Background. Over the last decade, the understanding of pediatric disorders of gut-brain interaction has shifted from motility disorders to a comprehensive biopsychosocial model. The updated Rome V (2026) international guidelines introduce an anatomical classification principle and expand the role of modern instrumental methods for diagnosing esophageal pathology. This has enabled the identification of new esophageal disorders and the proposal of multidisciplinary approaches to their treatment. The purpose was to analyze the current state of the issue of pediatric disorders of gut-brain interaction, namely of the upper gastrointestinal tract, based on a review of the updated Rome V criteria, as well as to determine the main changes in diagnosis and patient management. Materials and methods. A comprehensive systematic review was performed using PubMed, Web of Science, Scopus, and Google Scholar databases from 2016 through May 2026. A total of 386 publications were identified, of which 47 met the inclusion criteria. Results. The transition to an anatomical classification principle in the Rome V criteria was shown to facilitate a more precise differentiation of functional esophageal disorders in children. The diagnostic characteristics of newly defined disorders, namely reflux hypersensitivity, reflux-negative esophageal pain disorder, and supragastric belching, were systematically analyzed. An evidence-based algorithm for the use of pH-impedance monitoring and high-resolution esophageal manometry was developed. Furthermore, the inclusion of multidisciplinary specialists, particularly psychotherapists and speech therapists, in personalized management strategies was justified. Conclusions. Prospective studies should be directed at clarifying the prevalence of pediatric esophageal disorders, identifying specific risk factors, and developing treatment.
Background. Neutrophilic airway inflammation is a central pathogenic mechanism in bronchiectasis. However, the prognostic value of serum inflammatory biomarkers in the paediatric population remains uncertain, and most available evidence derives from mixed-etiology cohorts and adult patients. The aim of the study was to evaluate serum interleukin-6 (IL-6) and neutrophil elastase (NE/ELA2) concentrations in children with bronchiectasis of different etiologies, determine their diagnostic utility, and assess associations with key disease-control outcomes, including the rate of exacerbations requiring antibiotic therapy, hospitalisation frequency, forced expiratory volume in 1 second, and quality of life measured using bronchiectasis child-specific parent-proxy QoL instrument. Materials and methods. A total of 150 children aged 2–17 years were enrolled and divided into three groups: non-cystic fibrosis bronchiectasis (non-CF, n = 50), cystic fibrosis-associated bronchiectasis (CF, n = 50), and apparently healthy controls (n = 50). IL-6 and NE/ELA2 were measured by enzyme-linked immunosorbent assay. Kruskal-Wallis and Mann-Whitney tests, ROC analysis with area-under-the-curve (AUC) comparison using DeLong’s method, Spearman correlation, partial rank correlation, and Firth logistic regression were applied. Results. Both biomarkers exhibited a stepwise gradient: controls < non-CF < CF (all pairwise p < 0.001), and their distributions in patients and healthy controls did not overlap (AUC = 1.000). For clinically meaningful discrimination between etiological groups, performance was moderate: IL-6, AUC = 0.884; NE/ELA2, AUC = 0.865 (DeLong p = 0.653). In the pooled cohort, 21 significant correlations among 34 tested associations were identified, as well as 13 significant odds ratios among 18 evaluated comparisons (3.6–10.2). Conclusions. Serum IL-6 and NE/ELA2 reliably reflect disease presence and etiologic category. Within diagnostically homogeneous groups, however, their association with individual clinical course did not reach statistical significance, which — given the cross-sectional design — indicates limited prognostic value for monitoring and warrants confirmation in prospective studies. Based on the present data, disease monitoring should rely primarily on clinical outcomes and quality-of-life measures.
Background. Modern treatment protocols for childhood acute lymphoblastic leukemia (ALL) have greatly improved survival; however, a growing number of survivors experience late endocrine complications as a consequence of treatment. The purpose was to evaluate the spectrum and frequency of late endocrine complications in childhood ALL survivors managed with a chemotherapy-only regimen. Materials and methods. A non-randomized, analytic cross-sectional study was conducted on 50 patients diagnosed with ALL between March 2011 and February 2020 at the Pediatric Hemato-Oncology Center, Children’s Central Teaching Hospital, in Baghdad, Iraq. All participants had achieved complete remission for at least 2 years. Clinical and laboratory investigations were performed to identify late endocrine complications. Results. Overweight and obesity were identified in 16 patients (32 %) and were significantly associated with age younger than 5 years at diagnosis (p = 0.044). Short stature was observed in 3 patients (6 %). Prediabetes was detected in 6 patients (12 %) and showed a significant association with overweight and obesity (p = 0.009). Subclinical hypothyroidism and delayed puberty were each detected in one patient (2 %). No significant associations were found between short stature, prediabetes, thyroid dysfunction, or delayed puberty with respect to age or sex. Conclusions. Overweight and obesity were the most frequent endocrine late complications among childhood ALL survivors and were associated with younger age at diagnosis. Prediabetes was more common in overweight and obese patients, highlighting the importance of long-term metabolic surveillance in this population.
