Introduction. Practical assistance of medical personnel to nursing women with difficulties in breastfeeding, joint search for solutions to the problem of hypogalactia contributes to the preservation of breastfeeding throughout the first year of a baby’s life.

Purpose of the study. The frequency and nature of lactation disorders in women in the first weeks and months of breastfeeding were studied.

Materials and methods. The attitude of women to various, including non-drug, methods of maintaining lactation was analyzed. The study was conducted following a survey of 58 women – patients of the perinatal center in the early postpartum period, 28 women whose children received breastfeeding/mixed feeding in the 1st year of life and 16 female employees of neonatological departments, whose children were also breastfed/mixed feeding in the 1st year of life. With women in groups 1 and 2 in the obstetric facility, there were talks about the benefits of breastfeeding and instructions on how to properly latch on the newborn to the breast. The respondents participated in the study only voluntarily.

Results and discussion. Revealed approximately the same nature of lactation disorders in all groups. The predominance of women with hypogalactia after preterm birth was noted; breastfeeding up to one and a half to two years was observed in 4% of young women without chronic somatic pathology after the first spontaneous birth. Respondents of groups 1 and 3 showed high awareness and greater adherence to non-drug correction of hypogalactia in the form of the use of herbal tea. At the same time, some of the respondents in group 2 showed low motivation to maintain breastfeeding and were skeptical about any way to maintain lactation. Among the surveyed respondents, 47% (48 women out of 102) used herbal tea for a long time (3–6 weeks or more). All of them characterized as an effective lactogonic agent, and also noted a calmer behavior of the child, a decrease in intestinal colic and an improvement in the quality of night sleep.

Conclusions. A data analysis of the survey of nursing mothers and women who had a breastfeeding experience showed that there is approximately the same pattern of lactation disorders regardless of the woman’s age, high or low awareness of breastfeeding issues.

Introduction. Improving the treatment of premature infants is one of the priorities in the development of perinatal care for children in Russia. The widespread introduction of modern high-tech methods of resuscitation of premature children has shown its effectiveness in improving their survival. However this has led to an increase in various health disorders. Therefore, it is extremely important to determine and practically use effective technologies of medical care that will not only save the lives of children born prematurely, but also significantly affect their health indicators in subsequent age periods.

Purpose of the study. To study the influence of various physical rehabilitation programs on the development of adaptive reactions and correction of impaired sensorimotor functions in early postnatal ontogenesis in premature infants.

Materials and methods. A comprehensive study of 120 infants in the first year of life was carried out, including functional testing, anthropometric, general clinical and physiological methods for the development and assessment of the impact of physical rehabilitation programs of different volume and content on sensorimotor development and the state of adaptive capabilities of the body of premature infants in the first year of life.

Results. The maximum effectiveness of rehabilitation measures for premature infants of the first year of life was noted only with a combination of sympathetic type of autonomic regulation of the heart rate and a program that included therapeutic exercises, massage, dry immersion and hydrokinesitherapy. In premature babies with a pronounced predominance of sympathetic regulation of the heart rhythm, the smallest rehabilitation programs are most appropriate.

Conclusions. When developing a physical rehabilitation program, it is necessary to take into account the state of the adaptive capabilities of the body of premature infants in the first year of life, which can be determined by the type of autonomic regulation of the heart rate.

Introduction. The use of  sisted reproductive technologies has had sufficient experience to reduce the risks associated with the technologies themselves. But pediatricians remain concerned about the health of children born from induced pregnancies because of the influence of the parents’ initial health on perinatal outcomes. Congenital malformations remain socially significant, the risk of which may be higher for children from induced pregnancy.

Objective: to evaluate the effect of initial parental health and the methods of assisted reproductive technology used on the formation of congenital malformations and minor anomalies in children from singleton induced pregnancies.

Materials and Methods. A retrospective cohort study was conducted using data on live-born children from singleton induced pregnancy born at the Avicenna Medical Center (Novosibirsk) over the period from 2007 to 2017 (n = 409). The reproductive, somatic, and infectious history of the parents and the methods of assisted reproductive technology used were assessed. Parental fertility treatment up to childbirth was performed in the same center, which ensured complete continuity of follow-up. Differences between the groups of children from SIP with and without congenital anomalies were determined using Pearson’s chi-squared test.

Results and discussion. We found that children with congenital malformations and minor anomalies were more often born as a result of subsequent pregnancies; thawed embryos transferred at the blastocyst stage were used in assisted reproductive technology programs (p < 0.05); exacerbations of herpes type 2 infection were diagnosed during the current pregnancy (p < 0.05). In the group of children with only CM, the parents had a longer history of infertility (8.3 ± 1.2) years; pregnancy was achieved by transferring fresh embryos at the blastocyst stage (in 68.2% of cases). In the group of children without congenital malformations and minor anomalies, the maternal infectious history was more severe: there were significantly more frequent cases of urogenital infections (p < 0.05) and exacerbations of herpes simplex virus type 1 during pregnancy (p < 0.05).

Conclusion. A set of measures aimed at an earlier solution of the infertility problem is necessary for the primary prevention of congenital abnormalities associated with the age and duration of parental infertility.

