1962 - 1985 - Department of Pediatrics of the Faculty of Medicine

1985 - 2010 - Department of Pediatrics of the Faculty of Pediatrics

Since 2010 - 2nd Department of Children's Diseases

The first staff of the department: V.A. Boyko, N.A. Gres, L.V. Evets, A.I. Ivanovskaya, V.K. Lizunova, I.F. Makarova, A.I. Spider, F.P. Santalova, M.P. Sheibak.

Teachers of the department: A.N. Berdovskaya (2004 - to the present), P.G. Bedin (2018-2021, from 2023 - to the present), A.N.Brakk (2022 - to the present), K.U. Vilchuk (1982-2004), M.P. Volkova (1984 - to the present), O.N. Volkova (2008 - to the present), P.R. Gorbachevsky (2008-2021), N.A. Gres (1966-1971), L.N. Gurina (2001 - to the present), O.N. Drokina (2019 - to the present), V.A. Zhemoityak (1981 - to the present), O.V. Zenevich (2019 - to the present), A.I. Ivanovskaya (1975-1993), E.K. Kapitonova (1978-1993), A.A. Karchevsky (2007-2021), D.A. Kovsh (2023 - to the present), E.A. Konyukh (2001 - to the present), T.A. Lashkovskaya (1983-2021), V.K. Lizunova (1962-1970), I.F. Makarova (1962-1983), N.A. Maksimovich (1991-2010), V.S. Malanova (1973-2008), T.V. Matsyuk (1991 - to the present), I.G. Meshcheryakova (1991-1995), A.M. Mironchik (2017-2019), M.G. Myslivets (2013 - to the present), A.I. Paltseva (1980 - to the present), N.S. Paramonova (1978 - to the present), A.I. Spider (1965-1966), T.S. Protasevich (2010 - to the present), V.V. Ravskaya (2022 - to the present), M.V. Russu (2018 - to the present), F.P. Santalova (1968-1977), L.N. Sinitsya (2012 - to the present), N.V. Tkach (1991-2007), V.Y. Tolkina (2018-2020), N.H. Trambovich (2021 - to the present), O.F. Kharchenko (1987 - to the present), N.I. Khlebovets (1971-2021), R.N. Khokha (1985 - to the present), L.N. Sheibak (1988 - to the present), M.P. Sheibak (1962-2001), N.I. Yankovskaya (1984 - to the present).

Scientific school

«Grodno Pediatric School»

• the exchange of trace elements in various pathological conditions in children;

• diagnosis and treatment of intestinal toxicosis in children;

• features of the functional state of the endocrine glands in chronic gastroduodenal pathology in children;

• impaired intestinal absorption syndrome and food allergies in children;

• diagnosis, treatment and prevention of eco-dependent pathology in modern conditions in children;

• diagnosis of endothelial dysfunction and oxidative stress in children with various somatic pathologies;

• ways to correct violations of NO-dependent vasodilation mechanisms in various somatic pathologies in children.

Mikhail Petrovich Sheibak and his students [Sheibak M.P., 1960; Boyko V.A., 1965; Lizunova V.K., 1969; Begun A.V., 1978; Kharchenko O.F., 1993; Zhemoityak V.A., 2001] were among the first in the Republic of Belarus to study vital trace elements and their role in the body of a healthy person and a sick child. Standards for the content of trace elements (copper, zinc, magnesium, nickel, cobalt, chromium, manganese, iron, etc.) were established in the mother and fetus, in the body of a healthy child at various age periods, which made it possible to carry out timely prevention of deficiency conditions in children. The exchange of trace elements was studied in a number of pathological conditions (pneumonia, leukemia, lymphogranulomatosis, chronic gastroduodenal pathology), some obstetric conditions in mother and fetus, which required a change in the standard approach to the treatment of these diseases. The most important result of research on the problem of trace elements was the scientific substantiation of the practical application of a number of trace elements for preventive and curative purposes.

