Background. The term "NSAID-induced gastropathy" was proposed in 1986 to distinguish specific damage to the gastric mucosa caused by prolonged use of nonsteroidal anti-inflammatory drugs from classic peptic ulcer disease. The widespread use of nonsteroidal antiinflammatory drugs (NSAIDs), on the one hand, and the need for their prolonged or continuous use, on the other, contribute to the spread of NSAID-induced gastropathy. Currently, there is a trend toward a 2-3-fold increase in the consumption of nonsteroidal antiinflammatory drugs every 10 years. Each year, more than 300 million people take nonsteroidal anti-inflammatory drugs, with only 1/3 of them doing so as prescribed by a doctor.

Objective. The article is devoted to one of the urgent problems of pediatric gastroenterology – peptic ulcer of the stomach and duodenum and complications in the form of gastrointestinal bleeding.

Results. Data on the pathogenesis, diagnosis, and treatment of ulcerative bleeding in children are presented. It is noted that the diagnosis of ulcerative bleeding is based on a combination of clinical manifestations, laboratory and instrumental studies. The article provides information on the prevalence, significant factors in the development of the disease, and research data showing a link between taking medications, mainly nonsteroidal anti-inflammatory drugs, and the risk of NSAID-induced gastropathy and ulcerative bleeding. The article shows how nonsteroidal anti-inflammatory drugs affect the course of peptic ulcer of the stomach and duodenum. Data on the possibility of ulcerative bleeding while taking nonsteroidal anti-inflammatory drugs are presented. The authors' own observations are presented as a demonstration. A clinical example describes a case of ulcerative bleeding in a teenager taking nonsteroidal anti-inflammatory drugs uncontrollably.

Background. DIn 2024, there is a marked increase in cases of mycoplasma community-acquired pneumonia in children. Some studies show that the prevalence of infection caused partly by Mycoplasma pneumoniae, which is antibiotic-resistant to macrolides, has increased by 30% compared to previous years. This increase may be associated with the widespread use of antibiotics such as macrolides (azithromycin and clarithromycin) in the context of the COVID-19 pandemic. Mycoplasma infection caused by Mycoplasma pneumoniae remains one of the urgent problems of pediatrics, especially in the context of growing antibiotic resistance and a changing climate of infectious diseases. An increase in the number of cases of mycoplasma community-acquired pneumonia is recorded every year, which requires more careful attention to this problem from the medical community. With an increase in the number of cases of mycoplasma infection, the spread of antibiotic-resistant strains is also observed. This creates serious problems for treatment, as standard antibacterial drugs become less effective. Studies show that resistance to macrolides, which have traditionally been used to treat this infection, has increased by 15-20% in two years. Symptoms of mycoplasma infection, such as cough, fever and fatigue, often overlap with other acute respiratory diseases. This creates difficulties for doctors in early diagnosis.

Objective. The purpose of the work was to determine the features of the spread and diagnosis of mycoplasma community-acquired pneumonia in children.

Conclusion. The problem of the spread and diagnosis of mycoplasma infection in children in 2024 requires close study and active action by the medical community. The growing level of antibiotic resistance and morbidity, erased clinical symptoms cause difficulty in the differential diagnosis of pneumonia and lead to improved awareness of doctors on mycoplasma community-acquired pneumonia issues.

Background. A clinical case of an encapsulated focal form of congenital hyperinsulinism in a young child is presented. A comprehensive examination was performed, including molecular genetic analysis, radionuclide diagnostics (PET-CT with 18F-DOPA) and intraoperative histological examination. During morphological analysis, an encapsulated focus of β-cell adenomatous hyperplasia was verified, located in the head of the pancreas. This finding necessitated an extended organ resection. It is particularly noteworthy that there is a clear fibrous capsule around the pathological focus, which presents a diagnostic challenge in differentiating this pathology from an insulinoma. The postoperative period was uneventful, and stable normoglycemia was achieved, which ultimately confirmed the positive outcome of the treatment and the patient's recovery. The unique feature of this clinical case is that it represents the first recorded example of the focal form of congenital hyperinsulinism, characterized by a well-defined fibrous capsule combined with adenomatosis lacking visible boundaries. As of today, similar observations have not been found in available publications from domestic medical centers, which highlights the rarity of the described case and its significance for expanding knowledge about the spectrum of focal forms of this disease. Analysis of this morphological variant highlights the importance of performing a rapid histological examination of tissues during surgery, which in this clinical case was a key factor in determining the extent of the resection. This decision allowed us not to be limited to just the encapsulated formation and ultimately led to the patient's full recovery.

Conclusion. This case demonstrates the importance of a multidisciplinary approach in the diagnosis of rare forms of congenital hyperinsulinism and highlights the need for a thorough histopathological examination of the surgical material to achieve correct clinical decision.

Background. Antiphospholipid syndrome is an autoimmune disease characterized by the presence of circulating antiphospholipid antibodies and thrombotic complications or pregnancy complications.

