ENT diseases are one of the most common reasons for visiting a doctor, especially in paediatric practice. The issue of interdisciplinary interactions between otorhinolaryngologists and paediatricians, their consistency in choosing therapy is extremely important. About 90% of morbidity rates relate to acute infectious respiratory viral etiology, which is characterized by high transmissibility and variability of manifestations. Particular attention should be paid to children attending preschool facilities, as they can catch acute respiratory viral infections up to 8 times a year, and 10-15% of them up to 12 times a year, which is 2 times more often than children who do not attend school, kindergarten, or any other educational facilities. The premature and unjustified prescription of antibacterial drugs, both local and systemic, remains a serious problem in the choice of therapy, which leads to increased number of antibiotic-resistant bacterial strains. Therefore, the issue of prevention and rational therapy, improvement of its effectiveness by the use of safe drugs appears relevant. The article points out that the irrigation-elimination therapy has been and remains the foundation of the prevention and treatment of diseases of the nasal cavity, paranasal sinuses and nasopharynx. The effectiveness and safety of this therapy has been studied and proven in the studies, and the inclusion of irrigation-elimination therapy in the international consensus documents such as EPOS 2012 and ARIA 2008 allows it to be widely used for the treatment of various ENT pathologies. It should be noted that availability of irrigation salt solutions with silver ions have significantly added to the possibilities of keeping the use of more aggressive drugs to a minimum, especially if the course of the disease is not complicated. Aquanasal drug containing natural Altai mineral water rich in silver ions is one of the commonly used drugs of a similar character with a wide range of indications, which has anti-inflammatory, anti-edematous, antimicrobial, antifungal and antiviral effects.

This article discusses the use of antibacterial therapy in the treatment of acute rhinosinusitis in children. The main problems causing the need for maximum rationalization of the use of systemic antibiotics in the treatment of respiratory pathology are listed. Indications for systemic and topical antibacterial therapy for acute rhinosinusitis in children indicated in Russian clinical guidelines were noted. The possibilities of using the combined drug thiamphenicol and N-acetylcysteine in the treatment of acute rhinosinusitis in children are considered separately. As an example, a model of the clinical situation at the outpatient stage of treatment, in which the use of inhalation therapy is advisable, is given. It is concluded that inhalation therapy with a combination drug of thiamphenicol and N-acetylcysteine in the treatment of acute rhinosinusitis is a reasonable choice in case the doctor doubts the need for systemic antibacterial therapy. Taking into account the high frequency of such situations in the practice of a pediatrician and a pediatric otorhinolaryngologist, the decision in favor of topical antibacterial therapy carries significantly less costs compared to the decision to prescribe systemic antibacterial therapy. But an obligatory element of the therapeutic tactics of acute rhinosinusitis with the use of topical antibacterial drugs should be monitoring the dynamics of the patient's condition during 3-4 days of therapy. In the absence of positive changes, the doctor is obliged to reconsider the need for systemic antibacterial therapy.

At present day, generalized forms are rarely found in the structure of tuberculosis in children. A significant risk factor for the development of generalized lesions is prolonged contact with a tuberculosis patient. The diagnosis of a specific etiology is often complicated by the absence of pathognomonic symptoms. Immunodiagnostics, microbiological and molecular genetic research play an important role in the diagnosis of tuberculosis infection in children. The purpose of this study was to analyze the case of the development and diagnosis of generalized tuberculosis in a child of primary school age (7 years and 11 months) with lesions of the lungs, larynx, middle ear. The examination methods included immunological intradermal tests (Mantoux test, RTA test), in vitro test (QuantiFERON-TB), multispiral computed tomography, bronchoscopy and laboratory methods of examination. The manifestation of the disease occurred gradually with the occurrence of hypochromic anemia with a further increase in symptoms of intoxication. A comprehensive examination established a disseminated process in the lungs, larynx and middle ear lesions. Family tuberculosis contact was established when the disease was detected in a child. During the examination, the evaluation result of the Mantoux test showed an increase in sensitivity to tuberculin. The hyperergic result of the RTA test indicated the activity of MBT in the body. At the same time, the irregular conduct of immunodiagnostics using the Mantoux test, the monotony of the test did not allow timely measures to be taken in relation to the in-depth examination of the child for tuberculosis. The specific etiology of the disease was reliably confirmed by cultural and molecular genetic research methods. The child was diagnosed with generalized tuberculosis, disseminated pulmonary tuberculosis in the infiltration phase, MBT (+) with drug resistance to isoniazid, streptomycin, paraaminosalicylic acid, tuberculosis of the larynx and vocal apparatus, PCR (+) with drug resistance to isoniazid, tuberculous right-sided otitis media, MBT (+) with drug resistance to isoniazid, streptomycin, paraaminosalicylic acid. The presented clinical case indicates the need for timely detection of tuberculosis contacts, regular immunodiagnostics, and compliance with phthisiological alertness of doctors of all specialties in relation to children with long-lasting symptoms of various diseases. The complete physical examination using an intradermal RTA test (Diaskintest), microbiological and molecular genetic research methods allows to establish the tuberculous etiology of the lesion.

Introduction. Acute respiratory viral infections hold a dominant place in the infectious diseases pattern. There are many drugs that can affect separate arms of the immune response.

Aim. To analyze the effectiveness of the systemic use of a combined drug containing interferon-α-2b and a complex immunoglobulin preparation in the treatment of respiratory diseases in frequently ill children.

Material and methods. We examined 103 children aged 2-12 years. Upon admission, the children were treated with a combined drug containing interferon a-2b and a complex immunoglobulin preparation (CIP) (Kipferon®) rectally. Children in the control group received standard therapy.