Breastfeeding is the gold standard of optimal nutrition and largely determines the health of the child not only at an early age, but also in subsequent periods of his life. Due to the optimal composition of breast milk, the child forms such features of lipid, carbohydrate, mineral and energy metabolism, which provide not only the best conditions for physical and intellectual development of the child, but also its social adaptation. Prolonged breastfeeding reduces the subsequent risk of developing socially significant diseases such as atherosclerosis, hypertension, obesity and type 2 diabetes mellitus. Since the 1970s, the World Health Organization (WHO) and the United Nations Children’s Emergency Fund (UNICEF) have been active in reviving the culture of breastfeeding. In 1989, they developed a joint declaration Protection, Promotion and Support of Breastfeeding Practices: the Special Role of Obstetric Services, which is based on Ten Principles of Successful Breastfeeding (training of medical personnel, antenatal preparation of pregnant women for breastfeeding, early breastfeeding in the delivery room, keeping mother and baby together and feeding a healthy baby on demand, helping mothers in difficult situations, exclusive breastfeeding, informing mothers about the dangers of pacifiers in initiating breastfeeding, follow-up assistance to mothers after discharge from the maternity hospital). The duration of exclusive breastfeeding (feeding only breast milk) is important for the health of the infant. According to the 2003 WHO recommendations, which are reflected in the Global Strategy for Infant and Young Child Feeding, exclusive breastfeeding should last 6 months. The national program for optimizing the feeding of children of the first year of life in the Russian Federation (2009, 2019) defines recommended periods of exclusive breastfeeding in the range of 4-6 months, and they depend on the health status of the infant. Modern industrially produced complementary foods are created taking into account the principles of healthy eating and contribute to the formation of proper nutritional behavior in children from an early age, which undoubtedly has a favorable effect on the child’s health in the future.

Introduction. The relevance of the problem of rhinosinusitis in different ages is due to their high prevalence. The article presents information with approaches of  the  treatment rhinosinusitis in  children, which allow preventing irreversible changes in the mucous membrane of the nasal cavity and paranasal sinuses. The importance of eliminating dysregulation in biological networks underlying the disease is noted. Such capabilities are possessed by means of bioregulatory medicine.

Aim of the study: To carry out a comparative analysis of the effectiveness of chronic rhinosinusitis treatment with Euphorbium compositum and conventional methods of therapy in children.

Materials and methods: We conducted retro- and prospective study in children’s polyclinic No. 1 and homeopathic center “Homeopathic medicine” in Samara. There were 66 children aged 7 to 12 years old diagnosed with chronic rhinosinusitis under observation. The children were observed in two groups for 2 years. Results. In chronic sinusitis within 2 weeks after the beginning of the course of therapy significant symptomatic improvement was registered in 75.8% of the patients receiving Euforbium compositum and in 71.3% of the patients receiving conventional medical therapy. During the clinical observations there was not a single case of adverse effects against the background of Euphorbium compositum therapy, the patients’ general condition and nasal breathing parameters reliably improved.

Results. Numerous scientific studies noted: the ability of nasal spray Euphorbium compositum to have a complex multi-target effect on the process of inflammation, on the state of nasal mucous membranes; safety and effectiveness.

Conclusions. Complex bioregulating action of Euphorbium compositum Nasentropfen C allows to control and optimize the course of chronic inflammatory process in rhinosinusitis. Its application promotes restoration of structure and function of nasal cavity mucosa, it is not accompanied by complications. These characteristics in combination with good tolerability make it possible to use the drug for treatment of rhinosinusitis.

Acute respiratory diseases are one of the most common reasons for visiting a doctor in pediatric practice. Most episodes of this pathology have a viral etiology, signs of inflammation from the upper respiratory tract and proceed with symptoms of acute rhinitis (acute nasopharyngitis). The most of episodes of acute rhinitis last no more than 10 days and end with the patient’s recovery. The most common complications of acute rhinitis in children are acute rhinosinusitis and acute otitis media. These diseases are often mild and rarely have complications. However, a large number of patients with acute respiratory diseases increases the likelihood of a situation in which the doctor will encounter a problem patient. The article proposes care pathways for practitioners to manage patients with acute rhinological symptoms lasting up to 10 days and from 10 days to 3 months. The care pathways are based on several key points. No1: each patient must be analyzed for the presence of alarming symptoms, upon detection of which the patient should be urgently hospitalized. No2: all patients should be dynamically observed by a doctor until complete recovery, the patient should not receive treatment without the supervision of a doctor. No3: the basis of treatment is drugs for symptomatic therapy, which are selected depending on the dominant symptom that has the greatest impact on the patient’s well-being. To eliminate nasal mucosal edema, it is rational to use nasal decongestants (original oxymetazoline) for children of all ages; the course and dosages are determined according to the age of the child. Antibacterial drugs should be prescribed strictly according to indications in the presence of convincing data for the bacterial etiology of the disease.

Introduction. Traditional antiallergic therapy for atopic dermatitis, including allergen elimination, therapeutic cosmetic skin care, external anti-inflammatory therapy and antihistamines, does not always lead to the desired result. On this basis, the search for new methods of treatment is urgent and promising

Aim. To study the clinical efficacy of a combination of Lactobacillus rhamnosus GG and prebiotics in children in the first years of life with atopic dermatitis (AD).

Materials and methods. The observed children were divided into 2 parts: 30 children aged from 1 month to 3 years old, patients with AD constituted the main group, it differed in that these patients were synbiotic (combination of Lactobacillus rhamnosus GG and prebiotics) – 1 sachet per day for 14 days. This drug was prescribed as part of complex therapy. The remaining 25 children with AD made up a comparison group, which was characterized by the fact that children received only antiallergic therapy without symbiotic. Clinical methods of blood pressure examination, laboratory instrumental and specific allergological methods were carried out.

Results and discussion. Against the background of the therapy in children with blood pressure in the main group, общий overall treatment effect was higher and amounted to 86.6 + 4.0%, and in the comparison group – 76.0 + 3.9%, p < 0.05. This was manifested in a decrease in the duration of the exacerbation period by 1.4 times, the prevalence of a high individual therapeutic effect by 1.5 times, a decrease in the SCORAD index by 4 times against the background of an increase in the number of bifidobacteria and lactobacilli in the intestine. The revealed clinical efficacy was noted against the background of an increase in the number of bifidobacteria and lactobacilli in the intestine.

Conclusions. The obtained results allow us to recommend a combination of Lactobacillus rhamnosus GG and prebiotics in children in the first years of life as part of complex therapy to increase the effectiveness of treatment.

