Endothelial dysfunction (ED) is common in acute leukemia patients. The study of ED can provide more information about pathological processes in lungs of children with acute lymphoblastic leukemia (ALL). The purpose of the study is to assess the levels of vascular endothelial growth factor A (VEGF-A) and its prognostic value for pulmonary complications in children with ALL. Materials and methods. The control group consisted of 15 healthy children. The level of VEGF-A in serum was assessed by enzyme-linked immunosorbent assay. Results. Pulmonary complications were common in the examined children with ALL, among them: аcute bronchitis (23), recurrent episodes of acute bronchitis (5), pneumonia (18), wheezing (9), bronchial asthma (3), interstitial pneumonia (1), pleurisy (1), pneumothorax (3), lung fibrosis (2), respiratory failure (6). The frequency of pulmonary complications was 82.5 % during chemotherapy protocols and 20.0 % in ALL survivors after a complete course of chemotherapy. Statistically significant increase in VEGF-A level in groups 1 (180.41 (158.16; 200.00) pg/ml) and 2 (165.61 (131.65; 198.45) pg/ml) compared to controls (130.65 (129.45; 132.15) pg/ml) has been detected (p1-C = 0.000011; p2-C = 0.007009). There were no significant differences in VEGF-А levels between children from experimental groups (p1–2 = 0.338394). According to receiver operator characteristic (ROC) analysis, the level of VEGF-A > 198.34 pg/ml after the complete course of chemotherapy can predict the presence of pulmonary complication in ALL survivors (area under the ROC curve 0.965; sensitivity 100.00 %; specifi­city 89.47 %). Conclusions. Children with ALL have significant ED. The level of serum VEGF-A can be predictive for pulmonary complications in ALL survivors.

Background. The russian aggression in Ukraine has caused numerous casualties among civilians, including children. Military actions lead directly or indirectly to increased morbidity in adults and children and to chronic stress, especially in children. The purpose of this research was to analyze the problems of providing medical assistance to the children of Ukraine who are suffering from the russian invasion. Materials and methods. We have used the official statistical and own data for 2022–2023. Results. Currently, more than 7.5 million Ukrainian children are suffering from the war, not only due to physical injuries but also violations of their mental and psycho-emotional state. A special problem for Ukrainian paediatricians at the beginning of 2023 was an increase in the incidence of acute respiratory diseases, COVID-19 and stress disorders in children due to a shortage of medical personnel and infrastructure. Also, in conditions of limited access to medical care and medicines, it is necessary to pay attention to chronic diseases, in particular, asthma and other allergic diseases. Paediatricians from the departments of the Bogomolets National Medical University provided voluntary assistance to children in frontline regions. Conclusions. In the new conditions of warfare, where civilians and life support infrastructure have become the target of armed attacks, children have become the most vulnerable group. The issues of restoration of full medical care for children, including emergency and urgent care, provision with doctors of certain paediatric specialties, full supply of medicines and medical devices, and restoration of destroyed medical infrastructure remain extremely relevant to the health system in the frontline and liberated areas.

Background. Children with atopic dermatitis may be at increased risk of developing dental caries. This problem is poorly understood and needs attention. The aim of this study was to investigate the oral health status of children and adolescents with atopic dermatitis. Materials and methods. One hundred children with atopic dermatitis aged 2 to 17 years, median of 6 [3.5; 10], and 103 children without atopic dermatitis, median age 7 [5; 12.5] years, were included in the study. Clinical parameters included age, sex, age of onset and severity of atopic dermatitis according to the SCORing AD index (SCORAD). Patients with at least one type of caries at any stage of progression (from white spots to carious lesions with pulpal damage) were included in the caries group. The risk of caries in the atopic dermatitis group and in healthy children, and the significance of the presence of asthma and allergic rhinitis for the development of caries were evaluated using the odds ratio (OR) with a 95% confidence interval (CI). Results were considered statistically significant at the p < 0.05 level. Results. Caries was detected in 46 % of children with atopic dermatitis and 22 % controls (OR = 2.9630, CI 1.6131–5.4424, p = 0.0005). In the group of allergic rhinitis, 24 patients were found to have caries, and among those without allergic rhinitis, 22 children had caries. It was found that patients with concomitant allergic rhinitis were significantly more likely to develop caries (OR = 3.4406, CI 1.4693–8.0563, p = 0.0044). No such significance was found depending on the presence of asthma (OR = 1.3986, CI 0.4913–3.9814, p = 0.5). Conclusions. Children with atopic dermatitis have a significantly higher risk of dental caries than healthy children. Based on the results of our study, clinicians should be aware of dental manifestations in patients with atopic dermatitis and recommend regular dental examinations for early caries detection.

