This review article highlights the features of breastfeeding in case of obstructed nasal breathing in infants, special attention is paid to non-sucking or alternative methods of bottle feeding with expressed breast milk for the period when breastfeeding is not possible or formula supplementation is necessary as an addition to breastfeeding.
Breathing through the mouth is considered a pathological adaptation due to difficulty in nasal breathing and is associated with the development of many pathological conditions. There is an evidence base that prolonged breastfeeding is associated with nasal breathing at an older age, as well as the correct formation of the bite. The anatomical and physiological features of the structure of the upper respiratory tract in infants predispose to a more frequent occurrence of difficult nasal breathing compared to adults, which causes difficulties in breastfeeding, up to the refusal of the child’s breast. Therefore, knowledge of modern methods of supplementary feeding with expressed breast milk for this period, as well as ways to effectively and safely deal with nasal congestion in infants, will help doctors and parents to overcome the difficult period of the disease, accompanied by nasal congestion without loss and maintain breastfeeding for as long as possible, in the light of modern data on influence of breast milk on the subsequent life of mother and child.
The main method of treatment for nasal congestion of various etiologies is irrigation-elimination therapy. According to the literature, good tolerability and no side effects were found when using a nasal aspirator used in conjunction with isotonic saline.

Scientific discoveries of recent years demonstrate a crucial role of the human microbiome in human health. The establishment of a healthy, functional gut microbiota of the newborn requires physiological conditions, one of which is breastfeeding. The role of breast milk as a “direct supplier” of live microbes for the establishment of the newborn gut microbiota became known only at the beginning of the new millennium, previously it was believed that the breast milk was sterile. Today, the breast milk microbiota can be defined as multi-species assemblage, in which microbes interact with each, representing a complex organized ecosystem, among which the genera Streptococcus and Staphylococcus are dominant. Lactobacillus, Pseudomonas, Bifidobacterium, Corynebacterium, Enterococcus, Acinetobacter, Rothia, Cutibacterium, Veillonella and Bacteroides are also often referred to the common bacterial genera. The article presents two theories of the origin of bacteria in the breast milk (endogenous and exogenous bacterial translocation pathways) and explains why both of them are true. The role of bacteria in the breast milk of healthy women, in the global sense, is viewed in the context of the establishment of the infant gut microbiota. The article lists the main producers of antibacterial peptides (bacteriocins) in the breast milk and considers the effective immunological protection using the example of the population of bifidobacteria and bacteroids prevailing in the breastfed infant gut. However, the breast milk microbiota is also important for women’s health. We tried to explain why infectious lactational mastitis is now considered to be the result of dysbiosis in the mammary ecosystem, which leads to the development of an inflammatory process, and why Streptococcus thermophilus (TCI633) shows promise in the fight against human ageing.

Introduction. Acute respiratory viral infections in children remain an urgent problem, not only because of the high incidence, but also a significant contribution to the mortality structure of young children. Approaches to the treatment of acute respiratory viral infections are considered, taking into account the possibility of the impact of drugs on the main links of pathogenesis and prevention of complications from the perspective of a bioregulatory approach to therapy and complex bioregulatory drugs.
The purpose of the study. To present the effectiveness of bioregulatory therapy of respiratory viral infections in children from the perspective of clinical and pathogenetic aspects of the disease.
Materials and methods. A pro- and retrospective study was conducted for 2 years of 70 sick children aged 6 to 12 years with acute respiratory infections of moderate severity. The patients were observed in the homeopathic center “Homeopathic Medicine” in Samara.
Results. Improvement in children was observed by day 3 of the disease in patients receiving bioregulatory therapy (group 1) and by day 5 in children receiving conventional therapy (group 2) for respiratory infections (temperature and well-being normalized, intoxication syndrome was stopped). Remission of the disease occurred in 72% of group 1 children on day 5 of the disease and on day 6–7 in 47% of group 2 children. Taking Engystol® in tablets for 1 month after recovery allowed to reduce the number of relapses by almost 3 times during the year compared with children of group 2 who did not receive bioregulatory drugs.
Discussion. With a moderate course of respiratory infections, it is possible to use the drugs Girel, Viburcol®, Engystol® without the use of allopathic remedies, which significantly reduces the drug load on the body of a sick child and prevents the development of undesirable reactions.
Conclusions. The effectiveness, safety, and good tolerability of the drugs Girel, Viburcol®, and Engystol® are confirmed by their own results. These drugs can be recommended for use in pediatric practice in respiratory viral infections.

The article presents various types of acute rhinosinusitis progression in pediatric practice depending on the duration of the disease, based on the available modern consensus papers and clinical guidelines. The main clinical terminology of the nosological forms of rhinosinusitis was determined, and aspects of their differential diagnosis and stages of the treatment were studied. The authors provided insight into disease pathogenesis, taking into account literature review data on the spectrum of the most common bacterial agents of the nose and paranasal sinuses pathologies. The available data on the treatment of rhinosinusitis are summarized from the perspective of consensus papers and modern clinical guidelines of the Ministry of Health of the Russian Federation, the use of which for the prescription of treatment is the most important quality criterion for medical care provided. A clinical case of the treatment of acute bacterial uncomplicated rhinosinusitis in a 12-year-old child is described. In this case, an aerosolized form of topical antibiotic therapy combined with a mucolytic component was used as a drug of choice alongside with the standard irrigation-elimination therapy and nasal decongestants, which gives an advantage in achieving the maximum effective concentration of the active substance at the site of inflammation. A drug with a mucoactive effect helps to decrease mucus viscosity and discharge, and at the same time facilitates the entry of an active substance into the tissues and inhibits bacterial adhesion to the epithelium of the respiratory tract. Antibacterial component – thiamphenicol, a derivative of chloramphenicol with a mechanism of action associated with inhibition of bacterial protein synthesis has a broad spectrum of action and a maximum degree of accumulation and action in the site of inflammation due to the method of delivery to the epithelium of the respiratory tract.

Introduction. Inflammatory diseases of the lymphoid ring of the pharynx in children are widespread and account for more than 30% in the structure of ENT pathology. Lymphoid tissue, especially the palatine tonsils, largely determines the formation of local and general protective reactions of the child’s body.
The aim of this work is to assess the efficacy and safety of using topical bacterial lysate in chronic tonsillitis of streptococcal and herpes viral etiology in frequently ill children.
Materials and methods. The study was conducted on a sample of 31 children aged 7–17 who were treated in the pediatric department of the Saint Petersburg Research Institute of Ear, Throat, Nose and Speech inpatiently or outpatiently, which were divided into 2 groups. Group 1 consisted of 15 children with decompensated chronic tonsillitis of streptococcal etiology, who were prescribed tonsillectomy according to indications. Group 2 consisted of 16 children with chronic compensated tonsillitis, who, after an acute respiratory infection, showed signs of acute pharyngitis in the form of pain and discomfort in the throat, perspiration, low-grade body temperature. In both groups children were prescribed to take topical baclerial lysates.
Results. A subjective pain relief of sore throat in patients (groups 1 and 2) was observed from day 2–3 of administration of the topical bacterial lysate. The clinical therapeutic effect resulted in decreased intensity of inflammation of the posterior pharyngeal wall, reduction in size and tenderness of regional lymph nodes from day 4–5 of administration of the drug. The clinical recovery from acute pharyngitis in children of both groups was observed in 98% of cases at visit 3.
Conclusion. The persistence of pathogenic viruses and bacteria contributes to the development of secondary immunodeficiency states and participates in the formation of a kind of “vicious circle” In these causes prescription of topical baclerial lysates may be an effective conservation therapy as well as antibiotics and antiviral drugs. The drug showed its efficacy in the treatment of acute and chronic diseases of the pharynx in children of both viral and bacterial etiology.

