Medical science of Uzbekistan

THE STATE OF IMMUNOREACTIVITY IN CHILDREN DEPENDING ON TYPES OF NUTRITION

2025-11-28T14:59:18+05:00

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.

RISK FACTORS AND CHARACTERISTICS OF URINARY TRACT INFECTIONS IN ADOLESCENT GIRLS WITH COMORBID PATHOLOGIES

2025-12-01T12:31:12+05:00

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.

MODERN COURSE OF RECURRENT OBSTRUCTIVE BRONCHITIS IN PRESCHOOL CHILDREN AND THE ROLE OF VITAMIN D STATUS

2025-12-11T09:46:12+05:00

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

2025-12-11T09:46:10+05:00

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

2025-12-11T09:46:08+05:00

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.

PREVALENCE AND MAIN PROBLEMS OF ANEMIA IN CHILDREN WITH CHRONIC KIDNEY DISEASE

2025-12-11T09:46:04+05:00

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

2025-12-11T09:46:01+05:00

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

2025-12-11T09:45:59+05:00

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

2025-12-11T09:45:57+05:00

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.

POST-COVID CHANGES IN CLINICAL AND LABORATORY PARAMETERS AND THEIR INTERRELATIONSHIPS IN CHILDREN WITH BRONCHIAL ASTHMA

2025-12-11T09:49:32+05:00

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

2025-12-11T09:48:27+05:00

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.

FEATURES OF SYMPTOM COMPLEXES IN PRESCHOOL CHILDREN WITH ANEMIA

2025-12-11T09:45:50+05:00

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.

FEATURES OF PERIPHERAL BLOOD IN PREMATURE INFANTS BORN TO MOTHERS WHO HAD COVID-19 OF VARIOUS SEVERITY

2025-12-11T09:45:46+05:00

Most literature devoted to analyzing the course of novel coronavirus infection in pregnant women, women in labor, and newborns has assessed the somatic status and morphofunctional characteristics of children born to women with a positive COVID-19 PCR test at delivery. Given the hypercoagulability observed in COVID-19 patients, perinatal complications in children are likely due to impaired fetoplacental perfusion and/or possible thrombotic changes in the mother, vasculopathy, decreased placental barrier function, and inflammatory changes in the placenta. Some international authors have suggested that virus-induced placental changes lead to chronic and acute fetal hypoxia and premature delivery, which contributes to the severe condition of children at birth. The purpose of the study. To study the features of changes in the peripheral blood in dynamics in newborns born to mothers who had COVID-19 of varying severity. Materials and methods. 70 premature infants were examined: the 1st main group consisted of 40 children born to mothers who had COVID-19 of varying severity during pregnancy, the 2nd - comparison group consisted of 30 premature infants whose mothers did not have this infection. Clinical, laboratory and statistical studies were conducted. Results. Significant changes were detected in premature infants born to mothers who had coronavirus infection. These newborns had low hemoglobin levels and red blood cell counts, which continued to decrease dynamically and had the lowest values by the end of the 2nd-3rd week of life, especially in children born to mothers who had severe coronavirus infection. Children in the main group had higher platelet counts, especially in newborns born to women who had severe COVID-19 during pregnancy.

ADRENAL CORTEX HYPERPLASIA IN A NEWBORN GIRL (Case Study)

2025-12-11T09:45:45+05:00

Main The pathogenesis is linked to impaired cortisol synthesis, a deficiency of which, through a feedback loop, stimulates ACTH secretion, leading to adrenal cortex hyperplasia and increased steroidogenesis. Moreover, the levels of not only those steroids formed in the stages preceding the blocked stage increase, but also those whose synthesis pathway bypasses the blocked stage. In many forms of congenital adrenal hyperplasia, adrenal androgen secretion also increases, leading to virilization in female patients. Therefore, congenital adrenogenital hyperplasia was previously called congenital adrenogenital syndrome. Objective. The objective is to present a clinical case of congenital adrenal cortical dysfunction, the virilizing – salt-wasting form, in a newborn infant. Methods. We present a clinical case of congenital adrenal cortical dysfunction, the virilizing – salt-wasting form, observed by the authors in a newborn infant. An analysis was performed on the patient's inpatient medical records and the results of clinical, laboratory, and instrumental examination methods. Results. Congenital adrenal cortical dysfunction, the virilizing – salt-wasting form, belongs to the group of genetically determined electrolyte balance disorders. These arise from impaired sodium ion reabsorption in the renal tubules due to the low sensitivity of tubular epithelial receptors to aldosterone. The clinical presentation is variable, and the disease may proceed with a risk of fatal outcome due to severe salt loss and pronounced hyperkalemia. Key manifestations include polyuria, polydipsia, vomiting, failure to thrive (physical developmental delay), arterial hypotension, and episodes of dehydration. We present the specific features of the clinical course of congenital adrenal cortical dysfunction, the virilizing – salt-wasting form, as well as the dynamics of laboratory parameters before and during treatment in the newborn infant. Conclusion. In newborns presenting with persistent hyperkalemia amidst progressive hypotrophy (failure to thrive), congenital adrenal cortical dysfunction should be ruled out. The presented clinical case will allow clinicians to broaden their perspective on the issue of hyperkalemia and the characteristics of clinical manifestations of rare tubulopathies, facilitating timely diagnosis and the correct selection of management strategy.

