ANTIBIOTIC ASSOCIATIVE DISORDERS OF THE MICROBIOCENOSIS OF THE COLON IN INFANTS WITH ACUTE RESPIRATORY DISEASES.

OBJECTIVE: The aim: Study the effect of antibiotics of different groups on the condition of the colon microflora in infants with acute respiratory pathology. PATIENTS AND METHODS: Materials and methods: 140 infants with acute respiratory pathology were examined. Clinical, laboratory and instrumental examination, assessment of the functional state of all organs and systems, chest x ray, clinical signs of the colon microbiocenosis violation, analysis of bacteriological examination and immunological studies of local colon immunity (immunoglobulin concentration (sIgA, IgA, IgG, IgM) in coprofiltrates) were done. RESULTS: Results: The negative effect of antibiotics of different pharmacological groups on the colon microflora state in infants with acute respiratory diseases has been established. The indigenous microflora of the colon is most inhibited by drugs from the group of 3rd generation cephalosporins, aminoglycosides and their combination. While cephalosporins 1-2nd generations, penicillins and macrolides to a lesser extent affect the state of the microbiocenosis of the colon. The use of two courses of antibacterial therapy to a greater extent disrupts the microbiocenosis of the colon in the examined children, compared with one course of therapy. In commune acquired pneumonia and acute complicated bronchiolitis in infants on the background of antibiotic therapy there is a probable decrease in secretory immunoglobulin in coprofiltrate (sIgA), compared with healthy children (p <0.05). CONCLUSION: Conclusions: The analysis of the obtained results showed that antibiotic therapy negatively affects not only the condition of the colon microflora in the examined children, but also suppresses humoral factors of local immunity of the colonic mucosa. Key words: digestive tract microbiocenosis, antibiotic therapy, children.

INHERITED EPIDERMOLYSIS BULLOSA IN NEWBORN (CASE STUDY).

Inherited epidermolysis bullosa (IEB) is a group of genetically and clinically heterogeneous diseases characterized by the formation on the skin and mucous membranes blisters and erosion due to injury. Different forms of IEB can be accompanied by various extracutaneous complications, such as blisters and erosion on the cornea and mucous membranes, stenoses and strictures of the respiratory system, gastrointestinal tract, urinary system, muscle dystrophy, and malignant tumors. Therefore diagnosis and prescribing appropriate treatment and follow-up care is an important task for neonatologists and pediatric dermatologists. Because the manifestations of IEB are numerous, a specialized center is required for optimal care, where multidisciplinary care will be provided (neonatologists, pediatric surgeons, pediatric dermatologists, etc.). The purpose of this case report is to pay attention of specialists to a disease that is rare, to present clinical case of IEB in newborn who was admitted to the intensive care unit of newborns of Vinnitsa Regional Children's Clinical Hospital.

CONGENITAL HEMOLYTIC ANEMIA IN CHILDREN, FEATURES OF THE COURSE AND DIAGNOSIS. THE CLINICAL CASE.

We've reported a clinical case of congenital hemolytic anemia which was treated in Vinnitsa Regional Children's Hospital from newborn period until now. We've used complete blood count, biochemichal blood investigation, ultrasound investigation of the abdominal cavity in every hospitalization. Also IFA for TOXO IgG, IgM and G CMV, IgG HSV-6 IgG EBV (EBNA) and IgM EBV, study to hepatitis B and C viruses and HIV were made. There were checked levels of serum iron, ferritin, vitamin B 12 and folic acid in blood serum.

INSTRUMENTAL MARKERS OF THE RIGHT VENTRICLE FUNCTIONAL CONDITION WITH TISSUE DOPPLER IN CHILDREN WITH TETRALOGY OF FALLOT AFTER SURGICAL CORRECTION AND THEIR CONNECTION WITH VALVULAR FUNCTION OF PULMONARY ARTERY.