The physiological role of cough is to restore mucociliary clearance in the respiratory tract. However, if there are inflammatory changes against the background of a respiratory infection, cough may be non-productive and impair the patient’s quality of life. For a rational choice of drug, the true cause of cough should be determined on the basis of history, physical examination and, if necessary, additional instrumental/laboratory investigations. Modern phytopharmaceuticals are considered effective and safe for cough relief. Herbal medicines contain biologically active substances, which are incorporated into the metabolic processes of the body in a more natural way, in contrast to synthetic analogues. The article focuses on the effectiveness of an ivy leaf extract, which has a complex composition: it contains saponins, flavonoids, glycosides, as well as components of essential oils. Due to its composition, it has several effects: expectorant due to its secretolytic and mucolytic action, and antispasmodic based on the increased sensitivity of β2-adrenoreceptor cells of bronchial smooth muscle cells to endogenous and exogenous stimulation, on reducing intracellular calcium levels and bronchial relaxation. The efficacy of ivy leaf extract has been shown in a total of more than 20 clinical trials, mainly in children suffering from upper respiratory tract infections. Cough treatment aims at changing the rheological properties of the secretion and increasing the effectiveness of the cough. The good compatibility of herbal medicines with other drugs, including antibiotics, allows their use not only as monotherapeutic agents, but also in combination therapy for the treatment of cough in children.

Introduction. The work includes the results of clinical and microbiological studies that determine the feasibility of using the herbal preparation EPS® 7630 for the treatment of rhinopharyngitis (RF) in children. The introduction provides a brief review of the literature data on the role of the microbial factor and the important contribution of dysbiotic disorders of the URT microflora in the development of the Russian Federation. The porpose of persistent properties of opportunistic microorganisms (UPM) is outlined: the ability to biofilm formation – BPO and inactivation of lysozyme – ALA as dysbiotic markers of RF, which create conditions for relapses and chronicity of the disease, reduce the effectiveness of antimicrobial therapy. Goal.

The aim of the work was the clinical and microbiological substantiation of the effectiveness of using EPS® 7630 in the treatment of RF in children.

Materials and methods. The study involved 79 children aged 3 to 15 years. 1st group – 43 children who received treatment, including, along with traditional treatment, the drug Umckalor EPS® 7630, 2nd group (comparison) – 36 children who did not receive the tested drug. Microbiological examination was carried out by taking swabs from the pharynx and nose before and after treatment; BPO and ALA were determined according to the methods of Bukharin O.V. et al. (1999).

Results. Conducted clinical studies have established a reduction in the timing of relief of the main symptoms of RF (cough, rhinitis, sore throat, fever) in children treated with EPS® 7630 compared to the comparison group. Microbiological studies of microorganisms isolated from the nasopharynx of children with RF revealed the ability of EPS® 7630 to suppress bacterial persistence factors (BPO and ALA) by 60% or more from the initial level.

Conclusions. The data obtained reveal one of the mechanisms of the antimicrobial action of EPS® 7630, which consists in suppressing the persistent potential of UPM and regulating the effect of the drug on the microbiocenosis of the URT. The clinical and microbiological efficacy of using EPS® 7630 in the treatment of RF in children has been proven.

Introduction. The incidence rates regulated by the decree of the Government of the Russian Federation have been achieved in the Russian Federation, but the epidemic situation for tuberculosis in the conditions of the COVID-19 pandemic remains tense, Primarily due to lockdowns, tuberculosis examinations, especially for children and adolescents, may be reduced.
The purpose of the study. Analysis of the effectiveness of preventive measures among children and adolescents in the context of ongoing COVID-19 and predicted other epidemics/pandemics.
Materials and methods. The statistical data of the Ministry of Health of the Russian Federation for the region over the past 30 years and its own scientific research in the region are considered. The results of clinical and laboratory-instrumental methods for detecting tuberculosis in children and adolescents are analyzed.
Results. The article examines the effectiveness of providing medical care for tuberculosis to children and adolescents in the context of the COVID-19 pandemic. There are no trends to the deterioration of the epidemic situation, but there is a decrease in the volume and narrowing of the focus of anti-tuberculosis anti-epidemic measures carried out by the anti-tuberculosis service.
Conclusions. Taking into account these features of the functioning of the TB service in the conditions of possible predicted other epidemics/pandemics, it is necessary to reorganize the system of providing TB care to children and adolescents with a change/expansion of its functions and material and technical base. A promising option for the intensification of such assistance in the context of pandemics is the integration of its implementation by all health services for the prevention of socially significant infectious diseases.

The review article presents an analysis of the data of foreign and domestic researchers characterizing the effectiveness of nebulizer therapy for bronchial asthma in children. The paper considers new data comparing the effectiveness of aerosol delivery devices. The advantage of inhalation therapy, which determines its widespread use in childhood, is its rapid delivery to the respiratory tract, high local and low systemic concentrations of the drug in target organs. Difficulties in observing the correct inhalation technique due to the difficulty of synchronizing inhalation and drug delivery, especially in young children, remain an urgent problem in the practice of treating chronic bronchopulmonary diseases, which leads to a severe and uncontrolled course, disability and adverse outcomes. The main disadvantage of ultrasonic nebulizers is the inactivation of suspensions, antibiotics and other drugs. Widely used jet nebulizers create noise during inhalation, have a large residual volume in the nebulizer chamber. In this regard, the improvement of delivery forms continues, taking into account the anatomical and physiological characteristics of the respiratory organs, the age of patients and comorbid conditions. The characteristics of the optimal inhaler include simplicity and ease of use, reliability, the possibility of effective inhalation of various drugs in combination with economical consumption. From this point of view, one of the universal means of transporting aerosols is membrane or electronic mesh (mesh) nebulizers, which provide excellent regional drug deposition in all age groups of children. The rapid achievement of clinical effect, compactness, mobility expand the possibilities of using mesh nebulizers at all levels of medical care.

Introduction. The WHO recommends using acetaminophen (paracetamol) and ibuprofen in fever treatment in children and does not recommend their use in sequence to avoid overdose. However, in recent years, preparations containing both medicinal components have appeared, which allows fever to be relieved safely and the daily dosage of the medicines to be reduced.
Objective. To obtain additional data on the efficacy and safety of antipyretic drug combination in comparison with mono drugs in children with the febrile syndrome in acute upper respiratory tract infections
Materials and methods. Single-center non-interventional (observational) comparative study was conducted in children from 3 to 12 years of age with acute respiratory infections accompanied by fever. Children were divided into 3 groups: the treatment group (83 children) received a combined antipyretic drug in the form of dispensable tablets (100 mg ibuprofen and 125 mg paracetamol); control group 1 (42 children) received paracetamol in the form of suspension; control group 2 (43 children) received ibuprofen in the form of suspension. The clinical efficacy and safety of antipyretic therapy and also the satisfaction of the patients’ parents, were evaluated in the dynamics.
Results. The results showed similar efficacy and safety of all three medications, but the daily dose of medications with the combined dispersible tablets was lower, more so for paracetamol and somewhat less so for ibuprofen. In the combined dispersible tablets group, the proportion of patients with a temperature < 37.2 °C was statistically significantly higher 1 hour after administration than in the paracetamol and ibuprofen drug groups. Ibuprofen only compared with the study drug in terms of efficacy after 2 hours, while paracetamol was already effective after 3 hours.
Conclusions. The study showed that the combined drug in the form of dispersible tablets (100 mg of ibuprofen and 125 mg of paracetamol) showed statistically significant efficacy parameters, is safe and well-tolerated by patients.

