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ANDIJAN STATE MEDICAL INSTITUTE and I-EDU GROUP
Prevalence and clinical significance of the mtr gene a2756g polymorphism in congenital pathology in newborns
Aim. To investigate the distribution frequency and evaluate the association of MTR gene polymorphic variants (Asp919Gly, rs1805087) in newborns with congenital malformations (CMs). Materials and Methods. The study included 113 newborns with CMs (main group), subdivided into three clinical subgroups: folate-dependent CMs (n=75), folate-independent CMs (n=21), and CMs associated with chromosomal abnormalities (n=17), as well as 110 healthy newborns (control group). Genotyping was performed using real-time polymerase chain reaction (RT-PCR). Results. The frequency of the minor Gly allele in the main group (35.84%) was significantly higher than that in the control group (21.36%). The most pronounced differences were observed in the subgroup with folate-dependent CMs, where the Gly allele frequency reached 40.67%, and the homozygous Gly/Gly genotype was detected in 21.33% of cases compared with 7.27% in the control group (χ²=7.8; p=0.01; OR=3.46; 95% CI: 1.45–8.26). Hardy–Weinberg equilibrium analysis demonstrated a significant deviation in the main group (χ²=5.03; p=0.028), with a deficiency of heterozygotes (D=−0.21). No significant associations between the MTR A2756G polymorphism and folate-independent CMs or CMs associated with chromosomal abnormalities were identified. The Gly/Gly genotype demonstrated high specificity (SP=0.93) and an area under the ROC curve (AUC=0.57) as a marker of folate-dependent CMs. Conclusion. The findings suggest that the MTR Asp919Gly polymorphism may serve as a potential molecular genetic marker of susceptibility to folate-dependent congenital malformations in newborns.
Copyright (c) 2026 Medical science of Uzbekistan https://creativecommons.org/licenses/by/4.0
Hepatobiliary Surgery and Liver Transplantation in Children: Structure, Logistics, and Clinical Outcomes of the Department of Minimally Invasive Surgery and Transplantation of the National Children’s Medical Center
Aim. To evaluate the organizational structure, logistics, spectrum of surgical interventions, and clinical outcomes of the Department of Minimally Invasive Surgery and Transplantation of the National Children's Medical Center, a specialized pediatric center of the Republic of Uzbekistan. Materials and Methods. The study included 259 pediatric patients consecutively treated in the department between 2020 and 2026. Data from patients with biliary atresia, choledochal cysts, echinococcosis, extrahepatic portal hypertension, congenital portosystemic shunts, malignant liver tumors, as well as patients who underwent liver transplantation and pancreatoduodenal resections were analyzed. Clinical characteristics, intraoperative parameters, complications, and follow-up outcomes were evaluated. Results. The most common conditions were echinococcosis (n = 91), biliary atresia (n = 56), choledochal cysts (n = 54), and extrahepatic portal hypertension (n = 17). Among patients with echinococcosis, liver involvement predominated (n = 67), whereas lung involvement (n = 13), combined lesions (n = 6), and involvement of the spleen, diaphragm, and pelvis were less frequent. Open surgery was performed in 68.1% of patients, laparoscopic surgery in 28.6%, and video-assisted thoracoscopic surgery in 3.3%. Recurrence of echinococcosis was observed in 7.7% of patients and was predominantly associated with poor adherence to postoperative albendazole therapy. Twelve living donor liver transplantations were performed in children aged 5 months to 16 years. The main indications for transplantation were biliary atresia, autoimmune hepatitis, Wilson disease, and Caroli disease. The mean operative time was 523.8 ± 117.0 minutes, and the median blood loss was 200 mL. Vascular complications occurred in 25% of recipients, whereas no biliary complications were observed. Recipient and graft survival reached 100% throughout the follow-up period. All donors were first- or second-degree relatives; Grade II complications according to the Clavien–Dindo classification occurred in 16.7% of donors, with no donor mortality. The cohort also included 20 patients with primary malignant liver tumors (hepatoblastoma and hepatocellular carcinoma) managed through a multidisciplinary approach in collaboration with the pediatric oncology service. The extent of liver resection was determined according to the PRETEXT classification. Experience with extended right hemihepatectomy in infants aged 5–11 months demonstrated R0 resection in all cases, with a mean intraoperative blood loss of 120 mL and no perioperative mortality. Liver transplantation was considered for unresectable tumors according to established oncological selection criteria. Among 17 patients with extrahepatic portal hypertension, all underwent preoperative wedged angiography. A Rex shunt was performed in one patient, a Warren shunt in five patients, and devascularization procedures in two patients. Two patients required reoperation because of shunt thrombosis and stenosis. Between 2023 and 2026, five pancreatoduodenal resections were performed: four for solid pseudopapillary neoplasms of the pancreas and one for insulinoma. One patient developed a gastroenteric anastomotic fistula, while another experienced recurrent insulinoma requiring subtotal pancreatectomy. All patients were discharged and remained under outpatient follow-up. In addition, four patients with congenital portosystemic shunts were treated. Conclusion. The experience of the National Children's Medical Center demonstrates the feasibility of establishing a comprehensive pediatric hepatobiliary surgery and liver transplantation program in a middle-income country. An integrated patient referral system, a multidisciplinary approach, and international collaboration enabled excellent survival outcomes and facilitated the development of a national referral center for pediatric HPB surgery in Central Asia.
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Antibiotics and bacteriophage therapy in surgical site infection prevention and treatment: a structured evidence-mapping review with descriptive safety and outcome summaries
Aim. Surgical site infection (SSI) remains a major postoperative complication and contributes to prolonged wound care, antibiotic exposure, antimicrobial resistance and healthcare costs. Bacteriophage therapy has re-emerged as a targeted antibacterial approach, but the available clinical literature includes very different contexts, ranging from routine antibiotic prophylaxis to salvage treatment of chronic, biofilm-associated or implant-related infections. Materials and methods. This article is presented as a structured evidence-mapping review with descriptive safety and outcome summaries, not as a full systematic review or meta-analysis. A complete database screening log, duplicate-removal record, full-text exclusion list and prospectively documented PRISMA flow counts were not available. Therefore, the findings should be interpreted as an evidence map based on an extracted source set rather than as an exhaustive systematic synthesis of all available literature. Clinical sources were classified by clinical purpose: SSI prevention, treatment of established infection, chronic wound/diabetic foot infection and prosthetic joint/implant-associated infection. Outcomes were separated into negative prevention outcomes, such as SSI incidence, and positive treatment outcomes, such as wound healing, bacterial eradication or clinical resolution. Methodological confidence was considered according to study design using principles consistent with RoB 2, ROBINS-I, JBI checklists, AMSTAR 2 and GRADE. Results. Antibiotic-only prophylaxis studies reported variable SSI or wound-infection rates, with a descriptive event summary of 11.17% in general-surgery prophylaxis. Phage evidence was concentrated mainly in treatment settings, where endpoints included infection resolution, eradication, reduced bacterial burden or wound healing. Phage-only chronic-wound studies showed an 80.9% descriptive success/healing/burden-reduction signal, whereas phage-only orthopedic evidence was based mainly on very small case reports or case series. One small phage-plus-antibiotic prophylaxis study reported 13.63% SSI in the intervention group. These descriptive summaries are not directly comparable across prevention and treatment categories and should not be interpreted as comparative efficacy estimates. Conclusion. Antibiotic prophylaxis remains the most established approach for SSI prevention. Current clinical evidence suggests that bacteriophage therapy may be a promising adjunct for selected complicated, resistant or biofilm-associated infections, but its role in routine SSI prevention remains insufficiently defined. Available safety data indicate a generally favorable short-term tolerability signal, although this conclusion is limited by small samples, heterogeneous reporting and scarce standardized microbiome or resistance surveillance. Larger prospective controlled studies with reproducible search and reporting frameworks are needed before broad perioperative implementation can be recommended.
