NEONATOLOGY
The skin of newborns and infants is characterized by structural and functional immaturity. Diaper dermatitis is one of the most common skin conditions in this age period. This condition has a complex and multifactorial etiology. The interaction of several causes, including high humidity under the diaper, skin maceration, and prolonged contact with irritants, leads to destruction of the immature epidermal barrier, microbial invasion, and inflammation. Diaper dermatitis should be differentiated from allergic contact dermatitis, candidiasis, atopic dermatitis, seborrheic dermatitis, psoriasis. Effective measures to prevent diaper dermatitis are to keep the skin dry, reduce friction, limit the time of contact with urine and feces, as well as the topical application of protective products. Today, of all the disposable diapers on the market, the high quality disposable diapers developed and produced by the Japanese company KAO Corporation are proven effective in preventing diaper dermatitis.
Introduction. Premature infants are at risk of developing central nervous system malformations; therefore, increased survival rates among infants with very low birth weight and extremely low birth weight have contributed to the rise in prevalence of neurologic deficit in extremely premature infants.
Purpose. To summarize the literature data and demonstrate rare family clinical observations of preterm infants associated with adverse neurological outcomes as a result of exposure to various perinatal factors.
Materials and methods. For the literature review, we used data from full-text scientific research from international scientific databases. The influence of ante-, intra-, and postnatal risk factors on the neurological outcome of the disease was studied in two male sibs born at 27 weeks of gestation with a weight of 980 and 970 grams, a body length of 34 and 33 cm, and an Apgar score of 5/7 and 6/7, respectively. The analysis of anamnestic data and results of clinical and laboratory-instrumental examination was performed; the catamnestic observation was 24 adjusted months of life.
Results.The presented observations revealed a combination of various ante-, intra-and postnatal risk factors that lead to CNS damage in preterm infants. The obtained results indicate that prematurity and extremely low birth weight are not the only risk factors for neurological disorders, but the burdened neonatal period (congenital sepsis, bronchopulmonary dysplasia, lung atelectasis, neonatal convulsions, and 2-degree intraventricular hemorrhage verified by USC/MRI of the brain on both sides) contributed to the formation of neurogolic pathology in the second examined sibs. The results obtained can be considered preliminary, and a larger study is needed.
Conclusion.Thus, the obtained results indicate that prematurity, extremely low birth weight and low Apgar score are not the only risk factors for the formation of neurological disorders. A combination of several significant ante-, intra-, and postnatal risk factors is necessary for the development of severe perinatal CNS damage, the formation of adverse neurological outcomes, and severe delay in motor and psycho - speech development in preterm infants. The prognosis of neurological outcome in a preterm baby requires long-term dynamic monitoring and a comprehensive approach using clinical and instrumental diagnostic methods. The results obtained can be considered preliminary, requiring additional more extensive research.
Mother’s milk is the most suitable product for feeding a newborn baby, its uniqueness is obvious. However, there are situations when breastfeeding is not possible at all or its volume is limited, so under certain circumstances mothers are forced to partially supplement or completely feed the child with an artificial formula. Although the composition of the ingredients in most modern formula feeds is similar, there are nevertheless differences in their composition and in the processing of the ingredients in the formula. In addition, the child may have individual taste preferences as well as unexpected negative reactions to any adapted milk formula. This review presents the achievements of recent years in creating adapted goat’s milk-based formulas for feeding newborns and first-year infants. Goat’s milk-based formulas have a number of advantages over cow’s milk-based formulas. One of the representatives of modern artificial formulas are those containing goat’s milk, which is characterized by low α-s1-casein genotype and high β-lactoglobulin content, which provides easier protein digestibility, contributes to more comfortable digestion and better absorption. Knowledge of the biological and nutritional value of goat milk, taking into account the peculiarities of the gastrointestinal tract of newborns and their needs, made it possible to develop and introduce into the goat’s milk-based formula the DigestX lipid complex, which is a complex of vegetable oils with a high content of palmitic acid in the sn-2-position in the triglyceride molecule, which is similar to breast milk. Goat’s milk, compared to cow’s milk, contains 4-6 times more oligosaccharides, which retain their beneficial properties in the production of artificial goat’s milk formula.Recent scientific literature data is presented, including that from the standpoint of evidence-based medicine, proving the effectiveness and safety of artificial goat’s milk-based formulas. The necessity of consulting mothers, psychological support and practical assistance not only in breastfeeding, but also in artificial feeding is substantiated.
HEALTHY CHILD
Vitamin D has pleiotropic effects, including maintaining calcium and phosphate homeostasis, and affecting the immune and endocrine systems. The article summarizes data on the expected biological effects of vitamin D on children’s health. The results of randomized clinical trials evaluating the effect of vitamin D supplementation on the incidence of acute respiratory tract infections are reviewed in detail. It has been shown that daily intake of vitamin D at a dose of 10 to 25 mcg/day (400–1000 IU/day) compared with placebo leads to a significant decrease in the proportion of children and adolescents who have had at least one episode of acute respiratory infection. The criteria for the provision of calciferol and the gradation of the status of vitamin D deficiency and deficiency in different countries are discussed. It has been shown that in the interpretation of the 25 (OH) D results there is a consensus on two points: calcidiol levels below 12 ng/ml (30 nmol/L) are considered clearly insufficient, and levels above 30 ng/ml (75 nmol/L) are considered sufficient in all regions. The incidence of hypovitaminosis D has been reported in children aged 3 to 7 years, where the overall combined assessment, regardless of age group, ethnic composition and breadth of the studied populations, showed that 13% of European children had a serum calcidiol concentration of less than 12 ng/ml (<30 nmol/L), and about 40% had a level of less than 30 ng/ml (<75 nmol/L). The data on the physiological need and the recommended daily dose of vitamin D for preschool children have been analyzed. In each country, the recommended intake of vitamin D is set (from 400 to 4000 IU), depending on the target concentration of serum calcidiol, the level of insolation, and nutritional characteristics. The necessity of conducting clinical studies in the age group from 3 to 7 years to determine an adequate, effective and safe preventive dose of vitamin D for preschool children in the Russian Federation is emphasized.
