Abstract
Lyme disease is an infectious disease caused by bacteria of the Borrelia burgdorferi sensu lato (Bbsl) complex and is characterized by predominant lesions of the skin, cardiovascular system, nervous system and musculoskeletal system. We have described a clinical case of first- degree atrioventricular block in a 14-year-old boy caused by Lyme borreliosis. The disease started with the manifestations of cardiovascular system involvement. The patient and his parents did not recall observing a tick bite or manifestation of erythema migrans (EM). The boy was prescribed doxycycline. Three weeks after antibiotic therapy a second ECG examination was performed and showed no abnormalities.

Хвороба Лайма (кліщовий бореліоз, Лайм-бореліоз) – це інфекційне природно-осередкове трансмісивне захворювання, яке спричиняється бактеріями комплексу Borrelia burgdorferi sensu lato і характеризується переважним ураженням шкіри, серцевосудинної системи, нервової системи й опорно-рухового апарату. Комплекс Borrelia burgdorferi sensu lato включає 8 різних видів борелій, 3 із них мають патогенний потенціал для людини : B. Burgdorferi sensu strico, B. Afzelii, B. bavariensis, B. bissettii, B. Garinii, B. Kutenbachii, B. Lusitaniae, B. Spielmanii, B. Valasiana. Найчастіше зустрічаються 3 види: B. Burgdorferi sensu strico (Пн Америка і Європа), B. Afzelii (Європа та Азія, ураження шкіри), B. Garinii (Європа, ураження ЦНС). Офіційна реєстрація хвороби Лайма в Україні проводиться з 2000 року. За даними Центру Громадського Здоров’я, протягом 2019 року було зареєстровано 4 482 випадки хвороби Лайма серед українців, з них - 492 випадки у дітей до 17 років. У США щорічно реєструють близько 300 000 випадків хвороби Лайма і дане захворювання посідає друге місце за частотою після ВІЛ-інфекції. У Канаді з 2009 по 2022 рік було зафіксовано 17080 випадків хвороби Лайма. У Західній Європі виявляють 22 випадки хвороби Лайма на 100 000 населення за рік

Hematohidrosis (bloody sweat) is a symptom of trophic damage to the vascular wall, in which sweat mixes with blood and seeps onto undamaged areas of the skin in the form of red or pink liquid (depending on the ratio of sweat to blood). In our study we have analyzed 25 case reports of hematohidrosis in children, reported throughout the world using PubMed, ResearchGate with detailed description and opened access. We took into consideration: 
age of the patient, sex, location of bloody excretion, cause or trigger, treatment and its effectiveness. Our clinical case present a 9-year-old girl complained of a periodic bleeding from the intact skin of the face, neck, thighs (without visible damage to the skin) manifested by red or pink liquid, nosebleeds, and  bloody discharge from the mucous membrane of the eyes. The secretions were of varying intensity and lasted up to several hours. Most of all episodes are associated with a strong emotional exertion. One of the theories of hematohidrosis pathogenesis is evident vasoconstriction of the blood vessels surrounding the sweat glands, provoked by hyperactivation of the sympathetic nervous system, which is followed by their excessive vasodilation up to rupture and blood entering the sweat gland ducts. Capillary endothelial cells are known to contain β2-adrenoceptors, which, through the modulation of nitric oxide release, cause endotheliumdependent vasodilation. Blocking β-adrenoceptors (for example, propranolol) prevents excessive vasodilation of blood vessels and, accordingly, their rupture and blood flow to the sweat gland. We managed to find out that the patient’s bloody sweat was a manifestation of a separate pathological phenomenon, and not one of the symptoms of another disease. A properly formed treatment complex and the great trust of the parents enabled to stabilize the child’s condition, and later to cure her. Currently, hematohidrosis is recognized as an independent disease that requires in-depth study of the triggering mechanisms of development, pathogenetic and clinical features.

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).