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Complex diagnostics and prognostic aspects of neuro-endocrinological indicators in combined acute traumatic brain injuries
Combined acute traumatic cerebral injury causes direct damage to brain structures and disrupts the work of distant organs, depending on the severity of the traumatic factor. Neuroendocrine disorders are often underdiagnosed in combined acute traumatic brain injuries, which entails the development of complications in both the acute and chronic phases of the disease. The purpose of this study was to analyse the latest scientific evidence on neuro-endocrinological indicators in combined acute traumatic brain injuries to improve patient management protocols and overall survival rates. The research papers from open databases over the past five years have been analysed. It was found that the most common neuro-endocrinological conditions after brain injuries are hypopituitarism, diabetes insipidus, hypothalamus dysfunction, and cognitive disorders. Low blood pressure (both systemic and internal cerebral), anaemia and hypoxia can cause ischemic changes in the central endocrine glands. In the acute phase of the course of combined traumatic brain injuries, signs of deficiency of somatotropic, gonadotropic, and adrenocorticotropic hormones prevail. Vasopressin deficiency in the acute phase is associated with an increased risk of brain oedema, and oxytocin – with the development of neurodegenerative pathologies. Differential diagnosis of neuro-endocrine disorders should be carried out on the basis of anamnestic data and indicators of biochemical and hormonal data of the patient. The obtained data emphasise the importance of timely diagnosis of neuroendocrine disorders along with neurological disorders during the management of patients with traumatic brain injuries can be used both at the stage of primary diagnosis and during the rehabilitation process.
The role of regional lymphatic therapy in gunshot wounds of the extremities
Cases of gunshot wounds of the extremities are increasing every year in the Republic of Uzbekistan and other countries of the world. The urgency of this problem is justified by the high rates of death, purulent-septic complications, and disability, especially given the progress in the development of new types of weapons with greater penetrating power. The purpose of this study was to conduct experimental regional lymphatic treatment and use the results of the protocol to manage patients with isolated and combined gunshot wounds of the extremities. To achieve the goal of the study, 169 patients with gunshot wounds of the extremities were examined and divided into four main groups receiving lymphotherapy and control subgroups receiving standard treatment. In experimental studies, gunshot wounds of the extremities on the first day after injury are characterized by volumetric swelling of the intercellular space with the accumulation of microbes and deposition of fibrin, cellular dentin, and necrobiosis products in the lymph nodes. The use of regional lymphatic therapy in the experimental groups showed an active and rapid process of soft tissue regeneration in the traumatized area compared to that in the control group. Timely sorting and transportation of the wounded to specialized medical institutions contributed to the high effectiveness of surgical and therapeutic treatment methods in the first hours after the injury. The use of lymphotropic antibiotic therapy with cephalosporins or aminoglycosides and lymphatic stimulation showed positive dynamics of connective tissue remodelling, consistently high and long-term concentration of drugs in the lymph nodes, and low rates of infectious complications. The data obtained can be used in military medicine, emergency medicine, and surgery to improve protocols for managing patients with gunshot wounds of the extremities and the introduction of tactics aimed at preserving the functionality of regional tissues and preventing infectious complications.
Characteristics of microelementosis as a risk factor of chronic gastroduodenal diseases in HIV-infected population
Chronic gastroduodenal diseases (CGD), including peptic ulcers, chronic gastritis, and gastroduodenitis, are common among people living with HIV. One of the major risk factors associated with these conditions is microelementosis (MTOS), characterized by imbalances in essential trace elements. This study investigates the prevalence and impact of MTOS in the HIV-infected population.\\ Aim. To evaluate the prevalence, severity, and specific biochemical deficiencies associated with MTOS and its potential role as a risk factor for CGD in HIV-infected individuals. Materials and methods. This study involved 507 HIV-infected adults, aged 20–69, residing in Andijan, Uzbekistan. Participants were assessed for levels of key electrolytes, including potassium, calcium, and sodium, using fasting blood samples. Participants were categorized by age and gender to explore demographic variations in MTOS prevalence and severity. Results. The study found high rates of electrolyte deficiencies among participants, with 89.2% experiencing hyponatremia, 72.2% hypokalemia, and 28.8% hypocalcemia. Significant gender-based differences were observed, with HIV-infected women displaying higher prevalence rates of hyponatremia and hypokalemia. The data also indicated a progressive increase in the prevalence of severe MTOS with age (P < 0.05), suggesting an age-related risk for CGD. Conclusion. Microelementosis represents a significant risk factor for CGD in HIV-infected individuals, and this study underscores the need for targeted nutritional support and regular electrolyte monitoring in this population. Preventative strategies, including diet modifications and micronutrient supplementation, may help mitigate CGD progression in HIV-infected patients.
Chronic obstructive pulmonary disease and congestive heart failure: iarc-icpms. Three clinical applications of the human gene: a narrative literature review of comorbidity, pathophysiology, diagnosis, and management
Chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are among the leading causes of morbidity and mortality in the world. The high comorbidity burden presents important clinical challenges in exacerbating the issues of diagnosis and treatment due to overlapping symptom profiles, shared risk factors, and interconnected pathophysiological processes. This narrative review summarizes recent evidence on the epidemiology, pathophysiology, diagnostic challenges and therapeutic strategies for these patients. Peer-reviewed studies were identified by conducting a systematic search of PubMed, MEDLINE, and EMBASE from 2016 to 2024. Existing data suggests that COPD occurs in 20–30\% of patients with CHF, and a comparable proportion of moderate-to-severe COPD has left ventricular dysfunction. Coginitive impairment is an independent predictor of adverse clinical outcomes, including higher rates of hospitalization and mortality. Systemic inflammation, oxidative stress, skeletal muscle dysfunction and neurohormonal activation are shared pathways linking these different diseases. Differential diagnosis is limited because of clinical symptom overlap; however, each mentioned biomarker has complementary diagnostic utility in general: natriuretic peptides will identify pulmonary hypertension due to left heart failure, echocardiography can assess underlying structural heart disease and pulmonary function testing helps characterize the underlying pathology. Management should be a personalized and multi-faceted approach focusing on drug safety related to beta-blockers and bronchodilators along with non-pharmacologic strategies such as pulmonary rehabilitation and cardiac rehabilitation. This review underscores the need for joint clinical assessment and supports more prospective studies of this high-risk group.
