An interview with Professor Dilorom Ilkhamovna Akhmedova, Doctor of Medical Science, Head of the Chair of Hospital Pediatrics No. 2, Traditional Medicine at the Tashkent Pediatrics Medical Institute. Chief Pediatrician of the Republic of Uzbekistan. An author of over 550 scientific publications, possesses 5 certificates of authorship and 2 patents of invention. She supervised 18 successful candidate and 8 doctorate theses. Dilorom Ilkhamovna told us about her path in healthcare, about the influence of the outstanding scientists of the Republic of Uzbekistan on her professional development and rise. Also, she shared information about the design of the educational process in the present-day environment, about the new post-graduate and advanced training system, and about strategic objectives in medical education for 2024–2030.

Aim. Assessing the effectiveness of the influence of omega-3-polyunsaturated fatty acids (PUFAs) on the somatic and cognitive status of healthy children.

Design. Observational prospective study.

Materials and methods. The study included 90 healthy (without chronic diseases) children aged 3 to 17 years (mean age — 9.2 ± 6.8 years): 35 (38.8%) girls and 55 (62.2%) boys. All children received dietary supplements omega-3, in accordance with the instructions for use, for 1 month. During the study, 3 face-to-face visits to a pediatrician took place: screening (before starting the dietary supplement), at the end of the intake and 2 months after completion of the course of treatment. A comprehensive laboratory and instrumental examination (biochemical blood test), measurement of the omega-3 index, levels of omega-3-PUFA and omega-6-PUFA in “dry” drops of blood, ultrasound examination of the abdominal organs, testing on a computer device for psychophysiological research KPFK-99M Psychomat.

Results. All examined children initially had a deficiency of omega-3 PUFAs, while while taking dietary supplements, the main indicators reflecting the saturation of the body with omega-3 PUFAs (omega-3 index, levels of eicosapentaenoic and docosahexaenoic acids) increased, but the target values were achieved only in 4 of the observed children children. The reference concentrations of PUFA fractions were determined in children from 3 to 17 years old. When taking omega-3, the incidence of acute respiratory pathologies decreased and their course became milder. The positive effect of omega-3 on indicators of fine motor skills, verbal and visual perception, visual-spatial memory, attention span, as well as a slight decrease in anxiety with stabilization of the emotional background, which persisted in all age groups 2 months after completion of the course. The positive effect of dietary supplements on autonomic functions has been demonstrated: the process of falling asleep, sleep quality, appetite. Dynamic observation showed good tolerability and the absence of adverse reactions to taking omega-3, according to laboratory and instrumental studies, as assessed by doctors, patients and their parents.

Conclusion. Taking omega-3 for 1 month (in addition to a healthy diet) is a safe, convenient way to support optimal immune and nervous system function, potentially reducing the risk and impact of infections in children 3–17 years of age.

Aim. To study and evaluate the quality of life of primary school-age children living in different social conditions due to marital status in Lugansk.

Design. A prospective cohort non-randomized study was conducted.

Materials and methods. A survey of 222 children aged 7-10 years was conducted. Depending on the living conditions of children, 3 groups were identified: group I - 74 children living in dysfunctional families (36 boys and 38 girls); group II - 62 children raised in an orphanage in Lugansk (32 boys and 30 girls) and group III - 86 children from full, prosperous families (40 boys and 46 girls). To study the quality of life of children living and being brought up in various social conditions, the international questionnaire Pediatric Quality of Life Inventory 4.0 was used.

Results. The study showed that the lowest indicators of quality of life in terms of physical functioning were observed in children from disadvantaged families. In terms of emotional functioning, boys brought up in an orphanage had the lowest rates. The children of the orphanage had higher scores in terms of social functioning and school functioning, compared with children from disadvantaged families. The highest results of psychosocial health were observed in children from prosperous families.

Conclusion. The results of the study indicate the need for dynamic supervision of doctors, psychologists, social workers for children from social risk groups, as well as involving not only parents, but also teachers in the work of education in order to create optimal conditions for school and social adaptation.

