International Journal of Scientific Pediatrics
Андижанский государственный медицинский институт
Metabolic cooperation and proteolytic activity of the gut microbiome in children with congenital heart disease
Introduction. Children with congenital heart disease exhibit alterations in the gut microbiome accompanied by changes in its metabolic activity. Short-chain fatty acids (SCFAs) are considered the most informative functional biomarkers of these metabolic changes. Objective. To investigate age-related characteristics of short-chain fatty acid production and the functional state of the gut microbiome in young children with congenital heart disease. Materials and Methods. The profile of short-chain fatty acids was analyzed in fecal samples obtained from young children with congenital heart disease and age-matched healthy controls. Concentrations of acetate, propionate, butyrate, total branched-chain fatty acids, the IsoCn/Cn ratio, and the anaerobic index were determined by gas–liquid chromatography according to the method developed by M.D. Ardatskaya. Participants were stratified into three age groups: 0–6 months, 6–12 months, and 1–3 years. Results and Discussion. Children with congenital heart disease demonstrated impaired metabolic activity of the gut microbiome across all age groups. The most pronounced finding was a reduction in butyrate production, reaching a 3.7-fold decrease in children aged 6–12 months compared with healthy controls. These changes were accompanied by reduced propionate levels, a lower anaerobic index, and an increased IsoCn/Cn ratio, indicating a predominance of proteolytic metabolism. The observed metabolic alterations suggest decreased activity of butyrate-producing obligate anaerobes, impaired saccharolytic fermentation, and the development of functional metabolic insufficiency of the gut microbiota. Conclusion. Young children with congenital heart disease exhibit age-dependent disturbances in short-chain fatty acid production, characterized by butyrate and propionate deficiency, enhanced proteolytic metabolism, and reduced functional activity of the obligate anaerobic gut microbiota.
Copyright (c) 2026 https://creativecommons.org/licenses/by-nc-nd/4.0
Structural Features And Factors In The Development Of Congenital Heart Disease In CHildren Who Underwent Surgery At The Andijan Regional CHildren’s Multidisciplinary Medical Center, Republic Of Uzbekistan, In 2021–2025
Introduction. Congenital heart disease remains a leading cause of childhood morbidity and disability. The problem is becoming increasingly important because of the growing proportion of severe and combined forms, whose pattern and prognosis may be influenced by regional and ethnic factors. Therefore, continuous monitoring of CHDs is important for improving early diagnosis, cardiac surgical care, and rehabilitation. Objective. To determine the structural characteristics of congenital heart defects (CHDs) and clinical and anamnestic factors among children who underwent surgery at the Andijan Regional Children’s Multidisciplinary Medical Center in 2021–2025. Materials and methods. The study included 927 children with CHDs treated in 2021–2025, of whom 497 underwent surgery. The medical records of all 927 children were analyzed retrospectively, while 128 children from the overall cohort were additionally examined prospectively. The structure of heart defects, patients’ age and place of residence, clinical manifestations, comorbid conditions, maternal pregnancy history, and family history were assessed. Quantitative variables were compared using the Mann–Whitney U test and the Kruskal–Wallis test. Categorical variables were analyzed using Pearson’s chi-square test and Fisher’s exact test. Differences were considered statistically significant at p<0.05. Results. Among the 497 operated children, ventricular septal defect (36.4%), patent ductus arteriosus (29.8%), and atrial septal defect (20.9%) predominated. Tetralogy of Fallot accounted for 5.8%, atrioventricular canal defect for 3.0%, and transposition of the great arteries for 2.2%. In 2023–2025, the proportion of operations for complex and critical CHDs increased. The main clinical manifestations included perioral cyanosis, respiratory failure, and heart failure. Maternal histories frequently included infections during pregnancy, gestosis, impaired uteroplacental blood flow, and somatic diseases; hereditary burden and consanguineous marriages were also recorded. Conclusion. Ventricular septal defect, patent ductus arteriosus, and atrial septal defect predominated among surgically corrected CHDs in the Andijan region. The findings support regional monitoring of CHD patterns, early diagnosis, improved patient referral, and multidisciplinary follow-up.
