25 января 2016 года отметила юбилей Ирина Николаевна Захарова - д.м.н., профессор, заведующая кафедрой педиатрии РМАПО, заслуженный врач РФ, главный внештатный педиатр Центрального федерального округа России.

The article analyzes problems arising during breastfeeding and possible solutions.

The article presents the results of the genome-wide bioinformatic analysis of the vitamin D receptor interactions with the human genome DNA. Using a biological system assay, biological roles of proteins were analyzed that are specifically associated with the impact of VDR receptor. Systematization of the biological roles of vitamin D opens broad and previously unexplored perspectives for pediatric applications of vitamin D preparations for the prevention and treatment of a wide range of diseases starting from the fetal stage and early childhood.

Adequate supply of micronutrients including vitamins is essential for the normal functioning of child's body. Currently, about 2 billion people worldwide suffer from vitamin deficiencies. The most vulnerable population groups are pregnant women, children and adolescents. Vitamin deficiency which developed in childhood has adverse long-term outcomes throughout the whole life. One of the priority areas of the public policy of the Government of the Russian Federation in the field of healthy nutrition is to improve vitamin sufficiency in children and adults. This article describes biological effects of the essential vitamins and outcomes of deficiencies; the need for the management of vitamin deficiency is substantiated.

The article discusses the problem of teething in babies, the related mechanisms and factors. The research findings demonstrate the importance of different clinical symptoms of teething in infants, the relationship of the process with the baby's body type. Questions of the current therapy of pathological teething are considered.

Recently, health products based on herbs and plants - herbal medicines - have been increasingly used in practical medicine. In October this year, an educational workshop with international participation on the use of herbal medicine in pediatrics was held at the Department of Pediatrics of the Russian Medical Academy of Postgraduate Education of MH RF (the department is headed by Zakharova I.N. - the chief pediatrician of the Central Federal District of the RF, Honored Doctor of the Russian Federation, MD, Prof.) We interviewed the participants of the workshop and asked to give an expert assessment of the use of herbal medicines in pediatric practice.

The article tells about the etiology of acute tonsillitis, pharyngitis, sinusitis and acute otitis media in children; there is data on the sensitivity of the bacterial pathogens of the infectious and inflammatory diseases of the respiratory tract to the most commonly prescribed antibiotics. The focus is on the global spread of antibiotic resistance of pathogens and questions of restraining its further acceleration. Approaches to the rational use of antibiotics for bacterial infections of the upper respiratory tract are discussed. Benefits of antibiotics in dispersible tablets are demonstrated. Algorithms for the primary selection of antibiotics for acute bacterial tonsillitis, pharyngitis, sinusitis and acute otitis media in children are suggested.

The article presents data on the place of the modern endogenous interferon inducers in the treatment and prevention of influenza and ARVI in children and the mechanisms of action. The focus is on the domestic antiviral innovation Kagocel which demonstrated high clinical efficacy and safety in a number of multi-center, blind, placebo-controlled studies of the treatment and prevention of ARVI/flu in children over 2 years old.

Inflammatory oropharyngeal pathologies are diverse in etiology and include infectious diseases, lesions of the lymphoid tissue of the pharynx, as well as non-communicable diseases. The article summarizes the results of studies and clinical findings on the effectiveness Lysobact in the treatment of inflammatory diseases of the oropharynx in children.

Challenges of cough pharmacotherapy in the treatment of acute respiratory viral infections in children are specific and determined by the nature of cough, its duration and so on. Herbal medicines (extract of plantain and thyme) are feasible for the treatment of cough not only in acute inflammatory diseases of the upper respiratory tract but also in the period of recovery/rehabilitation. The combination of herbal medicines and special exercises improve the condition of children after acute respiratory viral infections.

Currently, the most effective drugs for the treatment and management of bronchial asthma (BA) are inhaled corticosteroids (ICS) which, according to global guidelines, are indicated as initial therapy for persistent asthma of any severity.

Respiratory disease is the most common infectious and inflammatory pathology in humans. The problem of respiratory tract infections is especially relevant in the pediatric practice due to extremely high prevalence of the pathological processes among children. Whereas every adult suffers from acute respiratory disease 2-3 times a year on average, in children of preschool and early school age, 8-10 clinical cases are registered annually. The incidence is significantly higher when the child starts to visit organized groups (nursery, primary school, etc.). [1] In the future, the number of cases of respiratory tract disease diminishes due to the acquisition of a specific immunity by the child.

