Introduction. Mother’s breast milk is considered to be the best source of infant nutrition and, paradoxical as it may sound, the only product of the infant diet, which composition is still poorly known to us. This article presents the findings of a study on the breast milk microbiota conducted in the Russian Federation for the first time.

Aim. To study the composition of the breast milk microbiota of healthy women living in the Russian Federation and identify the impact of various factors on its diversity.

Materials and methods. A molecular genetic study on 56 colostrum samples and 12 mature breast milk samples from 56 healthy donors using a method based on sequencing of bacterial 16S rRNA gene was conducted.

Results. In a batch of 56 colostrum samples, 22 species and 242 genera of bacteria were identified. Firmicutes, Proteobacteria, Actinobacteriota were the most predominant species of bacteria in healthy women with a normal body mass index, from a physiological pregnancy, who did not take antibiotics, after natural delivery at term; Streptococcus, Staphylococcus and Gemella were the most predominant at the level of delivery. Statistical analysis of the impact of nationality, age, number of children in the family and duration of hospitalization (PERMANOVA) showed no significant differences in the proportions of bacteria in the colostrum of women (p > 0.05). The gender of the child was the only factor that turned out to be significant. The biodiversity of colostrum of girl-delivered mothers were higher (Shannon index) than that of boy-delivered mothers. In addition, the mature breast milk microbiota (1 month after delivery) has lower alpha diversity as compared to colostrum.

Discussion. The analysis of our results and reports from foreign colleagues showed significant similarities and differences, which, certainly, were explained by a number of reasons related to methodological and geographical differences, the method, timing and even the time of day when breast milk samples were collected.

Conclusion. In general, the colostrum of healthy women had a fairly stable bacterial composition, and its rich biodiversity fully demonstrated high quality of the first microbial inoculum for the newborn intestine. Our results provide valuable insights into the healthy breast milk microbiota in women living in the Russian Federation and can be used as reference ranges, as well as for comparison with similar indicators in women from other countries.

Introduction. The question of the optimal timing of cessation of lactation from the perspective of maternal-child relationships remains controversial.

Aim. Тo determine the optimal timing for stopping breastfeeding based on data on the formation of the child’s personal characteristics and the relationship with the mother.

Materials and methods. The results of a prospective study of mother-child relationships during the period of cessation of breastfeeding are presented. The age of the child was assessed at the termination of breastfeeding, the difficulties experienced by the mother and the child at its termination (affective attachment, characteristics of the child’s behavior). Observation was carried out in the classroom in the group of short-term stay in preschool conditions 1–2 times a week for at least 1.5 hours. 108 mother-child pairs were under observation. Depending on the duration of breastfeeding, couples were divided into two groups. The first group – 64 children who are breastfed for no more than 18 months, the second group – 44 children who are breastfed for more than 18 months. Statistical processing of the obtained data was carried out using the Excel program using Student’s t-test and Pearson’s _χ² method. Differences were considered statistically significant at p < 0.05.

Results and discussion. Since the conditions of the children’s polyclinic do not allow for monitoring the child and his mother, the study was carried out in a group of short-term stay in a preschool educational institution, which is quite typical for the modern urban maternal population. The work was carried out jointly with teachers and psychologists who developed criteria for assessing mother-child relations and the child’s behavioral characteristics. In the group of children who were breastfed after 18 months, affective attachment to the mother, use of the breast to soothe them in the absence of breast milk, anxiety when falling asleep, were 2 times more common than in children who were breastfed for less than 18 months. The data obtained indicate the need to inform nursing mothers about the mental characteristics of a child’s development in certain age periods, a decrease in lactation after a year, and its frequent termination by 18 months.

Conclusions. Based on the data obtained, it can be considered appropriate the optimal duration of breastfeeding up to one and a half years.

Introduction. The microbiota of the oral cavity and oropharynx, actively interacts with the epithelium of the mucous membrane and the immune system, creates antagonistic conditions for the growth and reproduction of pathogens. Microbiocenosis-preserving therapy can provide conditions for maintaining colonization resistance and reduce the likelihood of adhesion of respiratory viruses.

Aim. To evaluate the effect of local use of various antimicrobial drugs on the microbiota of the oropharyngeal mucosa in children with acute respiratory infection.

Materials and methods. 120 children (5–10 years old) with acute respiratory infection were divided into three groups, in which they were used as part of complex therapy: in group 1^st – hexetidine-containing aerosol, in group 2^nd – a children’s spray containing gramicidin S and cetylpyridinium chloride, in the 3^rd – 0.01% solution of benzyldimethyl-myristoylamino-propylammonium. On the 1^st and 12^th days of observation, participants had a throat swab taken to study the state of the oropharyngeal microbiota using 16S rRNA sequencing. The results obtained were compared with those of healthy peers.