Results. Children were admitted to the hospital in the first days of the disease (66.02%), mainly in the moderate form of the disease (96.12%). 81.55% had symptoms of intoxication, catarrhal phenomena and respiratory syndrome. Comparing the time from the onset of the disease when prescribing IFN-α-2b to children, their significantly significant differences were established. Introduction in the early stages of the disease contributes to a faster elimination of all symptoms: fever stopped on average (M ± SD) after 1.76 ± 0.33 and 2.05 ± 0.29 days, respectively, from the moment of admission to the hospital, which was on average 2 days less than in the control group. The transition to a productive cough in the main group occurred on average (M ± SD) after 3.25 ± 0.27 days, in the comparative group - after 5.23 ± 0.31, in the control group - after 8.19 ± 0.42 days. In patients of the main and comparative groups, the length of stay in the hospital was significantly shorter - on average (M ± SD) 8.04 ± 0.81 days than in the control group - 10.56 ± 1.42 days. Hematological parameters returned to normal at an earlier time.

Discussion. Rectal route of recombinant IFNi-a2b delivery as suppositories is substantiated with regard to etiopathogenesis and immunology.

Conclusion. The article presents the outcomes of the clinical use of Kipferon® as part of the combination therapy and prevention of complications of acute respiratory viral infections in children: reduced duration of intoxication, fever, faster improvement of the auscultatory status of the lungs, improvement of immune status indicators.

Introduction. Diagnosis, treatment and prevention of respiratory infections in the practice of a pediatrician occupy one of the leading places. Currently, much attention is paid to various links in the pathogenesis of viral respiratory diseases. Among them, particular importance is attached to the system of antioxidant defense and cytokine regulation of inflammation. It is important to study the effect of various drugs on these links of pathogenesis in order to increase the clinical effectiveness of therapeutic methods.

Aim. To evaluate the clinical efficacy and impact on lipid peroxidation of Kagocel® in the treatment of respiratory viral infections in children.

Materials and methods. An observational study was conducted involving 124 children aged 6 to 15 years with manifestations of a respiratory viral infection who received symptomatic treatment, of which 89 children additionally took antiviral therapy with Kagocel®.

Results. Along with the good tolerance of Kagocel® and the absence of side effects in children on the background of its use, a significantly shorter period of regression of the main clinical symptoms of acute respiratory infection was shown. It was noted that in children taking Kagocel® on the 3^rd-5^th day of therapy, there is an increase in the total antioxidant activity of blood plasma and a decrease in the level of malondialdehyde compared with patients who did not take the drug, which demonstrates the antioxidant effects of Kagocel®, which certainly have a positive effect on the character course of the healing process.

Conclusion. Kagocel® has been shown to have high clinical efficacy and antioxidant effects.

Introduction. The role of the respiratory tract microflora violations as an etiological and pathogenetic factor in the development of the inflammative upper respiratory tract disease is indisputable, and the importance of persistence factors of respiratory opportunistic microorganisms (URT) is high. The traditional use of antibiotics and antimycotic agents in the pathology of URT has failed due to a significant increase in the number of antibiotic-resistant strains of microorganisms and the development of a number of undesirable adverse reactions in patients. An alternative advantage in these conditions is belonged to herbal preparations.

Aim. To conduct a comparative in vitro study of antibacterial and antifungal activities of the plant essential oils as a component of the Dyshi Oil composition and the Dyshi Oil composition itself against opportunistic microorganisms - causative agents of inflammatory upper airway diseases.

Materials and methods. Essential oils of clove, juniper, peppermint, eucalyptus, as well as the composition of oils “Dyshi” were used in the work. Staphylococcus aureus ATCC 25923, Klebsiella pneumoniae ICIS-278, Pseudomonas aeruginosa ATCC 27853, and Candida albicans ATCC 24433 bacterial cultures were used as test cultures. Staphylococcus epidermidis 25 strain, isolated from a conditionally healthy person, was chosen as a representative of the URT normobiota. Antimicrobial activity of essential oils was determined by the method of diffusion in nutrient agar, MIC - by the method of serial dilutions.

Results. The presence of zones of pronounced growth retardation of Staphylococcus aureus, Klebsiella and Pseudomonas, as well as yeast-like fungi was established when exposed to the composition of “Dyshi” oils, while separately used oils did not have a visible effect on the growth of bacteria and fungi, which indicates a synergistic interaction of the drug oils components.

Conclusion. The presence of a synergistic antimicrobial effect of the “Dyshi” oil composition against opportunistic bacteria and yeast-like fungi of the genus Candida has been proven. The absence of an inhibitory effect on the growth of Staphylococcus epidermidis, which is a representative of the upper respiratory tract normobiota indicates a possible selective effect of “Dyshi” oil aimed at maintaining the colonization resistance of the URT biotope.

Therapeutic training is an integral part of the treatment of chronic diseases such as diabetes mellitus. It makes patients aware of the importance of living well and taking care of their health. It is not possible to successfully control a chronic disease even with the successful use of all medical gadgets of modern medicine without the active participation of the patient. Diabetes mellitus is a prime example of a disease where the success of treatment depends on the patient's active participation. He must not only agree with the doctor's instructions, but also constantly monitor his condition and make decisions related to nutrition, physical activity, health. Managing your health requires specialized training that can be obtained from doctors and other medical professionals. This training program will help the patient to better understand their disease and learn to successfully control it in various life situations. It is important not only to communicate information, but also to help patients make the right decisions and find motivation to change their habits. Education should be tailored to the individual needs of each patient and take into account their psychological characteristics. All this requires serious training of specialists and continuous improvement of methods of schools for patients with diabetes mellitus. The issue of social support for patients is also an important element of diabetes education. The WHO Resolution notes the need to provide patients with access to social and psychological support as it helps them to cope with the psychosocial problems associated with their illness and increases the effectiveness of therapy.