The article summarizes the results of the work of domestic and foreign researchers on the study of homeostasis of the nasal cavity, including the state of the microbiota of the nasal mucosa in healthy children and in inflammatory diseases of the upper respiratory tract. The normal microbiota of the nasal cavity is represented by corynebacteria (diphtheroids), neisseria, coagulasenegative staphylococci, alpha-hemolytic streptococci. From among the transient species, such species as Staphylococcus aureus, Escherihia coli, beta-hemolytic streptococci would be found in the specified biotope. The main attention is paid to the features of the nasal microbiota in newborns and young children (dependence of the nasal microbiota on the type of feeding, age and season). The role of hypercolonization by opportunistic microflora and its persistent potential (ability to biofilm formation, degradation of lysozyme, interferon) in the pathogenesis of inflammatory diseases of the upper respiratory tract is noted. The pathogenetic mechanisms providing multilevel protection of the organism from pathogens are considered. The expediency of using elimination-irrigation therapy as a hygienic means of sanitizing the nasal cavity in young children has been determined. The questions about the advantages of the use of isotonic solutions, their effectiveness for ensuring normal colonization resistance of the nasal mucosa are discussed. In conclusion, we must say that for hygienic care and sanitation purposes it is recommended only to rinse the nasal mucosa in newborns and infants using drops of isotonic saline solution and an aspirator to avoid aspiration and inflow of liquid into the cavity of Eustachian tube and middle ear, and also for the preventive purposes, as it allows to maintain homeostasis of the nasal mucosa and prevent the development of acute respiratory diseases.
BRONCHOPULMONOLOGY. ENT
Introduction. In 2020, most doctors were at the frontlines in the fight against the novel coronavirus infection (COVID-19). In the process of searching for effective etiotropic drugs, news came in that type I interferons had been successfully used for the treatment of COVID-19. Choosing the optimal COVID-19 treatment strategy is of pivotal importance for vulnerable populations such as children.
Objective of the study. To show our own experience in providing medical care to children with COVID-19 and present the results of a comparative study of the efficacy and safety of interferon alfa-2b drugs combined with highly active antioxidants in the complex COVID-19 therapy in children.
Materials and methods. A comparative study of the efficacy and safety of interferon alfa-2b drugs combined with highly active antioxidants in the complex COVID-19 therapy in children was conducted. The study included children with a laboratoryconfirmed diagnosis of COVID-19 aged 1 – 17 years (n = 85). In the treatment group (n = 45), children received interferon alfa-2b drugs such as VIFERON® rectal suppositories and VIFERON® gel for topical administration according to the dosage regimen and standard therapy. In the control group (n = 40), children only received standard therapy in accordance with the recommendations of the Ministry of Health of Russia.
Results and discussion. 3,696 patients, including 3,507 children, received medical care in the City Children’s Hospital No. 1 in Kazan since April 2020. The share of laboratory-confirmed COVID-19 cases among admitted children was 21% (n = 736), of which 85 were enrolled in the study to assess the efficacy of complex therapy with interferon alpha-2b drugs combined with highly active antioxidants. The interferon alfa-2b therapy of COVID-19 children reduced the duration of the key clinical symptoms of the disease by 1.5-4 days and the virus elimination time by 6 days.
Conclusions. The use of interferon alfa-2b VIFERON® rectal suppositories and VIFERON® gel for topical administration according to the dose regimen in combination with the standard therapy in COVID-19 children contributed to faster elimination of clinical symptoms of the disease and virus elimination compared to the standard therapy.
Acute respiratory diseases (ARIs), a group of infectious diseases with similar epidemiological and clinical characteristics, are the most common reason for seeking medical care, children skipping attendance of educational institutions and parents skipping work. The clinical picture of ARI is characterized by a combination of the following symptoms: increased body temperature, nasal discharge, mostly mucous, nasal congestion, sore or scratchy throat and cough. In some cases, myalgia and manifestations of asthenia such as weakness, rapid fatigue, headache and decreased appetite may be noted. Pathogenetic therapy of ARI is based on clinical syndromes and includes symptomatic, antiviral and antibacterial drugs, also mucolytics, expectorants, cough suppressants; H1-histamine receptor blockers and immunocorrectors if necessary. Hyperthermia is the most significant problem faced by parents of young patients and pediatricians when dealing with ARI. The production of interferon gamma, interleukin-2 and tumor necrosis factor, which stimulate the production of IgG, is significantly increased with fever. Therefore, it is especially important to know the algorithms of behavior and criteria for understanding when and what antipyretics should be prescribed to a child. Administration of antipyretics for fever is aimed not only at stopping the fever, but also to improve the child’s wellbeing and reduce the pain syndrome during ARI. When choosing antipyretics, it is necessary to consider the age of the child, the preferred method of administration, the allowable doses, the frequency of administration, the prevention of complications in children at risk. Antipyretics may be prescribed in the form of combined drugs, not only able to reduce fever, but also eliminate other symptoms that occur against the background of acute respiratory infection.
Acute respiratory infections hold the leading position in the structure of infectious pathology in children and are one of the main reasons for visits to the doctor. Most often causative agents of acute respiratory infections are viruses. In recent years, respiratory infections of combined etiology are becoming an increasingly significant problem, the proportion of which is increasing.
In co-infections, clinical diagnosis is difficult, which once again emphasizes the importance of the widespread introduction of highly sensitive etiological diagnostic methods, in particular polymerase chain reaction. Data on the tendency to a more severe course of co-infections compared to mono-infections are ambiguous, which seems to depend on the specific causative agent and the level of viral load. Another urgent problem of acute respiratory infections in children is the frequent registration of concomitant respiratory viral and herpes virus infections. The clinical picture of acute respiratory tract infections is not very diverse: fever, intoxication symptoms, cough, nasal congestion, rhinorrhea, sore throat, etc. At the same time, pathognomonic symptoms can be identified in some monoinfections, but in coinfections such clinical diagnosis is difficult, suggesting the importance of etiological diagnosis, especially polymerase chain reaction (PCR).
All of the above, as well as age and clinical manifestations largely determine the rational selection of antiviral therapy simultaneously effective against both respiratory viruses and herpes viruses. One such drug is Cycloferon, which has not only a broad antiviral spectrum, but also a high level of safety.
Inclusion of an interferon inducer in the treatment of acute respiratory infections will reduce the need to prescribe other drugs, including antibiotics, and reduce the medication load on the body.
Inhaled antibacterial drugs have been used since the 1940s with greater or lesser effectiveness, due to the possibility of targeted delivery of drugs directly to the infection site at concentrations higher than MICs. High local concentrations of antibacterial agents expand the possibilities of treating infections caused by multiresistant strains and reduces antibiotic resistance in the population. The inhaled delivery method is characterized by a high level of safety due to the absence of systemic toxic effects, which reduces the risk of pseudomembranous colitis and other complications of antibiotic therapy. Thiamphenicol glycinate acetylcysteinate is a combined drug that includes thiamphenicol and N-acetylcysteine, which causes its antibacterial and mucolytic activity. The results of clinical studies have demonstrated the effectiveness of TGA in the treatment of acute and chronic bronchitis, chronic obstructive pulmonary disease, community-acquired pneumonia, laryngotracheitis, rhinosinusitis and other infections of the upper and lower respiratory tract. In pediatrics, the drug is used to treat bronchitis and pneumonia, especially those that cannot be treated with other antibacterial drugs, bronchiolitis, whooping cough, and cystic fibrosis. The article presents data on the effectiveness and safety of containing TGA. A wide spectrum of antibacterial actions, the ability to form high local concentrations of antibacterial and mucolytic components in the focus of infection, a low risk of serious side effects in both adults and children are noted. The topical use of the combination drug has proven to be effective not only in bringing about a pronounced clinical improvement, but also in reducing the frequency of use of systemic antibiotic therapy. The efficacy of thiamphenicol glycinate acetylcysteinate is not inferior to macrolide antibiotics.