Background. Chronic diseases among children, such as asthma, are increasing globally. Asthma is one of the most common chronic illnesses and represents a major global health issue that results in significant morbidity. The purpose of this review is to discuss the effectiveness of education programs on knowledge, medication adherence, asthma management skills, and self-efficacy among children and their parents with asthma. Materials and methods. Database searches were completed in CINAHL, Springer, Science Direct, PubMed, MEDLINE, Google Scholar, and EBSCOhost. Papers published between 2015 and 2025 were included using keywords such as asthma, child, self-management, self-efficacy, and adherence interventions. A total of 165 records were identified. After removing duplicates and irrelevant studies, 12 papers were included in the final review. Results. The included studies demonstrated significant improvements in asthma knowledge, medication adherence, asthma management skills, and self-efficacy among children and caregivers. Conclusions. Asthma education interventions positively impact outcomes for children with asthma; they still need to build up a unified, evidence-based approach including structured education, accessible action plans, and continuous reinforcement for optimizing asthma control in children.
Background. Sustained asthma control in children is often difficult to achieve, and biomarkers reflecting airway epithelial integrity are needed. Club cell secretory protein 16 (CC16) is a candidate marker of epithelial injury and lower airway inflammation. Objective: to determine serum CC16 in children with asthma according to disease severity and control. Materials and methods. This prospective study enrolled 72 children aged 6–17 years: 52 with asthma (mild, n = 13; moderate, n = 22; severe, n = 17) and 20 healthy controls. Serum CC16 was measured by enzyme-linked immunosorbent assay, and asthma control was assessed with the Childhood Asthma Control Test. Data are presented as mean ± SEM; a multivariable model assessed the association between CC16 and asthma severity, adjusted for confounders including age and sex. Results. Children with asthma had markedly lower serum CC16 concentrations than controls (1.80 ± 0.16 vs 2.51 ± 0.15 ng/mL; p = 0.0001). CC16 showed an inverse correlation with asthma severity (r = –0.45; p < 0.001). In children with mild asthma, the mean CC16 level was 2.42 ± 0.56 ng/mL and was notably higher than in severe asthma, where the lowest values were recorded (1.20 ± 0.06 ng/mL; p = 0.024). In moderate asthma, the mean CC16 concentration was 1.90 ± 0.14 ng/mL and was also lower than in the control group (p = 0.006). No statistically significant differences were found according to asthma control status (p = 0.148), although a downward trend in CC16 concentration was observed with poorer disease control. Mean CC16 decreased across control categories: 2.32 ± 0.43 ng/mL in controlled, 1.56 ± 0.11 ng/mL in partially controlled, and 0.85 ± 0.02 ng/mL in uncontrolled asthma. In the multivariable model, asthma severity remained an independent predictor of serum CC16 (β = –0.73; p = 0.002). Conclusions. In children with asthma, serum CC16 is reduced in proportion to disease severity, with the lowest levels in severe asthma, supporting its potential as a non-invasive biomarker of disease course.
Background. Significant advances in pediatric oncohematology in recent years have been driven by modern polychemotherapy protocols combined with hematopoietic stem cell transplantation, which has led to improved survival rates in children with hemoblastoses. Simultaneously, a growing number of researchers focus their attention on long-term outcomes, especially psycho-emotional and metabolic abnormalities. Obesity is a critical dimension hindering the rehabilitation process, it impairs emotional status, self-esteem, social integration of a child, thus calling for multifaceted rehabilitation strategy. The purpose was to assess the psycho-emotional state of children with hemoblastoses in late remission considering comorbid obesity and to evaluate the effectiveness of Passiflora incarnata extract. Materials and methods. A prospective single-center non-randomized quasi-experimental study was conducted. It included 166 children aged 8–18 years with hemoblastoses in late remission and 250 healthy controls. Psycho-emotional status was assessed using the Spielberger-Hanin scale and the Dembo-Rubinstein method. Statistical analysis included ANOVA with Tukey post hoc test and Bonferroni correction, Pearson’s χ2 test, and multivariate regression analysis. Effect size was estimated using η2. Sample size calculation was done using G*Power 3.1 (α = 0.05; power = 80 %). Results. Children with hemoblastoses demonstrated increased anxiety levels and reduced self-esteem compared to controls (p < 0.01). Comorbid obesity was associated with more pronounced psycho-emotional disturbances (p < 0.01; η2 ≈ 0.27). The use of Passiflora incarnata extract contributed to reduced anxiety and improved self-esteem (p < 0.01). Conclusions. The use of standardized Passiflora incarnata extract may be effective as an adjuvant component in the comprehensive rehabilitation of children with hemoblastoses and requires further confirmation in randomized controlled trials.
