Every year, with the arrival of changeable fall weather we are being attacked by more than 200 types of viruses that cause acute respiratory virus infection. That are coronaviruses, adenoviruses, influenza viruses, parainfluenza, etc. However, the Covid-19 pandemic has exacerbated the situation, and caused particular concern in the medical community. Given that the damage of the body begins with the upper respiratory tract, one of the first specialists to encounter this disease is an otorhinolaryngologist. We turned to the Professor of the Department of  otorhinolaryngology of the RUDN University, head of the center of otorhinolaryngology “On-clinic”, Irina Kirichenko, MD with questions about the treatment and prevention of complications of acute respiratory virus infection in children.

Rickets is a disease that has been known to mankind for several decades. Overcoming this public health problem was a triumph of science and public policy in the 20th century, but over the course of several decades rickets sharply returned as a result of cultural, environmental and political factors. Vitamin D plays a fundamental role in the regulation of calcium and phosphorus homeostasis, and, consequently, in the development of rickets. In addition to these classic skeletal effects, recent studies have shown that vitamin D has other significant extracellular effects that can complicate the course of the disease and have long-term effects on children’s health. Vitamin D sufficiency in children has been defined as serum 25(OH) D levels of over 30 ng/ml, insufficiency as 21-30 ng/ml, deficiency as less than 20 ng/ml. The upper limit of the reference range is 100 nmol/L, as levels above may be associated with vitamin D toxicity in children. Serum 1.25(OH)2D should not be used for the assessment of vitamin D status. Natural sources of vitamin D are very limited, therefore, its use in the form of nutritional supplements is the primary mean of preventing and treating rickets. The recommended drug for the prevention and treatment of vitamin D deficiency is cholecalciferol (D3). Colecalciferol is recommended to be given at a dose of 1000 IU/day to all children aged 1 to 6 months regardless of the type of feeding or the season of the year to prevent vitamin D deficiency. This article presents modern ways of preventing, diagnosing and treating rickets.

Acute respiratory infections are the most common problem in the paediatric practice, especially in young children: 112,981.86 per 100,000 population at the age of 1-2 years and 106,996.16 per 100,000 population at the age of 3–6 years. Modern features of the etiology of respiratory infections in children are represented by associations of pathogens, among which are respiratory viruses, herpes viruses, bacterial pathogens, which makes additional problems in the treatment. On the one hand, the treatment of acute respiratory infections is not such a difficult problem, yet at the same time it is very often ineffective, and a pediatrician has to prescribe additional medications, which leads to polypharmacy and a potential risk of side effects. According to statistics, the number of drugs to be administered to treat ARVI reaches three or more INNs in 70% of cases, which involves the risk of drug-drug interactions and adverse events. For example, administration of two drugs leads to drug-drug interactions in 6% of patients, administration of five drugs increases the frequency of such effects up to 50%, and if a patient administers 10 drugs, this indicator reaches 100% of cases. A modern strategy for improving the quality of treatment of children with acute respiratory infections is to use homeopathic medicines, since they have a complex effect (antiviral, anti-inflammatory, immunomodulatory, etc.), mutually reinforce and complement each other if they are given in combination, and have the maximum therapeutic effect while minimizing the drug load.  According to the results of the meta-analysis of 29 clinical studies in 5,062 patients with acute upper respiratory  infections, the administration of complex homeopathic medicines has demonstrated a positive result in favour of  homeopathy: 6 of 7 RCTs showed that the homeopathic treatment was at least equivalent to the conventional treatment, and 8 of 16 placebocontrolled studies showed advantage of homeopathy.

Due to the COVID-19 pandemic, special attention should be paid to patients with chronic diseases, and we have many questions about the additional risks for children with bronchial asthma. We asked for an answer to these questions from Yuriy Mizernitskiy, Honoured Worker of Healthcare of the Russian Federation, Dr. of Sci. (Med.), Professor, Head of the Department of Pulmonology of the Scientific-Research Clinical Institute of Pediatrics named after academician Yu.E. Veltishchev of the RNRMU named after N.I. Pirogov of the Russian Ministry of Health, Head of the Children’s ScientificPractical Pulmonology Centre of the Russian Ministry of Health.

