The article discusses interactions between medications (Ms) and food. The influence of Ms on the processes of absorption of the essential food ingredients, vitamins, macro- and trace elements in the gastrointestinal tract is analyzed. The significance of the malabsorption syndrome, antibiotic-associated diarrhea as cause of the impaired nutritional status is emphasized. Simultaneously, food products are able of altering the pharmacological effect of some most common drugs. Administration of Ms depending on food intake is discussed. The importance of taking into consideration the influence of foods and theirbiologically active substances on the pharmacokinetics of Ms in the body is pointed out.

There is a high frequency of combination of components of metabolic syndrome (MS) and liver damage in obese patients.Of interest is the study of clinical and pathogenetic relationships between the morphofunctional state of the liver and the development of MS in children.

Objective: to Study the functional state of the liver in children with MS and to assess the relationship with its main components.

Materials and methods. 483 obese children (SDS BMI≥2.0) aged from 5 to 16 years (285 boys and 198 girls) were examined: I gr. — 237 children with MS, II gr. — 246 obese children without MS. Comprehensive examination included anamnesis, anthropometry, clinical and biochemical blood tests, lipid spectrum and carbohydrate metabolism, ultrasound examination of the abdominal cavity and retroperitoneal space, CT of the abdominal cavity. Statistical processing of the results was carried out using the package «STATISTIKA 6.0».

Research result. Ultrasound-signs of nonalcoholic fatty liver disease (NAFD) in I gr. revealed significantly more often than in II gr. (166 — 70% and 125 — 51%, respectively, p<0.05). The majority (91%) of children with NAFD are 10–16 years old. Boys slightly more than girls (58% and 42%). The increase of ALT in the I gr. it was registered at 27% of children, in II gr. — in 18% of children (p<0.05). Increase of ALT in boys was detected 2 times more often than in girls (26% and 13%, p<0.05). In patients with NAFLD, regardless of the group, signs of atherogenic dyslipidemia (increased triglycerides, decreased HDL), impaired carbohydrate metabolism (insulin, C‑peptide and IR index) were more often diagnosed. A higher frequency of hyperglycemia in children I gr. was established. regardless of the liver condition (68% of children without NAFLD and 69% of children with NAFLD), whereas in II gr. it was registered more often in the presence of NAFLD (16% and 8%). In both groups, the level of MC in children with NAFLD was higher than without it, and in I gr. this indicator was significantly higher than in children of II gr. Mean fibrinogen levels were also higher in children with NAFLD, and these differences were significantly significant in I gr.

Conclusion.

1. Ultrasound criteria for NAFLD in children with MS are diagnosed significantly more often (70%) than in children with uncomplicated obesity (51%).

2. CT-changes in liver parenchymain NAFLD are characterized by the presence of diffuse focal process with the presence of different sites with changes in the type of fatty dystrophy and steatohepatitis against the background of unchanged parenchyma.

3. Adolescents over 12 years of age and males predominate among children with NAFLD.

4. Waist circumference in children with NAFLD, regardless of the group, significantly exceeds that of children without it, which indicates the relationship of functional disorders of the liver with the development of abdominal type

of obesity — the main component of MS.

5. Hyperfermentemia in the form of increased ALT levels is most often registered in children with MS in the presence of NAFLD (27%), in 15% of them the values exceed the normative indicators by 1.5 or more times, which indicates a high risk of developing an inflammatory process of the type of steatohepatitis.

6. Lipid metabolism disorders in the form of an increase in TG and a decrease in HDL in children with NAFLD are recorded more often than in children without it, regardless of the presence of MS, but their combination is diagnosed exclusively in children with MS: in children with NAFLD — in 29% of cases, without it — in 23%.

7. Regardless of the group, changes in carbohydrate metabolism in the presence of NAFLD were more pronounced than in children without it, while children with MS and NAFLD showed a more significant increase in glycemia, insulin and IR index.

8. Children with MS and NAFLD have a higher incidence of purine metabolism disorders.

9. A correlation between hepatic metabolism and disorders in the fibrinolysis system, which progress with the duration of the disease, was obtained.

Objective: to assess the nature of changes in the level of neuron-specific enolase (NSE) in children suffering from chronic gastroduodenitis, depending on the severity of the disease, gender and physical development indicators.