Introduction. Despite new diagnostic methods contributing to an understanding of the etiopathogenesis of acute respiratory tract diseases and a variety of drugs for effective therapy, respiratory tract diseases continue to stand first in the overall morbidity profile in both children and adults. Frequently ill children are most susceptible to diseases, especially at the age of 3 to 6 years old, which accounts for up to 75% of all acute respiratory infection cases and shows no positive response to the medical-preventive activities. The article discusses the relationship between allergic rhinitis and recurrent respiratory diseases.
Materials and methods. The possibility and effectiveness of complex treatment of allergic rhinitis in 65 frequently ill children aged 3 to 12 years are considered. The main group consisted of 35 children who were included in the traditional anti-allergic therapy with an isotonic solution of sea salt in an age-related dose for 10 days. The comparison group consisted of 30 children who received only traditional anti-allergic therapy, which was comparable in the compared groups. Patients underwent in-depth clinical and specific allergological examinations, as well as assessment of atopic response parameters of mucosal immunity, including determination of eosinophil levels, side, and Il-4 concentrations in nasal secretions.
Results. Thus, the 12-month follow-up control over children with AR showed that the annual frequency of ARIs in the treatment group decreased by 1.4 times and, when averaged, was 5.2 cases, while in the comparison group it was 7.3 cases p < 0.05.
Conclusions. In children with recurrent respiratory diseases, suffering from allergic rhinitis, the complex anti-allergic therapy, with the inclusion of elimination and irrigation therapy with a preparation based on isotonic sea salt solution, led to a decrease activity of markers of allergic inflammation in the nasal mucosa, which is confirmed by a decrease in the level of eosinophils, secretory IgE and IL-4 in nasal secretions against the background of a decrease in the frequency of acute respiratory diseases during follow-up for a year.
Introduction. Cough accompanies an acute infectious process in the respiratory tract. The article focuses on the symptomatic treatment of cough using a modern herbal preparation with complex action and standard therapy.
Goal. To study the effects of a herbal preparation with complex action in the treatment of cough in children.
Materials and methods. The study included 72 patients of both sexes (mean age 14.6 ± 2.3 years) with a symptom of unproductive/unproductive cough, against the background of acute bronchitis or community-acquired pneumonia.
Results and discussion. When using a herbal preparation with complex action was used in ¾ of the children, cough decreased by the 3rd day and in most patients it stopped by the 10 th day. The severity of daytime and nighttime coughs decreased by 3.0–3.5 points, the number of seizures decreased to 2–4 per day, the duration of seizures also decreased significantly, the median of this indicator in the main group reached 0 points. In both groups, the proportion of patients with seizure frequency of no more than 4 per day increased. While taking a herbal preparation, a more pronounced decrease in all indicators of cough by 3.5 times was noted throughout the treatment, and the corresponding effects developed 3 days ahead of time against the background of a full course of therapy. The average value of the efficacy and safety assessment given by the medical researchers to the action of the herbal preparation with complex action was 3.6 points. Analysis of objective and subjective data based on the results of evaluating case histories and individually developed questionnaires for patients on drug tolerance showed equivalence in terms of excellent and good results. Against the background of the full course of treatment with the herbal preparation, a 1.8 times more pronounced decrease in the characteristics of the cough syndrome was noted.
Conclusion. The drug has shown high efficacy and safety, which makes it possible to recommend it as a symptomatic therapy for cough in school-age children as part of a combination or monotherapy.
Introduction. In outpatient practice, acute nasopharyngitis in children is one of the most common reasons for seeking medical attention. The local pediatrician, as a rule, is the first to examine the child and determine the tactics of treatment. A competent approach to the choice of drugs avoids polypharmacy.
The article presents the published scientific evidence on the modern approach to the treatment, as well as the author’s own clinical observation.
Objective. To study the effectiveness of modern methods for the treatment of rhinopharyngitis, including the use of silver proteinate to treat acute respiratory infections in a group of frequently ill children.
Materials and methods. The study involved 38 children aged 3 to 4 years, included in the group of frequent illnesses. The children were divided into 3 groups. In the first group (12 people), for four months (October-December 2019), children received symptomatic treatment of an acute respiratory infection; between episodes of acute respiratory infection, daily prophylactic irrigation of the child’s nose and throat with saline was used. In the second group (13 people), symptomatic treatment and nasal instillation of a preparation of silver proteinate were used at each episode of acute respiratory infection. In the third group (13 people), children received only symptomatic treatment for acute respiratory infection.In the first and third groups, children received symptomatic treatment of an acute respiratory infection without the use of silver proteinate.
Results. The chosen approach to the ARVI treatment such as nasal instillation of silver proteinate into the bilateral nasal cavities has shown its effectiveness without having to carry out preventive measures between episodes of the disease.
Conclusion. The application of elimination and antiseptic therapy with the use of Sialor for each episode of ARVI in the group of frequently ill children can reduce polypharmacy and incidence of morbidity.
Influenza A and B epidemics, occasionally pandemics, are characterized by high morbidity and mortality rates. In most cases, an uncomplicated disease ends with recovery, but unfavorable outcomes, up to lethal, are possible, especially in premature, low birth weight, infants and young children, old people, pregnant and postpartum women, with chronic diseases, immunocompromised, receiving salicylates and anticoagulants. The use of modern diagnostic methods allows early detection of patients with influenza, distinguishing them from the total number of patients with respiratory infections. This allows you to optimize the timing of the examination, avoid unnecessary prescription of antibiotics, and timely prescribe specific chemotherapy and chemoprophylaxis. During epidemics, in the presence of an epidemiological history, the conclusion of the clinician is decisive for the diagnosis. Vaccination is an excellent method of preventing or relieving the flu. However, in case of an unfavorable course of the disease, in risk groups, in closed groups, it is recommended to use chemotherapy, pre-exposure or post-exposure chemoprophylaxis. Numerous studies have proven the effectiveness of the use of the drug oseltamivir, a specific blocker of the virus neuraminidase. As a result, its replication stops. The drug does not complicate the vaccination, it can be used in vaccinated people, in all age groups, is available in different dosages, and can be used with food. Treatment for uncomplicated influenza lasts 5 days. In certain situations, chemoprophylaxis and chemotherapy with the specific antiviral drug oseltamivir can help control influenza outbreaks in certain populations.
