International Journal of Scientific Pediatrics
Андижанский государственный медицинский институт
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.
Copyright (c) 2026 https://creativecommons.org/licenses/by-nc-nd/4.0
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.
Copyright (c) 2025 https://creativecommons.org/licenses/by-nc-nd/4.0
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.
OBESITY AND OVERWEIGHT AS EARLY PREDICTORS OF CARDIOVASCULAR DYSFUNCTION IN CHILDREN
Relevance. Childhood overweight and obesity remain among the most pressing issues in pediatrics and public health. The rising prevalence of excess body weight in children is associated with lifestyle changes, reduced physical activity, and dietary habits. Pediatric obesity is linked not only to metabolic disorders but also to the early onset of cardiovascular abnormalities. Elevated body mass index (BMI) correlates with arterial hypertension and electrocardiographic (ECG) changes, which may serve as early predictors of cardiovascular diseases. Studying these associations in school-aged children is essential for developing preventive strategies. The purpose of the study is to assess the impact of overweight and obesity on blood pressure and electrocardiographic parameters in 7-year-old children. Materials and methods of the study. A cross-sectional study was conducted involving 120 children aged 7 years. Participants were divided into three groups: normal BMI (n=67), overweight (n=29), and obese (n=24). Anthropometric measurements were performed according to WHO standards, BMI and SDS were calculated, and arterial blood pressure was measured three times to determine systolic and diastolic values. Standard 12-lead ECG was performed for all participants. Statistical analysis included descriptive statistics, Student’s t-test, Mann–Whitney test, and correlation analysis (Pearson and Spearman). A p-value <0.05 was considered significant. Research results. Children with obesity demonstrated significantly higher systolic and diastolic blood pressure compared with children of normal weight (p<0.01). ECG analysis revealed that the frequency of functional cardiac abnormalities increased proportionally with higher BMI: 40.3% in normal-weight children versus 70.8% in obese children. The most common findings included early repolarization syndrome, sinus tachycardia, and nonspecific intraventricular conduction disturbances. A positive correlation was found between BMI and blood pressure (r=0.42; p<0.01), as well as between BMI and functional ECG abnormalities (r=0.36; p<0.05). Conclusion. Overweight and obesity in early school-aged children are associated with increased arterial blood pressure and a higher prevalence of functional ECG changes, which may serve as early predictors of cardiovascular pathology. These findings highlight the importance of routine monitoring of cardiovascular parameters in overweight children and emphasize the need for comprehensive preventive measures, including dietary modification and increased physical activity, starting from early childhood.
THE ONSET OF SCHIZOPHRENIA IN CHILDHOOD AND ADOLESCENCE AS AN UNFAVORABLE PROGNOSTIC INDICATOR (based on the results of an epidemiological study in the socio-economic conditions of the Fergana Valley of the Republic of Uzbekistan)
Relevance. Schizophrenia with onset in childhood and adolescence is one of the key unfavorable prognostic factors affecting the course and outcome of the disease. In the Fergana Valley, this problem is particularly relevant due to the high proportion of early onset cases. The aim of the study is to identify the characteristics of early-onset schizophrenia in the Fergana Valley, substantiate its prognostic significance, and establish priorities for early detection and prevention programs. Materials and methods. A retrospective analysis of 1087 cases of schizophrenia registered in the Fergana Valley between 1984 and 2024 was conducted. Patients were categorized by age of disease onset (under 20 years, 21-29, 30-39, 40 and older). Statistical methods were used to assess the influence of age and associated factors (heredity, exogenous triggers, schizoid premorbid personality) on the course of the disease. Results. Nearly 44% of cases had onset before age 20, a figure that has remained stable over 40 years. Early onset is associated with longer episodes, reduced quality of remission, and deterioration in social adaptation. Hereditary predisposition and schizoid premorbid personality are linked to a more severe course and incomplete remissions, while exogenous factors show a tendency towards improved prognosis. A statistically significant increase in cases with onset between ages 30-39 was noted. Conclusion. Early onset of schizophrenia is a persistent unfavorable prognostic indicator, necessitating the development of regional programs for early detection and comprehensive psychosocial support. Special attention should be given to patients with hereditary predisposition and schizoid premorbid personality. Modern treatment approaches contribute to improving the course of the disease; however, additional preventive measures are necessary.