Cough is one of the most common symptoms in daily pediatric practice. Clinical presentation of cough in children may vary from a slight cough that has almost no impact on well-being and behaviour, to a strong, painful one that disrupts sleep and overall health status, which significantly worsens the child’s quality of life. Cough is a multidisciplinary problem due to a wide variety of causes, that’s why in the clinical pediatric practice there are certain difficulties in verifying the diagnosis, especially in children with prolonged cough, and in selecting the optimal treatment. The need for mucoactive therapy and the choice of a drug primarily depend on the cause and nature of the cough, the features of the development of the cough reflex in childhood, as well as the mechanisms of action of the drugs used. The main purpose of mucoactive drugs is to restore mucociliary clearance and effectively eliminate secretions from the respiratory tract, but apart from them some drugs have a few additional properties. The article presents the main causes of acute and chronic cough in children and considers the modern therapy options to treat cough. Ambroxol is one of the most commonly used mucoactive drugs to treat cough in children due to its pronounced mucolytic, expectorant, anti-inflammatory, antioxidant and immunomodulatory activity, as well as stimulation of surfactant synthesis. Ambroxol has been shown to have efficacy and favourable safety profile in numerous international and Russian studies. A wide choice of dosage forms, which provide different routes of medication administration, allows to use Ambroxol in children with acute and chronic bronchopulmonary diseases from an early age.

Constipation is one of the most common nosologies that a pediatric gastroenterologist deals with during outpatient visits. In the vast majority of children with constipation the problem is functional in nature. According to studies published in the Russian Federation, the frequency of constipation in children accounts for about 25–30%. The joint clinical guidelines of the European and North American Societies of Pediatric Gastroenterologists, Hepatologists and Nutritionists for the management of children with functional constipation were published in 2014. The national guidelines for the diagnosis and treatment of functional constipation are based on these guidelines. According to the clinical guidelines, the 2006 Rome III criteria should be used to establish the diagnosis of functional constipation in children. In May 2016, the Rome IV criteria that provide separate diagnostic criteria for infants and children under 4 years of age and children over 4 years and teenagers were adopted. A group of children with symptoms of constipation, who have already had toilet skills at the time of diagnosis, was identified among infants and children under 4 years of age. The presence of anxiety symptoms or refractory constipation (constipation that does not resolve within 3 months while taking adequate therapy) is considered an indication for use of additional examination methods, including instrumental ones. The manifestation of constipation is often associated with a change in eating habits - the period of introduction of complementary feeding in infants or the beginning of going to a day-care centre, inadequate fluid intake. The onset of constipation often coincides with the period of the development of hygiene skills (potty training). The voluntary stool retention by a child who is trying to avoid painful defecation experiences is the main mechanism for the development of constipation. The aim of functional constipation treatment is to soften the stools, which facilitates painless defecation and ensure that there is an urge to defecate. Clinical examples of the treatment of patients with functional constipation and chronic colonic stasis, functional constipation and encopresis are provided. The outcome of the treatment of functional constipation is to ensure painless defecation and the development of a stable defecation reflex. The drug therapy for functional constipation is based on the use of laxatives. Dietary advice and behavioral therapy also play an important role.

Infant colic is one of the most common, yet least studied, functional disorders of the gastrointestinal tract. Until now, there is no certainty both in the understanding of the nature of this condition and in the approaches to its correction. At the same time, infant crying is of concern to parents, forcing them to seek professional help and incur considerable medical expenses and to resort, sometimes unreasonably, to dietary and medical corrections. This article provides information on the etiology, pathogenesis and management of infantile colic from an evidence-based perspective, based on a review of the current literature. Various preconditions for the occurrence and development of infantile colic are analysed in detail, none of which can affect all occurrences. Evidence for the proven efficacy of including Lactobacillus reuteri in the treatment of intestinal colic in infants is presented. Effects on the gastrointestinal tract microbiome can be of undeniable benefit. Lactobacillus reuteri is one of the most studied and scientifically documented probiotics. 203 completed clinical trials involving 17,200 participants, including 67 trials involving 8,200 participants between 0 and 3 years of age. Numerous placebo-controlled studies have shown that taking Lactobacillus reuteri DSM 17938 can significantly reduce crying time in infants with colic, and in these studies, rates of 50% or more reduction in crying time were 2.3 times higher compared to controls.

Breast milk is the optimal feeding, which meets all the newborn’s body needs. For nutritional support and development of the baby, at certain periods of life it is required to introduce complementary foods into the diet, which is an important intermediate link between the milk nutrition and the general diet. In addition, complementary foods contribute to the development of taste habits, introduce a baby to a variety of foods and tastes, to a more complex food texture, and contribute to the development of such important physiological skills as chewing and swallowing. Nutrition in infancy may influence eating behaviour and eating habits at a later age. The babies become familiar with scents in the mother’s womb via amniotic fluid and then during breastfeeding when scents and flavours from the mother’s diet are tasted.
The article provides evidence in support of the recommended age when complementary foods should be introduced, the main factors affecting the eating behaviour of babies: exposure to sweet, salty, sour, bitter, or specific tastes. The impact of sweet foods on the health of babies in the future is of great importance, for example, it may increase a risk of developing overweight/obesity as compared to those who had the lowest intake of sweet foods. Attention is paid to the most important risk factor for developing early sensitization, namely the nature of feeding babies in the early period, and the immunogenicity evaluation of the first complementary foods. The article provides a rich selection of commercial first complementary foods that contribute to the correct development of eating habits in babies from an early age.

From an evolutionary standpoint, breast milk is the optimal food for nutrition of infants, which contains, in addition to macro- and micronutrients, functional components required for the morphofunctional maturation and development of regulatory interactions between organs and systems mostly of the digestive system. The choice of formula for artificial feeding of infants is determined, first of all, on the basis of its functionality. Interest in goat milk as a source of nutrition has been known for a long time, and recommendations highlighting its dietary and healing properties are found in both ancient treatises and modern guidelines. In this regard, goat milk formulas deserve special attention. Based on the results of the research, were identified the features of goat milk composition, which determine the unique metabolic and physiological properties for young children. The article presents comparative data on the features of the chemical composition of goat, cow and breast milk, as well as the functional characteristics of the adapted goat milk based formula. The advantages of goat’s milk allow us to consider goat milk based formula as physiological (providing normal physical development and metabolic processes), as functional (due to growth, regulatory and protective factors) and prophylactic — to prevent the occurrence of functional disorders (regurgitation, constipation) due to compliance with the functional capabilities of the gastrointestinal tract of the child. Such formulas are indicated for healthy infants and can be used in infants with risk factors for the development of functional gastrointestinal disorders. Such risk factors include caesarean-section delivery, exposure to antibiotics in the first days of life, perinatal pathology of the central nervous system.

Introduction. Currently, the coronavirus infection pandemic caused by the SARS-CoV-2 virus continues around the world. Research data from domestic and foreign authors indicate that the kidneys are a target organ for a new infection, lesions vary from proteinuria and hematuria to acute kidney injury.
Aim of the study – to determine the frequency and nature of kidney damage in children with confirmed coronavirus infection.
Materials and methods. A retrospective and prospective analysis of cases of confirmed COVID-19 infection in children (n = 441) admitted to the Samara Regional Children’s Infectious Diseases Hospital from March 2020 to July 2021 was carried out. SARSCoV-2 RNA was detected in all patients by a one-step reverse transcription reaction combined with a polymerase chain reaction. The changes in the kidneys that occurred in 57 children were studied. The research results were processed using the Statistica 7.0 software (StatSoft, USA).
Results. The involvement of the kidneys in the infectious process was detected in every 8 children with COVID-19 (12.9%), more often in the form of isolated urinary syndrome, the detection rate of which correlated with the severity of the course of coronavirus infection: in severe cases, proteinuria was detected in 31.6% of patients, hematuria – in 21%, acute kidney injury – in 10.5%, diabetic nephropathy – in 5.3%. Kidney damage was combined with damage to the respiratory and gastrointestinal tract, characterized by rapid recovery of urine output and azotemia parameters without special renal therapy. A clinical case of the onset of nephrotic syndrome that developed 2 weeks after suffering a coronavirus infection is described.
Conclusions. Children with COVID-19 require kidney function monitoring for early detection and correction in case of impairment. Patients with isolated urinary syndrome in the acute period require long-term observation in order to detect latent renal pathology.