GASTROENTEROLOGY
Functional gastrointestinal disorders in children are one of the most common reasons why parents visit a pediatrician. Functional gastrointestinal disorders include various persistent combinations of chronic or recurrent gastrointestinal symptoms in the absence of any organic pathology in the gastrointestinal tract (structural abnormalities, inflammatory changes, infections, or tumours) and metabolic disturbances. The article presents details on the mechanisms of development, clinical manifestations, diagnostic criteria and approaches to the treatment of functional gastrointestinal disorders. Clinical manifestations of functional gastrointestinal disorders vary depending on age and characteristics of physical and intellectual development. In more than half of children, they are observed in various combinations, less often as one isolated symptom. The drug therapy should consider the main components of pathogenesis and facilitate the solution of the following issues: improvement of digestion; restoration of intestinal microenvironment and motility; reduction of visceral hypersensitivity. Special attention is paid to the management of motor disorders and restoration of intestinal microenvironment using symbiotics. When choosing a supplement, it is advisable to focus on the composition of probiotic strains, which should comply with the WGO global guidelines (Bifidobacterium bifidum, Lactobacillus acidophilus, etc.).
Prescription of peripheral δ-, μ- и κ-receptor agonists – trimebutine and pre- and probiotics combinations to children with functional gastrointestinal disorders results in decreased signs of functional disorders of the digestive tract. By acting on the enkephalinergic system, trimebutine regulates the bowel activity, improves motility, and reduces visceral hypersensitivity. Trimebutine is included in the Russian guidelines for the diagnosis and treatment of functional disorders of the digestive tract in children, as well as in the clinical guidelines for the treatment of irritable bowel syndrome, functional dyspepsia, and functional abdominal pain.
Nephrotic syndrome occupies one of the leading places among kidney diseases in children. Scientific studies indicate that edema syndrome, arterial hypertension, disorders on the microcirculatory level occurring in case of nephrotic syndrome contribute to the slowing and reduction of blood flow in the pancreas, which leads to the development of hypoxia and metabolic disorders. Under conditions of metabolic and microcirculatory disorders, as well as against the background of the therapy used in children with nephrotic syndrome the risk of secondary pancreas lesion increases significantly. Pathogenetic treatment of nephrotic syndrome involves the administration of glucocorticosteroid and cytostatic therapy. The study of autopsy materials of the pancreas in children who died of glomerulonephritis revealed histomorphological changes in 35.7% of children in the form of acute interstitial pancreatitis and pancreonecrosis. At the same time there are still few works in the scientific literature, devoted to the study of functional state of the pancreas in children with kidney diseases. The data on pancreatitis prevalence in children are extremely inconsistent. Significant variation in the frequency of pancreatic lesion in children (from 5 to 25%) is most often associated with diagnostic difficulties. Ultrasound examination after a meal (postprandial test) allows to diagnose pancreatic pathology (indirect signs of chronic pancreatitis, reactive pancreatic changes) with higher accuracy (by 23%) than traditional examination. Late diagnosis of pancreatic lesion and lack of correction can significantly affect patients’ health and quality of life. There is a need to study functional state of pancreas in children with nephrotic syndrome to improve understanding of pathogenesis of possible involvement in pathological process and optimization of preventive and therapeutic tactics.
Acute intestinal infections are the most common cause of a diarrheal syndrome at an early age and represent a great challenge in paediatrics. Over one billion people suffer from acute infectious diarrhoea worldwide every year, of which 65–70% are children under 5 years of age. Along with pharmaceutical (etiotropic and pathogenetic) therapy, nutritional therapy is the most important part of the treatment of children suffering from acute intestinal infections, as the unbalanced and improperly selected nutrition may cause development of a long-lasting diarrheal syndrome resulting in a weight loss, lactase deficiency and some other unfavourable conditions. It is obvious that the issue of adequate nutrition becomes important in case of intestinal infections in children, as it should be easily digested and assimilated, replenishing energy and microbiocenotic losses. An early return to a normal nutrition ration helps reduce duration of the disease, speed up recovery in both functional and anatomical aspects. Today, there is a sufficiently large selection of products in the paediatric practice, which contribute, to one degree or another, to a balanced nutrition of children in the acute stage of the disease. Probiotic products hold a most unique position among these products. The article pays special attention to the baby foods produced by the Russian manufacturer, which is the leader in the Russian paediatric nutrition market and has been producing natural and healthy products for babies for about 30 years. The product line of this manufacturer includes a wide range of probiotic and functional products for patients of older age groups for the management of microbiota dysbiosis in acute intestinal infections.
The use of antibiotic drugs (ABDs) has significantly reduced the number of severe bacterial infectious diseases and mortality in children, especially in infants. But the widespread and unnecessary use of ABDs, including reserve antibiotics (the use of carbapenems increased by 45%, polymyxins – by 13%), to treat uncomplicated acute respiratory infections is open to many hazards, such as increased antibiotic resistance of pathogens. Antibiotic-associated diarrhea is one of the common complications of antibiotic therapy. According to various authors, the incidence of antibiotic-associated diarrhea is 6–80% among patients treated with antibiotics, on average 35% of patients (approximately every third patient) receiving antibiotics report symptoms of antibiotic-associated diarrhea. Disruptive changes in the qualitative and quantitative composition of the intestinal microbiota are accompanied by a decrease in the protective functions of the intestinal mucosa and contribute to the growth of pathogenic and opportunistic microorganisms (Clostridium spp., Candida spp., Salmonella spp., Staphyloccus aureus). The findings of most studies obtained on a large sample of paediatric population, as well as the clinical guidelines of the World Association of Gastroenterologists recommend the use of L. rhamnosus GGprobiotic strain (level of evidence 1) to prevent antibiotic-associated diarrhea in children. L. rhamnosus GGpresents chromosomal resistance to a range of antibiotics, which varies with species and strain. They do not contain plasmid DNA, which is dangerous for the spread of antibiotic resistance among other bacteria, which enables their wide therapeutic and prophylactic use. Clinical case studies of the course of antibiotic-associated diarrhea in children are presented to demonstrate the variability of clinical symptoms. Fever in children with ARI, particularly in tender-age infants, requires special attention from parents and doctors, as its main risk lies with a dehydration due to significant water loss during breathing, and especially increased sweating (including sweating induced by antipyretics). Therefore, oral rehydration therapy is an important method for treating infectious diseases in children. Complications that develop in patients, especially in children, after administration of antibiotics, diseases that can lead to water and electrolyte imbalance are life-threatening conditions that require immediate medical attention. Correction of water and electrolyte balance, timely restoration of intestinal microflora improve prognosis in such patients and promote faster recovery.
