Analysis of factors causing appearance of food hypersensitivity in young children in Lviv oblast

Food hypersensitivity in young children is a topical issue, since it encompasses a wide range of clinical symptoms and requires a personified approach in diagnostic, therapeutic and preventive measures. A progressive increase in different forms of food hypersensitivity is associated with many factors, particularly malnutrition and harmful ecological conditions. Epigenetic and genetic factors, which potentially can be related to food hypersensitivity and allergy, are being thoroughly studied. In this complex situation, the detection of risk factors for disease development is important for offering patients proper recommendations on diet, living conditions and lifestyle. Aim of the research: to perform analysis of factors, which cause appearance of food hypersensitivity in young children in Lviv oblast. Materials and methods. A study of the number of children with food intolerance was conducted using a specially compiled questionnaire. Thus, 4500 questionnaires were distributed in pre-school and medical establishments to question parents. The questionnaire had 34 questions that were grouped into four parts: general information and detailed information in parts A, B, and C. The general information part of the questionnaire included questions about the region where the child lived, passport data of the child (age, gender) and presence of serious disease (either past or present). Part A had questions about serious diseases that a child had suffered; part B asked about the child’s genealogical and medical history and presence of harmful habits in the family; part C had questions about the environment and living conditions of the child, as well as nutrition and its relation to the development of clinical symptoms of disease. Results. Analysis of 3214 questionnaires was conducted, which enabled to obtain information from parents on anamnesis and living conditions of young children. Values of 56 factors were analyzed, calculating correlation coefficients with a formation of food hypersensitivity for each of them. Statistical analysis allowed distinguishing 15 signs among these factors, which significantly correlated with the formation of food hypersensitivity in young children. Conclusions. The investigation enabled not only to detect factors that affect formation of food hypersensitivity in young children, but also to suggest a mathematical model of individual calculation of risk factors for this pathology. Data of conducted mathematical analysis can be used for elaboration of a complex of prophylaxis measures on development of food hypersensitivity in young children in Lviv oblast.

Specific features of pathology of gastro-duodenal zone organs in children of preschool and junior school ag

Pathology of organs of gastrointestinal tract - one of constituents of serious problem of health of child's population, that has certain features in the different age-related groups. The aim of this study was to analyse structure and features of pathology of organs of gastro-duodenal zone for the children of preschool and junior school age in the conditions of work of general somatic permanent establishment. Materials and methods. The results of child's gastroenterologist’s and endoscopist’s cabinet’ work at the SI “Institute of children and adolescences health care of National Academy of Medical Science” of Kharkiv were analysed for the last five years. 107 children were inspected in age from 5 to 10 years for this time. Upper endoscopy and intragastric pH-metry were conducted to all children. Results. Peculiarities of the clinical picture in children were the presence of abdominal pain of moderate intensity with localization in the epigastric region. When analyzing the nature of sex-dependent pain, it was found that early pain was predominant in boys, while late pain was more common in girls. Of the dyspeptic complaints, nausea was the most frequent, with 37.4 ± 4.6% of children complaining. When analyzing the endoscopic picture, it should be noted that pathological changes were more often registered in the age group of 8-10 years. When performing intragastric pH-metry hyperacidity was detected 2 times more often than normoacidity. Functional disorders of the gastrointestinal tract predominated in preschool children. According to the results of ultrasound of the gallbladder, the presence of gallbladder inflection was found in almost all subjects, and also more than half of this inflection was combined with bladder enlargement. Conclusions: 1. the children of preschool age have atrophic and destructive forms of defeat of mucous membrane of stomach and duodenum considerably rarer; 2. for children 7-8 years old, mainly children who study at school first year, more often there are agile violations, atrophic and destructive forms of defeat of mucous membrane of stomach and duodenum, that, probably, it is related to influence of stress factor; 3. children of preschool and junior school age have the united character of motion, that it is important to take into account at the choice of further tactics of conduct and treatment of patient.

