An important part of the activities of the health care system and social services is developments in the field of preventive medicine and demography. A socially oriented state is obliged to help strengthen the family, act in the field of protecting the health of women and children, stimulate the birth rate, form and educate the correct reproductive behavior of adolescents, which will be carried out by the family, school, and education system. Based on the sociobiological purpose, the most important social responsibility of a woman should remain the role of a mother. The incentive to solve problems is the achieved results in the field of preventive activities of medical workers, carried out in parallel in Russia and Belarus.

Obesity is recognized as a global problem, and its prevalence has reached pandemic proportions. Obesity has been found to be a significant risk factor for the development and progression of various pathologies, including NAFLD. Objective. To determine the features of body composition in children with exogenous-constitutional obesity depending on the presence or absence of NAFLD. Materials and methods. The study included 103 children of both sexes (58 boys and 45 girls) aged 12 to 17 years with exogenous-constitutional obesity (SDS BMI> +2.0). Patients were randomized into two age- and gender-matched groups: Group 1 - children with obesity and NAFLD (n = 51), Group 2 - children with obesity without NAFLD (n = 52). Results. In group 1, a reliable predominance of higher values of BMI (Me 34.7 [30.8; 38.2] versus Me 30.5 [28.55; 33.1], p=0.0002) and SDS BMI (Me 3.1 [2.66; 3.69] versus Me 2.74 [2.37; 3.06], p=0.0004) was revealed compared to group 2. Children in group 1 were characterized by statistically significantly higher indicators: FM (Me 39.6 [32.3; 48,1] versus Me 31.65 [26.8; 38.95], p=0.002); IFM (Me 22.6 [16.6; 33.1] vs. Me 16.850 [13.0; 23,7] p=0.004); TM (Me 60.0 [50.1; 70.0] vs. Me 50.50 [45.45; 56.95], p=0.0003); ACM (Me 32.2 [27.2; 37.8] versus Me 27.05 [24.15; 31,55], p=0.0005) and SMM (Me 26.9 [22.7; 33,6] versus Me 23.35 [21.05; 29,2], p=0.02); 36.95 [33.25; 41,65], p=0.0003) and BF (Me18.1 [15.6; 20.8] versus Me 15.6 [14.15; 17.45], p=0.0002). Conclusions. According to bioimpedance analysis, children with exogenous-constitutional obesity and signs of NAFLD have more pronounced changes in body composition, both its fat and lean components, compared to children without NAFLD.

COVID-19 in children is characterized by a predominance of mild and asymptomatic forms, along with frequent gastrointestinal symptoms. It is known that comorbid conditions are a risk factor for severe COVID-19 in children; however, the course of SARS-CoV-2 infection in children with chronic digestive system diseases remains under-researched. Objective. To identify the specific characteristics of COVID-19 in children with chronic digestive system diseases, assess risk factors for severe COVID-19, and evaluate the impact of immunosuppressive therapy on COVID-19 outcomes. Materials and Methods. A single-center cohort retrospective and prospective non-randomized study was conducted, including 74 patients with COVID-19 and chronic digestive system diseases and a control group of 30 patients with COVID-19 without comorbidities, all hospitalized in the infectious disease department of the Russian Children’s Clinical Hospital, Moscow, in 2022 and 2023. Results. Сhildren with underlying digestive system diseases were not at a higher risk of severe COVID-19 compared to the control group. Severe, uncontrolled somatic disease and the presence of two or more comorbidities were risk factors for complicated SARS-CoV-2 infection. The duration of detectable SARS-CoV-2 RNA in the study group was nine days. Conclusion. Patients with chronic digestive system diseases, including those receiving immunosuppressive therapy, do not appear to be at higher risk for severe or unfavorable COVID-19 outcomes; however, prolonged SARS-CoV-2 RNA shedding was observed. Risk factors for severe COVID-19 include the presence of two or more comorbidities and severe somatic disease.