DERMATOLOGY
Epidermis plays an important role in protecting the body from negative environmental influences. The horny layer plays a special role in carrying out these functions. Skin defense mechanisms are multistage and include 5 protective barriers responsible for maintaining the integrity and performing the main functions of the skin. The first one is a microbial barrier – determined by commensal flora which prevents contamination of pathogenic microorganisms; the second one is a physical barrier preventing mechanical skin damage, penetration of allergens and microorganisms; the third one is a chemical barrier achieved by forming pH and components of natural moisturizing factor as well as epidermal lipids; the fourth one – immune barrier – Langerhans cells, tissue basophils, lymphocytes etc.;
the fifth is the neurosensory barrier – numerous nerve endings transmitting signals of skin integrity damage and controlling metabolic processes and homeostasis maintenance. Epidermal barrier of newborns and infants is imperfect and differs in its structure and functional activity from that of adults. Children’s skin is prone to excessive dryness, irritation, allergic reactions and inflammation. For young children, it is very important to minimize the risk of these manifestations. Individual selection and use of emollients in the basic care of infants promotes the functional stability of five protective «frontiers» of the epidermal barrier: prevents skin damage when exposed to unfavorable environmental factors, reduces TEWL, supports the normal microbiome, has antipruritic and anti-inflammatory action. Modern emollients restore the hydrolipidic layer of the epidermis and prevent the development of dermatitis and skin infection in children. An important role when choosing an emollient is played by its texture, which can be represented by a lotion, cream, balm, ointment. Chemically, creams, lotions and balms are emulsions, i.e. they consist of two immiscible components – fat (oil) and water. In this case, one of the components is in the other in the form of tiny droplets. Most skin diseases faced by young children are related to the integrity of the epidermis, which is why daily care should be primarily focused on protecting the skin barrier
Modern external therapy of dermatoses is aimed at controlling the subjective symptoms, the dynamics of inflammatory manifestations, the achievement and duration of remission. The step-by-step approach to the treatment of dermatoses in children and adults is based on the adequate use of various external forms and means according to the inflammatory manifestations and localization of the inflammatory process. The article describes clinical cases of treatment of atopic dermatitis in patients aged 8 and 11, and contact allergic dermatitis in a 15-year-old adolescent using methylprednisolone aceponate cream with ceramides in its base, tacrolimus ointment and emollients. High efficacy and safety of anti-inflammatory drugs for external use have been shown. Clinical examples have proven that the combined use of topical corticosteroids and emollients contributes to a rapid reduction of skin dryness and itching, as well as the intensity of inflammation. The possibility of combining methylprednisolone aceponate cream with ceramides in the base once a day and emollients with physiological lipids increases the effectiveness of therapy and reduces the risks of side effects when using topical corticosteroids in children.
ALLERGOLOGY AND IMMUNOLOGY
Bronchial asthma is one of the most common chronic lung diseases observed in children. According to the international and Russian guidelines, the long-term objectives of asthma treatment in children and adolescents are to achieve good symptom control, minimize the risk of asthma exacerbations, reduce hospital admissions, decrease the use of short-acting bronchodilators, reduce restrictions in the airflow and side effects, and ensure that normal activity levels are maintained. The asthma treatment is based on the use of inhaled corticosteroids as a backbone therapy and addition of adjunctive therapy if the disease control is poor or worsening. Tiotropium bromide is the first anticholinergic drug that has been approved for children and adults with poorly controlled asthma and is currently used as a treatment option for moderate to severe bronchial asthma. Randomized clinical trials in children and adolescents with persistent bronchial asthma showed high efficacy and safety of tiotropium. The addition of tiotropium in the form of 2 inhalations of 2.5 μg once a day to the bronchial asthma therapy in children over 6 years old, including medium doses of inhaled corticosteroids, is a preferred and safe option to increase the therapy coverage compared to an increase of a dose of inhaled corticosteroids to high levels, regardless of the disease phenotype (In atopic, non-atopic bronchial asthma, bronchial asthma with obesity, etc.). Tiotropium adjunctive therapy may also be a therapeutic option for children using inhaled corticosteroids, who have asthma that does not respond well to long-acting β2-agonist therapy, or for those, who are worried about the safety of long-acting β2-agonists.
Allergic rhinitis is the most common pathology among all allergic diseases. The article presents the epidemiologic and pathogenetic issues of the allergic rhinitis. The underdiagnosis of allergic rhinitis and its underestimation as a systemic pathology were observed in various countries. The importance of allergic rhinitis in paediatric practice, its impact on the quality of life, studies, and cognitive abilities is considered. The extranasal manifestations of the disease, as well as the role of allergic rhinitis in the development of increased respiratory viral morbidity are assessed. The differences between allergic and vasomotor rhinitis (non-allergic non-infectious rhinopathy) are analysed. Frequent interdependence and interaction of the allergic and vasomotor rhinitis are stressed. The signs of nonspecific hyperreactivity of the upper respiratory tract affected by the allergic rhinitis are presented. The role and importance of decongestants in the treatment of both allergic and vasomotor rhinitis are discussed in detail. Vasoconstrictors would help reduce hyperemia and nasal mucosa oedema, reduce the level of mucus secretion, improve the drainage of paranasal sinuses, normalizing the pressure in them. The use of a combination drug – a sympathomimetic combined with a local antihistamine agent would be the most appropriate treatment for patients with AR. The use of intranasal combination therapy for allergic rhinitis is justified: a sympathomimetic phenylephrine combined with a blocker of H1-histamine receptors dimethindene. The insights into the safety and efficacy of above drug combination in paediatric practice are presented. The use of a combination intranasal drug based on phenylephrine and dimethindene in patients with allergic rhinitis is justified in paediatric practice as both symptomatic and pathogenetic treatment. It is also advisable to administer it to treat acute respiratory viral diseases, in the post-viral period with situational exacerbations of the vasomotor component.
