Introduction. Inadequate vitamin D supply worldwide is a public health problem. Low vitamin D levels during pregnancy can lead to abnormal placentation, placental insufficiency and abnormal fetal development, which contributes to poor health after birth.

Objective of the study is to analyze the vitamin D status of premature infants born in the south of Russia.

Materials and methods. A total of 141 premature infants were examined. Extremely low birth weight was found in 19 (13.4%) newborns, very low birth weight in 35 (24.8%), and low birth weight in 75 (53.2%).

Results and discussion. Premature infants had vitamin D deficiency in the majority of cases (51%), with a median of 16.9 [11.7; 22.9] ng/mL. Correlation analysis demonstrated a positive association between 25(OH)D levels and body weight in very low birth weight infants (r = 0.34, p = 0.043). Serum vitamin D concentrations were 1.6 times lower in infants whose mothers did not receive multivitamins than in those whose mothers received multivitamins, 13.8 [9.7; 20.9] and 21.6 [16.9; 28.6] ng/mL, respectively (p = 0.001). Infants with an Apgar score of 7-10 had higher vitamin D levels, 17.8 [11.9; 22.7] ng/mL, than infants with severe asphyxia, 13.8 [9.9; 16.8] ng/mL (p = 0.036). Premature infants with congenital infection had lower 25(OH)D levels than infants without an infectious process, 15.6 [10.8; 22.9] and 18.4 [14.2; 22.7] ng/mL, respectively. Children with an infectious process that subsequently ended in death had lower 25(OH)D levels than children without an infectious process (p = 0.001). Children with cerebral ischemia had lower 25(OH)D concentrations than children without cerebral ischemia (p = 0.001).

Conclusions. Premature infants born in the south of Russia have vitamin D deficiency in more than half of the cases. Administration of preparations containing cholecalciferol reduces the proportion of newborns with severe vitamin D deficiency, but does not ensure optimal serum levels. Initially low levels of 25(OH)D can be considered as an unfavorable prognostic sign against the background of the development of congenital infection.

Teeth eruption is a multifactorial process, which requires a thorough evaluation of a child's general state of health. During temporary teeth eruption, unpleasant sensation associated with swelling and tenderness in the gingival area, which is accompanied by excessive salivation, fever, rhinorrhea, increased anxiety, poor appetite, etc. may occur. Today, there are pharmacological and non-pharmacological treatments for easing the symptoms of eruption of temporary teeth. The article presents feasible approaches to the relief of symptoms that occur at this period. It draws attention to the issue of competent and timely evaluation of symptoms and signs and identification of underlying causes of babies' unwellness, as well as risks of using pharmacological products. The prevailing opinion among parents and medical professionals suggests that the symptoms of teeth eruption can and should be controlled. The local symptoms during difficult eruption of temporary teeth include gingival edema and hyperemia, as well as tenderness on palpation in the eruption area. Different pharmacological and non-pharmacological methods are used to reduce the symptom load of teeth eruption in children. One of them is a baby herbal teething gel. Therapeutic indications for using the gel are pain syndrome in baby tooth eruption (for massaging gums). No contraindications have been identified. If the gel or its components cause a hypersensitivity reaction, its use is not recommended. Active ingredients are exclusively of natural origin. Non-pharmacological treatments to ease the symptoms of temporary teeth eruption include a simple and available method - massage of predeciduous dentition. Putting pressure on them reduces the pain syndrome. Specialized silicone brushes can be used for massage. Gel-filled cooling or silicone teething toys reduce swelling and relieve painful sensation.

Introduction. Sore throat often accompanies acute pharyngitis and tonsillitis in both children and adults. Inflammation of the posterior pharyngeal wall, acute pharyngitis, almost never occurs in isolated form in children and is often accompanied by symptoms of acute adenoiditis and / or tonsillitis.

Aim. To study the effectiveness of the treatment of exacerbation of chronic non-streptococcal tonsillitis with an antiseptic herbal product in childhood.

Materials and methods. We examined 58 children diagnosed with exacerbation of chronic tonsillitis for the period from June 2018 to December 2019. The age of the children ranged from 6 years 4 months up to 14 years old, the average age was 8.3 + 2.4 years, the group included 32 boys (55%) and 26 girls (45%). The duration of the disease ranged from 1 to 5.5 years. The exacerbations of chronic tonsillitis occured 3-4 times a year. The patients included in the study received the antiseptic herbal product in the form of drops at a dose of 15 drops five times/day for 7 days, and then 15 drops three times/day for another 7 days. The course of therapy was 14 days.

Results. The provided course of therapy resulted in the significant positive changes overtime: reduced intensity of complaints already at the second visit, significant reduction of complaints at the third visit and actual relief of complaints by the fourth visit in the patients receiving the monotherapy with antiseptic herbal product.

Conclusions. Preservation of the normal microbiome of the upper respiratory tract in children maintains effective functioning of MALT and thereby reduces the risk of the development and chronification of inflammation in the oropharynx. The antiseptic herbal medicinal product may be regarded as the alternative to antibiotic therapy in children with exacerbation of chronic tonsillitis, as it has a multifunctional effect on the mucous membranes lining upper respiratory tract, stimulates innate and adaptive immunity, and increases the resistance of mucous membranes to the pathogens.