The article is devoted to the discussion of the carbohydrate component of infant formula for feeding healthy and sick children. The role of glycemic and non-glycemic carbohydrates is shown. In addition to lactose, the following glycemic carbohydrates can be used in infant formulas: maltose, sucrose, glucose, glucose syrup, maltodextrins, pretreated starch and gelatinized starch. Resistant oligosaccharides, nonstarch polysaccharides, and resistant modified starches are also used in child nutrition. The composition and amount of lactose, the main carbohydrate of women’s milk, is discussed. The article presents data on the role of galactose, which is conditionally essential for children in the first months of life due to the rapid growth rate of the infant. Information is presented on the lactose breakdown, the importance of enzymes in the digestion and assimilation processes, the prebiotic effects of lactose, and its effect on the absorption of calcium and other minerals. Advantages of lactose include its low glycemic index, as well as its reduced sweetness, which affects the proper development of taste and low risk of dental caries compared to other fermentable sugars. Specific requirements for the carbohydrate composition of low-lactose and lactose-free formulas are discussed because of the often unwarranted increase in the frequency of their use. Evidence is presented using the Cochrane Systematic Review (2018) that reducing or eliminating lactose from infant formulas in infants with infantile colic is not always appropriate. Special low-lactose and lactose-free formulas replace lactose with glucose polymers such as maltodextrin, glucose syrup, and solid glucose syrup, which are produced by hydrolyzing starches (corn, rice, or potato). The article discusses the data on the effect of maltodextrin on the state of the intestinal mucosa, the microbiota of the large intestine and the possible role of this ingredient in the pathogenesis of chronic inflammatory bowel diseases. The results of various studies regarding the effect of maltodextrin on the intestinal microbiota are contradictory. However, special low-lactose or lactose-free products are prescribed in the presence of symptoms of lactase deficiency in an artificially fed baby. It is a major mistake to prescribe lactose-free mixtures on the basis of intact protein or partially hydrolysed ones for secondary lactase deficiency caused by an allergy to cow’s milk proteins. The carbohydrate component of Friso therapeutic hydrolysates contains no maltodextrin, and lactose is partially or completely replaced with glucose syrup.

Abstract Introduction. Protein-induced enteropathy is one of the common manifestations of gastrointestinal food allergy in young children. The search of non-invasive methods for intestine estimation is especially relevant for early diagnosis and timely prevention of exacerbation.

The aim of the study was to determine the serum and urinal levels of the intestinal fraction of the protein binding fatty acids in children with protein-induced enteropathy and to evaluate their clinical and diagnostic significance.

Materials and methods. It was examined 36 children with protein-induced enteropathy aged 1.5 months to 1 year and 20 healthy children (control group). All patients underwent esophagogastroenteroscopy with morphological examination of biopsy specimens for differential diagnosis with congenital gastrointestinal diseases. The Cow’s Milk-related Symptom Score (CoMMiS) was used to evaluate clinical symptoms. The intestinal fraction of a fatty acid binding protein was determined for all children in blood serum, urine by enzyme- linked immunosorbent analysis.

Results. It was found the increase its serum level (125.20 ± 23.79 pg / ml), and urinal level (0.164 ± 0.031 pkg / ml) compared with the control group (19.21 ± 4.94 pg / ml, 00.039 ± 4.62 pkg / ml, respectively, p < 0.05). There were found direct strong correlations between the severity of gastrointestinal manifestations and its serum and urine level (p < 0.05).

Discussion. Epithelial barrier damage provides an increased penetration of intact food allergens. It plays a key role in allergic sensitization, and it is the first pathogenetic link of allergic inflammation in most cases. A statistically significant I-FABP increased level in all studied biological fluids correlates with morphological changes in the children with protein-induced enteropathy, as well as with clinical symptoms of gastrointestinal tract lesions. That confirms its high informational value for an indirect assessment of the state of the intestinal barrier.

Conclusions. Thus, an increase in serum and urinal I-FABP levels in children with protein-induced enteropathy confirms the clinical and diagnostic significance of determining this biomarker in all biological fluids. Its high sensitivity and specificity of determination in urine are promising for use in pediatric practice.

The main high-risk group for a diagnosis of bronchial asthma (BA) are children with recurrent obstructive bronchitis, complicated by a widespread form of acute respiratory viral infections. Basic therapy of BA is aimed at suppressing inflammation of the bronchial wall. In addition to inhaled glucocorticosteroids, the antileukotriene drug montelukast has a proven anti-inflammatory effect. This article discusses published work on the effect of montelukast on inflammation biomarkers in real clinical practice and remodeling of the bronchial wall in the experiment. A comparative study of the clinical efficacy of an antileukotriene drug and inhaled glucocorticosteroids in patients of different age groups and asthma phenotypes is presented. The use of montelukast in children at high risk of developing BA, with an indication for allergic rhinitis, is discussed. Presented current information on the risk of psychiatric AE against the background of using an antileukotriene drug. Literature review is illustrated by our own observation: a cohort of 127 patients was formed on the basis of the dispensary group of the City Allergy Cabinet of the Children’s City Polyclinic No. 44 in St. Petersburg in 2018, a prospective observation was conducted, which lasted 2 years. The inclusion criteria were age of 5 years to 5 years 11 months (5 ± 0.5 years) and an established diagnosis of mild BA. The patients were followed up for 2 years with evaluation of the change of basic therapy, control of the disease and functional indices achieved with therapy with the original drug montelukast. This observation showed high clinical efficacy of montelukast monotherapy in the group of preschool-age patients, which was expressed by a significant proportion of patients who had no exacerbations of BA for a year, a high score on the Asthma Control Test, statistically insignificant increase in forсed expiratory volume in 1 second after bronchodilator. Today Montelukast is a safe, effective and widely prescribed component of therapeutic regimen in patients with varying degrees of severity of bronchial asthma over the age of 2 years.

