International Journal of Scientific Pediatrics
Андижанский государственный медицинский институт
Characteristics of Clinical Signs in the Comorbid Course of Allergic Rhinitis and Bronchial Asthma in Children
Introduction. Allergic rhinitis and bronchial asthma are among the most common allergic diseases in children and are pathogenetically interrelated. The comorbid course of these diseases may lead to more severe clinical manifestations, difficulties in disease control, and a reduction in patients’ quality of life. The aim of the study was to investigate the characteristics of clinical signs in children with allergic rhinitis comorbid with bronchial asthma. Materials and methods. The study was conducted at the Department of Pediatric Allergology of the multidisciplinary clinic of Tashkent State Medical University. The age of the examined patients ranged from 7 to 18 years, with a mean age of 10.1 ± 0.31 years. Group 1 included 100 children with comorbid allergic rhinitis and bronchial asthma. Group 2 included 50 children with allergic rhinitis, of whom subgroup 2a consisted of 24 patients with intermittent allergic rhinitis (IAR), and subgroup 2b consisted of 26 patients with persistent allergic rhinitis (PAR). The main clinical symptoms, their frequency, severity, and interrelationships were analyzed in children with allergic rhinitis and bronchial asthma. Results and discussion. Nasal obstruction was identified in 72 patients (72%) in Group 1 with combined allergic rhinitis and bronchial asthma, in 15 patients (62.5%) in subgroup 2a with intermittent allergic rhinitis, and in 17 patients (65.3%) in subgroup 2b with persistent allergic rhinitis (p<0.001). Rhinorrhea was most frequently observed as persistent, occurring both during the day and at night (4 points), in 59 patients (59%) of Group 1 and in 12 patients (50%) of subgroup 2a with intermittent allergic rhinitis (p<0.01). In subgroup 2b, among children with persistent allergic rhinitis, less frequent rhinorrhea (2 points) was more commonly observed in 15 patients (57.6%) (p<0.01). Sneezing in patients with allergic rhinitis and bronchial asthma was of moderate severity in 43% of cases and marked severity in 39% of cases. Its intensity corresponded to that observed in the persistent allergic rhinitis subgroup, which may be explained by increased allergic sensitivity of the respiratory tract and the presence of an inflammatory process. Conclusions. The obtained results indicate that the coexistence of allergic rhinitis and bronchial asthma aggravates the clinical picture of the disease in children and demonstrates the need for early diagnosis and a comprehensive approach in the management of such patients.
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Modern Principles of Diagnosis and Comprehensive Treatment of Obstructive Bronchitis in Young Children
Introduction. In recent decades, acute bronchitis and bronchiolitis remain among the most common respiratory diseases in young children and represent a significant problem in pediatric practice. The severity of these conditions is determined not only by pronounced inflammatory changes in the airways but also by the development of obstructive syndrome, which impairs lung ventilation and provokes respiratory failure. One of the key factors contributing to the unfavorable course of the disease is the insufficiency of the immune response in young children, making them more vulnerable to infectious and viral agents. Therefore, particular attention is given to the development and justification of comprehensive treatment strategies aimed not only at alleviating the symptoms of the disease but also at correcting the child’s immune status. Objective: To evaluate the efficacy of immunomodulin in acute obstructive bronchitis and bronchiolitis in young children based on the assessment of clinical signs of the disease. Materials and Methods. The study was based on data obtained from a three-year research project. conducted at the 1st Somatic Department of the Tashkent City Children’s Clinical Hospital. A total of 95 young children aged 1 month to 3 years (mean age 1.5 ± 0.63 years) with obstructive bronchitis and bronchiolitis were examined. Among them, 59 (62.1%) were boys and 36 (37.9%) were girls. Results and Discussion. In children with acute obstructive bronchitis (AOB), the use of immunomodulin contributed to faster resolution of clinical symptoms, including perioral cyanosis, skin pallor, tachycardia, wheezing, and cough, significantly increasing the overall treatment efficacy. In children with acute obstructive bronchiolitis (AOBl), recovery of breathing, disappearance of expiratory dyspnea, cyanosis, skin pallor, tachycardia, wheezing, and cough occurred more rapidly, also resulting in noticeable improvement in clinical outcomes. Thus, immunomodulin significantly accelerates the regression of clinical manifestations of AOB and AOBl in young children and enhances overall treatment efficacy. Conclusion. The use of immunomodulin in young children with acute obstructive bronchitis and bronchiolitis promotes faster resolution of clinical symptoms and improves overall treatment effectiveness. The results support the rationale for including immunomodulin in the comprehensive management of these conditions to accelerate the restoration of respiratory function and overall health status of the child.
Spastic Diplegia (Juber Syndrome) In a CHild With Coronary Circulatory Disorder And Anemia
Introduction. In recent years, comprehensive evaluation of clinical and instrumental features of cerebral palsy (CP), taking into account perinatal risk factors and comorbid somatic conditions influencing neurological severity, has gained particular importance. Early hypoxic-ischemic brain injury remains one of the leading causes of spastic forms of CP. The aim of the study. To present a clinical case of spastic diplegia in a child and to assess clinical and instrumental characteristics of the disease course, including the impact of concomitant anemia on neurological status. Materials and Methods. The study is based on clinical observation of a female patient born in 2011 diagnosed with spastic diplegic cerebral palsy and hospitalized at the multidisciplinary clinic of Tashkent State Medical university in 2026. Clinical-neurological examination, laboratory tests (complete blood count, biochemical analysis), and instrumental studies (EEG, EchoEG, ECG) were performed. Brain MRI data were also analyzed. Results and Discussion. The patient demonstrated signs of spastic hemiparesis predominantly affecting the left side, hyperreflexia, pathological reflexes, and delayed psychomotor and speech development. MRI revealed periventricular gliosis. EEG showed dysfunction of midline brainstem structures. Moderate anemia was detected (hemoglobin 88 g/L). These findings correspond to the typical course of spastic cerebral palsy associated with hypoxic-ischemic injury of periventricular white matter. Concomitant anemia may aggravate cognitive impairment due to chronic tissue hypoxia. Conclusion. The presented clinical case confirms the role of early hypoxic-ischemic CNS injury in the development of spastic diplegia. Concomitant anemia requires correction within comprehensive therapy, as it may worsen cognitive outcomes. A multidisciplinary approach is essential for patient stabilization and functional improvement.
Thyroid Gland and Chronic Kidney Disease in Children
Introduction. Chronic kidney disease in children is accompanied by pronounced metabolic, hormonal, and inflammatory disturbances, among which alterations in thyroid status occupy an important place. As renal function declines, peripheral thyroid hormone metabolism becomes impaired, iodine clearance decreases, chronic inflammation intensifies, and the likelihood of developing a biochemical profile consistent with low T3 syndrome increases. Aim. To summarize current evidence on thyroid dysfunction in children with chronic kidney disease and to analyze the main pathogenetic mechanisms, laboratory abnormalities, and clinical significance of thyroid status alterations in this patient population. Materials and methods. This study was conducted as a narrative literature review. Recent publications on chronic kidney disease in children, thyroid profile abnormalities associated with reduced renal function, the pathogenetic mechanisms of low T3 syndrome, and the clinical significance of hormonal disturbances in this patient population were reviewed and analyzed. Results and discussion. Thyroid dysfunction in children with chronic kidney disease does not always reflect primary thyroid pathology, as it often develops secondary to uremic intoxication, impaired deiodinase activity, chronic inflammation with activation of proinflammatory cytokines, protein-energy deficiency, and metabolic disturbances. The most common hormonal abnormality is low T3 syndrome, which should be regarded as one of the markers of systemic metabolic maladaptation in chronic kidney disease. In childhood, these changes are of particular clinical importance because they may be associated with growth retardation, impaired nutritional status, abnormalities of bone metabolism, and reduced adaptive capacity. Conclusion. Thyroid dysfunction in children with chronic kidney disease is a clinically significant manifestation of systemic disorders and requires comprehensive assessment during follow-up, especially in patients with growth retardation, malnutrition, and a marked decline in renal function.
