The purpose of this study is to substantiate the choice and evaluate the efectiveness of therapeutic tactics aimed at suppressing collagen formation and improving metabolic processes in the kidney parenchyma in young children with pyelonephritis against the background of vesicoureteral refux associated with undiferentiated tissue dysfunction. 67 children from 2 weeks to 3 years old with pyelonephritis and vesicoureteral refux were examined. All children during the period of remission of the infammatory process were examined for the content of oxyproline in the urine. Urine crystallinity and urinary excretion were determined, and markers of the morphofunctional state of the cytomembranes of the renal epithelium were determined: calcifcation test—the presence of polar lipids in the urine and test for the presence of lipid peroxidation products in the urine.
Children with high urinary hydroxyproline excretion prior to protocol treatment of pyelonephritis during the remission of the infammatory process at the stage of maintenance therapy were recommended to receive metabolic preparations that can inhibit collagen formation and improve parenchyma metabolic processes during the month—vitamin E 10% and l-carnitine in age-related doses. After 6 months, a study was made on the functional state of the renal parenchyma in the dynamics of treatment. After metabolic antihypoxic and membrane-protective therapy, there was a signifcant positive dynamic of all markers of tissue hypoxia and membrane destruction in the kidney parenchyma, which confrms the inhibition of collagen formation processes and a decrease in tissue hypoxia with vitamin E and l-carnitine in age-related doses.

The high incidence of children with recurrent episodes of acute obstructive bronchitis is a widespread problem. Correct identification of children at risk of developing bronchial asthma at school age may improve treatment and prevention approaches to this pathology, but the ability to identify these children remains limited. The purpose of the study was to determine the effectiveness of recombinant interferon alpha-2β in children with recurrent episodes of acute obstructive bronchitis in the course of treatment based on the assessment of cytokine profile. The study examined 59 children of the main group with recurrent episodes of acute obstructive bronchitis and 30 children of the comparison group who suffered from acute bronchitis, aged 2–8 years, who were in the hospital. The results of laboratory studies were compared with the data of 30 healthy children. In children with recurrent episodes of acute obstructive bronchitis, the content of serum interferon-γ and interleukin-4 was significantly reduced compared to healthy children, after treatment with recombinant human interferon alpha-2β, the content of interferon-γ and interleukin-4 in children significantly increased. The content of interleukin-1β in children with recurrent episodes of acute obstructive bronchitis was significantly higher than in healthy children, after immunomodulatory therapy with recombinant interferon alpha-2β, interleukin-4 normalized to its level in healthy children. It was found that children with recurrent episodes of acute obstructive bronchitis have an imbalance of cytokines, the effectiveness of recombinant human interferon alpha-2β therapy, which normalized the levels of the studied cytokines in the serum.

616.61-053.2:575:576.5

It  should  be  noted  that  oxidative  stress,  as  a  universal  mechanism  of  tissue  hypoxia  at  the  cellular  level, accompanied by non-enzymatic free radical oxidation and accumulation of lipid peroxidation products (LPO) in the blood, has attracted particular interest among medical professionals in our time. Research in the last decade has shown that there are all reasons to consider the activation of free radical LPO as a nonspecifi c component of physiological and pathological reactions characterizing the stress of activation of homeostasis maintenance systems.The aim of stady to establish the relationship between the impact of LPO processes, antioxidant defense, and membrane destruction of renal epithelium in children with dysmetabolic nephropathy.Materials and methods. Two groups of examined children were formed from the examined group, including those  with  dysmetabolic  nephropathy  and  secondary  urinary  tract  infections:  Group  I  -  52  individuals  in  whom  dysmetabolic nephropathy was complicated by the superimposition of infl ammatory processes in the kidneys and urinary tract - complicated DN (I-UDN), and Group II - 56 children with uncomplicated course of DN (II-DN), (a total of 108 children). The control group consisted of 65 healthy children. In children of all groups, the indicator of LPO process activity and the indicator of catalase activity in blood and urine were determined as a mechanism for regulating the antioxidant system of the body.Results. Against the intensifi cation of lipid peroxidation and membrane destruction processes in the bodies of children  with  DN,  the  possibilities  of  antioxidant  protection  are  exhausted,  which,  in  turn,  leads  to  even  greater  intensity of the LPO process. The catalase activity indicator in urine is an informative, reliable, and sensitive marker not only for the result of the impact of epigenetic factors on a child’s body but also a prognostic marker for a more severe course of dysmetabolic nephropathy in children.Conclusions.The revealed facts allow us to assert that against the background of intensifi  cation of lipoperoxidation and  membrane  destruction  processes  in  the  body  of  children  with  DN,  the  possibilities  of  antioxidant  protection  are  depleted,  which  in  turn  leads  to  an  even  greater  intensity  of  the  process  of  lipid  peroxidation.  And  the  index  of  catalase  activity  in  urine  is  an  informative,  reliable  and  sensitive  marker  not  only  of  the  result  of  the  impact  of  epigenetic  factors  on  the  child’s  body,  but  also  a  prognostic  marker  of  a  more  severe  course  of  dysmetabolic  nephropathy in children.

