The literature review is concerned with the analysis of current studies on the disorders of the autonomic nervous system in childhood. Autonomic dysfunction syndrome (ADS) occurs in the general child populaton in more than 20% of cases, and in some children may cause the development of many somatic diseases. Recently, there has been a tendency toward the increase in the number of children with manifestations of this pathology. This may be explained by the ambiguousness of the methodological approach, taking into account either all or markedly pronounced disorders only. The prevalence of vegetative dysfunction is obvious, even among people who consider themselves to be apparently healthy. Moreover, there are no such pathological conditions the development and course of which do not involve vegetative mechanisms. Primary dysfunction of the autonomic nervous system initially causes functional disorders, particularly those of the cardiovascular system. In fact, arterial hypertension and hypotension are the basis for the development of such serious diseases of adults as coronary heart disease and hypertension leading to the development of serious complications. The symptoms of vegetative-vascular dystonia are associated with the dysfunction and coordinated interaction of the two parts of the autonomic nervous system, rather than the pathology of any internal organ. It is important not to miss the patient’s subjective complaints related to the functioning of various organs which simulate the disease, but in fact no pathology is detected, as the clinical symptoms are associated with the imbalance of the nervous system. In case of any autonomic disturbance, the etiology and nature of the disorder should be clarified; the level of involvement of the autonomic nervous system, brain structures, parasympathetic and sympathetic autonomic formations must be determined. As reported by the publications, psycho-emotional factors are among the main reasons that contribute to ADS development, especially in senior schoolchildren. In most of them, vegetative lability in puberty is unstable, but with additional exposure and a combination of other causes it stabilizes. That is why, special attention should be paid to the factors affecting children’s psycho-emotional state, the phenomenon of “bullying behavior” (bullying). Well-known bullying researchers have studied the reationships between young people at school and have concluded that bullying behavior involves some negative actions leading to resentment and chronic stress. Some publications state that current stressful environment is a powerful trigger for nervous system dysfunction and can lead to negative consequences in adult life. The development of new approaches to the early diagnosis, treatment and prevention of this pathology in childhood is integral for reducing the incidence of the disease among adult population. Nowadays, the management of autonomic vegetative nervous system dysfunction is significantly difficult. Vegetative stigmatization, which accompanies any pathological process, is routinely perceived as its obligatory component, inherent in both clinical symptoms of the disease and its pathogenesis. Therefore, due attention is not always paid to the management of autonomic disorders in somatic pathology. Treatment of vegetative disturbances is based on conventional regimens, which are mostly ineffective; it is obvious that proper diagnosis and successful treatment requires individual approach to each patient.

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Background. The problem of obesity in adolescents has gained its medical and social relevance since the incidence of the disease is steadily increasing. The purpose of the study is to improve the effectiveness of early diagnosis and prevention of obesity in adolescents. Materials and methods. To study the risk factors for obesity, a comparative assessment of lifestyle among adolescents aged 15–17 years with obesity, overweight and physiological body weight was conducted. In adolescents of the same age with comorbid obesity (basic group), overweight and physiological body weight (two comparison groups), the types of food behavior were determined using the Dutch eating behavior questionnaire (DEBQ). Bioelectrical indicators of bio-impedancemetric analysis were studied on a Tanita apparatus (Japan). The probability of differences in mean values was determined using Student’s t-test. Results. It was found that the frequency of imbalance of the food pyramid, movement disorders, sleep and rest, nervous tension, burdened heredity increased significantly among obese adolescents. Obesity was found to dominate by external type of eating behavior (57.2 %); at the excess weight — restrictive type (60 %); at physiological body weight — emotional type (40 %). Bio-impedancemetry showed that the reliable bioelectrical parameters of obesity were total fat (35.5 ± 4.5 % and 29 ± 2 % vs. 17.5 ± 2.5 %); visceral fat (17 ± 2 % and 12 ± 3 % vs. 8.5 ± 1.5 %); and metabolic age (33 ± 8 and 21.5 ± 1.5 years versus 16 ± 1 years). Conclusions. Risk factors for obesity include the imbalance of the food pyramid, movement disorders, sleep and rest, nervous tension, bad habits, burdened here­dity. The predominance of external type of eating behavior in obesity, restrictive — in overweight and emotional type in adolescents with physiological body weight should be taken into account when prescribing personalized lifestyle adjustments. The most informative bioelectrical parameters of bio-impedancemetry were total fat, visceral fat, and metabolic age. Bio-impedancemetry as a non-invasive predictive method of diagnosing obesity can be re­commended for widespread implementation in pediatric practice.