The development of inflammatory process in the skin has proven to be primarily associated with the immune system defects, in particular T-lymphocytes: the Th2 response predominates during the acute phase of the disease, when Th2 cells are stimulated with the subsequent hyperproduction of IgE; during the chronic phase, the Th2- shifts to Th1-immune response. At the same time, a significant amount of pro-inflammatory cytokines IL-4, IL-5, IL-13, IL-31 and IFN-γ move into this process. In addition, it is known that skin reactions can be induced not only by food allergens, but also by other allergens (house dust mites, Staphylococcus aureus enterotoxins, mold fungi). The prevalence of atopic dermatitis among the children’s population is up to 20%, while half of the children have skin lesions characterized by a severe long-term course, which violates their quality of life. The main goal of external therapy of dermatoses is to achieve control over subjective symptoms (especially skin itching), as well as regression of inflammatory manifestations with subsequent persistent remission of the allergic process. Local therapy of manifestations of atopic dermatitis is based on the adequate use of various external forms, as well as means in accordance with the inflammatory manifestations and localization of the inflammatory process. The article describes clinical cases of treatment of atopic dermatitis with various variants of its course using methylprednisolone aceponate cream with ceramides, emollient agents. It has been shown that the combined use of topical corticosteroids and emollients contributes to a rapid reduction of inflammation, dry skin and itching. The absence of toxic and side effects on this type of therapy in children with high treatment efficiency is emphasized.

Introduction. In present day conditions, atopic dermatitis is characterized by an early onset, persistent relapsing course, development of complications and has certain difficulties in treatment. Nowadays, in unfavourable environmental context and irrational use of antibiotics, bacterial and fungal infection is one of the factors leading to the aggravation of atopic dermatitis, which plays an important role in maintaining a chronic inflammatory process in the skin.
Aim. To improve methods for treating atopic dermatitis complicated by fungal and bacterial infection in children by using non-steroidal activated zinc pyrithione drug (in the form of 0.2% cream or 0.2% aerosol), which has antimicrobial and antifungal, as well as anti-inflammatory effects.
Materials and methods. 46 children aged 1 to 3 years with complicated forms of atopic dermatitis were observed. They used activated zinc pyrithione drug applied topically as part of the complex antiallergic therapy.
Results and discussion. The on-going therapy resulted in a positive clinical effect in 69.5% of cases and the achievement of a stable remission of the disease on average on the 16th day from the start of therapy. The results of cultural bacteriological and mycological examination were negative in 78.1% of cases. The one-year dynamic follow-up of children showed that 53.1% had a stable remission of the disease, and 28.1% of children had exacerbations observed after treatment, which were characterized by a lower intensity of clinical manifestations.
Conclusions. The introduction of a nonsteroidal activated zinc pyrithione drug (0.2% cream or 0.2% aerosol) as topical monotherapy in the complex treatment of atopic dermatitis complicated by secondary fungal and bacterial infection showed high clinical efficacy.

Acute respiratory infections (ARIs) have been holding leading positions in terms of prevalence rates in all age groups for much longer than one year, accounting for more than 70%. World Health Organization experts note that ARI is the most common group of diseases in the human population. Back in 1995, D.J. Rowlands stated in his publication that the average person has ARI for a total of about two years during his life. The published report “On the state of the sanitary and epidemic well-being of the population in the Russian Federation, 2017” showed that the acute respiratory viral infection (ARVI) and influenza rate has increased by 9.3% over the past 6 years, more than 20% of the population have ARVI annually and children of younger age groups account for 70–80% among them. The annual economic damage from the burden of influenza and SARS is estimated at more than 500 billion roubles. The use of drugs that can prevent the spread of ARI, prevent attachment of secondary bacterial infections, reduce the need for prescribing systemic antibacterial drugs will allow to reduce the antibiotic resistance in microbes. However, the existing medicinal products are mainly represented by vaccines and antiviral drugs against influenza in almost complete absence of drugs against other ARI pathogens. In 2013, the World Health Organization launched the BRaVE initiative to expand treatment options for ARVI with the development of effective antivirals against the most significant pathogens and/or safe and effective biological response modifiers.
The article is devoted to the challenge of treatment and prevention of ARI in children, the therapeutic potential of a plant preparation containing aloe extract. The data presented in the clinical results review of the use of this drug prove the feasibility and safety of its introduction in the ARI treatment and prevention regimens in children.

Introduction. Allergic diseases are a global medical and social problem due to the adverse effect on the physical, psychological and social state of a person. The basic principle of pharmacological therapy of acute allergic diseases is acute urticaria, angioedema (Quincke) – control/elimination of syndromic complexes.
Aim. To evaluate the clinical efficacy of the antihistamine dimetindene in the treatment of acute allergic reactions in children.
Materials and methods. We analyzed 36 patients aged 3 to 17 years with diagnoses of acute urticaria and acute urticaria with angioedema in a state of moderate severity. Patients felt a violation of the general condition – malaise (88.89%), chills/fever (5.56% and 8.34%, respectively), joint pain (2.78%). All patients underwent general clinical, laboratory and instrumental examination with subsequent analysis of the data obtained. To assess the response to treatment, UAS 7, the CU-Q2oL quality of life questionnaire were used.
Results and discussion. The article discusses the main aspects of acute urticaria and angioedema, as the most common nosological forms in patients with atopy. The features of antihistamine therapy and its influence on the stages of the inflammation process are analyzed. The level of eosinophilia in the general blood test (median and interquartile range) was 6.5% (1.3%; 19.1%). An increase in total IgE was recorded in 80.56% of patients. The burden of allergic history was revealed in 86.12% of patients. By the end of the 1st day of treatment, symptoms were absent in every tenth patient (χ² = 1.2461, p = 0.0865), remained in every
fifth child (χ² = 53.6152, p = 0.0057) and significantly decreased in 2/3 children under study (χ² = 59.6281, p = 0.0062). By the end of the 3^rd day of therapy with dimetindene in the complex of treatment of acute urticaria and angioedema, a statistically significant improvement in clinical dynamics was recorded (χ² = 102.1364, p = 0.0041) in the combined assessment of symptoms in 4/5 of the subjects and a decrease in discomfort associated with sleep in the overwhelming majority of the subjects (χ² =51.4627, p = 0.0036).
Conclusion. As a result of our own research on the use of dimetindene in patients with acute allergic reactions, it was shown that dimethindene has characteristics that meet the requirements for the exposure of the therapeutic effect, the level of effectiveness and the safety profile.