Hyperglycemia is a well-known side effect of glucocorticoid (GC) therapy. GC treatment can lead to steroid diabetes mellitus (DM) manifestation. Glycemic control is essential for patients receiving GC. Three clinical cases of carbohydrate metabolism impairment (hyperglycemia) in children receiving GC needing glycemic control were described. In the 1^st case transient fasting hyperglycemia up to 8.3 mmol/l (while normal data after meals) was detected during 3 days after start of GC pulse-therapy of bronchial asthma. Normalization of glycaemia was evident since the 4^th day in spite of GC therapy continuing for 6 days. In the 2^nd case transient hyperglycemia while pulse-therapy of juvenile arthritis with systemic onset was detected on the 3^rd day (7.25 mmol/l), GC in tablets was added, pulse-therapy with gradually dose reduction continued 9 days else. Hyperglycemia (up to 11.7 mmol/l) persisted for 4 days, then glycaemia normalization was detected in spite of continuing GC therapy (50 mg or 0.7 mg/kg). In the 3rd case steroid DM in a patient with juvenile systemic scleroderma, familial history of DM type 2, and obesity manifested after 2 months of treatment with GC tablets (35 mg or 0.6 mg/kg), metformin was prescribed. While reduction of GC dose trend to glycaemia normalization was seen. In 4 months after cessation of GC impaired glucose tolerance and insulin resistance were diagnosed.

Glycemic control is essential for patients receiving GC. Hyperglycemia while receiving GC can be both transient or persistent. Risk of steroid DM is higher in cases of family history of DM type 2, obesity, high doses, and prolonged GC treatment. In patients at-risk of DM type 2 impairment of carbohydrate metabolism can persist after cessation of GC; this needs repeated examination.

The disappointing results of epidemiological studies in recent years continue to attract the attention of scientists to obesity - one of the most acute medical and social problems of our time. In the last few decades, adipose tissue has been regarded as an immunobiological and endocrine organ that secretes a large number of hormones, adipokines and growth factors that play an important role in regulating energy homeostasis and a variety of immune processes. The latest results of molecular genetic, immunometabolic, morphological and microbiological studies force scientists to approach the study of this complex issue from different angles. One of them is a change in the work of the immune system in conditions of overweight, which is based on the formation of chronic nonspecific inflammation. The presented review examines the pathogenetic mechanisms of the formation of the inflammatory process against the background of obesity, in the development of which several stages are currently conditionally distinguished: adipocyte hypertrophy, hypoxia, adipocyte necrosis, cellular infiltration and the formation of fibrosis. The article also analyzes modern scientific data on the relationship of chronic inflammation with complications of obesity and the physiological characteristics of the child's body, which can be an important link in the formation of metabolic disorders. In addition, the authors discuss the possible connection of the formation of various obesity phenotypes with a violation of the implementation of certain immune mechanisms – an area in which there is currently a significant amount of disagreement and unresolved issues. Further study of the phenotypes of obesity is one of the key points underlying the formation of metabolic disorders in this disease.

Functional constipation is a significant medical problem in pediatrics. Constipation often causes discomfort in children of any age and, in the absence of timely and effective treatment, can lead to chronic intoxication and the development of various complications, ultimately affecting the patient's quality of life. The article presents the definition of functional constipation in children over 4 years of age in accordance with the Rome IV Criteria (2016), etiology, pathophysiological mechanisms, clinic, diagnostic criteria and differential diagnosis of functional and organic constipation in preschool and school age children, possible complications. In accordance with the draft Consensus of the Society of Pediatric Gastroenterologists (2013), for a more objective assessment of the nature of the stool, the Bristol scale of stool forms is given. The physiology of the colon and the role of motor disorders in the occurrence of functional constipation are described. The physiology of the colon and the role of motor disorders in the occurrence of functional constipation are described. In accordance with the recommendations of the National School of Gastroenterology, the National Institute of Health and Clinical Excellence (NICE) in the UK, ESPGHAN and NASPGHAN, the basic principles of constipation therapy in preschool and school age children are given. The main groups of drugs that are used in the treatment of constipation in children of this age are described: stimulating and osmotic laxatives, prokinetics. Numerous foreign studies and clinical recommendations indicate that stimulants are effective and safe for the treatment of functional constipation, including in children's practice and are most in demand. The analysis of the use of one of the main drugs of the group of stimulating laxatives - sodium picosulfate in numerous international and Russian clinical studies is presented. The effectiveness and favorable safety profile of sodium picosulfate, the possibility of individual dose selection in connection with the liquid form of release are shown. A clinical example of the treatment of functional constipation in a 6-year-old child is given.