The review presents current literature data on the prevalence of obesity and metabolic syndrome in children. According to the WHO’s prognosis, over 25% of children will be overweight and obese and about 7% of children will have metabolic syndrome in Europe by 2025. Long-lasting improper diet combined with reduced physical activity, with daily caloric food value exceeding vital energy requirements, is the main cause of excess body weight and obesity. It has been presented new, never-before-seen, properties of adipose tissue being the largest endocrine organ, which contains receptors for many hormones and produces its own peptide hormones-adipokines (leptin, adiponectin, resistin, tumor necrosis factor-alpha, etc.). It has been indicated that patients suffering from obesity and metabolic syndrome have impaired incretin effect (glucose-dependent insulin stimulation, decreased glucagon secretion) in response to the action of incretin hormones (glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide) caused by acquired receptor defects . It has been noted that differentiation of mesenchymal stem cells into two pools of cells (Myf5-positive and Myf5-negative) is subsequently completed with their transformation into white, brown and previously unknown beige adipose tissue. Metabolically healthy obesity, the phenotype of which is mainly due to the gene expression in the CNS, and Metabolically Unhealthy Obesity, the phenotype of which is due to the expression of peripheral tissue genes, are the most common phenotypes of polygenic obesity. It has been emphasized that Metabolically Unhealthy Obesity is considered by some authors to be the modernized name of the metabolic syndrome. The metabolic syndrome is known to be pathogenetically associated with obesity, hypertension, dyslipidemia, impaired glucose tolerance, and type 2 diabetes mellitus. It has been noted that until recently there were no uniform criteria for determining the metabolic syndrome in children. Nowadays, researchers keep to the criteria for Metabolically Unhealthy Оbesity in children, recommended by the American Association of Clinical Endocrinologists and the American College of Endocrinologists (AACE / ACE), 2014; and the European Society of Endocrinologists (ESE) and the Pediatric Endocrinology Society (PES), 2017. Early diagnosis and timely correction of obesity and metabolic syndrome is impossible without modern innovative medical technologies. The use of bioimpedancemetry for the diagnosis of total fat, visceral fat and metabolic age makes it possible to accurately diagnose visceral obesity, which is not recognized by body mass index, and timely administer a personalized lifestyle correction. Consequently, the widespread introduction of bioimpedancemetric analysis in paediatric practice will facilitate the early primary and secondary prophylaxis and development of comprehensive personalized treatment programs for obesity and metabolic syndrome in children.

An analysis of domestic and foreign literature on the prevalence, causes and mechanisms of pneumonia in children. This article highlights the prevalence and features of the clinic and diagnosis of pneumonia in children based on a review of the literature. Out-of-hospital pneumonia today remains a pressing medical and social problem, often leading to complications and often causing the death of children, both in Ukraine and around the world, so it needs more in-depth diagnosis. It is known that the severity of this disease depends on age, etiology, comorbidity and timely hospitalization. The incidence and prevalence of respiratory diseases is one of the main indicators of health among children in the world. Therefore, the purpose of this research is to analyze foreign and domestic literature sources on the prevalence and search for the most informative diagnostic criteria for pneumonia in young children. More recent meta-analyzes of etiological data indicate a change in the profile of the pathogen, which increases the recognition that community-acquired pneumonia is caused by sequential or simultaneous interaction of more than one microorganism. Given the epidemiology of community-acquired pneumonia and long-term hospital stays, the study and synthesis of data on the diagnostic criteria for community-acquired pneumonia remains relevant. It is currently not possible to identify a single marker or clinical sign that can be used to distinguish bacterial from viral pneumonia. It is important to evaluate all indicators of objective, instrumental and laboratory examination. Based on literature data, cytokine status indicators can be used to prevent the development of complications from pneumonia, prescribe adequate therapy and determine the duration of treatment. There are many other biomarkers that have been linked to the severity of pneumonia in children. According to statistics, a study of children with COVID-19 showed that the blood of patients, especially those with severe disease, has high levels of proinflammatory cytokines, especially IL-6, which during infection may be a key cytokine that causes serious inflammation and acute damage to many organs and systems. In particular, such a biomarker is IL-6 - the only serum cytokine, the presence of which probably correlates with the severity of pneumonia. The relationship between serum IL-6 and IL-10 levels is an important diagnostic criterion for determining the severity of pneumonia in children on admission, which allows screening for the risk of complications and assessing the possibility of rapid recovery. The use of immune and inflammatory markers in children with pneumonia can potentially lead to the development of innovative methods for predicting complications of community-acquired pneumonia and determining the severity. In addition, it has been shown that serum IL-6 levels are significantly reduced in patients with pneumonia during the recovery period, which allows to evaluate the effectiveness of treatment. Procalcitonin is also an important indicator of the inflammatory process. There are conflicting data on the ability of procalcitonin to distinguish between bacterial and viral infections. Given these data, procalcitonin can be used as a diagnostic criterion for the presence of bacterial infection and the appropriateness of antibiotic therapy. Analysis of available scientific works on prevalence features of the clinic and diagnosis of pneumonia in children, showed that the issue of timely diagnosis and differential diagnosis of pneumonia in children is still relevant and requires further research.