Materials and methods. The study group included 154 children aged 8–15 years with chronic gastroduodenitis. The main group includes children with superficial gastroduodenitis (group I) and erosive gastroduodenitis (group II). The control group consisted of 56 healthy children. All children underwent an assessment of physical development. The serum NSE level was determined by enzyme-linked immunosorbent assay. It was revealed that the main parameters of the physical development of children from the control group exceeded the values of similar parameters of children of the main group. High NSE values were established in children with chronic gastroduodenitis in comparison with the control (p≤0.01). The NSE level in boys exceeded the value of the indicator in girls in the main group and in the control group. The level of NSE in girls of the main group exceeded the value of NSE in healthy girls (p≤0.05). Studying the level of NSE taking into account gender and the severity of the pathological process revealed higher rates in boys with erosive gastroduodenitis compared with the control group (p≤0.05). In the group of children with erosive gastroduodenitis, higher NSE rates were found in boys compared with girls (p<0.05).

Conclusions: A high level of NSE in children with erosive gastroduodenitis and revealed gender differences in NSE concentrations in blood serum indicate the possible role of this indicator in the development of severe forms of the disease and do not exclude the possible association of the effects of this enzyme with the function of sex hormones. The quantitative values of NSE for predicting the development of chronic gastroduodenitis in children are established. 

We analyzed the physical development indicators of two groups of children aged 6 and 12 months who were born prematurely and had different dynamics of blood levels of insulin-like growth factor-1 (IGF-1) in the neonatal period. At the age of 6 and 12 months, deviations in height or body weight from the reference values were more often observed in children who had a relatively low level of the hormone in the early neonatal period, followed by its increase in comparison with children who had the opposite dynamics of the hormone. In this group, a close relationship between somatometric indicators of infants and the blood content of IGF-1, albumin and glucose in newborns was revealed, which indicates a long-term persistence of the features of the nutritional status of the neonatal period and its influence on the subsequent physical development of these children.

Goal. To establish significant epidemiological risk factors for pancreatic diseases in children and adolescents in the Krasnodar region.

Materials and methods. This paper examines 24 of the endogenous and exogenous risk factors in 839 children and adolescents with diseases of the pancreas and 150 healthy children. Were identified from medical, biological, social, hygienic and environmental risk factors that significantly affect the formation of pancreatic diseases in the younger population living in the territories of Krasnodar region with different environmental conditions.

Results. The study of the influence of different endogenous and exogenous epidemiological risk factors on the occurrence of diseases of the pancreas in children let set 24 the most important factor. Used the methods of analytical epidemiology to identify risk factors for the formation of pancreatic diseases allowed to identify the most informative factors.

Conclusion. Discovered risk factors allow to generate children at risk for the occurrence of disease of the pancreas,promptly appoint a survey of diagnosis, treatment and to develop targeted programmes in primary prevention and rehabilitation of these diseases.

Atresia of the biliary tract, or biliary atresia (BA), is a destructive, inflammatory disease in which progressive biliary tree fibrosis in an infant leads to obstruction of the bile ducts and, as a result, to cirrhosis of the liver. If untreated, progressive cirrhosis leads to death by 2 years. Biliary atresia can be divided into 3 types, each of which depends on the level closest to biliary obstruction. Type I (obstruction of the common bile duct), type II (patency of the bile ducts to the level of the common hepatic duct), type III (obstruction at the level of the gates of the liver). It is very important to distinguish between types of BA and conduct differential diagnosis with other cholestatic diseases. There are nonsyndromic, syndromic, and BA, combined with other malformations. In diagnostics, in addition to clinical manifestations and specific changes in blood biochemical parameters characterizing cholestasis, an ultrasound examination of the abdominal cavity organs, gepatobiliscintigraphy, magnetic resonance cholecystopancreatocholangiography, according to indications, a puncture biopsy of the liver and histological examination are performed. The main method of treatment is hepatoportoenterostomy according to Kasai, which must be performed no later than 3 months, and with liver cirrhosis and hepatic insufficiency, liver transplantation. Additional methods of treatment include the use of ursodeoxycholic acid, fat-soluble vitamins.