STUDY OF THE CIRCADIAN RHYTHM OF CATECHOLAMINE METABOLISM AND LIPID PEROXIDATION PROCESSES IN YOUNG INDIVIDUALS ENGAGED IN IT PROFESSIONS

2025-12-11T09:42:59+05:00

Relevance. At present, there is a growing interest in studying the role of the central and especially the autonomic nervous system in the development and pathogenetic course of hypertension. However, many aspects of this disease remain insufficiently explored. In particular, the available literature lacks comprehensive scientific studies that describe catecholamine metabolism, the activity of the main catecholamine deamination enzyme-monoamine oxidase, the levels of the final deamination product (VMA), and lipid peroxidation products such as MDA. In recent decades, a priority area of scientific research has been the identification of informative and easily accessible laboratory and instrumental markers that enable early detection of hypertension in young individuals. Aim of the study. To investigate the characteristics of sympathoadrenal system dysfunction and lipid peroxidation processes in young individuals engaged in the IT profession. Materials and methods. A total of 90 men aged 25-44 years were examined; the mean age was 33,2±0.93 years. Clinical, instrumental, and specific laboratory methods were used. Results and conclusions. It was found that young individuals actively engaged in the IT profession exhibit disorders in the functional activity of the sympathoadrenal system, manifested by increased excretion of catecholamines (particularly adrenaline and noradrenaline), disruption of the circadian rhythm of catecholamine excretion, reduced activity of monoamine oxidase (MAO) — the key enzyme responsible for catecholamine deamination — increased levels of vanillylmandelic acid, a secondary metabolite of catecholamines, as well as elevated malondialdehyde (MDA), a secondary product of lipid peroxidation.

CURRENT PERSPECTIVES ON INFLAMMATORY BRONCHOPULMONARY DISEASES WITH AIRWAY OBSTRUCTION IN CHILDREN

2025-11-28T11:14:47+05:00

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.

SCIENTIFIC BASIS OF THE NURSE’S PREVENTIVE ROLE IN EARLY DETECTION AND PREVENTION OF ANEMIA AND OBESITY AMONG PRESCHOOL CHILDREN

2025-11-28T11:25:54+05:00

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.

CLINICAL AND PATHOGENETIC FEATURES OF MICROCIRCULATORY CHANGES IN BRONCHOPULMONARY DISEASES IN CHILDREN

2025-11-28T15:45:48+05:00

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

2025-11-28T16:07:28+05:00

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.

MICROCIRCULATORY CHANGES AND THEIR PROGNOSTIC SIGNIFICANCE IN CHILDREN WITH ATYPICAL PNEUMONIA

2025-12-11T09:46:05+05:00

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.

BOLALARDA BRONXIAL ASTMA VA OZIQLANISH TRAKTIDAGI BUZILISHLARNING O‘ZARO BOG‘LIQLIGI: KLINIK-FUNKTSIONAL JIHATLAR

2025-12-11T09:45:49+05:00

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.

CURRENT STRATEGY FOR THE TREATMENT OF RESPIRATORY DISTRESS SYNDROME IN NEWBORNS (literature review)

2025-12-11T09:45:43+05:00

Respiratory distress syndrome (P22.0; ICD-10) is a condition associated with lung immaturity and surfactant deficiency in neonates born prematurely. Treatment of RDS remains a key component of neonatal intensive care. The aim of the study was to analyze current treatment strategies for neonatal respiratory distress syndrome. Materials and methods of the study: scientific literature and methodological recommendations of foreign and domestic authors of recent years were analyzed. Study results: the prognosis for newborns who have received prenatal steroids, respiratory support, and exogenous surfactant therapy is favorable. Mortality is less than 10%, and in some studies, survival rates reach 98% when using advanced treatment methods. The evidence base for the updated recommendations and the emergence of some new positions require the implementation of a national protocol for the management of newborns with RDS, which will improve the quality of medical care for newborns and reduce mortality rates among premature infants and severe complications.