Results. According to sequencing data, the microbiota of participants in all groups before treatment differed from the microbiota of healthy peers in terms of alpha and beta diversity, as well as in the results obtained by the nearest balance method. Local use of antiseptic drugs influenced the microbiota at the level of species and genera of microorganisms. After treatment in the 2^nd group, in contrast to the 1^st and 3^rd, statistically significant changes in the balances at the level of microorganism species were revealed towards the indicators of healthy peers.

Conclusions. A combined drug containing cetylpyritinium chloride and the bacteriocin-like antimicrobial peptide gramicidin S demonstrated no negative effect on commensal microbiota and contributed to the stabilization of the regional microbiota.

Introduction. Cough is the most common symptom of acute respiratory infections, which results from inflammation of the upper and lower respiratory tract. Herbal medicines that include an ivy leaf extract preparation are widely used for the treatment of cough.

Aim. To evaluate the effectiveness and safety of the ivy leaf extract preparation as a syrup in young children with acute bronchitis. Materials and methods. We observed 44 children with acute bronchitis aged 4 months up to 3 years. The main group included 24 children receiving the ivy leaf extract preparation as part of complex therapy: 2.5 ml once a day for under 1-year children, and 2.5 ml 3 times a day for children aged 1–3 years for 7–10 days. The comparison group included 20 children receiving ambroxol at an age-appropriate dose as part of complex therapy. The complex therapy for bronchitis did not differ in the groups to be compared. Clinical effectiveness was assessed by analysis of the changes in the main symptoms of the disease.

Results and discussion. It was found that the intake of the ivy leaf extract preparation showed high clinical effectiveness in 91.6% of cases, which included rapid relief of the main symptoms of the disease (cough, wheezing in the lungs), a 1.7-fold reduction of the exacerbation period, a 1.8-fold decrease of the cough period. Prescription of systemic antibiotics for children with acute bronchitis was required in 12.5% patients of the treatment group, and in 25% patients of the comparison group. The overall assessment of tolerability of the ivy leaf extract preparation was rated as excellent and good in 95.8% of cases.

Conclusion. Due to high clinical effectiveness and safety of the ivy leaf extract preparation, it can be recommended for common practical use in acute bronchitis children from the first days of life.

Inflammatory diseases of the ENT organs are currently the most common pathology in children. Diseases of the nasal cavity and paranasal sinuses occupy the leading place in the structure of primary morbidity, averaging 55.5%. In the paediatric population, ENT pathology develops more often as a secondary bacterial complication of a previous viral infection of the upper respiratory tract. Bacterial otorhinolaryngological complications often require the prescription of antibacterial drugs. In outpatient practice, the choice of rational and safe therapy is of utmost importance. The article presents clinical cases of ENT diseases in children and algorithms for the choice of initial antibacterial therapy. Recommended drugs for the treatment of ENT diseases and the main indications for their administration are presented. Most national and international guidelines recommend amoxicillin as a first-line drug for the treatment of major respiratory pathogens (S. pneumoniae, H. influenzae, S. pyogenes) and bacterial complications of ENT diseases in children, taking into account its low toxicity, cost and convenient form of administration. In case of ineffective therapy or in the presence of risk factors for drug resistance of pathogens, semi-synthetic penicillins in combination with _β-lactamase inhibitors are recommended.

Introduction. The use of genetic engineering biological agents (GEBA) in the treatment of rheumatic diseases over the past decades has led to a significant improvement in the prognosis in this group of patients. However, against the background of anti-tumor necrosis factor _α therapy (anti TNF-_α), the risk of developing tuberculosis increases tenfold.

Aim. To evaluate the specificity and safety of Mantoux test, recombinant tuberculosis allergen (RTA) test, IGRA tests: TB-Feron IGRA, T-SPOT.TB, QuantiFERON-TB GIT in patients from 5 to 18 years of age, who are at risk for the development of tuberculosis, due to the use of immunosuppressive therapy, including GEBP.

Materials and methods. This clinical trial is a prospective single-center open-label study with 120 patients under observation. Girls predominated among the patients – 71 (59.2%), the average age was 12 years (95% CI [5.2–17.4]). As part of the treatment of the underlying disease, patients in the vast majority of cases (78.3%) received iFNO-_α drugs: etanercept (67 people), adalimumab (25 people), golimumab (2 people).

Results and discussion. According to the results of a comprehensive medical examination, including CT scan of the chest organs, the presence of active tuberculosis was not established in any of the patients. A positive result of the RTA sample was registered in 0.8% of the subjects, Mantoux test in 46.6%, T-SPOT.TB – 1.7%, TB-Feron IGRA and QuantiFERON-TB GIT – 0.8% each. During the safety assessment, it was noted that within 28 days after the study, none of the 120 patients had any adverse events. Patients need appropriate screening before starting treatment and regular follow-up examinations.