Impaired secretion and removal of mucus from the respiratory tract are important pathophysiological links in the development of several pulmonary pathologies: chronic obstructive pulmonary disease, bronchial asthma, bronchiectasis, cystic pulmonary fibrosis, etc. In the article, modern approaches to the use of inhaled hypertonic (3-7%) sodium chloride solutions in children with various recurrent and chronic bronchopulmonary pathologies are analysed. The combination of hypertonic sodium chloride solution and hyaluronic acid can minimize the unpleasant effects of hypertonic solution, such as irritating cough caused by the effect of salt on the cough receptors of the upper respiratory tract. At the same time, hyaluronic acid has unique water-retaining properties, therefore it plays an important role in regulating the fluid balance in the lung interstitium, moistens the airways, reduces bronchial hyperresponsiveness, decreases inflammation and destroys the biofilm associated with chronic infection. The use of nebulizer inhalations with a combination drug containing hypertonic sodium chloride solution and hyaluronic acid has proved to be successful in pulmonological pediatric practice. The authors have learned first-hand that this combination is highly efficient. The described clinical cases demonstrate the positive experience of inhaled use of the domestic combination drug of 3% hypertonic sodium chloride solution and hyaluronic acid in the treatment of preschool patients (5 years old) with the following diagnoses: recurrent bronchitis, primary ciliary dyskinesia (Kartagener's syndrome). This inhalation therapy helped not only to improve the rheological properties of sputum, quickly restore the bronchi to health, reduce signs of inflammation of the respiratory tract, but also generally improve the patients' breathing and quality of life.

Acute respiratory infections (ARIs) still represent a considerable challenge in the infectious pathology patterns. ARIs are included in the list of diseases with the greatest economic importance in the Russian Federation. According to the State Report on Sanitary and Epidemiological Welfare of Population in the Russian Federation in 2020, ARIs hold a dominant position in the infectious and parasitic disease patterns. The issue of concomitant infection is extremely topical today. Three scenarios of interaction between respiratory causative pathogens may develop in co-infections: synergism (more severe progress of a disease as compared to mono-infections), antagonism (milder progress of an infectious disease) or indifference (absence of interaction between two infectious pathogens, as a result of which a disease develops as two separate infections). A clinical symptom presentation of a disease may be distorted, as new symptoms that are not typical of the traditional progression of each of the infections may appear. In clinical practice, antibacterial therapy is often prescribed in cases where etiological infectious agents are not identified, and a reference point is the clinical characteristics of a disease and the severity of patient's condition that is most frequently caused by intoxication symptoms and intensity of feverish reaction and is exhibiting similar symptoms in viral and bacterial ARIs. That is why the rapid identification of the causative agents can help avoid irrational therapy and polypragmasia. The article provides a clinical case of the treatment of ARI of concomitant etiology which required a differentiated approach and prescription of an antiviral drug.

The history of the use of fermented, easily digestible products in the treatment and for prolonging life began long before their basis was called probiotics. Recipes for fermenting milk from various animals, endowing it with healing properties, have a long history. The first descriptions of fermentation of milk for making sour milk drinks and cheese are documented in the sacred writings of Indians and date back to about 2000 B.C. The first attempts to explain the secrets of sour milk began only in the second half of the XIX century and are associated with the works of outstanding scientists of the time - Louis Pasteur, Henri Tissier, I.I. Mechnikov, Stamen Grigorov and others. Today, in the usual sense, probiotics are living microorganisms that benefit the host when administered in adequate quantities. It is quite obvious that belonging of a probiotic strain to different species and types of bacteria determines a different set of immunological and non-immunological effects, as well as a number of specific, unique qualities. Lactobacillus reuteri is one of the most well-studied species with respect to both efficacy and safety. The beneficial health effects of L. reuteri strains (DSM 17938, ATCC PTA 6475, ATCC PTA 52899) have been confirmed in more than 200 clinical trials with the participation of about 18,000 people of all ages. The article most fully describes the effects of L. reuteri DSM 17938, the use of which is not limited to the well-known means of prevention and treatment of infantile colic.

Constipation in children is currently one of the major complaints that parents present at a pediatrician's appointment. The article discusses the issues of diagnosis and treatment of functional constipation in children based on the international and Russian clinical guidelines. The following are some major causes of constipation in young children. Constipation is most often caused by colon dyskinesia (hypo- and hypermotor disorders), impaired and painful bowel movement (spasm of the rectal sphincters, weakened smooth muscle tone, etc.) or a combination of these factors. In rare cases, the cause of constipation is organic disorders. Also, low parental socio-economic status, low educational level, depression, neuroticism, attitude of parents towards their children's upbringing such as being overprotective, and attitudes that promote high or low levels of autonomy, increase the risk of functional constipation. In addition, the article sets detailed factors leading to constipation in older children and adolescents. The pathogenesis of functional constipation is given, and the problem of psychological constipation is described. The outlined therapeutic approach includes dietary intervention, compliance with drinking water treatment, behavioural and drug therapy. The author presents its own experience of using sodium picosulfate to treat constipation in children. Constipation in children is a common problem, functional constipation accounts for 95% of cases, therefore in most cases they do not require clarifying diagnostic methods. Besides, you shouldn't forget about the possibility of organic pathology, malformations in young children. Constipation in children requires the timely administration of complex treatment.