Integrated clinical and metabolic assessment of children with obesity and arterial hypertension
Introduction. Childhood and adolescent obesity is one of the most important medical and social challenges in modern pediatrics and pediatric cardiology. The increasing prevalence of abdominal obesity is accompanied by a growing incidence of arterial hypertension, insulin resistance, dyslipidemia, and early cardiovascular disorders. Despite numerous studies, the relationships between clinical, metabolic, and cardiovascular alterations in obese children remain insufficiently understood, emphasizing the need for a comprehensive assessment of cardiometabolic risk factors. Objective. To investigate the clinical and metabolic characteristics of children with obesity, evaluate the relationships between anthropometric parameters, disorders of carbohydrate and lipid metabolism, arterial hypertension, and cardiovascular changes, and determine the structure of metabolic syndrome components in pediatric patients. Materials and Methods. A prospective clinical and laboratory study included 55 children aged 10–18 years with exogenous constitutional obesity. The control group consisted of 20 age-matched healthy children. All participants underwent comprehensive clinical examination, anthropometric assessment, body mass index calculation, waist circumference and waist-to-hip ratio measurements, blood pressure evaluation, electrocardiography, and biochemical investigations including carbohydrate and lipid metabolism parameters, serum uric acid, immunoreactive insulin, and HOMA-IR index determination. Statistical analysis included correlation analysis between clinical and laboratory variables. Results and Discussion. Children with abdominal obesity and arterial hypertension demonstrated an earlier onset of the disease, accelerated physical growth and pubertal development, a higher prevalence of functional cardiovascular abnormalities, and persistent elevation of arterial blood pressure. Disorders of carbohydrate metabolism were detected in approximately one-third of the patients and were accompanied by elevated HOMA-IR values, indicating insulin resistance. Hypertriglyceridemia, increased total cholesterol and low-density lipoprotein cholesterol, together with reduced high-density lipoprotein cholesterol, were significantly more common in children with abdominal obesity. Serum uric acid concentrations were increased and showed significant positive correlations with body mass index and blood pressure. Correlation analysis demonstrated close associations between obesity severity, carbohydrate and lipid metabolism disorders, hyperuricemia, and cardiovascular abnormalities, confirming the common pathogenetic mechanisms underlying metabolic syndrome and cardiovascular disease in obese children. Conclusion. Children with abdominal obesity, particularly those with concomitant arterial hypertension, exhibit the most pronounced clinical, metabolic, and cardiovascular abnormalities. The development of insulin resistance, dyslipidemia, hyperuricemia, and functional cardiovascular changes is closely associated with increasing obesity severity and elevated blood pressure. These findings highlight the importance of early identification of metabolic syndrome components and comprehensive assessment of cardiometabolic risk factors to prevent long-term cardiovascular complications in obese children.
Current Views on the Relevance of Minimal Brain Dysfunction in Children: Prevalence and Diagnosis (Literature Review)
Minimal brain dysfunction is a complex of neurological disorders that can arise from trauma or problems during pregnancy. This article analyzes the literature, explains the main symptoms and causes of the syndrome, its prevalence, and the reasons for the obsolescence of the term "MMD" from a historical perspective and based on current data. Modern diagnostics, which have replaced the old term, influence the effectiveness of diagnostic methods and the treatment of patients. This article presents the results of an analysis based on the latest international literature on the prevalence of this syndrome in the pediatric population and its potential solutions. The article also includes information aimed at addressing the psychological challenges of children in the late stages of MMD development. It is demonstrated that the polymorphism of MMD clinical signs plays an important role in differentiating it from several neuropsychiatric disorders. Based on the literature on this topic, it can be concluded that in all cases of MMD, there is a delay in the functional development of brain activity, which becomes the basis for subsequent clinical manifestations. Children's intellectual development corresponds to the stages of ontogenetic development, and they struggle to master school skills and social adaptation. They develop psychoemotional instability, lack of self-confidence, low self-esteem, and personality changes such as aggression. Almost all children experience various problems and conflicts in the family and school environment, depending on the degree of maladjustment. Difficulty mastering school subjects, irregular attendance at classes, and a tendency to participate in various informal groups develop.