There are many studies devoted to the study of the intestinal microbiota. They prove the leading role of microorganisms in the formation of the immune response of the host. Intestinal microbiota contributes to the switch of preferential differentiation of Th-lymphocytes from Th2-type, typical for newborns, to the formation of Tr-cells (regulatory) with a corresponding increase in the formation of TGF-β and IL-10. Consequently, immunological tolerance is formed under the influence of the intestinal microbiota. This process occurs in the first months of life and has a long-term effect, setting the features of the body’s immune response to external infectious and food antigens, which determines the predisposition to the development of food allergies later in life. This article describes the factors that influence the colonization of the baby’s gut. Maternal gut microbiota, maternal health, mode of delivery (natural childbirth or cesarean section), type of feeding (breastfeeding or formula feeding) - all these factors affect the colonization of the gut and the formation of an immune response. In addition, lactobacilli and bifidobacteria play a critical role in the formation of immunological tolerance. Probiotics can modulate the immune response similar to the intestinal microbiota. Lactobacillus and bifidobacterium infant strains are optimal. Clinical studies have proven the effectiveness of perinatal and early administration of probiotics for the prevention of food allergies. A balanced combination of Lactobacillus rhamnosus and Bifidobacterium longum is a symbiosis of bacteria that enhances the effectiveness of each other, which promotes the optimal establishment of the intestinal microbiocenosis from birth and is the prevention of both infectious diseases and food allergies. A combination probiotic containing both Lactobacillus rhamnosus and Bifidobacterium longum seems to be the optimal choice.

Prevalence of allergic rhinitis among chronic upper respiratory diseases in pediatrics is one of highest. Beside anti-inflammatory drugs (topical steroids, antileukotrienes, antihistamines), reliever therapies are important too in treatment of allergic rhinitis. Decongestant prescription in children should lasts no more than 7–10 days; combination of alpha1-adrenomimetic with topical antihistamines is one of possible ways to improve the efficacy, for example, the combination of dimetindene maleate with phenylephrine as nasal drops. We present the results of retrospective evaluation of 625 patients aged from 0 to 17 years with allergic rhinitis, diagnosed not less than 12 month ago. Among examined group, mild allergic rhinitis prevalence was 56.9%, moderate 37.2% and severe 5.9%. During the year all patients experienced 1754 exacerbations (on average, 2.79 ± 1.13 exacerbations per patient). Contact with allergen (35.3%) and respiratory infections (28.8%) were more prevalent reasons of exacerbation; non-specific trigger provocation (pungent smells, air humidity or temperature change etc.) (19.8%) and unknown reason (16.4%) of allerhttps://doi.org/10.21518/2079-701X-2022-16-1-184-189 gic rhinitis exacerbation were less prevalent. When treated with combined nasal drops of dimetindene maleate and phenylephrine median [Q25; Q75] duration of exacerbation was a bit shorter 7.94 [6.25; 17.15] days, than using other decongestants, but difference was statistically insignificant. Combined nasal drops were maximal clinically efficient among patients under 12 years old with exacerbations, caused by allergens contacts. We did not register any adverse events caused by decongestant treatment, during our study. Patients with allergic rhinitis should be provided with written action plan for the disease exacerbation. Using as reliever therapy combined nasal drops (dimetindene maleate and phenylephrine) registered for patients from 1 year old, decrease number of medicines and reduce allergic rhinitis exacerbations duration.

Introduction. Acute respiratory infections occupy the leading place in the structure of total infectious morbidity and account for more than 90% of all cases of infection. One of the most frequent clinical symptoms of acute respiratory infections is cough.
Aim. To evaluate the therapeutic efficacy and tolerability of syrup based on active natural components in the treatment of cough in 2 to 7 years old children.
Materials and methods. Patients 2 to 7 years old diagnosed with mild to moderate acute respiratory infections who had been coughing for no more than 3 days were included in the study.
Results and discussion. We observed 123 children: 67 boys (54.5%) and 56 girls (45.5%). A statistically significant reduction in the severity of cough occurred on the 3rd day of treatment in both groups. On the 7th day of treatment, the degree of cough severity in both groups decreased on an average of 5 times. By the 7th day of taking the syrup, 97% of the children showed positive therapeutic effect: 55% of the patients’ cough symptoms resolved completely, 43% of the children had cough symptoms that became clinically insignificant. All these children recovered and were allowed to attend educational institutions. Reduction in the severity of cough when taking a syrup based on natural active components was accompanied by normalization of night sleep on average on the 4th day from the start of treatment.
Conclusion. Receiving a syrup based on natural active ingredients in the early administration (within 3 days of coughing) for acute respiratory infections of mild and moderate severity allows 97% of children to cure a cough within 7 days.

Introduction. The results of numerous studies indicating the relationship between the development of reactive arthritis (ReA) and the disturbance of the intestinal microbiocenosis give rise to interest in commensal microorganisms that make up the intestinal microbiota as potential initiators of immune-dependent inflammatory diseases of the joints. In this regard, the question of the expediency of using probiotic preparations for the correction of ReA patients intestinal microflora is of practical interest.
The purpose of the study was to evaluate the effectiveness of Lactobacillus rhamnosus LGG (LGG) in the preventive treatment of children with ReA to prevent the development of relapses.
Materials and methods. Clinical and microbiological study included 60 patients with ReA from 3 to 17 years old, who were divided into two groups, 30 children each. Patients of the group 1 received courses of treatment with LGG in the inactive phase of the disease. Patients of the group 2 (comparison group) were not treated with probiotic. The criteria for the effectiveness of treatment were the number of relapses of ReA during follow-up observation for 1 year; dynamics of intestinal microbiocenosis condition according to the following parameters: indicator of microbial contamination (IMC) of intestinal microsymbionts; ability to biofilm formation (BF); levels of lactoferrin and lysozyme in coprofiltrates.
Results. In patients treated with LGG, relapses of arthritis were significantly less frequent during 12 months of prospective observation relative to the comparison group. Patients of the group 1 showed positive dynamics of the state of intestinal microbiocenosis: a decrease in the severity of dysbiosis, a decrease of lactoferrin and lysozyme level in coprofiltrates, IMC and BF of opportunistic microorganisms against the increase IMC and BF in bifidobacteria and lactobacilli.
Conclusions. The use of LGG in the treatment of children with ReA in the inactive phase of the disease contributes to the correction of intestinal microbiocenosis disorders and reduces the number of arthritis relapses.

Introduction. Rotavirus infection is the leading cause of acute gastroenteritis in young children. Due to the lack of etiotropic treatment of viral gastroenteritis, the interest of scientists and practitioners in the use of antiviral drugs is increasing. Studies of domestic authors have proven that the low molecular weight interferon inductor – meglumine acridonacetate has antiviral, immunoregulatory and anti-inflammatory activity.
Aim. Evaluation of the efficacy and safety of the antiviral drug meglumine acridonacenate in the treatment of acute gastroenteritis of rotavirus etiology in children aged 4–7 years in a hospital setting.
Materials and methods. A prospective analysis of cases of treatment with meglumine acridonacetate for moderately severe rotavirus gastroenteritis in preschool children (n = 29, group I) was carried out. The comparison group consisted of patients receiving standard therapy (n = 31, group II). The presence of rotavirus infection was confirmed by the detection of the pathogen antigen in the feces. Meglumine acridonacetate was prescribed according to the scheme, parenterally, every other day.
Results and discussion. The effectiveness of therapy with an antiviral drug on the 3rd day of treatment of moderately severe rotavirus gastroenteritis was 79.3% (p < 0.05). The elimination of the main clinical symptoms of the disease was noted on days 2–3: a decrease in the symptoms of intoxication, fever, a significant decrease in the duration of vomiting and diarrhea (p < 0.05), a reduction in the pathogen elimination period by 2.67 days (p < 0.01), meglumine acridonacetate was well tolerated, no side effects of the drug were detected.
Conclusions. Meglumine acridonacetate can be recommended for the complex treatment of moderate rotavirus infection from the first days of the disease.