Cystic duplication as a rare congenital anomaly of the gastrointestinal tract in children
Case: A 1-year-old female patient presented for the workup of a cystic abdominal lesion that was first discovered at 6 to 7 months of life. A first CT scan of the abdomen and retroperitoneal space showed a cystic mass localized nearby the left adrenal gland. Based on these results the patient was referred to our clinic. An abdominal multislice computed tomography (MSCT) was performed later, which could separate the diagnoses of splenic cyst and gastric duplication cyst. On serial ultrasound examinations, the lesion progressively increased in size, and surgical management was undertaken. Histopathological examination confirmed the diagnosis of gastric duplication. Conclusion. The multimodal diagnostic approach allows early identification of this rare pathology, aids the differintial diagnosis in atypical gastric duplication localization cases and allows to determine indications for surgical treatment.
Study of pharmacokinetics of gentamicin in rats under conditions of lymphotropic and intramuscular administration
The study of the pharmacokinetics of antibiotics on model objects makes it possible to optimize their dosage and method of administration for further clinical practice. Aim. The aim of this study was to compare the pharmacokinetics of gentamicin sulfate in rats following intramuscular and lymphotropic pretracheal administration. Materials and methods. The disk diffusion method was used to determine the antibiotic concentration in blood and tissue homogenate for Escherichia coli NCTC 8172. Gentamicin sulfate concentration was highest in blood samples after intramuscular administration for the first hour and lowest in pleura. In the lymphotropic method, drug concentration in tissues was higher than after muscle injection, and most antibiotics accumulated in lung tissue within the first hour. Antibiotic kinetics were either linear or logarithmic. Results. The results indicated that the highest concentration of gentamicin sulfate was found in blood samples after intramuscular administration for the first hour, while the least amount of antibiotics accumulated in the pleura. The kinetics of gentamicin were observed to be either linear or logarithmic. The half-life of the drug for lymphotropic administration was found to be 4 hours, while for intramuscular administration, it ranged from 2 to 5 hours, depending on the object of screening. After 24 hours, regardless of the method of administration, the antibiotic was eliminated at residual amounts of no more than 10 μg/mg. Conclusion. The study concluded that the pretracheal method of administration is more effective and can be used to optimize gentamicin treatment of bacterial infections.
RISK FACTORS AND CHARACTERISTICS OF URINARY TRACT INFECTIONS IN ADOLESCENT GIRLS WITH COMORBID PATHOLOGIES
Relevance. Urinary tract infections (UTIs) in adolescent girls are among the most common childhood diseases, second only to respiratory tract infections. Special attention is required for cases with comorbid pathologies, where UTIs develop against the background of various somatic or functional disorders. This combination leads to an increased frequency of relapses, chronic inflammation, and reduced quality of life. The present study analyzes the risk factors of comorbid pathologies in urinary tract infections among adolescent girls, which is crucial for early detection and prevention of complications. Objective. To study the risk factors and clinical characteristics of urinary tract infections in adolescent girls with comorbid conditions. Materials and Methods. The study included 50 female patients aged 10–17 years who received inpatient treatment in the Department of Urology and Pediatric Gynecology, Clinic No. 2, Tashkent State Medical University. All patients underwent a comprehensive examination following a standardized protocol, which included a detailed medical history (including perinatal and gynecological data), clinical assessment, laboratory tests (urinalysis, urine culture with pathogen titer determination), coprological and microbiological stool analysis, and ultrasound scanning of the abdominal and pelvic organs. Results and Discussion. Patients were divided into two groups according to age and nature of the identified pathology. Group I included girls aged 10–13 years (n = 30; 60.0%). Among them, 18 (60%) had isolated urinary tract diseases, while 12 (40%) had comorbid urinary and genital tract pathologies. Group II consisted of girls aged 14–17 years (n = 20; 40.0%). In this group, isolated urinary tract diseases were found in 8 (40%) patients, and combined urinary and genital tract diseases were observed in 12 (60%). The mean age of patients with comorbid urinary and genital infections was 13.1 ± 1.2 years, which was significantly higher than that of patients with isolated urinary diseases (10.6 ± 1.1 years; p < 0.05). Comorbid urinary tract infections with somatic and gynecological disorders in adolescent girls were characterized by more severe clinical manifestations, higher recurrence rates, structural renal changes (ultrasound findings: chronic pyelonephritis – 32.5%, reflux nephropathy – 27.5%), and metabolic disturbances (anemia – 86.3%). The data indicate that the risk and severity of UTIs directly depend on comorbid somatic, hormonal, and microbiological disturbances, as well as early perinatal factors. This underscores the need for a comprehensive multidisciplinary approach to patient management. Conclusions. In girls with combined somatic and gynecological diseases, urinary tract infections are more severe and recurrent (3.4 ± 0.6 vs. 1.9 ± 0.3, p < 0.001) and are accompanied by more pronounced clinical symptoms. Antenatal and perinatal risk factors significantly contribute to susceptibility to urinary infections (57.1% vs. 20.0%, p < 0.05). The predominant clinical manifestations include lumbar pain, dysuria, subfebrile temperature, and signs of urogenital inflammation (vulvovaginitis – 34.9%, adnexitis – 2.4%). Microbiological analysis revealed a high frequency of bacteriuria and vaginal dysbiosis, with matching pathogens in 38% of cases, confirming an ascending infection route. Menstrual dysfunction and endocrine–metabolic disorders (oligomenorrhea, algomenorrhea, PCOS, obesity) play an important role in maintaining chronic inflammation.
Copyright (c) 2025 https://creativecommons.org/licenses/by/4.0
CURRENT PERSPECTIVES ON INFLAMMATORY BRONCHOPULMONARY DISEASES WITH AIRWAY OBSTRUCTION IN CHILDREN
Relevance. Inflammatory bronchopulmonary diseases remain among the leading causes of morbidity in children, particularly those under three years of age. The increasing incidence of bronchial obstruction, antibiotic resistance, and environmental pollution has elevated the clinical and public health significance of this issue. Aim. To explore modern aspects of pathogenesis, clinical features, and therapeutic approaches in children with inflammatory bronchopulmonary diseases accompanied by airway obstruction. Materials and Methods. A review of current national and international literature was conducted, including data on the prevalence of bronchiolitis, acute bronchitis, and community-acquired pneumonia in early childhood, etiological factors (viral and bacterial agents), and recent advances in treatment strategies and clinical recommendations. Results. Respiratory viruses, particularly RSV, metapneumovirus, and coronavirus, remain the dominant etiological factors. The inflammatory process is closely associated with impaired mucociliary clearance, elevated proteolytic activity, and airway remodeling. Environmental pollutants and passive smoking exacerbate disease severity. Pathogenetically targeted therapy — including enzymatic airway sanitation and rational antibiotic use — plays a critical role in management. Conclusions. Early detection and comprehensive treatment of inflammatory bronchopulmonary diseases in children reduce the risk of chronic airway remodeling and improve outcomes. Preventive strategies should focus on viral infection control, environmental health, and the development of pediatric rehabilitation programs.