Аnxiety as a Clinical Marker of Atopic Dermatitis Activity in CHildren
Introduction. Atopic dermatitis is one of the most common chronic diseases in children and is often associated with psychoemotional disturbances. The aim of the study to study the relationship between psychoemotional status and clinical activity of atopic dermatitis in children. Materials and Methods. A total of 41 children aged 7–12 years with atopic dermatitis and 20 healthy controls were examined. Disease severity was assessed using the SCORAD index. Anxiety levels were evaluated using the Spielberger–Khanin scale. Results and Discussion. Moderate severity predominated (51.2%). High anxiety levels were mainly observed in severe cases. A direct relationship between disease severity and anxiety level was established. Conclusion. Anxiety can be considered a clinical marker of atopic dermatitis activity, supporting the need for a comprehensive therapeutic approach.
Bronchial Asthma in Adolescents with Undifferentiated Connective Tissue Dysplasia: Role of Th17 Cytokines, Vitamin D and Microelement Imbalance
Introduction. Bronchial asthma is a chronic inflammatory disease of the airways characterized by bronchial hyperreactivity and airway remodeling. In recent years, increasing attention has been paid to the role of undifferentiated connective tissue dysplasia (UCTD) in the development and progression of bronchial asthma in adolescents. Structural abnormalities of connective tissue may contribute to changes in the architecture of the bronchial wall, enhancement of inflammatory processes, and worsening of the clinical course of the disease. Aim of the study. To evaluate the role of Th17 cytokines (IL-17), transforming growth factor-β (TGF-β), vitamin D status, and the balance of trace elements (zinc and magnesium) in adolescents with bronchial asthma associated with undifferentiated connective tissue dysplasia. Material and methods. The study included 182 adolescents aged 12–17 years. The main group consisted of patients with bronchial asthma combined with UCTD (n=92), the comparison group included patients with bronchial asthma without UCTD (n=60), and the control group consisted of practically healthy adolescents (n=30). Clinical, laboratory, immunological and biochemical methods of investigation were used. The levels of IL-17, TGF-β, IgE, vitamin D, zinc, and magnesium were assessed. Results and discussion. Adolescents with bronchial asthma associated with UCTD demonstrated significantly higher levels of IL-17, TGF-β and IgE, as well as significantly lower levels of vitamin D, zinc and magnesium compared with the control group (p<0.05). Multivariate regression analysis revealed that elevated IL-17 levels and vitamin D deficiency were independent predictors of severe bronchial asthma. These findings indicate the involvement of immune dysregulation and connective tissue abnormalities in the processes of airway remodeling and disease progression. Conclusion. The obtained results suggest that adolescents with bronchial asthma associated with UCTD have pronounced immune and metabolic disturbances, which may contribute to the severity of the disease and its progression. Assessment of cytokine profile, vitamin D status, and trace element balance may be important for improving the diagnosis and management of bronchial asthma in this group of patients.
undifferentiated connective tissue dysplasia
Modern Clinical and Epidemiological Features of The Course of Hemorrhagic Vasculitis in CHildren
Introduction. According to the literature, hemorrhagic vasculitis (Henoch-Schonlein purpura) is one of the most common systemic vasculitis in children. In recent years, the disease has been increasing not only in preschool and primary school children, but also in adolescents, and often develops in connection with respiratory infections, allergic conditions, and changes in the immune system. The aim of the study is to study the modern clinical and epidemiological characteristics of the course of hemorrhagic vasculitis (Henoch–Schonlein purpura) in children. Materials and methods. A retrospective analysis of the scientific literature published in the last decade on hemorrhagic vasculitis (Henoch–Schonlein purpura) in children was performed. The obtained data were mathematically verified and compared by year. Results and discussion. The results of the study showed that the formation of immune complexes, inflammation of the vascular walls, and microcirculation disorders play an important role in the pathogenesis of the disease. In the clinical picture, hemorrhagic skin rashes, joint and abdominal syndromes, kidney damage, and mixed symptoms are the leading ones. Also, the course of the disease has individual characteristics, and its severity is determined by the main clinical symptoms and the development of complications. Conclusion. The scientific data obtained as a result of the study indicate that in-depth study of modern clinical and epidemiological characteristics is important for early detection of hemorrhagic vasculitis, assessment of risk factors, and prognosis of the course of the disease.
Adaptation of children to Learning in Schools with Different Educational Models: The State of Autonomic Homeostasis and Personal-Characterological Adaptive Resources
Psychological and behavioral factors participate in the pathogenesis of most chronic non-communicable diseases (cardiovascular, respiratory, etc.). The aim of the study is to study the adaptation characteristics of children (parameters of vegetative homeostasis, personality characteristics, and adaptive behavior style) under conditions of moderate chronic stress. Materials and methods. The study included 177 children aged 10 to 12 (11.3±0.2 years), with first and second health groups, who graduated from primary school and are enrolled in the private "IQRO" school or the secondary level of general education schools. The main group consisted of 119 students from the "IQRO" school (55 girls). The comparison group consisted of 58 students (31 girls) from one of the general education schools. All patients underwent standard electrocardiography (ECG). The baseline autonomic tone was determined using the A.M. Vein questionnaire modified by N.A. Belokon. Vegetative tests were performed based on the analysis of heart rhythm and blood pressure. A.M. Prihozhan's adapted Phillips test and L.A. Yasukova's modified 12-factor Kettell personality questionnaire were used. Statistical Analysis. Data processing was performed using the Statistica 10 software package. The critical level of statistical significance for testing null hypotheses was set at p = 0.05. To compare the distributions of quantitative variables across groups, in addition to the classical analysis of variance (ANOVA), nonparametric methods were applied, including the Kruskal–Wallis analysis of variance with Wilcoxon rank scores and the Van der Waerden test. Results. The analysis demonstrated that parameters of autonomic homeostasis are closely associated with personality traits and adaptive behavior styles. Baseline sympathicotonia was associated with high levels of general anxiety (p = 0.000) and reduced volitional self-control (p = 0.000). Children with excessive sympathetic reactivity were characterized by increased emotionality (p = 0.000), pronounced psychological tension (p = 0.04), decreased independence (p = 0.001), reduced communicative activity (p = 0.01), and lower volitional self-control (p = 0.03), as well as a tendency to adopt non-constructive behavioral coping strategies (p = 0.001). Conclusions. The criteria for optimal adaptation of children aged 10–12 years to new learning conditions include a balanced autonomic regulation system, good tolerance to academic workload, and successful academic performance. Deviations in health status, a sympathetic predominance in autonomic nervous system responses, reduced tolerance to loads, and insufficient learning effectiveness indicate a strained course of the adaptation process and require psychological, pedagogical, and medical-preventive interventions.