Conclusions. The Mantoux test with 2 TE has low specificity (0.49), and the sample with RTA (0.99), TB-Feron IGRA (0.99), T-SPOT.TB (0.98) and QuantiFERON-TB GIT (0.99) are highly specific and safe as tests for detecting tuberculosis infection in children with juvenile idiopathic arthritis.

Studying the causes of cough, which is one of the most common respiratory symptoms when seeking medical help, remains a pressing problem for doctors of various specialties. Due to the growing interest in herbal remedies, in the current study we aimed to analyze the effectiveness of marshmallow root in the treatment of cough. We conducted a systematic search in modern scientific literature in electronic databases PubMed, EMBASE, Cochrane Library, Wiley, PubFacts, Springer Link platform, scientific publishing house Elsevier, CyberLeninka. An analysis of 80 full-text reviews on the use of herbal medicine in the treatment of cough showed higher quality of life scores, lower rates of adverse events and less severe cough. The authors also provide evidence that herbal therapy successfully complements traditional treatment methods, providing longer periods of remission for chronic cough. Although coughing is a protective reflex responsible for clearing secretions and foreign bodies from the airways, it can be an unpleasant symptom that causes discomfort in patients. The use of preparations based on root extract of Althaea officinalis L leads to the formation of a protective film, which promotes faster regeneration of the damaged mucous membrane of the respiratory tract caused by a dry cough. The mucous membrane of the respiratory tract is a highly vascularized tissue. In this regard, anti-inflammatory phytochemicals that improve lesion repair, such as local neovascularization, are critical to promote healing. The herbal medicinal product containing the active component marshmallow root extract fully meets safety requirements and can be successfully used in patients with acute and chronic respiratory diseases. 

The review discusses the multifaceted effect of vitamin D on antiviral immunity, induction of antimicrobial peptides, functional activity of immunocompetent cells, autophagy processes, clearance of viruses and viral fragments. The relationship between vitamin D and allergic inflammatory cells, its modulating and tolerogenic potential is considered. The inhibitory effect of vitamin D on eosinophils, mast cells, the production of pro-inflammatory and proallergic mediators, and the synthesis of IgE has been shown. The protective role of vitamin D in the development of remodeling and hyperresponsiveness of the respiratory tract has been established by reducing the number of goblet cells, mucus hypersecretion, and the expression of metalloproteinases. The effects of vitamin D on the replication of respiratory viruses and experimental resistance to them through the induction of antimicrobial peptides and other mechanisms have been demonstrated. Data from clinical studies on the preventive effect of vitamin D on the incidence of respiratory infections and episodes of persistent wheezing in children are presented. Children with respiratory syncytial infection and vitamin D deficiency were more likely to require respiratory support and mechanical ventilation. The preventive role of vitamin D in the development of obstructive bronchitis in children and severe bronchiolitis in infants has been shown. It has been established that normal levels of 25(OH)D in the mother significantly reduce the risk of developing bronchial obstruction in the child. Alternative data that do not support a protective effect of vitamin D on respiratory morbidity and wheezing in children are discussed. Further monitoring studies that take into account geographic location and analysis of the dose of cholecalciferol used to assess its preventive role in the development of wheezing and bronchial asthma in children are advisable.

The Centers for Disease Control and Prevention reports that more than 4 million children have been diagnosed with asthma. Currently, there is no treatment that could prevent the development of asthma or change its natural course over long-term follow-up. However, the disease can be controlled using treatments used in clinical practice. For persistent asthma in children aged 5 years and younger, low doses of inhaled glucocorticosteroids are recommended, as well as the administration of montelukast, a leukotriene receptor antagonist. In addition, montelukast is prescribed to patients with allergic rhinitis as an alternative to or in combination with oral antihistamines or nasal corticosteroids. Leukotrienes are lipid mediators that play a key role in acute and chronic inflammation and allergic diseases. They exhibit their biological effects by binding to specific G-protein-coupled receptors. Each subtype of the leukotriene receptor has unique functions and expression patterns. Leukotrienes play an important role in various allergic diseases, including bronchial asthma and allergic rhinitis. Montelukast is a cysteinyl leukotriene receptor-1 antagonist widely used to suppress the inflammatory response in asthma and allergic rhinitis. This review briefly summarizes the biology of leukotrienes and their receptors, recent developments in the field of antileukotriene drugs and the prospects for their different therapeutic applications. The role of antileukotriene drugs and key indications for the use of montelukast in the complex therapy of asthma and allergic rhinitis in children have been determined.

Introduction. The basic research demonstrated an important role of vitamin D in strengthening the immune response to Mycobacterium tuberculosis and proved its effect on the production of antimicrobial peptides. However, the correlation between the levels of vitamin D and defensins (_β1 and _β2) in children and adolescents with different forms of pulmonary TB was not studied.

Aim. To study the correlation between the levels of vitamin D and _β1- and _β2-defensins in children and adolescents with different forms of pulmonary TB.