Problems associated with impaired gastrointestinal function are common in children with cerebral palsy. Typical gastrointestinal manifestations of cerebral palsy include dysphagia, gastroesophageal reflux disease and constipation, which in chronic course lead to the development of nutritional status disorders, micronutrient insufficiency, osteopenia, reduced immunity and rehabilitation potential. Often it is the gastroenterological aspects of management of children with cerebral palsy that determine the quality of life of the child and his family.

Hyperlipidemia is a known cause of atherosclerosis and directly contributes to the current epidemic in cardio-vascular disease. Pregnancy is typified by an increase in serum levels of total cholesterol and triglycerides pushed by the rise in estrogen, progesterone and lactogen. Mobilization of stored fat depots in late pregnancy may provide a reservoir of fatty acids for fetal growth and placental tissue steroid synthesis. This physiologic increase in lipids performs an essential role during pregnancy. However, elevated levels of lipids in predisposed women can carry increased risk for maternal-fetal complications. Hyperlipidemia during pregnancy is associated with preeclampsia, preterm birth and gestational diabetes. Lipid profile abnormalities in maternal patients with GDM increase the risk of vascular injury, which may lead to endothelial dysfunction. Offspring of these mothers show a propensity to enhanced fatty streak formation and an increased risk of progressive atherosclerosis, neurological, cognitive and emotional disorders

To study the microelement composition of hair in children with gallstone disease living in an environmentally disadvantaged region of the Krasnodar Territory.
Material and methods. The study involved 44 children with gallstone disease and 35 healthy children. For the study, hair was taken from the parietal, frontal, temporal and occipital regions from the root along the entire length, and using microspectrometry with inductively coupled plasma, the Agilent 7500CE was used to determine the micro- and macroelement composition of hair in children of Krasnodar.
Results. The study revealed an imbalance in the macro- and microelement composition of hair in children with gallstone disease, namely the accumulation of molybdenum, cobalt and copper, a decrease in mercury, zinc, manganese.

The purpose of the study is to study the characteristics of the digestive system in children suffering from bronchial asthma.

Materials and methods. A survey of 60 children with asthma in the acute stage conducted. The average age of the examined children was 8±1.1 years. All children, along with standard studies, conducted EFGDS, abdominal ultrasound, feces for dysbiosis.

Results. In case of bronchial asthma, a high frequency of the pathology of the gastrointestinal tract is detected, which is characterized by an erased, low symptom course. The most common pathology of the digestive tract, which was detected in children with asthma are gastritis 70%, superficial gastroduodenitis — 43.3%, biliary dyskinesia — 75%, intestinal dysbiosis — 58.3%.

The aim of our study was to develop a new scale for predicting clinical outcome in newborns with sepsis, taking into account the information about depth of metabolic disorders.

Methods. Design of study — retrospective observational single-center study. Medical cards data of 163 newborns with sepsis were included in analysis. To measure the predictive value of the analyzed clinical and laboratory signs we used the Kullback measure. The clinical outcome of the disease was determined as the response function: survived or died.

Results. An analysis of the predictive value of the clinical and laboratory parameters of in newborns with sepsis was made, the threshold values of the most informative indicators were developed, which were: the number of blood platelets, the level of total blood protein, body weight and the number of blood neutrophils. The Clinical and Laboratory Condition Index for Newborns scale has been developed, which takes into account the depth of metabolic disorders. ROC analysis (Area Under Curve — 0,723) and the information method (information coefficient 0.992) showed that the Clinical and Laboratory Condition Index score can be used in the intensive care unit to predict the risk negative clinical outcome and evaluate the effectiveness of treatment in infants with organ dysfunction caused by systemic infection.

Conclusion. New Clinical and Laboratory Condition Index score scale allows to predict the development of negative outcome of sepsis in newborns taking into account the depth of metabolic disorders in newborns with sepsis.

The aim of our study was to develop a new scale for predicting clinical outcome in newborns with sepsis, taking into account the information about depth of metabolic disorders.

Methods. Design of study — retrospective observational single-center study. Medical cards data of 163 newborns with sepsis were included in analysis. To measure the predictive value of the analyzed clinical and laboratory signs we used the Kullback measure. The clinical outcome of the disease was determined as the response function: survived or died.

