It is assumed that serum concentrations of type I, III, IV collagen (Col I, Col III, Col IV) and hyaluronic acid (HA) can provide informative evidence for the diagnosis of liver fibrosis (LF) using non-invasive procedures, however, there is insufficient data on the subject in paediatrics. Objectives: to study characteristics of changes in concentrations of Col I, Col III, Col IV and HA in blood serum in accordance with the stages of liver fibrosis in children. Materials and methods of research: a prospective study was carried out, which included 80 patients aged 5 to 17 years with chronic liver diseases of various etiologies, who underwent marginal resection of liver tissue under laparoscopic control, then a morphological study of the obtained biopsy was performed with determination of the stage of fibrosis on the METAVIR scale and the content of Col I, Col III, Col IV and HA in blood serum by the method of enzyme immunoassay. Results: the assessment of the content of K-I in the blood serum allows differentiating the stage F1 and F3 from F4 (p=0,025, p=0,006), Col IV – F1 from F2 (p=0,011), F3 (p=0,002) and F4 (p<0,001), HA – F1 from F3 (p=0,041), and also F4 from F1 (p<0,001), F2 (p<0,001) and F3 (p<0,001). There were no statistically significant differences in the content of Col III at different stages of LF (p=0,061). Statistically significant correlations of the histological stage of LF with changes in serological levels of Col I (ρ=–0,267, p=0,023), Col IV (ρ=0,409, p<0,001), and HA (ρ=0,575, p<0,001), and also the relationship between the concentrations of Col IV and HA (ρ=0,265, p=0,023). Conclusions: the correlations found in the histological phase of LF with changes in serological levels of Col I, Col IV and HA lead to the conclusion that fibrosis direct biomarkers are of diagnostic importance in determining the stage of LF, which is of great importance for practical medicine, especially in pediatrics.

Materials and Methods. The study included 80 patients aged 5 to 17 years with chronic autoimmune hepatic disorders. Patients underwent marginal liver excision with laparoscopic control, then the morphology of biopsy samples was examined, HF was determined using METAVIR scale, and ELISA was used to assess blood C-I and HA concentrations. Study Results. Regressive coefficients demonstrated that reduction in C-I concentration by 1 ng/mL increases the odds of HC by 0.983 times, while HA increase by 1 ng/mL results in 1.032-fold increase in the odds of HC. Moreover, increase in HA concentration by 1 ng/mL raises the odds of marked HF or HC by 1.036 times. The resulting regression models are statistically significant (p < 0.001 in both cases). Conclusion. We found statistically significant differences in serum concentration of C-I and HA at various hepatic fibrosis stages in children and developed four predicative models; three of them have satisfactory sensitivity and specificity to predict marked fibrosis and cirrhosis depending on biomarker concentration. Keywords: hyaluronic acid, type I collagen, hepatic cirrhosis, hepatic fibrosis, children.

Relevance. Dairy-free diet is the basis of cow’s milk allergy (CMA) patient’s management. Duration of the diet is individual, but some children don’t develop tolerance.The aim of the study was to investigate health and growth indices in children with CMA depending on tolerance development by the age of five. Materials and methods. 153 children from 1 to 18 months with diagnosed CMA were included in the prospective study (76.5% with IgE-mediated form). The tolerance was determined after 6–12 months of a milk-free diet and at the age of 5 using an open challenge test. Anthropometry indices (Anthro Plus), levels of specific IgE (Immuno CAP 250) and IgG4 (ELISA) to dietary proteins and the presence of allergic diseases in children also were assessed.Results. 50.3% of children developed tolerance to cow’s milk protein after 6–12 months of a milk-free diet. By the age of 5 63.3% of patients had complete tolerance of dairy products. Partially formed tolerance was observed in 22.9%. 13.8% of patients still had clinical reactions to cow’s milk proteins. Patients with persistent CMA typically had IgE-mediated form, lower growth indices and multiple allergic pathology.Conclusion. The consideration of tolerance development predictors can allow to personalize the management of CMA. Additional researches are needed to clarify the causes of growth indices decline in children with persistent CMA.

