THE PECULIARITIES OF CLINICAL COURSE OF ATOPIC DERMATITIS AND THE COMORBID CONDITIONS IN EARLY INFANCY.

Atopic dermatitis represents one of the most prevalent manifestations of atopy in children, which is distinguished by the early onset and high frequency of chronicity. The aim of this study was to study the clinical features of atopic dermatitis in early childhood and to evaluate comorbid conditions. The prospective research was conducted to study the cohort of 68 patients, who were developed the atopic dermatitis under 2 years of age. It was revealed, that the age of onset of the disease and the clinical severity was determined by the genetic predisposition on the mother's side. According to the clinical severity of the disease there were revealed the series of peculiarities especially in the case of moderate course: the high frequency of comorbid allergic pathology (rhinitis, conjunctivitis, urticaria, allergic gastritis) and the co-existing gastroenterological disorders (colic, constipation and foaming). The use of CoMISSas a non-invasive tool assumes the great importance in respect of making timely diagnosis of the allergy to cow's milk protein.

ASTHMA CONTROL STATUS AND LUNG FUNCTION IN RELATION TO VITAMIN D LEVEL IN CHILDREN WITH BRONCHIAL ASTHMA.

The aim of the study - low circulating vitamin D level maybe related to poor asthma control status and decreased lung function. The aim of our research is to establish correlation between serum vitamin D level, asthma control status and lung function. The study was performed in children aged 6-15 years old, including patients with asthma (n=50), who referred to Sachkhere medical center for a visit. The status of asthma control in the basic group was classified as controlled (n=31) and uncontrolled (n=19). The children underwent serum vitamin D and IgE level, spirometry and skin prick tests for the study. Using the multivariate logistic regression analysis, the presence of asthma was associated with the reduced level of vitamin D (OR = 1.35, 95% CI (1,14-1.58) P = 0.011; χ2=6.78; F-0.022) in children with uncontrolled bronchial asthma. 48% of the patients in the group- controlled asthma (n=15) had vitamin D deficit, and in 52% of the cases (n=16) was confirmed with vitamin D insufficient. In the group -uncontrolled asthma - 5% of the patients (n=1) had Vitamin D insufficiency in blood serum. In 95% (n=18) of the patients vitamin D level was significantly low <20 ng/ml. According the results, decreased pulmonary function (p-0.039; χ2-3.12) is strongly associated with low level of vitamin D; but neither serum IgE level (p-0.54; χ2-10.9), nor skin prick test result on dust mite (p-0.50, χ2-5.12 ) was correlations with serum vitamin D low level. The presence of vitamin D deficiency effectively predict increased risk of uncontrolled bronchial asthma in children. Serum vitamin D level is related to lung function too. Therefore, the normalization of the serum levels of Vitamin D may have beneficial effect on improvement of asthma control in the complex of asthma management and preventive measures.

COMPLEX EVALUATION OF THE HEALTH STATUS OF PRIMARY-SCHOOL AGED CHILDREN (ADJARA REGION).

Goal of the research was complex evaluation of the health status of the primary-school aged children residing in various regions (urban, rural) of Adjaria. Cross-section, one-stage research was conducted in the City of Batumi and village Tsikhisdziri. In the process of survey health status of children of 4 public schools, from 6 to 9 years old was studied. Observations covered up to 800 school children in total. Screening included consultations of the multidisciplinary group of specialists, additional laboratory and instrumental studies intended for the purpose of accurate diagnostics. Performed studied showed that 28.3% of the studied population was actually healthy, 55% had functional disorders and 16.7% - chronic diseases. In both, urban and rural areas the share of the digestion system, blood and blood-generating organs, nervous system, ophthalmological pathologies and locomotion system diseases prevailed.

PSYCHO-EMOTIONAL CHARACTERISTICS OF THE ADOLESCENTS WITH ALLERGIC RHINITIS.

Allergic rhinitis is a widespread allergic disease, with 35-40% prevalence in the world population. It is characterized with increasing frequency, particularly in children's population. Goal of the work - study of psycho-emotional profile in adolescents with allergic rhinitis of different severity. Single-stage research was conducted, in compliance with the ethical norms. Study included 86 children (41% girls and 45% boys) of age from 11 to 13 years with allergic rhinitis of different severity and 30 healthy children. For the purpose of study of the patients' psychological profile Esenek Personality Questionnaire (EPQ) intended for assessment of characterological and individual psychological features in children and adolescents (10-15 years) was used. Psycho-emotional sphere of the adolescents with allergic rhinitis was assessed also by Psychopathologic Symptom Checklist (Symptom Checklist-90-Revised-SCL-90-R). Clinical scale of self-assessment of psychical condition is widely applied in ambulatory and hospital practice. At the final stage of research the mathematical-statistical data processing was provided by means of SPSS/v12 software package. According to the research results, susceptibility to significant and mild introversion was identified in severe and average AR cases. Such patients are often locked into their inner world. These children are reserved, communicate with the parents and close friends only. They make decisions with due care, love order, control their emotions, are pessimistic and rarely aggressive. Results of neuroticism study by G. Esenek techniques are provided in Table. Neuroticism is associated with the lability of nervous system, characterizes emotional condition or emotional lability (emotional stability or instability). According to the research results, allergic rhinitis is characterized with emotional instability, anxiety, as manifested by unsatisfactory adaptation, instable nature, depression, low resistance to the stress situations. Based on the conducted researches, we regard that individual assessment of psychological profile of patients with allergic rhinitis would be reasonable, for the purpose of management optimization.

ALLERGIC DISEASES AND ASTHMA IN ADOLESCENTS.