OBJECTIVE: The aim: To improve efficacy of the right ventricle functional condition evaluation in children with tetralogy of Fallot after surgical correction by estimation of instrumental markers of myocardial dysfunction. PATIENTS AND METHODS: Materials and methods: We completely examined 35 children with tetralogy of Fallot after their surgical correction at the age of 3 - 17 years. For all the patients was presented tissue doppler. We evaluated peak myocardial velocities of right ventrical in different phases of the heart cycle (S, E`, A`), tricuspid annular plane systolic excursion (TAPSE), diastolic myocardial velocities ratio (E/E`), peak myocardial velocity during isovolumic contraction (IVV), isovolumic relaxation time (IVRT). RESULTS: Results: All children of the study group had pulmonary insufficiency of different severity with main predominance of mild pulmonary regurgitation (20 patients, 57,14±8,36 %). Children with tetralogy of Fallot after surgical correction were admitted with: decreased TAPSE up to 1,39±0,28 cm, decreased S` up to 8,00±1,90 cm/s, and decreased IVV up to 5,69±0,95 cm/s that is significantly lower results of the healthy children. Severe pulmonary regurgitation usually followed by high chances of the right ventricle systolic dysfunction, exactly with: decresed TAPSE<1,5 cm (OR=0,500; 95% CI 0,323 - 0,775), S`<8,1 cm/s (OR=0,600; 95% CI 0,420 - 0,858) and IVV<5,9 cm/s (OR=0,250; 95% CI 0,117 - 0,534). As well we admitted significant decline of the velocities in earl and end diastole periods to compare with the results of the control group (E`= 12,11±1,22, A`= 4,56±0,92 cm/s (Р=0,009 and P=0.0002)), boost of the E/E` ratio - 7,96±2,33 (P=0.01) and decline of the RV IVRT up to 43,49±6,04 ms (P=0.017). Severe pulmonary regurgitation followed by high chances of the right ventricle systolic dysfunction development with TAPSE <1,5 cm (OR=0,500; 95% CI 0,323 - 0,775), S`<8,1 cm/s (OR=0,600; 95% CI 0,420 - 0,858) and IVV<5,9 cm/s (OR=0,250; 95% CI 0,117 - 0,534). As well we noticed high chances of the E/E`ratio > 6,0 in 1,5 times (95% CI 1,072 - 1,903) and decreased E` <12,2 cm/s (OR=0,200; 95% CI 0,083 - 0,481). CONCLUSION: Conclusions: Apart of clinical symptoms of the heart failure in children with tetralogy of Fallot after surgical correction markers of the right ventricle myocardial dysfunction are presented by indices of myocardial velocities, received during tissue doppler in different phases of the heart cycle.

Prognostic influence of toll-like receptor 4 gene polymorphism into community-acquired pneumonia course among young patients with cytomegalovirus persistence.

OBJECTIVES: The aim of this study was to determine the predictive role of TLR4 polymorphism in CAP course among young cytomegalovirus-positive patients. SUBJECTS AND METHODS: One hundred and five patients with pneumonia (age range: 18-44 years) and 61 healthy respondents were observed clinically and specifically (by cytomegalovirus markers and TLR4 + 3725 G/C polymorphism). RESULTS: Among CAP patients, there were 51 male (48.6%) and 54 female (51.4%), with average age 34.1 ± 0.8 years, and there were 19 (18.1%) patients with Pneumonia Patient Outcomes Research Team (PORT) I, 46 (43.8%) patients with PORT II, 31 (29.5%) patients with PORT III, and 9 (8.6%) patients with PORT IV. Cytomegalovirus persistence was detected in 80 (48.2%) patients and 34 (20.5%) healthy respondents (P = 0.003). G/G genotype of TLR4 signaling was found in 78 (74%) patients with pneumonia, G/C in 24 (23%) patients, and C/C in 3 (3%) patients. Among G/C patients, there were 16.2% cytomegalovirus-positive patients versus 6.7% negative patients (P < 0.05), as well as among G/G patients, and there were 59% versus 15,2%, accordingly (P < 0.01). The patients of the main group with G/G genotype were characterized by mostly mild (PORT I - 15 [14.3%]) and moderate pneumonia severity (PORT II - 32 [30.5%] and PORT III - 26 [24.8%] patients). The patients with G/C genotype were characterized by mostly PORT II (11 [10.5%] patients). All C/C genotype patients have PORT II (P < 0.05). CONCLUSIONS: Cytomegalovirus persistence worsens the pneumonia course. G/G and G/C TLR4 genotypes are associated with mild pneumonia severity.

Trombosis of mesenterial vessels in acute lymphoblastic leukemia (case report).

The article presents data on classification, diagnostic problems, treatment of acute lymphoblastic leukemia in children. Remaining unresolved problems of protocol chemotherapy complications of acute lymphoblastic leukemia. The presented clinical case of successful treatment of thrombosis of mesenteric vessels in a child with acute lymphoblastic leukemia, which included the stages of thrombolytic therapy and surgical treatment for resection of necrotized part of the ileum.