Yurii Antypkin

Background. Sustained asthma control in children is often difficult to achieve, and biomarkers reflecting airway epithelial integrity are needed. Club cell secretory protein 16 (CC16) is a candidate marker of epithelial injury and lower airway inflammation. Objective: to determine serum CC16 in children with asthma according to disease severity and control. Materials and methods. This prospective study enrolled 72 children aged 6–17 years: 52 with asthma (mild, n = 13; moderate, n = 22; severe, n = 17) and 20 healthy controls. Serum CC16 was measured by enzyme-linked immunosorbent assay, and asthma control was assessed with the Childhood Asthma Control Test. Data are presented as mean ± SEM; a multivariable model assessed the association between CC16 and asthma severity, adjusted for confounders including age and sex. Results. Children with asthma had markedly lower serum CC16 concentrations than controls (1.80 ± 0.16 vs 2.51 ± 0.15 ng/mL; p = 0.0001). CC16 showed an inverse correlation with asthma severity (r = –0.45; p < 0.001). In children with mild asthma, the mean CC16 level was 2.42 ± 0.56 ng/mL and was notably higher than in severe asthma, where the lowest values were recorded (1.20 ± 0.06 ng/mL; p = 0.024). In moderate asthma, the mean CC16 concentration was 1.90 ± 0.14 ng/mL and was also lower than in the control group (p = 0.006). No statistically significant differences were found according to asthma control status (p = 0.148), although a downward trend in CC16 concentration was observed with poorer disease control. Mean CC16 decreased across control categories: 2.32 ± 0.43 ng/mL in controlled, 1.56 ± 0.11 ng/mL in partially controlled, and 0.85 ± 0.02 ng/mL in uncontrolled asthma. In the multivariable model, asthma severity remained an independent predictor of serum CC16 (β = –0.73; p = 0.002). Conclusions. In children with asthma, serum CC16 is reduced in proportion to disease severity, with the lowest levels in severe asthma, supporting its potential as a non-invasive biomarker of disease course.

Background. Radioactive contamination of the northern districts of Zhytomyr Oblast with caesium-137 and strontium-90 persists to the present day, generating cumulative mutagenic and epigenetic burden on the developing organism of children. Despite four decades having elapsed since the disaster, no systematic analysis of the structure of neurological pathology in the affected districts, incorporating data from contemporary diagnostic methods, has been conducted to date. Purpose. To systematise data on the spectrum of neurological pathology in children from radioactively contaminated territories of Zhytomyr Oblast, to analyse the transformation of its structure, and to evaluate the role of chronic low-dose radiation exposure as a teratogenic and mutagenic factor within the framework of current neurobiological concepts. Materials and Methods. A systematic literature review was conducted using PubMed, Google Scholar, Cochrane Library, and the repository of the Vernadsky National Library of Ukraine, with a search depth spanning 1990–2025. Regional medical and statistical data, population-based data from the OMNI-Net congenital anomaly surveillance programme, and original clinical observations verified by diffusion tensor imaging tractography and whole-exome sequencing were additionally analysed. Results. The structure of neurological pathology in the contaminated territories has undergone substantial transformation over the past decade. Among congenital malformations of the central nervous system, anomalies of the posterior cranial fossa, corpus callosum, and hippocampus — structures particularly susceptible to chronic low-dose radiation exposure — have come to the fore, displacing neural tube defects and microcephaly. Concurrently, the pattern of referrals from affected territories is now dominated not by congenital structural anomalies but by neurodevelopmental disorders — autism spectrum disorders, epileptic and developmental encephalopathies. Precise statistical data in Ukraine are lacking: no epidemiological study of neurological disorders in children residing in radiation-contaminated zones has been conducted, and official registries capture only referrals rather than true disease prevalence. The presented clinical case illustrates the combined neuropathology typical of affected districts, comprising structural brain changes, epileptic encephalopathy, and neurodevelopmental impairment resulting from radiation-induced damage to major white matter tracts. Conclusions. Chronic low-dose radiation exposure remains a persisting determinant of neurological pathology formation in children from the affected territories. Neurodevelopmental disorders in young children from affected districts constitute an indication for comprehensive neurological investigation aimed at identifying their underlying cause. An urgent priority remains the establishment of a regional registry of neurodevelopmental disorders in children from radioactively contaminated territories.