Influenza and other acute respiratory viral infections (ARVI) are among the most widespread infectious diseases, accounting for up to 90—95% annually in the structure of the registered infectious morbidity. According to the World Health Organization (WHO), every adult on average a year suffers from respiratory infections 2 times, a schoolchild — 3 times, a preschool child - 6 times. Currently, among this group of infections, only influenza is controlled by annual immunoprophylaxis. According to the results of numerous studies, it has been found that with timely vaccination, flu can be prevented in 80–90% of children and adults. It should also be noted that in the vaccinated, the disease proceeds in a milder form and without complications. Therefore, specific immunoprophylaxis against influenza is the most effective means of protecting a susceptible  organism, helping to reduce the circulation of influenza viruses among the population, which makes it possible to recommend it for the general population. However, most of the viruses belonging to the ARVI group do not lend themselves to specific immunoprophylaxis, therefore, it is necessary to use non-specific means of preventing infections caused by respiratory viruses. In recent years, there has been a tendency for the  widespread use of natural products, which include complex preparations of bioregulatory medicine. This  approach is based on the concept of the complexity of diseases and is aimed at eliminating those dysregulation in biological networks that underlie diseases. The goal of bioregulatory medicine is to improve patient outcomes by maintaining the body’s ability to self-regulate. Drugs related to bioregulatory medicine have antiviral, immunomodulatory and cytoprotective effects. This group of drugs has practically no side effects and toxic  effects, they do not create a pharmacological load on the organs of detoxification and excretion, therefore they can be recommended among the child population. This group of funds includes the drug Engystol®;  Euphorbium compositum®, which is used for rhinitis, sinusitis and rhinosinusitis; Girel®, used as a symptomatic remedy for ARVI, including influenza.
The article presents data on the effective use of bioregulatory medicine in the complex therapy and prevention of respiratory viral infections.

Whooping cough is an acute highly contagious infectious disease, the main manifestation of which is a prolonged paroxysmal cough. Despite the availability of the vaccine, over the past 10 years there has been an increase in the incidence of pertussis in both Russia and the world, which is associated both with the refusal of the parents to vaccinate and with the use of the acellular vaccine that induces a time-limited immune response. In the phase of spasmodic cough, the severity of the condition is determined by the frequency and intensity of  cough paroxysms. Against the background of coughing, young children may develop apnea and hypoxic encephalopathy, and older children and adolescents may develop neurosis-like reactions, sleep disturbance, enuresis. Virulence factors for bacteria of the genus Bordetella are known, but the pathogenesis of coughing with whooping cough has not been adequately studied. Antibacterial therapy accelerates the eradication of the pathogen, but practically does not affect the duration of symptoms. Due to the severe course of whooping cough, children in the first year of life often require hospitalization in the intensive care unit. Many common methods of treating cough (inhalation therapy, the use of acetylcysteine, carbocysteine, codeine-containing drugs) worsen the course of disease. In this regard, the main place in therapy is the correct treatment of cough. The article provides an overview of the main pathogenetic concepts of coughing and approaches to therapy: during the period of an obsessive spasmodic cough, to reduce the frequency and intensity of coughing, it is recommended to use an antitussive drug with a central effect of butamirate, oxygen therapy, refuse to perform invasive ventilation methods when child has apnea, and rapid rehabilitation of the children.

Acute otitis media is a common disease in children and accounts for about 2% of the total child morbidity. In the largest percentage of cases, acute otitis is usually successfully resolved, but its relapses increase the possibility of complications and lead to higher treatment costs, as well as lower quality of life for both the patient and his or her family in general. Therapy of acute otitis media depends on the stage of disease development and clinical manifestations and is aimed at early resolution of inflammatory process and prevention of disease progress and complications development. Pathogenetic therapy is shown at the 1st and 2nd stages of development of acute otitis media and is based on restoration of auditory tube function and normalization of nasal breathing (unloading – intranasal therapy). As a local analgesic therapy for acute otitis media in children, ear drops containing non-opioid analgesic antipyretic drug phenazone and lidocaine, consisting of a combination of phenazone (40 mg) and lidocaine hydrochloride (10 mg), are most commonly used. Phenazone is a nonsteroidal anti-inflammatory drug  and has an anti-inflammatory effect, typical for non-selective inhibitors of cyclooxygenase, while lidocaine has a local analgesic effect. Based on the clinical trials conducted, it was recommended to include combined topical drugs  as a local analgesic and anti-inflammatory drug with effective action and good tolerability in all age groups into the combined therapy of acute preperforative otitis media.