Background. The purpose was stratification of factors that lead to the chronicity of inflammatory diseases of the urinary system in children, as well as creation of a mathematical model for predicting their course. Materials and methods. The research group consisted of 97 children (average age — 10.0 ± 1.3 years). The main group was divided into subgroups: the first one — 43 children with acute urinary tract infections (UTIs), the second one — 34 patients with chronic UTIs. The control group consisted of 20 conditionally healthy children. The content of 1,25(OH)2D3, vitamin D-binding protein, inducible nitric oxide synthase (NOS2), cystatin C, cathelicidin, hepcidin, lactoferrin, interleukins 6, 15 was investigated by immunoenzymatic analysis. The impact of factor characteristics on the process of UTI chronicity was evaluated using factor and cluster analyses. A logistic regression equation was used to predict the probability of developing chronic UTIs. The quality of the constructed model was assessed by its sensitivity and specificity, and receiver operator characteristic (ROC) analysis was also used. Results. It was found that 6 factors had the greatest significance: the factor of functional disorders of the urinary tract, the factor of comorbid conditions, the protective factor, the immune factor, chronic foci of the disease, and the NOS2 factor. According to the results of logistic regression, the model for predicting the probability of developing chronic UTI in children had the form of an equation that included 6 variables (early manifestation of the disease, vitamin D level, vesicoureteral reflux, dysmetabolic nephropathy, neurogenic bladder, UTI in the mother in childhood). The classification ability of the model was determined based on the data of the training sample and was 75.0 %. The sensitivity of the model was 78.3 %, and the specificity was 76.5 %. The area under the ROC curve that corresponded to our mathematical model was equal to 0.776. The Gini index was 55.2 %, which corresponds to the good quality of the model. Conclusions. The process of chronicity of the inflammatory process in the urinary system in children occurs under the conditions of the interaction of some pathological factors. The leading risk factors for the chronicity of the inflammatory process are the presence of functional disorders of the urinary tract, early manifestation of the disease, the level of vitamin D, intestinal dysfunction, and the presence of UTI in the mother in childhood.

Background. The main objectives of the treatment of bronchopulmonary diseases in children are to control the disease, achieve a stable remission of the process, restore the function of external respiration, the nervous system, increase the body’s tolerance to the action of allergens. Kinesiotherapy is one of the most effective methods in non-drug rehabilitation. The purpose of our study was the pathogenetic justification of the use of kinesiohydrotherapy by the method of controlling the function of external respiration at the stage of rehabilitation of children with recurrent bronchial obstruction. Results. A comparative analysis of spirometric indicators in children with recurrent bronchial obstruction before and after kinesiohydrotherapy in the experimental and control groups showed the effectiveness of the method of comprehensive rehabilitation with the inclusion of kinesiohydrotherapy with special breathing exercises on land and in the pool. After a one-year rehabilitation period, violations of the ventilation capacity of the lungs by the obstructive type maintained in mild form. Сhildren with recurrent bronchial obstruction who did not effectively use physical rehabilitation with additional medical recommendations and physiotherapy as in experimental group, still had violations of the function of external respiration during the recovery period. Clinically, the children of control group continued to have frequent relapses of bronchial obstruction on the background of acute respiratory infections. Therefore, they belong to the group with a prolonged course of bronchial obstruction and the risk of transition to bronchial asthma. After the course of treatment, the cough became much less frequent, there were no night attacks, and the body temperature was steadily normal. Auscultation of wheezing was not heard, breathing had a harsh tinge. Conclusions. Thus, the use of therapeutic water procedures and respiratory physical exercises, i.e. kinesiohydrotherapy, is an effective method in the rehabilitation of children with recurrent bronchial obstruction.