Aim. To develop a non-invasive method for diagnosing reflux esophagitis in patients with comorbid pathology: HP associated chronic gastritis and atopic dermatitis. Materials and methods. Two groups of children were examined: 60 had AtD and HP+CG and 30 had HP+CG without At D. Risk factors were selected on the basis of clinical, anamnestic, laboratory, and instrumental data, a decision tree was created as well. Conclusion. The conducted research allowed us to develop a plausible non-invasive method for diagnosing reflux esophagitis in children with AtD and HP+CG. Every risk factor (female gender, complaints of bitterness in the mouth, heartburn, abdominal pain, increased fat mass according to impedanceometry and increased level of zonulin in feces) is estimated as 1 point; the sum of points 5 and more indicates the presence of reflux esophagitis with a probability of 94.1% (invention application № 2024139936 from 26.12.2024).

Bacteria with probiotic properties are used to improve the health of the microbiome, the state of which has a multifaceted effect on human health. The effects of probiotic bacteria are strain-specific and can be enhanced by both prebiotic substances (fructooligosaccharides, inulin, etc.) and essential micronutrients. In particular, the trace element zinc is important for maintaining the normophysiological intestinal microbiota (which is the source of the microbiota of all other organs) and for the functioning of the immune system. This paper presents the results of the analysis of two promising probiotic strains (lactobacilli L. rhamnosus GG (ATCC 53103), bifidobacteria B. longum CECT 7894) and zinc citrate, which is a highly absorbable source of the trace element zinc. The analysis of the pharmacology of L. rhamnosus GG, B. longum CECT 7894, the genomes and proteomes of the studied probiotics and the pharmacological properties of zinc citrate allowed us to identify systemic biological synergism between the studied probiotic strains and zinc. It was found that the annotated segment of the L. rhamnosus GG proteome contains 103 zinc-dependent proteins, and the proteome of B. longum CECT 7894 contains 204 proteins. Functional groups of proteins implementing metabolic processes were identified (1) mainly in L. rhamnosus (metabolism of sugars, amino acids methionine and histidine, proteolysis, vitamin PP-dependent functions), (2) mainly in B. longum (oxidation-reduction processes, nucleotide metabolism, fructose metabolism, biosynthetic processes, detoxification processes, including protection against heavy metals) and (3) to the same extent in L. rhamnosus and B. longum (DNA repair, processing of information encoded in bacterial DNA, metabolism of amino acids serine and glycine, energy metabolism, folate metabolism, synthesis of short-chain fatty acids - butyrate, propionate, acetate, etc.). The results of proteomic analysis show that zinc citrate, maintaining the metabolism of L. rhamnosus GG and B. longum CECT 7894, enhances the probiotic properties of both bacteria. This conclusion is supported by the results of fundamental and clinical studies.

Aim. To develop a non-invasive method for diagnosing reflux esophagitis in patients with comorbid pathology: HP associated chronic gastritis and atopic dermatitis. Materials and methods. Two groups of children were examined: 60 had AtD and HP+CG and 30 had HP+CG without At D. Risk factors were selected on the basis of clinical, anamnestic, laboratory, and instrumental data, a decision tree was created as well. Conclusion. The conducted research allowed us to develop a plausible non-invasive method for diagnosing reflux esophagitis in children with AtD and HP+CG. Every risk factor (female gender, complaints of bitterness in the mouth, heartburn, abdominal pain, increased fat mass according to impedanceometry and increased level of zonulin in feces) is estimated as 1 point; the sum of points 5 and more indicates the presence of reflux esophagitis with a probability of 94.1% (invention application № 2024139936 from 26.12.2024).

Autism spectrum disorder (ASD) is a group of disorders with inherent problems in social communication and stereotypical behaviour, often accompanied by various comorbidities. Eating disorders are one of the most common but often neglected problems in children with ASD occurring in 51-89% of children with the disorder. This study analysed genetic factors associated with eating disorders in children with ASD using a whole-genome sequencing and a Sanger sequencing in a sample of 28 children. Pathogenic mutations in several genes such as ANKRD11, ARID1B and UBE3A, which affect neuroplasticity and sensory perception, were identified. The results of the study emphasize the link between eating disorders in ASD and genetic mutations. Understanding these genetic factors may lead to the development of more effective treatments and management of eating disorders allowing for a personalised approach to the therapy. This study confirms the importance of the incorporating genetic testing into a clinical practice to better predict and improve the quality of life of children with ASD.