THE STATE OF IMMUNOREACTIVITY IN CHILDREN DEPENDING ON TYPES OF NUTRITION
Relevance.Exclusive breastfeeding during the first six months of life plays a decisive role in the development of the immune system and healthy growth of children. The aim of the study. To study and compare the immunological status of children depending on the type of feeding. Materials and methods of the study. A total of 123 children with different feeding patterns were examined. Blood tests and immunological assessments were performed using monoclonal antibodies CD3, CD4, CD8, CD16, CD23, CD25, CD38, and CD95 to evaluate cellular and humoral immunity. Research results. Artificially fed children demonstrated a significant increase in lymphocytes, leukocytes, and CD3+ cells, along with a decrease in CD4+. Levels of B-lymphocytes, CD16+, CD23+, and CD38+ were elevated, indicating activation of apoptosis. A marked imbalance of IgM and IgA, increased circulating immune complexes, and higher allergization factors were observed in artificially fed groups. Conclusion. Immunological changes in children are closely related to the type of feeding. Breastfeeding supports the maintenance of immune balance, whereas artificial feeding is associated with physiological depletion of immune system reserves.
CLINICAL AND PATHOGENETIC FEATURES OF MICROCIRCULATORY CHANGES IN BRONCHOPULMONARY DISEASES IN CHILDREN
Relevance. Inflammatory bronchopulmonary diseases in children, such as bronchitis, pneumonia, and bronchiolitis, remain among the most urgent problems in modern pediatrics. Microcirculatory dysfunction plays a central role in their pathogenesis. Impairment of the microcirculation not only disrupts alveolar gas exchange but also affects tissue trophic supply. Contemporary research highlights a close association between this dysfunction and the imbalance of inflammatory mediators — interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), and the anti-inflammatory cytokine interleukin-10 (IL-10). These mediators alter endothelial cell function, increase capillary wall permeability, cause degradation of the glycocalyx structure, and consequently lead to impaired microvascular perfusion. Objective. The aim of this study was to identify the main pathophysiological mechanisms of microcirculatory dysfunction in inflammatory bronchopulmonary diseases in children, to assess the relationship between the levels of inflammatory cytokines (IL-1β, IL-6, TNF-α, IL-8, IL-10) and microcirculatory parameters, and to determine their clinical significance as prognostic biomarkers. Materials and Methods. To evaluate the state of microcirculation in pediatric patients, a comprehensive set of instrumental and laboratory diagnostic methods was applied. Capillaroscopy was used to assess the morphofunctional state of nail-bed capillaries, pulse oximetry was employed to determine arterial oxygenation levels, and blood lactate concentration served as a marker of metabolic hypoxia. Additionally, hemostasiogram parameters and microperfusion indices were calculated. The levels of inflammatory mediators were determined by the enzyme-linked immunosorbent assay (ELISA), followed by statistical correlation analysis to examine interrelations between cytokine and microcirculatory indicators. Results and Discussion. The analysis revealed a significant increase in inflammatory cytokine levels among children with bronchopulmonary diseases, which contributed to the development of endothelial dysfunction. Increased capillary wall permeability, degradation of the glycocalyx, and enhanced interstitial edema led to a decrease in microcirculatory blood flow. These changes were accompanied by impaired blood rheology, reduced erythrocyte deformability, and microthrombus formation. A statistically significant positive correlation (r = 0.68–0.74; p < 0.01) was established between IL-6 and TNF-α levels, on the one hand, and lactate concentration and capillary perfusion indices, on the other. This relationship was found to be a reliable diagnostic biomarker for predicting severe courses of pneumonia and bronchiolitis. Particularly in young children, the morphofunctional and metabolic immaturity of adaptive mechanisms leads to rapid transition of microcirculatory disorders into a hypoxic-decompensatory stage. Conclusion. The obtained results confirm that microcirculatory dysfunction represents a key pathogenetic link in the development of inflammatory bronchopulmonary diseases in children. Early diagnosis and complex correction of these disorders can reduce disease severity, prevent hypoxic complications, and improve clinical outcomes. In the future, integrating microcirculatory markers, inflammatory cytokines, and oxidative stress indicators into a unified monitoring system may provide a basis for optimizing diagnostic and therapeutic strategies in pediatric practice.
FEATURES OF THE HEMOSTASIS SYSTEM IN INFANTS WITH ACUTE PNEUMONIA ON THE BACKGROUND OF PERINATAL CENTRAL NERVOUS SYSTEM INJURY
Introduction. Acute pneumonia remains one of the leading causes of morbidity and mortality in early childhood. According to WHO data, approximately 15–18% of deaths among children under five years of age are due to lower respiratory tract infections. The course of pneumonia in infants with perinatal central nervous system (CNS) injury—resulting from hypoxia, ischemia, or perinatal asphyxia—is often severe and prolonged. These patients exhibit impaired immune responses, endothelial dysfunction, and disturbances in microcirculation, predisposing them to coagulation abnormalities. Therefore, assessment of the hemostatic system in this population is of critical clinical and prognostic importance. Objective. To evaluate the changes in hemostatic parameters among infants with acute pneumonia associated with perinatal CNS injury and to determine their relationship with disease severity and inflammatory activity. Materials and Methods. A comprehensive review and meta-analysis of 40 national and international studies published between 2015 and 2024 were conducted. Key parameters assessed included fibrinogen, D-dimer, APTT, PT, antithrombin III, protein C, and protein S levels. The concentrations of inflammatory cytokines (IL-6, TNF-α) were also evaluated. Statistical correlation and regression analyses were applied with a significance level of p < 0.05. Results. Infants with perinatal CNS injury demonstrated significant hemostatic imbalance characterized by hypercoagulation and impaired anticoagulant activity. Fibrinogen and D-dimer levels were increased by 1.5–2 times, while APTT and PT were shortened. Antithrombin III activity decreased by 25–30%. Elevated IL-6 and TNF-α levels showed strong positive correlations with D-dimer concentration (r = 0.62; p < 0.01), confirming the existence of a “coagulation–inflammation” feedback loop. Prophylactic anticoagulant therapy (microdose heparin, dipyridamole, pentoxifylline) significantly reduced thromboembolic complications (by 3–4 times) and accelerated clinical recovery and radiological resolution of pulmonary infiltrates. Discussion. These findings support that hemostatic disturbances constitute a fundamental pathophysiological mechanism in pneumonia associated with perinatal CNS injury. Hypercoagulability, endothelial injury, and suppressed fibrinolysis contribute to microcirculatory failure, tissue hypoxia, and prolonged inflammation. Conclusion. Regular monitoring of hemostatic markers (fibrinogen, D-dimer, antithrombin III) and inflammatory cytokines (IL-6, TNF-α) is essential for early detection of complications. Implementing timely anticoagulant therapy may improve outcomes, shorten recovery time, and reduce morbidity in infants with perinatal CNS injury.