Goat milk has a long history of use in human nutrition. There are currently many studies examining the functional characteristics and nutritional value of goat milk and its importance in the production of various dairy products. Before, native goat milk was widely used for feeding young children if the breastfeeding was impossible. To date, however, the practice of feeding unmodified goat milk, as well as cow milk, to infants under 12 months of age is strongly discouraged, as this leaves them exposed to the risk of electrolyte imbalance, as well as iron, folic acid, and vitamin B₁₂ deficiencies. Commercial production of formulas based on goat milk began in the 1980s, and since then there have been many studies which show the safety and effectiveness of these formulas. The review provides the latest evidenced-based information on the composition and functional properties of individual components of the goat milk and goat milk formulas. The protein and amino acid composition of goat milk, as well as the features of its effects on the formation of the infant's intestinal microbiota, are described in detail. The studies investigating goat milk oligosaccharides and their similarity to human milk oligosaccharides are presented. The characteristics of the goat milk fat profile have been demonstrated. As an example of an adapted goat milk formula, a formula designed to meet all standards is presented. The fat profile of the presented formula is modified by introducing a patented lipid complex consisting of β-palmitate in its composition. In addition, the presented formula composition includes such oligosaccharides as galacto- and fructo-oligosaccharides, which availability ensure the formation of an optimal intestinal microbiota.

Introduction. Glucometers are the most available devices for glycemic control in children with type 1 diabetes mellitus (DM1). Changing social conditions and development of modern technologies can influence patients' preferences.

Aim. To study the factors affecting the choice and usage of glucometers in children and adolescents with DM1 in real clinical practice

Materials and methods. In 06.2020-05.2021, 107 patients 12.0 (8.8; 15.0) years with DM1 for 4.4 (2.0; 7.6) years filled in a questionnaire about the usage of glucometers.

Results and discussion. While questioning patients used glucometers Contour (34 patients, 31.7%), OneTouch (33, 30.8%), Accu-Check (33, 30.8%), Satellit (3, 2.8%), AiChek (1, 0.9%), Easy Touch (1, 0.9%). Children start to use glucometer together with parents at 4.5 (4.0; 5.3) years, by themselves - at 6.0 (5.0; 7.0) years. Do not clean hands before finger puncture 55 (51.4%) patients, use wet wipes - 24 (22.4%), use antiseptics - 26 (24.3%), wash hands with soap - 2 (1.9%). Episodes of inflammation at the sites of punctures were reported by 21 patients (19.6%); patients using antiseptics faced with inflammation significantly rarer than others - OR = 2.7 (95% CI 0.6-12.6). Errors of glucometers were reported by 48 (44.9%) patients independently to method how they clean hands. Choosing glucometers patients pay attention to accuracy (76, 71.0%), blood drop volume (48, 44.9%), memory amount (22, 20.6%), size of device (22, 20.6%), mobile application (17, 15.9%), invisibility (10, 9.3%), design (7, 6.5%); and lightening, comfortable blood pin, battery indicator, possibility to add blood sample (1 per each, 0.9%).

Conclusion. Children and adolescents with DM1 use glucometers Contour, OneTouch, and Accu-Check more often. Self-dependent usage of glucometers starts at preschool age. The majority of patients do not clean hands before puncture of a finger; antiseptics usage decreases the probability of inflammation. Choosing glucometers patients pay attention to technical characteristics and comfort.

Diabetes mellitus (DM) in children has an impact on the social world of the child, changing his environment and his own role. A comprehensive approach to the treatment of diabetes in childhood involves taking into account the characteristics of a growing organism, analyzing socio-psychological factors and individual personality traits. The article analyzes the significant social spheres in which a child's relationships are built: family, non-family environment (peers and other children, educators, teachers, doctors). Special attention is paid to the negative impact of the Internet and social networks on the formation of opinions and attitudes of a child with diabetes and his parents to doctors and treatment. One of the tasks of DM therapy is to create a social situation that will contribute to the formation of personal qualities in a child that are necessary for managing the disease and maintaining psychological well-being. The tools for implementing this direction are both traditional diabetes schools and promising types of programs with the creation of groups of children involved in active joint activities: artistic, sports, dance, intellectual, etc. As an example of an innovative approach to teaching, adaptation and inclusion of children with diabetes in society, the social health and educational program “Diabetes. Dances. Children”, which has been implemented since 2020 in Moscow. The program is attended by 15 children and adolescents with diabetes (5-15 years), diabetes experience from 2 months to 10 years. The features of the program consist in the adaptation of dance and physical activities to the glycemic indices of children in dynamics; participation in the program of children, their family environment and friends; accompanying endocrinologists and clinical psychologists; conducting seminars for children and parents as part of an educational marathon; participation of children in dance competitions and festivals, video filming and various creative events.

Introduction. Congenital hyperinsulinism is a rare group of genetic disorders resulting in persistent hypoglycemia which can lead to delay of neurodevelopment.

Aim. To assess psychomotor development and certain neurophysiological parameters of children treated for congenital hyperin-sulinism.

Materials and methods. This prospective and retrospective cohort study included 73 infants with congenital hyperinsulinism admitted to the National Almazov Research Centre from 2017 to 2021. All subjects underwent standard clinical examination including physical and neurological assessment as well as 18F-DOPA PET/CT, genetic testing, electroencephalography. Developmental screening was performed using “Ages and Stages” questionnaire in 33 subjects. Possible risk factors for neurode-velopmental sequelae due to hypoglycemia were analyzed.