Introduction. The role of disturbance of the intestinal microbiota in the development of diseases of infectious genesis and the possibility of using probiotics as an immunomodulatory agent are confirmed by the evidence base of numerous studies.
Purpose. To study the results of using a multi-strain immunoprobiotic from the first days of acute respiratory infection as an emergency prevention, for the purpose of reducing the duration and severity of the disease.
Materials and methods.Children from 2 to 10 years old took part in the clinical observation: the main group (45 children) received a multi-strain immunoprobiotic in accordance with the instructions for use for 1 week, starting from the 1–2 day of acute respiratory infection and the comparison group (37 children) who did not receive an immunoprobiotic.
Results and discussion. As a result of the study, the effectiveness and safety of the use of an immuno-probiotic in children of preschool and primary school age, when prescribed from the first days of acute respiratory infection, and its positive effect on the course of the disease were shown. The duration of the disease in patients receiving the immunoprobiotic was statistically significantly less, and the severity of the disease was milder than in the comparison group. The incidence of repeated respiratory infections during one month after discontinuation in the main observation group was 3.1 times lower than in the comparison group. At the end of the experiment, statistically significantly higher levels of leukocytes, eosinophils, monocytes and the absolute number of lymphocytes were revealed in the comparison group that did not receive the immunoprobiotic.
Conclusions. The obtained results allowed to substantiate the use of a multi-strain immuno-probiotic as a non-specific immunomodulatory agent for emergency prevention when prescribed from the first days of a respiratory infection for the purpose to reduce the duration and severity of the disease.

Introduction. Cystic fibrosis associated (related) diabetes mellitus (CFDM) is one of the most common severe complications of cystic fibrosis. Today, the issue of the goodness of a single measurement of fasting blood glucose, glycated hemoglobin and fructosamine to assess the degree of carbohydrate metabolism disorders in children with cystic fibrosis is a subject of debate. The gold standard for diagnosing carbohydrate metabolism disorders (impaired fasting glycemia, various pre-diabetic conditions, diabetes mellitus) is the oral glucose tolerance test. Data about the diagnostic value of fructosamine for predicting CFDM aren’t dispositive. No credible studies of fructosamine in children with cystic fibrosis have been found in the Russian medical literature.
Aim. To determine the diagnostic informative value of the blood fructosamine and other single-measured glycemic marker levels in the early diagnosis of carbohydrate metabolism disorders at the pre-diabetes stage in children with cystic fibrosis.
Materials and methods. The results of laboratory tests and instrumental examinations of 87 children with cystic fibrosis aged 5–18 years were reviewed. A cross-sectional study of fructosamine, fasting blood sugar and glycated hemoglobin level (some patients underwent an oral glucose tolerance test), and liver fibroelastometry were also performed.
Results and discussion. An increase in the fructosamine level was observed, which indicates a possible CFDM in children (p = 0.049): CFDM is highly likely, if the level of fructosamine is ≥255.5 µmol/l (reference ranges for children are 272–285 µmol/l; sensitivity = 57.1%, specificity = 85.2%). It has been found that children with cystic fibrosis and liver cirrhosis have increased fructosamine levels: cut-off = 253.0 µmol/l (Sn – 70.0%, Sp – 85.2%).
Conclusion. The fructosamine level, a single determination of fasting blood glucose and glycated hemoglobin are not informative markers for the diagnosis of pre-diabetic conditions in cystic fibrosis in children. It is important to bear in mind that concomitant liver cirrhosis can affect the fructosamine levels. CFDM can be diagnosed at the lower fructosamine level, despite the generally accepted ranges.

Concomitant congenital malformations are an actual problem in pediatrics. Association of tracheobronchial tree anomalies and congenital heart disease (CHD) could be the cause of the patient’s condition deterioration before and after cardiac surgery. We present a clinical case of a patient with multiple malformations with a long-term and poorly corrected broncho-obstructive syndrome, combined with pneumonia and hypoventilation. After surgery for tetralogy of Fallot at 3 months, the boy needed mechanical ventilation for a long time due to bilateral pneumonia complicated by bilateral pneumothorax. At 7 months, a respiratory infection required hospitalization in the intensive care unit. When pneumonia resolved, the boy was discharged home with continued oxygen support using an oxygen concentrator. The reason for the patient’s prolonged respiratory failure could be explained by prolonged hypoventilation due to narrowing of the left main bronchus and consecutive congenital pneumonia, repeated aspirations, and postoperative mechanical ventilation-associated pneumonia with bilateral pneumothorax. At the age of 1 year 3 months in the Department of Thoracic Surgery of St. Vladimir’s biodegradable stent in the left main bronchus was installed. The bronchus lumen was restored. The boy did not need oxygen support, and his physical and motor development indicators improved. Thus, in patients with tetrad of Fallot, a thorough assessment of the condition of the tracheobronchial tree is advisable in order to develop an appropriate treatment plan if needed. The collaboration of specialists in various fields of care for pediatric patients is the basis for a favorable prognosis in terms of the full growth and development of patients with multiple malformations.

Lymphatic malformations are benign neoplasms that form as a result of impaired formation of embryonic lymphatic sacs during embryogenesis. Lymphangiomas and lymphgemangiomas (visceral forms) rarely develop in the intra-abdomen, such localization does not exceed 8–15% of all observed lymphangiomas in children. Among the visceral forms are more common the forms that involve intestines, mesentery, spleen, omentum, liver in the pathological process, less often - the lymphatic vessels and lymph nodes of the mediastinum, and retroperitoneal tissue. The clinical presentation of lymphatic malformations is multivaried and depends on their localization, the patient age, and the development of complications. In case of complications, the clinic manifestation of “acute abdomen” requires emergency surgical intervention, during which the diagnosis and scope of surgical treatment are specified. a 14-year-old boy was admitted to the department of infectious diseases with complaints of fever, weakness, abdominal pain, sore throat and loose stools. Previously, the patient had complaints of abdominal pain for a year; ultrasound examination of the abdominal cavity was performed repeatedly, in which no pathological changes were detected. The patient underwent laparoscopic appendectomy; During the revision of the abdominal cavity, a space-occupying lesion emerging from the mesentery of the ascending colon and twisted around the vascular pedicle by 3 turns was revealed. Education removed. Histological and immunohistochemical examination confirmed the diagnosis of lymphatic-venous malformation. No signs of malignancy of lymphatic malformations are described in the literature. However, though lymphatic malformations are benign in nature, they tend to have an infiltrative growth pattern, often relapse, and sometimes become infected. The available literature doesn’t provide a proper description and analysis of the results of treatment of intra-abdominal lymphatic malformations using endovideo technologies. Transabdominal access provides the best exposure of the complete surgical field, freedom of movement and clarity of anatomical landmarks. The main advantages over open abdominal surgery are minimal trauma to the anterior abdominal wall and rapid rehabilitation of patients.

Lysosomal acid lipase deficiency (LAL-D) is a rare, progressive, autosomal recessive disease, which develops due to impaired degradation and subsequent intra-lysosomal accumulation of triglycerides and cholesterol esters causing dyslipidemia. The clinical manifestations of the disease presumably depend on the residual activity of the enzyme, lysosomal acid lipase. A profound deficiency of the enzyme known as Wolman’s disease has an onset in the first 6 months of life. The disease reveals itself by dyspeptic disorders in the form of vomiting and diarrhea, lack of weight gain, hepatosplenomegaly, and adrenal calcification. If the Wolman’s disease is not treated, children die within the first 6 months as a result of exhaustion caused by malabsorption syndrome combined with progressive deterioration of liver and adrenal glands. Partial deficiency of lysosomal acid lipase manifests itself at a later age and is called cholesterol ester storage disease. Its clinical presentations include hepatosplenomegaly, elevated transaminases, hypercholesterolemia, and, in some cases, hypertriglyceridemia. Liver failure is the main cause of death in the natural course of cholesterol ester storage disease. Delayed diagnosis of the disease leads to its progression causing irreversible liver damage. The implementation of mass screening programs with the determination of cholesterol levels in childhood is critical to identifying asymptomatic patients.
The article presents a clinical case of a patient aged 3 years. The molecular genetic testing showed a mutation in exon 8 of the LIPA gene: NM_000235.3:c.894G>A synonymous variant in the homozygous state. It was also found that both parents of the girl had this type of mutation in the heterozygous state. The patient was prescribed sebelipase alfa in a dose of 1 mg/kg once every 14 days. The treatment was well tolerated. Due to the early verification of the diagnosis and timely pathogenetic therapy, the prognosis of the course of LAL-D, the duration and quality of life of the child were considered to be favourable.
Raising the awareness of doctors along with the introduction of effective screening programs for the timely detection of dyslipidemia in children contributes to timely diagnosis and early initiation of pathogenetic therapy, which can increase the life expectancy of patients with lysosomal acid lipase deficiency and improve their quality of life.

