Magnesium is a macroelement that plays an important role in the regulation of many physiological processes. In the case of insufficient intake of magnesium, which does not meet the needs of the child's body, its deficiency develops. Clinical manifestations of magnesium deficiency are nonspecific and may be similar to symptoms of various diseases, including asthenic syndrome. In turn, asthenic syndrome is common in children who have suffered infectious diseases, COVID-19, influenza, and other acute respiratory infectious pathology. In such children, excessive anxiety, rapid fatigue, sudden mood changes, sleep disorders, and emotional lability can be detected. Given that the leading role in ensuring the proper functioning of most of the body's enzyme systems, tissue respiration, energy exchange, and synthetic processes belongs to magnesium, it is assumed that the development of the described symptoms may be related to its deficiency. Purpose - to summarize literature data on the role of magnesium in the body of a healthy person, the peculiarities of its metabolism, its importance in the course and rehabilitation after respiratory infectious pathology and COVID-19, signs of deficiency, and methods of its correction; evaluate the results of own research. Materials and methods. General clinical (analysis of anamnesis data), laboratory (determination of magnesium level in blood serum), statistical, bibliographic, and information-analytic research methods were used. 60 children aged 9 to 18 took part in the study, among them 35 children who had COVID-19 (the first group) and 25 children who did not have COVID-19 (the second group). Results. It was established that the average value of magnesium level in blood serum in children of the first group was lower than in children of the second group (p=0.005). Individual analysis showed that 31.4% of patients in the first group, who had a term of 4-5 months after COVID-19, noted the presence of post-COVID-19 symptoms, such as excessive fatigue, headache, muscle weakness, impaired sleep, appetite, which coincides with the data of the literature. Conclusions. The data of our study may indicate the effect of transferred COVID-19 on the level of magnesium in the blood serum, which may be one of the reasons for its deficiency and, accordingly, the development of post-COVID-19 symptoms in children. It is advisable to carry out laboratory determination of the magnesium level in children who had acute respiratory infectious pathology, including COVID-19, to establish the causes of the development of individual symptoms that aggravate the general well-being, prevent the development of magnesium deficiency and find additional ways of rehabilitation after respiratory infectious pathology and COVID-19. No conflict of interests was declared by the authors.

3URMHFW 'LUHFWRU D.O

Lymphoma is a group of neoplastic diseases characterized by the clonal proliferation of lymphoid cells, manifested by the response of various stages of differentiation of normal B-lymphocytes, less often T-lymphocytes or natural killer cells. The etiology of most lymphomas is unknown. Some of the proven causal-consequence factors are: viral infections and immunodeficiency conditions. Purpose - to draw the attention of non-immunologists to the peculiarities of detecting the primary immunodeficiency (PID) states and the problem of their late diagnosis based on the data of a clinical case. Clinical case. A clinical observation of severe non-genetically differentiated PID is given. Screening signs of PID in the form of recurrent infectious respiratory tract syndrome and frequent long-term use of antibacterial drugs are highlighted, which should alert doctors to clinical and immunological markers of primary immunodeficiency. The presence of Burkitt's lymphoma in the boy also does not exclude the possibility of the manifestation of an immunodeficiency state, both secondary to the drug treatment of lymphoma, and primary, which can manifest itself in puberty. Common variable immunodeficiency is one of those PIDs that "starts" with Burkitt's lymphoma. Conclusions. The problem of low detection of probable PID in children in Ukraine is urgent. Primary care physicians are the first to be able to partially solve this problem by examining the infectious history and laboratory screening tests. There is incomplete awareness of related medical specialties regarding the signs of PID in lymphoproliferative syndrome in children. This clinical case demonstrates signs of PID at an early age. Low detection is also associated with poor capacity and quality and/or lack of immunological laboratory testing, particularly in public facilities. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the of the child’s parents was obtained for the research No conflict of interests was declared by the authors.

Alopecia (baldness) is a pathological hair loss. A chronic relapsing course leads to a violation of the emotional sphere of the child, worsens the quality of life. Alopecia is considered autoimmune, since it is characterized by hair loss due to lymphocytic infiltration around the hair follicles. It can be secondary as a result of infectious and inflammatory processes. Purpose - is to conduct own clinical observation of a child with total alopecia to increase the awareness of doctors about this pathology in children. Clinical case. The article presents a clinical case of total alopecia in an 11-year-old child. It is known from the anamnesis that in 9 months the child began to lose hair on his head, at 2 years old - eyebrows and eyelashes, at 3 years old he was diagnosed with total alopecia. The patient had a complex clinical and laboratory examination with the involvement of a multidisciplinary team, since alopecia can occur under the mask of autoimmune diseases and immunodeficiencies. Total alopecia, atopic dermatitis, changes in immunological status in the anamnesis, cases of early mortality among family members, as well as a history of alopecia areata in the father gave us reason to suspect a genetic disease in the patient, including autoimmune polyendocrinopathy candidiasis-ectodermal dystophia (APECED syndrome) with mutation in the AIRE gene. Conclusions. For verification the diagnosis and choose a treatment strategy, the patient needs an additional examination: sequencing of the relevant locus of the AIRE gene to detect mutations characteristic of APECED syndrome, as well as a serological test to detect the titer of antibodies to Candida and a puncture biopsy of the scalp. Considering the above, the prognosis for recovery is unfavorable. The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of parents was obtained for the study. No conflict of interests was declared by the authors.

