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Objectives COVID-19 continues to range around the world and set morbidity and mortality antirecords. Determining the role of genetic factors in the development of COVID-19 may contribute to the understanding of the pathogenetic mechanisms that lead to the development of complications and fatalities in this disease. The aim of our study was to analyze the effect of TNF-α (rs1800629), IL-6 (rs1800795) and VDR (rs731236 and rs1544410) genes variants on the development risk and the course of COVID-19 in intensive care patients. Methods The study group included 31 patients with diagnosis “viral COVID-19 pneumonia”. All patients underwent standard daily repeated clinical, instrumental and laboratory examinations. Determination of IL-6, TNF-α, and VDR genes variants was performed using the PCR-RFLP method. Results It was found a significant increase in the rate of the CC genotype and C allele (38.7 vs. 12.0% and 0.6 vs. 0.4%, respectively) of the IL-6 gene in all patients of the study in comparison with population frequencies. There was a significantly higher rate of heterozygous genotypes TC and GA of the VDR gene in group of died patients. The rs1800629 variant of the TNF-α gene is associated with the need for respiratory support and its longer duration in patients with COVID-19. Conclusions The obtained results support a hypothesis about the influence of variants of IL-6, TNF-α and VDR genes on severity of COVID-19. However, in order to draw definite conclusions, further multifaceted research in this area are need.

One of the pressing issues of healthcare nowadays is applying methods of molecular genetics aimed at identifying and assessing genetic risk factors and early diagnosis of perinatal pathology. Numerous studies have contributed to identifying risk factors that affect the health of newborns. The aim of this work is to investigate the associations between the development of perinatal pathology in premature and full-term infants with polymorphism of genes of the glutathione transferase family (GSTT1, GSTM1, GSTP1), renin-angiotensin system (ACE, AGT2R1). Materials and methods. The study included 110 full-term infants with asphyxia, 30 healthy full-term infants for the control group, and 125 preterm infants with perinatal infections, 21 preterm infants with broncho-pulmonary dysplasia, and 70 conditionally healthy preterm infants. A set of routine clinical and laboratory methods of research and determining gene polymorphism was performed. Results. The presence of a non-functional allele of the GSTT1 gene and DD variant of the ACE gene in newborns is associated with the development of severe perinatal asphyxia (p = 0.006 and p = 0.003, respectively). Children with GSTT1 "-" and AC AG2TR1 genotypes have significantly higher levels of diastolic pressure in the first day after birth than children with functional genotypes of these genes (p

Purpose — to demonstrate the features of the course and treatment of Gilbert's syndrome in a newborn. Materials and methods. We present A clinical case of follow-up of a newborn with Gilbert's syndrome. The paper examines the features of the course and treatment of this disease. Results. Important is the fact that the difficulties in diagnosing Gilbert's syndrome in newborns are primarily due to current problems in neonatology, namely the diagnostics of pigmentary disorders that occur during bilirubin metabolism. The polymorphism of Gilbert's syndrome symptoms and the lack of a clear association with plasma bilirubin levels make it difficult to diagnose the disease, especially in newborns. The peculiarity of the course of Gilbert's syndrome in the given case is as follows: early onset of the disease (from the day of birth), the presence of high hyperbilirubinemia (total bilirubin — 189.2 μmol/l, direct bilirubin — 24.3 μmol/l, indirect bilirubin — 164.9 μmol/l), intermittent attacks of jaundice. The severity of the disease is also due to the transient condition of the newborn: hypoxic and ischemic lesions of the CNS, transient dysfunction of the adrenal cortex, open oval window, and the mother's failure to follow clear principles of treatment of Gilbert's syndrome in breastfed infants. Conclusions. The peculiarity of this disease is the fact that the mother is at risk of giving birth to a sick child due to a burdened hereditary history of the paternal line (Gilbert's syndrome). Therefore, it is necessary to provide medical and genetic counseling when planning the birth of a child to determine the degree of risk of birth with this disease. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: Gilbert's syndrome, hyperbilirubinemia, a newborn.