SPECIFIC FEATURES OF BRONCHIAL ASTHMA ASSOCIATED WITH ATOPIC DERMATITIS IN CHILDREN LIVING IN THE KHOREZM REGION

2025-12-11T09:45:41+05:00

Bronchial asthma and atopic dermatitis occupy a leading place among chronic allergic diseases of childhood. Their prevalence worldwide shows a steady upward trend, which is associated with changes in the ecological situation, lifestyle, and the influence of urbanization. Objective: to study the clinical, immunological, and regional features of the comorbid course of bronchial asthma and atopic dermatitis in children living in the Khorezm region. Materials and Methods. The study was conducted on the basis of pediatric departments of the Khorezm region and the Department of Children’s Diseases of the Tashkent State Medical University. A total of 120 children aged 6 to 15 years, permanently residing in the Khorezm region, were included in the study. Results. The average age of onset of bronchial asthma in children with comorbid course was 5.2 ± 0.8 years, which was significantly earlier than in children with isolated asthma (7.1 ± 0.9 years, p < 0.05). Patients with BA+AD had a higher number of nocturnal coughing episodes (5.6 episodes/month on average) compared to those with isolated BA (3.1 episodes/month). The total number of exacerbations per year was also higher in children with the comorbid course (3.8 ± 0.6 vs. 2.1 ± 0.4, p < 0.01). Conclusion. In children of the Khorezm region, the comorbid course of bronchial asthma and atopic dermatitis is characterized by an earlier onset, more frequent exacerbations, and a pronounced immunological imbalance with predominance of the Th2 response, which determines a severe recurrent course and requires an individualized therapeutic approach.

THE GLOBAL BURDEN OF RESPIRATORY SYNCYTIAL VIRUS INFECTION IN CHILDREN: ACHIEVEMENTS AND CHALLENGES OF MODERN PEDIATRICS

2025-12-11T09:43:52+05:00

Relevance. Respiratory syncytial virus (RSV) infection remains one of the leading causes of acute respiratory diseases in infants and young children, representing a serious medical and socio-economic problem worldwide. Its high contagiousness, pronounced seasonality, and severe course in newborns have a significant impact on childhood morbidity and mortality rates. Objective. To assess the current state of the RSV infection problem in children, including its epidemiological, clinical, and socio-economic aspects, as well as to analyze new advances in prevention, diagnosis, and therapy — particularly the introduction of monoclonal antibodies and vaccine platforms. Materials and Methods. An analytical review was conducted based on national and international sources from 2019–2025, covering materials from the World Health Organization, results of multicenter cohort and randomized clinical studies, as well as data from meta-analyses and systematic reviews published in leading scientific databases (PubMed, Scopus, WHO Global RSV Surveillance). Results. RSV infection continues to be one of the major causes of acute respiratory diseases in infants and young children. According to WHO data, more than 33 million cases are registered annually, of which approximately 3.6 million require hospitalization, and up to 100,000 result in death. The highest burden of the disease falls on infants during the first six months of life, particularly among premature newborns and patients with congenital heart defects or bronchopulmonary dysplasia. In recent years, significant progress has been achieved in prevention: long-acting monoclonal antibodies (nirsevimab), vaccines for pregnant women (Abrysvo, Arexvy), and the development of mRNA vaccines have been introduced. These advances open new opportunities to reduce the global burden of RSV-related disease. Nevertheless, therapeutic approaches remain largely symptomatic, while early laboratory diagnostics and the rational use of healthcare resources require further improvement. Conclusions. RSV infection represents a major medical and social problem characterized by high contagiousness, seasonality, and severe complications in infants. Strengthening epidemiological surveillance, implementing highly sensitive diagnostic methods, and expanding vaccination programs are key strategies for reducing mortality and hospitalization rates. Recent advances in vaccinology and monoclonal antibody therapy form the foundation for a comprehensive preventive strategy aimed at protecting the most vulnerable groups of the pediatric population.

CLINICAL, LABORATORY, AND IMMUNOLOGICAL CHARACTERISTICS OF COMMUNITY-ACQUIRED PNEUMONIA IN YOUNG CHILDREN

2025-12-11T09:43:01+05:00

Background. Community-acquired pneumonia (CAP) in young children remains a leading cause of morbidity and complications, necessitating early detection of clinical, laboratory, and immunological markers of severe disease. Despite the decrease in overall child mortality in recent decades, CAP remains the leading cause of death among infectious diseases in early childhood, especially in countries with economies in transition. Objective. To evaluate the analysis of clinical, laboratory, and immunological characteristics of community-acquired pneumonia in young children and identify markers most closely associated with a severe course of the disease. Materials and methods. Eighty children aged 12–36 months with confirmed CAP were examined. Clinical manifestations, respiratory function, radiographic signs, complete blood count, biochemical markers (including C-reactive protein), microbiological data, and immunity parameters (IgA, IgM, IgG, CD4+, CD8+, CD4/CD8 index) were analyzed. Patients were divided into groups with mild (n = 40) and severe (n = 40) course. Statistical analysis included Student's t-test, Mann–Whitney test, and χ² (p < 0.05). Results. The data obtained indicate that children with severe CAP exhibit a pronounced inflammatory response and immunoregulatory imbalance. Increased levels of leukocytes, neutrophils, ESR, and C-reactive protein are accompanied by a decrease in lymphocytes. Conclusions. Severe CAP was accompanied by severe respiratory failure, high fever, extensive infiltrates on radiographs, leukocytosis, neutrophilia, increased ESR and CRP, and a decrease in lymphocytes. Immunological testing revealed a decrease in CD4+ and IgA, an increase in CD8+ and IgM, and a significant decrease in the CD4/CD8 ratio. Clinical signs, inflammatory markers, and immunological markers can serve as a reliable system for the early diagnosis of severe CAP in young children.