Cough is a common problem in childhood, which leads to frequent paediatrician visits, affects the quality of life, and causes material losses to the family and society. In pediatric practice, cough is most often associated with acute respiratory infections, which can develop in children up to 5–8 times a year. 50–70% of children under 1 year old and 30–60% of school age children visit pediatricians with this problem. Examination of patients with cough shows that the most common causes of recurrent cough may include bronchial asthma, lingering bacterial bronchitis, chronic ENT diseases, gastroesophageal reflux, as well as bronchial reactivity after respiratory syncytial,  rhinovirus or pertussis infections. Mucociliary clearance in children may decrease under the influence of external factors, which contributes to the development of infections. The effectiveness of cough in children, especially young children, depends on the severity of the cough reflex, bronchial patency, viscosity of bronchial secretion. The choice of therapy to treat cough should take into account the age and etiology of the cough. The inappropriate antibiotic therapy for prolonged cough increases the risk of developing antibiotic resistance. Due to  potential side effect in the form of respiratory depression and opioid toxicity, codeine-containing drugs are not  recommended for use in children under 12 years of age. An alternative to cough drugs is herbal medicines with compound effect: anti-inflammatory, bronchodilator, expectorant and mucolytic.

Introduction.Coughing affects quality of life and is the most common reason patients seek medical attention. In children, establishing the pathophysiological cause of the condition associated with cough is of particular importance for making an adequate diagnosis and prescribing the correct therapy.

Target. To assess the efficacy and safety of butamirate use in the complex treatment of preschoolers with acute bronchitis.

Materials and methods. The initiative study was carried out in accordance with the requirements of the Declaration of Helsinki and included 63 patients with a dry cough symptom at the age of 3–7 years with a diagnosis of acute bronchitis. The effectiveness of therapy was assessed using a point system. In the main (1) group – 21 children – used a non-narcotic antitussive drug of central action butamirate, 5 ml of syrup 3 times/day before meals for 4,7 ± 0,6 days. In the main (2) group – 21 children – butamirate was administered at 25 drops inside 4 times/day for 4,9 ± 0,8 days. In the comparison group – 21 children – antitussives were used according to the protocol for the treatment of acute bronchitis.

Results. In 80,3 ± 5,4% of patients in the main (1 and 2) groups, by the fourth day of treatment with butamirate in relation to the comparison group, the state of health improved (0,5 ± 0,07 points, p = 0,032), the intensity of cough decreased (0,1 ± 0,01 points, p = 0,015), dry cough leveled out (0,3 ± 0,02 points, p =  0,023), the cough period decreased with exhausting cough (0,2 ± 0,01 points, p = 0,017). There were no statistically significant differences between the two main groups. In no case did butamirate cause respiratory depression, impairment of cognitive functions, sedation and drug dependence. In the comparison group, the patients’ state of health improved less intensely, the characteristics of dry cough persisted for a longer time.

Conclusions. Butamirate is effective and safe in the treatment of dry cough in acute bronchitis in preschoolers.

Introduction. The number of complications in flu and acute respiratory viral infection, especially during epidemics, reaches 20–30%. The main causes of complications are immune protection disorders, leading to a sharp decrease in the antibacterial resistance of the body. Of particular importance is the prevention and treatment of flu in risk groups, especially in young children and elderly people.

Aim of the study. Experimental study of possible antiinfluenza action of plant-based antiviral drug (EPs 7630) on the model of influenza A virus adapted to the human fetal lung fibroblast culture in conditions as close as possible to the lung tissue lesion in influenza infection.

Materials and methods. The drug (EPs 7630) in the form of 11% solution in ethanol was diluted with sterile nutrient medium for application in the culture medium in the appropriate concentration. Transformed diploid culture of human fetal lung fibroblasts was used. Before the research 10 passages of the culture were made using growth medium with 10% embryonic bovine serum. Influenza virus A/Aichi/1/68 (H3N2) was also used, which was preliminarily adapted to the reproduction of human fetal lung fibroblasts in the cell culture. The cytotoxicity of the drug and its antiviral activity regarding the influenza virus were studied.

Results. The presence of the drug in the human fetal lung fibroblasts culture in 3 tested concentrations had dose-dependent antiviral effect on the production of influenza virus A/Aichi/1/68 (H3N2), which also depends on the multiplicity of infection and the scheme of the drug use.

Conclusion. The obtained data indicate that in case of low multiplicity of infection, the preparation has both preventive and therapeutic antiviral effect on the reproduction of influenza virus. The combination of antiviral and immunomodulatory action determines the bifunctionality of the drug, which contributes both to the suppression and elimination of influenza virus from the organ – the target and the body as a whole, and increase its non-specific congenital resistance, which makes it possible to consider the plant-based drug (EPs 7630) as the preferred tool in the prevention and comprehensive treatment of influenza and other respiratory viral infections in children and adults.