OBJECTIVE The aim: Analysis of electrocardiographic parameters in newborns from mothers with metabolic syndrome. PATIENTS AND METHODS Materials and methods: We conducted a prospective cohort trial of 125 newborns, which included the study of their anthropometric, clinical and laboratory indicators and, in particular, ECG parameters. The main group consisted of 40 children, born from mothers with diagnosed metabolic syndrome, the comparison group included 2 subgroups: 28 term newborn and 57 preterm, from mothers without metabolic syndrome. RESULTS Results: In newborns from mothers with metabolic syndrome on a fragmentary ECG we revealed abnormal depolarization, manifested by changes in the ventricular complex -QRS expansion (p

The high prevalence of obesity and metabolic syndrome throughout the world over the past two decades provided the grounds to the WHO to consider overweight as a non-infectious pandemic. Among the factors that negatively affect the metabolism, result in metabolic disorders and obesity there are genetic, prenatal, diet-related, somatic, psychogenic and others. Analysis of LEPR and GR gene polymorphisms among mothers and their newborns can be an important component in the prediction of metabolic disorders and obesity. The aim of this study was to analyze the presence of clinical and genetic determinants of metabolic syndrome in mothers and their newborns. Materials and methods. A cross-sectional study of 42 pairs of mothers and newborns was performed; we analyzed their anthropometric, clinical and laboratory parameters and, in particular, 2 types of genetic polymorphisms (LEPR rs1137101 and GR, BClI polymorphism). The main group consisted of 15 mother-child pairs, where the woman was clinically obese (body mass index more than 30), the comparison group included 27 mother-child pairs, where the women were overweight (body mass index more than 25). Results. Obese mothers were significantly more likely to have a miscarriage (p = 0.01). Children from obese mothers had significantly higher percentiles of birth weight compared to the control group (60.9 ± 7.7 and 49.75 ± 4.5, respectively, p = 0.05). The GG genotype of the GR gene was associated with more common indications for hospitalization (p = 0.012), rapid delivery (p = 0.01), umbilical cord entanglement around the neck of the foetus (p = 0.012). Among the children- carriers of the GG BclI genotype GR, cardio-metabolic disorders detected by the auscultation of the heart (arrhythmia, functional noise) were found out as significantly more frequent (p = 0.003). Conclusion. The study did not find the associations between LEPR and GR gene polymorphism in obese mothers and the development of overweight in their children, but the study revealed an adverse effect of polymorphic variants on obstetric and gynaecological status of mothers, labour and adaptation of infants in the early neonatal period.

Introduction. The clinical course of respiratory diseases is often accompanied with the impairment of the nervous system, it makes up a large proportion in the clinical picture of diseases, and often leads to long-term adverse effects. The purpose of the study is to elaborate the diagnostic algorithm for predicting the course of diseases in children with respiratory pathology during the intensive care based on the thorough study of clinical and anamnestic predictors. Subjects and methodology. The study included 132 children aged from 1 day to 1 year with various pathologies during intensive care. The children were divided into 6 groups: I group included 87 patients with acute respiratory viral infection (ARVI), pneumonia; II group included 21 children with ARVI, stenosis of II-III degree, III group involved 10 children with hypoxic-ischemic encephalopathy. There was a group of children supported with artificial lung ventilation (14), who make up IV group; 20 children died. The control group consisted of 25 healthy children aged under 1 year old. We carried out clinical, bacteriological, immunological examination and statistical processing of findings obtained. Results. When assessing the cases of the clinical course in children up to 1 year, who needed intensive care to mitigate the symptoms of acute respiratory failure of II-III degree, we have found out that except of aggravating factors in the ante-, intra- and postnatal period, there are the number of pathological change detected by neurosonography, which are of unfavourable predictive value: 29.5% of children had subependymal haemorrhages; 10.3%, of children had intraventricular haemorrhages, 9% of children had periventricular haemorrhages. Infants with acute respiratory failure III degree who needed artificial lung ventilation (50% of them were premature) were born to mothers with a pathologic pregnancy and childbirth. Among children who were in the intensive care unit, the general mortality was 15.2%. The causes of death of newborns included asphyxia (80%), respiratory disorder syndrome III degree (10%), hypoxic-ischemic encephalopathy (10%). In the long-term period, the main cause of death was pneumonia, complicated by acute respiratory failure III degree, brain oedema. Conclusion. Applying of the markers to prevent and reverse the development of infants’ critical condition promotes to the reduction of morbidity, disability and mortality of children.

