[Fat-soluble vitamins and immunodeficiency: mechanisms of influence and opportunities for use].

The role of vitamins in the formation of the immune response, both innate and acquired immunity, is well known. At the same time, deficit of fat-soluble vitamins A, E, D leads to impaired response of the immune system to the infectious invasion and to disorders of immune system functioning. The aim of this article is to analyze the literature data on the impact of fat-soluble vitamins on the function of the human immune system and the possibilities of their use in patients with immunodeficiency. Results. Сurrently, there are enough evidences of the successful use of fat-soluble vitamins in secondary immunodeficiencies. Data on the usage of vitamins A, E, D in the treatment of primary immunodeficiencies are few. However, even reducing of antibiotics and other medicines administration in children with primary immunodeficiency indicates the feasibility of their using. The results of scientific studies on the successful use of vitamins D and A in the treatment of allergic diseases, vitamin D in the prevention and improvement of the treatment of autoimmune and oncological diseases indicate the possibility of their use as adjuvant immunomodulatory therapy in children with primary immunodeficiency. Promising may be the use of vitamins A and E, as powerful antioxidants in patients with primary immunodeficiencies with defects in DNA repair processes. Conclusion. The analysis of the literature data has shown that despite many questions need to be resolved, fat-soluble vitamins A, D, and E, and their analogues can be used in clinical settings to enhance the therapeutic effect in children with immune deficiency.

[Survey assesment of vitamin D and calcium dietary intake in children with somatic pathology].

Vitamin D and calcium play a key role not only in maintaining skeletal integrity, but are also important in the functioning of other systems of the human body. The aim of the study is to evaluate the dietary intake of calcium and vitamin D in the children with different somatic pathologies (gastroenterological and endocrine) and its impact on somatic health indicators. Material and methods. 114 children, aged 4-17 years old, were involved in the study. They underwent inpatient treatment for somatic pathology. The patients were divided into 4 groups: 36 children with chronic gastroduodenitis (the 1st group); 25 children with functional disorders of biliary tract (the 2nd group); 30 children with hypothalamic pubertal syndrome (the 3rd group); 23 patients with type 1 diabetes mellitus (the 4th group). Dietary intake of calcium and vitamin D was evaluated using a questionnaire. The sources of vitamin D and calcium intake were determined and the amount of these sources in the weekly diet of a child was evaluated. Then the total of vitamin D and calcium in the diet of each child and the average daily consumption of these nutrients with each food source were evaluated as well. All children underwent physical examination; a special attention was paid to the health of their teeth, nails, hair, skeletal system, as well as the presence of allergic reactions. Serum calcium concentration was determined by the colorimetric method with o-cresolphthalein in an alkaline medium and inorganic phosphorus by the phosphomolybdate method with aluminum molybdate in an acidic medium. Results and discussion. It was established that the diet of the most children comprised baked goods (94.7%), meat (92.9%), dairy products (up to 90.4%), and eggs (90.4%). The children received most of their dietary vitamin D with fish (335.63±472.82 IU), butter (124.64±114.31 IU) and eggs (101.15±96.77 IU) per week. The dairy products, i.e. milk, yogurt, cheese, and cottage cheese, were the largest source of calcium. Calcium intake varied in different patient groups due to their food preferences and dietary recommendations related to their health. It was also proved that the average daily diet vitamin D intake at 123.98±53.52 IU was insufficient. The average daily intake of calcium with food was 524.53±248.38 mg. The insufficient intake of vitamin D and calcium with food correlated with clinical manifestations. Posture disorders were evidenced in 48.2% of children, tooth decay - in 40.4%, and hair illnesses - in 32.4%. These disorders were more significant in the children of the 1st group, who were proved to have the lowest vitamin D intake. The serum calcium level was lower than the reference values in 79.8% of children, the phosphorus level was lower than the reference values in 41.2% children. Conclusion. The dietary intake of calcium and vitamin D in the children with different somatic pathologies (gastroenterological and endocrine) was insufficient, despite differences in children's diets under various pathologies, which led to the appearance of clinical signs of mineral metabolism disorders, among which posture disorders and tooth decay were most often observed.

AWARENESS OF PRIMARY IMMUNODEFICIENCY DISEASES AMONG MEDICAL STUDENTS.

Primary immunodeficiency diseases (PID) are a group of more than 300 rare, chronic disorders in which a part of the body's immune system is missing or functions improperly. The issue of early diagnosis, timely and effective treatment, prevention of complications and improved prognosis remains extremely relevant. The aim of this study was to assess the awareness of graduating medical university students about the signs of primary immunodeficiency in children and adults. A survey on awareness of primary immunodeficiencies was conducted among sixth year (graduating) students of the Faculty of Medicine of I.Horbachevsky Ternopil State Medical University, Ukraine. Questionnaires were offered to 271 students. The questionnaire consisted of 25 questions. The average percentage of correct answers given by the surveyed students for each question was 59.2% (ranging from 22.5% to 82.3%). The percentage of correct answers to the questions about warning signs of PID in children was 64.4%, and in adults was 54.2% (p=0.0491). The percentage of correct answers to the questions about general signs of PID was 61.6% and about specific signs of PID 51.7% (p=0.0016). The percentages of correct answers among surveyed students ranged from 26 to 88%. 223 (82.3%) medical students gave more than 50% of correct answers to all questions, but only 21 surveyed students (7.7%) gave more than 75% of correct answers. This study has revealed the lack of awareness for PID among medical students. The lowest knowledge was about PID warning signs in adults and the specific signs of PID, especially those concerning verification and management of Nijmegan breakage syndrome and common variable immunodeficiency. This study indicates a significant need to increase knowledge of medical students about primary immunodeficiencies, taking into account low levels of diagnosis of these diseases in Ukraine and the need to raise knowledge and awareness about PID among physicians of all specialties.