Modern Features of the Pathogenesis, Epidemiology and Clinical Course of Acute glomerulonephritis in children
Introduction. In recent years, the evolution of acute glomerulonephritis in children has been accompanied by an early decline in renal function, with an increase in the frequency of latent and chronic variants of the disease. This situation requires serious attention to glomerulonephritis in children with various diseases (secondary immunodeficiency, allergic, metabolic) caused by environmental factors, which is a global problem. The aim of the study is to analyze the current features of the pathogenesis, epidemiology and clinical course of acute glomerulonephritis in children and the impact of environmental problems on it. Materials and methods. A retrospective review of the literature on acute glomerulopathies in children (including acute poststreptococcal glomerulonephritis (APSGN)) over the past decade was conducted. The data obtained was mathematically verified and compared by year. Results and discussion. APSGN in children is a serious problem today, and many aspects of the disease have not been fully resolved. Today, the real situation often differs radically from the traditional description of the disease. The reasons for the development of the pathological process in different clinical manifestations in individual patients and its severity remain unclear. Conclusion: In recent years, the leading etiological factor of OCSGN in children has been streptococcal infection, and the most typical clinical symptoms remain hematuria, generalized edema, and arterial hypertension. The development of the disease is often fundamentally dependent on the activation of a latent streptococcal infection in the body due to the influence of risk factors (ecology, hereditary predisposition to glomerulopathy, chronic foci of infection, the addition of a new viral-bacterial infection, secondary immunodeficiency, comorbidity of allergic, metabolic diseases).
POLYMORPHISM OF THE FTO GENE (RS9939609) AS A RISK FACTOR FOR EARLY KIDNEY DAMAGE IN CHILDREN WITH OBESITY
Introduction. The problem of obesity in children continues to attract the attention of pediatricians worldwide. The development of a comorbid pathology, namely kidney damage, is of particular importance. In the pathogenesis of kidney disorders in obesity, both metabolic disorders and genetically determined predisposition lie. Studying these facts will allow us to identify a high-risk group among children with obesity for early preventive and treatment measures. The aim of the study is to study the relationship between kidney functional disorders and FTO gene polymorphism in children with obesity. Material and methods. 211 children with alimentary exogenous-constitutional obesity were examined, and from the examined sample of patients, groups were formed according to the types of fat tissue distribution: a group of children with abdominal fat tissue distribution type; a group of children with a uniform fat tissue distribution type. The control group consisted of 104 children of the same age and sex with normal body weight. We investigated the features of anthropometric data, biochemical and molecular genetic studies, including determining the excretion of albumin with urine, cystatin levels, calculating glomerular filtration rate, and determining the polymorphism of the FTO gene. Results and Discussion. Our studies showed that in children with abdominal obesity, the frequency of the AA genotype was higher (28.4%) compared to the group of children with moderate obesity (16%) with a statistically significant advantage (2=4.529, p=0.034). This allowed us to classify the AA genotype as predisposing to the development of abdominal obesity. Both in children with abdominal obesity and in children with moderate obesity, the highest level of urine albumin (77.03±6.52 mg/l and 54.11±5.17 mg/l) was noted in carriers of the A/A genotype, and the lowest in children with carriers of the T/T genotype (38.83±5.03 mg/l and 21.39±3.14 mg/l; p<0.001). In children with a uniform type of obesity, carriers of the mutant A/A genotype showed a decrease in blood cystatin levels and an increase in glomerular filtration rate, which indicated hyperfiltration, which is the beginning of pathological changes in the kidneys in obesity. In children with abdominal obesity and carriage of the A/A genotype, unlike children with moderate obesity, an increase in the level of cystatin and a decrease in the glomerular filtration rate were observed, which is a manifestation of obesity glomerulopathy. Conclusion. Studies have shown that the polymorphism of the FTO gene in children with obesity is associated with functional kidney damage. Carriers of the A/A genotype with abdominal obesity are more susceptible to metabolic disorders, namely metabolic kidney damage, which is expressed in a significant increase in the level of microalbuminuria, a pathology of the level of cystatin, and a decrease in glomerular filtration rate.
DEPRESSION IN PARKINSON'S DISEASE: THE DETERMINING ROLE OF DISEASE STAGE AND MOTOR DEFICIT
Introduction. Depression is a frequent non-motor manifestation of Parkinson's disease (PD), significantly affecting patients' quality of life and prognosis. The aim of the study the prevalence of depression using the HADS scale and its associations with clinical and demographic parameters in PD patients. Materials and Methods. A total of 153 PD patients were examined. The assessment tools included Part III of the Unified Parkinson's Disease Rating Scale (UPDRS-III) for motor evaluation and the Hospital Anxiety and Depression Scale (HADS) for depression screening. Patients were categorized based on HADS scores into groups: no depression (0-7), subclinical depression (8-10), and clinical depression (≥11). Results and Discussion. Subclinical depression was identified in 68.6% (n=105) of patients, while clinical depression was found in 9.9% (n=15). Age and gender did not differ significantly between the groups (p>0.05). Strong positive correlations were established between the depression score and the Hoehn & Yahr stage (p=0.00043) as well as the UPDRS-III score (p=0.002). In the multivariate regression model, the PD stage was a borderline significant predictor of clinical depression (p=0.065). Conclusions. Depression in PD is predominantly subclinical and is strongly associated with the severity of motor deficit and disease stage. This justifies the rationale for implementing stage-oriented screening for depression in this patient population.
THE ROLE OF PERINATAL AND POSTNATAL FACTORS IN THE FORMATION OF THE GUT MICROBIOME AND HEALTH STATUS OF INFANTS DURING THE FIRST YEARS OF LIFE
Introduction. The first year of life represents a critical “window of development” characterized by high microbiome plasticity and increased sensitivity to various early-life factors. During this period, the foundations of immune tolerance, intestinal barrier function, and regulation of inflammatory responses are established. Numerous studies have demonstrated the significant influence of the gut microbiota on the health status and development of infants in the first year of life. The aim of the study. To analyze international experience in assessing the role of perinatal and postnatal factors in the formation of the gut microbiome and health status of infants during the first year of life. Materials and Methods. A total of 36 publications were analyzed, including systematic reviews, cohort studies, prospective randomized controlled trials (RCTs), and original research articles focusing on the role of perinatal and postnatal factors in shaping the gut microbiome and its association with infant health outcomes. Results and Discussion. The formation of the gut microbiome begins at birth and represents a stepwise dynamic process. The mode of delivery has a significant impact on the initial composition of the intestinal microbiota. Vaginally delivered infants are predominantly colonized by microorganisms of the genera Bifidobacterium, Lactobacillus, and Bacteroides, whereas infants born by cesarean section demonstrate reduced microbial diversity and delayed intestinal colonization. The maternal microbiome status, nutritional characteristics, and the presence of somatic diseases significantly influence primary intestinal colonization in newborns. The maternal microbiota has been identified as one of the main sources of microorganisms transmitted to the infant during the perinatal period. Thе microbiome is determined not only by its taxonomic composition but also by its metabolic activity, particularly the ability of microorganisms to synthesize biologically active metabolites such as short-chain fatty acids (SCFAs) — acetate, propionate, and butyrate. Up to 10% of the daily energy requirements in infants may be covered by microbial metabolites, primarily SCFAs. Delayed formation of an “age-appropriate” microbiome is associated with slower weight gain, reduced body length increment, and impaired proportional physical development. This phenomenon is especially pronounced during the first 6–12 months of life, when the microbiota undergoes active maturation. Conclusion. The gut microbiome represents a crucial link connecting early-life factors with physical and psychomotor development during the first year of life. Disruptions in microbiome formation during this period may be associated with impaired physical development, increased susceptibility to infectious diseases, and the development of functional gastrointestinal disorders, highlighting the importance of early prevention and correction of dysbiosis conditions.