Objective The aim of the study was to analyze and identify risk factors for the development of early onset sepsis in preterm neonates and to develop a clinical prognostic model. Patients and methods Materials and methods: A retrospective cohort study included 152 newborns with birth weight from 1000 to 2500 g, who were treated in the neonatal intensive care units of medical institutions in the Poltava region. Among 152 children, 121 had clinical and laboratory symptoms of infection, which were regarded as manifestations of early onset sepsis, the rest of the children (n = 31) had no manifestations of infection. Results Results: According to the results of multiple stepwise logistic regression analysis, the predictive model has been developed. It included gestational age, visual changes of placenta, Apgar score at the 1st minute, the level of monocytes more than 6.5%, the history of abortions and premature rupture of membranes. The diagnostic characteristics of the developed model had high: sensitivity - 82.2%, specificity - 93.55%, positive predictive value - 97.98%, negative predictive value - 58%. Conclusion Conclusions: The prognostic model developed by us, which showed high diagnostic characteristics, includes information on maternal risk factors, the state of the newborn immediately after birth, and biomarkers of infection (C-reactive protein and monocyte count). Therefore, we believe that when interpreting biomarkers, the decision to prescribe antibiotics should be based on the presence of maternal risk factors and clinical symptoms of infection in the prematurely born child, which may be nonspecific.

Introduction. All children who have an oncological or hematologic diagnosis during the period of diagnosis of treatment are in specialized departments, but failing of effective training of the patient, parents and family members in child care skills, with an oncological diagnosis negatively affects the results of treatment and the quality of life of the family. The process of training parents and family members allows the medical team to correct incorrect and false information that family members can get from different sources, as well as strengthen the skills of caring for a child with an oncological diagnosis in the conditions familiar to the family. The research objective is to develop an algorithm that can be used in practice to control the learning process of parents and family members of children with an oncological or oncological and hematological diagnosis. Materials and methods. As a basis for the development of the algorithm, we took the recommendations of experts from the 2016 Children's Cancer Group. Results and its discussion. An algorithm has been developed and adapted that is based on five basic principles: the perception and awareness that in pediatric oncology the education of parents and family members should be family oriented; Awareness of the child’s oncological diagnosis is emotionally difficult and takes some time to develop a plan to address current life needs; training of cancer patients, his parents and family members should be an interprofessional event, which is based on diagnosis and treatment, as well as discussion of psychosocial support and the organization of basic child care; training should be continuous and continuous; It is necessary to create an enabling environment for learning. Conclusions. Implementation in practice and the implementation of the training algorithm for caring for a child with an oncological diagnosis, the use of an integrative direction of training for family doctors will provide the opportunity to work with the main educational content, establish and strengthen feedback between doctors in specialized hospitals and family outpatient clinics, and increase the effectiveness of the prevention of complications that arise upon receipt of special treatment (polychemotherapy, radiation therapy, etc.), which in turn will lead to an improvement the quality of family life while receiving therapy with a child diagnosed with cancer.

In the perinatal-specific infection mortality pattern, bacterial sepsis of newborns and congenital pneumonia account for 23.5% and occupy the I rank. Among the many non-specific clinical signs of infection, hemodynamic disorders are dominant in the development of adverse medical effects. Polymorphism of genes of the renin-angiotensin system, as one of the regulating units, can lead to peculiarities of disorders of hemodynamics in the infectious process. Aim of the study: to study the effect of ACE, AGT2R1 and eNOS gene polymorphism on the development of early bacterial infections and their most severe manifestation – arterial hypotension syndrome. Materials and Methods: two groups of children were formed to achieve the goal. The main group includes 121 prematurely born infants with bacterial infections of the early neonatal period, and the comparison group includes 31 prematurely born infants with no signs of early bacterial infections. Genetic methods included the study of ID polymorphism of ACE gene, AC polymorphism of gene AGT2R1 gene polymorphism and 4a/4b polymorphism of eNOS. Analysis of vital functions in children stratified according to the genotype of the ACE gene, showed that at the first day of life in prematurely born children with genotype II, the mean blood pressure was significantly higher than in children with the genotype ID (35.3 ± 1.55 mm Hg) and 31.7 ± 0.88 mmHg, respectively, p = 0.033). In children with the II genotype of ACE, the hourly diuresis rate at day 1 was significantly lower than in children with the DD genotype (1.6 ± 0.2 ml/kg/h and 2.2 ± 0.21 ml/kg/h, respectively, p = 0.0017), which may indicate better renal circulation in children with the DD genotype. As a result of the study, no influence of the genes of the renin-angiotensin system on the fact of early bacterial infections occurrence was found, but significant influence of the CC-genotype of the AGT2R1 gene on the development of arterial hypotension syndrome in premature infants (OR = 10.17) was detected. A practical recommendation for public health may be to conduct a genetic study to identify ACE and AGT2R1 gene polymorphisms in preterm infants, which will help identify the risk group for systemic and organ haemodynamic disorders and manage it individually.