Sore throat is a common complaint among children and adults. In addition to infection, causes of sore throat include non-infectious pathological conditions. Among possible causes are viruses, bacteria, fungal flora. Identification of etiology significantly affects the disease management. The prescription of systemic antimicrobial agents is justified, if bacterial etiology is confirmed or a child develops complications; the presence of β-hemolytic streptococcus is an absolute indication for antibiotic therapy. Increasingly greater attention is now paid to topical agents in the treatment of bacterial tonsillopharyngitis, in particular, to the drugs that combine the antiseptic and antibiotic properties. The article provides data on the use of a combination drug containing antibacterial substance gramicidin S and antiseptic component cetylpyridinium  chloride that proved its efficacy, safety, and low risk of side effects in pediatric and adult patient population. The authors present their own clinical observations of the successful use of this combination drug in paediatric practice.
Clinical case 1. A 15-year-old child K. with a polyvalent drug allergy to antibacterial drugs. Moderately grave condition, subfebrile temperature 37.8 oC; submandibular lymph nodes increased up to 2.0 cm with expressed tenderness; preliminary diagnosis is acute tonsillopharyngitis; Infectious mononucleosis?». Pharyngoscopy showed bright hyperemia of edematous mucous membrane, hyperemia of enlarged palatine tonsils, visualized white plaque; single vesicular rashes on the anterior palatine arches and uvula. The patient received active etiotropic, pathogenetic and symptomatic therapy. Instead of systemic antibacterial therapy, a combination  drug based on gramicidin S and antiseptic component cetylpyridinium chloride was chosen. The patient was  discharged from the hospital on Day 10 of hospitalization, the child had no complaints, the general condition returned to normal.
Clinical case 2. A 6-year-old child was diagnosed with acute pharyngitis, degree II palatine tonsils  hypertrophy, degree II nasopharyngeal tonsil hypertrophy, submandibular and cervical lymphadenitis. The  laboratory test results showed absence of β-hemolytic streptococcus. The combination drug based on gramicidin S and antiseptic component cetylpyridinium chloride was prescribed, the pharyngotonsillitis symptoms disappeared on Day 7 of observation.
Clinical observations demonstrate the possibility of using the combination drug for the complex treatment of  acute tonsillopharyngitis of any etiology, including those that develop in childhood.

Community-acquired pneumonia remains one of the most pressing problems in pediatrics. The article presents data on its prevalence, child mortality from this disease, diagnostic criteria and approaches to therapy. In the Russian Federation, respiratory diseases in children aged 0-17 take third place in the structure of causes of death after external causes and malformations. The age characteristics of the etiological spectrum of community-acquired pneumonia in children and the problem of drug resistance of pathogens are discussed in detail. The sharp increase in resistance to macrolide antibiotics of the most common pathogen of the disease in early and pre-school age, pneumococcus, which occurred in recent years, makes it necessary to reconsider the question of the place of these drugs in pediatric practice. At the same time, macrolides remain highly active against atypical pathogens, whose etiological significance increases with age. In this regard, modern indications for prescription of macrolides, unique distinctions of 16-membered josamycin macrolide from other drugs of this series, and mechanisms of its action are reviewed and clarified in the article. Due to the peculiarities of its chemical structure, josamycin remains active against a significant part of pneumococci, which is increasingly resistant to 14- and 15-membered macrolides. The  advantages of children’s dosage forms are presented, in particular, the dispersible tablet (solutab). This form, due  to controlled release, provides convenience of use, maximum bioavailability (regardless of food intake), minimal frequency of side effects, and does not affect the gastrointestinal motility. Treatment of pneumonia and other respiratory tract infections, especially in young children, is not limited by antibiotics, is always complex and is based on the prevailing syndromes in the clinical picture.

Children with chronic diseases, such as neurological, neuromuscular, respiratory, in particular cystic fibrosis, hereditary, metabolic, oncological, and congenital heart defects often suffer from malnutrition, often accompanied by stunted growth. The main reason leading to a change in nutritional status is inadequate intake of nutrients and energy with increased nutrient requirements or various eating problems. Lack of nutrient status correction and continued malnutrition contribute to major body changes that worsen disease progression, increase the risk of death and reduce patients’ quality of life. To fully cover the body’s nutrient needs, the use of specialized enteric nutrition is a priority. Sufficient clinical experience has been accumulated, confirming the high effectiveness of the use of enteral nutrition formulas in children with malnutrition through gastrointestinal feeding. It has been proved that this method of delivery of food is safe for patients, improves nutritional status, simplifies care, as well as reduces the duration of hospitalization, the frequency of respiratory and infectious complications and, consequently, the cost of treatment and rehabilitation. The article presents the assortment of “Nutriсia” formulas for enteral nutrition, which allows a differentiated approach to nutrition of patients depending on the clinical situation. Nutritional problems in patients with neurological disorders and ways of their correction are described in detail. The advantage of using domestic enteric nutrition through feeding tube for the correction of nutritional deficiencies. Timely assigned nutritional support is a highly effective method of correction of nutritional deficiencies or preventing their development in children with chronic diseases.