Background. Objective assessment of acute asthma severity in children remains challenging, particularly in emergency settings where rapid and accessible biomarkers are needed. The eosinophil-to-lymphocyte ratio (ELR), derived from routine complete blood counts, has emerged as a novel inflammatory marker. This study purposed to evaluate the correlation between ELR and the Pediatric Asthma Severity Score (PASS) in children with acute asthma exacerbation. Materials and methods. This cross-sectional study included children aged 2–18 years admitted to a tertiary hospital with acute asthma exacerbation between January 2022 and December 2025. ELR was calculated from absolute eosinophil and lymphocyte counts obtained at initial emergency department presentation. Asthma severity was assessed using PASS. The association between ELR and PASS was analyzed using the Spearman correlation coefficient. Differences in ELR across severity categories were evaluated using the Kruskal-Wallis test. Receiver operating characteristic (ROC) analysis was performed to assess ELR’s ability to discriminate severe exacerbations. Results. A total of 98 children were analyzed (63.3 % male; median age 9 years). The median PASS was 8 (IQR 2), and the median ELR was 0.25 (IQR 0.36). ELR showed a significant moderate positive correlation with PASS (r = 0.511; p < 0.001). ELR values differed significantly across severity categories (p < 0.001), with higher median ELR levels in moderate and severe exacerbations than in mild cases. However, ROC analysis demonstrated limited discriminatory performance for severe exacerbation (AUC 0.603; 95% CI 0.367–0.840; p = 0.391). Conclusions. ELR is moderately correlated with clinical severity, as assessed by PASS, in children with acute asthma exacerbation. Although ELR may reflect inflammatory burden, its ability to distinguish severe from non-severe exacerbations is limited. Therefore, ELR may serve as an adjunct inflammatory marker in the initial clinical evaluation, but should not be used as a standalone predictor of severe disease.
Background. Coronavirus disease (COVID-19) has caused significant long-term multisystem consequences, especially in children and adolescents. Post-COVID-19 syndrome (PCS/long COVID) substantially impairs quality of life and increases the burden on healthcare systems. Objective: to systematize current literature data on clinical manifestations, risk factors, and structure of PCS in children and adolescents, as well as to identify the most effective areas of rehabilitation measures. Materials and methods. A narrative literature review was performed in PubMed/MEDLINE, Google Scholar, Wiley Online Library, and the Vernadsky National Library of Ukraine for December 2020 — April 2026. A total of 564 publications were identified; 109 met the inclusion criteria and were analyzed. Results. PCS develops in 10–30 % of children and adolescents after SARS-CoV-2 infection and is characterized by high polysyndromicity and multisystem involvement. The most frequent manifestations include pathological fatigue, dyspnea, headache, cognitive impairment (“brain fog”), sleep disorders, anxiety/depressive disorders, reduced exercise tolerance, myalgia/arthralgia, and skin lesions. Key risk factors are female sex, adolescent age, obesity, bronchial asthma, severe acute course, hospitalization, and multisystem inflammatory syndrome. Conclusions. PCS in children is a complex multisystem condition requiring early risk stratification, long-term monitoring, and comprehensive rehabilitation. The most effective interventions are cognitive and olfactory training, cognitive-behavioral therapy, nutritional correction (especially vitamin D supplementation), and vaccination, which reduces the risk of PCS by approximately 75 %. Timely rehabilitation prevents chronicity and improves quality of life.