In the Russian Federation the incidence of cancer remains high. Depending on the nosology of the tumor, the probability of malnutrition during primary hospitalization may be 10-50%, and during treatment it may reach 100%. Undernutrition and obesity are independent factors of poor prognosis, reducing the overall effectiveness of treatment. At the same time, the diagnosis of nutritional status (NS) in pediatric oncology is not clearly regulated, which, in the presence of a large number of factors affecting the functioning of the digestive, nervous, endocrine and other systems, creates prerequisites for untimely recognition of nutritional disorders and, accordingly, inadequate nutritional support. Taking into account the mentioned tendencies above it is of great value to establish the foundations for recommendations on the assessment of NS and for making nutritional diagnosis in pediatric oncology. In order to highlight and resolve this challenge the interpretation of clinical aspects, advantages and disadvantages of existing screening scales for NS assessing, anthropometric indicators, methods for body composition evaluation, eating disorders classification according to the World Health Organization, the International Classification of Diseases 10 revision and specialized medical associations was carried out. Based on modern convictions regarding the pathogenesis of protein-energy malnutrition and cachexia, side effects and complications of antitumor treatment, available tools for assessing NS, their systematization, a unified nutritional diagnosis structure was formed. It includes: NS screening, nutritional history, anthropometry dynamics, evaluation of the gastrointestinal tract state and the presence of metabolic disorders, alimentation level, determination of nutritional risk factors. NS is a complex indicator and its reflection can be a nutritional diagnosis, which will potentially allow determining the current NS state, predicting the risks of malnutrition developing, implementing rational nutritional support, and thus improving the effectiveness of cancer treatment.

The article explores modern concepts about functional gastrointestinal disorders in children, considers features of the classification according to the Rome criteria and Russian clinical guidelines, and presents the evolution of views in the context of understanding the general pathophysiological mechanism as impaired “gut-brain” interactions, which leads to dysmotility in different parts of the gastrointestinal tract, visceral hypersensitivity, changes in the local immune system functions, dysbiosis of the gut microbiota and a failure of the central nervous system to process signals. Dysregulation of the central nervous system and the enteric nervous system causes functional gastrointestinal disorders with pain syndrome: irritable bowel syndrome, functional dyspepsia and centrally mediated abdominal pain syndrome. In addition, the article discusses the Russian version of the guidelines due to differences in the diagnostic instrumental and laboratory facilities, as well as national peculiarities of marketing authorization, indications and contraindications for drug use in children. Subject to understanding of the mechanisms of functional gastrointestinal disorders in children, the authors presented information on the role of trimebutine, a universal motility regulator of different parts of the gastrointestinal tract, in the development of functional gastrointestinal disorders, as well as modern approaches to their prevention and correction using a drug of proven efficacy. Numerous national and foreign studies proved the efficacy of trimebutine in hyperkinetic and hypokinetic movement disorders, decreased gastric evacuation function, and impaired gallbladder contractile function in patients with both hypomotor and hypermotor types of functional disorders. The accumulated experience determines the prospects for its use in pediatric practice.

Gastroesophageal reflux disease (GERD) prevalence in children and adolescents is estimated as high. GERD has a wide variety of clinical signs that significantly reduce the patients' quality of life. Typical symptoms include heartburn, belching, and regurgitation (regurgitation). Extraesophageal symptoms are mainly represented by complaints indicating the involvement of the respiratory, ENT organs, and oral cavity organs in the process. In addition, gastroesophageal reflux disease is a major risk factor for Barrett's esophagus and esophageal adenocarcinoma. The main factors predisposing to the development of gastroesophageal reflux disease in children are obesity, overeating, congenital anomalies of the esophagus, surgical interventions at the cardioesophageal junction, immature autonomic nervous system, nervous system diseases, administration of certain drugs, as well as vices such as smoking and alcohol drinking in adolescence. The mainstay of treatment of gastroesophageal reflux disease is antisecretory therapy with proton pump inhibitors. However, some patients using proton pump inhibitors at a standard dosage fail to achieve the clinical and endoscopic remission of the disease. The causes of the gastroesophageal reflux disease refractoriness to the adequate therapy most often include impaired barrier function and increased esophageal mucosal permeability. The use of esophagogastroprotective agents contributes to the optimization of therapy of gastroesophageal reflux disease and aims at achieving the disease remission in a larger number of patients. Clinical case reports of diagnosis and treatment of patients aged 12 and 16 years with gastroesophageal reflux disease are presented. The use of the esophagoprotective agent provided rapid relief of both esophageal and extraesophageal symptoms of the gastroesophageal reflux disease. In addition, complete healing of erosive esophagitis was achieved during its therapy.

The article focuses on the most frequent skin diseases in young children. Atopic/allergic dermatitis is one of the most common diseases in children. Approximately 45% of patients develop their first symptoms within the first 6 months after birth, 60% show the onset of atopic dermatitis during the first year of life and 80-85% at the age of 1 to 5 years. The article also speaks about the issue of allergic contact dermatitis (diaper rash in newborns). The disease represents non-specific inflammatory skin changes in the contact area in infants, the onset of which occurs mostly at the age of 1 to 15 months. The factors responsible for causing these diseases, the pathogenesis of their development and the potential of topical therapy mainly targeted at the reduction of clinical manifestations and frequency of exacerbations, improvement of the quality of life and prevention of infectious complications are considered. As an initial treatment, the authors consider a drug containing methylprednisolone aceponate with ceramides of domestic manufacturing. Its effectiveness and safety in the combination therapy of young children suffering from atopic/allergic and contact dermatitis may be evaluated in clinical practice. Clinical case reports of treatment of children with dermatitis of various etiologies aged from 4.5 months up to 3 years are presented. The outcomes of the use of Komfoderm K in children with AD demonstrated a significant decrease in the severity of inflammation, reduction of the skin lesion area and the intensity of symptoms, decreased need for additional intake of antihistamines and anti-inflammatory drugs, and the ability to achieve stable clinical remission.