SCIENTIFIC BASIS OF THE NURSE’S PREVENTIVE ROLE IN EARLY DETECTION AND PREVENTION OF ANEMIA AND OBESITY AMONG PRESCHOOL CHILDREN
Introduction. Preschool-aged children (1–5 years) represent a critical stage for growth and health development. Anemia and obesity remain major public health challenges affecting cognitive and physical outcomes. Early detection and prevention are essential to reduce long-term health risks. Objective. To evaluate the effectiveness of nurse-led preventive interventions in early detection and prevention of anemia and obesity among preschool children. Materials and Methods. A systematic review was conducted on 150 articles (2000–2025) from Web of Science, Scopus, PubMed, and Google Scholar databases. Forty-two studies were included in detailed analysis. Keywords used: “Anemia”, “Obesity”, “Preschool children”, “Nurse-led interventions”, “Growth monitoring”, “Prevention”. Data analysis followed PRISMA guidelines. Results and Discussion. Regular growth monitoring (GMP), nurse-led counseling, and community-based interventions significantly reduced the prevalence of anemia and obesity. The most effective strategies were comprehensive approaches integrating nutrition improvement, physical activity, and parental education. Nurses played a central role by bridging healthcare services with families. Conclusion. Evidence from 2000–2025 confirms that nurse-led interventions and growth monitoring are pivotal in preventing nutritional disorders in early childhood. Integrating family and community participation is the cornerstone of sustainable child health promotion.
CONTEMPORARY APPROACHES TO MYOCARDIAL INFARCTION WITHOUT CORONARY ARTERY STENOSIS
Non–ST-segment elevation myocardial infarction (NSTEMI) is one of the most common forms of acute coronary syndromes and represents a leading cause of cardiovascular morbidity and mortality. In recent years, a substantial proportion of patients presenting with a clinical picture of NSTEMI have been found to have no significant coronary artery stenosis on coronary angiography; this condition is currently defined as myocardial infarction with non-obstructive coronary arteries (MINOCA). This review aims to highlight the pathogenetic mechanisms, diagnostic approaches, risk stratification, and principles of personalized management of myocardial infarction without obstructive coronary artery disease. Diagnostic and therapeutic strategies for MINOCA were analyzed based on international clinical guidelines, large registries, and systematic reviews. MINOCA is a heterogeneous syndrome encompassing multiple pathogenic mechanisms, and treatment tailored to the underlying etiology identified through contemporary imaging modalities significantly improves clinical outcomes. Comprehensive diagnostic evaluation and mechanism-oriented, personalized therapy represent the optimal clinical strategy for patients with NSTEMI presenting as MINOCA.
myocardial infarction without coronary stenosis
EPIDEMIOLOGY AND GENETIC ASPECTS OF CYSTIC FIBROSIS (LITERATURE REVIEW)
Relevance. Cystic fibrosis (CF), also known as mucoviscidosis or Landsteiner-Fanconi disease, is an autosomal recessive hereditary disorder characterized by systemic damage to the exocrine glands. It manifests as pathological mucus secretion, leading to chronic inflammation and dysfunction of the respiratory, digestive, and reproductive systems. Among all forms of the disease, the intestinal form is the most common, particularly in newborns, making it essential to study its prevalence, immunohistological features, and genetic predisposition. The aim of the research is to investigate the epidemiology and genetic aspects of cystic fibrosis. Results. Analysis of various screening programs indicates that the most effective methods combine biochemical analysis (IRT) with molecular testing (CFTR variant panels). However, the effectiveness of newborn screening (NBS) depends on establishing optimal IRT threshold values, expanding genetic testing panels to account for ethnic specificity, and implementing repeat testing to reduce the proportion of false-negative cases. Conclusion. This review examines current research on the implementation of screening programs, the sensitivity and specificity of tests, and the clinical significance of identified CRMS/CFSPID cases.
MENTAL DISORDERS IN PATIENTS WITH NEWLY DIAGNOSIS OF TUBERCULOSIS
Relevance. The problem of tuberculosis, as an infectious disease, does not lose its heart against the background of a widespread decrease in tuberculosis. The results of the study indicate the development of borderline mental disorders in patients with tuberculosis after diagnosis, the elimination of which will help increase the effectiveness of complex treatment of tuberculosis. Purpose of the study. Before the end of the second month of anti-tuberculosis chemotherapy, we set ourselves the goal of analyzing the development of observed mental disorders in patients of different ages with newly diagnosed tuberculosis, as well as comparing the obtained results with the control group of healthy people. Materials and methods of the study. The study involved 120 patients who were first diagnosed with tuberculosis. 78 of the patients were male and 42 were female. The control group consisted of relatively healthy people who regularly visited polyclinics, namely 135 men and 45 women. The study was conducted using the method of differential diagnosis of depressive states by V. Zung, adapted by T.I. Balashova. The study was conducted in outpatient and inpatient settings with the participation of patients with depression of mental or organic origin. Research results. Neurogenic mild depression was observed in 18 (23,1%) men and 14 (33,3%) women. A masked depression was observed in 5 (6,4%) men and 8 (19,04%) women. Such people are chronically tired, sleep poorly at night and are excessively sleepy during the day, their memory deteriorates sharply, and they have difficulty concentrating on a particular type of activity. Despite the relatively low percentage of patients in this category, close supervision by a doctor is required. Such individuals experience such conditions as a state of constant depression, a slowdown in mental and labor activity, somatoneurological disorders, a decrease in life needs, a pessimistic assessment of oneself and its place in the surrounding reality. Conclusion. To identify patients in need of measures to improve their mental state, as well as patients with tuberculosis for the first time, the V. Zung method of differential diagnosis of depressive states, adapted by T. I. Balashova, can be used. In the majority of patients with newly diagnosed tuberculosis, depressive disorders were not detected by the end of the second month of chemotherapy. As a result of the study, it was found that patients with tuberculosis diagnosed for the first time experience mild depression more often than healthy people. Therefore, psychological and even some medical care specially organized to overcome depressive tendencies of different degrees may be needed at the end of the second month of chemotherapy for patients diagnosed with tuberculosis for the first time.