The goal of our research was to find out, whether asthma phenotyping, based on presence of accompanying allergic diseases is significant for asthma classification or not. Research was conducted on the basis of questioning of random and representative cohorts of Tbilisi children's population, by cross-section method of epidemiological research. Special extended screening questionnaire was developed for epidemiological study of allergic diseases. Diagnostic criterion for allergy was analyzed and representative cohort was selected. Research was conducted in 2010-2014 period. Studied population included 1450 children from 2 to 17 years age representing Tbilisi general population (of them, 850 girls and 600 boys). As a result of research the following findings were made: asthma was confirmed where at least two of the listed was present: diagnosis of asthma made by doctor, asthma symptoms and consumption of drugs against asthma. Allergic rhinitis was confirmed, where more than one of the listed symptoms was present and children should not have caught cold, rhinorrhea, nasal obstruction or snore, combined or IgE with some inhalation allergen. Atopic dermatitis was confirmed if the subject had atopic dermatitis at a time of interview or clinical study. Markers of asthma severity were based on number of asthma episodes and number of symptoms, or regular consumption of corticosteroids, number of missed days at school and answer of subjects to the question: for the past year what was the degree of discomfort attributable to asthma ("very high" - "absolutely not"). Allergic sensitization was assessed based on the skin prick-test and test of specific immunoglobulin E in serum and was deemed positive where the average diameter of blebs in skin prick tests was 3 mm larger than negative control and IgE-0,35kU/l. Lung function was assessed by means of respirometers, by evaluating maximal forced expiration data and flow-volume curves. Allergic rhinitis was regarded as the most common accompanying disease. Subjects with non-specific hyperresponsiveness of bronchi and asthma before age of 12, were classified only as being in remission and having accompanying allergic disease and subjects without obstruction and asthma were classified as absence of asthma and were designated as independent group. Population was divided into "active" (indicate presence of symptoms or are subjected to treatment) and "ever" (diagnosis was made before involvement into the study) groups. Main finding is identification of correlation between airways inflammation and phenotype accompanying asthma in children of age from 2 to 16. Research showed than of 860 children (398 males and 462 females) of age from 2 to 8, 62 children had asthma (17 females and 45 males) with at least accompanying disease. Of 590 children (311 males and 279 females) of age from 9 to 17, 81 children had asthma (26 females and 55 males) with at least accompanying allergic disease. The most common asthma phenotype was only asthma, in 32.8%, further asthma and allergic rhinitis (27.9%), asthma with allergic rhinitis and atopic dermatitis (13%), asthma with atopic dermatitis (4.9%). Asthma phenotypes did not differ significantly, with respect of asthma severity and need of anti-inflammation medication. Gender was notably correlated with only one phenotype of asthma; boys are more susceptible to asthma and allergic rhinitis, compared with the girls (9.5% boys and 4.9% girls) p=0.001. Lung function is significantly correlated with hyperresponsiveness of bronchi associated with asthma phenotype with the lowest FEV 2% data - in case of asthma, allergic rhinitis and atopic dermatitis. Our research showed than asthma in adults is accompanied with allergic rhinitis or atopic dermatitis (approximately 14.9%). In puberty, asthma phenotypes with allergic rhinitis was mostly associated with non-specific hyperresponsiveness of bronchi and airways inflammation (p>0.05). In the combinations of allergic diseases the association of the phenotypes with gender was mostly found in males (p=0.001).

Anthropometric data peculiarities in early school children population.

The anthropometric data were studied in early school aged (6-7 years old) children and the degree of harmonization during physical development was evaluated. Representative population of 400 otherwise healthy early school aged children was included in study group. Study period covered the end of school year. In the selected under observation focused population the level of individual anthropometric data was determined in percentile intervals according its position. Anthropometric data assessments by using percentile method it was revealed in early school aged (6-7 years of old children) excess in body height and weight in comparison with normal values. This phenomenon indicates the prevalence of acceleration and weight gain. Anthropometric data in boys were increased while comparing with physical development data in girls. This result difference has the tendency to statistically insignificant. Physical development harmonization values were studied in 200 children. Harmonized physical development revealed in 50 children (25%); disharmonized physical development I 50 children (15%), among them with I degree weight gain were 48 (24%), and with I degree weight deficit were 2 (1%). Markedly disharmonized development had 100 children (50%), among them with II degree weight gain were 98 (49%), and with II degree weight deficit were 2 (1%). According to the children's anthropometric data and assessment by physical development harmonization percentiles tables three groups of children were organized: main, risk group and the group with deviation in physical development. On the basis of resulted data the study of early school age children's physical development gives possibility for risk groups stratification, which in turn itself makes a strong basis for reasonable preventive measurements and stepwise monitoring implementation.

Clinical and psychological characteristics of school adaptation.

70 girls and 50 boys--totally 120 practically healthy children were examined; Three age-specific groups with equal number of children were chosen. Goal of the research was to evaluate the adaptation ability and analyse the disadaptive derangements in primary school age children. Cross-sectional, one moment research was carried out according to D. Stot's "Map of Observation". Adaptive potential determination and evaluation of vegetative nervous system functional state was done. Special charts for children were filled in. 56% of pupils were practically healthy and well adapted to school obligations. In the rest of cases different degree and form of school dysadaptation derangements were revealed. The dysadaptation contingent with cognitive function was seen in 14% of children. Emotional attitude derangements to learning process was revealed in 18% of children.; and hard to cope with the derangements correction in behavior was seen in 12% of children. The study results enabled us to reveal different types of school dysadaptation in primary school age children as well as to study the main reasons for their formation on the basis of age-specific characteristics. The above-mentioned fact should be taken into consideration while elaborating complex rehabilitation actions and school disadaptation prevention.