Results and discussion. Normal neurodevelopment in general was observed in 23 subjects (69%), 10 patients had developmental delay. Focal form of CHI had the greatest modifying effect on positive neurodevelopmental outcome in general. Individual skills such as communication, fine and gross motor, problem solving in children with a focal form of CHI were significantly better than those with a nonfocal forms. Age of manifestation and verification of the disease, the minimum level of glycemia and the maximum level of glucose utilization did not significantly affect the formation of either individual skills (with the exception of gross motor skills) or psychomotor development in general. The indicators of gross motor skills in children with a lower level of glucose utilization turned out to be significantly better. Kaplan-Meier survival analysis showed that the alpha rhythm appearance was significantly earlier in patients with a focal form of CHI and with earlier verification of the diagnosis (<28 days of life).

Conclusion. The focal form of the disease has the greatest modifying effect on the positive outcome of the psychomotor development. The age-appropriate gross motor skills were observed more often in the group of children with low glucose disposal rates. The association of the early occurrence of the alpha rhythm with the focal form of congenital hyperinsulinism, as well as with the early verification of the disease, was found.

Chronic inflammatory skin diseases are accompanied by the development of objective and subjective symptoms, which are manifested by erythema, edema, infiltration, accompanied by itching of varying severity. The goal of treatment of chronic skin diseases is resolution of objective symptoms and reduction of subjective complaints. Currently, the stages of treatment of varying degrees of severity of chronic dermatoses are defined. Topical glucocorticosteroids are traditionally used in treatment, which have a pronounced anti-inflammatory, immunosuppressive, antiproliferative effect, but the presence of side effects limits their use. In clinical practice, topical calcineurin inhibitors are successfully used, which, along with topical glucocorticosteroids, have an anti-inflammatory effect, reduce the intensity of itching. This article discusses the possible use of pimecrolimus cream 1% in atopic dermatitis and chronic dermatoses (off-label): psoriasis, squamous lichen, rosacea, lupus erythematosus, focal scleroderma, vitiligo, mastocytosis. Pimecrolimus 1% is administered to patients of different age groups in areas with thin sensitive skin, increased resorption capacity, on mucous membranes. Long-term use of pimecrolimus 1% both as a monotherapeutic agent and in combination with other external medications is safe, allows to stop objective and subjective clinical symptoms of diseases, gives an opportunity to use it as a proactive therapy. Long-term clinical studies confirm the safety of the use and long-term use of pimecrolimus cream 1% in different age groups and at different lesion areas. The use of pimecrolimus in skin and mucosal lesions is very promising. Long study of the drug in various dermatoses in different age groups proves its effectiveness and safety.

Atopic dermatitis (AD) is more common in children, but can also occur in adults. Doctors of different specialties, including pediatricians, dermatologists, allergists-immunologists, gastroenterologists and infectious disease specialists deal with this problem. Despite the efforts of pediatricians, the problem of AD remains pressing. The progressive growth of this disease among children and increased persistence in adulthood make it important to study the mechanisms of AD not only for dermatology, but also for the health care system as a whole. The presence of pruritus is an obligatory manifestation of AD, which entails an inevitable decrease in the quality of life of patients. Thus, there are prerequisites for the emergence of new concepts of pathogenesis and the search for the most effective therapeutic methods of treatment. Currently, AD is considered as an interaction of endogenous (impaired immune response, insufficient function of the epidermal barrier) and exogenous factors (exposure to allergens, chemical or physical irritants, microorganisms). The work presents clinical cases of topical calcineurin inhibitor use in the treatment of moderate-to-severe AD. We presented patients with complaints of rashes accompanied by intense itching, on the skin of the extensor surfaces of the limbs, on the skin of the face and torso. Application of topical cal-cineurin inhibitor resulted in reduction of severity of subjective and objective symptoms of various forms of atd. The efficacy of topical calcineurin inhibitors in the treatment of atd with a pronounced anti-inflammatory and antipruritic effect was confirmed. Long-term staggered scheme of their use is the most pathogenetically justified and safe method of treatment of moderate forms of AD.

Introduction. The causative agent of chickenpox is ubiquitous. In children, especially with a burdened premorbid background, there is a high incidence of severe forms and complications.

Aim. To study the course of chickenpox in children in modern conditions.

Material and methods. 58 pediatricians (group 1), 42 parents of children aged 0 to 3 years (group 2) and 43 parents of children aged 3 to 6 years (group 3) were surveyed.

Results and discussion. In the 1^st group, 224 children (73.68%) had a long period of rashes, 57 children (18.75%) had a mild and not long period. At the age of 16, unvaccinated children first fell ill with chickenpox. In 23 patients (7.57%), there were obvious clinical manifestations of chickenpox with a pronounced and prolonged intoxication syndrome. In 67.43%, a positive Mantoux test was recorded with an increase in papule and corolla of hyperemia in dynamics. The development of complications significantly more often (p = 0.0429) was recorded in the group of children with aggravated premorbid background. All pediatricians are positive about vaccination. In the 2^nd group, out of 37.5% of parents who are against vaccination, 16.67% believe that the vaccine does not always have a positive effect on the health of the child. The ineffectiveness of vaccines is recognized by 45.83% of respondents. 40.47% of children have not been vaccinated and they do not have vaccination certificates. In the 3^rd group, 32.56% of children were ill with chickenpox, of which 79.07% had a mild form of the disease. 67.44% have a positive attitude towards vaccination against chickenpox. The coverage of all vaccines according to the National calendar was 100%.