Objective. Evaluation of crystalloscopy and tesigraphy results in children with reduced nutritional status and long-chain 3-hydroxyacyl-CoA fatty acid dehydrogenase deficiency in a 10-month-old patient. Materials and methods. The saliva crystallography technique is fast and cost-effective. In addition, it is non-invasive, which is of particular importance in pediatric practice. In our work, the following indicators of saliva crystalloscopy were evaluated: crystallinity, structural index, degree of facies destruction and clarity of the marginal protein zone in eight children with reduced nutritional status without confirmed acute and chronic diseases. Nutritional status was determined on the basis of anthropometric data on the Z-Score scale. The crystalloscopic method was based on the study of the shape, size, color and other characteristics of saliva facies crystals. The crystals themselves were obtained by dehydrating a drop of saliva on a plate and conducting thesigraphy for faster crystallization - additional administration of chemicals to the biological fluid. Results. Such indicators of thesigraphy as: the main thesigraphic coefficient, crystallinity, the degree of destruction of facies and the clarity of the marginal protein zone were evaluated. Conclusion. Pronounced shifts in crystallogenic properties were revealed in the crystallograms of blood serum in the studied hereditary enzymopathy, and activation of dehydration structuring of blood serum was also recorded, which shows an increase in crystallizability and the structural index. Similar to urine samples, a sharp increase in the degree of facies destruction was revealed in blood serum in comparison with the samples of healthy children’s biological fluids, which indicates the diagnostic significance of the crystalloscopic method. The crystalloscopic “pattern” of biological fluid (saliva) in children with reduced nutritional status is characterized by an insignificant increase in crystallizability, a significant increase in the structural index and the degree of facies destruction. The tesigraphic “pattern” of biological fluid (saliva) in children with reduced nutritional status is characterized by a significant decrease in the main tesigraphic coefficient, a significant increase in crystallinity, and the degree of facies destruction. It is necessary to clarify the reasons for the change in these parameters.

Probiotic strains of L. acidophilus DDS-1 and Bifidobacterium animalis subsp. lactis UABla-12 (BB-12®) in doses of 10 billion CFU/day in the form of mono- or combined use are highly effective in correcting the manifestations of irritable bowel syndrome - abdominal pain, constipation, diarrhea, flatulence, including overcoming lactose deficiency, in adults and childs. It prevents of of chronic stress and atopic dermatitis, and decreases in the number of seasonal colds.

Purpose of the study. To attract the attention of gastroenterologists and doctors of other specialties to the problem of the clinical picture, diagnosis and treatment of celiac disease in combination with comorbid pathology. Materials and methods. A literature review was conducted on the topic of comorbid pathology most often associated with celiac disease. Results of the study. The literature review presents celiac disease as a systemic autoimmune disease. The frequent combination of celiac disease with other autoimmune diseases is due to common pathogenetic mechanisms. These include genetic predisposition involving common genes, intestinal barrier integrity disorders leading to increased permeability, and other factors that have not yet been fully studied. The review pays special attention to the most common associations of celiac disease with autoimmune thyroiditis, type 1 diabetes mellitus, bronchial asthma, atopic dermatitis, and obesity. It is noted that a strict gluten-free diet is a prerequisite for improving the condition of patients with celiac disease, regardless of the presence of other autoimmune diseases. Conclusion. Today, it is well known that the course of diseases associated with wheat protein intolerance is characterized by a diverse clinical picture, which makes the diagnosis of diseases more labor-intensive. One of the important medical and social aspects in the study of “gluten-dependent conditions” is that they are often combined with autoimmune diseases (diabetes mellitus type 1, autoimmune thyroiditis, rheumatoid arthritis, etc.), which certainly leads to a decrease in the patient’s quality of life, up to disability. A direct correlation has been revealed between early diagnosis of wheat protein intolerance and comorbid conditions and timely adequate pathogenetic therapy, which ensures the prevention of the development of oncological diseases (lymphoma, carcinoma, etc.), and also helps compensate for concomitant comorbid pathology, which undoubtedly improves the quality of life of patients and reduces the economic costs of their treatment.