The analytical review is devoted to modern methods of immunotherapy of respiratory infections in childhood. The article provides literature data and the authors' findings related to the evaluation of clinical effectiveness of the bacterial extract Broncho-Vaxom in the prevention and treatment of acute respiratory infections in children.

Rational antibiotic therapy is one of the most important components in the treatment of children with various infectious and inflammatory diseases. However, wide and sometimes unjustified use of AB in pediatric practice often leads to the development of a variety of complications. Children receiveing AB, especially during the first 5 years of life, are at a very high risk of developing antibiotic-associated diarrhea (AAD) which manifests itself in three or more episodes of unformed stools for two or more consecutive days or for 8 weeks after withdrawal. The most relevant pathogen of AAD is C. difficile which, according to various data, causes from 10 to 25% of AAD cases and 90 to 100% of all cases of pseudomembranous colitis (PMC). Given the high probability of developing dangerous complications such as PMC, special attention should be paid to the prevention of the infection associated with C. difficile by reducing the frequency of uncontrolled and unjustified use of AB. A new generation of eco-antibiotics can be recommended which allow to maintain diversity of the intestinal microbiota and are less likely to cause complications.

Breast milk is the gold standard of infant feeding during the first year of life that ensures adequate physical and psychological development. The composition of human milk changes all the time in the process of one feeding as well as throughout the whole period of lactation. The ingredients of breast milk promote the normal growth of the baby, affect postnatal differentiation of tissues, the formation of the central nervous system (CNS), auditory and visual analyzers, development of the intestinal microbiota of the infant. Breastfeeding contributes to a strong psycho-emotional bond between mother and child which provides the best conditions for further development of the mind, intelligence and behavioral characteristics.

The article discusses indications for antibiotic treatment and choice of drugs in children with acute enteric infections. Our study demonstrated the efficacy and safety of cefixime, the oral third-generation cephalosporin. The regimen with Pancef (cefixime) oral suspension for children is presented.

The article tells about the specific application of antimicrobial agents in pediatric practice, and the most common implications of the use of antibiotics are described. Inclusion of metabiotics into the regimens can improve the quality of treatment of patients, reduce unwanted drug reactions, reduce overall costs if the resources ensuring adequate care for children are used properly. Clinical and microbiological efficacy of this group of drugs, as well as their favorable safety profile, are demonstrated in many randomized clinical trials.

We are starting the regular column "ESPGHAN Experts Club" in our journal. European Society for Pediatric Gastroenterology, Hepatology and Nutrition - ESPGHAN - is a non-profit organization which focuses on the following: ■ creation and dissemination of knowledge in the field of pediatric gastroenterology, hepatology and nutrition, ■ promotion of research in these areas of medicine.

ARVI (acute respiratory viral infections, also often called ARD - acute respiratory disease) is a group of diseases that are similar in character and mostly characterized by a pathology of the respiratory system. If the pathogen is not identified, the patient is usually diagnosed with ARD, since the agent is not necessarily a virus. In developed countries, 18% of children aged 1--4 years suffer from acute respiratory viral infections [1]. Children aged 3 to 14 years suffer from ARVI most often. At the same time, children in the first year of life are practically not affected by acute respiratory viral infections. This is contributed by passive immunity which is acquired at birth and maintained during the first months of life thanks to breastfeeding. Influenza and ARVI account for 90% of all infectious pathologies and are the second leading cause of death from infectious diseases [2]. Delayed influenza mortality during epidemics can reach 100 cases per 100 thousand people [3]. Influenza epidemics cause enormous economic damage: in Russia, it equals more than 20 billion rubles each year [4].

Despite the fact that according to the guidelines of the World Health Organization all patients with allergic disorders should be annually vaccinated against influenza, regardless of the form or severity of the disease and ongoing drug therapy, that is still not applicable in practice. This fact entails at least two negative outcomes: the risk of infectious disease and its complications, as well as increased likelihood of exacerbation of the allergic disease against a background of the intercurrent infection. The aim of the study was to investigate the effectiveness and tolerability of domestic and foreign vaccines against the flu in children with allergic diseases. The study demonstrated good tolerability of the researched vaccines, absence of evident local and/or systemic reactions and of exacerbations of allergic diseases. The study found that vaccination completely protects children from the flu and significantly reduces the incidence of ARI, leading to an increase in the remission period and lower incidence of exacerbations of the underlying disease.