Aim. To study the association of six polymorphic regions of MBL2 (rs11003125, rs7096206, rs7095891, rs1800450, rs1800451, rs5030737), two regions of FCN2 (rs7851696, rs17549193) and one region of MASP2 (rs72550870) with Helicobacter pylori infection and the severity of neutrophilic inflammation in gastric mucosa among children with recurrent abdominal pain.

Design. Genetic association study of single nucleotide polymorphisms, case — control type.

Materials and methods. 96 adolescents aged 12–17 years with recurrent abdominal pain were examined. Medical history, general clinical methods and fibrogastroscopy with a biopsy of the gastric mucosa were included in the medical testing. Biopsy samples were recorded and processed to assess the neutrophil infiltration and the presence of H. pylori. The results were interpreted according to the Sydney System of Gastritis Classification. Genotyping of allelic gene variants was carried out using real-time polymerase chain reaction (MBL2, MASP2), as well as the restriction analysis of amplification products of specific genome regions (MBL2, FCN2).

Results. A high rate of H. pylori colonization was associated with a high frequency of the L allele of the rs11003125 gene polymorphism of the MBL2 gene and with a decrease in the proportion of high MBL — expressing genotypes. Carriage of the Q allele of the rs7095891 gene polymorphism of the MBL2 gene was associated with less pronounced neutrophilic infiltration, and a high frequency of the T allele of the rs7851696 gene polymorphism of the FCN2 gene was associated with severe neutrophilic inflammation in gastric mucosa. No differences in the distribution of MASP2 genotypes were found.

Conclusion. The results obtained suggest that genetic defects in the production of MBL and ficolin-2 may cause chronic helicobacteriosis in children and more severe inflammation of gastric mucosa. Further study of these proteins seems to be promising for new approaches to the treatment and prevention of H. pylori complications in children to be identified.

Aim. To evaluate tolerability, safety and efficacy of target products used in the treatment of cystic fibrosis (CF) in children.

Design. Retrospective and prospective comparative study.

Materials and methods. The study included 12 patients aged 3 to 18 years old with complete genetic analysis of CF, which can be treated with target therapy (TT), and a chronic bronchopulmonary process. Seven children were treated with a two-component drug and five children — with a three-component drug. A control group included 12 patients with CF, but not treated with TT; the groups were similar in age and sex and had mutations of respective classes. All subjects underwent clinical, laboratory and instrumental tests and assessments. Condition was monitored at baseline, in 2 weeks, 1, 3, 6 months.

Results. At baseline, the majority of patients had minor complaints which resolved without any intervention. Adverse effects, which required drug discontinuation, were recorded in one patient treated with the two-component drug. Patients, who received the three-component therapy, had significant improvement in nutritional status, marked and stable reduction in sweat test values.

Conclusion. Modern TT for CF is well-tolerated, quickly improves patients' state, especially when a three-component drug is used. Subjective perception of improved breathing function, reported by patients, was not confirmed with pulmonary function test results and requires monitoring in a larger population.

Aim. To study peculiarities and to optimise the micro- and macroelemental status of children during the first year of life, the prenatal development of which fell at a military conflict.

Design. Phase one was a retrospective analysis of medical documents (medical history of a pregnant woman, labour and delivery medical record, infant's record; phase two was comparison of the elemental composition of children's hair.

Materials and methods. The study included 154 children less than a year of age: prenatal development of 81 children fell at a military conflict (study group) and 73 children — during the time of peace (controls). Children in both groups were formula-fed as their mothers had agalactia because of stress caused by military actions. Elemental composition of children's hair was determined using an AAC 2280 Perkin Elmer atomic absorption spectrophotometer (USA); identified diselementosis was corrected with introduction of an adapted and enriched formula, and the analysis was repeated in 6 months.

Results. The first analysis revealed imbalance in micro- and macroelemental composition of children's hair in the study group: lower levels of iron, copper, selenium, magnesium, zinc, manganese and potassium, as well as accumulation of toxic elements — lead, cadmium, chrome. A repeated analysis showed significant optimisation of essential micro- and macroelements, as well as reduction in the level of toxic microelements in children's hair.