Materials and methods. We carried out a prospective study of 75 patients with pulmonary TB aged 2–17 years (52 new cases and 23 retreatment cases) in 2021–2023. The levels of 25(OH)D and _β1- and _β2-defensins were determined at admission to hospital.

Results. Out of 75 patients 2.7% had adequate levels of vitamin D (more than 30 ng/mL), 13.3% had insufficient levels of vitamin D (20 to 30 ng/mL), 34.7% had deficient levels of vitamin D (10 to 20 ng/mL), and 49.3% had severe deficiency of vitamin D (less than 10 ng/mL). We established a direct correlation between 25(OH)D and _β1-defensin levels (p = 0.004766) and lack of correlation between 25(OH)D and _β2-defensin levels. We discovered significant differences in the levels of 25(ОН)D and β1-defensin between new and retreatment cases: 13.10 ± 1.04 ng/mL and 8.74 ± 1.07 ng/mL (p = 0.004644) and 6.66 ± 0.79 ng/mL and 4.0 ± 0.85 ng/mL (p = 0.024816), respectively.

Conclusion. The differences in the levels of calcidiol and _β1-defensin between new and retreatment cases witness an impaired function of one of the innate non-specific immunity components during long-lasting advanced pulmonary TB in children and adolescents.

Introduction. Recurrent respiratory infections in children are a pressing problem in pediatrics. To maintain and function the immune system in children, their provision of vitamins and minerals is important.

Purpose. To assess the provision of children with recurrent respiratory infections with vitamins (A, E, D, C, B₆, B₁₂, folic acid) and minerals (Zn, Fe, Mg, Ca, P) and to correct their deficiency with a vitamin-mineral complex.

Materials and methods. The study was conducted on 65 children aged 3 to 8 years in 2 groups of children: group 1, children with RID, n = 50; group 2 – control, n = 15). An outpatient examination, a parent survey and a blood test for vitamins (A, E, D, C, B₆, B₁₂, folic acid) and minerals (Zn, Fe, Mg, total Ca, Ca++, P) were carried out. 30 children with RID were prescribed the vitamin and mineral complex, 1 tablet 2 times a day, with an assessment of vitamin and mineral sufficiency and the frequency of respiratory infections after the end of the dose.

Results. In all examined children, both in the main and control groups, the most common were deficiencies of fat-soluble vitamins D (69%), A (40%), E (35%) and the minerals Zn (70%) and Fe (44%). In children with RID, deficiency of vitamins D, A and Zn was more common than in the control group (p < 0.05), in 96% of cases it was combined, more often in the form of a combined deficiency of fat-soluble vitamins D, A, E and minerals Zn, Fe (66% of cases). Taking vitamin-mineral complex in the 2^nd prophylactic dose for 1 month contributed to an improvement in vitamin and mineral sufficiency and a decrease in respiratory morbidity in the next 2 months after stopping the drug.

Conclusion. Vitamin-mineral complex can be successfully used to maintain vitamin and mineral levels and reduce respiratory morbidity in children with recurrent respiratory infections.

Introduction. Otitis media with effusion (OME) is the most common and asymptomatic form of otitis in preschool children, accompanied by the accumulation of exudate in the middle ear with the development of conductive and mixed hearing loss. The article discusses data on the nature of comorbid diseases in exudative otitis media and modern ideas about the effectiveness of a combination drug for concomitant bronchopulmonary pathology in children.

Aim. To study the nature of comorbid diseases in OME and evaluate the effectiveness of a combined expectorant drug in the treatment of upper and lower respiratory tract infections.

Materials and methods. 104 children diagnosed with acute and chronic otitis media with effusion were examined. All children were divided into 2 groups: Group I (50 people) with acute otitis media with effusion, Group II (54 people) with chronic otitis media with effusion. The average age of children in group I was 5.02 ± 0.48 years with the highest prevalence in the younger group (70%), the average age of children in group II was 5.87 ± 0.47 years with the highest prevalence in the preschool and primary school groups (88%). Group I children with tracheitis and bronchitis received a combined expectorant.

Results and discussions. The recurrent course of otitis media with effusion is supported by allergies in 43%, and by pathology of the upper and lower respiratory tract in 34%. The development of hearing loss leads to dysarthria in 26% of cases, which can undoubtedly negatively affect the further social adaptation of the child. Complex therapy of cough with a combined expectorant gave a positive clinical effect in 95% of cases, reduced the need for systemic antibiotics by 2.5 times, shortened the duration of the disease by 1.7 times.

Conclusions. Early diagnosis of comorbid diseases in AOME at a young age, timely complex treatment of bronchopulmonary pathology will prevent the development of COME with impaired speech development in older children.