Conclusion. Chickenpox is a serious unsafe infectious disease that requires specific prophylaxis.

Introduction. BCG vaccination is included in the vaccination schedules of many countries. Numerous studies show its high efficacy, especially in regions with a high prevalence of the disease, and the limited efficacy of revaccination.

The objective of the study: to estimate the occurrence of clinical forms of childhood tuberculosis (TB) depending on BCG vaccination in regions with a high prevalence of TB.

Materials and Methods. The research design is a retrospective continuous comparative study. We analyzed the data of registration forms No. 089/y-tub of children aged 0 to 17 years with primary active tuberculosis (n = 450) over the period from 2017 to 2020 in Primorsky Territory. Children were divided into groups: 0-3 years old (n = 124), 4-6 (n = 88), 7-10 (n = 61), 11-14 (n = 75), and 15-17 (n = 102).

Results. Contact with TB patients was a significant risk factor for children aged from 0 to 3 years.The study revealed a significant predominance of primary tuberculosis among non-BCG-vaccinated children aged 0 to 17 (60.7 and 84.2%, χ² = 8.234, p = 0.005). Secondary tuberculosis prevailed in vaccinated children (32.3 and 5.6%, χ² = 12.094, Pearson's contingency coefficient was 0.134 for primary forms and 0.162 for secondary forms).

There were no significant differences between the generalized and extrapulmonary forms depending on the vaccination. At the same time, extrapulmonary forms were more common in unvaccinated children (4.9 and 10.5%, χ² = 2.217, p = 0.137). Revaccination had no significant effect on the occurrence of clinical forms of TB.

Conclusions. BCG vaccination has a protective effect against TB. The main preventive measures are early diagnosis of latent tuberculosis using a recombinant tuberculosis allergen skin test. Also, preventive therapy protects against endogenous and secondary TB. No convincing evidence of an additional protective effect of BCG revaccination was obtained.

Introduction. When performing thermometry, different measuring instruments can be used: from contact individual to remote. Doubts about the accuracy of the measurements obtained arise in the course of severe infections, impaired general well-being, a feeling of fever, headache.

The aim of the study was to evaluate the effectiveness of daily monitoring of body temperature in children with COVID-19 coronavirus infection and other acute respiratory viral infections using a medical thermograph designed to graphically display the dynamics of changes in the child's body temperature during the day to monitor its variability, compared to a halystone thermometer.

Materials and methods. The clinical study was performed at two clinical sites of the Academician G.N. Speransky Department of Pediatrics, Russian Medical Academy of Continuing Professional Education: the Khimki Regional Hospital and the Z.A. Bashlyaeva Children's City Clinical Hospital. The study included 120 children aged from 3 months to 3 years, divided into 4 groups. Group 1 and 2 were children with ARI, Group 3 and 4 were children with COVID-19. Body temperature in the 1st and 3rd groups was measured only by a halistane thermometer; in the 2nd and 4th groups - by a new generation intellectual thermograph with halistane thermometer control in the specified time intervals.

Results. The study obtained high reliability of indicators of the new thermograph, designed to graphically display the dynamics of changes in body temperature during the day, compared with the halistane thermometer, commonly used in hospitals.

Conclusions. The thermograph registers the child's body temperature with high reliability, which makes it possible to react to its changes in time. The use of thermograph makes it possible to set the critical value of body temperature at its rise for each user individually depending on his premorbid background, which is especially important in the group of children with a high risk of febrile convulsions and microcirculatory disorders in terms of prevention of the possible development of adverse events.

Introduction. Celiac disease is an immuno-mediated systemic disease, which is defined as intolerance to gluten and the corresponding prolamins in the mucous membrane of the small intestine in genetically predisposed children, and is characterized by the development of atrophic enteropathy. The seronegative form of celiac disease, in which serological markers are not determined, but the development of appropriate symptoms and the effect of gluten-free diet (GFD) is observed, still remains a diagnostic and therapeutic dilemma.

Objectives. Analysis of a clinical case of a child with seronegative celiac disease (SNCD).

Results. The disease in a young child before the final diagnosis was severe due to chronic diarrhea and severe flatulence. The girl received outpatient treatment at the place of residence several times with a short-term positive effect, the condition worsened in dynamics: the child lost weight, stopped walking. At the age of 5, she was hospitalized in the gastroenterology department of the Republican Specialized Scientific and Practical Medical Center of Pediatrics, where, on the bases of normal values of antibodies to tissue transglutaminase and total IgA and IgG (анти-tTG IgA and G), changes in biopsies of the mucosa of the postbulary department of the duodenal bulb, characteristic of Marsh 3, and the presence of HLA DQ2, seronegative celiac disease was supposed to diagnose. The girl was prescribed GFD, symptomatic drug therapy was performed. The dynamics of the condition has improved. After 6 months, at the second visit, there were no gastrointestinal symptoms, physical development corresponded to age, what could help to confirm diagnosis of seronegative celiac disease.

Conclusions. This clinical case in a girl with a classic form of celiac disease and severe atrophy of the mucosa of the bulbous small intestine, HLA DQ2, was accompanied by normal values of анти-tTG and total IgA. Treatment of a gluten-free diet was very effective: the girl fully compensated for weight deficiency and laboratory tests.