Factors of prolonged martial law in Ukraine significantly worsen the condition of children with neurological disorders, making it relevant to evaluate the effectiveness of rehabilitation systems in this vulnerable group. Aim - to evaluate the application of the Intensive Neurophysiological Rehabilitation System (INRS) according to the method of Academician V.I. Kozyavkin in children with neurological disorders from Ukrainian regions affected by hostilities, through the analysis of changes in gross motor functions, muscle tone, and psycho-emotional state. Materials and methods. A retrospective analysis of 257 discharge summaries from medical records of children aged 1–18 years who underwent a course of INRS from January to October 2025 was conducted. The included children had diseases of the nervous system and resided in regions affected by hostilities. Descriptive statistics, Gross Motor Function Classification System (GMFCS), Modified Ashworth Scale for muscle tone assessment, Manual Ability Classification System (MACS), as well as evaluations of psycho-emotional state and speech were used. Results. Overall clinical improvement was recorded in 96.9% of children (249 out of 257) with an average course duration of only 10 days. Reduction of muscle tone was observed in 71.2%, increase in the range of active movements - in 74.3%, and improvement of gross motor functions - in 41.2% of patients. Improvement in speech and psycho-emotional state was noted in 36.6% of children. This study enabled the evaluation of the Intensive Neurophysiological Rehabilitation System (INRS) specifically in a cohort of children who lived in areas affected by military actions. Conclusions. The Intensive Neurophysiological Rehabilitation System according to the method of Academician V.I. Kozyavkin contributes to the recovery of motor, cognitive, and psycho-emotional functions in children with organic lesions of the central nervous system under conditions of prolonged military stress. The results substantiate the need to expand access to INRS for children from affected regions and to include this method in the standards of rehabilitation for children with nervous system disorders in conditions of martial law. The authors declare no conflict of interest.

Inborn errors of metabolism (IEM) represent one of the most clinically significant yet underdiagnosed causes of epileptic encephalopathies in young children. The team of the Department of Pediatric Neurology at the State Institution "Ukrainian Center of Maternity and Childhood of the NAMS of Ukraine" has been investigating this problem for over 25 years, which served as the foundation for the preparation of this publication. Particular attention is warranted by pyridoxine-dependent epilepsy (PDE) — a rare autosomal recessive disorder caused by pathogenic variants in the ALDH7A1 gene — as a classical example of a treatable metabolic epileptic encephalopathy. Aim - to systematize current evidence on epileptic encephalopathies in inborn errors of metabolism in young children, and to elucidate the underlying pathogenetic mechanisms, clinical features, and approaches to diagnosis and treatment. A systematic review of the scientific literature was conducted using PubMed/MEDLINE and OMIM databases, with a focus on publications from the past 10 years. A clinical case of a 3-month-old girl with neonatal epilepsy refractory to standard therapy is presented. The diagnostic workup included prolonged video-EEG monitoring, brain MRI, biochemical investigations, and next-generation sequencing (NGS) using the CarrierSeq panel (420 genes). Epileptic seizures associated with IEM are characteristically resistant to standard antiseizure medications and may present as status epilepticus at onset. Age of manifestation serves as a key diagnostic indicator: the neonatal period is most typical for pyridoxine-dependent epilepsy, urea cycle defects, and nonketotic hyperglycinemia, while infancy is more characteristic of GLUT1 deficiency, biotinidase deficiency, and peroxisomal disorders. The diagnostic algorithm encompasses three tiers: a basic biochemical panel (glucose, lactate, pyruvate, ammonia, blood gas analysis, plasma amino acids, urine organic acids, acylcarnitine profile), specialized metabolic tests (α-aminoadipic semialdehyde, pipecolic acid, cerebrospinal fluid pyridoxal phosphate level), and molecular genetic analysis. An empirical therapeutic trial with pyridoxine (30 mg/kg/day for 3 days) is indicated in all neonates with seizures of unknown etiology refractory to conventional therapy. In the presented case, two pathogenic variants in compound heterozygous state were identified in the ALDH7A1 gene, confirming the diagnosis of PDE. Targeted therapy comprising pyridoxine, arginine, folinic acid, and a lysine-restricted diet resulted in sustained seizure remission and normalization of psychomotor development. Conclusions. Early identification and verification of a metabolic defect enables pathogenetically targeted treatment with the potential to fundamentally alter the disease prognosis. Nutritional and vitamin-micronutrient therapy represents an effective therapeutic approach for treatable forms of metabolic epilepsy, particularly in pyridoxine-dependent epilepsies. The authors declare no conflict of interest.

