Background. A significant increase in understanding of the role of vitamin D in the body, more effective detection of celiac disease, and the need to monitor the health of children against the background of long-term adherence to a gluten-free diet were prerequisites for our study. The study was aimed to analyze the level of vitamin D in children with celiac disease. Materials and methods. The results of the examination of 29 children aged from 6 months to 18 years with a verified diagnosis of celiac disease were analyzed. Serum vitamin D levels were measured by the electrochemiluminescent method (Roche Diagnostics GmBH, Mannheim, Germany). The results of vitamin D supplementation in patients with celiac disease were compared with the control group of 30 healthy children aged from 1 to 18. Mathematical processing of the material included a standard algorithm for statistical research using Microsoft Excel 2016, Attestat. Results. Among the patients included in the study, typical celiac disease was found in 24 (82.7 %) cases, which is 4.8 times more common than atypical — in 5 (17.4 %) children. The gastrointestinal symptoms dominated in a clinical picture. Manifestation of the disease in most patients was observed in the first year of life — in 17 (58.6 %) cases, in 7 (24.1 %) patients aged from 1 to 3 years, and only in 5 (17.4 %) children older than 3 years. The average rate of vitamin D in children with celiac disease was probably lower than in healthy children and accounted for 24.4 ± 1.2; 21.2 [16.45–35.21] ng/ml. The number of children with normal vitamin D content is the highest among young patients, while the frequency of vitamin D deficiency is the lowest. The median serum vitamin D in patients on a gluten-free diet was 1.4 times higher (p < 0.05) than in the acute period, but 1.3 times lower (p < 0.05) than in the control group. Adherence to a gluten-free diet leads to increased levels of vitamin D but does not allow reaching the level in healthy children. Conclusions. Vitamin D deficiency is registered in children with celiac disease. All patients with celiac disease, regardless of the stage of the disease and adherence to a gluten-free diet, need to be monitored for vitamin D levels.
The article presents the results of a literature review on Klinefelter syndrome combined with familial male-limited precocious puberty and describes a clinical case. Klinefelter syndrome is a form of male hypogonadism, characterized by the presence of an extra X chromosome, small testes, seminiferous tubule dysgenesis, high levels of gonadotropin, low serum testosterone level, underdeveloped secondary sex characteristics and male infertility. Klinefelter syndrome is characterized by extreme heterogeneity of clinical and genetic manifestations. The prevalence of Klinefelter syndrome is 0.1 to 0.2 % in male newborns and increases to 3 to 4 % among infertile men and 10 to 12 % in patients with azoospermia. Currently, it is not known how to treat patients with mild Klinefelter syndrome that remains undiagnosed or is combined with other genetic pathology, including gonadotropin-independent precocious puberty. This disease is caused by an autosomal dominant inherited activating pathogenic variant of the gene encoding the luteinizing hormone/chorionic gonadotropin receptor, which belongs to the family of G protein-coupled receptors. In men, activation of pathogenic variants of this gene causes excessive secretion of testosterone, which triggers early peripheral (precocious) puberty. Treatment recommendations have been developed in part mainly because of the limited number of reported cases, small sample sizes, and short-term outcomes. The presented clinical case is important in view of the possible risk of developing malignant testicular neoplasms in patients with precocious puberty. Therefore, long-term follow-up during and after puberty is recommended. It is of great importance to take into account the aforementioned clinical manifestations in order to made early diagnosis of this syndrome, offer timely genetic counseling to parents, and rehabilitate these patients physically, psychically and socially.
Background. Anti-Mullerian hormone (AMH) has now gained popularity as a marker of ovarian reserve. It is important to determine the place and role of AMH in children. The purpose of this work was to analyze the data of the scientific literature on the role of AMH in pediatric practice. Materials and methods. A review of the literature in PubMed was conducted, limiting itself to articles in English and updating the search in February 2022. The search term was “anti-Mullerian hormone”. A total of 437 manuscripts were found, including 37 review articles. The search was gradually narrowed with filters of clinical trials and systematic reviews to 75 articles. The references of the original and review articles were then checked to ensure a complete review. AMH is responsible for the differentiation of the gonads, provokes the regression of Mullerian ducts in the male fetus, correlates with karyotype, sexual development, levels of luteinizing hormone, follicle-stimulating hormone, and its serum levels reflect the ovarian reserve in women, even in childhood. Serum AMH is high from prenatal life to puberty. In postnatal period, the secretion of AMH by the testes is stimulated by follicle-stimulating hormone and strongly inhibited by androgens. AMH is of clinical value as a marker of testicular tissue in men with differences in sexual development and cryptorchidism, as well as in the assessment of persistent Mullerian duct syndrome. Determination of AMH is useful for assessing the function of the gonads without the need for stimulation tests and guides the etiological diagnosis of childhood male hypogonadism. In women, AMH is used as a prognostic marker of ovarian reserve and fertility. The use of criteria developed for adult women is problematic for adolescent girls, as clinical signs associated with polycystic ovary syndrome are normal phenomena of puberty. AMH can be used as an additional criterion in the diagnosis of polycystic ovary syndrome in adolescents. However, the lack of an international standard for AMH limits comparisons between AMH analyzes. Conclusions. AMH has broad clinical diagnostic utility in pediatrics, but interpretation is often complex and should be made in the context of not only the age and sex, but also the stage of development and puberty of the child. Recognition of the role of AMH beyond the development and maturation of the gonads may lead to new diagnostic and therapeutic applications that will further expand its use in pediatric practice.