M.P. Sheibak's doctoral dissertation (1974) and a number of PhD dissertations by his students [Gres N.A., 1971; Evets L.V., 1974; Santalova F.P., 1976; Khlebovets N.I., 1981] are devoted to the problem of intestinal toxicosis in children. The authors have not only studied the etiopathogenetic mechanisms of the development of this pathology and developed its diagnostic criteria, but also proposed rational therapy schemes, the introduction of which into pediatric practice has significantly reduced infant mortality rates in the Grodno region. Based on the materials of scientific research, a monograph "Intestinal toxicosis in young children" was published, the relevance of which remains today.

Since the late 80s, M.P. Sheibak and his students began to develop a new scientific direction devoted to the study of small intestine insufficiency in intestinal diseases and pathology of other parts of the digestive tract (disaccharidase deficiency, gluten disease, primary malabsorption, etc.). The relevance of the research was determined by the fact that disorders of the small intestine, which are quite common in medical practice, are not always accompanied by distinct symptoms, masked by extra-intestinal disorders, in some cases lead to severe eating disorders, especially in young children, which creates significant diagnostic difficulties. Much attention was paid during the research not only to the primary congenital forms of enteral insufficiency, but also to secondary disorders. The frequency and features of clinical manifestations of disaccharidase (primarily lactase) insufficiency of the small intestine in children with various pathological conditions were studied, an algorithm for diagnosing disaccharidase insufficiency in children was developed [Kapitonova E.K., 1982; Paramonova N.S., 1985; Paltseva A.I., 1986; Lashkovskaya T.A., 1987; Sheibak L.N., 1988; Yankovskaya N.I., 1991].

Since 2001, a theoretical basis has been formed for a new direction of clinical research at the school. After receiving the Nobel Prize in Medicine by F. Murad, R. Furshgot and L. Ignarro (1998), a number of researchers convincingly demonstrated the important role of nitric oxide in the realization of the basic functions of all organs and systems of the body, however, in the vast majority, these were experimental animal studies. We have not found any clinical papers on this problem in children. The state of the NO system in cardiovascular pathology, kidney and gastrointestinal diseases in children has been studied.

As a result of the conducted studies, the role of endothelial dysfunction in the pathogenesis of cardiovascular diseases has been proven [Berdovskaya A.N., 2012; Maksimovich N.A., 2013]. The characteristic of the state of endothelium-dependent vasodilation is given and the formation of endothelial dysfunction (DE) in patients with CHD is established. It was shown that patients with a natural course of CHD had a lower increase in maximum pulse blood flow in the forearm according to the results of the test with reactive hyperemia compared with children after surgical correction of CHD. Children with DE, regardless of the nature of the course of CHD, were more often diagnosed with heart failure, pulmonary hypertension developed, and phenotypic manifestations of connective tissue dysplasia syndrome occurred: impaired posture, flat feet, and visual impairment. In 76% of children with CHD, there was an increase in the processes of endothelial desquamation, an increase in the blood level of stable nitric oxide metabolites and the development of oxidative stress, which explains the mechanisms of DE development in this category of patients.

Criteria have been developed to diagnose heart failure and pulmonary hypertension based on the level of circulating endothelial cells in blood plasma, the concentration of stable nitric oxide metabolites and the degree of depression of endothelium-dependent vasodilation.

In 47% of children with vegetative disorders, endothelial dysfunction was diagnosed, its connection with the initial sympathicotonia, hypo- and hyperkinetic type of central hemodynamic disorders, with cardialgia and cephalgia was established, which makes it possible to predict the risk of endothelial dysfunction in patients even at the stage of diagnosis of vegetative disorders. An increase in the absolute risk of developing labile arterial hypertension to 95.2% (additional risk – up to 58.7%) in endothelial dysfunction has been proven. The dependence between the index of endothelium-dependent vasodilation and the index of regulatory equilibrium of peripheral vascular tone was revealed, which made it possible to clarify the pathogenesis of labile arterial hypertension and reveal the important role of endothelial dysfunction in its development.

A decrease in the level of stable metabolites of nitric oxide, α-tocopherol, retinol and an increase in platelet aggregation in children with endothelial dysfunction was found, and the possibility of using the dynamics of these indicators to assess the effectiveness of correction of identified endothelial dysfunction in vegetative disorders was shown.