POST-COVID CHANGES IN CLINICAL AND LABORATORY PARAMETERS AND THEIR INTERRELATIONSHIPS IN CHILDREN WITH BRONCHIAL ASTHMA
Relevance. The COVID-19 pandemic has significantly altered the clinical course of many chronic pathologies. Despite the relatively mild course of infection in most children, in the post-COVID period patients with bronchial asthma increasingly present with persistent functional impairments, immune imbalances, and biochemical shifts that can affect disease severity, frequency of exacerbations, and the effectiveness of basic therapy. Objective: to identify the clinical and laboratory features and their correlations in children with bronchial asthma during the post-COVID period. Materials and Methods. To comprehensively study the immune status of children suffering from bronchial asthma (BA) who had previously contracted COVID-19, a clinical and laboratory study was conducted, covering 135 children aged 7 to 15 years. All patients were under observation in pediatric inpatient and outpatient settings. Results and Discussion. A moderate correlation was found between the duration of wheezing and serum potassium (K⁺) levels (r = +0.57), while the relationship with calcium (Ca²⁺) was weak (r = –0.37). The annual frequency of exacerbations correlated negatively with Ca²⁺ (r = –0.42), but showed a strong positive correlation with K⁺ (r = +0.80) and phosphorus (P) (r = +0.71). These findings indicate that clinical manifestations of BA are directly associated with microelements such as potassium and phosphorus, which may aggravate the disease course. Conclusion. The identified changes in microelement levels confirm their importance in the pathogenesis of bronchial asthma, especially in the context of viral infection, and they may be considered as additional markers of disease severity and therapeutic effectiveness.
CLINICAL CHARACTERISTICS OF HYPOXIC-ISCHEMIC ENCEPHALOPATHY IN NEWBORNS DEPENDING ON SEVERITY LEVEL
Introduction. Hypoxic-ischemic encephalopathy (HIE) in newborns is one of the most severe forms of perinatal central nervous system injury. This condition develops as a result of oxygen deficiency and impaired cerebral circulation during the intrauterine period, childbirth, or early postnatal stage. The severity of the disease is directly related to the duration and depth of hypoxia, which affects the expression of clinical symptoms, prognosis, and treatment outcomes. Studying the course and clinical manifestations of HIE according to its severity plays an important role in early diagnosis, prognosis assessment, and the selection of effective therapeutic strategies. Objective of the study. To study the clinical characteristics of hypoxic-ischemic encephalopathy (HIE) in newborns depending on the degree of severity. Materials and methods. The study included 110 newborns diagnosed with hypoxic-ischemic encephalopathy who were treated in the Department of Neonatal Pathology at City Children's Hospital No. 5. Group 1 consisted of 39 infants with stage I HIE, Group 2 included 36 infants with stage II HIE, and Group 3 comprised 35 infants with stage III HIE. Diagnosis was established based on clinical examination, neurological assessment, and neurosonography of the newborns. Statistical analysis of the obtained data was carried out using Microsoft Excel 2010 and Statistica 6 software packages. Results. The study results demonstrated that in moderate and severe forms of hypoxic-ischemic encephalopathy, the diversity of clinical symptoms may be associated with the dynamics of morphological changes in brain structures. It should be noted that regardless of the degree, nature, depth, and extent of morphological and functional insufficiency of the central nervous system, the similarity and generality of clinical manifestations often make diagnosis challenging.
MODERN COURSE OF RECURRENT OBSTRUCTIVE BRONCHITIS IN PRESCHOOL CHILDREN AND THE ROLE OF VITAMIN D STATUS
Relevance. Recurrent obstructive bronchitis (ROB) is an inflammatory disease of the bronchi characterized by repeated episodes of inflammation of the mucous and submucosal layers of the bronchial tree, leading to bronchial obstruction due to edema, hypersecretion, and smooth muscle spasm. ROB remains one of the leading causes of pediatric morbidity in preschool-aged children. Objective. To study the clinical features of recurrent obstructive bronchitis (ROBB) in preschoolers and to assess the association between serum 25(OH)D levels and the frequency of exacerbations. Materials and methods. The study included 50 preschool children with ROB. Clinical, laboratory, and instrumental examinations were performed, along with the collection of data on vitamin D intake and environmental factors. Results. Fifty preschool children with recurrent obstructive syndrome were examined. Based on serum vitamin D levels, participants were divided into three groups: Group 1 – children with vitamin D deficiency (n = 15; 30.0%), mean 25(OH)D level 17.6 ± 1.2 ng/mL; Group 2 – children with vitamin D insufficiency (n = 19; 44.0%), mean 24.6 ± 1.2 ng/mL; Group 3 – children with normal vitamin D levels (n = 16; 32.0%), mean 30.6 ± 1.2 ng/mL. The mean age of the participants was 4.2 ± 1.1 years (median — 4.0 years); 28 (56%) were boys and 22 (44%) were girls. A high frequency of exacerbations was observed among children with low vitamin D levels. A statistically significant inverse correlation was found between serum 25(OH)D levels and the number of annual episodes (r = –0.45, p < 0.01). In the group with 25(OH)D < 20 ng/mL, the mean number of exacerbations per year was 5.2 ± 1.3, whereas in those with 25(OH)D ≥ 30 ng/mL it was 3.1 ± 1.1 (p = 0.002). Vitamin D deficiency may serve as a marker of increased risk for obstructive exacerbations in preschool children. It is recommended to include serum 25(OH)D assessment in clinical practice and to correct deficiency when necessary. Summary. Our study demonstrates that preschoolers with recurrent obstructive bronchitis and low 25(OH)D levels have a higher frequency of obstructive episodes, more severe disease course, and increased hospitalization rates. These findings suggest that vitamin D insufficiency may play a role in the pathogenesis of recurrent obstructive airway diseases in children. Larger prospective randomized studies are needed to confirm this hypothesis. In clinical practice, vitamin D assessment should be incorporated into the diagnostic and preventive algorithm for children with severe or recurrent ROB.
PREDICTING THE POSSIBILITY OF DEVELOPING MULTIORGAN DEFICIENCY SYNDROME IN PATIENTS WITH PERITONITIS
Study Objective: To determine the feasibility of predicting the development of multiple organ dysfunction syndrome (MODS) in children with peritonitis based on an analysis of blood coagulation (hemostasis) parameters. Materials and Methods: The study included 52 children aged 6 to 18 years admitted to the surgical department of the Tashkent State Medical University, with a diagnosis of peritonitis confirmed during surgery. Patients were divided into three groups: Group I (22 children): with localized peritonitis. Group II (22 children): with generalized peritonitis but without obvious clinical and laboratory signs of sepsis (with one or two signs of a systemic inflammatory response). Group III (8 children): with generalized peritonitis and pronounced clinical and laboratory signs of sepsis. Results: Initial analysis showed that all patients with peritonitis had increased blood coagulation compared to normal. Further observation of the disease revealed the following: Children in Group I successfully managed peritonitis thanks to the therapy administered, and they did not develop POES. In Group II, POES developed in 10% of patients, and in 50% of patients in Group III. In cases of POES development, a change in treatment strategy was required. Conclusion: A study of the blood coagulation system in children with peritonitis allowed us to identify three types of the body's response to abdominal infection: Favorable type: characterized by the absence of POES and the presence of no more than two signs of a systemic inflammatory response. Questionable type: accompanied by the development of POES in 10% of cases, with no more than two signs of a systemic inflammatory response. Unfavorable type: associated with the development of POES in 50% of cases and the presence of more than two signs of a systemic inflammatory response, indicating abdominal (peritoneal) sepsis.