Fever is a defensive and adaptive reaction of the body that develops in response to the action of pathogenic stimuli. It often accompanies various infectious, autoimmune, oncohematological and other diseases. Due to the frequent significant deterioration of children's general health, the occurrence of fever in children gives rise to concern not only in parents, but also in pediatricians. According to temperature level, fever can be classified into different categories: subfebrile - 37.1 to 37.9 °C, moderate -38 to 39 °C, febrile - 39.1 to 41 °C and hyperthermic - above 41 °C. By clinical manifestation distinguish benign, or rose, and malignant, or white, fever. The need to use antipyretic drugs depends not only on the hight of the body temperature elevation, but also on the patient's general health. The clinical guidelines state that the use of acetylsalicylic acid, nimesulide and met-amizole to lower the body temperature in children is not recommended, due to high risk of adverse reactions. Ibuprofen and paracetamol are the drugs of choice to lower body temperature in children both in Russia and abroad. Over 120 comparative studies of these two drug formulations have shown their close efficacy, but ibuprofen is most preferred for the treatment of fever and pain. In order to lower body temperature, parents can uncontrollably use antipyretic drugs in various combinations and incorrect dosages, which leads to severe toxic effects. The article presents a clinical case of Reye's syndrome in a 10-year-old girl, which is most likely associated with the use of aspirin as an antipyretic.

Introduction. Chronic liver diseases in children are accompanied by fibrocirrhotic transformation of the organ. Modern ultrasound diagnostic procedures offer a method that can differentiate between the fibrous and unchanged tissues. The paper includes the results of a study of liver stiffness in healthy children using shear wave elastography. The method presented in the article can come to an active use in the non-invasive detection of fibrosis as part of the integrated assessment of liver in pediatric practice. Aim. To study the stiffness of unchanged liver in children of different gender and age groups.

Materials and methods. Shear wave elastography was performed in 200 healthy children aged 3 to 18 years (103 girls and 97 boys) using Aixplorer apparatus (Supersonic Imagine, France), in three age subgroups: a 3- to 6-year-old group (n = 103), a 7- to 11-year-old group (n = 52), and a 12- to 18-year-old group (n = 45). The measurements were taken in different segments of the right lobe of the liver, in the area free from the vascular structures, fixing the zone of scanning at the depth of 3-5 cm from the capsule. Not less than 10 measurements were made, which enabled to calculate the mean value of liver elasticity.

Results. The study identified the liver stiffness measurement normal range in a group of healthy children. Significant differences in liver stiffness were obtained by comparing the values of 3- to 6- year-old and 7- to 11-year-old groups (P = 0.001); 3- to 6-year-old and 12- to 18-year-old groups (P = 0.001); there were no statistically significant differences in the stiffness values depending on gender (P = 0.345).

Conclusions. Young modulus values obtained may be used as normative. The use of shear wave elastography enhances the accuracy of the conventional ultrasound examination in identifying patients with liver disease.

The gut microbiota is a complex collection of bacteria, viruses, protozoa, archaea, and fungi colonising the human gastrointestinal (GI) tract. The microbiota plays a fundamental role in keeping the body healthy and the development of various diseases, including mental ones. Clinical studies have showed that there exists a bidirectional communication between the gut, microbiota and brain within the brain-gut-microbiome axis. It is understood that gut microbes play a role in many mental disorders and may be a potential therapeutic target. The nervous system and GI tract communicate through a bidirectional signalling network that includes multiple pathways, among which are the vagus nerve, the immune system, the hypothalamic-pituitary-adrenal axis, some transmitters, and bacterial metabolites. The available data indicate the mutual influence of the microbiota and the activation of inflammatory processes in the brain. Psychobiotics have been increasingly used for the management of the microbiota in case of injury of this pathway. The term that was used for the first time in 2013 defined psychobiotics as probiotics, which have a positive effect on mental health provided that they are taken orally at adequate doses.

Afterwards they were included in the definition, given the proven benefit of prebiotics. Thus, psychobiotics are beneficial bacteria (probiotics) or auxiliary substances for such bacteria (prebiotics) that affect the communication and interactions between bacteria and the brain. Following ingestion, probiotic bacteria concentrate mainly in the intestinal epithelium, providing the host with nutrients and influencing the immune system, as well as producing neuroactive substances that act on the brain-gut axis. This review is devoted to the new interesting area that correlates the gut microbiota with nervous system diseases and its possible treatment with psychobiotics.

Introduction. Intraoperative control of bleeding during surgical treatment of juvenile nasopharyngeal angiofibroma (JAN) remains controversial. There is no consensus as to the routine use of preoperative embolization, given its high cost and inconsistent availability of the procedure in care centers. There were no publications devoted to the comprehensive pharmacoeconomic analysis of preoperative vascular embolization (PVE) occlusion classes on the surgical treatment of JAN by the time of publication Aim. To evaluate pharmacoeconomic value of preoperative vascular embolization (PVE) occlusion classes (non-embolized, incomplete and complete) on the surgical treatment of JAN.

Materials and methods. A total of 139 patients who underwent JNA surgical resection in 2013-2021 time period were identified. All of these patients were treated in National Medical Research Center for Children's Hematology, Oncology and Immunology named after Dmitry Rogachev. We evaluated JNA surgical resection outcomes, length of stay (LOS) with prognostic factors using a multiple linear regression (MLR), cost-per-day (CPD), cost-minimization analysis (CMA), cost-utility ratio (CUR), willingness to pay (WTP) with purchasing power parity (PWP).