Conclusion. Prenatal development during an active military conflict causes diselementosis, which leads to somatic pathologies in children of both neonates and infants. An optimal formula makes it possible to correct elemental imbalances during the first year of child's life.

Aim. To compare the microbiome of the healthy gingival sulcus of children with bronchial asthma (BA) and different dental conditions.

Design. Open comparative clinical and laboratory study.

Materials and methods. Gingival substrate was obtained from 19 children aged 3–6 years with exacerbation of BA; the results of sequencing the genes of 16 subunits of ribosomal ribonucleic acid (16S rRNA) on the MiSeq platform (Illumina) were analyzed.

Results. Five major phyla have been identified in the gingival sulcus: Firmicutes, Proteobacteria, Actinobacteria, Fusobacterium and Bacteroidetes and the dominant genus, Streptococcus. A significantly high relative prevalence of the species Neisseria oralis (p = 0.0073), Hemophilic massiliensis (p = 0.046), Hemophilic paraphrohaemolyticus (p = 0.05) and Lautropia mirabilis (p = 0.05) in children with asthma without caries was established. The level of immunoglobulin E (IgE) is significantly higher in children with asthma and caries compared to children without caries (461.79 ± 60.58 and 276.97 ± 81.15 IU/ml).

Conclusion. The predominance of opportunistic and “healthy” bacterial species of the phylum Proteobacteria in the healthy gingival sulcus of children with BA may be an indicator of oral dysbiosis in BA. Overproduction of IgE in children with caries may be due to cariogenic flora, which requires further study.

Aim. To determine the existing possibilities for protecting the brain in children during an unfavorable course of the perinatal period.

Key points. Injury of the central nervous system are one of the most common pathological conditions in the neonatal period. The article presents modern data on the pathogenesis of perinatal brain injury. Characteristics of various therapeutic and preventive strategies for perinatal neuroprotection are given, modern methods and candidate drugs for providing it are described. Particular attention is paid to their mechanisms of action, as well as advantages and disadvantages.

Conclusion. Additional strategies for the prevention and treatment of brain injury are urgently needed for improve the outcome and prognosis of preterm and full-term neonates.

Aim. To present up-to-date information on the epidemiology and manifestation of type 1 diabetes mellitus (DM1) in children and adolescents. The review is based on relevant publications obtained by selective literature search in PubMed and eLIBRARY.RU.

Key points. The incidence of DM1, despite the development of technical and information trends in methods of diagnosis, treatment and self-control, is steadily increasing in childhood and adolescence. DM1 is one of the most common chronic diseases of the endocrine system in childhood. As of 01.01.2023, the total number of patients with diabetes mellitus in Russia registered at the dispensary, according to the Federal Register of Diabetes Mellitus, amounted to 4,962,762 people (3.31% of the population), of whom: with DM1 — 277.1 thousand (5.58%) people, children and adolescents — 48,031 people. The disease significantly reduces the quality of life of the child and his family, threatens the development of microvascular complications and early disability of patients and is a medical and social problem of our time.

Conclusion. The study of the issues and patterns of epidemiology and manifestation, the formation of the epidemiological situation in relation to DM1, including the study of environmental, social and biological factors, allows us to determine the dynamics of the disease and evaluate existing programs for the prevention and treatment of the disease.

Aim. To evaluate the effect of the lactulose prebiotic on the functional state of the gastrointestinal tract and the state of the intestinal microbiome of infants with constipation based on data from Russian and foreign publications.

Key points. The multiple positive effects of breastfeeding on the health of mother and child are unique. However, more than 50% of children in the Russian Federation are artificially fed, and the choice of formula for artificial feeding is fundamental and determines the further state of the baby's health. The review describes on the role of the development of the intestinal microbiota in the child's health, examines the origin and functioning of the “brain — intestine — microbiota” axis, its role in the genesis of functional gastrointestinal disorders (FGID) in children — the most common FGID in infants — functional constipation. The article discusses the use of lactulose in the dietary nutrition of infants, primarily with functional constipation.