Preventive vaccination is currently the most affordable and economical way to reduce morbidity and mortality from many infections, improve quality and human life expectancy with an almost ideal balance of benefits and risks among all medical procedures. The article deals with the reasons for variability of the immune response caused by vaccines, between individuals and between populations, which is of fundamental importance for human health. The authors have presented data indicating a key role of the gut microbiota in the control of the immune response to vaccination. Particular attention is paid to the microbial diversity in different loci of the body. The role of microorganisms in the proper functioning of the body and the formation of a number of pathological conditions is described. Most modern vaccines are live-attenuated, killed / inactivated or subunit (recombinant) vaccines, and they are designed for the parenteral route of administration. Most of these vaccines elicit a weak immune response, especially in the mucous membranes, due to the route of administration and are associated with weak cell-mediated immunity. Therefore, mechanisms that can enhance virus-specific vaccine immunity in infants and children are required, such as the use of more potent or selective immunity-enhancing adjuvants. Some probiotic strains may be considered as promising vaccine adjuvants. This article evaluates the recent clinical studies of probiotics used to enhance vaccine-specific immunity in adults and infants. The present-day knowledge on the role of the probiotic strain Lactobacillus rhamnosus GG with the aim of activating immunity after vaccination are presented.

This article provides an overview of current views on the problem of allergic rhinitis (AR) in children. Modern data on the epidemiology of AR and the main comorbid conditions are highlighted. It has been noted that adolescence is the peak incidence of AR. Despite the similar clinical manifestations of AR in adolescent children, it should be borne in mind that patients in this age group represent a unique population with needs and perceptions of problems that are different from those of adults and young children. Mental perception of the symptoms of the disease is more often more pronounced in adolescents than in other age groups. This manifests itself in a large negative impact on both sleep and rest patterns, as well as on learning activity and exam results. The work of a doctor with patients of this age group requires the most rationalized approach. Based on the data of the latest consensus documents, the role of I and II generation antihistamines, intranasal antihistamines and intranasal glucocorticosteroids was assessed. The possibilities of symptomatic therapy of symptomatic moderate and severe AR with the help of nasal sprays based on a fixed combination of intranasal glucocorticosteroids and antihistamines have been evaluated in more detail. The available data from clinical studies of the use of a nasal spray based on a fixed combination of mometasone furoate and olopatadine are reviewed. Based on the above material, it was concluded that nasal sprays of a fixed combination of mometasone furoate and olopatadine are effective means of starting therapy for moderate to severe seasonal and perennial AR in children over 12 years of age. Such combination drugs can reduce the severity of AR symptoms with a relatively low risk of developing adverse events.

Abstract Introduction. Considering the development of technologies and techniques, it is highly relevant today to continue studying the features of interaction of drugs developed and introduced into clinical practice in the 1960s and 1980s with the elements of the immune system located in the mucosa, since many of these drugs have local dosage forms. One such drug is benzidamine hydrochloride, registered as a nonsteroidal anti-inflammatory drug with extended pharmacodynamic properties.

Objective. To evaluate the effect of benzidamine hydrochloride preparation on the cells of innate and acquired immunity located in the mucosa in an in vitro model.

Materials and Methods. Cell fractions of neutrophils isolated from patients with infectious inflammation were used in the study. Sterile isolated neutrophils from the venous blood of patients were transferred into RPMI-1640 medium, where the investigated pharmacological drug was added, and incubation with cells was performed. Fluorescence microscopy was used to detect and count neutrophil extracellular traps. Cell fractions of lymphocytes isolated from patients with infectious inflammation were also used in the study. A commercial drug containing benzidamine hydrochloride, Tantum Verde (Angelini Pharma S.p.a., Italy), was used in the study.

Results and discussion. Benzidamine causes significant inhibition of neutrophil extracellular trap formation. This suggests that at the beginning of application the drug enhances the antimicrobial response of the body, and then as the concentration decreases it demonstrates classic anti-inflammatory properties. The drug also enhances the neutrophil extracellular trap structure. The total number of B-lymphocytes tends to normalize under the effect of benzidamine. These data allow us to conclude about the ability of the drug to attenuate the severity of the inflammatory process, apparently by inhibiting the action of inflammatory cytokines.

Conclusion. In the course of the in vitro study it was shown that benzidamine hydrochloride (Tantum Verde) has immunomodulatory properties against innate immunity cells – neutrophils, and its anti-inflammatory properties against adaptive immunity cells – lymphocytes – were confirmed.

Abstract Introduction. Anorectal malformations are one of the most numerous groups of proctologic pathology in children. The incidence is 1 per 5,000 live births. Perineal ultrasound, distal colostography, and MRI of the pelvic organs and sacrococcygeal region are used to clarify the anatomico-topographic features of the malformation and identify concomitant malformations (presacral masses, distal spinal cord pathology). This article presents a clinical case of surgical treatment of an 11-year-old girl who underwent primary surgery for anorectal malformation with rectovestibular fistula in infancy. In the postoperative period for 10 years, the parents practically did not carry out rehabilitation therapy. These factors led to persistent decompensation of the lower intestine in the form of a giant megarectum, which required repeated anorectoplasty with resection of pathologically dilated parts of the intestinal tube. The article presents description of the repeated surgery with intraoperative electromyoidentification of the perineal muscles, data of follow-up 9 months after the repeated anorectoplasty with instrumental diagnostic methods (irrigography, functional study of the closing apparatus of the rectum).

Discussion. This clinical observation illustrates complications following surgical treatment of anorectal malformation with rectovestibular fistula. Lack of intraoperative electromyoidentification of the muscles during primary anorectoplasty often resulted in ectopia of the neoanus relative to the center of the perineal muscle center. This circumstance was one of the causes of persistent chronic constipation in the postoperative period.

Conclusion. The use of electromyostimulation during primary proctoplasty for reliable determination of the sphincter-levator complex topography is mandatory. Long sequential rehabilitation in the postoperative period including neoanus bougienage, provision of regular full defecation, physiotherapeutic treatment, as well as regular follow-up examination in the in-patient department is also an integral part of the treatment.