Rhinitis is an inflammation of the nasal mucosa with rhinorrhea, nasal congestion, sneezing and nasal itching. Rhinitis can be acute or chronic (allergic rhinitis, non-infectious rhinitis, infectious rhinitis) with nasal symptoms, ophthalmological symptoms, ear congestion, sore throat, postnasal drip, cough. Up to 98% of cases of acute infectious rhinitis develop against the background of an acute respiratory viral infection. The pathogenesis of acute viral rhinitis and acute viral sinusitis is based on nasal congestion, difficulty in mucociliary transport and blockage of the paranasal sinuses. When prescribing treatment for children with acute viral rhinitis and acute rhinosinusitis, it is necessary to take into account the age and weight of the child, use elimination therapy and improve drainage of the paranasal sinuses. The use in pediatric clinical practice of the combined decongestant, which includes _α2-adrenomimetic and dexpanthenol, is effective and safe in the treatment of almost all conditions accompanied by nasal congestion, promotes rapid restoration of nasal breathing.

Introduction. Dry nose syndrome is a polyetiological condition that is common among patients of all age groups from infancy to profoundly old age. The low effectiveness of treatment is associated with the progression of atrophic mucous membrane degeneration, which also affects the cartilaginous and bony parts of the nasal cavity. Significant impairment of the protective, respiratory and olfactory function leads to decreased quality of life of patients, delayed adaptation, and arrested psychosomatic and physical development of children. Herbal medications refer to the agents that have minimal toxicity and side effects and effectively facilitate the restoration of functional integrity of the mucous membrane.

Aim. To discuss the results of studies on the effectiveness of natural medicines in the treatment of patients with dry nose syndrome.

Materials and methods. We conducted a literature search and studied publications (articles and relevant abstracts) containing information on various diseases that are accompanied by dry nose syndrome, as well as therapeutic options for this syndrome in Russian and foreign databases. The material was selected according to the following keywords: dry nose syndrome, atrophic rhinitis, mint essential oil, pine essential oil, eucalyptus essential oil. The study was conducted using the search engines Scopus, PubMed, CyberLeninka, Elibrary.ru, Google Scholar.

Results and discussion. The study results suggested the potential and benefits of the topical use of a combination medicine containing essential oils of eucalyptus, mint, and pine as a treatment and prophylactic medication in patients with dry nose syndrome.

Conclusion. Dyshesol, a herbal medicine that is an oil solution, meets the requirements for complex pathogenetic therapy in patients with dry nose syndrome of various etiologies, and can be recommended as a preventive and therapeutic medication for all age groups, and children from the age of two.

Introduction. Ultra-fast-acting insulin aspart has great potential for improving postprandial glycemia in patients with type 1 and type 2 diabetes mellitus due to its pharmacological characteristics. The development and production of biosimilars are increasing the availability of modern insulins for patients.

Aim. To evaluate the comparability of the pharmacokinetics and pharmacodynamics profiles of insulin aspart GP40311 (tested biosimilar of domestic production) and the reference drug (produced in Denmark) under conditions of a hyperinsulinemic euglycemic clamp in healthy volunteers. To evaluate the stability of a new ultrafast-acting biosimilar when used for continuous subcutaneous infusion in insulin pumps.

Materials and methods. Double-blind, randomized, crossover study assessing the pharmacokinetics, pharmacodynamics and safety of the tested biosimilar GP40311 of domestic production and the reference drug produced in Denmark, in the form of a solution for intravenous and subcutaneous administration of 100 IU/ml, the study was conducted under conditions of a hyperinsulinemic euglycemic clamp with the participation of 36 healthy volunteers. A study of the stability, dosing accuracy and tendency to catheter occlusion of a domestic drug for continuous subcutaneous infusion was carried out using several types of insulin pumps using the gravimetric method for 72 hours. Dosing accuracy was determined at the minimum and maximum bolus dose, stability was assessed by pH and quantitative insulin content aspart. The quantitative content of insulin and impurities was assessed by high-performance liquid chromatography.

Results and discission. The 90% confidence interval for the ratio of geometric mean values of the main parameters of pharmacokinetics (AUC_ins.0-t and C_ins.max) of insulin aspart test and reference drugs corresponded to the acceptable values of 80.00– 125.00%, which indicated their biosimilarity. When assessing PD, the comparability of action parameters is shown. The safety of the study drugs is comparable. Domestic insulin aspart met the specification standards when used for continuous subcutaneous infusion according to physicochemical parameters: pH, quantitative determination of insulin aspart, impurity content. The accuracy of dosing and the absence of occlusions in systems for 72 hours when using the drug in pumps have been established.

Conclusion. The study drugs were found to be biosimilar and equally safe. Domestic insulin aspart meets specification standards and can be used in various types of pumps.

Introduction. Obesity is a non-communicable pandemic and a major problem worldwide. As the prevalence of childhood obesity increases, there is growing evidence of an association between obesity and risk factors for menstrual disorders.