The morphological specifics of the stromal and parenchymal liver components of 6-12-months old children from hiv-mono-infected mothers

To determine the morphological specifics of the stromal and parenchymal liver components of 6-12-months old children from HIV-mono-infected mothers. Materials and methods. The morphometric investigation included 87 liver tissue biopsies of 6-12-months old dead children from HIV-mono-infected mothers. All morphometric parameters of the parenchymal and stromal liver components were calculated using the Avtandilov`s microscopic morphometric grid, which was consisted of 100 equidistant points. It was inserted into the microscope`s ocular tube with a total × 200 microscope magnification. The number of points that were found on the corresponding types of parenchymal and stromal liver components was calculated. In every case, it was selected 10 random microscopic areas and then all data were obtained, calculated and presented as percentages. Results. Morphometric parameters of hepatocytes: mononuclear hepatocytes – 90.2±7.6 % [control – 93.5±7.1], two-nuclear hepatocytes – 9.8±1.2 % [control – 6.5±1.2], TMHC (two-/mononuclear hepatocytes coefficient) – 0.10±0.02 [control – 0.06±0.01], hepatocytes with fat vacuoles – 19.6±2.1 % [control – 0.5±0.2]. Parenchymal and stromal liver components: parenchyma – 56.1±3.3 % [control – 74.2±4.3], stroma (including blood vessels and bile ducts) – 43.9±3.7 % [control – 25.8±2.6], SPI (stroma/parenchyma index) – 0.78±0.02 [control – 0.34±0.01]. Morphometric parameters of all of the liver components: hepatocytes – 56.1±3.3 % [control – 74.2±4.3], portal tracts – 26.4±2.1 % [control – 3.1±0.6], central veins – 8.1±1.2 % [control – 9.3±1.4], sinusoids – 7.3±1.2 % [control – 10.5±1.3], bile ducts – 2.1±0.1 % [control – 2.9±0.2]. Expression level parameters: fibronectin – 73.2±4.2 % [control – 17.3±2.5], collagen type I – 15.9±1.2 % [control – 9.7±1.9], collagen type III – 20.1±2.6 % [control – 10.1±0.9], collagen type IV – 7.3±0.2 % [control – 5.9±0.2]. Conclusions. It was established, that in the liver of 6-12-months old children from HIV-mono-infected mothers, the parenchymal component of the liver showed the signs of its significant reduction, increase of regenerative activity of hepatocytes, and fatty degeneration of hepatocytes with a certain sign of reactive steatohepatitis. Also, it was established, that the stromal component of the liver of children from HIV-infected mothers showed the signs of its progressive proliferation and collagenization due to increased production and accumulation of fibronectin, type I, type III collagens in the stroma of portal tracts and newly formed septa, and the signs of hepatic sinusoid capillarization due to type IV collagen accumulation in the space of Disse of the hepatic sinusoids.

Peculiarities of the clinical course of hypothyroidism during pregnancy

The article presents an analysis of resources about the course of thyroid pathology, specifically hypothyroidism, during pregnancy. This problem is of current interest, because hypothyroidism can cause infertility or miscarriage. This applies not only to overt but also to the subclinical one. The physiological changes that occur in the thyroid gland during pregnancy are described. Attention is drawn to the signs that can be mistaken for pathological. In addition, the reference values of hormonal thyroid parameters during pregnancy differ significantly from those in non-pregnant women. This should also be taken into account in the diagnosis of appropriate disorders. The presented resources data are illustrated by two clinical cases. The first case history demonstrates the deterioration of the autoimmune process on the background of the pregnancy. Interesting is the fact that this effect was delayed, ie during pregnancy, compensatory mechanisms created a proper supply of the body of a woman and two fetuses with thyroid hormones. At the same time, during lactation period there was a pronounced decompensation of the patient's condition, which was manifested by activation of autoimmune aggression against thyroid tissue with increasing titer of antithyroid antibodies, the development of overt hypothyroidism and deepening structural changes in the thyroid gland. The need for further follow-up of postpartum women with autoimmune thyroiditis is emphasized, even if no thyroid dysfunction has been reported throughout pregnancy. The second clinical case illustrates the importance of following the recommendations of the European and American thyroid associations regarding the level of thyroid-stimulating hormone (TSH) during pregnancy. When planning the first pregnancy of this patient, the doctor did not pay attention to the fact that TSH level, being within normal values for non-pregnant women, did not meet international guidelines for planning a pregnancy and its first trimester. This had extremely adverse consequences in the form of two miscarriages. The prescription of an appropriate hormone replacement therapy and careful monitoring of the patient both at the planning stage and throughout the pregnancy, led to the birth of a healthy baby. Thus, compliance with the principles of management and use of the proposed treatment regimens for pregnant women with thyroid pathology will ensure the normal course of pregnancy and the birth of a healthy child.