Introduction. Connective tissue (CT) forms the structural and functional basis of all organ systems in the human body, including the gastrointestinal (GI) tract. Congenital CT disorders, commonly referred to as connective tissue dysplasia (CTD), result from mutations in genes encoding extracellular matrix proteins. CTD includes both differentiated forms, such as Marfan syndrome and Ehlers-Danlos syndrome, and undifferentiated CTD (UCTD), which lacks a specific clinical pattern. UCTD is highly prevalent, affecting up to 20% of the population, and is associated with GI disorders in more than 69% of pediatric cases. Methods. A literature review was conducted to evaluate the impact of CTD on the GI tract, focusing on anatomical abnormalities, motor disturbances, inflammation, microbiota alterations, and associated complications. Clinical data on structural changes, dysmotility syndromes, and comorbidities were analyzed. Results. CTD leads to a wide spectrum of gastrointestinal abnormalities, including motor and tonic dysfunction, sphincter weakness, and various types of reflux (gastroesophageal, duodenogastric, biliary-pancreatic). Structural anomalies of the oral cavity (e. g., high-arched palate, malocclusion, macroglossia) impair food processing and increase digestive load. Visceroptosis and elongation of hollow organs (dolichosigmoid, megacolon, elongated gallbladder) result in impaired motility and stagnation, promoting diverticulosis and chronic inflammation. CTD is associated with a higher incidence of inflammatory diseases of the upper GI tract (esophagitis, gastritis, duodenitis), dysbiosis, and atypical peptic ulcers. Gastrointestinal manifestations also include a more severe course of irritable bowel syndrome and celiac disease, with increased visceral hypersensitivity, dysmotility, and persistent intestinal inflammation. Discussion. CTD predisposes individuals to polymorphic GI pathology, with a distinctive clinical course and complications. Underlying mechanisms involve autonomic dysfunction, impaired collagen synthesis, reduced smooth muscle tone, and structural disorganization of the extracellular matrix. Given the prevalence and systemic nature of UCTD, early recognition and stratification of at-risk patients are essential for individualized preventive and therapeutic strategies. Conclusion. Connective tissue dysplasia significantly influences gastrointestinal health, contributing to the development and progression of various digestive disorders. Recognizing patients with both differentiated and undifferentiated forms of CTD is crucial for timely diagnosis and for optimizing management plans to reduce complications and improve outcomes.

The study of comorbid pathology in Gilbert’s syndrome is an important area in medical genetics and pediatrics. An important feature of Gilbert’s syndrome is that its clinical manifestations can vary from an asymptomatic course to the appearance of a number of comorbid conditions, such as diseases of the gastrointestinal tract and the biliary system. Its study makes it possible to better understand the mechanism of development of these conditions, to develop effective diagnostic and therapeutic approaches.

The review includes 61 sources, including modern and earlier domestic and foreign recommendations for feeding children in the first months of life, as well as large long-term observations and original studies concerning the timing of the introduction of potentially allergenic products, the use of mixtures based on cow’s milk protein hydrolysates, mixtures based on the milk of other animals and based on plant protein hydrolysates. The paradigm of the formation of food tolerance through the early introduction of allergenic products is considered, as well as new technologies for the creation of breast milk substitutes with a low risk of developing allergic pathology.

Objective. The assessment of comorbidities is fundamental to optimise the management of patients with bronchial asthma. The overall aim of this article is to describe the characteristics of the main comorbidities in paediatric bronchial asthma reported in the literature and to provide clinicians with information to recognise these conditions. Material and Methods. Scientific articles on comorbidities in children with asthma were used for the study. A literature review was conducted to systematise existing data and summarise the results of clinical studies to present a complete picture of the impact of comorbidities on asthma control in children. Results. These results emphasise the seriousness of comorbid conditions in children with asthma. A better understanding of the impact of comorbidities in children with asthma may help in the development of best practices for the assessment, treatment, and control of comorbidities. Conclusion. A review of the literature revealed that obesity, allergic rhinitis and gastroesophageal reflux disease are the most common comorbid conditions in children with asthma. These conditions complicate asthma control, increase the frequency of exacerbations and may require modification of standard therapy.