Results and discusion. Surgical transnasal endoscopic treatment of JAN in the quaternary healthcare center, regardless of the degree of embolization and the presence/absence of intraoperative blood transfusion, is at the willingness-to-pay threshold for the healthcare system of the Russian Federation. The most cost-utility method of treatment remains the absence of embolization (within clips placed in the larger diameter vessels). and the absence of blood transfusion, the least cost-utility method is the incomplete embolization, regardless of the presence/absence of blood transfusion.

Conclusion. The results of the pharmacoeconomic study emphasize the high significance of the rejection of routine preoperative vascular embolization of JAN and implementation of standard risk-adapted treatment algorithm for indications of preoperative vascular embolization. Which is particularly important for resource allocations and health policy decision making to increase the efficacy and safety of the JNA treatment.

The article presents a clinical case of systemic juvenile idiopathic arthritis that began after a spinal injury in a 9-year-old child. The authors noted the importance of dysregulation of the innate immune system in the pathogenesis of systemic juvenile idiopathic arthritis that entitled this variant of the disease to be regarded as autoinflammatory, and not “classical” autoimmune diseases. The article emphasized the leading role played by interleukin 6 in the development of extra-articular manifestations of the disease (fever and thrombocytosis, stimulation of hepatic production of acute-phase proteins of inflammation, anaemia, inhibition of the production of adrenocorticotropic hormone and cortisol, production of growth hormone and procalcitonin, development of amyloidosis), highlighting the need for inhibition of interleukin 6 activity in patients receiving therapy for systemic juvenile rheumatoid arthritis. It stressed the importance of early initiation of therapy from the standpoint of modern understanding of the pathogenesis of this disease: the use of new biological agents, which action is directed at interleukins 1 and 6. This approach is associated with inefficiency of such drugs as corticosteroids, methotrexate, tumour necrosis factor inhibitors. Of no less importance is the fact that the use of these biological agents can significantly reduce the effect of corticosteroids. The course of the presented disease caused some difficulties in its diagnosis and selection of therapy. This is largely due to the fact that the pathology of the sacroiliac joint is extremely difficult to diagnose clinically. Inflammatory immune response associated with trauma may be accompanied by cytokine release, free radical accumulation and apoptosis, pointing to the need to exclude juvenile spondyloarthritis and other juvenile arthritis with a view to administer adequate therapy. In this case, an attempt to treat sacroiliitis as an inflammatory disease was unsuccessful. The focus on persisting fever, arthralgia, anemia, lymphadenopathy, high values of acute phase parameters in the patient, who received courses of antibiotic therapy, allowed the doctors of the surgical department to refer the patient to a specialized pediatric rheumatology department. Resistance to glucocorticoids and a tumour necrosis factor inhibitor (etanercept) was also noted. The successful result of the use of tocilizumab (interleukin 6 receptor blocker) includes: relief of visceral manifestations, normalization of laboratory activity indicators of the disease that persisted for 1.5 years.

Introduction. The natural history of bronchial asthma (BA) in newly diagnosed children is not well understood.

Objective. To determine the trends in the course of mild BA in children over 3 years from the date of initial diagnosis.

Materials and methods. A prospective controlled study included 149 children (106 boys, 43 girls) aged 5 years to 5 years 11 months with mild BA diagnosed less than 1 year ago. During a 3-year follow-up, the severity of BA, the need for basic and emergency therapy were assessed. An increase in therapy and the severity of BA was regarded as progression of the disease; the spectrum and extension of sensitization to inhaled allergens were taken into account.

Results and discussion. Of 149 children with persistent asthma, 103 were sensitized to one or more household allergens, most frequently to cat (36.2% in the cohort) and dust mites (30.9%). During 3 years of follow-up, the patients did not develop a stable remission of BA with the possibility of canceling basic therapy for more than 6 months in a row. In children receiving basic therapy, it is typical (up to 71% of cases) that the need for therapy remains, or the volume of therapy increases (up to 27% of cases). In children who initially did not receive basic therapy, an increase in therapy is typical (63% of cases). Disease progression was noted over 3 years of follow-up in 70 (47%) patients, most often in the group who initially did not receive basic therapy (73.5%) as well as among children with polysensitization to household allergens (88.9%).

Conclusion. Dynamic observation of preschool age patients with BA shows a tendency to persistence or progression of the disease in the first 3 years from the diagnosis.

Skin immunological tests are the main method for detecting tuberculosis infection in children and adolescents. A Mantoux test with two tuberculin units (TU) PPD-L has been one of the most effective methods for detecting tuberculosis in the pediatric group over a period of many decades. The development of a new test - a recombinant TB allergen diagnostic test - has changed approaches to screening for tuberculosis infection in children. Today, both tests are used but with differentiation according to the age category of children (Mantoux test - from 1 year to 7 years, recombinant tuberculosis allergen - from 8 to 17 years). This approach was enshrined in the current directive and guidance documents in 2014. However, there is no single document that could serve as a desk book on this issue for a paediatric practitioner. Moreover, the article presents one of the most difficult issues that require knowledge of the relevant legislation and ability to conduct health education work on the part of the practitioners - the legal aspects of tuberculosis immunodiagnosis in children and adolescents in case of refusal of skin immunological testing. The low health and sanitary literacy regarding tuberculosis and its prevention in the population can also be viewed as a result of the use of mass media on the issue by non-professionals. It should be noted that some of the documents are published on the website of the Russian Society of Phthisiologists as guidance manuals and clinical recommendations, which are overlooked by practitioners of general medical institutions. The summation of directive and guidance documents on all issues of the use of skin immunological tests with comments is aimed at enhancing knowledge and, accordingly, the effectiveness of their use.