The issue of the quality of medical education in Ukraine has acquired nationwide significance. In the context of the COVID-19 pandemic, the full-scale war, and the rapid development of artificial intelligence, there is a growing need to adapt teaching approaches in medical universities to contemporary challenges, taking into account the current state of physicians’ professional training. The objective: to analyze perceptions of the current quality of higher medical education by students, interns, and young physicians. Materials and methods. A two-stage survey using an online questionnaire was conducted in 2023 (300 participants, including students and interns) and in 2025 (450 participants, including students, interns, and young physicians with up to 5 years of clinical experience). The respondents represented leading medical higher education institutions (MHEI) in Ukraine and assessed their perception of the current state of higher medical education using a 10-point scale according to the following criteria: human resources capacity, material and technical base, methodological support, integration of innovative technologies, international cooperation, and the level of implementation of modern clinical guidelines and standards (protocols) of medical care in the educational process. Results. Comparison of data from 2023 and 2025 revealed a statistically significant increase in scores related to the integration of innovative technologies into the educational process of MHEI and the development of international cooperation, indicating successful digitalization of education and adaptation of academic mobility programs in recent years. At the same time, a significant decrease in scores was observed for human resources and methodological support, as well as for the level of material and technical infrastructure. The most pronounced gap was identified in the assessment of the implementation of clinical guidelines and standards in the educational process among different respondent groups (from 5.12 ± 0.17 points among students to 2.10 ± 0.12 points among young physicians), highlighting insufficient development of skills related to understanding clinical and legal requirements of real clinical practice at the undergraduate education stage. Conclusions. Based on the survey of students, interns, and young physicians, a positive trend was identified in the development of innovative technologies and international cooperation in MHEI, along with a statistically significant decline in assessments of human, methodological, and material resources. Particular attention is drawn to the low level of practical use of clinical guidelines and standards of medical care reported by interns and young physicians who, unlike students, are engaged in practical medicine. The need to modernize educational programs by expanding elective courses and studying sector-specific regulatory documents from the undergraduate level is substantiated.

Background. X-linked creatine transporter deficiency (CTD) is a rare genetic metabolic disorder causing significant neurological impairments. It results from mutations in the SLC6A8 gene, which disrupt creatine transport into the brain. Clinical manifestations include developmental delay, intellectual disability, behavioral disorders, and epilepsy, often complicating early diagnosis. The purpose was to summarize current data on the pathogenesis, diagnosis, and treatment of CTD, and to present a clinical case illustrating the diagnostic challenges in this condition. Materials and methods. This article reviews the pathogenesis of CTD, which stems from a deficit in creatine transport to the brain. Diagnosis relies on clinical presentation, biochemical tests (creatine/urine creatinine ratio), and magnetic resonance spectroscopy (MRS), which reveals an absence of creatine peaks in the brain. The gold standard for diagnosis is molecular genetic testing (whole exome sequencing — WES). We present a clinical case of drug-resistant epilepsy and developmental delay in a boy whose CTD diagnosis was confirmed by WES and MRS. Results. Early diagnosis and timely initiation of therapy are crucial for improving prognosis. While no standardized treatment exists, combination therapy with creatine, L-arginine, and glycine proves more effective than creatine alone, as creatine precursors can utilize alternative pathways of transport into the brain. Promising avenues include the development of lipophilic creatine analogs and chaperone therapy. Conclusions. CTD is a serious condition requiring high awareness among clinicians for timely diagnosis. Combined supplementation with creatine and its precursors is the most evidence-based treatment strategy. Further research into novel therapeutic approaches, such as gene therapy, is vital for future treatment.