Evaluation of the safety profile of vaccines in patients with rheumatic diseases requires an assessment of their impact on disease activity. The effect of antipneumococcal vaccination on the activity of systemic juvenile idiopathic arthritis (sJIA) has not been studied so far. Objective. To evaluate the dynamics of sJIA activity after immunization with pneumococcal 13-valent conjugate vaccine (PCV13) of patients receiving biologicals. Patients and methods. This study included patients with sJIA in remission or active disease receiving biologicals during inpatient treatment and vaccinated with PCV13. To evaluate the effect of immunization on sJIA activity, we measured serum levels of high-sensitivity C-reactive protein (hs-CRP) and calprotectin. In addition to that, we assessed the number of new cases, when concentration of these markers was above the upper limit (UL) 4 weeks after PCV13 administration. Results. In 18 out of 53 patients in remission (34%) and 3 out of 25 patients with active sJIA (12%), hs-CRP levels were undetectable (0.1 mg/L) at both time-points (baseline and after 4 weeks). Among those with detectable hs-CRP levels in at least one time-point 4 weeks after vaccination, patients in remission (n = 35) had no significant changes in hs-CRP (median -0.17 mg/mL; 95% CI -0.84…0.41), whereas patients with active sJIA (n = 22) demonstrated a 3-fold decrease in hs-CRP level (median -0.94 mg/mL (95% CI -3.93…0.05). We observed no significant difference in calprotectin levels in the groups. Concentration of hs-CRP above the UL 4 weeks after vaccination was detected in 2 out of 53 sJIA patients in remission (4%) and none of the patients with active sJIA. Сoncentration of calprotectin above the UL 4 weeks after vaccination was detected in 8 out 53 (15%) and 5 out 25 (20%) sJIA patients in remission and with active disease, respectively. Conclusion. Vaccination against pneumococcal infection in patients with sJIA led to an increase in the level of highly sensitive laboratory markers of sJIA activity in 4–20% of patients. Key words: disease activity, safety, high-sensitivity C-reactive protein, biological drugs, calprotectin, juvenile idiopathic arthritis, pneumococcal 13-valent conjugate vaccine

The article presents the experience of vaccination with a pneumococcal 13-valent conjugate vaccine (PCV13) of a patient aged 5 years with oligoarticular juvenile idiopathic arthritis (JIA) receiving methotrexate at a dose of 15 mg/m2 per week subcutaneously. Treatment with methotrexate provided a remission of JIA, but was accompanied by frequent respiratory infections — up to 8 times a year. During infection progression, methotrexate injections were omitted. Gaps in the treatment with methotrexate were accompanied by an exacerbation of the underlying condition. Vaccination of the patient with PCV13 reduced the frequency of respiratory infections to 2 times a year, which was accompanied by the development of persistent remission of the disease. Adverse events and exacerbation of JIA in a child after vaccination with PCV13 were not registered.

Despite modern achievements in child allergology, the question of evaluating tolerance formation and defining the safest time for expanding the child’s ration after an eliminatory diet remains open. This article contains the results of the authors’ own investigation concerning the practical meaning of specific immunoglobulins (sIg) class G4 as tolerance formation markers at food allergies in children. Thus, it has been found that high levels of sIgG4 are not only a favourable prognostic factor for light manifestations of food allergy, but also an index of a tolerance formation. The prevalence of high food allergy sIgG4 was statistically significantly higher in early age children from the comparison group than in patients with food allergy. Thus the authors suggest that the production of sIgG4 is a normal physiological process which hinders the development of hypersensitivity, while high levels of sIgG4 are evidence for the child’s immune system “contacting” this or that product. Clinical tolerance formation predictors define lighter clinical manifestations of food allergies, a non IgE-mediated form of food allergy and the retention of breastfeeding.

The article presents the analysis of laboratory tests, which indicate the response of the body to systemic inflammation. The revealed interconnection of these parameters with peripheral hematosis alterations at chronic inflammatory diseases will allow objectively approaching the diagnostics of functional disorders at non-specific ulcerative colitis in children. The authors attempted to develop new approaches to the analysis of laboratory indicators, which will help to evaluate individual dynamics of processes at the systemic inflammatory response of the body and select adequate therapy of the primary disease.

Evaluation of prolonged storage of breast milk safety for nutrition of newborns remains actual problem of modern nutritiology. Objectives: to evaluate an influence of freezing and prolonged storage of expressed breast milk on its nutritive, biological values and microbiological safety. Methods: samples of expressed breast milk (native samples and after 1 and 3 months of storage in containers Philips AVENT in t -18°С) were analyzed; levels of secretory IgA, lysozyme, transforming growth factor (TGF) β1, potassium, calcium, magnesium, pH, buffer capacity and bacterial cells were detected. Results: there is no statistically significant influence of low temperature and prolonged storage of expressed breast milk on levels of secretory IgA, lysozyme, TGF β1 and bacterial cells. Potassium and calcium levels significantly decreased (on about 10% and 20% accordingly), pH increased, and buffer capacity of milk lowered after freezing during 3 months. Conclusion: children’s feeding with native and expressed breast milk defrosted after 3 months of storage is equal in nutritive and biological values and microbiological safety.