Relevance of the research. The causes of asphyxia are well known, but the debates about the importance of antenatal and intranatal factors in its development are still ongoing. Identification of clear predictors for the development of the dysfunction in vital and non-vital organs will improve the existing algorithms for monitoring neonates who are subject to hypoxia/asphyxia, and will enable the doctors to make decisions on the timely use of personalized therapeutic and diagnostic measures aimed at reducing mortality, morbidity, childhood disability and enhancing the quality of their life. The aims of the research are substantiation and development of the integrated model for prediction of organ dysfunctions, and improvement of the algorithm for monitoring newborns with asphyxia in the early neonatal period. Materials and methods. The study included 72 full-term infants with asphyxia and 35 healthy newbornswho were born at the perinatal centre of M.V. Sklifosovsky Poltava Regional Clinical Hospital and Poltava City Clinical Maternity Hospital in 2011-2013. We studied the associations between the development of organ dysfunction and risk factors characterizing the somatic, obstetric, antenatal/intranatal history of the mother, the condition of the infant, the volume of primary resuscitation, as well as the metabolic, inflammatory and vascular biomarkers. The prediction of lesions of organs and systems of the newborn is considered from the point of view of pathophysiological mechanisms of circulatory and non-circulatory adaptation reactions in newborns with asphyxia, when against the background of increased cerebral, coronary and adrenal blood flow, there is a decrease in perfusion in the kidneys, lungs, gastrointestinal tract, liver and their dysfunctions. Results of the research. The proposed integrated model for the prediction of lesions of vital and non-vital organs demonstrates the insignificant role of ante and intranatal factors in the prognosis of multiorgan dysfunction development. It was determined that the prognostic model for the development of hypoxic and ischemic encephalopathy, which includes poor uterine contraction strength (odds ratio 13.2), administering 0.9% solution of sodium chloride during primary intensive care (OR 9.2), LDH level >1700 units/l (OR 7.4) and creatinine>110 mmol/l (OR 15.9) for 1 day of life has an area under the ROC curve of 0.8711. The development of myocardial dysfunction is reliably associated with glucose levels 7.0 mmol/l (OR 21.3) and NO2¯+ NO3¯

The task of higher medical education at the present stage of the society development is training specialists who demonstrate creative activity, autonomy, fluency in mastering the profession and capability of selfimprovement. At present, the principle of complete education, in which the knowledge, obtained at the pregraduation stage of learning, retains its value throughout the entire professional activities, is substituted with the principle of lifelong learning. The concept of continuous education includes the formation of conditions for all-round development of a person, regardless of age, place of residence, acquired profession, level of mastering the professional skills, but also taking into account the individual abilities, motives and interests of the individual. Continuous education is oriented not only to the needs of the society, but also to the needs of the individuals, their activity. At all stages of teaching the abstract thinking, an important task of modern pedagogical science is the formation of the ability to analyze and synthesize, to understand the professional activity, to search and analyze the information, the ability to be critical and self-critical, the ability to generate new ideas. On the following stages of lifelong education, these principles remain the key ones. The better the self-motivation of continuous education is formed, the deeper is the awareness of its necessity, the more the whole system of goals and means of learning rebuilds. At the present stage of the society development, self-development and self-organization in the professional training acquire high relevance, since the creative initiative and the ability to adapt easily that are the key prerequisites for a highly skilled specialist. Consequently, education acquired at the pre-graduate stage and the formed professional status give rise to a certain social position. However, the professional status under the conditions of high competition is constantly to be confirmed, strengthened, and promoted. These opportunities are provided by coursework learning (re-certification, advanced training courses, etc.). Another aspect of continuous education is the formation of multi-level knowledge, which is an indicator of professional mobility. It is important to form an integrated competence: the ability to solve typical and complex specialized tasks and practical problems in professional activity, which involves conducting research and / or innovations and is characterized by complexity and uncertainty of conditions and requirements. It is important to understand that the main driving force in the continuous education are not the outwardly organized educational processes, which are the main ones in the specialists training, and education is largely a personal affair of an individual. As a result, education becomes personified. Thus, continuous education is a prerequisite for the professional activity of a modern physician as a multi-vector process, which is accompanied by changes in the internal sphere of individual, changes professional self-consciousness and forms professionalism.