The influence of a high level of atherogenic risk factors on the development of endothelial dysfunction in patients with vegetative disorders has been proven, which gives reason to consider their elimination as one of the methods of preventing violations of endothelium-dependent vasodilation mechanisms.

The effectiveness of the combined use of multivitamins, fish oil preparations and enalapril in low doses (0.05 mg /kg) for the correction of endothelial dysfunction has been shown. As a result of the application of this treatment regimen, indicators of endothelium-dependent vasodilation improve, platelet aggregation properties and the level of natural antioxidants normalize, endothelial NO production increases, the frequency of cephalgia, cardialgia decreases, blood pressure levels normalize, which is the basis for recommending the inclusion of these therapeutic effects in treatment protocols for children with disorders of the autonomic nervous system against the background of dysfunction endothelium.

The high specificity (95%) and sensitivity (99%) of the reactive hyperemia test were established based on the use of impedance rheovasocardiography in patients with labile arterial hypertension and high levels of atherogenic risk factors, which allows us to recommend the widespread use of this method for non-invasive diagnosis of endothelial dysfunction and its inclusion in the examination protocols of this category of children.

The possibility of screening diagnosis of endothelial dysfunction (accuracy 94.2%) based on the developed clinical test (based on the results of discriminant and cluster analysis), including clinical manifestations of autonomic disorders and atherogenic risk factors, which ensures the selection of children at risk for hypertension.

Thus, it has been proven that endothelial dysfunction makes a significant contribution to the development of labile hypertension in children with disorders of the autonomic nervous system. It is assumed that the introduction of this technology into rehabilitation protocols for patients with vegetative and endothelial dysfunction will reduce the risk of transformation of this pathological process into atherogenic diseases and primary arterial hypertension, which will reduce the mortality rate of people of working age from cardiovascular pathology [Maksimovich N.A., 2013].

The state of the NO-system in children with chronic inflammatory diseases of the stomach and duodenum has been studied. A change in the metabolism of nitric oxide was revealed, manifested by an increase in the level of stable metabolites of nitric oxide in the blood plasma of patients with chronic gastroduodenal pathology in the acute stage, depending on the duration of the disease, the severity of morphological changes in the coolant and duodenum, the presence of infection and the degree of contamination of Helicobacter pylori coolant. When the general condition of patients is normalized against the background of ongoing treatment, there is a decrease in the level of stable NO metabolites to figures that do not significantly differ from the values of this indicator in children of the comparison group. Violations in the state of the prooxidant-antioxidant system of the body were revealed in the direction of increasing radical formation and inhibition of antioxidant protection (the level of α-tocopherol and catalase in erythrocytes), depending on the phase and duration of the disease, the presence of H. pylori in patients with chronic inflammatory diseases of the stomach and duodenum. The relationship between the severity of the main morphological changes in the coolant (the activity of the inflammatory process, the development of atrophy), the concentration of POL products and the antioxidant supply of the body, as well as the activity of POL processes, the state of antiradical protection of the body and the level of end products of nitric oxide metabolism in the blood plasma of the examined children, which confirms their pathogenetic relationship.

It has been shown that in patients with HCDP, there is a decrease in NO-conditioned EDVD according to the results of a test with reactive hyperemia, which is probably due to damage to the endothelial lining of blood vessels by the action of endotoxins, inflammatory mediators and POL products as a result of the development of an active pathological process in the coolant and DPC. The degree of decrease in ESRD depends on the duration of the disease, the presence and degree of contamination of the gastric mucosa with H. pylori, the severity and activity of inflammation, the presence of atrophic changes in the coolant and duodenum. The formation of DE in children with ESRD and DPC has been proven, which confirms the role of vascular factor in the pathogenesis of these diseases. In patients with DE, involvement of the pancreas in the pathological process and a decrease in the lactase activity of the small intestine were significantly more often noted. Assessment of the state of the NO-system in children with dyspepsia syndrome will make it possible to accurately and early diagnose chronic diseases of the gastroduodenal zone in children, and, consequently, the possibility of its successful prevention and treatment [Matsyuk T.V., 2009].