Aim: review of current data from scientific medical literature on the prevalence, genetic features, etiopathogenesis, approaches to diagnosis and treatment of atopic dermatitis in children. Atopic dermatitis (AD) affects 15% to 20% of children and 5% to 20% of adolescents and is the most common chronic relapsing inflammatory skin disease in children with severe pruritus. In recent years, the incidence of AD has increased 2-3 times in industrialized countries and varies depending on the geographical region. The manifestation of AD is realized in the interaction of genetic and environmental factors. Mutations in the filaggrin gene lead to a violation of the skin barrier function and an increase in the transdermal transfer of allergens and are a significant genetic factor that contributes to the formation of both AD and AD combined with asthma in children. The severity of the course of AD depends on the intestinal microbiota, the presence of food sensitization, and food allergy. The diagnosis of AD is established on the basis of criteria Hanifin and Rajka (three main and three additional) and the British group of experts. According to the criteria of the British group, the presence of the main criterion (itching of the skin in the last 6 months) and three or more secondary criteria (onset of symptoms before the age of 2 years; damage to the flexural areas of the skin in the anamnesis; general dryness of the skin; other atopic diseases) is necessary to establish the diagnosis of AD in the anamnesis of the child or parents, siblings; dermatitis of flexural areas of the skin). Depending on the age of the child, there are baby (from birth to 2 years), childhood (2-12 years), and adolescent (from 12 years) forms of AD. For the treatment of AD in children, a step-by-step approach is used, which is based on the severity of the course of AD, using emollients, various strengths of topical glucocorticosteroids, calcineurin inhibitors, in case of a refractory course, systemic immunosuppressive therapy and biological drugs. Conclusions. A timely diagnosis and individually selected treatment will allow parents and children to cope with the disease, avoid complications of AD and other psychosocial problems. No conflict of interest was declared by the authors.

According to experts, the Russian Federation's aggressive war against Ukraine, whose most vulnerable population groups are mothers and children, may become one of the bloodiest in modern history. Aim - to analyze the activities of the maternal and child health service of Ukraine under martial law using SWOT-analysis. Materials and methods. The research materials were data on the financial, economic, personnel, logistical and marketing potential of the maternal and child health service, the socio-economic situation and the regulatory framework during martial law in Ukraine. The methods of systematic approach, bibliosemantic, comparative analysis, and SWOT-analysis were used. Results. The data of the analysis indicate the existence of the main opportunities and strengths of the maternal and child health service of Ukraine during martial law - favorable economic policy of the state, assistance from the international community and charitable institutions, introduction of a new financial mechanism in the medical field and increase in salaries of medical workers, uninterrupted functioning of the modern system of medical care for mothers and children, which meets the basic principles of the World Health Organization. Key obstacles to medical care for mothers and children during martial law were the unfavorable demographic and economic situation in the state, the lack of legislative definition of the priority of state policy on maternal and child health, the impact of adverse factors of military aggression on the state of medical care and health of mothers and children, and the lack of experience of medical personnel in martial law. Conclusions. The SWOT-analysis of the state of medical care for mothers and children in Ukraine during military aggression is an effective tool for reducing and mitigating the negative effects of military aggression and making strategic, short-term and long-term management decisions to further improve medical care for mothers and children. The authors declare that they have no conflicts of interest.