GENETIC PROFILE OF THE RISK OF DEVELOPING FATAL CASES IN PREMATURE NEWBORNS WITH SEVERE INTRAVENTRICULAR HEMORRHAGES

Diabetes mellitus (DM) is one of the most common chronic diseases in childhood. With DM-1 there is depletion of the CNS, cessation of the body, and violation of basic mental functions. Patients with diabetes have many fears, on the one hand, and seek peace and security, on the other. Almost all patients with diabetes mellitus-1 at the time of diagnosis, except for somatic complaints, have moderate depression, anxiety. After 6-9 months, the symptoms usually disappear, but remain in some patients, more often in girls, and even develop with increasing duration of the disease. Depression and impaired perception of diabetes mellitus have a negative impact on disease adaptation and metabolic control. Children and adolescents with diabetes mellitus-1 are at high risk of psychosocial pathology − primarily depression, anxiety, eating disorders, family conflicts, low self-esteem, problems with compliance with medical recommendations. An increased risk of developing psychiatric diseases is observed in 10-20% of adolescents with diabetes. Adolescent girls with family problems are in the highest risk group. Patients with diabetes-1 are also characterized by feelings of insecurity, emotional neglect, a desire to take care of themselves, and an active search for dependence on others. Children with diabetes are more depressed, more dependent, and more withdrawn than their peers. Two years after diagnosis, depressive and anxiety problems are found twice as often in children with diabetes than in healthy peers. In children with diabetes, life is limited to the disease, the fight against it. As a result, there is isolation, avoidance of contact with people, and passivity that lead to the formation of limited behavior: inertia, decreased activity. The development of disorders of the emotional and volitional sphere is facilitated by asthenia, which reduces the overall tone of the body. The earlier psycho-emotional disorders are detected in children with diabetes and corrective work is started in a timely manner, the more positive the expected results will be. Psychological and educational influences play a key role in determining the effectiveness of diabetes control in children.

GENETIC MARKERS OF VENTRICULAR DILATION AND HYDROCEPHALUS INDUCED BY INTRAVENTRICULAR HEMORRHAGES IN PREMATURE INFANTS

OBJECTIVE Introduction: The safe thresholds of blood pressure in preterm neonates are still unclear. The aim of our study was to substantiate the diagnostic criteria for the syndrome of arterial hypotension (AH) and indications for the appointment of hemodynamic support in premature infants with early onset bacterial infections. PATIENTS AND METHODS Materials and methods: A prospective cohort study was conducted. 2 experimental groups were formed -premature babies with early onset bacterial infections and AH (n = 58), and control group (n = 62), premature babies without AH. The subjects of the study were a number of risk factors. Simple and multiple logistic regression analyses were used. RESULTS Results: In premature infants with AH, compared with those without AH, there are significantly lower values of stroke index of left ventricle (SILV), index of resistance (IR) of the middle cerebral artery, pH, significantly higher level of urea in serum and a higher proportion of children with hypoglycemia. Multiple logistic regression analysis was used to develop a clinical prognostic model for the AH-syndrome. Only prognostic model, which included SILV, blood pH and blood glucose, had high prognostic characteristics and the largest area under the ROC curve. CONCLUSION Conclusions: The following diagnostic criteria can be used for the appointment of medical support for hemodynamics: the digital value of the level of mean blood pressure, expressed in mmHg, is less than the gestational age in weeks, and at least one of the following indicators -pH is less than 7.2, blood glucose level is less than 2.8 mmol/l, SILV is less than the normal ranges.