Introduction. According to the results of available studies, health status of cadets is often higher than in general population, however, data shows unfavorable trends in the physical development of cadet boys.

Aim. Analysis of cadets' physical development.

Materials and methods. 122 cadet boys aged 12-15 were included in the study using the continuous sampling method. All children underwent anthropometry, bioimpedance analysis and measurement of the functional state of the body. The results were evaluated in accordance with centile chart.

Results and discussion. The majority of children (80 - 65.6%) had 1st health group. The most common pathology was refraction disorders (14 - 11.5%) and urological pathology (9 - 7.4%). Height of the majority of the examined boys was in the average values, however, short stature was found out in 4 (3.3%) cases. According to BMI, 4.9% (6) of children were underweight, 32.0% (39) - overweight and 4.1% (5) had obesity. According to percentage of fat mass by bioimpedance analysis, 4.1% (5) were underweight, 27.0% (33) - overweight and 22.1% (27) were obese. Muscle strength values below the average were in 11.5% (14) of boys, and muscle strength by kg of weight - in 36.1% (44). Almost a third (33 - 27.0%) of children had high blood pressure, and another 10 people (8.2%) had arterial hypertension. According to the results of the Martinet-Kushelevsky test, nine children had pathological type of reaction to dosed physical activity. Low resistance to anaerobic exercise by Genchi test was found in 19.7% (24) of children. The results of the coordination test showed unsatisfactory results in the majority of children - 48.4% (59).

Conclusion. Physical development of adolescent boys studying in the cadet corps was average. High percentage of boys, although less, then in general population, were overweight and obese. Despite seemingly optimal nutrition, daily routine and physical activity provided in cadet corps, 20% of children had low resistance to anaerobic exercise, low strength index and non-physiological response of the cardiovascular system to dosed physical activity.

Autism spectrum disorders in children is a very urgent problem. Today, there is an increase in the number of children suffering from autism spectrum disorders around the world. The relevance of early diagnosis of autism spectrum disorders for timely treatment and correction is high. However, the diagnostic criteria for ASD require an assessment of certain psychomotor skills in a child, which mature much later than necessary for a timely diagnosis, so the diagnosis is made by 5-7 years. New clinical guidelines suggest that primary screening should be performed by a pediatrician. However, practice shows that in reality this does not happen. The reason for this is not only a contradiction in the diagnostic criteria, but also the current ICD-10 classification, which does not reflect the pathogenetic processes in the child's body. Despite this, new clinical guidelines recognize the role of genetic disorders and epigenetic factors in the development of autism spectrum disorders. In this regard, it is proposed to consider autism spectrum disorders as a syndrome that accompanies various genetic disorders, both chromosomal and monogenic anomalies. This approach enables early diagnosis of autism spectrum disorders, as well as the development of treatment and correction methods based on pathogenetic disorders. Currently, more than 100 genes associated with autism are known. In the above studies, it was noted that the polygenic nature of disorders in autism does not allow focusing on phenotypic features. Probably, this is the reason for the difficulties in diagnosing autism by external signs and the low efficiency of the currently known screening methods for diagnosing autism spectrum disorders. Therefore, autism spectrum disorders must be considered from the point of view of pathogenetic changes in the child's body, usually of a hereditary nature, which will allow us to offer effective methods of diagnosis, treatment and correction.

The article is dedicated to the 40th anniversary of the pediatric endoscopic service of the Republic of Karelia. In the introductory part of the article, the authors briefly describe the history of the appearance of endoscopy in the world, which dates back to 1881, when J. Mikulicz-Radecki designed and first used a rigid gastroscope in an adult patient, and then developed very slowly for a long time. Isolated attempts to use gastroscopy, bronchoscopy, and laparoscopy are described. For laparoscopy, a frontal reflector, electric lamps, mirrors were used, and later - the first cystoscopes and rectoscopes. In 1890-1930, there were only a few publications per decade devoted to the development of endoscopic technology. In the Republic of Karelia, the formation of the endoscopic service is associated with the formation of the Karelian Center for Pediatric Surgery. Gastroscopies were initially performed with rigid endoscopes and the main reasons for the appointment of such studies were injuries and burns of the esophagus. The first gastroscopy of a teenager was performed in March 1982, an artifact is presented - a photo of the conclusion of this study. The authors tell about the stages of the formation of the service in the Republic of Karelia. In pediatric practice, the most difficult contingent of patients are newborns and premature babies. Endoscopies for newborns have been performed since 1985. Intraluminal endoscopic interventions have been performed since 1989, and diagnostic laparoscopies have been performed since 1990. Since 1991, laparoscopic operations have been performed under visual control - 57 interventions were performed before the appearance of video resistance. We also recall the period of the economically difficult last decade of the twentieth century, when the development of the endoscopic service continued thanks to the supply of equipment from the twin city of Tubingen. With the advent of the video system, the endoscopic service has gradually developed to the modern level, at which the entire main range of endosurgical interventions is performed.