Background. Healthcare-associated infections (HCAIs) now include the development of infectious processes in various organ systems of patients and at hospitals of different work directions. It is believed that HCAIs are infections that first occur 48 hours or later after hospitalization or 30 days after receiving medical care. The aim of our research was a retrospective analysis of the incidence of HCAIs among children in Ukraine during 2009–2021. Materials and methods. Statistical analysis of the prevalence of registered cases of HCAIs in Ukraine for 2009–2021, according to the Center for Public Health of the Ministry of Health of Ukraine. Results. On average, 966 ± 489 cases of HCAIs were registered annually in Ukraine among children of various ages. According to the age distribution, the number of annual cases of HCAIs among newborns of up to 1 month of age averaged 65.8 %, for those aged 1 month to 1 year — 5.9 %, from 1 to 17 years — 28.3 %. According to the nosological structure of HCAIs, infections of certain conditions occurring in the perinatal period prevailed among children. On average, the number of such diseases for 2010–2021 was 49.5 ± 7.5 % (among children 0–17 years old) and 13.8 % of the total cases of HCAIs in Ukraine. Conclusions. In recent years, there has been an underestimation of HCAI cases in Ukraine among adult patients and children. Nevertheless, indicators provided by institutions of some regions (Odesa and Kyiv regions) make it possible, with a certain degree of probability, to get an idea of the structure of HCAI incidence in the country. According to the age structure, HCAIs in children (0–17 years) for 2009–2021 accounted for 22.06 % of the total number of HCAIs. Most cases during the specified period were recorded among newborns, 65.8 % of all children with HCAIs. Therefore, the primary efforts should be aimed at reducing HCAIs among newborns.

Background. Genomic effects of vitamin D are determined by conformational changes in the structure of the vitamin D receptor (VDR) determined by single nucleotide variants (SNV) of the VDR gene. The purpose is to study the association of the SNV of the VDR gene with metabolically unhealthy obesity (MUO) in children. Materials and methods. Two hundred and fifty-two obese children aged 6–18 years were examined. The main group (n = 152) was represented by patients with MUO. The control group (n = 100) consisted of children with metabolically healthy obesity. Whole genome sequencing (CeGat, Germany) was performed in 31 children of the main group and 21 controls. The level of serum 25-hydroxyvitamin D (Synevo, Ukraine) was measured in all patients. To verify the results, Spearman’s correlation coefficient (r) and p-value for each variable were calculated. Results. Five SNVs of the VDR gene were identified: rs2228570 (1 DNA copy number variation (CNV): c.2T>C in 94.23 %); rs731236 (2 CNV: c.11056T>C, c.1206T>C in 65.38 %); rs10783218 (2 CNV: c.296+8C>T, c.146+8C>T in 7.69 %); rs2228572 (2 CNV: c.57C>T, c.207C>T in 1.92 %); rs12721365 (2 CNV: c.1059C>T, c.909C>T in 1.92 % of patients). A correlation between SNV VDR and MUO was observed in the following genotypes: AA rs12721365 (r = 0.21), AA rs2228572 (r = 0.21), GG SNV rs731236 (r = –0.15) and GG rs2228570 (r = –0.31), p < 0.05. Conclusions. The genotypes AG SNV VDR rs12721365, rs2228572 are highly associated with the development of MUO.

Background. Vitamin D deficiency is associated with impaired glucose tolerance, insulin resistance, metabolic syndrome, and an increased risk of developing type 2 diabetes. Aim: to study the role of vitamin D levels associated with single nucleotide variants (SNV) of the vitamin D receptor (VDR) gene in the development of metabolically unhealthy obesity (MUO) in children. Materials and methods. Two hundred and ten obese children aged 6–18 years were exa­mined. The main group (n = 125) was represented by children with MUO. The control group (n = 85) included children with metabolically healthy obesity (MHO). Whole genome sequencing (CeGat, Germany) was performed in 31 randomly selected children of the main and 21 children of the control group. The level of serum 25-hydroxyvitamin D (Synevo, Ukraine) was measured in all children. Verification of results: calculation of Spearman’s correlation coefficient (r) and p-value for each variable. Results. The mean serum level of 25-hydroxyvitamin D was significantly lower in children with MUO than in those with MHO: 14.57 ± 1.63 ng/mL versus 28.82 ± 1.93 ng/mL (t = 5.64, p = 0.00061). In patients with MUO, serum 25-hydroxyvitamin D levels are associated with the following predictors. Highly significant factors (0.7 ≤ |r| 0.5 (r = –0.41); AA genotype SNP VDR rs12721365 (r = –0.41) and AA genotype SNP VDR rs2228572 (r = –0.39); metabolic-associated fatty liver disease (r = –0.39); physiological postprandial glycemia (r = 0.38); level of interkeukin-1β (r = –0.36); triglyceridemia (r = –0.34); body mass index (r = –0.33); adiponectinemia (r = 0.32); arterial diastolic hypertension (r = –0.32). Low-significant factors (0