RISK FACTORS FOR THE DEVELOPMENT AND FEATURES OF THE COURSE OF URATE NEPHROPATHY IN FREQUENTLY ILL CHILDREN
Objective: To determine the prevalence, risk factors, and clinical features of urate nephropathy (UN) in frequently ill children (FIC). Materials and Methods: The study was conducted at the multidisciplinary clinic of Tashkent State Medical University, in the Department of Pediatric Nephrology, during the period from 2022 to 2024. At Stage I, a retrospective, in-depth analysis of the medical records of 1,323 children aged 3 to 12 years who received inpatient treatment was carried out. At Stage II, a comprehensive clinical examination was conducted on 120 children with a confirmed diagnosis of UN. Results: Among frequently ill children, diseases of the urinary system, including urate nephropathy, occur significantly more often than in healthy children. In FIC, UN is commonly associated with background diseases such as tonsillitis, bronchitis, gastroduodenitis, and others, and is characterized by marked seasonality. The main risk factors for the development of the disease include maternal comorbidities, which may increase the likelihood of kidney tissue pathologies in the child in the future. In children with UN, clinical manifestations show age-specific features depending on the developmental stage of the child. Conclusion: To prevent complications of urate nephropathy in frequently ill children, early detection of urate metabolism disorders and timely correction are essential.
MICROCIRCULATORY CHANGES AND THEIR PROGNOSTIC SIGNIFICANCE IN CHILDREN WITH ATYPICAL PNEUMONIA
Relevance. In recent decades, there has been an increase in the proportion of atypical pneumonias caused by pathogens such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, less frequently Legionella pneumophila, and viral-bacterial associations.Objective. To study the features of microcirculatory disorders in children with atypical pneumonia and to assess their role in the formation of clinical course and prognostic significance of the disease. Materials and Methods. The study included 82 children diagnosed with atypical pneumonia who were hospitalized in the pulmonology department of the Andijan State Medical Institute between 2022 and 2024. The age of patients ranged from 3 to 15 years, with a mean age of 9.2 ± 3.1 years. Among the examined children, there were 45 boys (54.9%) and 37 girls (45.1%). Results. Clinical data analysis revealed that in children with atypical pneumonia, the severity of symptoms and the duration of illness were directly dependent on the severity of the disease. The average duration of fever in patients with mild pneumonia was 4.2 ± 1.1 days, with moderate pneumonia — 7.3 ± 1.8 days, and with severe pneumonia — 11.6 ± 2.4 days (p < 0.01 compared to mild cases). The duration of hospitalization also varied, from 8.4 ± 1.7 days in children with mild pneumonia to 18.2 ± 3.5 days in severe cases. Conclusions. The degree of microcirculatory changes depends on the severity of the disease: in mild cases, moderate perfusion disorders are observed; in moderate cases, pronounced stasis and reduced perfusion indices are noted; and in severe cases, there is a significant suppression of microcirculation up to critical hypoperfusion.
PREVALENCE AND MAIN PROBLEMS OF ANEMIA IN CHILDREN WITH CHRONIC KIDNEY DISEASE
Relevance. In recent years, chronic kidney disease (CKD) has become a serious global health problem. Mortality due to CKD continues to rise, and according to forecasts, by 2040 these diseases may rank fifth among all causes of death. In children, anemia frequently develops against the background of CKD and is associated with cardiovascular complications and a decrease in quality of life. Moreover, untimely diagnosis and ineffective treatment of anemia accelerate the progression of CKD. Therefore, prevention and optimization of effective treatment methods for CKD-associated anemia in children are of high importance. Objective. To analyze the prevalence of anemia in children with chronic kidney disease, determine the causes of its development, assess the effectiveness of existing therapeutic approaches, and develop preventive recommendations based on these findings. Materials and methods. The analysis was conducted using international databases — PubMed, Scopus, Mendeley, CyberLeninka — and national electronic sources. The search was performed using the keywords “chronic kidney disease in children, anaemia, treatment, prevention” and “children, chronic kidney disease, anemia, prevention.” More than 175 scientific sources were reviewed, and 38 of them were analyzed in depth. Results. The global prevalence of CKD has more than doubled between 1990 and 2021. It was found that the prevalence of CKD among children is nearly comparable to that in adults. The prevalence of anemia in chronic kidney disease depends on the stage of the disease. Among children with CKD stages III–V, anemia was observed in 80–90% of cases. One of the main causes of anemia is reduced erythropoietin production by the kidneys, which occurs even at early stages of CKD. Several challenges in the management of anemia in this group of patients remain unresolved. Conclusion. Anemia is highly prevalent among children with chronic kidney disease, and its severity correlates with the stage of renal insufficiency. To prevent anemia, it is important to regularly monitor hemoglobin and ferritin levels, identify sources of infection in a timely manner, and individually select iron supplements and erythropoiesis-stimulating agents. A comprehensive and personalized approach can reduce anemia-related complications in CKD and improve the quality of life in affected children.
INFLUENCE OF THYROID HORMONAL IMBALANCE ON THE SEVERITY OF NEPHROTIC SYNDROME IN CHILDREN
Relevance. Nephrotic syndrome (NS) in children is a common kidney disorder often associated with immune and endocrine imbalance. Thyroid hormone changes may affect NS pathogenesis, clinical manifestations, and treatment response. Purpose of the study Evaluation of the effect of thyroid dysfunction on the clinical manifestations of NS in children. Materials and methods of the study. Eighty children (1–18 years) with NS and 30 healthy controls were studied. According to serum TSH, T3, and T4, patients were divided into groups with normal thyroid function, hypothyroidism, and hyperthyroidism. Clinical, biochemical, ultrasound, and immunological parameters were evaluated. Research results. Subclinical hypothyroidism was common in active NS. In hypothyroid patients, edema lasted longer, hypoproteinemia, hypercholesterolemia, and proteinuria were more severe (p<0,05), with frequent relapses and corticosteroid dependence. Conclusion. Thyroid dysfunction increases NS severity. Regular thyroid evaluation and endocrinologist involvement are crucial in pediatric management.