Background. Despite available data, the problem of early prediction of COVID-19 severity in the pediatric population remains unresolved. The purpose was to assess the prognostic significance of NSE, S100, IFABP, NGAL, and E-selectin biomarkers in children with COVID-19 and to develop an integrated risk score for early identification of groups at risk of a complicated course. Materials and methods. The study was retrospective, observational and comparative. It included 88 children aged 0–18 years with laboratory-confirmed COVID-19 who were inpatients at the Kyiv City Children’s Clinical Infectious Diseases Hospital in 2022–2023. Participants were divided into two groups depending on the damage of the upper or lower respiratory tract, which corresponded to the mild and moderate course of the disease. Serum level of biomarkers (NSE, S100, IFABP, NGAL, E-selectin) was determined by the enzyme-linked immunosorbent assay during hospitalization. Statistical analysis was performed using the licensed program EZR v.1.54 (Graphical User Interface for R statistical software version 4.0.3, R Foundation for Statistical Computing, Vienna, Austria). Results. The study found that children with complicated COVID-19 had higher levels of NSE, E-selectin, IFABP, and NGAL compared to patients with uncomplicated disease, while S100 levels did not differ significantly between groups. According to the results of ROC analysis, all studied biomarkers demonstrated prognostic value for the development of COVID-19 complications in children (AUC 0.647–0.843), with S100 and NSE having the highest efficacy. The developed integrated risk scale based on five biomarkers demonstrated good discriminatory ability (AUC = 0.806; sensitivity 88.1 %; specificity 73.9 %) and allowed stratifying patients according to the level of risk of developing complicated COVID-19. Conclusions. The prognostic significance of NSE, S100, IFABP, NGAL and E-selectin biomarkers has been established for the development of complicated COVID-19 in children and the formation of lesions of the nervous, gastrointestinal, cardiovascular systems and endothelium. An integrated risk scale has been created, which allows for early stratification of patients and predicting the severity of the disease.
Background. Latent autoimmune diabetes in youth (LADY) is an overlooked clinical entity on the autoimmune diabetes spectrum, typically manifesting between 16 and 29 years of age. Because endogenous insulin secretion is initially preserved and clinical features frequently overlap with type 2 diabetes mellitus, LADY is regularly misdiagnosed, which delays targeted therapeutic interventions. The aim of this study was to define the specific metabolic profile of young patients with LADY by comparing directly with classical type 1 diabetes mellitus (cT1DM) and latent autoimmune diabetes in adults (LADA). Materials and methods. We conducted a single-center cross-sectional study involving 106 individuals with validated autoimmune diabetes, stratified into three cohorts: cT1DM (n = 40), LADA (n = 36), and LADY (n = 30). Clinical tracks focused on fasting plasma glucose, glycated hemoglobin, body mass index, waist circumference, and waist-to-height ratio (WHtR). Group variations were examined using non-parametric statistical criteria. Results. Age at onset in the LADY group mirrored the cT1DM cohort but was drastically lower than in the LADA group (p < 0.001). Body mass index in LADY occupied a distinct middle ground, scaling higher than in cT1DM (p = 0.005) yet remaining lower than in LADA (p = 0.002). Interestingly, both waist circumference and WHtR in LADY tracked closely with cT1DM, falling well below the values observed in LADA (both p < 0.001). The median WHtR for LADY individuals did not breach the standard 0.5 cardiometabolic risk threshold. Among the tested metrics, WHtR demonstrated the highest sensitivity for mapping cardiovascular risk differences between LADY and LADA. The low WHtR in LADY indicates minimal central fat distribution and a benign metabolic setup. Conversely, elevated WHtR markers in LADA align with an accumulation of cardiovascular vulnerabilities and a higher baseline for future vascular issues. Conclusions. LADY functions as a distinct metabolic endotype characterized by early presentation, ongoing autoimmunity, and a favorable metabolic profile with low visceral adiposity. Using WHtR offers a simple, accessible clinical strategy to separate LADY from LADA, signaling which young patients require immediate pancreatic autoantibody screening.