Impaired skin barrier plays a major role in the development of many skin diseases and conditions such as dry skin, sensitive skin, atopic dermatitis, contact dermatitis, etc. The topical therapy aims at not only suppressing the inflammatory response in the skin, but also at regenerating the destroyed protective epidermal lipid barrier in atopic dermatitis patients. Dexpanthenol was produced by synthesis in the middle of the last century and is a derivative of pantothenic acid. Topical dexpanthenol is well absorbed through the skin, where it is converted into pantothenic acid, a component of coenzyme A, and thus participates in the regulation of the synthesis of fatty acids and sphingolipids, components of the stratum corneum. Therefore, pantothenic acid is essential for the normal functioning of the epithelium. Topical dexpanthenol improves skin hydration due to its hygroscopic properties and ability to retain moisture. The hydrating effect is interrelated with its capacity to regenerate the epidermal barrier of the skin. Dexpanthenol also enhances the differentiation of corneocytes and lipid synthesis, stimulating the regeneration of the epidermis. Numerous studies show that the efficacy of dexpanthenol is comparable to the efficacy of glucocorticosteroids by a weak degree of activity. Dexpanthenol is the active ingredient of Pantoderm, which is available as cream and ointment. Pantoderm ointment and cream contain 5% dexpanthenol. The article presents its own clinical reports of the treatment of patients with atopic dermatitis and administration of the combination therapy. It may be concluded that the use of topical glucocorticosteroids combined with dexpanthenol can increase the effectiveness of therapy in patients with atopic dermatitis.

Atopic dermatitis is one of the most common dermatoses globally. It has been established that it can often be associated with a variety of autoimmune diseases. Vitiligo is one of such comorbidities. This concurrent combination is most often found in paediatric practice, as an early onset is typical for both diseases. Early onset of vitiligo and involvement of a larger area of skin have been shown to be associated with higher odds of atopic dermatitis. The pathogenesis of vitiligo is characterized by altered immune responses, and genetic factors also counts. It has been shown that some of these mechanisms are shared with the pathogenesis of atopic dermatitis, but the issue warrants further study. Oxidative stress triggering melanocytes destruction is believed to be a key factor in the development of vitiligo. In this regard, patients with vitiligo are advised to use photoprotective agents. Today, the study of effects of visible light on the skin is a very topical issue, specifically, particular attention is paid to blue light (400-500 nm). Studies show that it is this wavelength that has a more pronounced negative effect on the skin. However, research findings are contradictory, as this spectrum radiation is used in the treatment of various dermatoses, including atopic dermatitis. Thus, the concurrent vitiligo and atopic dermatitis place certain restrictions on the choice of therapy, care products and photoprotective agents. A photoprotective agent for such difficult patients should protect the skin from exposure to as wide solar radiation spectrum as possible and at the same time not contain potentially allergenic components that can aggravate the course of atopic dermatitis.

Introduction. The study of the mechanisms of adaptation and consequences of deadaptation in newborns, and especially premature babies in the first days of life is an integral part of neonatal practice. The cytokine system is considered as sensitive and informative indicators of homeostatic disorders in newborns of different gestational ages.

Aim. To assess the features of the early neonatal period in newborns of different gestational ages according to the nature of changes in the levels of interleukin-1, -4, -8 in the cord blood and on the 3-4th day of the infant's life.

Materials and methods. 108 newborns were examined, of which 64 premature infants of the gestational age of 32 (0/7) - 36 (6/7) weeks were included in the treatment group: moderately premature infants (32 (0/7) - 33 (6/7) weeks) and late premature infants (34 (0/7) - 36 (6/7) weeks). The control group included 44 conditionally healthy full-term infants born between 37 (0/7) and 41 (6/7) week of gestation: early full-term (37 (0/7) - 38 (6/7) weeks) and full-term intants (more than 39 (0/7) weeks).

Results and discussion. The full-term infants, as well as late premature infants, whose clinical status was assessed as satisfactory, usually showed minimum levels of all studied cytokines. If the early neonatal period was complicated, high levels of interleukin-1 and -8 with underlying slightly elevated levels of anti-inflammatory interleukin-4 were observed. This fact supports the activation of cytokine reactions during manifestation of pathological symptom groups generated by various organs and systems in the early neonatal period.

Conclusion. The nature of cytokine reactions can serve as a marker of unfavourable course of the early neonatal period in premature infants and a criterion that justifies the implementation of necessary corrective measures.

Since the incidence of tuberculosis (TB) of the middle ear is low, alertness to this condition among physicians is decreased. The absence of specific clinical signs of the disease results in the late diagnosis of tuberculous otitis media, the development of irreversible changes and extracranial or intracranial complications, which leads to patients' disabilities. The clinical example has demonstrated the development of tuberculous otitis media in the patient with chronic nonspecific inflammation in the middle ear and infiltrative pulmonary TB. The absence of pathognomonic signs led to the late diagnosis of tuberculous otitis media and, consequently, the development of bilateral mesotympanitis. Tuberculous etiology of the disease was suspected based on the case history analysis (drug-refractory chronic otitis media and exposure to TB), clinical and laboratory data (the absence of expressed pain syndrome and normal hemogram values along with expressed changes in the middle ear), active long-lasting pulmonary TB, positive immunological skin test results. The diagnosis was verified by microbiological detection of M. tuberculosis in the ear discharge. Complex treatment of the patient resulted in clinical cure of tuberculous otitis media after 18 months; infiltrative TB led to the development of a tuberculoma after 8 months. The late diagnosis of the disease resulted in surgical treatment (bilateral tympanoplasty, resection of two segments of the left lung).