Objective. The aim of the study was to demonstrate the difficulties of antiphospholipid syndrome diagnosing in children with non-criterial clinical manifestations, without signs of systemic connective tissue pathology at the onset, using a clinical case as an example, and to determine ways to overcome the problem in diagnosing such cases.

Materials and methods. Analysis of the medical record of an inpatient f.003/u, clinical, functional research methods. An analysis of open literary sources on the scientific sites Cyber Leninka, eLibrary, PubMed, Lvrach.ru on the problem of antiphospholipid syndrome, its relationship with rheumatic diseases was conducted. The analysis included literature reviews, scientific articles, clinical studies. Results. The article describes a case of late diagnosis of reliable antiphospholipid syndrome in combination with chronic systemic lupus erythematosus with debut at the age of 1 year with the development of bilateral sensorineural hearing loss of grade 4 in chronological connection with a previous respiratory viral disease. Later, with the addition of focal alopecia with hair loss by the age of thirteen, detection of a false-positive Wasserman reaction, hematological syndrome, livedo reticularis, arthralgia, triple positivity for high-titer antiphospholipid antibodies. Immune markers of systemic lupus erythematosus were also detected in the diagnostic titer. A reliable diagnosis was established 40 years after the onset of the disease, due to the difficulty of diagnosis: non-criterial clinical manifestations of antiphospholipid syndrome. Clinical manifestations and immune markers indicated reliable primary antiphospholipid syndrome.

Conclusion. Currently, efforts are being made to develop new criteria for the classification of APS, a relatively rare disease in pediatric practice, including criteria specific to pediatric patients.

Background. Treatment of whooping cough in children includes antibiotics that can inactivate the pathogen causing the disease. Early initiation of antibiotic therapy can help prevent complications and shorten the duration of the disease.

Objective. To study and analyze the course of whooping cough in children, depending on their vaccination. Materials and methods. We analyzed the medical records of children under the age of 1 who were undergoing inpatient treatment at the Regional Infectious Diseases Clinical Hospital named after A. M. Nichoga.

Results. In total, 437 children in the Astrakhan region had whooping cough in 2023, of which 25.6% (156 people) were under the age of 1 year. The disease was registered in all administrative territories of the Astrakhan region, with the largest number of cases of whooping cough reported in children living in the Volga, Volodarsky and Ikryaninsky districts of the region – 16, 14 and 13 cases. When clarifying the vaccination history, it was revealed that only 44.2% (69 people) were vaccinated with the DPT vaccine according to the national preventive vaccination calendar. The remaining 55.8% (87 people) were not vaccinated. The cause of the disease in all sick children is contact with the direct source of infection: family members – 90.8% (79 people), while walking with other children – 9.2% (8 people). In the observed small patients, there was a dry cough and mucous discharge from the nose. A special feature of this period was the persistence of cough: despite treatment, it gradually intensified and became paroxysmal, which meant a transition to the next period – the period of spasmodic cough.

Conclusions. Recently, the incidence of whooping cough among children has been steadily increasing. The disease is registered in all age groups. The most severe disease is manifested in unvaccinated children. The main cause of the disease is contact with the source of infection. The main complaints of all children were paroxysmal cough at night and sputum discharge.

Background. Treatment of colorectal cancer in late lines of drug therapy presents significant challenges, since the arsenal of antitumor therapy options is limited. The possibility of using cytokinogenetic therapy drugs is attractive for potentiating the effect of re-administered cytostatics.

Objective. To evaluate the efficacy and safety of cytokinogenetic therapy in combination with cytostatic therapy in a patient with stage IV progressive colon cancer in the late line of antitumor treatment.

Material and methods. A 62-year-old patient was observed, admitted with a diagnosis of primary multiple synchronous colon cancer: transverse colon cancer, usT3N2M1b (liver), surgery (09/27/2022), 4 lines of therapy (FOLFOX-6, FOLFIRI + bevacizumab, regorafinib, cetuximab), progression, rectal cancer pT2N0M0, surgery (06/18/2020, 09/27/2022). During the examination, magnetic resonance imaging (MRI) with contrast enhancement was used.

Results. The patient noted an improvement in his well-being after three courses of cytokinogenetic therapy, and after the 8th course he was able not only to do his usual housework and get to the hospital on his own, but also began to do his professional activities a little. The use of antitumor therapy according to the XELOX scheme (5th line) in combination with cytokinogenetic therapy was not accompanied by significant toxicity. According to MRI data, partial regression of tumor foci was achieved.

Conclusion. The combined use of polychemotherapy according to the XELOX scheme and cytokinogenetic therapy drugs made it possible to achieve partial regression of a previously progressing tumor and increase the patient's life expectancy.

Background. The present study provides a comparative analysis of organoleptic properties a of six commercial foods for special dietary uses. The relevance of this study stems from the importance of considering organoleptic properties and taste characteristics of enteral nutrition formulas when selecting appropriate options for patients.

Objective. The aim of this study was to conduct a comparative evaluation of organoleptic properties and taste characteristics of six commercially available specialised food products for dietary therapeutic nutrition (enteral nutrition).