Background. Linear IgA bullous dermatosis (LABD) is a rare autoimmune subepidermal vesiculobullous disease affecting both children and adults and frequently mimicking infectious or allergic dermatoses. In clinical infectious disease practice, LABD may be misdiagnosed as varicella, recurrent herpes zoster, drug-induced toxicoderma, and other autoimmune bullous dermatoses. The purpose was to provide a pragmatic diagnostic algorithm for differentiating infectious and autoimmune vesiculobullous diseases based on an analysis of own clinical case series and up‑to‑date evidence, with an emphasis on accessible diagnostic steps under limited resources. Materials and methods. This study is a retrospective clinical case series including 5 patients with clinically established LABD (two children aged 3 and 5; three adults aged 19, 25, and 27 years). All participants underwent clinical examination, basic laboratory tests; if indicated, polymerase chain reaction of vesicle contents for varicella zoster virus (VZV) and herpes simplex virus (HSV) 1/2 DNA to exclude the infectious nature of the disease. Based on the analysis of the literature and our own data, modern approaches to clinical morphological and immunopathological verification of LABD (biopsy + direct (DIF)/indirect immunofluorescence, linear IgA) were summarized. The report was prepared in accordance with the CARE 2013 and STROBE guidelines. Results. In 4 of 5 cases, a potential trigger occurred 1–3 months before onset (acute respiratory viral infection or lacunar tonsillitis; nonsteroidal anti-inflammatory drugs/paracetamol use). Fever or systemic toxicity was absent in all patients. Lesions were polymorphic with annular/arciform clusters (“string of pearls”), with moderate pruritus in 4 of 5 cases. Mucosal involvement was not observed, except erosive cheilitis in one child. We propose a stepwise diagnostic algorithm prioritizing exclusion of VZV/HSV infection before prescription of immunosuppressive drugs and emphasizing DIF as the diagnostic gold standard. Conclusions. LABD remains a multidisciplinary diagnostic challenge. In conditions of limited availability of immunopathological verification of the disease, it is advisable to use a structured algorithm: 1) assessment of clinical morphology of rashes and possible triggers; 2) exclusion of herpesvirus infections (VZV/HSV) in bullous rashes; 3) consultation with a dermatologist; 4) referral for biopsy with DIF; 5) assessment of severity; 6) individualized selection of therapy taking into account severity and safety.
Background. Length of stay (LOS) in the neonatal intensive care units (NICUs) shows illness severity and healthcare resource utilization. Longer hospitalizations raise the risk of complications and impose substantial economic and psychosocial burdens on families. Evidence regarding the factors influencing NICU LOS in secondary referral hospitals in Indonesia remains limited. Materials and methods. This retrospective observational study included 97 neonates admitted to the NICU of a secondary referral hospital in Indonesia between August 2024 and August 2025. Independent variables were sex, mode of delivery, gestational age, birth weight, Apgar scores, age at initiation of trophic feeding, and oxygen support category. LOS was measured in days. Mann-Whitney U and Pearson-Spearman correlation tests were used for bivariate analysis. Variables with p < 0.10 were entered into a multivariable Poisson regression model to identify independent predictors of LOS. Results. The median LOS was 10 days (interquartile range 11; range 3–72 days), and the mean was 13.65 days. Bivariate analysis showed significant associations between LOS and gestational age (p < 0.001), birth weight (p < 0.001), Apgar score at 5 minutes (p = 0.029), age at trophic feeding initiation (p < 0.001), and oxygen support category (p = 0.002). In the multivariable analysis, each additional week of gestational age was associated with a lower LOS (adjusted rate ratio (aRR) = 0.25; 95% confidence interval (CI): 0.06–0.98; p = 0.047). Each 100 g rise in birth weight also reduced LOS (aRR = 0.16; 95% CI: 0.04–0.69; p = 0.002). On the other hand, each day of delay in initiating trophic feeding was associated with a higher LOS (aRR = 2.68; 95% CI: 1.05–6.86; p = 0.039). Conclusions. Gestational age, birth weight, and the timing of trophic feeding were strong predictors of NICU length of stay. Early identification of high-risk neonates and timely initiation of enteral feeding may help shorten hospitalization and improve resource utilization. This is particularly important for NICUs in resource-limited hospitals.
Background. Birth defects (BDs) are a major cause of neonatal morbidity and mortality worldwide. Maternal socioeconomic, behavioral, and health factors may contribute to abnormal fetal development. Objective: to assess the association between maternal education, behavioral factors, and selected health conditions with BDs among newborns in the Lviv Region (Ukraine). Materials and methods. A case-control study was conducted using medical records from maternity hospitals in the Lviv Region (2002–2025). A total of 1,455 newborns with BDs and 1,448 healthy newborns (controls) were analyzed. Maternal education, reproductive history, lifestyle habits, endocrine disorders, extragenital diseases, and gynecological infections were evaluated. Results. Maternal educational level varied significantly between groups (p < 0.01). Mothers with incomplete secondary education were more frequent in the BDs group (10.2 vs. 1.6 %; odds ratio (OR) = 7.069; 95% confidence interval (CI): 4.528–11.036, p < 0.01), while there were less women with higher education in this group (24.5 vs. 30.2 %; OR = 0.811; 95% CI: 0.719–0.914; p < 0.01). Smoking (13.5 vs. 5.5 %; OR = 2.69; 95% CI: 2.06–3.52; p < 0.001) and alcohol consumption (2.0 vs. 0.14 %; OR = 14.6; 95% CI: 3.5–61.2; p < 0.001) were more prevalent among mothers of affected newborns. Endocrine disorders were more frequent in the BDs group (24.6 vs. 14.0 %; OR = 2.02; 95% CI: 1.68–2.43; p < 0.001), in most cases, it was thyroid diseases. Chronic extragenital disorders (33.1 vs. 22.0 %; OR = 1.501; 95% CI: 1.329–1.694; p < 0.01) and gynecological infections (24.1 vs. 19.3 %; OR = 1.248; 95% CI: 1.086–1.435; p < 0.01) were also significantly associated with BDs. No significant differences were observed between age at menarche, menstrual cycle characteristics, or hormonal contraceptive use (p > 0.05). Conclusions. Maternal socioeconomic, behavioral, and health-related factors may in common influence the risk of BDs, supporting their multifactorial etiology and the role of modifiable determinants. Further large-scale population studies are needed to clarify causal mechanisms.