Clinical and laboratory characteristics and elastography results in children with obesity and metabolic fatty liver disease
Introduction. To date, the obesity pandemic is closely linked to the spread of metabolic-associated fatty liver disease (MAFLD), the detection rate of which among children tends to increase. Purpose of the study: to determine the frequency of MAFLD in children with various types of obesity, evaluating metabolic status and liver parenchyma rigidity. Material and methods: this work is based on the results of a prospective study of 66 children with obesity aged 12-18 years, as well as 30 children with normal body weight. Anthropometric studies, biochemical studies to determine the levels of aminotransferases, bilirubin, alkaline phosphatase, and gamma-glutamyltransferase, and enzyme-linked immunosorbent assays to determine leptin and interleukins were conducted. Ultrasound examination of the abdominal organs and liver elastography were performed. The results of the conducted study indicate a high prevalence of MAFLD among children with exogenous-constitutional obesity, especially in its abdominal type. The obtained data align with modern concepts regarding the leading role of visceral obesity in the development of metabolic disorders and liver damage. The frequency of MAFLD in children with abdominal obesity was 57.14%, which was 2 times higher than the same indicator in children with uniform fat distribution (29.03%), confirming a higher risk of liver steatosis formation in cases of visceral fat accumulation. The study of biochemical indicators demonstrated the presence of functional liver changes in children with obesity. Despite the fact that the average values of transaminases were within the reference intervals, the levels of ALT and AST in children with abdominal obesity were significantly higher compared to both children with uniform obesity and the control group An increase in ALT of more than 1.5 times was primarily identified in children with abdominal obesity, which may indicate the formation of inflammatory changes in the liver and the development of metabolically associated steatohepatitis. It has been established that liver tissue stiffness indicators were significantly higher in children with obesity compared to healthy children, with maximum values observed in the combination of abdominal obesity and MAFLD. In children with abdominal obesity and MAFLD, the highest levels of leptin, TNF-α, and IL-6 were identified. An increase in leptin concentration reflects the development of visceral fat tissue dysfunction and the formation of leptin resistance. Simultaneously, an increase in TNF-α and IL-6 levels indicates the activation of chronic low-intensity inflammation. Conclusion. Thus, the research results confirm the multifactorial nature of MAFLD development in children and demonstrate a close correlation between abdominal obesity, inflammatory changes, impaired adipokin secretion, and early signs of liver tissue remodeling.
Age-related characteristics of proteolytic enzymes in acute bronchial obstructions in children
Introduction. Acute bronchial obstructions (ABO) in children remain one of the most frequent reasons for hospitalization in pediatric practice. The high prevalence, severity of clinical manifestations, and risk of developing chronic bronchopulmonary pathology make the problem extremely significant for modern medicine. Purpose of the study. To determine the role of proteolytic enzymes in the pathogenesis of acute bronchial obstructions in preschool and primary school children, as well as to evaluate the balance between neutrophilic elastase and α1 antitrypsin. Materials and methods. The study included 47 children with acute obstructive bronchitis. The patients were divided into two age groups: preschoolers (3-6 years, n=28) and schoolchildren (7-10 years, n=19). Clinical examination, laboratory determination of neutrophilic elastase (NE) and α1 antitripsin (α1 AT), as well as instrumental methods (spirometry, pulse oximetry, radiography) were performed. Results and Discussion. During the analysis conducted in children with acute bronchial obstructions, significant differences were identified in the activity of proteolytic enzymes and their inhibitor levels depending on age. In preschool children, the concentration of neutrophilic elastase (NE) was 188.6±5.77 ng/ml. In schoolchildren, NE levels were significantly lower at 159.4±8.79 ng/ml (15.5% lower, p≤0.05). α1-antitrypsin (α1AT) levels were elevated in both age groups. In preschool children, it was -3.72±0.275 g/l; while in school-age children, it was -3.29±0.119 g/l (p≤0.05). Conclusion. The obtained data demonstrate that the imbalance between proteolytic enzymes and their inhibitors is a universal mechanism for respiratory tract damage in childhood. Its severity determines the clinical features of the disease's course and can serve as a basis for developing new diagnostic markers and targeted therapeutic strategies.