Acute urticaria remains one of the most topical pediatric problems. Acute urticaria lasts for up to 6 weeks, during which blisters appear with varying frequency and intensity. In about 40% of cases, urticaria is accompanied by angioedema. The prevalence of acute urticaria is 1 to 5% in the population, and in the child population the frequency of acute urticaria reaches 6.7%. According to recent estimates, 10 to 20% of the population has had an episode of acute urticaria during their lifetime. About 50% of children with acute urticaria have concomitant allergic diseases. The management of children with acute urticaria presents significant diagnostic and therapeutic challenges. Treatment of acute urticaria in children begins with elimination of the significant trigger – appropriate measures are taken (withdrawal of the drug, administration of an elimination diet, therapy of infectious and inflammatory processes). First-line drugs for acute urticaria are H1-antihistamines, and it is recommended to use H1-antihistamines of the II generation. However, if clinical manifestations develop rapidly, if the patient has generalized urticarial rashes, angioedema, gastrointestinal symptoms, parenteral forms of first-generation antihistamines may be used to relieve the acute allergic reaction. Patients who do not respond to treatment with antihistamines may respond to short-term therapy with systemic glucocorticoids, although the efficacy of this treatment has yet to be tested in controlled clinical trials. The prognosis for acute urticaria is favorable – in most cases, acute spontaneous urticaria remains the only episode in the patient’s life. The disease develops into a chronic form in 5% of patients, and other estimates suggest that the symptoms of urticaria persist in 9.5% of children for up to 6 months.
Atopic dermatitis is one of the most common inflammatory diseases. This disease is characterized by severe itching, recurrent eczematous lesions and has a heterogeneous clinical picture. AD occurs in all countries, in both sexes, in different age groups. There has been a steady increase in the incidence of AD detection over the past three decades. The prevalence of AD symptoms in various regions of the Russian Federation (RF) ranged from 6.2 to 15.5%. There is no generally accepted classification of AD, the working classification of AD reflects the age dynamics, clinical and morphological forms, severity and stages of the course of the disease. Treatment of AD should be patient-centered and should include prevention of individual trigger factors, restoration of the skin barrier, and a stepwise and gradual approach to reduce inflammation based on the severity of the disease. mGCS are the first-line treatment for exacerbations of AD. Topical calcineurin inhibitors are tacrolimus and pimecrolimus. Pimecrolimus is indicated for the treatment of mild to moderate AD, and tacrolimus is indicated for moderate to severe AD. Tacrolimus and pimecrolimus are characterized by low systemic absorption, they do not cause skin atrophy and do not affect the function of the hypothalamic-pituitary-adrenal system. Systemic corticosteroids should be used only in exceptional cases for short-term treatment of an exacerbation or when starting another systemic therapy. The therapeutic value of 1st generation antihistamines lies in their sedative properties by normalizing nighttime sleep and reducing the intensity of itching. Dimetindene maleate is an effective and safe treatment for relieving symptoms of pruritus and normalizing sleep in patients with AD. Dimetindene maleate has a high safety profile and can be prescribed from 1 month of age.
Bronchial asthma is the most common chronic disease of children, the worst way is their quality of life. Compliance in the treatment of children is very important, since the actual effect of a drug is determined by both the effective drugs and patient adherence and correct use. A relevant test is the use of mild asthma, which is able to control bronchial hyperreactivity associated with exercise, cold air, and other nonspecific irritants (smoke, odors, etc.). Planning of baseline therapy for children with mild asthma aged 5 years old and younger is particularly problematic for paediatricians due to high incidences of acute respiratory viral diseases and viral-induced exacerbations of bronchial asthma among them. In these children, allergen-specific immunotherapy, long-acting B-agonists, the use of many metered-dose inhaled glucocorticosteroids. are not recommended.
Montelukast, an oral antileukotriene drug, has advantages in the treatment of children with mild asthma with virus-induced exacerbations, with asthma of physical exertion and severe bronchial hyperreactivity, especially when combined with allergic rhinitis, as well as in special clinical cases, when parents refuse to use ICS for treatment children with mild asthma or inability to use them for some reason. The use of montelukast for mild asthma in children in the current context of the COVID-19 pandemic also has advantages that pediatricians can use when observing these children in the pediatric area, taking into account contraindications.
CLINICAL CASE/PRACTICE
During COVID-19 pandemic the issue of diagnosis and rational therapy of community-acquired pneumonia in children became acute. This is caused by difficulties in verification of the diagnosis of community-acquired pneumonia in the outpatient department, peculiarities of interpretation of the respiratory system lesions. The article presents clinical cases of communityacquired pneumonia in children admitted to the pulmonology department of a pediatric hospital.
Clinical case 1. 5-year-old child, medical history: acutely fell ill, on 28.11.20, had a sore throat and fever up to 39.0 C. Received Kagocel, Miramistin, Nurofen. PCR for COVID-19 on 08.12.20 was positive, on 18.12.2020, 22.12.2020, 20.01.2021 - negative. Immunoassay (ELISA) on 12.23.20: IgM - 4.47, IgG - 255.25. Lung and pleural cavity ultrasound: echo signs of sharply pronounced interstitial syndrome, massive fibrinothorax on both sides, indirect signs of bronchopleural fistulas; lung radiography: bilateral polysegmental pneumonia, bilateral hydrothorax, bilateral fibrinothorax, with no marked progression; CT scan with IV contrast: CT picture of hydrothorax on the left, hydropneumothorax on the right, pleurisy on both sides, compression atelectasis of lower lobe segments of both lungs. With no marked progression. Treatment. Thoracentesis; antibiotic therapy, antimycotics, infusion therapy, immunotherapy, partial parenteral nutrition. Against the background of the therapy, positive dynamics was obtained. Clinical examples are also given: an 8-year-old child with suspected new coronavirus infection and a 5-year-old child with bilateral polysegmental pneumonia.
Introduction. A broad evidence base of numerous randomized clinical trials and meta-analyses asserts the role of intestinal microbiota dysbiosis in the development of various diseases, including those of infectious origin, in infancy and later stages of life.
Purpose. Assessment of the efficacy of a multi-strain immuno-probiotic during rehabilitation of frequently ill children visiting organized groups during the period of epidemiological distress for acute respiratory diseases.
Materials and methods.93 children older than 3 years of age were enrolled in an open comparative prospective clinical observation during the high-risk respiratory infection period – November, December. Children were observed for 1.5 months during administration of the multi-strain probiotic and 1 month after discontinuation of the probiotic. The subjects were randomized into two groups: the treatment group (60 children) received the multi-strain probiotic in the maximum age-specific dosage variances (children aged 3 to 12 years old – 1 capsule, older than 12 years of age – 2 capsules) once a day in the morning for 14 days and the comparison group (33 children) did not receive the multi-probiotic for the same period.
Results and discussion. It was found that the incidence of disease in children receiving the multi-probiotic (the treatment group – 60 children) was statistically lower, and the disease severity was milder than in the group of children, who did not receive the probiotic (the comparison group – 33 children). Not a single child who received the multi-probiotic in the course of disease did not require antibiotic therapy during the entire observation period. Moreover, the incidence of respiratory infections in the treatment group within a month after discontinuation of the probiotic was 4.6 times lower than in the comparison group. No side effects were reported.
Conclusions. The study results allowed the author to recommend the use of a multi-strain immuno-probiotic as a nonspecific immunomodulatory supplement for the seasonal prevention of acute respiratory infections, especially in frequently ill children at a high risk of infections.