CLINICAL FEATURES AND STRUCTURE OF CASES IN CHILDREN WITH CONGENITAL HEART DISEASE
Relevance. Congenital heart defects (CHD) represent the most common group of congenital developmental anomalies in children and remain one of the leading causes of neonatal and infant mortality. According to global statistics, the prevalence of CHD ranges from 6 to 10 cases per 1,000 live births. With the current advances in cardiac surgery and neonatology, timely diagnosis of clinical, laboratory, and instrumental parameters in children with CHD is of critical importance for determining prognosis, selecting optimal treatment strategies, and preventing complications. The purpose of the study. To assess the clinical manifestations, physical development, laboratory, and instrumental indicators in young children with congenital heart defects of varying severity. Materials and methods of the study. The study included 49 children with congenital heart defects who underwent examination and treatment at the Department of Cardiac Surgery, Tashkent Pediatric Medical Institute. The age of the patients ranged from several weeks to 3 years. All children underwent a comprehensive clinical and instrumental assessment, including medical history collection, physical examination, anthropometric measurements (height, weight, body mass index), laboratory tests (complete blood count, biochemical analysis, hemoglobin level, protein and electrolyte parameters), and instrumental methods such as electrocardiography (ECG), echocardiography (EchoCG), chest radiography, and abdominal ultrasound when indicated. The severity of heart failure was determined according to the Ross classification (Ross, 1992). Research results. The most common CHD among the examined children was ventricular septal defect (VSD), identified in 46.9% of patients. Ventricular septal defect and patent ductus arteriosus (PDA) were the next most frequent. Isolated defects were found in 51% of cases, while combined defects were observed in 47%, indicating a high prevalence of complex cardiac malformations in early childhood. Pulmonary hypertension (PH) was diagnosed in 57.1% of children, mainly in those with significant shunts and combined defects, underscoring the importance of early detection of elevated pulmonary artery pressure. Growth retardation was noted in most boys, likely associated with chronic hypoxia and reduced exercise tolerance. All patients exhibited anemia, reflecting impaired oxygen transport and compensatory adaptation to hypoxia. Congestive pulmonary changes were identified in 26.5% of cases, while gastrointestinal and urinary tract disorders were observed in 10.2% of children, indicating a systemic impact of cardiac pathology on somatic health. Conclusion. Young children with congenital heart defects demonstrate marked impairments in physical development, anemia, pulmonary hypertension, and a high frequency of combined cardiac defects. The degree of heart failure does not always correlate with the age at diagnosis, emphasizing the importance of a comprehensive approach to examination and follow-up. Timely detection of clinical, laboratory, and instrumental abnormalities helps to determine disease prognosis, plan surgical correction, and reduce the risk of complications.