Efficacy of tocopherol therapy in full-term newborns with congenital pneumonia
Introduction. Congenital pneumonia (CP) is diagnosed in neonates with a frequency of 1.5–5%, remaining one of the most severe forms of intrauterine infection. Its high prevalence, the risk of respiratory failure, and prolonged disease course necessitate the introduction of additional therapeutic approaches. The study aimed to investigate the dynamics of alpha-tocopherol levels in the blood of full-term newborns with congenital pneumonia. Materials and Methods. The study included 83 neonates: 63 with clinically and laboratory‑confirmed CP and 20 healthy infants in the control group. Patients with CP were divided into two subgroups: Group I (n=32) received standard treatment combined with oral α‑tocopherol therapy, while Group II (n=31) received standard treatment only. Clinical and laboratory examinations were performed for all participants, including complete blood count, biochemical analysis, measurement of α‑tocopherol concentration by high‑performance liquid chromatography with mass spectrometry, and chest radiography. Statistical analysis was conducted using variation methods to verify the significance of differences between groups. Results and Discussion. At baseline, blood α‑tocopherol levels were comparable across groups. By day three of life, antioxidant concentrations increased, with a more pronounced rise in infants receiving additional therapy. By day six, differences became significant, with α‑tocopherol levels up to 4% higher in Group I. Clinically, this was associated with faster resolution of respiratory failure (3–4 days versus 5–7), reduction of intoxication signs, normalisation of laboratory parameters, and accelerated resorption of pulmonary infiltrates (9–10 days versus 12–14). The average duration of hospitalisation was reduced by three days. Conclusions. The use of α‑tocopherol in the treatment of neonates with congenital pneumonia reduces the incidence of respiratory failure to 15.8%, intoxication signs to 19.2%, and shortens hospital stay by three days. These findings confirm both the clinical and economic effectiveness of α‑tocopherol therapy as an adjunct to standard treatment in neonatal congenital pneumonia.
The Significance Of Clinical Risk Factors In The Differential Diagnosis Of Upper Gastrointestinal Tract Pathologies In Infants With Vomiting Syndrome
Vomiting syndrome is one of the most common clinical conditions encountered in pediatric practice and is predominantly functional in nature. However, this symptom may also represent a manifestation of serious organic pathologies of the upper gastrointestinal tract, particularly congenital hypertrophic pyloric stenosis. Early differential diagnosis between functional and organic conditions remains an important clinical challenge, especially in primary healthcare settings with limited access to instrumental diagnostic methods. Objective. To evaluate the diagnostic significance of clinical risk factors in predicting organic pathologies of the upper gastrointestinal tract in infants. Methods. The study included 89 infants presenting with vomiting syndrome, including 65 boys (73.0%) and 24 girls (27.0%). All patients underwent standardized clinical assessment including medical history evaluation, analysis of vomiting characteristics, weight dynamics, and physical examination findings. After diagnostic verification, patients were divided into two groups: an organic pathology group (n=45) and a functional disorder group (n=44). The diagnostic significance of clinical risk factors was assessed using the χ² test, odds ratio (OR), and 95% confidence interval (95% CI). Results. The majority of patients (79.8%) presented within the first three months of life. Statistical analysis demonstrated a significant association between several independent clinical factors and organic pathology. In particular, age under 3 months significantly increased the probability of organic pathology (OR=7.24; 95% CI: 2.00-26.2; p<0.001). Projectile vomiting (OR=5.97; 95% CI: 2.33-15.3; p<0.001) and male sex (OR=2.64; 95% CI: 1.05-6.61; p<0.05) were also identified as independent clinical predictors. Postprandial vomiting showed a strong association with organic pathology (OR=5.81; p<0.001), whereas recurrent vomiting did not demonstrate significant differential diagnostic value (p>0.05). Conclusion. In infants with vomiting syndrome, age below 3 months, projectile vomiting, postprandial vomiting, and male sex are significant independent clinical predictors of organic pathology. Comprehensive assessment of these factors may facilitate early identification of high-risk patients in primary pediatric care and ensure timely referral for specialized diagnostic evaluation.