Introduction. The article presents basic information on approaches to pathogenetic therapy of acute intestinal infections. Data from our own research on the diagnosis and treatment of gastrointestinal manifestations of COVID-19 in children aged 3 months to 18 years are presented. The aim of the study was to evaluate the effectiveness of complex rehydration, cytomucoprotective and probiotic therapy for infectious diarrhea of  various etiologies, including those developing with a new coronavirus infection. 

Materials and methods. We analyzed data from our own observations of patients aged 3 months to 18 years with diarrhea against the background of acute intestinal infections of various etiologies (120 children), as well as with a new coronavirus infection caused by the SARS-CoV-2 virus (32 children). The children were treated in  accordance with current standards and treatment recommendations. Clinical examples are presented.

Results and discussion. Diarrhea was observed in 64% of patients with a new coronavirus infection. Clinical cases confirm the effectiveness of rehydration, cytomucoprotective and probiotic therapy for infectious diarrhea, regardless of the etiology, including COVID-19.

Conclusions. Diarrhoea and other symptoms of gastrointestinal disorders in COVID-19 are stopped when pathogenetic therapy is recommended for patients with acute intestinal infections.

According to the Rome IV revision criteria, functional gastrointestinal disorders are defined as “disorders of the gut-brain axis interaction”. The expression of symptoms of functional gastrointestinal disorders varies from mild to extremely severe. Their presence causes anxiety of parents, can contribute to a decrease in quality of life, and lead to the formation of immediate and long-term consequences in the form of children’s health disorders. Often, mothers stop breastfeeding their babies, and numerous replacements of formulas are made. The  recommendations include behavioral therapy and parental education as the first line of therapy.
For correction of nutrition in children with functional gastrointestinal disorders, in the absence of data for  intolerance of cow’s or goat’s milk proteins formulas based on goat’s milk may be recommended. In natural goat milk there are 14 kinds of oligosaccharides, and 5 of them are identical to breast milk oligosaccharides. The main serum protein of goat milk is α-lactalbumin. The dominating casein fraction of goat milk as well as breast milk is ß-casein. Relatively high content of albumins contributes to the formation of softer, smaller clots and small loose flakes. On the Russian market, goat milk based formulas include products that meet all standards established for infant formulas. The article contains data on goat milk mixtures with an updated formula of protein component. All the formulas of this mixture have reduced the total amount of protein and increased the content of whey protein fraction. Instead of palm oil coconut oil was added to the mixture, while the fat component has not changed its structure, maintaining 42% beta-palmitate, doubled the content of docosahexaenoic acid. The lactose content has been increased, which makes the carbohydrate profile of the mixes closer to breast milk, where the lactose content reaches 95%. In accordance with modern requirements, there were changes in vitamin and mineral composition of formulas, the content of vitamins D3, C, B6, calcium  and iron was increased. The effectiveness of this mixture has been studied in young children with functional disorders of the gastrointestinal tract. By the 4th week of taking the mixture, the number of children suffering from colic decreased by 42%, and regurgitation by 30%, there was an improvement in stool consistency. The  mixture can be recommended not only for healthy children, but also for children with functional gastrointestinal  disorders.

Introduction. Allergic rhinitis is one of the most common chronic upper respiratory diseases in children. Unfortunately, modern science has not made sufficient progress to cure allergic rhinitis permanently. Without eliminating exposure to the causative allergen, which is most often impossible, the treatment of this disease allows patients to achieve only some degree of management of symptoms, improving the patient’s quality of life. Pharmaceutical therapy is one of the most affordable and widely used methods for managing the symptoms of allergic rhinitis. Topical antihistamines are widely recognized as initial therapy in patients with mild to moderate allergic rhinitis, which may quickly lessen the severity of symptoms. To enhance the effect on the nasal obstruction symptom, preference is given to combination nasal drugs containing both an antihistamine and a decongestant.

Clinical cases. This article presents three most common “patient profiles” aged 3, 5 and 8 years with allergic rhinitis, which showed clinical efficacy of the use of nasal antihistamine and decongestant combination drugs. A rational choice of a nasal combination drug for the management of symptoms of allergic rhinitis is substantiated in each clinical situation.