Aim. To study the role of obesity treatment in shaping menstrual disorders in adolescent girls.

Materials and methods. Group: with obesity and menstrual cycle disorders. Group 2: obese and regular menstrual cycle. An assessment of anthropometric data, collection of hereditary history, life history, and analysis of data from menstrual cycle diaries were carried out. All girls were given recommendations aimed at reducing body weight, and after 12 months, weight dynamics and the nature of the menstrual cycle were assessed.

Results. An increase in body weight for every 1 kilogram added over 12 months significantly increases the risk of menstrual cycle disorders: the odds ratio is 1.45 (95% CI: 1.11–1.88), p = 0.005. An increase in body mass index by 1 unit over 12 months significantly increases the risk of menstrual cycle disorders: the odds ratio is 1.70 (95% CI: 1.28–2.24), p = 0.001, similarly decreasing with a corresponding decrease in body mass index.

Discussion. The risk of menstrual cycle disorders is associated with a dynamic change in body weight: with an increase in body weight during the year, the chances of menstrual cycle disorders for every 1 kg added increase by 1.45 times, decreasing by the same number of times with a corresponding decrease in weight. With an increase in body mass index for each added unit per year, the chances of menstrual cycle disorders increase by 1.7 times, decreasing by the same number of times with a corresponding decrease in body mass index.

Conclusions. Dynamic changes in body weight can have both a positive and a negative effect on the prognosis of menstrual cycle disorders, which determines the great importance of therapeutic efforts aimed at reducing body weight.

If mothers eat a balanced diet, their breast milk provides their babies with the high-quality nutrients essential for their growth, development and preservation of health. However, the Federal State Statistics Service of the Russian Federation finds that the percentage of infants that are breastfed at 3 to 6 months of age is 43.9% and at 6 to 12 months is 39.2%. At the same time, the average duration of exclusive breastfeeding is only 1 month as compared to 6 months recommended by the World Health Organization, predominant breastfeeding duration is 4 months, and the total duration is 10.6 months. There are a number of reasons and circumstances why an infant is deprived of mother’s milk. But the introduction of supplementary feeding or transition of an infant fully to formula feeding should be rigorously justified. The review presents current data on the composition of goat’s milk formula line. It noted its unique physicochemical properties as compared to the standard cow’s milk formulas. The effectiveness and benefits of using a goat’s milk formula have been shown not only in healthy infants, but also in the presence of minimal functional gastrointestinal symptoms. It highlights the features of the unique fat component of the modern goat’s milk formula with DigestX® lipid complex based on a vegetable oil complex using triglycerides of specific structure, which brings the product composition closer to the fatty-acid profile of the breast milk. The article also speaks about the structural individualization of goat milk: the predominance of low-molecular-weight proteins, low or zero levels of αS1-casein, the absence of β-A1-casein, the presence of oligosaccharides and relatively high natural levels of some vitamins and minerals.

Introduction. The course of central nervous system tumors in children and their therapy are associated with nutritional disorders that persist after the end of antineoplastic treatment. It is important to determine nutritional problems, which is usually carried out in the form of a survey by a physician. He also needs to be aware and understand the degree of fulfillment of appointments by patient at home.

Aim. To study the problems of organizing nutritional support for children with tumors of the central nervous system after the end of antitumor treatment.

Materials and methods. A cross-sectional study was conducted, which included a survey, involving the parents of 71 patients with central nervous system tumors, aged 10 to 18 years, undergoing routine rehabilitation at the Russian Field Medical and Rehabilitation Scientific center. The survey included questions that a nutritionist usually asks during a consultation, with answer options, as well as a description of the diet and usual food intake. Anthropometry data (z-score of height-on-age, BMI) are included.

Results. 45% of the children had deviations in BMI. The answers to the routine questions “What is the child’s appetite” and “Are there (any) problems with nutrition” were the most uninformative, did not coincide with the actual composition of the diet and food intake. More accurately, the parents answered the questions “Are there (any) problems with diet/regimen organization” and “... associated with eating”. 21 children were prescribed diets (gentle and “low-carb”), but only 6 followed these diets. 58% noted periodic “physical exhaustion”, only 7% are engaged in physical therapy at home. Only 2 children received nutritional support at home. An analysis of the composition of the diet and diet revealed significant problems in 61% of children.

Conclusion. In a routine medical survey, simple questions about appetite and “are there any problems with nutrition” are not enough. Simple anthropometry is not enough. The survey has shown its effectiveness, but an analysis of the questionnaire is needed. Not all patients can follow dietary recommendations, it is necessary to take into account the motivation and understanding of both parents and children.

Introduction. Studying the gut microbiota of C-section newborns and its correction is a topical problem at present.

Aim. To study the process of gut microbiota formation in healthy C-section infants, and the option for its correction using a Lactobacillus reuteri strain DSM 17938 probiotic.