Abstract Introduction. Hypertrophic cardiomyopathy is one of the most common diseases of the myocardium in children. Meanwhile, the relationship between indicators of strain and electrocardiographic changes, their diagnostic significance for children with hypertrophic cardiomyopathy remains an insufficiently well-studied issue.

Purpose. Тo analyze the relationship between indicators of strain of the left ventricular and ECG in children with hypertrophic cardiomyopathy (HCM).

Materials and methods. Have been examined 61 patients with an asymmetric form of hypertrophic cardiomyopathy aged from 7 to 17 years. Of these, 45 (73.8%) children with nonobstructive form, 16 (26.2%) children with obstructive form. Electrocardiography (ECG) and 24-hour Holter monitoring ECG had performed. The parameters of global longitudinal, radial and circular of the left ventricular myocardial strain and their rates had determined by echocardiography in the 2D speckle tracking mode

Results. In children with HCM, ECG signs of hypertrophy were studied (deviation of the electrical axis to the left, the predominance of the R wave in lead I, V6 over the S wave, the predominance of the S wave in lead V1 over the R wave) and myocardial ischemia (inversion of the T wave and a decrease in the ST segment in the leads I, II, V5, V6), rhythm and conduction disorders (ventricular extrasystole, degree I atrioventricular block, expansion of the QRS complex in leads V1-V3, incomplete blockade of the anterior left branch of the His bundle, increased duration of terminal activation), which significantly prevailed in obstructive form versus non-obstructive form. A decrease in the global longitudinal, radial, circular strain of the left ventricular myocardium and their rates had found, which had significantly more pronounced in the group with obstructive HCM. Inverse correlations had found between the parameters of strain and ECG-signs of hypertrophy and myocardial ischemia, conduction disorders, more pronounced between the parameters of longitudinal strain and ECG with a significant predominance in the obstructive form of the disease.

Conclusions. In children with obstructive HCM, compared with the non-obstructive form, there have significantly more pronounced signs of myocardial hypertrophy and ischemia, rhythm and conduction disorders on the ECG and with 24-hour Holter monitoring ECG.

Abstract Introduction. Celiac disease, or gluten-sensitive enteropathy, can be defined as a persistent intolerance of wheat gliadins and other cereal prolamines in the small intestinal mucosa of genetically susceptible individuals. The clinical picture of the disease can often be misleading because it varies greatly from patient to patient, resulting in delayed diagnosis.To analyze the clinical case of a child with celiac disease and acquired ichthyosis.

Results. The disease, until a final diagnosis was established, had a severe course due to gastrointestinal and dermatological disorders. From the age of 1.5 years, the child had frequent diarrhea, bloating, which is why she was repeatedly hospitalized in the hospital at the place of residence. However, there was no effect from the ongoing therapeutic measures, and other symptoms such as vomiting, peripheral edema, deficiency of height and weight, and severe peeling of the skin joined in. The diagnosis was finally confirmed at the age of 2.5 years after the test for antibodies to tissue transglutaminase IgA (fifty-fold excess relative to the norm). A genetic study revealed alleles of genes responsible for predisposition to celiac disease. The results of a biopsy of the mucous membrane of the duodenum had signs of atrophy, lymphoid infiltration, corresponding to a lesion of the small intestine according to the classification Marsh III. Microscopic examination of the skin – hyperkeratosis with a decrease in the granular layer. On the basis of the obtained data, the diagnosis was made: Celiac disease, active phase, severe course, complicated by proteinenergy insufficiency severe degree, exudative enteropathy syndrome, 2 degree anemia, concomitant diagnosis: acquired ichthyosis. The girl was prescribed a gluten-free diet, and symptomatic drug therapy was carried out. In dynamics, the condition has improved. After 6 months, at the second visit, gastrointestinal and skin symptoms were absent, physical development was age-appropriate.

Conclusions. The classic form of celiac disease usually manifests itself with several major symptoms, such as diarrhea, abdominal pain, weight loss, and nutritional deficiencies. In this article we wanted to talk about a rare combination of celiac disease with ichthyosis, therefore, practitioners should be wary of a combination of skin and gastrointestinal symptoms.

Takayasu’s arteritis is a chronic granulomatous arteritis with predominant involvement of the aorta and its main branches. It occurs both in youth and childhood, manifests between the ages of 10 and 30 years, female patients predominate. This article presents a clinical case of Takayasu’s arteritis in a child with prolonged fever. Clinical case. A 10-year-old girl E. was hospitalized with complaints of febrile fever episodes during the last two months; weakness and back pain were also noted.  Observed by an endocrinologist since 2015 with a diagnosis of Stunted growth. Delayed physical development. Diffuse changes of the thyroid gland, euthyroidism. Since 2020 has been observed with the diagnosis Constitutional immaturity. A tendency toward constipation was noted. Observed by an allergist with atopic dermatitis, food and respiratory allergies were diagnosed. By the time of hospitalization, the girl had been ill for two months. During this period, four episodes of fever with scanty catarrhal manifestations were recorded. The diagnostic search went in different directions, infectious, systemic and oncological diseases were excluded. The echographic pattern was typical and highly specific for Takayasu’s arteritis. Additional examination also revealed changes in the celiac trunk in the form of narrowing of its lumen. Clinical diagnosis «Non-specific aortoarteritis, type III, acute phase, stenotic variant, grade 1–3 activity with lesions of the right and left common carotid arteries and the celiac trunk» was made as a result of clinical, laboratory and instrumental examination. This clinical observation demonstrates the difficulty in making a diagnosis due to the variety of clinical forms and the absence of specific disease markers. It takes on average a year and a half from disease debut to clinical diagnosis of the patient. However, lack of therapy over a long period can be crucial for an adverse outcome of the disease.