A decrease in the maximum increase in pulse blood flow (PC) was found in acute (OGN) and chronic (CGN) glomerulonephritis in children, and the degree of decrease in PC and the frequency of DE formation depended on the form of the disease. An increase in the content of stable metabolites of nitric oxide (NOx) in OGN and CGN was revealed, which can serve as a marker of the activity of the inflammatory process. It was shown that the level of NOx in case of FIRE decreased with an increase in the degree of damage to the endothelial lining of blood vessels, in case of chronic damage it did not depend on the functional state of the endothelium. Violations in the state of the prooxidant-antioxidant system of the body were revealed in the direction of increasing radical formation and inhibition of antioxidant protection in patients with glomerulonephritis. It has been shown that against the background of standard therapy, there is an improvement in the functional state of the endothelium in children with OGN and CGN, and a positive dynamics of α-TF content in erythrocytes in OGN has been revealed. It was found that standard therapy of OHN and CGN in children does not affect the content of NOx, HC, CT, α-TF and GT in blood plasma, diene conjugates and malondialdehyde in erythrocytes and blood plasma, the activity of erythrocyte catalase, as well as the content of α-TF in erythrocytes in the chronic course of the disease (p>0.05), which indicates the continued activity of the inflammatory process, the markers of which are the above factors. The positive effect of antioxidant therapy of Acecex and Vita-melatonin drugs in experimental glomerulonephritis has been proven [Konyukh E.A., 2013].

Regular seasonal fluctuations in iodine availability have been identified and described. A method has been developed to assess individual iodine availability by the level of ioduria, assessed three times at intervals of 1-2 months. Optimal ways of correcting iodine deficiency have been developed, taking into account the seasonal characteristics of iodine availability and risk factors for the development of excessive ioduria. The effectiveness of using the multivitamin-mineral complex Vitus-M, "Potassium iodide" and "Potassium iodide" in combination with the antioxidant complex "Antioxycaps" for this purpose was evaluated. The influence of various individual iodine levels on the indicators of the general blood test and humoral immunity was assessed [Tikhon N.M., 2006].

It was found that children of pre- and puberty age have multivitamin deficiency, most pronounced in the spring period in relation to vitamins C and B6 (Grodno region) and vitamins C, B6 and E, regardless of the season (Gomel region). During the ten—year period of dynamic observation in the Gomel region, an increase in the frequency of hypovitaminosis C by 54.3% and E by 27.5% was noted. In children aged 10-14 years living in the Gomel and Grodno regions, a violation of the oxidant-antioxidant balance was revealed, which has characteristic biochemical signs of oxidative stress, the development of which depends on the provision of an antioxidant group of vitamins, selenium and exposure to radiation factor.

It has been shown that therapeutic and preventive measures carried out in organized groups of children should include correction of vitamin availability by prescribing vitamin and mineral complexes lasting at least 2 months, taking into account risk factors for the development of hypovitaminosis and oxidative stress [Rovbut T.I., 2007].

The analysis of the prevalence of elevated titers of autoantibodies to various antigens of the body was carried out, factors affecting the production of autoantibodies in children and adolescents living in territories contaminated with radionuclides and in iodine-deficient regions were studied.

It was found that autoantibodies to thyroglobulin in elevated titers without signs of autoimmune disease (autoimmune diathesis) are detected on average in 7.59% of residents of the Republic of Belarus, with varying frequency among children (6.31%) and adults (10.58%). The presence of AT-TG in diagnostically significant titers is closely related to gender and age. The frequency of determination of elevated AT-TG titers is related to the level of radioactive contamination of the area and has a linear dependence on the level of incorporated radioactivity. The concentration of AT-TG depends on the iodine content of the examined patients. Living in an iodine-deficient region contributes to an increase in the number of positive samples in women.