Special aspects of the course and diagnosis of neurosyphilis on the example of a clinical case

Neurosyphilis is an infectious disease caused by Treponema pallidum and characterized by damage of the central nervous system. This disease may be asymptomatic or have an atypical clinical course, which leads to late diagnosis. The most informative diagnostic methods for this disease are specific serological reactions to syphilis, MRI of the brain and cerebrospinal fluid analysis. Aim. To show the features of the course, treatment and diagnosis of neurosyphilis using the example of a clinical case. Materials and methods. Patient S., born in 1963, complained about significant memory impairment, difficulties with orientation in time and space, mood swings, verbosity and exaggeration, and was hospitalized at the State Institution “Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine”. Neurological status: eye slits and pupils were uniform. The movements of the eyeballs were painless. Insufficiency of the act of convergence was found. Corneal reactions were reduced. The patient felt pain after the palpation of supra- and infraorbital points. There was an asymmetry in the facial innervation. The tongue was on the midline, swollen, with tooth imprints. There were no pathological signs, sensitive violations. Shaking movements were noticed during the Romberg test. During the examination of the cognitive function using the Mini-Mental State Examination (MMSE) scale, the patient scored 21 points, which corresponds to mild dementia. Results. 1. According to the results of MRI examination of the brain, there was an MR-picture of areas of cystic-gliosis transformation of the poles of the temporal lobes and structural changes of the hippocampal gyrus (most likely, caused by the chronic inflammatory process); vascular foci of the brain as manifestations of dyscirculatory changes, moderate external hydrocephalus. 2. A serological examination for the presence of the antigen of the Treponema pallidum pathogen was performed, the result was positive. 3. Cerebrospinal fluid analysis revealed the following results. Cytosis was 1x106/l, protein was 0.21 g/l, glucose 3.4 mmol/l, Pandy test positivity. Based on the obtained data, the patient was diagnosed with neurosyphilis. The patient underwent etiopathogenetic treatment with benzylpenicillin sodium. After treatment the patient's condition gradually improved. Conclusions. Specific serological reactions to syphilis, MRI of the brain and cerebrospinal fluid analysis are mandatory tests for the diagnosis of neurosyphilis. Early detection of Treponema pallidum and rational therapy can prevent the development of severe consequences and improve the patient's condition. Syphilis is a multidisciplinary problem today and needs the attention of general practitioners, dermatologists and neurologists.

The role of the world health organization in solving international public health problems: history, modernity and development prospects

Epidemics of smallpox, cholera, plague and other infectious diseases in the world in the past were accompanied by the deaths of millions of people and often threatened humanity with destruction as a biological species. Therefore, society was forced to join forces to create an organization that would provide health protection on a global scale. On April 7, 1948, 26 UN member states created the World Health Organization, the main goal of which was to help provide the protection of health of the population of all countries of the world. Purpose of the study - analysis of the historical data of the process of creating the World Health Organization, achievements for all the years of its existence, financing in last years and formation of the opinions of authors on the role of this organization in solving health problems of all humanity. Results. The article presents data on stages of the formation of the World Health Organization. Information about positive results for more than 70 years in solving reproductive health problems, maternal and child mortality, eradicating many infectious diseases in different parts of the world and other problems is detailed. Joint resolutions of the World Health Organization with the United Nations were adopted about general and complete disarmament, protection of humanity from atomic radiation, ban on the use of chemical and bacteriological weapons, defining of the role of doctors and other health workers in the preservation and strengthening of the world. Information on the World Health Organization funding is provided. The prospects for the development of the organization are described. Conclusions. The World Health Organization actively continues its work – maintains contact with international experts, governments and partners for quick collection of scientific data on a new virus, tracks its distribution and assesses its virulence, provides to countries and population recommendations on health protection measures and preventing the spread of infection. The global climatic crisis and the coronavirus infection pandemic showed that the role of the World Health Organization should increase to prevent cataclysms in some countries and globally. It is the World Health Organization that has a huge positive international experience in fighting various public health problems and it remains the only effective organization that consolidates the efforts of most countries of the world to overcome the problems of all humanity.