Results. An analysis of the predictive value of the clinical and laboratory parameters of in newborns with sepsis was made, the threshold values of the most informative indicators were developed, which were: the number of blood platelets, the level of total blood protein, body weight and the number of blood neutrophils. The Clinical and Laboratory Condition Index for Newborns scale has been developed, which takes into account the depth of metabolic disorders. ROC analysis (Area Under Curve — 0,723) and the information method (information coefficient 0.992) showed that the Clinical and Laboratory Condition Index score can be used in the intensive care unit to predict the risk negative clinical outcome and evaluate the effectiveness of treatment in infants with organ dysfunction caused by systemic infection.

Conclusion. New Clinical and Laboratory Condition Index score scale allows to predict the development of negative outcome of sepsis in newborns taking into account the depth of metabolic disorders in newborns with sepsis.

Each new stage in the development of endoscopy was characterized by the creation of more sophisticated equipment and the expansion of diagnostic capabilities. The 21st century was marked by the transition to robotic remotely controlled endoscopic systems, the use of digital or electronic endoscopic technology in children. The modern level of endoscopy in pediatrics includes a high definition of the image obtained, a morphological study of biopsy specimens and a full range of endosurgical procedures. The paper presents the experience of introducing, teaching, preparing, conducting, analyzing and evaluating the results, features and nuances of use in children of therapeutic and diagnostic enteroscopy of a new generation: video capsule endoscopy and double-balloon enteroscopy. The modern approach to intraluminal diagnosis and endoscopic treatment of children with digestive system pathologies is substantiated.

The article presents modern data on etiology and pathogenesis of biliary tract diseases in children. Clinical forms of diseases are described, taking into account the anatomical and physiological age-related features of a child’s organism. The features are shown of conservative and drug therapy of biliary tract diseases in children. We present our own experience in the treatment of pain and dyspeptic disorders in children with biliary tract diseases against the background of various biliary dysfunctional disorders and associated diseases of the upper gastrointestinal tract. The article is intended for pediatricians, gastroenterologists, surgeons, and internists.

The aim — on the example of the analysis of clinical observations, the authors draw attention to various variants of the course of the classic auto — inflammatory disease-familial Mediterranean fever (SSL) with severe abdominal syndrome.

Materials and methods: the article present clinical material on two observations of patients with SSL in clinical symptoms, which were dominated by abdominal syndrome, from the moment of their request for medical care to the verification of the diagnosis.

Results: The article presents brief information about the diseases of the group of auto-inflammatory (periodic fever syndrome with mevalonatkinase deficiency, TRAPS-syndrome, Crohn’s disease, familial Mediterranean fever), in the manifestation of which gastroenterological symptoms play a significant role. An example of «early» and «late» diagnosis of auto-inflammatory diseases is illustrated by the results of the analysis of two clinical cases of patients with SSL.

The analysis of the analyzed clinical cases confirms the multidisciplinary nature of the problem of auto-inflammatory diseases and the importance of readiness not only of rheumatologists, but also of other specialists to make such a diagnosis.

A clinical case of autoimmune hepatitis with outcome of micronodular cirrhosis of the liver in a young man of 15 years is presented. The diagnosis is made at the age of 11 years. The disease is manifested by symptoms of cholestasis and intoxication after a herpetic infection. The disease was manifested by symptoms of cholestasis and intoxication after a herpetic infection. Autoimmune hepatitis has been confirmed on the basis of the detected diagnostic titer of antigmuscular antibodies (SMA) in a titer of 1: 1520. The number of points on the simplified IAIHG diagnostic scale was 6 points. Patient is receiving combination immunosuppressive therapy with prednisone and azathioprine with a positive effect.

The article presents a clinical case of liver fibrosis in a child on the background of open fetal vascular communication — ductus venosus Arantii. The clinical observation reflects the importance of early diagnosis, timely treatment of congenital pathology in children. It was shown that as a result of hepatoprotective therapy, the child showed a positive dynamics of clinical and laboratory parameters: a decrease in the severity of signs of portal hypertension, the size of the liver and spleen, a tendency to normalize biochemical parameters that reflect manifestations of the pathological process in the liver.