A Current Management Strategy for Children with Chronic Viral Hepatitis B, Based on International and National Guidelines.

BACKGROUND: Peculiarities of the course of chronic viral hepatitis B in children cause an important medical and social problem of health care, despite the implementation of modern treatment and prevention protocols. Pathogenetic mechanisms of the development and progression of viral hepatitis B infection, the presence of occult poorly diagnosed form, the impossibility of completely eliminating the virus and the specificity of the immune response in children are still not fully solved scientific problems. MATERIAL AND METHODS: The aim of this review is to examine current strategies for the diagnosis and treatment of chronic hepatitis B in children, based on international and national guidelines. RESULTS: A detailed analysis of modern guidelines on the course and pathogenesis of viral hepatitis B infection confirms the fact that chronic hepatitis B is characterised by a complex interaction between the immune system of the virus and the patient, whose dynamic balance is not only responsible for the various phases of chronic viral hepatitis B infection but also leads to the result of antiviral treatment. CONCLUSION: Despite the introduction of vaccination of children against hepatitis B, the level of viral hepatitis B vaccination of children in Ukraine remains insufficient, which leads to the further spread of the infection. Currently available antiviral drugs can provide functional treatment of viral hepatitis B infection in a limited number of patients, but today's Ukrainian realities have caused a change in approach to the treatment and monitoring of patients, which may negatively affect the implementation of the key goals of the World Health Organization Global Strategy on the prevention, diagnosis and treatment of viral hepatitis.

WAYS OF OPTIMIZING THE DIAGNOSTICS OF FOOD ALLERGIES IN CHILDREN BASED ON THE CLINICAL AND IMMUNOLOGICAL CRITERIA.

OBJECTIVE: The aim of the research was to investigate the spectrum of food sensitization, followed by the determination of the main clinical criteria and immunological markers of food allergy in children with gastroduodenal pathology and atopic dermatitis. PATIENTS AND METHODS: Materials and methods: We conducted a comprehensive clinical and immunological examination of 120 children aged from 6 to 15 years with gastroduodenal pathology (group 1; n = 64) and atopic dermatitis (group 2; n = 56), who had a history of adverse allergic reactions to food. The control group consisted of 22 apparently healthy children. RESULTS: Results: In the group of children with gastroduodenal pathology, the spectrum of the most common significant food allergens was represented by legumes, the reaction to which was observed in 25 (39.1%) subjects, eggs (25.0%) and fish (23.4%), which were found in every fourth child. Among patients with atopic dermatitis, the leading positions were occupied by fruits, which were registered in 20 (35.7%) children, nuts - in 15 (26.8%), honey and vegetables - in 11 (19.6%) children, respectively. The study of immunological status in comparison with the control group revealed reliable increases in pro-inflammatory T-helper-2 cytokines - interleukin-4 and chemokine TARC/CCL-17 and a simultaneous decrease in anti-inflammatory interleukin-10 in children of the 1st and 2nd groups who had gastrointestinal and skin manifestations of allergic reactions when eating food products. CONCLUSION: Conclusions: The study of peculiarities of adverse reactions to food in the examined children allowed us to identify specific clinical criteria and immunological markers of food allergy, which had certain features depending on the skin or gastrointestinal manifestations.

Peculiarities of crohn's disease in children - the way from diagnosis verification to the development of complications (clinical case).

OBJECTIVE: Introduction: Despite increasing frequency of inflammatory diseases of the intestine in the children worldwide, verification of Crohn's disease (CD) diagnosis in pediatric practice has not studied yet and it is difficult for clinician to determine the stage of the disease. The aim of our study was to analyze clinical case of Crohn's disease (CD) in a child based on literature data and own monitoring. PATIENTS AND METHODS: Materials and methods: 13 year old patient was involved in our examination who took complex lab and instrumental investigation, which allows verifying inflammatory intestinal pathology such as Crohn's disease. Clinical case of the disease demonstrates that clinical symptomatic picture, difficulties of differential diagnostics and the absence of effective interaction between relatives of the patient and doctor can't give the possibility to make correct diagnosis in pediatric practice and it can lead to complications of the development of disablement. CONCLUSION: Conclusions: Crohn's disease is a serious inflammatory intestinal disease that requires an interdisciplinary diagnostic approach for the successful verification of the diagnosis.