It was shown that in children and adolescents living in different regions of Belarus and having no signs of autoimmune diseases, autoantibodies to various autoantigens were detected in elevated titers, which is typical for an autoimmune anomaly of the constitution. The detection rate of AT-TPO among the examined children was 26.5%, anti-GAD – 41.5%, ANA – 68.2%, AMA – 10.1%, ASA – 7.8%, ANA – 38.8%, GBM – 16.7%.

Prospective observation showed an increase in the spectrum and titer of antibodies. The probability of the appearance of antibodies to other organs and tissues in the presence of AT-TG is significantly higher. Antibodies to Helicobacter pylori were detected in 66.7% of aAT carriers. In patients with Hp antibodies, AT-TSH, AT-TPO and AT A were detected more often than in their absence, indicating a possible trigger role of helicobacteriosis in the formation of autoimmune pathology.

Autoantibodies to various antigens of the human body were more often detected in children and adolescents living in territories contaminated with radionuclides, regardless of gender.

The presence of elevated titers of autoantibodies to thyroglobulin in children with autoimmune diathesis is associated with hereditary burden on the female line. In the presence of AT-TG in the father, a positive titer of AT-TG was determined in 8.6% of children, with AT-TG "+" in the mother – in 26.7% of children. In siblings of AT-TG positive children, antibodies to thyroglobulin were diagnosed in 60.0%. If AT-TG was detected in two parents, then the detection rate of AT-TG in children was 74.0%.

It has been proven that children and adolescents with autoimmune diathesis are characterized by a clinical and immunological phenotype, manifested by an increase in the frequency of chronic diseases of the gastrointestinal tract, ENT organs, autonomic dysfunction syndrome, an increase in CD19+ lymphocytes compared with AT-TG-negative children, a decrease in CD8+ and CD56+ lymphocytes, an increase in IRI. The functional properties of immunocompetent cells in the presence of AT-TG are characterized by a low proliferative response induced by interleukin-2, an increase in TNF-a in blood plasma. Changes in the humoral link of immunity in the presence of AT-TG are accompanied by an increase in immunoglobulin G, a decrease in the production of important components of antioxidant protection: alpha-2 macroglobulin, haptoglobin, ceruloplasmin, and an increase in beta-2 microglobulin.

In children with elevated autoantibody titers, changes in the microbial landscape of the pharyngeal mucosa and the contents of the large intestine were significantly more often determined than in the absence of AT-TG.

Children and adolescents with antibodies to glutamic acid decarboxylase have a significantly high concentration of serum insulin, which does not affect the level of glycemia. Higher insulin concentrations were accompanied by an increase in the insulin resistance index and the pancreatic b-cell function index. In this group of children, the risk of developing type 1 diabetes is high. Carriers of autoantibodies to thyroglobulin and thyroid peroxidase are characterized by a tendency to increase the level of thyroid-stimulating hormone and decrease total thyroxine, they more often than in the comparison group showed the development of thyroid pathology, including autoimmune thyroiditis, diabetes mellitus, diseases of the gastrointestinal tract and oncological pathology with a high risk of developing these diseases in the future.

For women with a history of autoantibodies to thyroglobulin, pregnancy complications in the form of gestosis, the threat of termination and anemia are characteristic. The intranatal period in 57.0% had a burdened course (premature, operative childbirth, discoordination and weakness of labor, injuries of the birth canal). In children born to mothers with AT-TG "+", in most cases there was a burdened course of the neonatal period (asphyxia, intrauterine growth retardation, edematous syndrome, jaundice), children with hypotrophy were more often born.

The first staff of the department: V.A. Boyko, N.A. Gres, L.V. Evets, A.I. Ivanovskaya, V.K. Lizunova, I.F. Makarova, A.I. Spider, F.P. Santalova, M.P. Sheibak.

In 1979, in accordance with the Resolution of the Central Committee of the Communist Party of Belarus and the Council of Ministers of the Belarusian SSR dated 12/23/1977 No. 416 "On the work of health authorities and measures to further improve medical care for the population in the light of the requirements of the XXV Congress of the CPSU", a pediatric faculty was opened at the Grodno State Medical Institute, and in 1985 – the Department of Pediatrics of the Pediatric Faculty which was headed and was its permanent head for 13 years by Professor M.P. Sheibak.