Conclusion. The presented literature data and reviewed clinical cases has led the authors to conclude that topical combination nasal drugs containing antihistamines and decongestants are an effective and safe initial treatment of symptoms of pediatric allergic rhinitis.

Severe bronchial asthma in children remains a serious problem, which is caused by high mortality, side effects from therapy with high doses of glucocorticosteroids and a significant consumption of health resources. According to statistics from the Monitoring, Analysis and Strategic Health Development Department of the Ministry of Health of the Russian Federation, 1028.6 BA cases per 100,000 children under 14 years of age were registered in Russia in 2017. The article presents modern data on the pathogenesis of bronchial asthma, causes of therapy-resistant asthma, participation of interleukin-5 (IL-5) in the development of eosinophilic inflammation. Research data demonstrate the safety and effectiveness of anti-IL-5 therapy as a supplement to standard treatment for severe eosinophilic bronchial asthma and its poor control. Mepolizumab is the most widely researched anti-IL-5-monoclonal drug. It statistically significantly reduces the level of eosinophils in sputum, reduces the frequency of  exacerbations and hospitalizations helps reduce maintenance therapy with glucocorticosteroids. As a result of randomized, placebo-controlled trials mepolizumab has been shown effective and safe in children 6 years of age and older, experts of leading world organizations approved its use for the treatment of severe eosinophilic asthma in children, what makes this drug the only one currently approved for use in patients in this age profile. However, further studies are needed to determine the optimal duration and long-term therapeutic efficacy in children.

Allergy to cow’s milk is a frequent diagnosis in infants and amounts to 2-3%. In most cases, manifestations of allergy to cow’s milk proteins are combined polyorganic in nature with the involvement of two or more systems of the child’s body, more frequent are lesions of the skin and gastrointestinal mucosa. Supporting breastfeeding remains the first task of a pediatrician when observing a child in the first year of life, but if there is a need to appoint and choose from a variety of formulas for supplementary feeding or as a basic diet, there is a difficult question of choosing the right one. Children at risk without clinical manifestations of allergy to cow’s milk proteins should use hypoallergenic preventive formulas based on partially hydrolyzed cow’s milk proteins. In formed clinical manifestations of allergy – formulas based on highly hydrolyzed protein, and in their severe manifestations – on the basis of amino acids. Unfortunately, a significant part of infants have polyvalent sensitization, so even a properly selected formula does not fully eliminate all symptoms. Therefore, in addition to diet correction, antihistamines, both systemic and topical, as well as hormonal topical remedies, emollients, etc., are often used. Pathogenetic treatment for food allergies has not yet been developed, and the only solution we can make, in addition to elimination diets, is to apply symptomatic therapy. A special problem in pediatrics is the lack of drugs, including antihistamines, allowed for use in children under the age of 1 year. At this age, allowed to use only a few: dimetindene, ceirizine, in emergency cases – chloropyramine, starting with the age of 1 month. Optimal forms of administration for infants may be syrup, suspensions, drops, as well as topical forms - lotion, gel, emulsion or cream. Taking into account many years of experience with dimethindene, clinical data on the efficacy and safety of the drug, allow its use in pediatric practice. The drug has good antihistamine activity, antipruritic, anti-edema and antispastic effect, and is able to quickly and firmly relieve symptoms of allergy.

Introduction. According to WHO, 98% of women in the world are capable of full lactation, however, only 35% of infants in the world get exclusive breastfeeding for the first 6 months after birth. Wounds and ulcers of nipples are common causes that lead to 95% of women refusing to breastfeed.

Aim of the study. To evaluate the efficacy and safety of the lanolin-based cream to prevent cracked nipples in women in the first 30 days after delivery.

Materials and methods. The population consisted of 128 patients in the early postpartum period, randomized into 2 groups depending on the features of breastfeeding and the method of prevention of cracked nipples: Group I – 99 patients who received lanolin-based cream with individual consultation on breastfeeding; Group II – 29 patients who did not receive the cream.

Examined substance – nipple cream, composition: 100% lanolin; pharmacotherapeutic group: antiseptic. The cream has keratolytic, antiseptic, wound healing effect. Method of application and dosage: externally, after each feeding (or as needed), the cream was applied to the nipple and areola, the cream does not require removal before applying to the child’s chest.

Results of the study and discussion. Evaluation of efficacy and safety was carried out on the basis of clinical data, complaints, objective data and the results of cytological studies in a comparative aspect - before the cream was applied and one month after its application.