Objective of the study: to assess the awareness of human papilloma virus (HPV) infection and HPV-related diseases among the parents of children aged 9-18 years and adults, to determine the level of readiness to be vaccinated and to vaccinate their children against HPV; to identify existing barriers to this, and to explore how war affects perceptions of vaccination.Materials and methods. A qualitative exploratory research was conducted. The data were collected through focus group discussions. Parents of children aged 9-18 and adults (men aged 18-26, women aged 18-45) took part in the research.Results. Most respondents were aware of HPV infection and HPV-related diseases, adult women and parents of children aged 9-18 years were more aware than adult men. However, the level of knowledge was limited and generally insufficient.The majority of respondents recognize HPV as a serious problem that leads to cancer, but the opinion that HPV is not a big problem was quite often expressed among adults and parents. Only a part of the interviewed women was informed about HPV by gynecologists, while men did not receive any data on this issue from health workers at all. The research revealed an extremely low level of awareness among adults and parents of children about the availability of HPV vaccination and its features. Adults and parents explained their ignorance in this matter by the fact that doctors mostly do not tell patients about this vaccine and do not recommend vaccination against HPV.The vast majority of parents did not want to vaccinate their children against HPV due to the lack of information about its effectiveness and safety. But they were more likely to reconsider their decision after receiving more information about the vaccine. Less often, parents reported a potential willingness to vaccinate their child against HPV. Common barriers to vaccination are primarily related to doubts about vaccine safety, mistrust of the medical system and vaccine manufacturers, and lack of knowledge about how vaccines work, what they are made of, and how they affect the body. However, parents and adults overwhelmingly believe that their attitudes toward HPV vaccination will improve if free vaccination is introduced.In the regions closest to hostilities (East, South) the situation with vaccination during the war worsened to a greater extent than in other regions. Most adults did not change their attitudes about vaccination during the war, and for a minority of them vaccination became less important. A third of parents reported that the relevance and importance of vaccination for them decreased, for a third it remained unchanged, and for another third it increased.Conclusions. Widespread and insufficient awareness of HPV infection and HPV-related diseases among parents of children aged 9-18 years and adults. Adults and parents base their assumptions that HPV is not a serious problem on the lack of objective information from doctors, as well as in the mass media or social networks.Most adults and parents of children aged 9-18 are not currently ready to vaccinate themselves or their children against HPV.The war affected both access to vaccination and the perception of the relevance of vaccination, depending on the distance of the region of residence from the front line. Vaccination access decreased in regions near active hostilities, in small cities and rural areas.Efforts are needed to increase awareness of HPV vaccination, including the importance of informing parents and adults about the HPV vaccine, timely vaccination, and regular screenings.

Armed conflicts have a detrimental effect on public health and destabilize health care systems, including perinatal care. Aim - to determine the impact of adverse factors of the full-scale war of the Russian Federation against Ukraine on the effectiveness of perinatal care. Materials and methods. The study was based on data from the scientific literature and medical statistics on the activities of perinatal care institutions subordinated to the Ministry of Health of Ukraine. The methods of systematic approach, bibliosemantic comparative analysis, and statistical data processing were used. Results. The analysis of the results showed a deepening during martial law of the violation of certain determinants of medical care and maternal health - a decrease in the frequency of timely coverage of pregnant women with early (up to 12 weeks of pregnancy) dispensary supervision - 87.82% in 2021 and 84.81% in 2023, OR from 95% CI: 1.29 (1.26-1.31), normal births - 62.03% and 60.40%, OR from 95% CI: 1.06 (1.05-1.08), with an increase in the incidence of syphilis among women - 2.7 and 3.2 per 100 thousand female population, OR with 95% CI: 1.18 (1.06-1.32), frequency of pregnant women’s anemia - 24.75% and 26.72%, OR with 95% CI: 1.08 (1.07-1.09), miscarriage - 6.2 and 6.7, OR with 95% CI: 1.01 (1.01-1.02), cesarean sections - 267.01 per 1000 births and 290.48, OR with 95% CI: 1.16 (1.14-1.18), low birth weight rate - 5.99% and 6.09%, OR with 95% CI: 1.04 (1.01-1.07), sick and diseased newborns - 196.93 per 1000 live births and 269.47, OR with 95% CI: 1.48 (1.46-1.50). Conclusions. The study confirmed the hypothesis of destabilization of perinatal care during martial law. The authors declare no conflict of interest.