Conclusion. The multilevel action of prebiotic lactulose allows it use it for a significant number of therapeutic indications. Lactulose-enriched formulas for the nutrition of children of the first year of life is justified. The article The article contains the Russian and foreign experience of using lactulose-enriched formulas in the nutrition of children of the first year of life.

Aim. To consider the role of hereditary predisposition in the formation of obesity, and to analyze the importance of genetic marker studies in the treatment and prevention of obesity in children and adolescents.

Key points. The increasing prevalence of obesity among children and adolescents over the past decades is one of the most important medical and social problems, since obesity contributes to the emergence of such non-infectious diseases as type 2 diabetes mellitus and arterial hypertension, which are rightly considered a non-infectious epidemic of the 21st century. At the same time, the role of hereditary predisposition in the formation of obesity is well known, and therefore the search for its genetic markers becomes relevant.

Conclusion. Genetic markers help not only to identify patients at risk for obesity, but also to diagnose metabolic disorders at early stages: dyslipidaemia, disorders of carbohydrate metabolism, early manifestations of endothelial dysfunction, which will help to prevent the development of heart attacks, strokes, type 2 diabetes mellitus, and thus reduce disability and mortality from non-infectious diseases. Along with this, the isolation of certain genetic markers and their combinations will allow the creation of personalized obesity treatment and prevention programs.

Aim. Description of the features of differential diagnosis and treatment of convulsive syndrome in children with pseudohypoparathyroidism on the example of a clinical case.

Key points. Pseudohypoparathyroidism is a rare hereditary disease in which clinical and laboratory signs of hypoparathyroidism are noted against the background of an increased level of parathyroid hormone in the blood. The pathogenesis of pseudohypoparathyroidism is based on the resistance of peripheral tissues to parathyroid hormone. One of the first clinical manifestations of this disease may be convulsive syndrome, which requires a broad differential diagnostic search.

Conclusion. The effectiveness of treatment of convulsive conditions directly depends on a correctly established diagnosis, and therefore it is extremely important for a doctor to competently navigate the differential diagnosis of conditions, one of the manifestations of which may be convulsive syndrome. Thus, a rationally structured systematic approach to the differential diagnosis of convulsive syndrome will successfully identify its cause and prescribe the right treatment. The diagnosis of pseudohypoparathyroidism requires a multidisciplinary approach from a team of doctors.

Aim. To study problems that pediatricians face in the management of necrotizing pneumonia, and to show ways to its optimization.

Materials and methods. Necrotizing pneumonia is a serious disease that causes difficulties in the choice of antibiotics, indications for pleural interventions and termination of the therapy. Although mostly pneumococcal, pneumonias with purulent cavities and methapneumonic pleurisy (immunopathologic in its origin) are clinically resistance to antimicrobials, and it is taken by pediatricians as indications for changing antibiotics and pleural taps. Hence the importance of studying the prevalent tactics. We conducted analysis of 52 tele-requests for children with pulmonary consolidation and air-filled cavities. Its share among all “general pediatric” requests increased from 5% in 2021–2022 to 18% in 2023–2024. Of 52 patients 43 had also pleural effusions, 11 — pneumothorax. Pneumonia followed measles in 6 children, pertussis in 3, scarlet fever — in 1. All diagnostic and curative actions were compared to Clinical guidelines.

Results. In all instances conditions for hospital care (including intensive) were generally adequate, diagnostic activities were often redundant (nonrelevant analyses, multiple computer tomography instead of X-ray). Only 16 patients were started on cephtriiaxone and amoxicillin/clavulanate recommended by Clinical guides, the rest received reserve antibiotics. All patients received the 2nd course (combinations of the reserve antibiotics), 20 of them also the 3rd course. Steroids were given only to 3 patients. Of 43 children with pleurisy taps or drainage had 33, only 9 of them according to indications.

Conclusion. Pediatricians are not fully conversant with Clinical guides and it causes excessive administration of 2–3 courses of reserve antibiotics, unnecessary pleural interventions, infrequent use of steroid therapy that shortens the length of hospital stay.

Aim. To determine the main categories of the International Classification of Functioning, Disability and Health that constitute a rehabilitation diagnosis in a premature infant with perinatal lesions of the nervous system.