Urinary tract infections are a common global problem among physicians of various specialties, including therapists, pediatricians, nephrologists and urologists. Today UTI is one of  the  leading bacterial infections in  both adult and child populations. The main type of therapy and prevention of recurrent UTI is the use of drugs with an antibacterial effect (antibiotics, uroseptics). An urgent problem in modern medical practice is the increasing antibiotic resistance, which requires the development of new approaches to therapy and prevention, including UTI. In recent years, special attention has been paid to the study of vitamin D receptor (VDR) gene polymorphisms as a possible risk factor determining the predisposition to a number of infectious and noninfectious diseases. More than 200 polymorphisms of the VDR gene have been identified, four of which – FokI, BsmI, ApaI, and TaqI – are particularly common. Different VDR alleles can cause small changes in receptor function, which can affect resistance or susceptibility to a particular infection. The review presents data from modern studies demonstrating the relationship between vitamin D supply and development, the frequency of recurrence and the nature of the course of UTI. In one study, vitamin D has been shown to enhance the cathelicidin-mediated antibacterial action of bladder epithelial cells. It also demonstrated the currently known defense mechanisms of vitamin D against urinary tract infections, including its effect on components of the innate immune system.

On the basis of the analysis of foreign and Russian scientific studies the current data on the role of the intestinal microbiota in the formation of immunity and changes in its qualitative composition in the formation of various diseases are presented: For example, a decrease or absence of Helicobacter pylori is associated with bronchial asthma and reflux esophagitis in childhood, a change in Firmicutes/Actinobacteria ratio in psoriasis, and Bacteroidetes/Firmicutes ratio in the gastrointestinal tract in obesity, inflammatory bowel diseases are accompanied by an increase in Enterobacteriaceae, functional disorders of the gastrointestinal tract by a growth of Veillonella bacteria. The article shows the mechanisms of influence of the microbiota of the gastrointestinal and respiratory tracts on reducing the frequency of repeated infections by induction of antiviral defense genes, which in studies of probiotic therapy is confirmed by significant clinical effects. A discussion of the benefits of multistrain probiotics with comprehensive effects on the intestinal microbiota is provided. The importance of including probiotic strains in the complex therapy of acute respiratory infections is confirmed by the studies proving their positive effect on the child’s immunity, reducing the severity of the disease and the frequency of complications and relapses. The results of modern scientific research prove the importance of the optimal ratio of probiotic strains in the combination of lactoand bifidobacteria, as well as their strain specificity. The article presents information on a synbiotic created using an innovative protective technology of each sachet microgranule including a combination of 9 probiotic strains of lactoand bifidobacteria. The presence of fructooligosaccharide in the prebiotic component enhances the effect of the probiotic component.

Introduction. The relatively young science of pediatric cardiology has made enormous breakthroughs in recent years: the labor intensity and complexity of modern diagnostic techniques have increased, and interventional methods of treatment are widely used. Modern pediatric cardiology covers a wide range of diseases: from intrauterine pathology, such as congenital heart and vascular defects, fibroelastosis, various arrhythmias, to acquired diseases represented by arterial hyperand hypotension, systemic vasculitis, autonomic dysfunction, juvenile rheumatoid arthritis.

Purpose. To demonstrate the important stages of the development of the children’s cardiological service in Grodno region over a sixty-year period, assess its current state and analyze the dynamics of the incidence rate of children’s heart and vascular diseases during 2005–2019 in this region.

Material and methods. During the period of 1960–2019 a retrospective research was carried out using the statistics: report of the chief substitute pediatric cardiologist, report of medical treatment for children during 2005–2019, analytical and conjunctral reports, reviews and references of chief doctors and local pediatricians.

Results and discussion. The sixty-years of activity of the children’s cardiological service in Grodno region were analyzed. It was found that over the past 15 years there has been an annual increase in the overall incidence of diseases of the circulatory system (classes I00-I99 ICD 10), while the primary incidence decreased from 331.06 to 265.63 per 100,000 of the child population. The overall incidence of congenital heart defects over the past 15 years was characterized by a low decrease from 916.40 to 800.16 cases against the stabilization of the primary incidence rate.

Conclusion. The obtained results indicate the well-organized work of the diagnostic, hospital, dispensary and prophylactic stages of medical assistance to children with cardiovascular pathology.

Obesity is one of the socially significant diseases of our time and is a generally recognized risk factor for the development of carbohydrate metabolism disorders, including type 2 diabetes mellitus (DM), the prevalence of which in the pediatric population is rapidly increasing.

Aim of the study. To demonstrate the most frequent types of carbohydrate metabolism disorders in children and adolescents with obesity.

Materials and methods. 123 obese patients under 18 years old were examined and the structure of obesity complications was analyzed.

Results. Carbohydrate metabolism disorders were identified in 24 patients (19%): impaired fasting glycemia (IFG) (8 girls, 6 boys (11%)), type 2 DM (6 girls, 3 boys (7%)), and type 1 DM (1 boy (1%)). Descriptions of 4 clinical cases are given: 1) patient, 17 years old, with constitutional-exogenous obesity of 3rd degree, arterial hypertension (AH), dyslipidemia and nonalcoholic fatty liver disease (NAFLD) and a history of transient IFG; 2) patient, 16 years old, with morbid obesity, NAFLD, AH, polycystic ovarian syndrome (PCOS), type 2 DM, compensated on metformin therapy; 3) patient, 17 years old, with constitutional-exogenous obesity of the 3rd degree, AH, dyslipidemia, NAFLD, type 2 DM (on insulin pump therapy), complicated by diabetic nephropathy and diabetic polyneuropathy; 4) patient, 12 years old, with type 1 DM, manifested against the background of obesity.

Conclusion. When screening for obesity complications in children and adolescents, carbohydrate metabolism disorders may be detected in one in five patients. Prediabetes in childhood can be transient. When a child with obesity is identified, differential diagnosis of type 1 and type 2 DM should be made. It is necessary to teach patients with type 2 DM the skills of self-monitoring on a par with patients with type 1 DM and motivate them to control glycemia regularly at home.