Conceptual basis of organization of medical care for school students in the period of reforming healthcare and education systems

Negative trends in the health status of the child population, the spread of non-communicable diseases require optimization of the system of their medical support. According to WHO, an educational institution can become a powerful tool for the preservation and strengthening of children's health through the rational use of human and material potential, opportunities for intersectoral interaction between education and medicine systems, and support for actions at the legislative level. The aim of the work is to develop a conceptual model of medical support for students of general secondary education institutions to prevent the spread of non-infectious diseases and the formation of health-oriented behavior of schoolchildren. Materials and methods: Analytical assessment of regulatory documents and scientific foreign and domestic publications on the health status and medical support of school-age children. Results and discussion. In the context of the innovative transformation of the health care system, the problematic issues of medical support for children in educational institutions are the issues of ensuring algorithms for monitoring the health of children, determining the influence of intraschool and medico-social factors on health and the formation of health-oriented behavior; systems for improving the skills and knowledge of school health workers on the issues of maintaining children's health, assessing health indicators and the results of preventive interventions.The solution of these issues is possible by introducing a unified coordinating structure of medical support for students of general secondary education institutions, with the development of its structural and functional model and defining the functions of all participants / performers to ensure an adequate system of medical support preserve the health of children in school conditions. The proposed Conceptual Model with substantiation of the functions and composition of specialists, elements of communication is aimed at preventing the spread of non-communicable diseases among students, the formation of a value attitude towards health in schoolchildren, will contribute to the formation of health-oriented behavior.

Pathogenetic substantiation of preterm births prevention methods

The study of the pathogenesis of premature birth is one of the important issues of modern obstetrics. This could contribute developing a scientifically sound program for predicting and preventing this complication of pregnancy. The aim of the study was to investigate the blood variables of the immune system and connective tissue metabolism in women with preterm birth at 23-36 weeks of gestation. Materials and methods. A total of 227 pregnant women were examined, 190 of whom had clinical signs of threatened preterm birth. Group I included 48 women with a threatened preterm delivery resulted in childbirth between 23 and 27 weeks. In group II, 142 women at risk of preterm birth were observed from 28 to 36 weeks. Group III included 37 women with a healthy pregnancy, completed at 38-41 weeks. Result. The number of lymphocytes and their subpopulations, the content of connective tissue metabolites in the blood of the examined patients were studied. In women of group, I relatively to women of group III there was an evident (p < 0.001) decrease in blood level of CD3 + -marker of T-lymphocytes by an average of 23 %, which suggests the presence of immunodeficiency and considered as a stress response. In women with preterm birth at 28-36 weeks of gestation (group II), the relative level of CD3 + in the blood, on the contrary, slightly but probably (p = 0.014) increased compared to women with healthy pregnancy by an average of 13%. A significant decrease in the immunoregulatory index in women of group I is associated with the suppression of the T-helper component and emphasizes the presence of T-cell immunosuppression. The decrease in the index in women of group II occurred due to cytotoxic T-lymphocytes. Сonclusions. Thus, the work confirms the opinion of R. Romero on the role of immune "rejection" in the third trimester, associated with the HLA-incompatibility of mother and fetus. In women of group I, compared with women of group III, there was a more pronounced increase in serum free oxyproline - a marker of collagen breakdown than bound oxyproline - a marker of collagen synthesis. Group II women also had a simultaneous increase in the level of the two oxyproline fractions, but more pronounced for the protein-bound fraction. This suggests that the violation of the metabolism of connective tissue leads to the destruction of the collagen matrix of the cervix and its shortening. Studies suggest that cerclage or insertion of pessary should be used to prevent cervical incompetence in the second trimester due to metabolic disorders in the connective tissue. The use of progesterone is appropriate for prevention of "short cervix" syndrome, as well as the possible immunosuppressive effect of the latter. The established signs of autoimmune processes require screening for antiphospholipid syndrome and the appointment, if confirmed, of anticoagulants.