Background. Considering the features of basic therapy for chronic inflammatory bronchopulmonary process in cystic fibrosis (CF), which includes almost daily inhalation of pharmacological drugs (mucolytics, hypertonic saline (HS), antibiotics), evaluation of their tolerability is relevant in practice. The purpose of the study is to create a prognostic scale convenient for use in practical medicine, which would predict development of bronchial hyperreactivity syndrome in children with CF, based on clinical and anamnestic data, the results of molecular genetic research and inhalation tests with increasing concentrations of HS to prescribe personalized treatment. Materials and methods. The results of clinical and anamnestic, microbiological, biochemical, molecular and genetic studies and inhalation tests with increasing concentrations of HS were analyzed in 40 children with CF. The creation of the predictive algorithm was based on the application of correlation analysis, receiver operating characteristic analysis, binary logistic regression, Wald and Kullback method. Results. Two prognostic models have been created that can be used at different stages of providing medical care. Model 1 was built for the ambulatory stage of providing medical care to patients with CF, considering clinical and anamnestic data, molecular genetic predictors, as well as clinical symptoms during inhalation tests with increasing concentrations of HS. This model also can be used in young children who cannot perform spirometry to assess their external breathing function. For the highly specialized medical care, model 2 was created, which considers indicators of spirometric data of inhalation tests with increasing concentrations of HS and the level of exhaled nitric oxide. Conclusions. The developed models make it possible to calculate with high probability the risk of developing bronchial hyperreactivity to perform a personalized selection of HS and choose preventive brocholytic therapy as needed.

Background. Impaired homeostasis of the essential microelements in the body of children plays a significant role in the etiology, pathogenesis and therapy of a number of diseases. Stu­dies on the exchange of bioelements in gastrointestinal diseases, in particular, the content of selenium (Se), have not been conducted enough. Aim: to evaluate selenium influence on the course of inflammatory diseases of the upper gastrointestinal tract in children. Materials and me­thods. The study included 112 school-age children with inflammatory diseases of the upper gastrointestinal tract (55 with chronic gastritis (CG), 57 with chronic gastroduodenitis (CGD)) as the main group and 20 practically healthy children of the corresponding age as the comparison group. Verification of CG and CGD diagnosis was based on clinical and endoscopic data according to the Houston mo­dification of the Sydney classification of chronic gastritis (1996) with assessment of topography and morphology. Quantitative determination of Se in blood plasma was carried out using mass spectrometry. Results. The average level of Se in blood plasma of children with inflammation of the gastric and duodenal mucosa was (75.82 ± 11.23) μg/l, in children of the comparison group — (85.42 ± 9.44) μg/l (p > 0.05). We did not find gender and age differences in Se plasma levels. Deficiency of Se in the blood of children with CG and CGD was found in 78 cases (69.6 %), while in the comparison group, a decrease in Se level was observed in only 4 children (20 %). There were no significant differences in the content of Se in children with CG and CGD. However, the analysis of indicators depending on the acti­vity of the inflammatory process revealed probable differences: with the first degree of the activity of the inflammatory process in the mucous membrane, the level of Se in the blood plasma was significantly lower ((66.2 ± 6.1) μg/ml), while with the second it was (78.5 ± 7.3) μg/ml (p < 0.05) and with the third — (86.9 ± 9.3) μg/ml (p < 0.01). Conclusions. The concentration of selenium, the essential trace element, in the blood plasma of children with chronic inflammatory diseases of the upper gastrointestinal tract was found to be probably lower than that of healthy children. The level of selenium in the blood plasma of these children probably positively correlated with the degree of inflammation in the mucous membrane of the gastroduodenal region. Changes in the concentration of selenium can affect the general condition of children, the duration and severity of the disease, which must be taken into account during the treatment of inflammatory diseases.