PREGNANCY OUTCOMES IN THE FIRST TRIMESTER COMPLICATED BY RETROCHORIAL HEMATOMA
Introduction. Retrochorial hematoma (RCH) in early gestation in women can predict adverse maternal, fetal, and neonatal outcomes. The relationship between the presence of RCH, its location, size, and perinatal complications was studied. Increased RCH size is associated with an increased risk of pregnancy complications such as vaginal bleeding in the first trimester, early fetal loss, fetal growth restriction, placental abruption, and preterm labor. The aim of this study was to investigate the association between first-trimester retrochorial hematoma and gestational and perinatal complications. Patients and methods. Information on 177 patients whose pregnancies in the first trimester (<14 weeks) were complicated by retrochorial hematoma was obtained from an analysis of archival material at Tashkent Regional Clinical and Practical Center No. 6, conducted between January 2023 and December 2025. A control group (35 healthy pregnant women) was recruited from the outpatient clinic of this institution. The presence of fetal cardiac activity at the time of diagnosis of retrochorial hematoma was a prerequisite for inclusion in the study. Depending on the hematoma size, pregnant women with RCH were divided into three groups: with small hematomas (RCH-I group, n = 57), with medium hematomas (RCH-II group (n = 101) and with large hematomas (RCH-III group, n = 19). The control group consisted of 35 pregnant women without RCH and vaginal bleeding. Statistical processing of the data was performed within the framework of a retrospective study using Statistica software (version 25.0). Results. Retrochorial hematoma is associated with an increased frequency of bleeding in the first trimester, regardless of its size, as well as with a lower gestational age of the fetus at delivery. At the same time, an increase in the size of a retrochorial hematoma increases the risk of placental abruption, preterm labor, SIDS and fetal loss. Conclusions. Thus, the association of early gestation retrochorial hematoma with The association of retrochorial hematoma with maternal, fetal, and neonatal complications is widely discussed and requires further research aimed at identifying common pathogenetic mechanisms of retrochorial hematoma and adverse pregnancy outcomes, particularly fetal growth restriction syndrome.
IMPROVING THE RESULTS OF DIAGNOSIS AND TREATMENT OF CRYPTORCHIDISM IN CHILDREN
Cryptorchidism is one of the most common congenital anomalies of the male reproductive system and is characterized by the failure of testicular descent into the scrotum. This condition leads to impaired microcirculation, vascularization, and thermoregulation of the testicular tissue, resulting in degenerative changes, suppression of spermatogenesis, and an increased risk of infertility. According to the literature, the incidence of cryptorchidism ranges from 1.6% to 9% in full-term newborns and reaches up to 30% in preterm infants. Delayed medical consultation, late diagnosis, and inappropriate treatment strategies significantly worsen therapeutic outcomes. Aim of the study: To improve the outcomes of cryptorchidism treatment in children through early diagnosis and a comprehensive therapeutic approach. Materials and methods: From 2020 to 2025, 253 patients aged from 8 months to 17 years with various forms of cryptorchidism were examined and treated at the In the urology department of the Andijan Regional Children's Multidisciplinary Medical Center. Diagnostic methods included Doppler ultrasonography, multislice computed tomography (MSCT), magnetic resonance imaging (MRI), and diagnostic laparoscopy when indicated. All patients underwent clinical and laboratory investigations; in cases of non-palpable gonads, serum sex hormone levels were additionally assessed. Results and conclusion: The results demonstrate that early detection of cryptorchidism and a differentiated surgical approach contribute to the preservation of gonadal function and reduction of postoperative complications. Timely application of minimally invasive endoscopic techniques significantly decreases the incidence of testicular atrophy, retraction, and the risk of infertility.
IMMUNOHEMATOLOGICAL MARKERS OF INFLAMMATION IN FULL-TERM NEWBORNS WITH CONGENITAL PNEUMONIA
Relevance. Congenital pneumonia (СP) remains one of the most severe forms of perinatal infection, exerting a significant impact on neonatal morbidity and mortality. According to the World Health Organization (WHO), over 7 million children in early infancy suffer annually from the consequences of intrauterine infection, with more than 600,000 cases resulting in death during the neonatal and infant periods. The purpose . To assess the diagnostic value of leukocyte profile parameters in umbilical cord blood of newborns with intrauterine pneumonia. Materials and Methods. A prospective study was conducted involving 81 full-term newborns (gestational age 37–42 weeks), including 61 infants diagnosed with СP (main group) and 20 healthy newborns (control group). Umbilical cord blood samples were collected within the first hours of life to determine absolute leukocyte and lymphocyte counts. Statistical analysis included calculation of mean values, standard deviations, correlation coefficients (r), and significance levels (p). Results. Significant alterations in leukocyte profiles were observed in newborns with СP. The mean leukocyte count was 14.77 ± 0.512 × 10⁹/L, markedly higher than in the control group (9.87 ± 1.317 × 10⁹/L). A similar trend was noted for lymphocytes: 6.02 ± 0.719 × 10⁹/L versus 1.56 ± 0.361 × 10⁹/L. A moderate positive correlation was found between leukocyte and lymphocyte counts (r = 0.59; p < 0.05), indicating synchronized activation of the innate immune response. Peak levels were recorded on the third day of life. Conclusion. The leukocyte profile of umbilical cord blood serves as a valuable marker of inflammatory activity in СP and can be utilized for early immunological monitoring in newborns.
ASSESSMENT OF THE RESULTS OF PREVENTIVE INTERVENTION TO CHANGE LIFESTYLE IN OVERWEIGHT AND OBESE CHILDREN
Obesity is associated with serious health problems in children and is a major and early risk factor for morbidity and mortality in adults. The direct health effects of obesity include hyperlipidemia, hypertension, and glucose tolerance. Purpose of the study: assessment of leptin and adiponectin levels before and after lifestyle changes in children with obesity and overweight and determining their role as biomarkers. Material and methods: One hundred and four overweight and obese children (51 boys and 53 girls) were included in this study and constituted the main group. Fifty-four children with normal body weight without endocrine, cardiovascular, gastrointestinal, or liver diseases constituted the study's control group. Of the first 104 children, 48 returned for re-examination after a year of lifestyle changes. Anthropometric indicators were assessed in these children at the initial stage, as well as after one year. Lifestyle intervention is included in the educational program, which includes changes in nutrition and physical activity. Children and their parents are advised to switch to a normal calorie diet based on a balanced distribution of carbohydrates (55%), proteins (15%), and lipids (total 30%, saturated fats less than 10%). When changing the form of physical activity, it is recommended to perform aerobic exercises three to five times a week for no less than 45-60 minutes. Results: Clinical and biochemical characteristics were determined in children with obesity and excess body weight (group A, n=104) at the initial stage compared to the control group (group B, n=54), at the initial stage (group C, n=48) and after 1 year of intervention (group D, n=48). After 1 year of preventive intervention, 48 children were re-examined. Children with unchanged body weight and those who lost weight were compared. Children with obesity and excess weight did not have statistical differences in many parameters, including insulin levels, HOMA-IR, and adiponectin levels, compared to children who lost weight and had normal weight, which once again indicates the positive effect of lifestyle changes on children. However, the level of leptin was still higher in children with obesity and excess body weight than in children with normal weight, which allows us to assume that, despite the "normalization" of metabolic status, leptin did not change in accordance with these positive changes. Conclusions: our study confirms the positive effect of simple dietary recommendations and physical activity on metabolic and clinical parameters in children with obesity and excess body weight. The level of leptin was significantly increased in children who did not lose weight, but in children who actually lost weight, there were no significant changes compared to the baseline level, which allows us to assume that leptin is not directly related to the change in body weight. Adiponectin is the best and simplest marker for assessing the positive results of prevention and treatment of obesity and excess weight in children, monitoring metabolic changes, and their detection.