Background. The results of most scientific studies in recent years have made it possible to reconsider the traditional ideas about the pathogenesis of chronic gastroduodenitis (CGD) from a new perspective. The purpose was to investigate the clinical and endoscopic features of СGD associated with Helicobacter pylori (H.pylori) in combination with giardiasis. Materials and methods. The study included 105 children aged 7–16 years divided into two groups: I — patients with СGD associated with H.pylori (n = 29), II — children with СGD associated with H.pylori in combination with giardiasis (n = 76). The study was conducted on the basis of the gastroenterology department of the Chernivtsi Regional Clinical Hospital during 2020–2021 and included esophagogastroduodenofibroscopy, ultrasound examination of the abdominal cavity, rapid urease test, determination of specific M, A and G immunoglobulins to H.pylori CagA antigen in the blood serum and in feces, fecal examination for Giardia lamblia (G.lamblia) antigen by polymerase chain reaction. Results. The most severe infection of G.lamblia occurred in children aged 9–13 years (17 people out of 29 positive). The number of children with G.lamblia increased between the ages of 7–9 and 10–12 years (p < 0.05, χ2 = 5.236, z = 1.899) and decreased in the age of 13–16 years (p < 0.05, χ2 = 7.144, z = 2.567). Patients with giardiasis complained of irritability (p < 0.05), headache, dizziness, restless sleep, heart pain, and they were more likely to show signs of intoxication and skin syndromes. Children of group I were most often diagnosed with corpus gastritis (p < 0.05), antral gastritis (p < 0.05) or pangastritis (p < 0.05) with focal hyperplasia (p < 0.05), and children of group II — with mainly antral gastritis, as well as severe duodenitis (p < 0.05). A characteristic endoscopic feature in children of group II was follicular duodenitis. Inflammatory process in group II significantly more often (p < 0.05) was severe (81.5 %) and active (77.6 %) and was associated with eosinophilic infiltration (51.3 %), microerosions and foci of lymphoid tissue hyperplasia (6.5 %). Conclusions. The clinical course of СGD associated with H.pylori in combination with G.lamblia is characterized by more pronounced dyspeptic symptoms with signs of intoxication and skin syndromes. According to the results of endoscopic examination, patients suffered from СGD associated with H.pylori infection had esophagitis, corpus gastritis, antral gastritis and pangastritis (p < 0.05) significantly more often. Children with G.lamblia invasion had severe follicular duodenitis (p < 0.05).
Currently, the attention of many researchers is drawn to determine the features of the regeneration of the mucous membrane of the gastrointestinal tract in ulcers, as one of the most important protective factors in this pathology. Purpose - to investigate the indicators of endogenous polypeptides (epidermal growth factor - EGF and transforming growth factor α-TGF-α) in the serum of children with duodenal ulcers. Materials and methods. The study included 56 children aged 7-18 years (36 children with duodenal ulcer - the main group and 20 healthy children (comparison group). The content of endogenous polypeptides in serum was determined by enzyme-linked immunosorbent assay (ELISA) using the Human EGF ELISA Kit (Invitrogen, USA) for EGF and R&D system (USA) for TGF-α according to the manufacturer’s instructions. Statistical processing of the obtained results was carried out using parametric and non-parametric methods of evaluation of the obtained results. Results. Slightly higher levels of EGF and TGF-α were found in boys of both subgroups of the main group (EGF: 561.45 [391.81-699.34] pg/ml and 544.67 [411.23-569.77] pg/ml, p>0.05; TGF-α: 47.91 [21.41-29.69] and 42.56 [35.45-49.21] pg/ml, p>0.05). Concentrations of endogenous factors in exacerbation of ulcerative process are higher than in remission (p<0.001) and in remission does not reach that in healthy children, p<0.01). In patients with severe duodenal ulcers, EGF and TGF-α concentrations are higher (p<0.01), which may be due to the maximum degree of inflammatory-destructive process. Conclusions. The course of duodenal ulcer leads to disorders in the regulation of proliferative processes in the mucous membrane, which is manifested by increased levels of EGF and TGF-α in the serum of sick children, the more severe the course, the higher process. 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 interest was declared by the authors. Key words: children, duodenal ulcer, epidermal growth factor (EGF), transforming growth factor α (TGF-α).
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