ARVI is the most common children infection: children aged 0–5 years suffer, on average, 6–8 episodes of ARVI per year; and in the 1–2 years of visiting kindergarten the incidence rate is higher for 10–15% than in unorganized children, and at school the latter get sick more often. The incidence of ARVI is the highest in the period from September to April and it amounts about 87–91 thousand per 100 thousand in the population. The respiratory infectious disease protection of the organism is carried out in several stages and at various levels. It primarily depends on a mechanical barrier that prevents entering the virus agent into the organism – the mucous membrane of the nasal cavity, paranasal sinuses and nasopharynx. It can be achieved due to the peculiarities of its structure – respiratory epithelium, mucociliary transport, mucus properties and lymphoid organs associated with mucous membranes. If the pathogen nevertheless penetrates this barrier, then innate immunity starts protection activity, and after that the acquired immunity activates. Antiviral protection has differences due to the structure of the virus, it’s extremely small size, and the impossibility of reproduction outside the cells. The formed immune response persists even after elimination of the pathogen in the form of immune memory, which allows a faster and stronger reaction when the pathogen reappears. Children with primary immunodeficiency, genetic, oncological, hematological diseases, bronchial asthma, chronic ENT pathology are a special risk group in terms of the frequency and severity of ARVI and influenza. In this connection, the prevention of the incidence of ARVI and influenza is extremely important.

Dehydration is one of the most common disorders of water and electrolyte metabolism in young children. The reasons leading to the lack of water in the child’s body are very diverse. In clinical practice, a correct assessment of the pathophysiological mechanisms in various types of dehydration is necessary, which will allow timely identification of changes in various organ systems and conduct rational rehydration therapy. Water losses in children occur in a certain sequence. First of all, the intravascular subsector of the extracellular sector is subjected to water losses (clinical manifestations of dehydration in the child in this case are absent). If the pathological process continues, the intercellular subsector of the extracellular sector loses water, and then the patient first presents clinical symptoms: loss of body weight, dryness and brightness of the mucous membranes, reduction of subcutaneous fiber turgor, shrinkage of the mole in children of the first year of life, reduction of diuresis. Last of all, the intracellular sector loses its volume. Depending on the osmolarity of the extracellular fluid, isotonic, hypertonic and hypotonic dehydration are isolated. The most difficult in children is hypotonic dehydration, which is accompanied by a low osmolarity of the extracellular sector with predominant losses of sodium from the body. A retrospective analysis of a clinical case illustrates water-electrolyte disturbances in hypotonic dehydration. The child developed extracellular hypotonic dehydration because of sodium and water loss through the gastrointestinal tract. Hypotonic dehydration is characterized by an extreme degree of dissonance of the water-electrolyte balance, that is, the patient has severe extracellular dehydration and intracellular hyperhydration (edema, cell swelling). In this clinical case, violations of the waterelectrolyte balance led to the development of cerebral edema against the background of the existing cerebral deficiency, and death.

Nowadays, when the number of couples affected by infertility increases significantly, the issue of the use of assisted reproductive technologies (ART) is particularly important. In vitro fertilization (IVF) is the ART that is used most frequently due to its high positive results. Priority status initially was accorded by the researchers to quantitative indicators, and the health of children born as a result of ART was analysed extremely rarely. At the present time, all the risks of using ART are being assessed. Despite the success of the procedure, there are times when children are born prematurely. In Russia, starting from 2012 all children born after 24 weeks of gestation and weighing more than 500 grams are legally regarded as human beings and must be provided with life-saving medical care. Observations show that such children have significant health problems: the most serious damage is caused to the nervous system, respiratory organs, and visual system. The article describes cases of premature IVF babies with critically low birth weight and reviews their further development. Approaches to the management of premature IVF babies should be based on the awareness of the problems of extreme morphofunctional immaturity, individual selection of habilitation programs. Observations should be comprehensive (involving narrow specialists according to indications), which plays an important role in the subsequent development of children. If the management of such babies is arranged properly, their health status improves significantly, and physiological parameters achieve close to “normal” standards.

Introduction. Pneumonia remains an acute problem not only in pulmonology, but also in pediatrics in general. The prognosis of neonatal pneumonia depends on the perinatal period course. In this case, the predictor of risk is the state of the brain, the main organ that regulates the whole organism’s work. The most available method for brain condition’ assessing in children of the first year of life is neurosonography. The ability of the brain to restore impaired functions is very high during infancy. Early diagnosis and treatment of the correlation relationships’ violations of brain structures in pneumonia of newborns will help prevent an unfavorable outcome of the disease.
Aim. Тo study the features of the correlation relationships of structural changes of the brain in pneumonia in infants.
Materials and methods. Neurosonographic study was carried out at 57 children: with pneumonia without concomitant diseases (17 children – group 1), against the background of: perinatal lesions of the nervous system (group 17 – 2), jaundice (group 16 – 3), congenital heart defects (group 7 – 4) with SonoScape 1000 apparatus. Neurosonography and echocardiography were performed with a sector transducer with a frequency of 7.5 MHz. All 377 correlations were assessed for 25 studied parameters.
Results. The study of correlations revealed the predominant participation of the sections of the right lateral ventricle and the flow system of the brain. The severity of synchronous functional activity (the number of correlations) characterizes the degree of functional tension, stress reaction of the studied structural part and has a relatively greater risk of depletion and, as a consequence, a greater likelihood of destructuring. In the process of adaptation and the formation of compensatory mechanisms, the predominant functional load falls on the right parts of the brain (right lateral ventricle).
Conclusions. The most pronounced changes in brain structures during neurosonography were found in infants with pneumonia, which developed against the background of neonatal jaundice and congenital heart defects. In all groups of patients with neonatal pneumonia, correlations were found between the parameters of the structure and flow system of the brain, laboratory parameters indicating the tension of the compensatory mechanisms of organs and systems. The revealed changes characterized the developing of the hydrocephalus in the absence of pathognomonic clinical and neurological symptoms in patients.