THE ROLE OF PEPTIDE YY3-36 IN THE DEVELOPMENT OF METABOLIC SYNDROME IN CHILDREN WITH OBESITY
This article presents data from a study of peptide YY-36 in obese children, which plays a key role in the regulation of eating behavior. This peptide is synthesized by L-cells in the distal small and large intestines, enters circulation after meals, and is an anorexigenic hormone. The results of this study are recommended for widespread implementation in the practice of pediatricians, general practitioners, and pediatric endocrinologists. Study objective: To determine the contribution of peptide YY3-36 to the development of metabolic syndrome in children with obesity. Materials and methods: A total of 108 children with exogenous-constitutional obesity, abdominal fat distribution, and waist circumference greater than the 90th percentile for age and sex were examined. For comparative analysis, 76 children with normal body weight were examined. A comprehensive set of anthropometric, biochemical, and enzyme immunoassay studies was conducted, and serum peptide YY3-36 levels were determined. Based on the criteria for diagnosing metabolic syndrome, the frequency of metabolic syndrome, its various forms, and combinations were determined in children with abdominal obesity. Study results: When studying peptide YY3-36 levels in obese children, a significant decrease was found in children with abdominal obesity (72,13 pg/ml), which was significantly lower than in controls (105,39 pg/ml; p< 0.001). When determining the gender dependence of intestinal neuroregulatory peptide YY3-36 production, statistically lower levels were observed in boys compared to girls, indicating a more pronounced imbalance in peptide YY3-36 production in boys with visceral fat distribution. The study noted a tendency toward decreased YY3-36 peptide levels as children aged 16-18 years compared to children aged 10-15 years. No similar age-related dynamics were observed in children in the control group. The duration of obesity in children with abdominal obesity played a role in the production of intestinal neuroregulatory peptide. YY3-36 peptide levels progressively decreased with increasing duration of the disease, which was apparently associated with a gradually increasing eating disorder. The study demonstrated that all children with abdominal obesity had low YY3-36 peptide levels, indicating an eating disorder, which is one of the dominant factors in the development of metabolic syndrome in the entire sample of children, with the lowest values ​​in children with complete metabolic syndrome. Currently, there is no interpretation of peptide YY3-36 levels for diagnosing pathological conditions, including metabolic syndrome, in children with obesity. Therefore, a threshold level for peptide YY3-36 was determined to assess the contribution of this hormone to the diagnosis of metabolic syndrome in children with abdominal obesity. In a study of the AUC-ROC of peptide YY3-36 levels, the AUC curve area reached sufficient diagnostic values at a threshold level ≤71,600, with a sensitivity of 84.2% and a specificity of 73.4%, demonstrating the good diagnostic accuracy of the AUC-ROC test (AUC = 0,856). Conclusions: The study suggests a significant contribution of abnormal peptide YY3-36 production to the development of abdominal obesity in children. The conducted work characterizes a significant decrease in the production of this food hormone in metabolic syndrome in children, the degree of pathology of which was greatest in boys with the full form of the syndrome.
MELKERSSON-ROSENTAL SYNDROME IN CHILDREN AS AN ORPHAN DISEASE: PREVALENCE, CLINICS AND TREATMENT METHODS
In this article, the authors, referring to their own practice, cases from practice, present information about a rare syndrome in children - Melkersson-Rosenthal. Based on the results of their own clinical observation, instrumental and laboratory studies, the clinical and diagnostic criteria of the syndrome are described. Historical and modern literary data on the rare Melkersson-Rosenthal syndrome are provided. The authors argue that the disease begins during the transition from childhood to adolescence, and after treatment, the progression of the disease slows down, but does not stop, which requires close monitoring by both pediatricians and general practitioners.
CURRENT STRATEGIES OF ANTIBIOTIC THERAPY OF ACUTE RESPIRATORY INFECTIONS IN PEDIATRIC PRACTICE
Resume. Acute respiratory pathology remains the leading cause of morbidity among the child population of the country. This review article highlights modern approaches to antibacterial therapy of infectious diseases of the respiratory tract in pediatric patients. Material and method. Analyz provedyon na osnobe obzora tekushchikh publication v bazax PubMed, Scopus i eLibrary za poslednie 10 let.Based on the analysis of modern scientific data, key factors influencing the choice of antibacterial drugs for respiratory infections are identified. Conclusion.The main reasons for the unjustified prescription of antibiotics in pediatrics include overdiagnosis by doctors, the desire to meet parental expectations, and the desire to accelerate the achievement of clinical improvement. Also, factors worsening the prognosis with irrational antibiotic therapy in pediatrics are identified.