Materials and methods. The study involved 41 adult volunteers who participated in a blind tasting of six ready-to-use nutritional formulae. Products were assessed using a 5-point scale (appearance, aroma, taste, texture, mouthfeel, and overall evaluation) and a 10-point visual analogue scale for individual taste parameters (sweetness, acidity, saltiness, bitterness, protein taste).

Results. Results demonstrated significant differences in organoleptic parameters between products (p < 0.001). Products 1 and 4 received the highest ratings, with Product 4 characterised by excessive sweetness, which some participants described as "cloying". Product 1 exhibited a more balanced taste profile with moderate sweetness and low saltiness. Products 2, 5, and 6 had more neutral flavours but comparably low organoleptic scores.

Conclusion. This study emphasises the importance of considering organoleptic characteristics when selecting and developing enteral nutrition products to enhance patient compliance and individualise nutritional support. Study limitations included participation of adults only and single tasting session. The results may contribute to formula optimisation and improvement of specialised nutrition quality in clinical practice.

Background. Neuroendocrine tumors represent a heterogeneous group of neoplasms that vary in localization, growth characteristics, and clinical symptoms, originating from neuroendocrine cells. More than half of neuroendocrine tumors arise from the endocrine system of the gastrointestinal tract and the pancreas. These tumors are relatively rare neoplasms; however, in recent years, the incidence of neuroendocrine tumors has increased. The widespread presence of cells from the diffuse neuroendocrine system in the body accounts for the variety of tumor locations. Gastrointestinal tract neuroendocrine tumors consist of different cell types: G, ECL, S, and others. The pathogenesis of the clinical manifestations of functionally active neuroendocrine tumors is determined by the action of the bioamines and hormonesthey secrete. The classification of neuroendocrine neoplasms into groups of highly and poorly differentiated neuroendocrine tumors is determined using the Ki-67 index. Based on their origin and clinical symptoms, carcinoid tumors are distinguished into asymptomatic tumors and those presenting with the clinical picture of carcinoid syndrome. The clinical picture of this syndrome is characterized by "flushing" caused by the production of histamine and bradykinin, which have a vasodilatory effect. According to their functional activity, gastroenteropancreatic tumors, which have the most clinical significance, are classified into carcinoid, insulinoma, somatostatinoma, glucagonoma, gastrinoma, VIPoma, and ACTH ectopic syndrome. Neuroendocrine tumors are included in hereditary syndromes and diseases, such as multiple endocrine neoplasia syndromes (MEN-1, MEN-2), von Hippe – Lindau disease, McCune – Albright syndrome, neurofibromatosis type 1, and Carney complex. Some neuroendocrine tumors have a long latent course, leading to diagnostic challenges.

Conclusion. Treatment of gastrointestinal tract and pancreatic neuroendocrine tumors requires a comprehensive approach aimed at regression of clinical symptoms, normalization of hormone production, removal of the tumor and its metastases, improving quality of life, and increasing survival rates.

Background. In modern medicine, chronic fatigue syndrome is an urgent problem for internists. The high prevalence of chronic fatigue syndrome, which has a significant impact on public health, requires primary care professionals to have an in-depth understanding of the diagnosis and management of this condition. This literature review analyzes the prevalence, diagnostic criteria, and approaches to managing patients with chronic fatigue syndrome in the practice of a general practitioner in order to raise awareness and improve the quality of medical care.

Results. Chronic fatigue syndrome is defined as unexplained, prolonged fatigue lasting more than six months, which is not eliminated by rest and increases with physical or mental exertion. The prevalence of chronic fatigue syndrome varies in different regions of the world, reaching, according to some estimates, from 120 to 140 million cases. In North America, prevalence rates range from 0.2% to 0.7%, in Europe from 0.1% to 1%, and in Australia from 0.2% to 0.4%. Among patients seeking therapy, the prevalence of chronic fatigue syndrome ranges from 5% to 10%. Risk factors for developing chronic fatigue syndrome include being female, low income, and living outside major cities. Genetic studies have revealed a link between chronic fatigue syndrome and 14 different genes. Various factors such as toxins, chronic stress, viral or bacterial infections, as well as an imbalance of the intestinal microflora (dysbiosis) can act as triggers triggering the development of chronic fatigue syndrome. The diagnosis of chronic fatigue syndrome presents certain difficulties due to the lack of specific biomarkers. Various criteria are used to make a diagnosis, including the CDC/Fukuda criteria, the Canadian Consensus Criteria, and the IOM/NAM criteria. Comprehensive treatment of chronic fatigue syndrome includes normalization of the daily routine, physiotherapy, psychotherapy and pharmacotherapy (including vitamins, immunocorrectors and drugs aimed at improving mitochondrial metabolism). At the same time, an individual approach to each patient is important. The effectiveness of treatment can be high, but relapses of the disease are possible. Prompt detection of chronic fatigue syndrome and provision of qualified, personalized management of patients suffering from this condition is a crucial factor in ensuring a significant improvement in overall well-being, increased physical and psycho-emotional activity, as well as restoration of full-fledged social and professional adaptation, which together contributes to a significant improvement in the quality of life of these people.