Introduction. In the Russian Federation, the number of new cases of congenital malformations and chromosomal abnormalities reported among children from birth to 14 years of age each year is over 1,000 per 100,000 population. Therefore, the urgency of the problem of diagnosis and prevention of congenital malformations does not admit of doubt.
Purpose of the study. To study the influence of antenatal risk factors on the formation of the urinary system’s congenital malformations in children.
Materials and methods. The study carried out by the “case – control” method. The main group included 126 mothers who gave birth to children with kidney and urinary tract defects, and the control group included 40 women with healthy children. The assessment of the results reliability the obtained carried out by calculating the odds ratio with a 95% confidence interval.
Results. The most significant factors in the formation of malformations of the urinary system were: the age of mothers over 35 years old (OR 3.264, 95% CI: 1.079–9.875), a burdened obstetric history (OR 2.380, 95% CI: 1.012–5.594), a burdened gynecological anamnesis (OR 2.825, 95% CI: 1.319–6.051), preeclampsia (OR 2.910, 95% CI: 1.057–8.010), exacerbation of opportunistic infections during pregnancy (OR 2.833, 95% CI: 1.103–7.280), the presence of chronic placental insufficiency (OR 3.413, 95% CI: 1.405–8.290), passive smoking during pregnancy (OR 2.711, 95% CI: 1.110–6.618), a burdened nephrological history in the mother (OR 3.462, 95% CI: 1.148–10.442), the presence of neurocirculatory dystonia (OR 4.703, 95% CI: 1.062–20.822). The work revealed the role of folate metabolism genes polymorphisms in the formation of kidney defects. In addition, a reliable relationship between the development of kidney and urinary tract defects with the absence of pregravid preparation was found, as well as untimely intake of folic acid preparations.
Conclusions. The study made it possible to identify the most significant factors of the antenatal period, influencing the development of congenital malformations of the urinary system. The results obtained must be taken into account at the stages of planning pregnancy in an outpatient setting.

Introduction. The issue of the readiness of adolescents with chronic kidney disease (CKD) for the transition to the adult service in the Russian healthcare system remains unexplored. One of the reasons of this problem is the lack of Russian tools for evaluating patient transition readiness.
The goal of this study is to develop Russian-language questionnaires to evaluate the readiness of adolescents for the transition to an adult health service based on the English-language originals.
Materials and methods. A literature search was carried out to identify English questionnaires, as well as recommendations for their translation and adaptation. Development of the Russian versions of the questionnaires included the following major stages: preparation, two forward translations, their reconciliation, adaptation and creation of an intermediate version, back-translation into English, cognitive interviewing of the adolescents, proofreading and approval of the final version by the authors of the original English questionnaires. Cognitive interviewing was performed with 10 adolescents with CKD aged 15–17 years.
Results. Four English questionnaires were identified. They were studied and comparatively analysed. Translated versions of these questionnaires into foreign languages were revealed. Two most promising questionnaires for translation into Russian were identified: UNC TRxANSITION Index and STARx. Russian versions of these questionnaires were developed based on the international recommendations. Cognitive interviewing provided additional adaptation and linguistic validation of the translated versions based on the adolescents’ opinions. UNC TRxANSITION Index is a provider-administered questionnaire and includes 32 questions. STARx is a self-report questionnaire and includes 18 questions.
Conclusions. Russian versions of questionnaires for evaluating adolescents’ transition readiness are available for use by health professionals and social workers. A further study of their psychometric properties and confirmation of the validity of their results in the context of the Russian healthcare system is required.

This review presents information on the prevalence, pathogenesis, clinical manifestations, diagnosis and treatment of Duhring’s dermatitis herpetiformis. Although the disease was first clinically described in 1884 by the American dermatologist L.A. Duhring, the study of its pathogenesis and the search for prognostic markers of its occurrence continue. Against the background of a significant expansion of ideas about gluten-dependent diseases and conditions, views on the mechanisms of autoimmune skin damage in dermatitis herpetiformis are detailed. A strong association with hereditary predisposition through the major human leukocyte histocompatibility complex (HLA) DQ2 and DQ8, and a role of epidermal transglutaminase as a major autoantigen in dermatitis herpetiformis are shown. The hypotheses explaining the decline in the incidence of dermatitis herpetiformis in recent decades against the background of increased and more effective serological screening and the resulting earlier diagnosis of celiac disease are commented on. A typical clinical picture of dermatitis herpetiformis, in which erythematous papules, plaques, vesicles are seen, usually clustered on the flexural surfaces of the extremities. Secondary elements are erosions, excoriations and crusts due to rupture of blisters and due to scratching caused by intense itching. A generally favourable prognosis for life and disease is shown with a gluten-free diet and the use of dapsone, glucocorticoids and, if these are ineffective, immunosuppressants. The authors describe a clinical case of the disease in an adolescent girl with a typical clinical history and characteristic rashes on the extensor surfaces of the limbs. The authors show that drug therapy without a gluten-free diet cannot be considered effective, and that the diet for dermatitis herpetiformis, like that for celiac disease, is lifelong. The growing understanding of gluten-associated pathology, which includes dermatitis herpetiformis, in recent decades has led to an intensive search for diagnostic and prognostic markers, as well as the development of ways to correct this group of diseases, including those not related to the lifelong elimination of cereal prolamines.

Introduction. Bone cysts are one of the most common tumor-like bone diseases of childhood, most often occurring in the 1^st and 2^nd decade of life. According to the world medical literature, there is still no consensus on the best methods of treating bone cysts.
Aim – to evaluate the effectiveness of surgical treatment of aneurysmal bone cysts (ABC) in children with the use of allografts of biological (animal and human) origin.
Materials and methods. This study included 56 pediatric patients with ABC treated at The National Medical Research Center for Children’s Health, Russia, Moscow. 37 patients with aneurysmal bone cysts (29 active ABC, 8 inactive ABC) underwent surgical treatment. Our follow-up period ranged from 12 months to 80 months. In the postoperative period, the examination was carried out at a period of 3, 6, 12, 18, 24 months and then once a year, while assessing: the presence/absence of the recurrence (radiologically), the timing of functional recovery of the operated segment, the timing of X-ray reconstruction of the graft, the assessment of physical and emotional components of the patients’ quality of life were evaluated using the PedsQL questionnaire at admission and within 12 months from the date of surgery.
Results and discussion. In 37 cases of surgical treatment of ABC with the use of allografts of biological origin, the recurrence presented in 7 patients (19%) – these patients, who had an active ABC, required repeated surgical interventions. The average time of complete bone repair in the lesion site ranged from 9 months to 22 months (14 months on average). Functional recovery of the operated segments was on average 10 months for the upper extremities and 12 months for the lower extremities.
Conclusion. The use of allografts of biological origin is effective in the case of inactive aneurysmal bone cysts. In case of active ABC the effectiveness of bone grafting with allografts of biological origin is reduced.

Introduction. Bronchial asthma (BA) pathogenesis is settled by bronchial wall inflammation, which is the main treatment target.
Aim. To study the dependence of thymic stromal lymphopoietin (TSLP) concentration in serum and nasal brush-biopsies from age, spirometry data deterioration and blood eosinophils in patients with uncontrolled BA.
Materials and methods. Patients with uncontrolled BA of three age groups: children (6–11 y.o., n = 38), adolescents (14–17 y.o., n = 35) and adults (25–50 y.o., n = 31) were included in 1-year long open prospective study. Clinical history, АСТ/сАСТ questionnaires, lung function test (LFT), common blood count, serum and nasal material to evaluate TSLP were obtained during first visit, if there were no any signs of acute respiratory infection for not less than 14 days. Maintenance therapy was revised based on first
visit findings. Patient were consequently examined twice with 6 months intervals, examination data, LFT readings, ACT results and eosinophil counts were collected. Statistical analyses included ANOVA (Kruskal-Wallis test) and Pearson’s correlation (r). Differences accepted significant with р < 0,05.
Results. Serum TSLP levels did not differ between age groups. TSLP concentration correlate directly and significantly with duration of uncontrolled BA in previous 12 months (r = 0.74). In patients with atopic BA, maximum TSLP level was in dust mites sensitized group (792.6 ± 114.1 pg/ml). We have found greater serum TSLP concentration in patients who demonstrated FEV1 below normal even on optimal controller therapy at Visit 3. Eosinophil count randomly changed inside normal values and did not correlate with asthma control or TSLP level.
Conclusion. Prognosis of future asthma exacerbations and LFT decrease is less favourable in patients with high serum TSLP level.