CARDIOPROTECTION IN ANESTHESIOLOGICAL SUPPORT FOR PEDIATRIC OPEN HEART SURGERY: CLINICAL CAPABILITIES OF SEVOFLURANE
Experimental studies have shown that volatile anesthetics can induce pharmacological preconditioning and reduce the degree of myocardial damage, however, clinical data in pediatric practice remain limited and contradictory. Objective. Compare the cardioprotective effects of sevofluron and total intravenous propofol anesthesia in children who underwent open-heart surgery using artificial blood circulation. Methods. A prospective one-centered study included 106 children aged 6 months to 5 years with congenital heart defects who underwent open-heart surgery with cardioplegic cardiac arrest. Patients were divided into two groups: sevofluran (n=53) and propofol (n=53). The primary endpoint was the maximum level of cardiospecific troponin T in the postoperative period. Secondary endpoints included the frequency of arrhythmias, indicators of hemodynamic stability, echocardiography data, the need for inotropic support, the duration of mechanical ventilation and stay in the intensive care unit. Results. In all observations, an increase in the level of cardiospecific troponin T after surgery was noted, however, its values were significantly lower in the sevofluran group at all stages of observation. After 3 hours, the level of cTnT was 1.2±0.3 ng/ml in the sevoflurane group and 1.9±0.4 ng/ml in the propofol group (p<0.05), after 8 hours-1.7±0.4 and 2.6±0.5 ng/ml respectively (p<0.01), after 12 hours-1.5±0.3 and 2.3±0.5 ng/ml (p<0.05), after 24 hours-1.1±0.2 and 1.8±0.3 ng/ml (p<0.05). Arrhythmias were registered in 11.3% of patients in the sevoflurane group and in 26.4% of patients in the propofol group (p<0.05). The need for inotropic support was lower when using sevoflurane (15.1% versus 32.1%, p<0.05). The time of artificial lung ventilation (9.2±3.1 versus 13.6±4.4 hours, p<0.01) and the duration of stay in the ICU (36±10 versus 52±14 hours, p<0.05) were significantly shorter in the sevoflurane group. Echo-indicators indicated a faster restoration of myocardial systolic and diastolic function in patients receiving sevoflurane. Conclusion. The use of sevoflurane in open-heart surgeries in children is associated with more pronounced cardioprotection compared to propofol, which is manifested by a lower degree of myocardial damage, more stable hemodynamics, and faster functional recovery of the heart in the early postoperative period.
ANESTHESIOLOGICAL DETERMINANTS OF PERIOPERATIVE OUTCOMES IN CHILDREN WITH INTESTINAL OBSTRUCTION
Intestinal obstruction in infants and young children is associated with high perioperative morbidity and mortality. Besides surgical factors, anesthesiological management and perioperative intensive care may significantly influence outcomes. Objective.This study aimed to identify perioperative predictors of adverse outcomes in children with intestinal obstruction and to evaluate anesthesiological management strategies. Methods. A retrospective observational study was conducted at the Andijan Regional Multidisciplinary Medical Center. Medical records of 99 children aged 0-3 years who underwent emergency surgery for intestinal obstruction were analyzed. Demographic, clinical, anesthetic, and perioperative variables were evaluated. Binary logistic regression and receiver operating characteristic (ROC) analysis were applied to identify independent predictors of adverse outcomes. Results. Adverse outcomes (severe complications and/or death) occurred in 34.3% of patients. Operation duration was identified as an independent predictor of adverse outcome (OR 1.064 per minute; 95% CI 1.023-1.107; p=0.002). Delayed hospital admission (>24 h) showed a borderline association with adverse outcome (p=0.057). The regression model demonstrated acceptable discrimination (AUC=0.722). Late hospital admission (>24 hours) was marginally associated with adverse outcomes (p=0.057). The regression model had satisfactory discriminant ability, with an area under the ROC curve (AUC) of 0.722. According to the results of the analysis, the duration of surgery was identified as an independent and reliable predictor of adverse clinical outcomes (OR=1.078; 95% CI: 1.028-1.131; p=0.002). This indicates that each additional minute of surgery increases the probability of developing an adverse clinical outcome by an average of 7-8%. This suggests that metabolic disorders associated with prolonged surgical time and increased surgical stress negatively affect clinical outcomes. Also, late hospital presentation (>24 hours) was noted as a significant factor significantly increasing the risk of adverse clinical outcomes (OR=9.20; 95% CI: 1.62-52.38; p=0.012). This result can be explained by the late diagnosis of the disease, increased risk of intestinal ischemia and infectious-septic complications. The type of anesthesia, in particular multimodal anesthesia, did not reach independent statistical significance within the multivariate model (p=0.301). Conclusion. Perioperative factors, particularly operation duration, play a critical role in determining outcomes in pediatric intestinal obstruction. Early hospital admission and optimization of anesthesiological management may contribute to improved clinical results.
IMPROVEMENT OF TREATMENT TACTICS FOR SEVERE DEGREES OF PECTUS EXCAVATUM IN PRESCHOOL-AGED CHILDREN
The pathogenesis of pectus excavatum involves not only osteochondral structures but also the soft tissue components of the anterior chest wall, including the sternodiaphragmatic ligament, which plays an important role. The aim of this study was to improve the treatment strategy for severe forms of pectus excavatum (PE) in preschool-aged children. Clinical material: the treatment outcomes of 30 children aged 1 to 6 years diagnosed with grade III–IV pectus excavatum were analyzed. Methods: the degree of deformity was determined using multislice computed tomography (MSCT). In all patients, the morphological and functional status of the sternodiaphragmatic ligament (SDL) was additionally assessed by ultrasonography (US). Based on these findings, an individualized treatment strategy was selected. In patients with grade III–IV deformities and the presence of contracture and fibrotic changes of the SDL, ligament release was performed followed by correction using the vacuum bell technique. Results: In preschool-aged children with severe pectus excavatum, assessment of the sternodiaphragmatic ligament using ultrasonography is of great importance for selecting the appropriate treatment strategy. In patients with a morphologically preserved ligament, vacuum bell therapy was effective, whereas in cases with fibrotic changes and contracture, the use of vacuum bell correction combined with ligament release provided significantly better clinical and anatomical outcomes. Statistical analysis of the obtained results demonstrated a significant association between anterior chest wall deformation and mechanical stresses and the severity of the deformity. According to MSCT and computational biomechanical modeling, both the compression depth and the maximum von Mises stress values increased in a statistically significant manner with increasing deformity severity (p < 0.01). Compared with patients with grade II deformity, those with grade III–IV deformities showed significantly higher compression depth values at the central anatomical points (P3–P5) (p < 0.01), while the differences at the peripheral points (P1–P2) were less pronounced (p < 0.05). This indicates that mechanical loading is predominantly concentrated in the central regions of the anterior chest wall. Conclusion: In the treatment of severe pectus excavatum in preschool-aged children, an individualized approach based on ultrasonographic evaluation of the sternodiaphragmatic ligament demonstrates high clinical efficacy, reduces the extent of invasive surgical interventions, and expands the possibilities for early correction.