Introduction. The issues of choosing the optimal product for enteral nutrition in children with cystic fibrosis in combination with comorbid conditions require a special clinical approach and cause difficulties for practitioners.
Aim. To evaluate the effectiveness of correcting the nutritional status in children with cystic fibrosis against the background of concomitant conditions using a semi-element product for enteral nutrition.
Materials and methods. 20 children (boys – 9, girls – 11) aged from 1 year to 3 years (average age 2.9±0.7 years) with a diagnosis of cystic fibrosis and concomitant comorbid conditions - uncupable intestinal syndrome, post-resection syndrome against the background of meconial ileus, food allergy (the semi-element formula was prescribed according to indications, the evaluation of effectiveness according to the SCORAD index was not included in the objectives of the study). The state of actual nutrition, pancreatin doses, intestinal syndrome, nutritional status (anthropometric indicators) were evaluated at baseline (before) and 3 months (after) the use of Peptamen Junior in the study group.
Design:prospective, observational, without comparison group.
Results and discussion. The analysis showed that the anthropometric indicators significantly increased against the background of the correction of the diet and the use of “Peptamen Junior” as an additional food. BMI increased from 34.5 percentiles to 57.0 (p < 0.05).
Correction of nutrition using a semi-element formula with an altered fat composition, including SCT, and correction of the dose of pancreatic enzymes by calculating the fat content in food, led to a decrease in the manifestations of intestinal syndrome.
Conclusion.The results obtained indicate the clinical effectiveness of the semi-element formula for enteral nutrition for the correction of nutritional deficiency (BMI less than 50 percentile) in young children with cystic fibrosis and concomitant pathology that requires a special approach.
Introduction.Stress and stress-induced disorders are not uncommon in pediatric practice. The range of causal stressors (information environment, gadgets, pandemic, armed conflicts, etc.) has expanded significantly these days. The article depicts the main clinical manifestations of stress reactions, pathogenetic mechanisms of their development, provides rational approaches to the therapy of elimination of stress manifestations and consequences in children and adolescents from a pediatric perspective.
Objective:To study the influence of stress on the psychoemotional sphere and cognitive functions in children aged 7 to 9 years from the armed conflict zone in the Donbass.
Materials and methods. 234 children of primary school age were included in the study, of whom 123 children had lived at the armed conflict zone in Donbass for a year. The psychoemotional state and cognitive functions status were determined by children’s tests using a scoring method to assess test results.
Results and discussion.The tests with a scoring method to assess test results showed that 100% of children from the armed conflict zone had a chronic stress, 63% had a moderate to severe stress, a high frequency of various types of phobias, as well as impaired concentration and memory.
Therapeutic approaches to the management of stress reactions directly depend on the cause and clinical manifestations of such reactions. The therapy strategy includes among other things general strengthening actions, psychotherapy, symptomatic and pathogenetic methods of treatment. In addition, both acute and chronic stress leads to intracellular magnesium deficiency and increased urinary magnesium wasting, as a large amount of catecholamines is released under stress conditions, which contributes to shifting magnesium out of cells. The magnesium deficiency results in increased permeability of cell membranes for calcium ions, which creates conditions for electrical instability and excessive excitability of cells, most significantly of neurons. This is reflected in the fact that the process of excitation prevails over inhibitory reactions, and stress reactions develop as the clinical manifestations. It has been established that an adequate balance of magnesium increases the adaptive capabilities in people. Its neurotropic effects made it possible to consider magnesium as an effective pathogenetic agent that can increase stress resistance, stress management, and activate the body’s adaptive reserves.
Conclusion. The causal stressors are manifold, the paediatrician has to deal with stress reactions in children much more often than doctors of other specialties. Magnesium supplements currently form the basis of treatment and rehabilitation actions in children with stress.
Introduction. The paper presents modern insights into the pathogenesis and role of inflammatory reactions in the development
of the respiratory pathology. The safety and high potential of the use of complex bioregulatory drugs as elements of pathogenetic and symptomatic therapy of the respiratory diseases have been substantiated. The authors present the results of their own clinical observations on the use of a complex bioregulatory drug as an anti-inflammatory agent to treat acute respiratory diseases in young children.
Clinical case 1. The observation included 102 children aged 1 to 3 years with the symptoms of acute respiratory viral infection, who underwent outpatient treatment. 53 children of them received a complex bioregulatory drug as a symptomatic antiinflammatory and antipyretic therapy according to the treatment regimen set out in the patient information leaflet. The comparison group consisted of 49 children, who received acetaminophen derivatives to relieve the similar symptoms at least once per day. The findings showed that the bioregulatory drug, when used according to the treatment regimen, effectively relieved the symptoms of fever in 46 children (87%), the same indicator in the comparison group was 44 children (89%) (p > 0.05%).
Clinical case 2.We observed 26 children aged 9 to 18 months with teething syndrome, which was treated with a bioregulatory drug as a symptomatic therapy. The therapy lasted 3 to 7 days. The results showed that the bioregulatory drug effectively relieved the whole complex of teething symptoms.
Сonclusion. Viburcol has been shown to be highly effective as an antipyretic agent, as well as a drug to relieve symptoms during teething. No children who used the drug showed side effects. The authors advise the widespread use of complex bioregulatory drugs in routine paediatric practice.
PEDIATRICIAN SCHOOL
Acute respiratory viral infections represent a group of clinically, pathomorphologically similar acute inflammatory respiratory diseases that manifest by fever, a runny nose, sneezing, cough, sore throat, a general feeling of ill health of varying severity. Activation of latent, persistent infections of viral and/or bacterial origin may occur in recurrent respiratory infections. Decreased production of local immunity contributes greatly to the development of viral and bacterial infections, persistence of pathogenic micro-organisms. Intestinal microflora can directly or indirectly affect the human respiratory tract through increased production of cytokines, short-chain fatty acids. In recent years, there has been a scientific interest in the therapeutic potential of probiotics for the prevention of acute respiratory viral infections. Earlier studies have shown a positive effect of probiotics on the respiratory tract with a view to prevent and reduce the incidence and severity of respiratory infectious diseases by expending the number of IgA secreting cells in the bronchial mucosa. Studies showed that the use of probiotics can reduce the incidence of acute respiratory infections, duration of fever, cough, and the need for antibacterial agents in children. Peptidoglycans and muramyl peptides that are constituents of the bacterial cell wall have antiviral activity. Probiotics can also inhibit virus attachment through a process of competing for the specific receptors. The regeneration of the mucous membrane is enhanced by the ability of mucin to prevent the virus from attaching to epithelial cells and suppress virus replication. The antiviral effect of probiotics may be caused by the ability to produce antimicrobial peptides, dehydrogenases and NOs. Probiotics can modulate the functions of epithelial and dendritic cells, CD4 +, CD8 + T lymphocytes, NK cells, stimulate the synthesis of secretory immunoglobulins, helping to neutralize the virus.