DIAGNOSTIC UTILITY OF DERMOSCOPY IN PEDIATRIC ATOPIC DERMATITIS
Introduction: Atopic dermatitis (AD) is a common chronic inflammatory skin disease in children, caused by genetic, immunological, and environmental factors. Its clinical manifestations are diverse, including exudative, erythematous-squamous, and lichenoid forms, with severity ranging from mild to severe. The SCORAD index is a standardized tool for assessing AD severity, combining objective signs (extent, intensity) and subjective symptoms (itching, sleep loss). However, minor skin changes may not be detected by clinical evaluation alone, highlighting the need for modern diagnostic tools. Aim of the study: To evaluate the diagnostic value of dermoscopy in atopic dermatitis in children by studying dermoscopic characteristics (morphology, vascular pattern distribution, scaling nature, and color) depending on clinical forms, age groups, and disease severity, and correlating these with clinical SCORAD scores. Materials and methods: This research explores the diagnostic potential of dermoscopy in evaluating atopic dermatitis (AD) in 60 children aged 4 months to 18 years, treated at the Department of Pediatric Dermatology, Tashkent Pediatric Medical Institute. Dermoscopic features, including morphology, vascular structure distribution (homogeneous or heterogeneous), scaling patterns, and color of skin structures, were assessed across clinical forms (exudative, erythematous-squamous, erythematous-squamous with lichenification, lichenoid, and prurigo), age groups (infantile, childhood, adolescent-adult), and disease severity (mild, moderate, severe) using the SCORAD index. Quantitative analysis provided mean values and standard errors (M±m) for dermoscopic feature coefficients. Results: Findings revealed distinct dermoscopic patterns: severe and exudative forms were characterized by heterogeneous vascular distribution and yellow crusts, while mild and erythematous-squamous forms showed homogeneous vascular patterns and white scales. Age-related differences highlighted increased lichenification in older groups. Conclusion: Dermoscopy proved to be a reliable, non-invasive tool for enhancing diagnostic accuracy and monitoring AD progression in children.
EFFICIENCY OF LANSOPRAZOLE IN THE TREATMENT OF CHRONIC GASTRODUODENITIS IN CHILDREN
Abstract. The original article presents the results of dynamic studies of the clinical picture after the use of a new drug lasoprazole in children with chronic gastroduodenitis. The results of the study are recommended for widespread implementation in the practice of general practitioners, primary health care clinics. Objective: To evaluate the effectiveness of lansoprazole in comparison with standard therapy with omeprazole in the treatment of chronic gastroduodenitis in children. Materials and methods: A comparative study of 60 children with chronic gastroduodenitis was conducted, divided into two groups of 30 people. The first group received lansoprazole, the second group - omeprazole as part of complex therapy. Efficiency was assessed using general clinical, laboratory and instrumental diagnostic methods. Results: The use of lansoprazole demonstrated a statistically significant improvement in clinical indicators and faster pain relief compared to the omeprazole group. Conclusions: Lansoprazole is an effective drug for the treatment of chronic gastroduodenitis in children and can be considered as an alternative to omeprazole.
NUTRITIONAL DEFICIENCY IN PREGNANT AND LACTATING WOMEN: THE ROLE OF VITAMINS IN CHILD HEALTH
Relevance. Vitamin and mineral deficiencies in pregnant and breastfeeding women increase the risk of congenital malformations and reduce the quantity and quality of breast milk. This issue requires not only enriching the maternal diet with nutritious foods but also ensuring proper adherence to preventive supplementation. Objective. To study the impact of vitamin and mineral deficiencies during pregnancy and lactation on child health. Materials and Methods. A literature review covering the period from 2013 to 2025 was conducted using PubMed, Google Scholar, and e-library databases. The search was performed with the following key terms: “nutrition recommendations during pregnancy and lactation” “role of vitamins and minerals in pregnancy and lactation”. Results. The reviewed literature showed that adequate nutrition for pregnant and breastfeeding women is a global health priority. The data highlighted the significance of dietary vitamin and mineral content, and the serious consequences of deficiencies for both maternal and child health. Conclusion. Continuous intake of vitamin-mineral complexes throughout pregnancy and lactation improves women’s vitamin status, reduces the risk of congenital malformations, increases both the quantity and quality of breast milk, and thereby ensures adequate nutrient supply for the infant.