Background. The concept of safety netting in pediatrics is considered an important tool for safely completing a consultation under diagnostic uncertainty. In pediatric practice, its importance is particularly great, since early manifestations of serious diseases in children are often nonspecific, and further monitoring of the child’s condition is largely carried out by parents or guardians. In modern literature, safety netting is interpreted as a combination of clinical thinking, communication, informing about signs of deterioration, and organizing repeat visits. The purpose is to generalize and analyze modern scientific data on the concept of safety netting in pediatrics and determine its clinical and educational significance. Materials and methods. The study was conducted as a narrative literature review. The search for sources was made in the PubMed/MEDLINE, Scopus and Google Scholar databases for 2016–2026 using the following keywords: “safety netting”, “safety netting + pediatrics”, “safety netting + diagnostic uncertainty”, “safety netting + primary care”, “safety netting + medical education”, “safety netting + parent communication”. Additionally, the snowball method and analysis of some sources of grey literature were used. The selection of publications was carried out in accordance with the PRISMA 2020 principles. The qualitative synthesis included 17 sources on the clinical, communication and educational aspects of safety netting in pediatrics and primary care. Results. It was found that safety netting is a multi-component concept that includes reporting diagnostic uncertainty, informing about red flags, explaining the expected course of the disease, determining the timing and routes of repeat visit, organizing follow-up and documenting recommendations. The sources analyzed indicate that the effectiveness of safety netting depends on the clarity, specificity, individualization and comprehensibility of advice for parents, as well as on the use of written or digital support formats. It has been shown that safety netting can contribute to the rational use of antibiotics, reduce unjustified repeat visits and increase parental confidence in caring for their child. At the same time, the evidence base remains limited due to the heterogeneity of studies, the prevalence of qualitative and descriptive designs and the lack of standardized models for implementing this strategy. The educational value of safety netting as a professional competence that requires targeted formation in medical students and doctors is particularly emphasized. Conclusions. The concept of safety netting in pediatrics is an important component of clinical safety, combining parent communication, management of diagnostic uncertainty and planning for further monitoring of the child. Its effectiveness depends on the quality of communication, adaptation of recommendations to a specific family and proper documentation. Given its clinical and educational significance, it is advisable to integrate safety netting principles into undergraduate and postgraduate training of physicians.
Background. Epilepsy in early childhood can cause a significant developmental and psychosocial burden, yet the determinants of health-related quality of life (HRQoL) in patients aged 2–4 years remain inadequately characterized, especially in clinical settings. This limited evidence becomes a hindrance to holistic management strategies for children with epilepsy. The purpose was to analyze factors that influence the quality of life of children with epilepsy, especially those aged 2–4 years. Materials and methods. A cross-sectional study was conducted involving 101 participants recruited from a pediatric neurology clinic. Questionnaire-based interviews using the PedsQL Epilepsy Module were performed to assess the HRQoL. Bivariate and multivariate analyses were used to assess factors associated with quality of life. Results. The highest proportion with poor HRQoL was observed in cognitive (67.3 %) and executive (73.3 %) domains. In multivariable analysis, seizure frequency ≥ 2 times per month (OR = 3.562; p = 0.026) and treatment duration ≥ 1 year (OR = 3.862; p = 0.006) were independently associated with poor HRQoL. Conclusions. The findings of this study highlight the importance of early detection of children with epilepsy who are at risk of reduced HRQoL, enabling more targeted interventions that extend beyond a sole focus on clinical improvement.