The problem of anesthesia includes mainly the treatment of pre-existing pain or surgical manipulations with the use of anesthesia. However, the problems of pain prevention during traumatic (invasive) procedures are also actively solved, methods of prevention are improved and expanded, taking into account the impact of pain on the quality of life. Pain is not a simple physiological process of conducting stimulation from the receptor apparatus to the CNS structures, but a complex phenomenon that includes biological, emotional, psychological and social components. Pain is one of the earliest formed psychophysical functions; by the 30 th week of fetal development all pathways of pain conduction and perception are already formed, so both fetus and child are already capable of perceiving pain, and the intensity is often even higher than in adults. Many believe that: young children do not feel pain because their central nervous system is immature; children remember themselves from the age of 4–5 years, so they do not remember the pain they suffered, so all surgical problems that cause pain should be addressed as early as possible; if the child is sleeping or playing, he or she has no pain, etc. Current research has demonstrated significant short-term adverse reactions and long-term negative effects in children in response to pain-related manipulations. Anesthesia of intact skin was previously impossible without prior painful anesthetic injection. Today, other ways of administering anesthetics are used as alternatives: oral, in enemas or suppositories, locally as sprays, ointments, or by application. To address the pain associated with invasive procedures, the effectiveness of a 5% local anesthetic cream based on a water-oil emulsion of lidocaine and prilocaine (1:1), which has good absorption properties, has been studied. Using local anesthesia can prevent and/or reduce the risk of pain-induced stress. Considering the results of these studies, the use of a local combined anesthetic containing 2.5% lidocaine and 2.5% prilocaine may be suggested.
On average, of the 57 million (currently more) annual deaths worldwide, more than 25% are directly related to infectious diseases. Of these, more than 90% are epidemics of respiratory viral diseases, including variants of influenza and a new coronavirus infection, as well as HIV/AIDS, gastrointestinal diseases, tuberculosis, malaria, measles, and associated bacterial complications. Of particular importance in the prevention and treatment of respiratory viral infections in at-risk groups is the use of plant preparations notable for their safety, absence of undesirable side effects and well studied in the treatment regimens of airborne diseases. The article focuses on an antiviral drug based on a liquid root extract of South African geranium Pilargonium sidoides (EPs® 7630) that meets these requirements. Antiviral activity of the drug was investigated and established in the model of different strains of influenza virus and other respiratory viral infections in cell cultures MDCK, Vero, A549, L 929 and human embryonic fibroblasts, as well as in vivo in a number of randomized clinical trials in children and adults with acute respiratory infections. In addition, EPs® 7630 has proven antiviral effect on the replication of a wide range of respiratory viruses, including influenza A virus (H1N1, H3N2, H5N1), respiratory syncytial virus (RSV), adenovirus, parainfluenza virus, rhinovirus, coxsackievirus and one of human coronaviruses. A review of randomized multicenter placebo-controlled double-blind clinical trials conducted in different years in different countries on the effectiveness of EPs® 7630 is presented. Taking into account the results of efficacy trials in the prevention and treatment of viral respiratory diseases conducted in different years, EPs® 7630 is deservedly included in international and Russian recommendations. It is preferred as a universal agent for antiviral therapy and prevention of a wide range of respiratory diseases in children and adults.
DIFFICULT DIAGNOSIS
This review article provides an up-to-date understanding of primary ciliary dyskinesia (immotile-cilia syndrome) and its particular variant, Cartagener syndrome, a genetically determined pathology leading to chronic inflammatory lesions of the respiratory tract, hearing organs, and impaired fertile function. This orphan disease is not well known to the general medical community. Primary ciliary dyskinesia is a rare hereditary disease of the group of ciliopathies that is based on a genetically determined defect in the ultrastructure of the cilia of the respiratory tract epithelium and similar structures, leading to impaired motor function. Various step-by-step algorithms have been proposed to verify the diagnosis, the obligatory components of which are assessment of the motor ability of the cilia of the atopic epithelium, nasal nitric oxide (nNO) level, electron microscopic examination of a bronchial mucosal biopsy specimen, and genetic examination. There is no gold standard for diagnosis of primary ciliary dyskinesia. Diagnostic search in patients should be complex and consist of certain stages. Currently, therapeutic strategies for primary ciliary dyskinesia are based on approved clinical guidelines. In many countries, the therapy of patients with primary ciliary dyskinesia is based on treatment protocols for patients with cystic fibrosis, despite the obvious differences in these diseases. The main goal of therapy is adequate airway clearance, control and prevention of infectious diseases, and elimination of potential airway exposure to various types of pollutants, including tobacco smoke. The article describes the clinic, characteristic symptoms of the disease, its prevalence and genetic aspects, discusses the problems of diagnosis, treatment, prognosis and monitoring of these children, as well as the need for a national register of patients with this pathology.
Introduction. Ultrasound scanning is one of the main methods of instrumental examination of patients after allogenic transplantation of kidney. The main reasons of dysfunction of the kidney transplant in long post-transplantation term are acute or chronic rejection, as well as acute and chronic nephrotoxicity of calcineurin inhibitors.
Objective. Assessment of dopplerographic indicators of the blood flow throughout the transplanted kidney vessels in patients with preserved nitrogen excretion function under various morphological changes.
Materials and methods. The study includes an analysis of the medical history of 98 children with end-stage chronic renal failure who underwent 98 allogeneic kidney transplants from a posthumous donor. There were analyzed the results of 185 percutaneous puncture biopsies and ultrasound studies of renal transplants. The analyzed data of morphological studies are divided into 4 groups. 1st group – there are no morphological changes affecting graft function. 2nd group – morphological signs of calcineurin toxicity. 3rd group – borderline damage of the graft. 4th group – acute and chronic graft rejection.
Results and discussion. Indices of resistance and pulsation measured at the level of the renal artery and interlobular arteries tended to decrease in the kidneys with immunological influence and remained stable in other morphological groups. This means that, the higher the degree of hyalinosis of the arteries, the lower the indices of resistance and pulsation indices measured at the level of the common renal artery and interlobular arteries.
Conclusions. The revealed tendency of a decrease in the values of the resistance index and the pulsation index at the level of the common renal artery of the interlobular arteries can be considered as one of the initial ultrasound signs that allow to speak of a decrease in the elasticity of the vascular wall. Normal indices of renal hemodynamics do not exclude the presence of pathological processes leading to graft dysfunction.
ISSN 2658-5790 (Online)