Conclusions. Correction of breastfeeding disorders in combination with a cream based on 100% lanolin has reduced the frequency of clinical manifestations to zero, and most importantly, to preserve exclusive breastfeeding for patients under observation. The studied cream is harmless for the child and effective in preventing cracked nipples.

Bile thickening syndrome or biliary sludge causing obstruction of the common bile duct and impaired passage of bile into the duodenum ranks second among “surgical jaundice” in newborns and young children. The syndrome should be diagnosed early to conduct timely conservative treatment to avoid surgical intervention and complications such as acute pancreatitis, acute cholecystitis, cholelithiasis. Risk factors for bile thickening syndrome include prematurity, extremely low birth weight, longterm parenteral nutrition, administration of  diuretics, third generation cephalosporins. If a threat of biliary sludge arises, repeat abdominal ultrasound imaging and identification of the following signs of this syndrome are indicated: dilatation of CBD more than 3 mm, the presence of heterogeneous sediment in the gallbladder and common bile duct. The article presents a clinical discussion of a bile thickening syndrome case in a an extremely low birth weight girl born at 29 weeks’ gestational age. The condition of the newborn at birth was very severe. The severity of the condition was caused by the type 1 respiratory distress syndrome, the girl was immediately intubated and mechanically ventilated. At the age of 1 month 10 days, the girl was transferred from the intensive care unit to the neonatal unit. The ultrasonic imaging showed an oval-shaped gallbladder of 26 x 6 mm in size, 0.5 ml in volume, instable angulation of the gallbladder body and neck, the walls of up to 2 mm in thickness, laminated, hyperechogenic, hyperechoic contents in the lumen (ointment-like bile), which allowed to draw a conclusion about the presence of bile thickening syndrome. Ursodeoxycholic acid at a dose of 20 mg/kg/day was prescribed immediately after ultrasonic imaging. 10 days later the dose of the drug was increased to 30 mg/kg/day. Two weeks later, the child was  discharged home in satisfactory condition without signs of bile thickening syndrome. Knowledge of the risk factors  for biliary sludge makes it possible to assign timely instrumental examination, establish early diagnosis and prescribe conservative therapy, and exclude surgical methods of treatment.

Introduction. Data on the vitamin D receptors (VDR) found on the surface of a large number of cell types of the human body were first published several decades ago, which served as a prerequisite to study the role of vitamin D in the development of some diseases, including infections.

Objective of the study.Evaluate the relationship between administration of cholecalciferol supplements, the synthesis of defensins, and the incidence and morbidity patterns of acute respiratory infections (ARI) in young children.

Material and methods.108 healthy children aged 1 month to 3 years were examined, of which 34 (31.5%) were vitamin D sufficient, 40 (37.0%) had a vitamin D insufficiency, 27 (25.0%) had a vitamin D deficiency and 7 (6.5%) children had severe vitamin D deficiency. After the course of treatment of vitamin D deficiency with  therapeutic doses, all patients were prescribed prophylactic doses of cholecalciferol supplements (1000 IU/day) for a 6-month course.

Results. Therapeutic doses of cholecalciferol promoted β1 and β2-defensin expression; a direct correlation was found between the daily dose of vitamin D and the increase of β2-defensin expression (r = 0.34, p <0.05). Administration of cholecalciferol in the prophylactic dose of 1000 IU/day for 6 months was accompanied by the  further increase in antimicrobial peptide (AMP) production, which resulted in the increase of the β1-defensin level by 2.4 times (p <0.001) and β2-defensin level by 2.5 times (p <0.001) as compared with the baseline levels. The incidence of respiratory morbidity amounted to 1.7 ± 0.2 episodes every 6 months against the background of ongoing cholecalciferol supplementation. The number of patients, who were not infected, was significantly more in the group of children with optimal vitamin D status, than in the groups of children with vitamin D insufficiency and deficiency.

Conclusions. Administration of vitamin D supplements induces antimicrobial peptide expression and reduces the frequency and severity of acute respiratory infections in young children.

Introduction.To determine the relevant indicators of strain and strain rate of the left ventricular myocardium in children and adolescents.

Materials and methods. Have been examined 67 patients form aged from 7 up to 17 years old. 1-st group – 30 children from 7 to 11 years old; 2-nd group – 37 adolescents from 12 to 17 years old. Аt an echocardiographic examination the systolic function of the left ventricle was determined: ejection and shortening fractions, in 2D-speckle-tracking mode – global and segmental longitudinal, circular and radial strain and strain rates.