Introduction. Abnormal bone remodelling process is one of the clinical manifestations of celiac disease, which increases the risk of developing osteopenia conditions, including bone fractures. The median age for the first fracture is similar in celiac disease and in the general population, but the incidence is higher in patients with celiac disease.

Aim. To compare clinical and anamnestic characteristics, anthropometric measurements and laboratory test results in celiac children and adolescents with and without bone fractures.

Materials and methods. A total of 151 children aged 1-17 years were included in the study. Patients were divided into two groups: those who had fractures in their lifetime - 21 (13.9%) children and those who had no fractures - 130 (86.1%) children. Results. The frequency of fractures among the patients included in the study was 13.9%, while among children with vitamin D deficiency fractures were reported 2.7 times more often than among children with its optimal level (p = 0.019).

Vitamin D deficiency was detected in 20 (95.2%) children with fractures, and levels of 30 ng/ml or higher were found in 1 (4.8%) child. In the group of patients without fractures, the 25(OH)D optimal level was observed in 43 (33.1%) cases.

It was found that patients with fractures had a significantly lower osteocalcin level than children without fractures - 26.9 (15.6; 32.9) ng/ml (p < 0.001), and children with fractures had C-terminal telopeptide level 1.9 times higher than the group of children without fractures (p = 0.01). The median PTH concentration in children with fractures was 34.6 (19.6; 54.7) pg/ml, whereas in children without fractures it was 24.2 (17.1; 39.5) pg/ml (p = 0.1).

Conclusion. Due to elevated PTH level and severe vitamin D deficiency, a predominance of osteoresorption over osteosynthesis was observed in children with celiac disease and fractures of tubular bones. It is important to maintain a 25(OH)D optimal level and monitor biochemical markers of bone metabolism in patients with celiac disease to assess the processes of bone formation and resorption.

Hypersensitivity pneumonitis (HP) (J67) is the most common interstitial lung disease in children and adolescents. The disease is immunologically determined, it can be a disease when exposed to various factors that cause harmful effects on the environment. The most significant are thermophilic actinomycetes, antigens of animal and fungal origin. Currently, cases of “two cases of infection” have been identified, when a genetic predisposition has been identified in case of detection of cases of antigen results in the implementation of diseases. Immunological studies in GP are mainly focused on identifying specific IgG to the “guilty” antigen. High-resolution computed tomography is the most sensitive method of visualizing the GP, pathological changes are detected in more than 90% of patients. According to the characteristics of the clinical course and duration of the disease, acute (lasting less than 6 months) and chronic (more than 6 months) variants of the disease are distinguished. The formation of fibrosis of the lung tissue up to the honeycomb lung is observed in approximately 18% of cases. There are variants of HP: with fibrous and non-fibrous (inflammatory) phenotype. The basis of drug therapy so far is systemic and inhaled glucocorticosteroids, the use of which is pathogenetically substantiated and clinically effective. The prospects for therapy are also associated with the use of antifibrotic drugs: pirfenidone and nintedanib, which slow down the decline in lung function and improve patient survival. At the same time, the exclusion of contact with a causally significant allergen plays a key role. Our own observations concern 280 children with GP aged 8 months to 16 years, including 70 patients in the first year of life. Most patients had a hereditary allergic burden (in 74%) and a causal factor was traced. The prognosis, with rare exceptions, was favorable. The main reasons for poor outcomes in GP are continued contact with a causally significant allergen, late diagnosis of the disease, and inadequate therapy.

Introduction. The results of cochlear implantation in patients with bilateral sensorineural hearing loss are influenced by many factors, including the type of electrode array. The location of the electrodes in relation to neurons of spiral ganglion affects on levels of perception of the patient's hearing sensations.

Aim. To evaluate the dependence of electrically evoked compound action potential (ECAP) thresholds values and comfortable levels depends on electrode array type.

Materials and methods. 26 patients with bilateral sensorineural hearing loss with cochlear implantation systems were examined. The patients were divided into 2 groups: 1) patients with a straight electrode array (n = 14); 2) patients with a perimodiolar electrode array (n = 12). We tested speech intelligibility and ECAP thresholds. The difference in the values of both parameters was estimated.

Results. For both groups of patients, the relationship between the threshold's profiles of ECAP thresholds and maximum comfortable stimulation levels was detected. For patients from the first group (straight electrode array), the differences in values between the studied parameters were 30.6 ± 6.1%. In patients from the second group, the differences in the values of the thresholds for ECAP thresholds and the levels of comfortable stimulation ranged 2.4 ± 2.1%.

Conclusion. The perimodiolar electrode array is located closer to the neurons of the spiral ganglion, which may explain the greater relationship between the values of the ECAP thresholds and the levels of comfortable stimulation. This pattern must be considered when programming the processor of the cochlear implantation system.

In this article, the authors raise the issue of the treatment of febrile conditions in young children. At the same time, the emphasis is on the definition of feverish conditions, etiopathogenesis, and the possibilities of modern diagnostics, taking into account various types of constitution in children. The authors provide their own data, based on many years of experience in monitoring children of the main three constitutional types according to M.S. Maslov. The features of fever therapy in children, indications and contraindications to the appointment of antipyretic drugs are discussed, emphasis is placed on side effects and contraindications of these drugs for infants. In recent years, the attention of many doctors has been drawn to the theory and practice of bioregulatory medicine, which is a branch of modern medicine that uses the experience of using natural remedies. The data of Russian and international researchers proving the expediency and effectiveness of treating fever symptoms with these drugs are presented. Special attention is paid to the drug Viburcol, which can be used for children starting from birth, which is undoubtedly important, since it is for children of the first year of life that safe and effective means are needed due to increased sensitivity to the toxic effects of all medicines. It is shown that the use of Viburcol suppositories in children is advisable, allows you to achieve the desired effect without any toxic and side effects. The authors, referring to international and Russian experience, recommend Viburcol for the treatment of fever, excitability, anxiety, pathological teething, as well as in the preparation and management of children during vaccination.