Background. Typhoid fever, caused by Salmonella enterica serovar typhi (S.typhi), remains a leading cause of morbidity and mortality in low- and middle-income countries. The global emergence of extensively drug-resistant strains has severely constrained therapeutic options, particularly in pediatric populations where the clinical consequences are most severe. The purpose was to determine the frequency of blood culture-confirmed S.typhi infection and to characterize the antibiotic susceptibility pattern of the isolates among children admitted to a tertiary pediatric hospital in Najaf, Iraq. Materials and methods. A cross-sectional study was conducted at Al-Zahraa Teaching Hospital for Children’s Health and Maternity between January 10, 2021, and July 28, 2022. A total of 319 children aged 9–156 months with clinically suspected typhoid fever were evaluated. Blood cultures were processed using the BacT/ALERT system, with subcultures on xylose-lysine-deoxycholate, MacConkey, and blood agar. S.typhi was identified and tested for antimicrobial susceptibility using the VITEK 2 automated system (Gram-negative identification and antimicrobial susceptibility testing cards). Data were analyzed with SPSS version 28; a one-sample chi-square test was used to assess the distribution of susceptibility and resistance across antibiotics, with statistical significance set at p < 0.05. Results. Blood culture confirmed S.typhi infection in 144 of 319 children (45.1 %). The mean age was 65.4 ± 38.7 months; 96 (66.7 %) were male, and 48 (33.3 %) were female. The highest susceptibility rates were observed for meropenem (125/144; 86.8 %), imipenem (116/144; 80.6 %), and trimethoprim-sulfamethoxazole (97/144; 67.4 %) (p < 0.01). Resistance was most frequent to ceftazidime (100/144; 69.4 %), gentamicin (82/144; 56.9 %), amikacin (76/144; 52.8 %), ciprofloxacin (75/144; 52.1 %), and ceftriaxone (75/144; 52.1 %) (p < 0.01). Conclusions. Extensively drug-resistant S.typhi poses a substantial clinical challenge among pediatric patients in Najaf. Carbapenems and trimethoprim-sulfamethoxazole retained the highest activity, whereas resistance to third-generation cephalosporins and fluoroquinolones was significant. Ongoing antimicrobial surveillance and stewardship are urgently required to guide empirical therapy.
Background. Hypertension in adolescence is associated with early hypertension-mediated target organ damage. Studying the individual stability of myocardial remodeling phenotypes in dynamics is critical for cardiovascular risk stratification. Objective: to investigate the dynamics of myocardial morphofunctional remodeling and its individual variability in adolescents with primary hypertension during a one-year follow-up. Materials and methods. We enrolled 108 male adolescents (aged 14–17 years) with primary hypertension and normal body weight (body mass index 21.8 ± 0.2 kg/m2). Following a prospective observational design, we re-evaluated 30 patients after one year. This sample reduction resulted from migration caused by martial law in Ukraine. We performed echocardiography (ASE/EACVI, 2023) and ambulatory blood pressure monitoring, calculating effect size (Cohen’s d) and statistical power (1 – β) to ensure data reliability. Results. Our findings demonstrate that primary hypertension in male adolescents induces left ventricular volume overload (end-diastolic volume +19.6 %, d = 1.04) and increases myocardial mass (+23.5 %, d = 0.62) while maintaining preserved conventional systolic function (d = 0.06). A hyperkinetic circulation dominated the hemodynamic profile (d > 1.0 for stroke volume and cardiac index). A one-year follow-up revealed pronounced individual variability in remodeling patterns: 33.3 % of adolescents changed their type of cardiac geometry. Isolated left ventricular hypertrophy showed a transient nature (100 % regression), whereas dilation and combined patterns remained stable. Group mean values masked a significant increase in circumferential fiber shortening velocity (Vcf, d = 0.65, power 78.4 %), indicating subclinical inotropic tension. Conclusions. Male adolescents with primary hypertension exhibit significant yet heterogeneous myocardial remodeling. The complete regression of hypertrophy versus the persistent nature of dilation justifies regular echocardiographic monitoring to differentiate physiological pubertal adaptation from progressive pathological remodeling.