Evaluation of prolonged storage of breast milk safety for nutrition of newborns remains actual problem of modern nutritiology. Objectives: to evaluate an influence of freezing and prolonged storage of expressed breast milk on its nutritive, biological values and microbiological safety. Methods: samples of expressed breast milk (native samples and after 1 and 3 months of storage in containers Philips AVENT in t -18°С) were analyzed; levels of secretory IgA, lysozyme, transforming growth factor (TGF) β1, potassium, calcium, magnesium, pH, buffer capacity and bacterial cells were detected. Results: there is no statistically significant influence of low temperature and prolonged storage of expressed breast milk on levels of secretory IgA, lysozyme, TGF β1 and bacterial cells. Potassium and calcium levels significantly decreased (on about 10% and 20% accordingly), pH increased, and buffer capacity of milk lowered after freezing during 3 months. Conclusion: children’s feeding with native and expressed breast milk defrosted after 3 months of storage is equal in nutritive and biological values and microbiological safety.

Among children with allergies, particularly with bronchial asthma, patients susceptible to frequent acute respiratory infections make up a large group. In recent years, a strong focus has been on persistency of viruses and other pathogenic microorganisms in various areas of the respiratory tract, which leads to change in responsiveness of the organism and warrants the practicability of applying agents with a combined immunomodulating and antiviral effect. The purpose of this study was to assess the clinical and immunological efficacy of inosine pranobex in children with bronchial asthma and frequent respiratory infections. 37 children with atopic persistent moderate asthma at ages 4 to 15 were examined, 26 of which were administered inosine pranobex orally in prevention dosages at 50 mg/kg twice a day over 14 days. The control group was made up of 11 children who were on no immunopharmacological prevention course. Virus antigens in nasopharyngeal smear samples were identified, cytokine status and antibody immune response were studied. In the main group, 23 children (88,5%) were found to have the frequency and length of intercurrent acute respiratory viral infections decreased 1,5 times (p < 0,05) and the number of asthma attacks decreased 1,7 times (p < 0,05). The obtained results demonstrate the efficacy of preventing respiratory infections with inosine pranobex in children with bronchial asthma and other allergic diseases. Key words: acute respiratory infections, allergy, bronchial asthma, children, prevention, immunomodulators, inosine pranobex. (Pediatric Pharmacology. – 2010; 7(5):30-37)

The prevalence rate of atopic asthma in children remains high. One of the reasons for lack of control over asthma symptoms is repeated infection. The article describes results from the study of immunomodulating medication inosine pranobex used in treatment of acute respiratory infections in children with atopic asthma. The results obtained prove the efficacy and safety of this medication. The use of this immunomodifier with antiviral activity during the period of acute respiratory infection in children with atopic asthma contributes to shortening of intoxication and catarrhal signs duration, elimination of viral agents. Key words: asthma, acute respiratory infections, immunomodifiers, inosine pranobex, children. (Pediatric Pharmacology. – 2010; 7(3):98-105)

Среди детей с аллергией, особенно с бронхиальной астмой, значительную группу составляют больные, склонные к частому заболеванию острыми респираторными инфекциями. В последние годы большое значение придается персистенции вирусов и других патогенных микроорганизмов в различных отделах респираторного тракта, что при-водит к изменению реактивности организма и обосновывает целесообразность применения препаратов с комби-нированным иммуномодулирующим и противовирусным действием. Целью исследования явилась оценка клинико-иммунологической эффективности инозин пранобекса у детей с бронхиальной астмой и частыми респираторными инфекциями. Было обследовано 37 детей с атопической БА среднетяжелого персистирующего течения в возрасте от 4 до 15 лет, 26 из которых получали инозин пранобекс внутрь в профилактической дозе из расчета 50 мг/кг в сут в 2 приема в течение 14 дней. Группу сравнения составили 11 детей, не получавшие иммунофармакопрофилактики. Определяли вирусные антигены в мазках носоглоточных смывов, изучали цитокиновый статус и антительный иммун-ный ответ. В основной группе у 23 детей (88,5%) было отмечено снижение частоты и длительности интеркуррент-ных острых респираторных вирусных инфекций в 1,5 раза (p < 0,05) и обострений бронхиальной астмы в 1,7 раза (p < 0,05). Полученные результаты свидетельствуют об эффективности профилактики респираторных инфекций ино-зин пранобексом у детей с бронхиальной астмой и другими аллергическими болезнями.Ключевые слова: острые респираторные инфекции, аллергия, бронхиальная астма, дети, профилактика, иммуномо-дуляторы, инозин пранобекс.