Stress in childhood affects not only the current health status of children, but also their psychosocial and somatic functioning at a more mature age, which leads to grave consequences in the long term, as well as higher frequencies of use of healthcare financial resources. The ability of a physician to identify clinical manifestations of stress in children with somatic diseases or during dispensary examination, on the one hand, is important for prescribing adequate therapy, helps determine a preventive approach to the management of children with stress-related consequences, and also to form a relevant set of actions to increase their stress resistance and create an adequate adaptive reserve and reactions at all levels of the body. On the other hand, it is important to identify children under chronic stress (the so-called point of no return), who have a high risk of developing psychosomatic diseases. The article also discusses the basics of a healthy lifestyle for children that makes it possible to not only increase adaptive capabilities, but also essentially mitigate the effects of chronic stress. For example, it addresses recommendations such as complete and proper nutrition, regular physical activity combined with rest, coping skills training. However, the authors emphasize that the most difficult part of all recommendations is their direct fulfilment by children themselves and by their environment (parents, teachers). Therefore, the issues of compliance with the prescribed therapy and preventive actions become very important, especially in situations where their fulfilment is associated with subjective and objective difficulties. The authors tried to suggest some ways of overcoming the latter.

The review presents data on the epidemiology of poisoning by petroleum products, their chemical and toxicological characteristics, clinical and radiological signs, and considers issues of treatment and prognosis. Numerous studies show the world-wide prevalence of hydrocarbon poisoning in children under 5 years of age. The largest number of messages comes from the regions of the Middle East and South Asia. The mechanisms of pathogenesis and clinical manifestations of poisoning by such petroleum distillates as gasoline and kerosene are well studied. In the last two decades, poisoning with ignition fluids, which are a mixture of saturated hydrocarbons, has been relevant for the Russian Federation. Their toxic effect upon oral administration is realized mainly through the development of aspiration pneumonitis, which is clinically manifested by cough and respiratory failure. Systemic effects are not typical, and neurological disorders are associated primarily with pulmonary hypoxia. A significant risk factor for severe aspiration is the presence of vomiting, attempts to induce it, and gastric lavage. One of the rare but characteristic manifestations of lung damage in hydrocarbon poisoning is the formation of a pneumatocele. Treatment for hydrocarbon poisoning has not been developed enough; respiratory support plays a leading role, in severe cases, early mechanical ventilation. Infusion therapy is not a means of detoxification, and, if carried out to fill the physiological need, should be carried out in a limited amount due to the risk of pulmonary edema. The effectiveness of antibiotics and glucocorticosteroids has not been established. In most cases, hydrocarbon poisoning ends in recovery, lethal outcomes are observed in rare cases. An unfavorable prognosis can be determined, first, by massive aspiration, as well as the presence of alcohols, unsaturated, halogenated and aromatic compounds in the composition of the liquid taken.

Introduction. The role and mechanism of the effect of vitamin D on the course of chronic lung diseases in children are not yet fully understood. In particular, there are not enough studies on the effect of vitamin D status on the production of interferon-γ (IFN-γ) in children with cystic fibrosis and bronchial asthma.

Aim. To analyse the changes in IFN-γ levels in children with cystic fibrosis and bronchial asthma according to the serum 25(OH)D level before and during cholecalciferol supplementation.

Materials and methods. A total of 114 children (aged from 3 months to 18 years old) were examined, including 51 (44.7%) children with bronchial asthma, 34 (29.8%) children with cystic fibrosis, and 29 (25.5%) children of the control group. If hypovitaminosis D was diagnosed, the children received a three-month cholecalciferol course at doses in accordance with the recommendations of the national consensus - Cystic Fibrosis: Definition, Diagnostic Criteria, Therapy and the national program - Vitamin D Deficiency in Children and Adolescents of the Russian Federation: Current Approaches to Management. The 25(OH)D and IFN-γ levels were twice determined in all children.

Results. Median 25(OH)D levels in patients with cystic fibrosis and bronchial asthma did not reach the level of healthy children either before or after supplementation with cholecalciferol drugs at the recommended doses. Vitamin D intake resulted in a decrease in IFN-γ levels in healthy children from 3.07 [2.29; 4.81] pg/ml to 2.18 [1.74; 3.45] pg/ml (p < 0.05), whereas such changes were not detected in the paediatric patients with cystic fibrosis and bronchial asthma in the general population. However, after supplementation with cholecalciferol, the IFN-γ level was significantly higher in patients with cystic fibrosis and bronchial asthma - 2.86 [2.13; 3.86] pg/ml and 3.11 [0.89; 5.0] pg/ml, respectively, than in healthy children - 2.18 [1.74; 3.45] pg/ml (p < 0.05). A statistically significant decrease in IFN-γ level was observed in girls with cystic fibrosis and in healthy girls after supplementation with cholecalciferol, whereas no significant changes in IFN-γ levels were detected in the groups of boys.

Conclusion. Modulation of IFN-γ levels appears to be one of the mechanisms of immunotropic effect of vitamin D on the course of chronic inflammation of infectious (cystic fibrosis) and allergic (bronchial asthma) etiology in children.