Introduction. Functional gastrointestinal disorders (FGIDs) are independent clinical entities not associated with structural or biochemical abnormalities but manifest with significant symptoms. Among these, functional dyspepsia (FD) stands out due to its unclear pathogenesis. Methods. A literature review was conducted including systematic reviews, experimental and clinical studies on the pathophysiology of FGIDs, particularly FD. Factors examined include neurogenic regulation, visceral hypersensitivity, microbiota alterations, mucosal inflammation, and the roles of H. pylori and COVID-19. Results. Key mechanisms identified include gastric motility disorders, visceral hypersensitivity, immune infiltration of the duodenal mucosa, impaired neuronal regulation, and the involvement of enteric hormones and neurotransmitters. A strong association was observed between FGIDs and prior gastrointestinal infections or COVID-19. The potential of probiotics and proton pump inhibitors (PPIs) as preventive and therapeutic agents was highlighted. Discussion. FGIDs significantly impact children’s quality of life and require a multifaceted, pathogenetically oriented approach. Development of individualized preventive strategies using probiotics and acid-suppressing agents is essential. Despite promising findings, issues regarding optimal dosing and treatment duration remain unresolved. Conclusion. FGIDs are multifactorial disorders with complex pathogenesis. Synthesizing current evidence supports early intervention and prevention strategies, particularly in pediatric patients. The use of probiotics and PPIs appears promising but needs further research for clear clinical guidelines.

The pathogenesis of celiac disease is characterized by its frequent association with autoimmune diseases, in particular, with type 1 diabetes mellitus. Possible causes of the association include the presence of common genetic markers in patients, cross-reaction of autoantibodies and activated T-lymphocytes formed in celiac disease with the body’s own antigens, systemic effects of proinflammatory cytokines, and similar provoking environmental factors. Celiac disease associated with type 1 diabetes mellitus is characterized by a low-symptom or asymptomatic course, which leads to untimely diagnosis, increases the risk of complications of both diseases, reduces the effectiveness of diabetes control, and worsens the quality of life of patients. The only way to timely detect gluten enteropathy is to conduct regular screening for celiac disease among patients with diabetes.

Pathogenic variants of the CFTR gene are the initiating and dominant genetic factor determining phenotypic manifestations in cystic fibrosis (CF). CF is a monogenic disease; however, modifier genes that do not cause the disease themselves have a strong influence on the severity of CF. Individual polymorphisms of modifier genes can both exacerbate and attenuate symptoms, explaining the highly variable clinical manifestations in people with the same CFTR genotype.

This publication is devoted to a rather late and difficult diagnosis of Whipple’s disease in an adult patient of 37 years old, with a 4-year history of slowly progressive formation of multiorgan failure against the background of lack of correct diagnosis, lack of prescription of etiologically significant treatment; at the same time undergoing detailed examinations in various medical structures for several years.

Multiple congenital malformations (MVP) are conditions when there is a violation of the structure and functioning of at least two organs or systems. They do not shorten life expectancy, but reduce its quality, require constant monitoring by specialists or certain conditions of detention. The most difficult malformation of the anorectal region in girls is a congenital cloaca - the fusion of the urethra, vagina and rectum into a single channel that opens in the genital fissure at the site of the external opening of the urethra or vagina. Often, patients with cloacal malformations often have associated VACTERLS abnormalities, which relate to abnormalities in structures originating from the embryonic mesoderm and tend to co-occur. The treatment of such patients requires the attention of specialists from several industries and constant supervision. This clinical case highlights the need for careful planning and coordination of the efforts of specialists from various fields of medicine for the successful management of patients with such complex malformations. Modern approaches to treatment, prognosis and possibilities for improving the quality of life of patients with cloacal malformation and associated anomalies are discussed.

Congenital malformations of the gastrointestinal tract are the third most common among all malformations and are one of the main causes of neonatal mortality. In most cases, they require urgent surgical intervention, so it is so important to diagnose this pathology in time and choose a treatment strategy. However, despite the fact that gastrointestinal tract malformations usually manifest themselves in the first days of life, their diagnosis can be difficult in the case of combined defects that give a similar clinical picture. In the case we presented, we described a combination of Ladd’s syndrome and duodenal membrane in a newborn, which caused high intestinal obstruction.

Acute pancreatitis (AP) remains a relevant issue in pediatric surgery. One of the risk factors for the development of AP is hereditary hypertriglyceridemia, which is often diagnosed only at the time of AP exacerbation. This article presents a clinical case of necrotizing pancreatitis of a 16-year-old girl with hereditary hypertriglyceridemia (type V hyperlipidemia). The management strategy for the child is described, with a comprehensive overview of diagnostic and therapeutic measures taken. Emphasis is placed on the main mechanisms of the inflammatory process’s pathogenesis. The necessity of timely diagnosis of lipid metabolism disorders and identifying factors contributing to AP development is highlighted to prevent potentially life-threatening conditions.