STUDY OF THE PATHOGENETIC CHARACTERISTICS AND CLINICAL SIGNIFICANCE OF VISFATIN AND FOLLISTATIN LEVELS IN ENDOCRINE INFERTILITY
Objective: This study aimed to evaluate the role of neohormones in the development of endocrine infertility in women with overweight and grade I–II obesity, and to determine the relationship between metabolic disturbances, hormonal imbalance, and impaired reproductive function. The relevance of the research is driven by the increasing prevalence of obesity among women of reproductive age and the limited understanding of how neohormones contribute to the pathogenesis of endocrine infertility. Materials and Methods: The study included 114 women with reproductive dysfunction and varying degrees of excess body weight. Clinical assessment, evaluation of hormonal profiles, analysis of carbohydrate and lipid metabolism, and examination of liver function were performed. Levels of neohormones, including leptin, adiponectin, and several metabolically active peptides, were determined using standard laboratory methods. Results: Significant differences in metabolic parameters were identified, reflecting the extent of adipose tissue dysfunction and disturbances in neuroendocrine regulation. Elevated leptin levels and reduced adiponectin concentrations were associated with markers of insulin resistance, increased liver enzyme activity, and an unfavorable lipid profile. Women with pronounced alterations in neohormone secretion more frequently exhibited anovulatory cycles and a reduced ovarian reserve. These findings confirm the critical role of metabolic disturbances in the development of endocrine infertility among women with obesity. Novelty: The study establishes a comprehensive relationship between neohormone levels, metabolic status, and reproductive dysfunction in women with obesity. The results expand current knowledge of the mechanisms underlying infertility in the context of metabolic disorders and highlight the potential diagnostic value of neohormones as biomarkers. Conclusion: The findings emphasize the importance of routine monitoring of metabolic and hormonal status, including neohormone assessment, in women with obesity and reproductive disorders. An integrated approach to diagnosing and correcting endocrine abnormalities may improve the effectiveness of infertility treatment and enhance reproductive outcomes.
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THE ROLE OF INFLAMMATORY MARKERS AND INNATE IMMUNITY PARAMETERS IN PREDICTING THE SEVERITY OF COMMUNITY-ACQUIRED PNEUMONIA IN CHILDREN
Introduction. Community-acquired pneumonia (CAP) is one of the most common respiratory infections in children and remains a major challenge in contemporary pediatrics. Assessing the risk of severe disease and predicting treatment outcomes in pediatric patients is of practical importance. Immunological biomarkers – including immunoglobulins, cellular subpopulations, and inflammatory indicators – play a key role in the pathogenesis of CAP and help characterize the immune response and disease severity. Objective. To evaluate the diagnostic and prognostic value of inflammatory markers and innate immunity parameters in children with varying severity of community-acquired pneumonia (CAP). Materials and Methods. The study included 80 children aged 1 month to 3 years with a clinically and radiologically confirmed diagnosis of CAP. Patients were divided into two groups based on disease severity: 40 children with mild CAP and 40 with severe CAP. Severity stratification was performed using clinical criteria, including respiratory rate, degree of intoxication, presence of respiratory failure, and oxygen therapy requirement. Plasma levels of procalcitonin and C-reactive protein, along with immunological parameters – CD16+, CD64+, and neutrophil phagocytic activity—were assessed as indicators of inflammation and innate immunity. Results. Significant differences were found between mild and severe CAP groups in leukocyte count, absolute lymphocyte count, procalcitonin and C-reactive protein concentrations, CD64+ expression, and neutrophil phagocytic activity. Elevated leukocytes, procalcitonin, C-reactive protein, and CD64+ expression (p<0.001) were associated with severe disease, while lymphopenia reflected impaired adaptive immunity (p<0.001). Phagocytic activity was also higher in severe cases (p<0.001). CD16+ did not reach statistical significance, though a tendency toward increased levels was observed. The most informative combination of markers included leukocyte count, procalcitonin/CRP, CD64+, phagocytosis, and lymphocyte count. Conclusion. A combined assessment of inflammatory and immunological biomarkers provides high diagnostic value for early risk stratification of severe CAP in children. The most significant predictors were leukocytosis, lymphopenia, elevated procalcitonin, C-reactive protein, and CD64+, as well as enhanced neutrophil phagocytic activity. Incorporating this biomarker panel may improve early identification of patients requiring intensive monitoring and therapy. The role of CD16+ warrants further investigation.
A CLINICAL AND RADIOLOGICAL STUDY OF THE ALVEOLAR PROCESS OF THE MANDIBLE IN DIFFERENT TYPES OF OCCLUSION IN PATIENTS AGED 7 TO 18 YEARS
Relevance. Malocclusions, accompanied by overload or underload of individual teeth in a specific region of the jaw, can cause pathological changes in the alveolar process, similar to those observed in periodontal disease. In this regard, clinical and radiological examination of the alveolar process at different age periods and with different types of bite is of great importance. The purpose of the study was to investigate the clinical and radiological age-related features of the normal structure of the alveolar process of the mandible in children and adolescents aged 7 to 18 years. Materials and methods of the study. In the present study, we selected for clinical and radiographic examination of the alveolar process a total of 600 individuals aged 7 to 18 years with orthognathic occlusion; 50 individuals with excessive maxillary development complicated by deep incisal overlap (prognathism combined with deep bite); 42 individuals with excessive maxillary development without contact between the anterior teeth (prognathism combined with open bite); 50 individuals with deep incisal overlap (deep bite); and 22 individuals with open bite. Of the 600 individuals with orthognathic occlusion, 160 were examined twice, and 29 were examined three times at intervals of 1–2–3–4 years after the initial assessment. Results. In the four types of malocclusion examined in our study, the radiographic structure of the alveolar process was generally similar to that observed in individuals with orthognathic occlusion. Only in subjects with excessive maxillary development and absence of contact between the anterior teeth (prognathism combined with open bite) was an increased radiolucency of the trabecular structure of the interdental septa observed more frequently (in 25 out of 42 individuals). These features were found only in subjects aged 12 years and older, and only in cases where no occlusal contact between the anterior teeth was present even upon mandibular protrusion. Conclusion. The structure of the alveolar process during tooth eruption differs from its structure after eruption is complete. Following the completion of tooth eruption, individual variations in the morphology of the interdental septal crests and the trabecular bone pattern become evident. With the completion of root formation, the development of the cortical plate and the periodontal space is finalized.