Diagnostic algorithm and peculiarities of monitoring for infants with disorders of the gastrointestinal tract.

INTRODUCTION: The most common medical conditions in infants, which belong to pediatric and gastroenterological disease areas, are functional gastrointestinal disorders, food hypersensitivity and food allergy. First of all, these symptoms can disguise lactase deficiency, cow's milk protein allergy, eosinophilic gastroenteritis, allergic proctocolitis, gastrointestinal manifestations of atopic dermatitis, functional disorders of gastrointestinal and biliary tract, etc. The aim of our study was to develop an algorithm of monitoring for infants with disorders of the gastrointestinal tract and to study the efficacy of probiotic and enzyme replacement therapy. Materials and metods: 47 children aged 1 to 3 years with gastrointestinal and atopic dermatitis symptoms underwent clinical and laboratory examinations. RESULTS: Analysis of additional examination revealed the causes of gastrointestinal disorders, and the following diagnoses were made: 15 children (32 %) had secondary lactase deficiency, 9 children (19 %) had sensitization to cow's milk protein and caseins. Molecular-genetic analysis of С > Т polymorphism at position 13910 of lactase gene (LСT) demonstrated that C/C-13910 genotype was observed in 44.7 % of children, С/Т-13910 heterozygous genotype was found in 36.2 %, and 19.1 % of children had Т/Т-13910 genotype; these were interpreted in conjunction with other clinical criteria for verification of secondary lactase deficiency diagnosis. CONCLUSIONS: Assessment of children over time during their treatment showed that combined therapy using lactase preparation and probiotics contributed to relief of clinical symptoms. All patients had their fecal pH increased (> 5.5), whereas the majority of children demonstrated improvement yet on days 2-3 (i.e., decrease in pain syndrome, flatulency, and stool frequency; restoration of normal stool consistency). Based on the obtained data, we proposed a practical algorithm for verification and monitoring of children with gastrointestinal disorders.

Regional features of the microbial landscape of urine and comparative evaluation of antimicrobial therapy in children with cystitis.

INTRODUCTION: Growing resistance of pathogens to antibiotics, including cross-resistance to other antimicrobial classes that are used in the treatment of recurrent infections of the lower urinary system in children demands constant control of issues of regional antibiotic resistance. In the present days, in the empirical treatment of such patients physicians still choose medications with preserved activity in relation to E. coli. The aim of our study was to investigate the regional features of microbial landscape of urine in children with cystitis and study the efficacy of 7-day administration of Furamag medicinal drug for the treatment of recurrent episodes of this disease in children. MATERIAL AND METHODS: 65 children aged 5 to 16 years underwent clinical and laboratory examinations. The patients in Group I (33 children) received Furamag as an antimicrobial therapy; the comparison group consisted of patients (32 children) who received cefuroxime axetil. The both therapies course duration was 7 days. RESULTS: Bacteriological examination results were indicative of prevalence of gram-negative opportunistic microflora; in particular, E. coli prevailed in the structure of isolated causative agents (61.9%). Analysis of detected pathogens susceptibility to antimicrobial agents showed a high level of E.coli resistance to ampicillin, amoxicillin/clavulanate and gentamicin (in 97.4% of cases), and in 50% of cases the E.coli were resistant to cefotaxime, ceftriaxone and cefuroxime. High rates of resistance of Enterococcus spp. (100%) and Enterobacter spp. (96.7%) to cefuroxime, cefotaxime and ceftriaxone were recorded. Furamag demonstrated significantly higher bacteriological efficacy vs. cefuroxime axetil as for eradication of the most clinically significant causative agents of cystitis identified in the Poltava region (93.9% and 68.8%, respectively, p <0.05). During the follow-up study, anti-relapse efficacy of Furamag appeared to be 1.5 times higher as compared to the reference drug in the children examined (p <0.05).