CLINICAL AND MICROBIOLOGICAL CHARACTERISTICS OF THE INTESTINAL MICROBIOTA IN CHILDREN WITH BRONCHIAL ASTHMA ASSOCIATED WITH MYCOPLASMA PNEUMONIAE AND CHLAMYDIA PNEUMONIAE
Objective To study the clinical and microbiological alterations of the intestinal microbiota in children with bronchial asthma associated with Mycoplasma pneumoniae and Chlamydia pneumoniae infections, and to determine their correlation with disease severity. Materials and Methods. From 2023 to 2025, 78 children aged 7–15 years with bronchial asthma were observed at the Department of Pediatric Allergology, Tashkent Medical Academy. Patients were distributed according to asthma severity: mild — 41 children, moderate — 23 children, and severe — 14 children. A control group consisted of 42 healthy children. All subjects underwent serological testing (for antibodies to M. pneumoniae and C. pneumoniae), spirometry, and microbiological analysis of intestinal flora. Results and Discussion. Infections caused by Mycoplasma pneumoniae and Chlamydia pneumoniae were found to exacerbate the clinical course of bronchial asthma in children. These infections lead to significant dysbiosis of the intestinal microbiota, characterized by a decrease in beneficial bacteria (Bifidobacterium, Lactobacillus) and an increase in opportunistic microorganisms (Escherichia coli, Clostridium, Bacteroides). The imbalance in the intestinal microbiome correlated with disease severity. In children with severe asthma, the level of beneficial bacteria decreased by 45–55%, while opportunistic flora increased by 30–40% compared to the control group. Additionally, elevated levels of pro-inflammatory cytokines (IL-4, TNF-α) and immunoglobulin E (IgE) were observed, indicating an intensified immune response and persistent airway inflammation. Conclusion. Mycoplasma pneumoniae and Chlamydia pneumoniae infections aggravate the course of bronchial asthma in children and induce intestinal dysbiosis. The reduction of beneficial bacteria and the overgrowth of conditionally pathogenic flora are associated with more severe forms of asthma. Alterations in the intestinal microbiota modulate immune activity by increasing IL-4, TNF-α, and IgE levels, which enhance inflammation and allergic reactivity. Early detection of dysbiosis and the inclusion of probiotic therapy in complex treatment regimens may improve the clinical course of bronchial asthma in children.
MODERN FEATURES OF PNEUMONIA COURSE IN CHILDREN DEPENDING ON ANAMNESTIC FACTORS
Relevance. Pneumonia is a polyetiological disease; its risk and severity depend on the infectious agent, age-related and comorbid factors, as well as on socioeconomic and environmental conditions. The etiology of pneumonia varies depending on climatic and geographical features, seasonality, and vaccination coverage, although certain patterns remain stable — viral pathogens dominate in children under 2 years old, while bacterial agents prevail in severe and secondary mixed infections. Objective. To study the role of anamnestic risk factors and the clinical course of acute pneumonia in children aged 3 months to 3 years. Materials and Methods. The study was conducted at the Clinical Base No. 2 of Tashkent State Medical University. A pro- and retrospective analysis of inpatient medical records of 110 patients aged 3 months to 3 years, hospitalized and treated in the department for infants from January to September 2025, was performed. Among them, there were 66 boys (55.0%) and 54 girls (45.0%). Results. Analysis of medical histories and parent interviews showed that 90% of children aged 3 months to 3 years had a history of frequent acute respiratory infections (≥3 times per year). The majority (60%) belonged to the first group, and 30% — to the second group. Most children were admitted in severe condition, characterized by endogenous intoxication, respiratory failure, and microcirculatory disturbances. In the first group, 98.3% of children were hospitalized within 3–5 days of disease onset; 50% had a history of prior respiratory infections. In the second group, 53.4% were admitted on days 5–7, and 46.6% — on day 10 of illness. Analysis of pneumococcal vaccination coverage showed that in the first group, 24 (37.5%) children received a full course of vaccination according to the National Immunization Schedule (Pneumo-1, -2, -3). Partially vaccinated children included 12 (18.7%) who received only the first dose (Pneumo-1), 19 (29.6%) — the second and third doses, and 9 (14.6%) — only the third dose. In the second group, 19 (33.9%) children completed the full course, 25 (44.6%) received two doses, and 7 (12.5%) — a single dose. A high level of vaccination coverage reflects the effectiveness of national preventive measures. However, incomplete vaccination still maintains the risk of severe pneumonia and recurrent bronchitis in young children. Conclusions. The course of pneumonia in young children is determined by the multifactorial nature of predisposition, where perinatal complications, nutritional factors, immune status, and comorbidities play a major role. The identified patterns help predict disease severity, optimize prevention, and personalize therapeutic strategies.
FEATURES OF SYMPTOM COMPLEXES IN PRESCHOOL CHILDREN WITH ANEMIA
Relevance. Anemia in preschool children remains one of the major medical and social problems in pediatrics, affecting physical and cognitive development, resistance to infections, and the formation of chronic pathologies (Ibragimova et al., 2020; Rakhimova et al., 2021). Latent asymptomatic anemia associated with vitamin and trace element deficiency is most commonly observed in children aged 3 to 7 years. Objective. To study the characteristics of clinical symptom complexes in preschool children with anemia of varying severity. Materials and Methods. The study involved 50 children aged 3–7 years diagnosed with community-acquired pneumonia. All patients were observed and treated in the Pulmonology Department of Campus-2 Clinic, Tashkent State Medical University. Results. Clinical and laboratory data of 50 preschool children with varying degrees of anemia were analyzed. Among them, 28 (56%) were boys and 22 (44%) were girls. The mean age was 3.5 ± 1.3 years. In the 3–4 year group, boys accounted for 58.6%, girls — 41.4%; in the 5–7 year group, boys — 65.5%, girls — 34.5%. According to medical records and maternal history, 34.5% of children were born full-term with a birth weight of 3050 ± 53 g; 25.6% were preterm (≈2010 ± 25.6 g), and 25.3% were low birth weight (900 ± 180 g). Anemia in preschool children was most frequent at 3–4 years of age, associated with a high incidence of infectious diseases and adaptive stress related to attending preschool institutions. As anemia severity increased (from grade I to II), a statistically significant (p < 0.01) decrease in protein and vitamin D. The high prevalence of clinical symptoms (hair and nail growth disorders, skin manifestations, decreased appetite) confirms the systemic nature of the anemic syndrome. Conclusion. Anemia in preschool children occurs most frequently between 3 and 4 years of age, linked to increased infection rates and adaptive stress during preschool attendance. With increasing severity of anemia, there is a statistically significant (p < 0.01) decline protein and vitamin D. The widespread clinical symptoms underline the systemic nature of anemia and emphasize the importance of early screening and correction of deficiency states in preschool children to prevent chronic pathologies.
BOLALARDA BRONXIAL ASTMA VA OZIQLANISH TRAKTIDAGI BUZILISHLARNING O‘ZARO BOG‘LIQLIGI: KLINIK-FUNKTSIONAL JIHATLAR
This article is devoted to the study of clinical and functional features in children with bronchial asthma combined with gastrointestinal tract disorders. The work reviews current data on the prevalence of comorbid conditions in pediatric patients, their pathogenetic mechanisms, and clinical significance. Particular attention is paid to the relationship between immunological disorders, the state of the intestinal microbiota, and functional indicators of the respiratory system. The study demonstrated that in children with bronchial asthma and concomitant gastrointestinal diseases, the course of the illness is characterized by a higher frequency of exacerbations, significant changes in pulmonary function, reduced levels of fecal elastase-1, and dysbiotic alterations of the intestine. These factors are associated with more severe clinical manifestations, decreased effectiveness of basic therapy, and impaired quality of life. A comprehensive diagnostic approach, including assessment of respiratory function, gastrointestinal examination, analysis of the microbiota, and evaluation of immunological parameters, makes it possible to identify comorbid conditions in a timely manner and to individualize therapy. The findings emphasize the necessity of a multidisciplinary approach in the management of children with bronchial asthma and concomitant gastrointestinal disorders.