The treatment of somatotropic insufficiency (SI) remains one of the most important problems in paediatric endocrinology. Since 1985, recombinant growth hormone (rGH) has been widely used to correct the growth of children with SI. Sufficient clinical experience has been gained in the use of rGH preparations, and the efficacy and safety of rGH therapy in children and adolescents with various forms of short stature has been proven. However, there are a number of factors that can have a significant impact on the achievement of final height in adulthood, including a wide range of sensitivity to exogenous growth hormone (GH), the degree of endogenous GH deficiency, patient compliance, and other uncertain factors. Patients with GH deficiency require long-term treatment, the effectiveness of which decreases significantly over time, prompting the search for optimal treatment options. Purpose - to evaluate the effectiveness of combined therapy of pre-pubertal children with SI with rGH and vitamin D drugs. Materials and methods. 23 pre-pubertal children with isolated SI were examined, who took monotherapy with rGH for 3 years. When the effectiveness of monotherapy decreases, vitamin D are added to the treatment complex. The level of 25(OH)D in blood serum is determined by the immunochemiluminescence method on microparticles (Abbott, USA). The levels of GH and insulin-like growth factor-1 were studied by solid-phase enzyme immunoassay using Immulite 2000 XPI kits. Results. At the end of the first year of rGH monotherapy, all patients showed a significant (p<0.05) increase in height. However, already after the second and third years of treatment, height velocity (HV) decreased in all patients. The increase in HV in the third year of treatment with rGH was significantly lower (p<0.05) than in the first year. Thanks to the addition of vitamin D, the further decrease in HV was stopped after the third year of monotherapy with rGH. The increase in HV during the first year of combined therapy was significantly (p<0.05) greater than during the third year of treatment with rGH monotherapy. The same trend was observed after the second year of combined therapy. Conclusions. In the presence of a decrease in the effectiveness of therapy with rGH after the first years of treatment, it is considered appropriate to use combined therapy of children with SI with rGH and vitamin D. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Zinc (Zn) is an essential trace element that is critical for growth, development and maintenance of immune function. Zn is an indispensable trace element for humans, which is part of more than 20 metalloenzymes, including DNA and RNA polymerase, phosphatase, carbonic anhydrase and some others. The cycle of cell development requires this trace element. The permeability of cell membranes is also related to Zn. It has antioxidant properties and delays the apoptosis of peripheral cells. The formation of immunity depends on the body’s supply of Zn, and its deficiency causes atrophy of the thymic-lymphatic system. Zn is part of insulin, accelerates the regeneration of the mucous layer of the intestines, increases the activity of enzymes of the brush border of enterocytes, increases the level of secretory antibodies and the intensity of cellular immunity. The provision of this element cannot but affect the course of various infectious pathologies. Purpose - by analyzing modern literature data, to find out the importance of Zn provision in infectious pathologies in children. It is analyzed a review of the literature on the pathogenetic role of Zn in the diagnosis, pathogenesis and treatment of infectious diseases, based on a search for articles in the Science, Medline and PubMed databases published from January 2017 to June 2021. An analysis of current literature has shown that Zn is an important micronutrient involved in the regulation of innate and adaptive immune responses. Zn is necessary to ensure the barrier function of membranes. It is involved in the modulation of the pro-inflammatory response. Zn homeostasis is essential for many aspects of the immune system, including hematopoiesis, cell maturation and differentiation, cell cycle progression, and proper immune cell function. Consequently, Zn deficiency leads to cell-mediated immune dysfunctions. Such dysfunctions lead to deterioration of the body's response to bacterial infection. Zn is known to modulate antiviral immunity. Due to zinc, the production of interferon-α is activated and its antiviral activity is increased. Studies show that during the infectious process there is a decrease in the concentration of zinc in the blood plasma. Such changes, on the one hand, provide the needs of immune protection factors, and on the other hand, reduce the availability of the trace element for pathogens. Conclusions. Zn is one of the important trace elements that plays a leading role in maintaining homeostasis and is an integral component of the pathogenesis of various pathological conditions of infectious origin. The most studied is Zn deficiency in infectious diarrhea in children, but studies have been conducted in developing countries with limited resources. No works studying the prevalence of Zn deficiency in Ukraine were found. No conflict of interests was declared by the authors.