The use of recombinant tuberculosis allergen (ATR) expands the possibilities of detecting tuberculosis. Nevertheless, the issue of the predictive value of the ATR test for assessing the result of tuberculosis therapy remains insufficiently studied.

Purpose. Тo clarify the information content of changes in the results of a test with a recombinant tuberculosis allergen against the background of chemotherapy for tuberculosis in children.

Materials and methods. We used the data of patients with active tuberculosis aged 0 to 14 years who were hospitalized. The main group in the study (1^st) included 280 children with a pronounced reaction to ATR, the comparison group (2^nd) consisted of 42 children with a moderate, mild and doubtful reaction to ATP at the time of tuberculosis detection.

Results. After 6 months from the beginning of the intensive phase of tuberculosis treatment, a hyperergic reaction to the administration of ATR was diagnosed in 74 (38.7%) children of the 1^st group and 4 (16.7%) children of the 2nd group (p = 0.025). A twofold decrease in the sample size was observed in children of the 1st group (121 children – 63.4%) than the 2^nd (7 children – 29.2%) (χ² = 8.97, p = 0.003; OR = 4.198; 95% CI 1.66–10.62). The increase in the sample is 2.9 times higher in children of the 2nd group (44 children – 23%) than in children of the 1st (χ² = 20.17, p = 0.000).

Conclusions. The extinction of sensitivity to the ATR test after specific therapy is 2 times higher in children who initially had a pronounced reaction. In the same group, a hyperergic reaction to the sample often persists or occurs after the intensive phase of anti-tuberculosis therapy.

Today, as in ancient times, diarrhea (loss of water and electrolytes along with stool) accompanies many pathological conditions in humans. The pathophysiology of various types of diarrhea has been studied, which made it possible to optimize therapeutic approaches and save the lives of many people. The most dangerous conditions occur in young patients with osmotic and exudative types of diarrhea, as they result in exicosis within a short time. In arriving at a diagnosis, rehydration therapy should be started as soon as possible. The article presents the historical aspects associated with the global pandemics of cholera. The history of the creation of solutions for intravenous and oral rehydration is covered. The authors presented tables for calculating fluid losses and the required volume of solutions for oral or parenteral administration. The modern requirements for rehydration solutions and the principles of rehydration in children are presented. Oral rehydration is particularly problematic for young children due to the limited range of drugs and requirements for the composition of solutions used in pediatrics. According to the recommendations of the World Health Organization and ESPGHAN, clinical recommendations of the Russian Federation, low-osmolar solutions should be used. When complex solutions containing probiotic and zinc are used, the therapy compliance increases. A rehydration solution, which contains a weighted amount of salt for the preparation of a low-osmolar solution, as well as the probiotic L. reuteri DSM 17938 at least 1 billion of viable bacteria and zinc sulphate 0.004 g is one of the latest solutions. The results of studies of this solution are provided.

The novel coronavirus disease (COVID-19) pandemic has become a strength test for the national healthcare systems and medical professional communities. The pandemic gave a revealing insight into the provision of resuscitation care, a shortage of personnel and protective equipment, and the lack of effective drugs to treat a novel, poorly studied infection. Objective. To identify the attitude towards immunoprophylaxis in general and against the coronavirus infection (COVID-19) in particular among medical students and pediatricians and to assess the dynamics of compliance to vaccination in these groups. Materials and methods. The survey was conducted among the 5-6-year students of the medical and pediatric faculties of the Ryazan State Medical University (RSMU) of the Ministry of Health of Russia in 2017 and 2021, the groups of students included 250 and 225 people, respectively. The children’s polyclinic pediatrician groups included 45 and 60 people in 2017 and 2021, respectively. The survey was conducted anonymously, face-to-face, and without compulsion. The identical questionnaires asked students 13 questions and pediatricians 10 questions with suggested response options. Results and discussion. The percentage of students who correctly named the number of vaccine preventable diseases in the National Immunisation Schedule has significantly decreased; the number of students who were not aware of the availability of the chickenpox vaccine has increased by 1.9 times. In 2021, the number of students giving priority to domestic vaccines decreased by 2.3 times, and the number of those choosing imported drugs as better and safer ones has increased by 1.5 times. In 2021, the number of senior students who were vaccinated against influenza doubled as compared to 2017. At the same time, the students agreed to recommend their patients to be vaccinated against influenza 1.4 times more often.  During the 2021 pediatrician survey, the number of respondents, who preferred imported vaccines as better and safer ones, increased by 4 times, and the number of domestic vaccine advocates decreased by 1.8 times. In addition, the number of pediatricians who did not decide on this issue has increased by 9.8 times. Сonclusion. The results of the survey showed that there is still a lack of compliance to vaccine prophylaxis in certain groups of the professional medical community. The student cohort showed a decrease in knowledge and confidence in the vaccine prophylaxis. Among practitioners, there has been a positive trend towards an increase in the percentage of pediatricians, who considered it expedient to vaccinate children with chronic pathology.

Nowadays pharmacological group classified by the ATX L03AX code as immunostimulants is demand among doctors of various specialties. The main area of application of such drugs is infectious respiratory viral processes, which are associated not only with the pathogenetic action of viruses, but also with a high risk of bacterial complications. Thus, the practitioner is faced with the task of preventing such complications and choosing an immunomodulatory drug with the most pronounced pharmacodynamic properties in this regard. In Russia, there are many drugs belonging to the group of immunomodulators with different mechanisms of action and end pharmacological and immunological points of application. The emphasis of the mechanisms of action of such drugs is made on the effect on the systems of both innate and adaptive immunity. At the same time, the severity of the effect on both one and the other immune system in drugs that is strong enough may differ, which requires special attention from the doctor when choosing a drug in a particular situation. A special place in the group of immunomodulatory drugs used for infectious respiratory diseases is occupied by interferoncontaining drugs that contain interferon alfa-2b (IFN-a2b). In addition, there are combination of IFN-a2b with an immunoglobulin complex, which increases the effectiveness of this drug in the treatment of various infectious and inflammatory diseases. The article describes the theoretical and practical aspects of administration this combined drug in pediatric practice and presents own experimental studies.

