УДК 616.22-006.6:616-057

Злоякісні новоутворення гортані порушують функціонування багатьох суміжних анатомічних структур і життєвих процесів, які забезпечують важливі фізіологічні та соціальні функції. Враховуючи той факт, що значна частка хворих на рак гортані є особами працездатного віку, проблема раннього виявлення та лікування такої категорії хворих набуває важливого соціально-економічного значення. У даній статті проведено науковий аналіз літератури, присвяченій професійним факторам ризику раку гортані (азбест, поліциклічні ароматичні вуглеводні). Отримані дані допоможуть розробити скринінгову програми серед груп підвищеного ризику та запровадити науково опрацьовану індивідуальну ризик-орієнтовану модель прогнозування появи раку гортані в діяльність закладів охорони здоров’я.

The purpose of this chapter is to highlight the opportunities for digitizing important processes in the healthcare system to improve the efficiency of population health management. The introduction of these digital processes will increase patient satisfaction with the healthcare system, as well as provide a holistic outlook of patient health through access to data and give patients more control over their own health. Healthcare managers will also be using the developed internet applications to conduct clinical audits and monitor health problems in the administrative district. It is proposed to develop and use free internet applications and computer programs, namely 1) drug compatibility test online application, which is designed primarily for students; 2) electronic individual antenatal drug passport for a promising way to predict, prevent, and reduce the risk of allergic reactions; and 3) medical intelligence app using the artificial intelligence technologies to develop an individual educational trajectory for doctors and pharmacists.

The aim: To determine the significance of multidisciplinary approach to management of pediatric patients with skin symptoms of food allergy.
Materials and methods: The study included of 36 patients aged 4 to 6 years with skin manifestations of food allergy, of which 18 were randomly included in the study group and had a multidisciplinary approach to treatment and the other 18 patients constituted a comparison group and used a standard therapy regimen. Observation of children was carried out for 3 months.
Results: Assessment of the severity of the cutaneous form of food allergy by SCORAD score showed the average degree of disease activity in the groups of the study at the beginning of treatment and significantly better dynamics in patients of the study group (p=0.0055). In 88.9% (n=16) of patients in the study group and 61.1% (n=11) of the control group, the process became mild.
Conclusions: The application of a multidisciplinary approach allows the integrated implementation of medical, nutritional, and psychological aspects, which significantly increases the effectiveness of treatment and improves the quality of life of patients and their parents.

УДК: 577.27:616-056.3:613.287.5]-053.3

Introduction. Cow’s milk protein allergy is an urgent problem in pediatrics and aff ects from 0.5% to 3% of infants under one year. IgE-dependent form is present in 60% of children with cow’s milk protein allergy and occurrence of symptoms is usually observed from several minutes to several hours from the time of allergen consumption. Molecular diagnostics opens many new opportunities for diagnosing diff erent forms of allergy and prognosticating effi cacy of treatment.
Purpose. To assess the eff ectiveness of molecular diagnostics in children with cow’s milk allergy in diff erent therapeutic tactics.
Materials and methods. Inclusion criteria of the investigation: children from six month to three years old, positive skin test to milk (papule ≥3 mm with prick method) and specifi cIgE to milk ≥0.35  kUa/L in the serum, positive oral provocation test (OPT). The children  had clinical changes associated milk consumption. The research did not include patienwith anaphylaxis in anamnesis, present severe concomitant or autoimmune diseasescontraindications to OPT. All 60 patients and their parents or custodians gave written consent to participation in the investigation. Assessment of a molecular profi le was performed for detecting major components of milk (Bos d 8 – casein, Bos d 5 – β-Lactoglobulin, Bos d 4 α-lactalbumin), minor (Bos d 6 – bovine serum albumin) and cross-reactive ones with serum albumin (Fel d 2 – felis domesticus allergen 2, Can f 3 – canis familiaris allergen 3).
Results. The study cohort consisted of 60 cow’s milk allergic patients, randomized into two groups, compared based on age (p=0.88) and gender (p=0.3).
Analysis of a molecular profi le of milk components permitted to detect the highest indices in the group of major molecules: Bos d 4 (2.10 kUa/L in specifi c oral tolerance group and 2.00 kUa/L in elimination diet group), Bos d 8 (1.90 kUa/L and 1.55 kUa/L respectively) and Bos d 5 (0.85 kUa/L and 1.60 kUa/L respectively). A skin prick test papule diameter had a statistically signifi cant correlation with sIgE to milk (r=0.51) and Bos d 8 (r=0.44). Bos d 8 had a statistically signifi cant correlation with papule diameter (r=0.44), as well as with Сan f 3 (r=0.39) and Bos d 4 (r=0.28). Bos d 6 had a statistically signifi cant correlation with Fel d  2 (r=0.64) and Can f  3 (r=0.44). The obtained data confi rm that bovine serum albumin indicates cross-reactivity with animals, particularly a cat and a dog. The children were observed for three years.

Conclusions. 1.Assessment of a molecular profi le is important for diagnosis and treatment of cow’s milk protein allergy irrespective of a choice of therapeutic tactics – specifi c oral tolerance induction or elimination diet. Identifi cation of individually signifi cant food allergens makes it possible to determine individual indications and contraindications for oral provocation test and select the most appropriate treatment, in particular, specifi c oral tolerance induction as a disease-modifying immunotherapy. 2. Cow’s milk protein allergy is basically accompanied by the presence of major molecules, in particular α-lactalbumin (Bos d 4), casein (Bos d  8) and β-lactoglobulin (Bos d  5). 3.  Casein (Bos d  8) is a major thermostable component of cow’s milk protein and has a statistically signifi cant positive correlation with a papule diameter (r=0.44), Сan f 3 (r=0.39) and Bos d 4 (r=0.28). 4. Bovine serum albumin (Bos d 6) is a minor component of milk and has a statistically signifi cant positive correlation with Fel d  2 (r=0.64) and Can f  3 (r=0.44), which indicates crossreactivity with animals, particularly a cat and a dog. 

Diseases of respiratory tract in young children are often accompanied by the development of bronchial obstruction syndrome. Recurrent episodes of bronchial obstruction are a common problem in young children with respiratory disorders in neonatal period. The aim of our work was to test secondary prophylactic measures concerning development and progression of recurrent bronchial obstructive syndrome in young children, who had suffered respiratory disorders in neonatal period. Prophylactic complex included basic therapy (inhalation of glucocorticosteroids—fluticasone propionate or budesonide), administration of immunomodulating drug Ribomunyl and conducting of prophylactic vaccination in specialized inpatient department after prior preparation whith antihistamines.

Objectives:

The feature of disease course was assessed based on the need of using drugs with symptomatic action, frequency of exacerbations, their mean duration and severity in 60 children, who had breathing disorders in neonatal period. Children were randomly divided into two groups. The study of efficacy of secondary prophylactic measures was conducted in 30 children (basic group) and in other 30 patients secondary prophylactic complex was not used (control group).

Methods:

Algorithm of secondary prophylactic complex included basic therapy involving inhalation glucocorticosteroids, administration of immunomodulatory drug Ribomunyl as recommended and conduction of planned prophylactic inoculations with the use of antihistamines.

Conclusions:

In children, who were administered secondary prophylactic complex was a positive dynamics in clinical picture and laboratory data.

Results:

Administration of secondary prophylactic complex enabled, to a certain extent, to prevent progression of bronchial obstructive syndrome and achieve a reliable increase in γ-INF, IgA, IgM, IgG levels and decrease in IL-4 (р < 0.01).