Key points. One of the urgent tasks in the formation of a unified approach to the rehabilitation and habilitation of premature babies when they are transferred from the first or second stage of rehabilitation is to assess the child's rehabilitation status and establish a rehabilitation diagnosis. For this purpose, we used the International Classification of Functioning, Disabilities and Health. Studied domains include nervous system structures; vision and related functions; hearing and vestibular functions; neuromuscular and movement-related functions; skeletal, digestive, and metabolic functions; child mobility; and environmental factors. The article describes a clinical case of a 9.5-month-old patient, born at 30 weeks' gestation, who was admitted to a rehabilitation course at a day hospital with a complaint of delayed motor development. After establishing the rehabilitation diagnosis, the infant's average rehabilitation potential was determined and a favourable rehabilitation prognosis was predicted on the basis of the rehabilitation results. The positive effect of the rehabilitation activities was associated with the emergence of new skills and improvement in the rehabilitation status of the child.

Conclusion. Formulating a rehabilitation diagnosis involves assessing the patient's current situation, which makes it possible to set rehabilitation goals, form a multidisciplinary rehabilitation team, justify the use of rehabilitation methods and evaluate the outcome of rehabilitation interventions.

Aim. To present a clinical case of atypical erysipelas, complicated by an allergic reaction, in a 10-year-old child.

Key points. Erysipelas is an urgent medical and social problem, and, despite the success of antibacterial therapy, its frequency does not tend to decrease. Erysipelas belongs to the group of pyoderma and occupies a leading place in the structure of purulent-septic diseases. The main etiological factor of erysipelas is considered to be group A Streptococcus. However, the ineffectiveness of traditional antibacterial therapy regimens speaks in favor of the polyetiological nature of this disease and requires great attention in choosing the starting drug. In children, the erythematous-bullous form is more common, which may require differential diagnosis not only with infectious diseases, but also with a number of allergic diseases with the prescription of desensitizing therapy. The article examines a clinical case of an atypical course of erysipelas in the area of the right half of the face, complicated by an allergic reaction in a 10-year-old girl. The ineffectiveness of initial antibacterial therapy and its correction based on the clinical picture, taking into account the negative results of laboratory tests, have been demonstrated.

Conclusion. Erysipelas in children with a burdened premorbid background, especially with atypical forms, requires great attention from doctors, since in these cases, if therapy is ineffective, the risk of complications may be increased.

Aim. To evaluate the results of rehabilitation of patients with Costello syndrome in a day hospital in the long-term period.

Design. A retrospective, single-center, prolonged, non-randomized observational study.

Materials and methods. The study included 6 patients with genetically verified Costello syndrome who were observed in a day hospital in the period from 2012 to 2024. The results of catamnestic observation and rehabilitation of patients are analyzed.

Results. Catamnestic observation in a multidisciplinary hospital for 2–12 years made it possible to evaluate the effectiveness of rehabilitation in the patients. Comprehensive individual rehabilitation programs were developed for 6 patients with Costello syndrome (5 girls, 1 boy) aged 4 months to 12 years. All patients received rehabilitation on the background of medication prescribed by pediatrician and neurologist, within botulinum therapy (2 children). In addition to physical influence (physiotherapy, kinesiotherapy), there were classes with a speech therapist, speech pathologist and a family psychologist. The results were evaluated according to indicators of psychomotor and speech progress, cognitive abilities and social adaptation. Positive dynamics was demonstrated in 5 out of 6 observed patients. Six patients underwent a complex individualized rehabilitation therapy during periods of stabilization of their condition after pediatrician approval. In our research 3 оf 6 children with Costello syndrome underwent 3 rehabilitation courses at the age of 1–2 years. Other 3 patients continued to undergo rehabilitation treatment one time per year during long-term follow-up observation in a day hospital, their programs were developed individually in accordance with current tasks. An integrated approach allowed children to adapt to society and start visiting the secondary school.

Conclusion. Comprehensive individual rehabilitation programs developed for each patient, based on the results of examination, made it possible to achieve an improvement in the patients' condition — neuro-orthopedic and somatic indicators, as well as cognitive development and social adaptation.