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The prevalence of dysmetabolic nephropathies in children is increasing from year to year, representing a significant problem in the overall structure of kidney diseases in pediatric age. Despite numerous studies dedicated to the issue of dysmetabolic nephropathies in children, the role of epigenetic factors in the pathogenesis of dysmetabolic nephropathy with calcium oxalate crystalluria remains insufficiently explored.
Aim — to identify the leading epigenetic factors in the pathogenesis of dysmetabolic nephropathy with calcium oxalate crystalluria in children. Materials and methods. The data from the medical histories and outpatient records of 173 children were studied. Each child was additionally
examined by narrow specialists of different profiles. Three groups were formed from the examined children: Group I — children with a complicated course of dysmetabolic nephropathy and a history of inflammatory processes in the urinary system (52 children), Group II — children with dysmetabolic nephropathy with persistent crystalluria (56 children) and the Control group, which included 65 healthy children.
Results. The most significant prenatal epigenetic factors are the threat of early miscarriage, gestosis of the first and second halves of pregnancy, maternal anemia during pregnancy, parental alcohol and tobacco use, mother's work on computer during pregnancy, presence of maternal
chronic diseases, parental exposure to industrial dust and noise, and heavy physical work of mother leading to fetal hypoxia.
Conclusion. The most significant postnatal epigenetic factors influencing children's susceptibility to a more severe course of dysmetabolic
nephropathy included low birth weight, early artificial feeding, frequent acute respiratory infections, atopic diathesis, and physiological jaundice
in the first year of life, as well as the presence of concomitant diseases such as chronic tonsillitis, dental caries, frequent acute respiratory infections, chronic gastritis, atopy, and chronic cholecystitis later in life. The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of these institutions. The informed consent of the children's parents was obtained for the research. No conflict of interests was declared by the authors. 

УДК 616.517-02: 616.72-002]-078.73-079.44

Psoriasis is a life-long chronic autoimmune disease characterized by thick scaly skin lesions and often associated with severe arthritis. At the present stage, psoriasis is considered to be a systemic disease that affects not only skin but also joints of patients and is accompanied by possible development of typical comorbid states (cardiovascular pathology, chronic inflammatory intestinal canal diseases, and metabolic syndrome).
Objective — to improve the diagnosis of arthropathic psoriasis (AP) taking into account some of the most important indicators of the immune-endocrine system and features of the disease course to specify their role in the pathogenesis of the disease and to develop the system of integrated therapy.
Materials and methods. A total of 178 AP patients have been systematically examined that had varying severity of process development, generalization and intensity of skin and osseous-articular apparatus damage, the presence of associated pathology. Additional instrumental studies, determination of biochemical, serological parameters and an assessment of stress-induced immune-endocrine system have been conducted in AP patients. The content of trigger cytokines (IL-1, IL-8, IL-17, IL-22) in blood serum, stress hormones (ACTH, cortisol), cellular and humoral immunity condition (CD3+, CD4+, CD8+, CD16+, CD22+, IgM and IgG levels) have been studied.
Results and discussion. The clinical course and characteristic features of AP instrumental tests are extremely versatile. Regardless of the disease duration period, we have detected in blood serum of AP patients probable decrease in parameters of cellular immunity (CD3+, CD4+, CD8+-fraction of T-lymphocytes, CD22+-fraction of B-lymphocytes) and compensatory increase in CD16+ of T-cells, decrease in parameters of cytokines (IL-1, IL-8, IL- 17, IL-22), stress hormones (cortisol, immunoglobulins IgM, IgG, and CIC), which indicates tension of their stress-induced mechanisms even despite occasional clinical stabilization of skin and articular process. We have offered and tested regiments to treat AP patients, which involve differential application within the integrated therapy of nonsteroidal anti-inflammatory medications (etoricoxib 30—60 mg 1 time daily/diclofenac 75 mg daily), diseasemodifying medications (sulfasalazine ЕН from 500 mg to 2 g daily/methotrexate 7.5—10 mg/week), lyophilised dialysate of leukocytes.
Conclusions. The analysis of specific features of the AP clinical course and data of integrated studies allows identifying the probability of manifestation or persistence of the pathological psoriatic articular process. The improvement of AP patients diagnostics taking into account some of the most important indicators of the immune-endocrine system and specifics of the disease course contributed to the improved therapy and mended quality of life of patients.