congenital hypertrophic pyloric stenosis
Optimization of diagnostical algorithms for pediatric polyneuropathy: etiological classification and immunological assessment in genetic and acquired types
Introduction. The timely diagnosis of polyneuropathies in children is a pressing issue in modern pediatric neurology, where etiological differentiation and immunological assessment significantly increase diagnostic accuracy. The aim of the study was to develop a highly sensitive, combined diagnostic algorithm based on the evaluation of etiological factors and immunological status in children with inflammatory and hereditary polyneuropathies. Materials and Methods. To optimize the diagnostic algorithm, a combined scoring system was developed. An integrative diagnostic model, based on the z-standardized sum of CSF protein, IgG, CRP, and motor NCV indicators (z-CSF + z-IgG + z-CRP − z-NCV), was established to reliably differentiate between inflammatory and hereditary polyneuropathies. Statistical analysis was performed using GraphPad Prism 10 software. The normality of distribution was assessed using the Shapiro-Wilk test. This prospective-retrospective study was conducted from 2022 to 2025. A total of 105 children (aged 1–18) were divided into three groups: inflammatory polyneuropathy (n=45), hereditary polyneuropathy (n=30), and control (n=30). Clinical, immunological (IgG, IgM, IgA, CD3+/CD4+/CD8+, TNF-α, IL-6), electroneuromyography (ENMG), and genetic methods were employed. Results and Discussion. In the inflammatory group, a decreased CD4+/CD8+ ratio (1.20±0.35) was observed, along with a significant increase in IgG (14.58±3.33 g/L), TNF-α, and IL-6 levels (p<0.0001). No immunological changes were observed in the hereditary group. The combined diagnostic algorithm demonstrated high accuracy, with an AUC of 0.986. Conclusion. The developed combined algorithm allows for the reliable differentiation of inflammatory and hereditary polyneuropathies and is recommended for implementation in regional clinical practice.
Clinical features of glomerulopathies in children with iodine deficiency: a literature review
Intraduction. This study aims to systematically analyze the clinical features, pathophysiological mechanisms, and progression patterns of glomerulopathies in children with iodine deficiency based on current literature. The aim of the study is to conduct a systemic analysis of the clinical features, pathophysiological mechanisms and nature of the progression of glomerulopathies in children with iodine deficiency based on data from modern scientific literature. Methods. A narrative literature review approach was applied using published data from peer-reviewed journals, including studies on thyroid–kidney interactions, pediatric glomerular diseases, and iodine deficiency-related metabolic and immunological alterations. Relevant clinical, experimental, and epidemiological studies were analyzed and synthesized. Results and discussion. Iodine deficiency leads to a reduction in the synthesis of thyroid hormones (T3, T4), which slows down metabolic processes, causes endothelial dysfunction, and activates the renin-angiotensin-aldosterone system. These changes result in a decrease in glomerular filtration rate, the development of proteinuria, and the progression of renal insufficiency. In addition, the activation of the immune system, an increase in pro-inflammatory cytokines (IL-2, IL-6, TNF-α), oxidative stress, and the activation of the complement system exacerbate glomerular damage. Clinically, these children are characterized by severe progression of glomerulopathies, stable proteinuria, edema syndrome, arterial hypertension, decreased glomerular filtration rate, and poor response to treatment. The results of the study confirm that iodine deficiency affects not only the endocrine system but also renal function. These findings are consistent with studies by Zimmermann, Pearce, and other authors, who have shown that iodine deficiency leads to systemic metabolic disorders. Iodine deficiency, as shown, exacerbates the development of glomerulopathies, proteinuria, and reduces kidney function. Conclusion. Iodine deficiency significantly influences both the development and progression of glomerulopathies in children through combined endocrine, immunological, and hemodynamic mechanisms. Early detection and correction of iodine deficiency, along with integrated nephrological and endocrinological monitoring, are essential for improving renal outcomes and preventing disease progression.
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.
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.
Copyright (c) 2025 https://creativecommons.org/licenses/by-nc-nd/4.0