Features of the clinical course of measles infection during the measles outbreak in 2018-2019 in Ukraine

Measles is an infectious disease characterized by an acute onset, a short prodromal period, presence of febrile, catarrhal and intoxication syndromes, as well as the development of typical enanthema and exanthema. Despite the active work of WHO to eliminate measles and the introduction of a vaccination program in developing countries, measles remains an urgent problem and the cause of high mortality rates among both children and adults. One of the dangerous complications of measles infection is the respiratory tract involvement in yhe form of out-of-hospital pneumonia, which occurs in 10-34% of patients. The out-of-hospital pneumonia was one of the main complications among the patients with measles who were treated in the Kharkiv regional clinical hospital and was registered both in patients with severe and moderate disease. That is why it was interesting to study the clinical and laboratory features of the course of measles infection in the adult population at the present stage. Objective: to determine features of the clinical course of measles infection and the factors that are prerequisites for the development of complications. Materials and methods. The study included 65 patients who were treated in the Kharkiv regional clinical infectious hospital in 2018-2019. Based on the clinical course of the disease, the severity and the presence of complications, the patients included in the study were divided into 4 groups. The control group consisted of 20 healthy voluntary donors who did not have exclusion criteria. On the day of admission to the hospital and on the 10th day of stay in the hospital, based on the data of a clinical blood test, we calculated the cellular reactivity leukocyte indices (CRLI) – the white blood cell shift index (WBCSI), the white blood cell index (WBCI) and the D. A. Ivanov immunoreactivity index (IRI). Results and discussion. The study shows that the patients from groups 1 and 2 on the 10th day of hospitalization showed a complete clinical recovery and was discharged from the hospital, whereas patients from groups 3 and 4 on the 10th day showed a clinical improvement and were transferred for further treatment to the general department. When assessing the CRLI on the day of admission to the hospital, an increase in the WBCSI in patients from groups 2, 3 and 4 was found, with the greatest increase observed in patients from group 4. In patients from group 1, on the contrary, a decrease in the WBCSI and and an increase in WBCI were determined, which indicates the activation of the lymphocytic link of the immune response. Conclusions. The development of measles infection in the adult population is characterized by changes in the leukocyte indices of cellular reactivity, which are markers of the functional activity of the immune system. The moderate course of the disease is accompanied by a tendency to normalization of the indices that characterize the activity of the inflammatory process, while its severe course is characterized by an increase in the values of these indices and a decrease in the activity of the lymphocytic link of the immune response. Assessment of changes in the parameters of leukocyte indices in dynamics makes it possible to predict the clinical course of the disease and the risk of complications, to assess the adequacy of the therapy, as well as to identify the need for immune correction therapy.

Autoimune component in the development of celebrovascular insufficiency in children with bronchial asthma

Bronchial asthma (BA) remains one of the most serious diseases of our time. A number of studies have shown that this disease in a number of cases, especially with the threat of termination of pregnancy, acute and chronic diseases of mothers, accompanied by fetal hypoxia, originates in the ante- and postnatal period. In general, taking into account the peculiarities of the cellular tissue organization of the brain and cerebrovascular blood supply, prolonged hypoxic lesions increase the activity of the hypothalamic-diencephalic structures and the cerebral cortex. The existing respiratory disorders lead to hemodynamic and metabolic disorders of cerebral structures, emotional sphere and autonomic regulation. However, this issue in childhood requires further study. The aim is to study autoimmune processes in the pathogenesis of cerebrovascular insufficiency in children with BA. Materials and methods. We examined 121 patients with asthma aged 5 to 15 years in the period of exacerbation. To study the role of the autoimmune component in the development of cerebrovascular insufficiency and its relationship with the autoimmune process in the bronchopulmonary system in AD in children, we used a method for the quantitative determination of autoantibodies to lipopolysaccharide antigens (LA) of cerebral vessels and topographic structures of the brain, as well as to homologous LA bronchi and lung tissue. The results of the studies have shown that the first signs of cerebral hemodynamic disturbance are recorded already in patients with mild disease and are aggravated depending on the severity of BA. Conclusions. The most characteristic changes are an increase in the tone of small and medium vessels and impaired cerebral venous circulation. It was also found that the levels of autoantibodies to lipopolysaccharide antigens of cerebral vessels and cellular tissue structures of the brain correlate with an increase in the level of autoantibodies to lipopolysaccharide antigens of the trachea, bronchi and lung tissue and reflect the severity of AD in children.