The research work of the staff of the Department of Pediatrics of the Pediatric and Medical Faculties is aimed at solving urgent tasks and problems of practical healthcare. M.P. Sheibak's scientific thought has always been ahead of its time. More than 30 years ago, Mikhail Petrovich spoke and wrote about the problem of intolerance to cow's milk, and only today doctors have no doubt that milk can be an allergen, and its individual components in a number of pathological conditions may not be broken down and absorbed by the child's body. Replacement therapy drugs (lactase-baby) and dairy-free mixtures have been created.

The scientific research of M.P. Sheibak and his team was devoted to the study of problems of pulmonology, neonatology, cardiology, gastroenterology, hematology. In recent decades, he has been actively working to study the problem of impaired intestinal absorption and food allergies.

In the field of pediatric gastroenterology, the department holds leading positions not only in Belarus, but also abroad, and this is the direct merit of Professor M.P. Sheibak. The scientific direction of the department continues to be developed by its students.

After the accident at the Chernobyl nuclear power plant, one of the priority scientific directions of the school is the study of the pathology of the thyroid gland (thyroid gland), the functioning of the immune system and other adaptive reactions in children living in environmental conditions. Since it is known that in conditions of anthropogenic environmental pollution, excessive accumulation of xenobiotics in the human body leads to a violation of the endoecological status, manifested primarily in immunological and antioxidant stress, changes in the regulation of metabolic processes in the body. Insufficient supply of vitamins-bioantioxidants, which form a complex complex of antioxidant protection of the body, with unbalanced intake into the body initiates prooxidant effects and further exacerbates the state of chronic oxidative stress, which predisposes to the occurrence and exacerbation of a number of diseases in children.

Since 2001, thanks to close scientific contacts with leading scientists of Western countries: Professor R. Griglevsky (Poland), Professor L.J. Ignarro (Austria), Professor D.S. Celermajer, author-developer of the test with reactive hyperemia (Australia), which is the "gold standard" in the diagnosis of endothelial dysfunction, a new direction of scientific activity has become possible schools – study of the state of the "L-arginine–NO" system in children in normal and in various pathological conditions.

Since, from the standpoint of the effectiveness of preventive measures and the rational use of health resources, it is advisable to focus on primary disease prevention since 2010, the main focus of the school's research work has been the search for clinical and laboratory markers of early health disorders in children and adolescents with somatic pathology. The results of the school's scientific research will make it possible to diagnose somatic diseases in children early, which will reduce the risk of its chronization, increase the effectiveness of treatment, improve the quality of life of patients, and contribute to its successful prevention in adults.

The staff of the department has published about 1 thousand scientific papers, including 6 monographs. 12 collections of works have been published. More than 150 scientific conferences devoted to topical issues of pediatrics have been organized and held.

The school actively conducts student research work, the results of which are regularly reported at student scientific conferences. A number of works were submitted to the Republican review competition and awarded diplomas of the I-III category.

The school staff is actively working on the preparation and publication of teaching aids. Thanks to fruitful publishing activities, educational and methodological complexes have been created for faculties, taking into account the specifics of teaching.

Based on the obtained research results, a number of instructions for use have been developed, approved by the Ministry of Health of the Republic of Belarus. Work is effectively underway to train highly qualified scientific personnel, develop new methods of diagnosis, treatment and prevention of somatic pathology in children, as well as actively implement the results of the research into practical healthcare. A number of the school's students work at our university and other research centers. Research projects funded by the Ministry of Health of the Republic of Belarus are being carried out.

International cooperation is carried out with the Jagiellonian University of Krakow, Bialystok and Poznan Medical Academies (Poland), Ludwig Maximilian University of Munich (Germany).

The members of the school interned at the Polish-American Institute of Pediatrics of Jagiellonian University, at the Children's Clinic of the Ludwig Maximilian Medical University of Munich (Germany), the Zdrovija Dzezka center in Warsaw. Close cooperation has been established with the Russian Academy of Medical Sciences. A significant contribution is being made to the development of the university's research potential.