Introduction. At the present time the expansion of the spectrum of urgent diseases of the abdominal cavity organs is registered due to the patients with complications of foreign bodies of the gastrointestinal tract. Development of rational treatment-diag nostic algorithm will promote to improve the results of surgical treatment of children with complications of foreign bodies of gastrointestinal tract.

Aim. To determine the efficacy of laparoscopic techniques in children with complications of foreign bodies of the gastrointestinal tract..

Materials and methods. 38 children with foreign bodies of the gastrointestinal tract of different characteristics, which required surgical treatment, were included in the study.

Results and discussion. On the basis of analysis of clinical and medical history data, results of instrumental methods of preoperative diagnostics and laparoscopy three clinical stages of the disease were distinguished. Statistically reliable differences of the presented indicators in different terms of the disease were proved. Surgical intervention involved laparoscopy, during which the volume of surgical intervention was specified. Laparoscopic techniques were effective in the groups of patients with I, II and III stages of the disease in 100, 46 and 20% of observations, respectively.

Conclusions. Clinical manifestations in complications of foreign bodies of the gastrointestinal tract are determined by the characteristics of the latter and the clinical stage of the disease. Laparoscopic techniques can be effective at initial stages of the disease. At a complicated course of the disease the required volume of surgical intervention can be performed during laparotomy. The variety of clinical manifestations of foreign bodies of the gastrointestinal tract complications is determined by the characteristics of the damaging agents and the clinical stage of the disease. Laparoscopic techniques of surgical treatment may be a priority in the absence of a complicated course of the disease; in late stages of the disease laparotomy is the operation of choice.

Conclusion. Analysis of treatment results of children with complications of FBs of GIT revealed statistically significant differences in some clinical and anamnestic data, results of instrumental methods of preoperative diagnosis and intraoperative manifestations, which allowed us to define three clinical stages of the disease.

Congenital hyperinsulinism causes irreversible damage to the cerebral cortex with subsequent disability in children. The article presents the features of etiopathogenesis, clinical picture of the disease. The histological variants of pancreatic lesions are analyzed in detail. The principles of correct diagnosis are formulated. A new in Russia method for the preoperative determination of the histological form of the disease, which is carried out at the y, Almazov National Medical Research Centre since 2017, – PET/ CT with 18F-DOPA, explained the biochemical basis of its clinical application and the examination technique. The principles of the selection of drug therapy with possible complications, the need for an adequate assessment of its effectiveness are described. If it is impossible to achieve a stable target euglycemia without the need for intravenous glucose infusion, surgical correction of the disease is indicated. In schematic drawings and intraoperative photographs, approaches to surgical treatment are described, the stages of operations and possible complications are clearly disassembled. The results of surgical interventions at the N.N. V.A. Almazov for 01.2017–02.2021, where 39 children with congenital hyperinsulinism were operated on. According to PET/CT with 18F-DOPA, 15 diffuse and 24 focal forms were diagnosed. After surgery, in 12 (31%) patients, a diffuse lesion of the gland was confirmed, in 23 (59%) – a focal nature of the lesion, in 4 (10%) – an atypical form was diagnosed intraoperatively. Of 39 children, 36 (92%) have complete relief of hyperinsulinism, a significant improvement in psychomotor development, of which 9 (23%) need insulin replacement therapy with minimal dosages, these are 8 children with a diffuse form of the disease and 1 child with an atypical one. Intraand postoperative complications were not observed. Thus, partial pancreatectomy for focal forms, subtotal for atypical and near total for diffuse forms, can cope with hypoglycemia due to congenital hyperinsulinism and prevent damage to the central nervous system of newborns and infants.

Introduction. The polymorphism of the vitamin D receptor (VDR) gene is associated with bronchial asthma (BA). Based on this, studies on the prevalence of VDR polymorphism in representatives of different races and peoples with AD and in healthy people are timely.

Aims. To determine the TaqI polymorphism of the vitamin D receptor gene (TT, TS and CC) in children and adolescents with a verified diagnosis of AD on the example of the Kazakh population of Western Kazakhstan.

Materials and methods. The study involved 54 Kazakh children with BA (Me age 12.8 years, fluctuations range 5–17 years). The control group consisted of residents of the same region without BA: Kazakhs – 66 children, Russians – 40 children. In each of these groups, children were born in the third generation of families without mixed marriages. The examination was performed by collecting venous blood with the informed consent of the legal representative of the child/adolescent. The samples were stored at a temperature of -80 ºC until the start of the analysis with further DNA sequencing and PCR at the INVITRO laboratory.

Results. In Kazakh children without BA TT alleles were recorded in 57.6%, TC – in 34.8%, CC – in 7.6%. In Russian children without BA, the TT allele was found in 35.0%, TC – 55.0%, CC – 10%. In children of Kazakhs with BA, the TT allele was in 74.0% of cases, TC in 26.0%, and CC was absent. The first stage of the study with a limited number of observations did not allow obtaining a statistically significant difference between the individual indicated groups. However, taking into account the probable protective effect of the CC allele, the differences in the frequency of the TT alleles and in total TC and CC and CC and in total TT and TC turned out to be significant: 0.000 and 0.030, respectively. When studying the distribution of alleles within the groups, it turned out that for Kazakhs in the control group and, especially, in AD, a decrease in the frequencies of TC alleles and, most clearly, CC alleles is typical.

Conclusion. The protective value of the CC allele cannot be ruled out. But it is not yet possible to formulate a final opinion on the functional significance of polymorphism. Further research will help to understand the relationship between the structural features of the VDR and BA.