Background. Transesophageal echocardiography (TEE) is the established imaging guide for transcatheter atrial septal defect (ASD) closure, yet it also carries significant drawbacks, including the need for general anesthesia in children, increased procedural costs, and contraindications in select patients. Although transthoracic echocardiography (TTE) is a noninvasive and readily available alternative, the degree of reliability with which it can guide device sizing and deployment is still poorly defined. The purpose was to evaluate the safety and efficacy of TTE-guided/performed transcatheter closure of secundum ASDs, and determine whether TTE-based measurements in conjunction with real-time echocardiographic assessment are reliable for selecting occluder size. Materials and methods. This is a prospective study of 89 patients (66 females; mean age 23 years; range 2.5–68) who underwent TTE-guided transcatheter secundum ASD closure at Al-Najaf Cardiac Centre, Iraq, from January 2023 to December 2025. The reference ASD size was the maximal ASD diameter measured on multiview TTE. In group A (n = 42, < 20 mm), TTE diameter ± 2–4 mm (15–20 %) of the measured defect size was considered, and in group B (n = 47, ≥ 20 mm), this allows a final device sizing of ± 5–7 mm (20–25 %) above the defect measurement. The primary endpoint was successful closure with the TTE-selected device (no residual shunt/no structural interference). Secondary endpoints included overall procedural success, complications, and fluoroscopy time. Results. Transcatheter closure was successful in 86/89 (96.6 %) patients overall, and the TTE-selected device was accurate in 81/89 (91.0 %) patients. Successful device selection was 95.2 % (40/42) in group A and 87.2 % (41/47) in group B (P > 0.05). Adequate rims predicted superior outcomes (94.9 .vs 63.6 % for deficient rims; P < 0.05). In group B, an upsize of 20–25 % was superior to an upsize of 15–20 % (91.1 vs. 70 %; P < 0.05). No patient died. Complications were minor and occurred in 12 patients (13.4 %) — transient arrhythmia (8), groin hematoma (2), and trivial residual shunt (2). Of the three, two with a deficient posteroinferior rim and one with a superior rim had to be referred for surgical evaluation. Conclusions. TTE provides safe, reliable, and cost-effective vguidance for transcatheter secundum ASD closure and accurate device sizing, especially when septal rims are adequate. For defects ≥ 20 mm, choosing a device 20–25 % larger than the TTE-measured diameter yields the best results.
Background. Pompe disease (PD) is a genetic orphan progressive multisystem neuromuscular disorder that belongs to the group of lysosomal storage diseases and often leads to death. The only treatment available is lifelong enzyme replacement therapy (ERT). Early diagnosis and early initiation of ERT prevent the development of PD manifestations. The purpose was to present the latest advances in the study of the pathogenesis, diagnosis, and clinical course of PD, as well as new directions in its treatment, to describe a clinical case of managing a child with PD at the Municipal Non-Profit Enterprise “Regional Clinical Children’s Hospital of the Kirovohrad Regional Council” in Kropyvnytskyi, and also to demonstrate the need for the use of new ERT agents in Ukraine. Materials and methods. Contemporary literature in Scopus, Web of Science, PubMed and other databases was analyzed. A clinical case of infantile-onset Pompe disease is presented. The registry of the Pompe Disease Center at the Erasmus University Rotterdam (Netherlands) was reviewed. Results. New directions in the study of PD pathogenesis (including autophagy disorders), the development and use of new ERT agents have been highlighted. A clinical case of an infantile-onset PD and the results of ERT use were analyzed: within one year of therapy, the child demonstrated improvement in general condition, re-emergence of previously lost motor skills, and reduction of cardiomyopathy signs. However, recovery of skeletal muscle function remained very slow, which led to the development of contractures. The emergence of new agents for PD therapy, whose effect on skeletal muscles is much better, offers prospects for improving the patient’s quality of life. Conclusions. Diagnosis of PD is challenging but feasible in Ukraine. Treatment consists of lifelong ERT, which should be initiated as early as possible. To ensure timely diagnosis, incorporation of acid α-glucosidase testing into neonatal genetic screening is advisable. According to the Erasmus University Rotterdam PD registry, the patient’s prognosis is potentially less severe; however, based on the clinical course, the child requires the use of new ERT agents.
Background. While duodenal obstruction exhibits a global mortality rate of 5 %, data from our hospital (2016–2024) demonstrated an elevated mortality rate of 30.5 %. Serum albumin serves as a critical indicator of paediatric nutritional status, with hypoalbuminemia predisposing neonates to increased postoperative complications following abdominal surgery. This study aimed to evaluate the relationship between preoperative albumin concentrations and mortality outcomes in neonates with duodenal obstruction. Materials and methods. A cross-sectional analysis was conducted on neonatal patients with duodenal obstruction treated at our hospital in 2016–2024. Data were extracted from electronic medical records, and statistical analysis was performed to assess the correlation between preoperative albumin levels and postoperative mortality rates. Results. Among 86 subjects analyzed, mortality occurred in 40.7 % (n = 35) of cases. Preoperative albumin levels demonstrated a statistically significant correlation with mortality outcomes (p = 0.001). Additionally, concomitant congenital heart disease showed significant association with preoperative albumin concentrations (p = 0.002). Conclusions. Preoperative serum albumin levels significantly influence clinical outcomes in neonates with duodenal obstruction, suggesting the potential utility of albumin optimization in perioperative management strategies.