Inflammatory bowel diseases (IBD) is a group of chronic diseases characterized by destructive non-specific immune inflammation of the intestinal wall. The main forms include Crohn's disease and ulcerative colitis. Currently, Crohn's disease is one of the most urgent problems of children's gastroenterology, which is due to the annual increase in morbidity, "rejuvenation" of the pathological process, difficulties of diagnosis treatment, and high risk in developing of complications. IBDs with very early onset of manifestation have an atypical or erased clinical picture, which makes timely diagnosis in this age group of patients much more difficult. Purpose - to describe own clinical observation of a case of Crohn's disease with a very early onset. Clinical case. Was presented an observation of a patient of 2 years and 7 months old with Crohn’s disease the feature of which was a severe course with pronounced lesion of the gastrointestinal tract. The results of clinical data, laboratory, instrumental and histological methods of research, the complex stages of diagnosing of Crohn’s disease, as well as the issues of the patient’s treatment were discussed. The peculiarity of the described case was the early onset of the disease, continuously relapsing course, frequent acute respiratory diseases accompanied with diarrheal syndrome, absence of some specific complaints and changes in biochemical and immunological tests, corticosteroid dependence and severe extraintestinal manifestations of Crohn’s disease (anemia of a mixed nature). The diagnosis of Crohn’s disease was made at the age of 1year and 9 months (1 year and 4 months after the appearance of the first symptoms), which was confirmed a year later after a repeat examination. Late diagnosis was caused by the variety of clinical manifestations, absence of clear symptoms of the disease at the first stages of observation. The research was carried out in accordance with the principles of the Declaration of Helsinki, informed consent of the child's parents was obtained for the research. No conflict of interests was declared by the authors.

ǁǗǢǗǖǡǝǒǤǟǚǛ ǷǟǖǗǜǣ NJǒǟǠǔǟǚǛ ǜǠǝǗǕǠМи прагнемо підвищити обізнаність про тромбоз, включаючи його причини, фактори ризику, симптоми та доказову профілактику і лікування

Purpose - to analyze the role of the pediatrician in the formation of the dentition and the preservation of dental health in children, reviewing world research on this topic. The data of scientific literature on the awareness of pediatricians in the prevention of children's oral health diseases and timely referral to a pediatric dentist are analyzed. Untreated tooth decay is known to negatively affect a child's overall health and well-being, causing pain, impairing the ability to bite and chew, and thus affecting weight gain and growth, self-esteem, and communication skills. Chronic pain and discomfort caused by dental caries also negatively affects cognitive development and is associated with school absenteeism and lack of concentration. Since the youngest children visit pediatricians much more often than dentists, it is very important that pediatricians have the appropriate knowledge of the development and progression of caries, the principles of its prevention, and ways to maintain and improve the child's oral health. The cooperation of a pediatric dentist, parents and pediatrician is a three-way process for the sake of a child's oral health. Most studies have shown that pediatricians have insufficient knowledge of caries and its transmission, and that pediatricians have limited knowledge and understanding of the initial clinical signs of caries, the recommended age for the first visit to the dentist, the etiology of caries, and recommendations for the use of fluoride toothpastes. No conflict of interests was declared by the authors.

Hemophilia A is an X-linked recessive disorder caused by a deficiency of plasma coagulation FVIII, which may be inherited or arise from a spontaneous mutation. FVIII deficiency leads to a decrease in normal hemostasis and is manifested by spontaneous or induced bleeding. As a result of hemorrhages in the central nervous system, neurological complications are possible. In such cases, doctors should be on the alert so as not to miss another accompanying pathology. Neurodegenerative disease with iron accumulation in the brain is a genetically and clinically heterogeneous group of hereditary progressive disorders of the central nervous system with pronounced iron accumulation in the basal ganglia, which have a specific picture on magnetic resonance imaging of the brain in combination with characteristic clinical signs. Purpose - is to describe a clinical case of a combination of two complex hereditary diseases in a 10-year-old boy, hemophilia A of moderate severity, complicated by an inhibitor, and a progressive neurodegenerative disease with accumulation of iron in the brain, with associated neurodegeneration associated with the protein of the mitochondrial membrane. The publication reports for the first time a clinical case of a combination of two complex hereditary diseases in a 10-year-old boy, confirmed by molecular genetic studies: hemophilia A of moderate severity, complicated by an inhibitor with the detection of a large deletion of exons 23-26 in the gene, and progressive neurodegeneration with brain iron accumulation, with the presence of a pathogenic mutation of the C19orf12 gene, variant c.204_214del (p.Gly69Argfs*10) in a homozygous state, autosomal recessive type of inheritance, Mitochondrial-membrane Protein-Associated Neurodegeneration. Coagulopathy is controlled by prophylactic administration of emicizumab subcutaneously. Neurodegeneration with brain iron accumulation in the child was manifested by: Friedreich's foot, equinus feet, positive Babinski symptom, high tendon reflexes, optic nerve atrophy; partial dysplasia of both eyes; with myopia of both eyes, impaired accommodation, progressively increasing paresthesias in both legs, impaired gait, ataxic gait, coordination difficulties, muscle atrophy of both legs, visual impairment, rapid fatigue with preserved intelligence and mental development. Magnetic resonance imaging of the brain showed a moderate bilateral symmetrical lesion of the globus pallidus. Our report confirms that the use of molecular genetic studies plays an important decisive role in the verification of the disease, often determining its type and possible complications. 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 interests was declared by the authors.