FEATURES OF THE IMMUNOLOGICAL PROFILE IN CHILDREN WITH JUVENILE ARTHRITIS OF SYSTEMIC ONSET DEPENDING ON DISEASE ACTIVITY
Relevance. Systemic juvenile idiopathic arthritis (sJIA) is a distinct autoinflammatory subtype of juvenile arthritis, characterized by pronounced systemic inflammation and extra-articular manifestations such as fever, rash, and hepatosplenomegaly. The disease is associated with dysregulated production of proinflammatory cytokines (IL-1β, IL-6, IL-18), which determine its severity and increase the risk of complications. Conventional inflammatory markers, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), are often insufficiently specific for accurate assessment of disease activity. Therefore, studying cytokine profiles and identifying reliable immunological biomarkers is particularly relevant for timely diagnosis, objective evaluation of disease activity, and optimization of individualized treatment strategies in children with sJIA, ultimately contributing to improved clinical outcomes and better prognosis. Objective. To study the characteristics of the course of juvenile arthritis depending on disease activity in patients with systemic-onset juvenile idiopathic arthritis (sJIA). Materials and Methods. A prospective cohort study including 74 children with juvenile arthritis (44 of them with sJIA) was conducted from 2021 to 2023. The diagnosis was established according to the International League of Associations for Rheumatology (ILAR) criteria (2001). Immunological assessments included measurement of proinflammatory cytokines (IL-1, IL-6, IL-18, TNF-α) using the RANDOX biochip technology, as well as autoimmune markers (S-100, serum ferritin) by enzyme-linked immunosorbent assay (ELISA) on a Multiskan FS, conducted in the clinical laboratory of RSSPMCP. The level of disease activity was assessed using the Juvenile Arthritis Disease Activity Score 27 (JADAS27). Statistical analysis was performed using StatPlus v8.0.3 and Microsoft Excel; correlations were assessed with Spearman’s rank correlation coefficient, and differences were considered statistically significant at p<0.05. Results. Our findings demonstrated a strong positive correlation between IL-1 and IL-6 (rs = 0.89; p = 0.0000), a moderate negative correlation between IL-1 and S-100 (rs = –0.298; p = 0.59), and a weak negative correlation with JADAS27 (rs = –0.278; p = 0.067). A very weak positive correlation was observed between IL-1 and TNF-α (rs = 0.15; p = 0.34) and between IL-1 and ferritin (rs = 0.18; p = 0.24). Conclusion. It has been demonstrated that systemic-onset juvenile idiopathic arthritis (sJIA) is characterized by a distinct immunological profile dominated by elevated levels of proinflammatory cytokines, including IL-1, IL-6, and IL-18, which contribute to the development of systemic clinical manifestations and disease severity. A significant positive correlation between IL-18 and ferritin levels (rs = 0.46; p = 0.0019) suggests that ferritin may serve not only as an indicator of inflammation but also as an active proinflammatory mediator involved in the immunopathogenesis of sJIA.
systemic-onset juvenile idiopathic arthritis
PROBLEMS AND PROSPECTS OF ANTIBACTERIAL THERAPY FOR INFILTRATIVE-PURULENT FORMS OF LARYNGITIS IN PEDIATRICS
Infiltrative-purulent forms of laryngitis in children represent one of the most clinically significant and potentially dangerous pathologies of the upper respiratory tract, characterized by a high risk of acute laryngeal stenosis and purulent-inflammatory complications. In the context of an evolving etiological structure of the disease and the growing prevalence of antibiotic resistance, the selection of optimal antibacterial therapy remains a complex and debated issue. This review systematizes current data on the etiology, pathogenesis, and clinical features of infiltrative-purulent laryngitis in children, and outlines the key principles of rational antibiotic prescribing. Special attention is given to the pathogenetic rationale for the use of various antibiotic classes, their pharmacokinetic properties, and their antimicrobial activity spectrum against common pathogens. The review also addresses issues related to increasing microbial resistance, the frequency of clinical prescribing errors, and insufficient patient compliance. A separate section examines the safety of antibacterial therapy in pediatric practice, including the risks of adverse reactions, age-related limitations, and the need for careful monitoring of potential complications. Furthermore, contemporary approaches to combined treatment are discussed, including the use of systemic glucocorticosteroids, anti-inflammatory agents, inhalation therapy, and surgical interventions in complicated cases. The review highlights key directions for improving antibacterial therapy, such as the development of personalized treatment regimens and the expansion of antibiotic resistance control programs.
THE ROLE OF SHORT-CHAIN FATTY ACIDS IN THE ASSESSMENT OF THE STATE OF INTESTINAL MICROBIOCENOSIS AND ITS DIAGNOSIS IN CHILDREN WITH CONGENITAL HEART DEFECTS
Annotation. Children with congenital heart defects constitute a highly susceptible cohort for the development of intestinal dysbiosis and epithelial barrier dysfunction. This athophysiological vulnerability stems from anomalous intestinal perfusion or hypoxemia, which manifests in conditions of low cardiac output or cyanosis. Disruption of gut microbiota eubiosis potentially exacerbates systemic inflammation, adversely affecting clinical outcomes in this patient group. Despite significant advancements in therapeutic strategies and survival rates for patients with congenital heart defects, the incidence of associated complications remains substantial, raising questions regarding the microbiome's role in the pathogenesis of inflammatory processes. Aim of the study: to analyze the characteristics, properties, mechanistic role, and diagnostic methods of short-chain fatty acids in assessing the state of the intestinal microbiocenosis in children with congenital heart defects, based on data from international and domestic research. Material and methods: a systematic literature review on the specified topic was conducted using electronic database resources including PubMed, Medline, eLibrary, Scopus, Web of Science, and Cochrane Library. Results and discussion: the obtained data provide a comprehensive understanding of the properties and composition of the intestinal microbiota in children with congenital heart defects. They emphasize the necessity of studying the microbiota not as an isolated organ, but as an integral system that supports interaction with all physiological systems of the body and plays a key role in maintaining homeostasis and adaptive reserves to changing internal and external environmental conditions. It has been determined that congenital heart defects remain the primary cause of child mortality, despite treatment advancements. In children with congenital heart defects, inflammation and low cardiac output are crucial pathophysiological factors exacerbating clinical outcomes. These conditions contribute to gut microbiome dysbiosis, leading to a decrease in the production of short-chain fatty acids such as acetate, propionate, and butyrate. As primary metabolites of beneficial microflora, they are critically important for maintaining intestinal homeostasis, including cell metabolism, barrier function, and systemic influence. The dysbiosis identified in children with these defects is caused by hypoxia, stress, antibiotics, and nutritional factors, which leads to a decrease in butyrate and propionate. Gas chromatography-mass spectrometry is an effective method for diagnosing short-chain fatty acids. A comprehensive assessment of the short-chain fatty acids profile in children with heart defects opens new avenues for improving diagnosis, prognosis, and optimizing therapeutic approaches aimed at correcting the microbiome and improving outcomes. Conclusions: potential interactions between congenital heart defects and the microbiome are illustrated, key signaling mechanisms are discussed, along with promising research directions and opportunities for the therapeutic translation of fundamental scientific data.
CARDIOVASCULAR DISORDERS IN CHILDREN WITH JUVENILE ARTHRITIS: THE IMPORTANCE OF INFLAMMATION ACTIVITY AND DISEASE DURATION
Relevance. Under the influence of progressive inflammatory activity, immunological disturbances, and pharmacological therapy, cardiovascular system damage in children with juvenile arthritis is considered one of the leading factors contributing to a poorer prognosis and increased risk of disability. The clinical manifestations of such disorders are often masked by the underlying disease, which leads to a delay in diagnosis. This highlights the necessity of a detailed investigation of cardiovascular abnormalities in this patient population. Objective. To assess the impact of inflammatory activity and disease duration of juvenile arthritis on the development of cardiovascular disorders in children. Materials and Methods. The study included 80 patients with JIA aged 2 to 17 years, divided into two groups: 50 with systemic-onset JIA and 30 with the articular form of the disease. Clinical, instrumental, and laboratory methods were applied. Statistical analysis of the data was performed using IBM SPSS Statistics v.26. Results. It was established that the frequency of cardiovascular disorders in children with systemic-onset JIA was higher than in those with the articular form. The following characteristic cardiovascular disorders were identified: chronic heart failure, myocardial remodeling, arrhythmias, conduction blocks, left ventricular hypertrophy, and decreased contractile function. A significant association was demonstrated between the frequency of these disorders, the severity of inflammatory activity, and disease duration. Conclusion. In children with systemic-onset JIA, cardiovascular disorders are more frequent compared to the articular form. The progression and high inflammatory activity of JIA are closely related to the development of structural and functional cardiac changes, including myocardial remodeling, conduction abnormalities, and valvular dysfunctions.