Iron overload (RV) is a condition caused by excessive intake of iron, and in the absence of the specific mechanisms for its excretion - excessive accumulation in tissues and their subsequent lesion leading to functional organ failure [1]. This condition most commonly occurs as a result of regular replacement therapy with erythrocyte mass in the treatment of various anemias. According to statistics, about 500 sick children and 2 000 adults develops post-transfusion RV in Russia in every year [2]. It develops in the context of hereditary anemia (major and intermediate forms of beta-thalassemia, other hemoglobinopathies, severe membrane and enzyme defects, congenital sideroblastic and dyserythropoetic anemia, constitutional hypo- and aplastic anemia) or acquired diseases (acquired aplastic anemia, myelodysplastic syndrome (MDS), myelofibrosis, etc.). [3--5].

One of the causes of hepatomegaly in children are rare (orphan) diseases associated with congential metabolic disorders. Starting from 2008, the last day of February is Rare Disease Day. As a rule, knowing that the child has a congenital metabolism disorder does not inspire pediatrician's optimism because of poor prognosis and ineffective therapy. However today, new drugs are emerging that can improve the quality of life of patients with orphan diseases. The main target of the pediatrician is timely diagnosis which allows to prescribe replacement enzyme therapy.

Up to 60 thousand hematopoietic stem cell transplantations (HSCT) are carried out globally all over the world. The outcome of HSCT is largely determined by the probability and severity of the graft-versus-host reaction/disease (GVHD). Treatment involves corticosteroids. Antithymocyte globulin, extracorporeal photopheresis, monoclonal antibodies to interleukins or their receptors, methotrexate, cyclosporine, tacrolimus, sirolimus, antithymocyte globulin, etc. are used in steroid-refractory GVHD. It is worth to mention that mycophenolate mofetil, esther of mycophenolic acid, blocks proliferation of T and B lymphocytes. In patients who are refractory to corticosteroids, the use of mycophenolate mofetil in isolation or in combination with cyclosporine, tacrolimus seems to be justified.

Fever is one of the most common nonspecific reactions to various pathological processes in children. The article tells about the specifics of thermoregulation processes, etiology and pathogenesis of fever in children, mechanisms of action of antipyretics. The focus is on age peculiarities of thermoregulatory mechanisms, as well as differential diagnosis of fever based on the etiological factor. The article also emphasizes the importance of adequate choice of antipyretic drugs for children.

In 2008, the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) in conjunction with the European Society for Paediatric Infectious Diseases (ESPID) published guidelines for the management of acute gastroenteritis in children [1] (Slide 5). When the new evidence-based data emerged in 2014, the document was updated. [2]

Respiratory mycoplasmosis is a group of infectious and inflammatory diseases of the respiratory system caused by pathogenic microorganisms - Mycoplasma species. It was found that the major causative agent is Mycoplasma pneumoniae (M. pneumoniae). The role of other mycoplasma pathogens in the development of respiratory infections still remains a subject of debate. Hence, the term "respiratory mycoplasmosis" is generally associated with M-pneumoniae infection [5, 7, 15, 22].

Atopic dermatitis (AtD) is one of chronic recurrent diseases. One of the most frequent complications of atopic dermatitis in children is secondary bacterial infection which plays a significant role in the pathogenesis of AtD and is a relevant factor for its aggravation. It is recurrent bacterial infection that often causes AtD refractory to standard therapy. Early effective etiotropic treatment of bacterial complications with baneocin is the key to achieving remission of AtD in children.

The article analyzes the etiological structure of the pathogens and clinical presentation of ARI with lesions of the larynx in children treated in the infectious box at the Samara City Children's Clinical Hospital No.1 named after N.N. Ivanova in the period from 2010 to 2015.

The article tells about the main stages of improving treatment regimens for acute lymphoblastic leukemia (ALL) in children, from monotherapy with prednisolone and 6-mercaptopurine to novel multicomponent risk-adapted chemotherapy protocols. The focus is on evaluating risk factors which varied with the expansion of knowledge about the molecular biological profile of ALL. Only the detailed analysis of the clinical and immunobiological characteristics of ALL allowed to develop novel, highly effective treatment schemes leading to recovery in over 80% of patients.