Varkani syndrome or trisomy 8 mosaicism (T8M) - is a described chromosomal anomaly with a frequency of 1 : 25,000 to 1 : 50,000 births, which is more common in men than in women (5 : 1). In the Department of Pediatric Surgery at Almazov NMRC, a 28-year-old woman was admitted at 39 weeks' gestation with a aggravated somatic history. Pregnancy occurred with the support of auxiliary reproductive technologies: extorporepical fertilization due to the male factor, overpermation and asthenospermia caused by mumps transferred in childhood. Antenatally diagnosed: multiple congenital malformations of the fetus: agenesis of the corpus callosum, triventricularhydrocephalus, macrocephaly, bilateral ureterohydronephrosis; megacystis. The spouses were karyotyped, karyotypes 46, XX - normal female and 46, XY - normal male. According to the results of the karyogram, the fetal karyotype is 46, XY - normal male. From the first day of life, the child has clinical epileptic myolonic generalized attacks. According to the results of the study: Neurosonography confirmed the presence of a malformation of the brain. Echocardiography: Ventricular septal defect (VSD). Ultrasound of the abdominal organs revealed bilateral ureterohydronephrosis with expansion of the pelvicalyceal system and ureters. At the age of 28 days, due to the existing neurogenic disorder of the function of the bladder against the background of a fixed spinal cord in order to constant urine, vesicostomy is performed. Performed diagnostic laparoscopy: in the right iliac region spreads education with a diameter of 2 cm, which is a diverticular-cystic doubling of the ileum. A wedge-shaped resection of the base of the diverticulum was performed, the operation was completed by vesicostomy. Discharged home in a satisfactory condition at the age of 2 months. As a result of karyotyping of the newborn, the result mos47, XY, +8[7]/46, XY [9] was obtained - a mosaic variant of trisomy on chromosome 8. Mosaicism of trisomy 8 rare chromosomal anomaly. The clinical case described by us is characterized by a combination of severe congenital defects, which were not previously reported. This is the first time of the birth of a child with a trisomy of 8 chromosome after auxiliary reproductive technologies: extracurporeal fertilization.

Introduction. There is enough evidence of the influence of the psycho-emotional state of children on the development of gas-troesophageal reflux disease, numerous studies reveal anxiety and depressive disorders in them. However, there is no common understanding of the specific causal relationships underlying the pathogenesis of this disease.

Aim. To identify the features and possible causes of anxiety and depressive disorders in children with gastroesophageal reflux disease and analyze their role using Yu.I. Burlan's system-vector psychology.

Materials and methods. 677 adolescents aged 11-17 years were examined on the basis of the pediatric department in the Clinic of the Research Institute of Medical Problems of the North (Krasnoyarsk). The gastroesophageal reflux diseasewas diagnosed by testing according to the Russian version of the Gastroesophageal Reflux Disease Questionnaire. Computerized testing “The Development and Well-Being Assessment” was used to identify mental disorders.

Results. In children with gastroesophageal reflux disease, all kinds of fears were significantly more common: fear of separation - 50.0 (25.1-74.9)%; darkness, thunderstorms, thunder, heights - 66.7 (38.6-86.1)%; blood injections, wounds - 58.3 (31.6-80.8)%; loud noise - 33.3 (13.9-61.4)%; to be far from home - 41.7 (19.2-68.4)%. 41.7 (19.2-68.4)% of children had manifestations of depression, which is 2 times more often than in the control group, and every fourth had self-harm. Separation from friends, panic attacks, fear of death, melancholy, resentment, learning problems, appearance were indicated as the causes of depression.

Conclusions. The causal relationships disclosed by the system-vector psychology, according to which certain stress factors play an important role in the development of gastroesophageal reflux disease. These factors depend on the type of character: for emotional children, these are all kinds of fears, phobias, breaking emotional ties, problems in relationships with others, and for obedient and calm children - resentment, learning problems and any factor of novelty (change of the usual environment, living conditions, team).

Over the past 20 years, the proportion of overweight and obese children and adolescents has increased significantly in most countries. Obesity represents a major cardiometabolic risk and is closely associated with comorbidities such as hypertension, hyperlipidemia, hyperinsulinemia, type 2 diabetes, and non-alcoholic fatty liver disease (NAFLD). There is a lot of uncertainty regarding the diagnosis of metabolic syndrome in children, mainly due to the various and conflicting definitions that have been proposed. The prevalence of metabolic syndrome varied significantly in children (from 6 to 39%) depending on the applied definition criteria. According to these definitions, only 2% of children met all the criteria for metabolic syndrome. Over the past decade, studies have shown that, in parallel with the increase in the prevalence of obesity in the pediatric population, NAFLD has become the most common form of liver disease in childhood. In NAFLD, inflammatory cytokines/adipokines and other factors lead to steatohepatitis and/or fibrosis. Recently, several adipocytokines and inflammatory cytokines have been identified with significant positive (leptin, chemerin, vaspin, TNF-α, IL-6 and IL-8) or negative (adiponectin) associations with metabolic risk factors. Some of them can be considered as pathophysiological factors linking obesity and its complications such as insulin resistance and NAFLD. However, data on other adipocytokines and their role in metabolism remain controversial and partially unknown, especially with regard to their role in childhood (resistin, NAMPT, FGF-21, A-FABP, RBP4, lipocalin-2, omentin-1, hsCRP). Adipocytokines are a novel and powerful tool not only for the diagnosis and stratification of NAFLD and the metabolic syndrome, but also as a potential therapeutic target. Adipocytokine therapy requires further study in all patients with metabolic syndrome and NAFLD, especially in children and adolescents.