Materials and methods. A total of 80 healthy newborns were included in the study. Of these, 59 completed the study: the treatment group consisted of 36 elective caesarean (EC)-section infants and the control group was made up of 23 vaginally delivered infants. Newborns of the treatment study group were randomized into subgroups, one of which received the L. reuteri strain DSM 17938 (L subgroup) probiotic, and the second one did not receive it (0 subgroup). During the entire period of the study, infants were exclusively breastfed. The gut microbiota was analysed with the 16S rRNA sequencing method, and the metabolic activity of the gut microbiota was additionally assessed using gas-liquid chromatography.

Results and discussion. The metagenomic analysis showed that the taxonomic richness and biological diversity of the gut microbiota in L subgroup infants increased in time interval 3, which indicated the active effect of the strain on the infant microbiota by Exposure Day 30. The gas-liquid chromatography analysis showed more pronounced changes in short-chain fatty acids in infants of the L subgroup: they were more similar to the findings in the control group (vaginal delivery). Also, bowel problems and allergies occurred less frequently in infants of this subgroup and they less frequently suffered from respiratory diseases during the year. The study showed the association between the mode of delivery and changes in anthropometric measurements.

Conclusion. The use of L. reuteri strain DSM 17938 probiotic had a significant effect on the formation of the microbiota by the 30th day of age. A daily long-term addition of a L. reuteri strain DSM 17938 probiotic can prevent early microbiota dysbiosis and have a protective effect in later age period. 

Introduction. Probiotics have been shown to be effective in the treatment of infant colic for Lactobacillus reuteri. In recent years, multi-strain probiotics have been used for the same purpose.

Aim. To evaluate the clinical course of infant colic during treatment with mono- and multiprobiotics and in follow-up.

Мaterial and methods. 110 children aged from 1 to 5 months (average age 3.2 ± 0.3 months) suffering from colic were examined. Patients were randomized into three groups: group 1 (n = 30), received the BioGaia Probiotic drops for baby, group 2 (n = 40) – Bac- Set Bab multiprobiotic, group 3 (n = 40) – symptomatic therapy.

Results. The average duration of crying of children who received multiprobiotic (group 2) was significantly less than that of children of the first and third groups (group 1 – 1.62 ± 0.5 hours; group 2 – 1.1 ± 0.3 hours; group 3 – 2.5 ± 0.6 hours; p < 0.001). The duration of crying during colic was in correlation with the level of zonulin in the stool (r = 0.58, p < 0.05).

Treatment with the multiprobiotic was accompanied by a decrease in the frequency of bowel movements from 4.15 times a day to 3.27 times and was not accompanied by an increase in constipation, while monostrain probiotic and symptomatic therapy did not change the frequency of daily bowel movements and did not affect pre-existing constipation.

Conclusions. The multiprobiotic turned out to be more effective than the single-strain monostrain probiotic and symptomatic therapy in the speed of relieving infant colic; it completely stops them in 87.5% of children and reduces them in 12.5%. The effect of multiprobiotic is persistent, relapse was noted in only 13.3% of children, whereas after taking monostrain probiotic the relapse rate was 33.33%. The effect of multiprobiotic is associated with its ability to normalize intestinal microbiota and reduce the permeability of the intestinal wall.

Vesicoureteral reflux-stenosis is a malformation of the urinary system in which reflux is combined with a narrowing of the distal ureter at the site of its confluence with the bladder. At the same time, the diameter of the lumen of the formed rigid section of the narrowed ureter is sufficient for the occurrence of reflux, but not enough for normal emptying of the upper urinary tract, which leads to the development of a reflux megaureter. Histologically, the wall of the narrowed ureter is characterized by the presence of fibrosis, atrophy of the submucosal layer and the absence of neuromuscular elements of the ureterovesical junction. Diagnosis of reflux stenosis should include mycological cystography and intravenous excretory urography, the results of which, in addition to reflux itself, often determine the “beak symptom” – narrowing in the distal ureter; cystoscopy, which reveals narrow ureteral mouths without peristalsis; computed tomography with contrast enhancement; ultrasound examination of the kidneys and ureters on a urethral catheter with a diuretic test – an increase in the volume of the upper urinary tract by more than 30% of the initial values indicates the presence of stenosis. To clarify kidney function, the study is supplemented with static nephroscintigraphy. The most preferable option is a staged surgical treatment – the narrowed distal ureter is bujured and a ureteral stent is installed for a period of 1 month. While maintaining reflux, according to the data of microvascular cystography, endoscopic plastic surgery of the ureteral mouth is performed. In case of ineffectiveness of minimally invasive interventions, they proceed to Cohen’s neoimplantation of the ureter with resection of the distal ureter and, if necessary, with straining of the enlarged ureter. 