MULTIMODAL APPROACH TO DIAGNOSING POLYNEUROPATHIES OF VARIOUS ORIGINS IN CHILDREN
Background: Polyneuropathies in children pose diagnostic challenges due to their diverse etiologies, age-specific clinical presentations, and the need for specialized assessment techniques. A multimodal diagnostic approach, combining clinical evaluation, electrophysiology, laboratory studies, and imaging, is crucial for accurate diagnosis and management. Objective: To evaluate the effectiveness of a structured multimodal diagnostic approach in identifying pediatric polyneuropathies and determine the diagnostic yield of various modalities. Methods: A retrospective analysis was conducted on 85 pediatric patients (age range: 0-18 years) suspected of having polyneuropathy at Fergana Regional Children’s Multidisciplinary Medical Center. The diagnostic protocol included comprehensive clinical assessment, nerve conduction studies (NCS) and electromyography (EMG), targeted laboratory investigations, neuroimaging, and genetic testing when indicated. Results: Definitive diagnoses were established in 78 patients (91.8%). The most common etiologies were hereditary neuropathies (34.1%), immune-mediated inflammatory neuropathies (28.2%), and metabolic causes (15.3%). Nerve conduction studies had the highest diagnostic yield (89.4%), followed by targeted genetic testing (72.3% in hereditary cases) and laboratory investigations (68.2%). Conclusions: A structured multimodal approach significantly improves diagnostic accuracy in pediatric polyneuropathies. Early use of electrophysiological studies, combined with targeted laboratory and genetic testing, enables timely diagnosis and appropriate intervention.
ANALYSIS OF RISK FACTORS FOR THE TRANSFER OF LATENT TUBERCULOSIS INFECTION TO ACTIVE TUBERCULOSIS IN CHILDREN LIVING IN FAMILY TUBERCULOSIS FACTORIES
Relevance. According to the WHO definition, latent tuberculosis infection (LTBI) represents a state of persistence of Mycobacterium tuberculosis in the absence of clinical manifestations of the disease, which can only be detected through immunological tests. Experts estimate that about one-quarter of the world’s population is infected with LTBI, with a lifetime risk of reactivation ranging from 5% to 15%, particularly within the first five years after infection and predominantly during childhood. Within the framework of the global tuberculosis control strategy after 2015, special attention has been directed to the early detection and prevention of LTBI as a key element in reducing the incidence of new cases. However, to date, no “gold standard” exists for diagnosing and differentiating latent and active forms of tuberculosis in children. Objective. To study the anamnestic and social indicators of latent tuberculosis infection development and active tuberculosis course in children. Materials and Methods. A retrospective-prospective cohort study was conducted in accordance with the international STROBE standard. A total of 60 children were included and divided into two groups: Group 1 consisted of 40 children with latent tuberculosis infection, and Group 2 included 20 children with active tuberculosis. Results. It was established that the key social risk factors for tuberculosis activation were living in low-income, large, and single-parent families, poor housing conditions, low parental education, unemployment, and harmful habits. Among biological factors, low birth weight, perinatal CNS lesions, early childhood anemia, as well as concomitant chronic conditions (helminthic invasions, gastrointestinal and endocrine disorders, myopia, rheumatism) were identified. Epidemiological factors included contact with bacillary patients, lack of chemoprophylaxis, non-compliance with sanitary measures in households, living in families with HIV infection, and a history of COVID-19. Conclusions. Thus, the study confirmed the multifactorial nature of the risk of LTBI activation in children, where social, biological, and epidemiological components play a significant role. The authors emphasize the necessity of a comprehensive assessment of risk factors and their justified differentiation for latent and active tuberculosis forms, which has practical significance for prevention, early diagnosis, and rational monitoring of children in risk groups.
CARDIOVASCULAR SYSTEM STATUS IN CHILDREN OF PRIMARY SCHOOL AGE DEPENDING ON OVERWEIGHT
Relevance. The problem of obesity in the population of children and adolescents is not only pediatric, but also a cardiological problem, since in children and adolescents with excess body weight, arterial hypertension, dyslipidemia, insulin resistance, and early signs of myocardial remodeling are significantly more frequently detected, which contributes to the formation of a high cardiovascular risk at a young age. In particular, in schoolchildren of different ages with metabolic syndrome, the likelihood of developing cardiovascular diseases is 14 times higher, and diabetes mellitus is 11 times higher compared to their peers without this syndrome. Purpose of the research. To study the features of the course of functional disorders of the cardiovascular system in children with excess body weight, depending on age (7-10 years). Materials and methods of research. The examination was conducted at the city adolescent center. The study involved 50 children with excess body weight and 30 children without excess body weight. The study involved 50 children with excess body weight and 30 children without excess body weight. Research results. In the main BMI group, excess body weight (+2 SD) was detected in 93.3% of boys and 94.2% of girls, and the risk of excess weight (+1 SD) was 6.7% of boys and 5.8% of girls, weight gain was observed, and growth was not observed in the control group. According to the study of parental questionnaires in the main group, it was revealed that heredity is complicated in children with various pathologies, among which cardiovascular system pathologies occurred in 72% (ischemic heart disease, arterial hypertension, those who had a heart attack at a young age), type 2 diabetes mellitus - in 16.7%, endocrine pathologies - in 42% (hypo- and hyperthyroidism, etc.). Among comorbidities, chronic tonsillitis occurred in 91.0% of children in the main group and 59.9% in the control group, anemia occurred in 78.2% of children in the 1st group and 39.9% in the 2nd group, which showed a significant value (p < 0.001), somatoform. Conclusion. In children with excess body weight, complaints of sleep disturbance, chest pain, shortness of breath during physical exertion, headache, and dizziness are registered significantly more often, which confirms the negative impact of obesity on the functional state of the cardiovascular system. According to ECG data, rhythm and conduction disorders were detected in such children, among which slowed AV conduction, rhythm driver migration, and extrasystole occur significantly more frequently. The nature of hemodynamic reactions to physical exertion in overweight children is determined by the predominance of the hyperdynamic type of blood circulation, while in their peers with normal body weight, the normotonic type is more common. The obtained results indicate that excess body weight in children is a significant factor in the formation of cardiovascular risk already in childhood and requires timely diagnosis, prevention, and correction.
INTEGRATING NEUROPHYSIOLOGICAL AND PARACLINICAL FINDINGS FOR DIFFERENTIAL DIAGNOSIS OF SUBACUTE SCLEROSING PANENCEPHALITIS IN PEDIATRIC PATIENTS
Relevance. Subacute sclerosing panencephalitis (SSPE) remains a devastating progressive encephalopathy in children, caused by persistent measles virus infection. Accurate differential diagnosis requires integrating clinical, neurophysiological, and paraclinical data. Materials and methods.This study analyzed 180 pediatric SSPE patients treated at the Center for the Development of Professional Qualification of Medical Workers and the National Children’s Medical Center between 2019 and 2024. Data included demographics, vaccination status, disease severity, electroencephalography (EEG), and magnetic resonance imaging (MRI). Results: Characteristic EEG periodic complexes and MRI white-matter abnormalities strongly correlated with clinical stage and functional decline. Vaccination coverage was low (40%), highlighting persistent susceptibility to measles-related complications. Our findings confirm that combining EEG, MRI, and cerebrospinal fluid antibody testing increases diagnostic certainty and distinguishes SSPE from mimicking neurological conditions. Conclusion. Early recognition through multimodal assessment is essential for timely management, counseling, and trial enrollment. Strengthening vaccination strategies and standardized diagnostic protocols may reduce disease burden and improve outcomes.