Results. Have been studied the relevant indicators of global and segmental longitudinal, radial, circular deformities of the left ventricular myocardium and their rates in healthy children and adolescents. A statistically significant increase in global and segmental longitudinal strain, radial and circular strain rates in the 2-nd group compared with the 1-st group had revealed. Had found that the uniform distribution of indicators in the ranges of confidence intervals, noted in the assessment of global radial strain and circular strain rate, as well as a statistically significant predominance of strain indicators in the subendocardial layers compared with the subepicardial layers of the myocardium left ventricle.

Conclusions. 1. In adolescents 12–17 years old, compared with children 7–11 years old, there is a statistically  significant predominance of global and segmental longitudinal strain, radial and circular strain rates of the left  ventricular myocardium. Radial strain and circular strain rate of the left ventricular myocardium are the most uniform in contrast to other indicators of strain.
2. In healthy children and adolescents, had observed statistically significant higher strain and strain rate in the subendocardial layer compared to the subepicardial layer of the myocardium.
3. The obtained indicators of global and segmental myocardial strain can serve as normative for children and  adolescents in assessing the systolic function of the left ventricle.

Acute respiratory infections are the most common reason to consult a paediatrician. Children, especially during critical periods of immune response, are one of the most vulnerable groups to infections. The prevention of recurring respiratory infections is very important, especially from the beginning of attending pre-school and school facilities. Since ancient times, preventive measures such as rational daily routine, sufficient physical activity, correction of nutritional status, phytotherapy and homeopathic treatment have been used. In recent years these children have been optimising their vitamin D status and taking antioxidant vitamins, micro- and macronutrients. To date, as a result of innovative research on the human microbiome, information has emerged on its impact on the human body as a whole. The connection of the intestinal microbiota with the brain (gut-brain axis), with the respiratory tract (gut-lung axis), the cardiovascular system, kidneys and even mental health has been proved. The use of multistrain and multispecies probiotics in the prevention of recurrent infections in children opens up new opportunities to influence the child’s immune response and to form food tolerance. Today, a new multistrain multispecies probiotic (manufacturer ADM Protexin, UK) for the prevention of recurrent respiratory infections in  children has appeared on the market. Studies have shown that using several strains of lactobacillus contained in this probiotic leads to more consistent results than monostrains and placebo in the prevention of respiratory diseases.
Given the problem of antibiotic resistance, especially in young children, the new possibilities of preventing acute  respiratory diseases in children using multistrain and multispecies probiotics make it possible not only to reduce  the number and severity of episodes of acute respiratory infections, but also to reduce the frequency of antibiotic use.

Child morbidity and disability is a national problem in any country, and measures to reduce it are the priority for every society. Recent years, children’s diseases such as neuropsychiatric diseases, (24,3%), nervous system diseases (22.9%); congenital anomalies (malformations), deformations and chromosomal disorders (16.2%). The absolute value of disabled children with nervous system diseases as of January 1, 2020 was 157,727.
At all stages of the nervous system formation, the process of cell membranes formation, covering both glial  cells and neurons themselves (and their branches - dendrites and axons), progresses actively. Cell membranes consist mainly of phospholipids, which are synthesized from long chain polyunsaturated fatty acids coming from food. In an attempt to determine the reasons for the growing disability of the child population, the researchers drew attention to the changed nature of the nutrition of society in general and the child population in particular over the past century. One of the significant components of the diet that affects the formation and development of the nervous system and the mental sphere were polyunsaturated fatty acids, some of which, with an unbalanced diet, can’t be obtained by the body from sources alternative to food. In this review, we observe the experience of correcting the nutritional status of young children and pregnant and lactating women with omega-3 polyunsaturated fatty acids. Numerous studies have confirmed the fact that there is a relationship between omega-3 polyunsaturated fatty acids deficiency, neurological deficiency and reduced intellectual abilities of a child.

The article contains information about life and professional activity of one of the founders of Russian pediatrics, age-dependent morphology and biochemistry, school hygiene – Professor N.P. Gundobin, his contribution to clinical, scientific and social pediatrics. N.P. Gundobin’s views on child examination and treatment, regularities of growth and development of children and their significance, prevention of diseases are presented.

The life of Orthodox saints has always been a feat. Whether this be labour and prayers in the monastery – veneration, propagation and protecting the faith – confession or meeting death for the name of Christ – martyrdom. Saint Luke (Voino-Yasenetsky), archbishop and surgeon, devoted his whole life to the common people, once choosing the path of ministry. He healed physical maladies as a skilled physician and spiritually instructed beginners in faith as a bishop. Saint Luke, glorified amongst the Saints by the Orthodox Church, has left behind a rich scientific and theological heritage and enjoys popular veneration as a healer to this day.