The skin of children of the first years of life has a number of structural and physiological features that determine the development of inflammatory process and clinical picture of the disease. Inflammatory skin diseases such as atopic dermatitis and allergic contact dermatitis are common in children in the first two years of life. Atopic dermatitis (AD) develops in individuals with hereditary predisposition, has a chronic recurrent course, is characterized by itching, typical morphology and localization of lesions. The prevalence of atopic dermatitis is up to 20%. Contact allergic dermatitis develops on the background of monovalent sensitization, the prevalence is about 16.5%. The clinical picture depends on the severity of the inflammatory reaction and the duration of the disease. The main goal of treatment of allergodermatoses is to stop the signs of inflammation, subjective symptoms. External therapy of inflammatory skin diseases consists in the prescription of topical glucocorticosteroids. When choosing the means of external therapy, it is necessary to take into account the age of the patient, the degree of severity of the inflammatory process, localization of lesions, pharmacokinetics of the active substance and other factors. The article describes clinical cases of treatment of atopic dermatitis, contact allergic dermatitis in patients of the first two years of life using methylprednisolone aceponate with ceramides in the form of cream, ointment. High efficacy and safety of topical corticosteroids in infants in combination with emollients has been shown to rapidly reduce the intensity of inflammation and subjective symptoms.

Introduction. Despite numerous scientific works devoted to the problem of acute respiratory diseases, its relevance does not decrease throughout the world, since serious complications with an unfavorable prognosis are possible.

Aim. To evaluate the effectiveness of preventive antiviral therapy in children with recurrent respiratory pathology.

Materials and methods. Under observation were 43 children (average age 7.43 ± 3.05 years) with recurrent respiratory pathology, who underwent health treatment in the summer period once for 14 days. The main group consisted of 22 children who were prescribed the antiviral therapy as a monotherapy for prophylactic use. The comparison group included 21 patients who underwent preventive treatment using nasopharyngeal irrigation with local antiseptic chemicals. The observation period was 3 months after prophylactic treatment.

Results and discussion. After preventive treatment, the total number of episodes of ARI during the observation period in the main group in relation to the comparison group was according to nosologies: acute pharyngitis (p = 0.0317), exacerbation of chronic tonsillitis (p = 0.0137), acute rhinitis (p = 0.0692), rhinosinusitis (p = 0.0429). In the main group, during the observation period, when episodes of upper respiratory tract diseases occurred, antibacterial drugs were prescribed statistically significantly less frequently (p = 0.0296). After the preventive course, compared with the initial data, there was a decline in the number of cases of upper respiratory tract diseases per child on average per quarter. Thus, in the main group, a more pronounced significant difference was revealed in all nosological forms (acute rhinitis, rhinosinusitis p = 0.0081, acute pharyngitis p = 0.0129, tonsillopharyngitis p = 0.0384). In the comparison group – respectively: p = 0.0426; 0.0387; 0.0439.

Conclusions. Carrying out preventive treatment as monotherapy in children with recurrent respiratory pathology demonstrated high effectiveness (86.37%) of the antiviral therapy.

The use of biological targeted therapy for allergic diseases has significantly increased the effectiveness of the treatment of patients with atopic dermatitis, bronchial asthma, and combined allergopathology. Dupilumab, a monoclonal antibody drug that blocks signaling from IL-4 and IL-13, is one of the options for biological therapy aimed at modifying the Th2 immune response. The article discusses current ideas about the pathogenesis of allergic Th2-dependent inflammation, about the key mechanisms of the formation of atopic dermatosis and its role in inducing the progressive course of atopy. A clinical example of successful treatment of an 8-year-old child with severe atopic dermatitis, moderate partially controlled bronchial asthma, allergic rhinitis, and multisensitization to food and pollen allergens is given. The use of biological targeted therapy with dupilumab made it possible to achieve sustainable remission in the course of atopic dermatitis and bronchial asthma. The SCORAD index, which was 66.8 points before dupilumab treatment, decreased to 8.9 points. Immunobiological therapy with an IL-4R_α inhibitor, dupilumab, is indicated for patients with moderate to severe allergic diseases when it is not possible to achieve adequate control with standard treatment methods. The presented clinical case of the use of the drug contributes to the study of the clinical efficacy and safety of dupilumab during its long-term use.

Introduction. Bronchial asthma (BA) is a multifactorial disease, but its pathogenesis in children is based on atopic inflammation, which is what modern therapies are aimed at combating; less attention is paid to factors of nonspecific inflammation, but they also affect the controllability of the pathological process. The regulation of any inflammation is carried out primarily by cytokines, therefore this work is devoted to the study of polymorphisms of genes for cytokines of nonspecific inflammation.

Aim. To explore the association between cytokine gene polymorphisms and clinical immunological features of uncontrolled asthma.

Materials and methods. We examined 167 children with asthma, who were divided into groups with and without complete disease control, according to the standard of clinical guidelines for asthma. Additionally, mononucleotide substitutions in the cytokine genes were determined: IL4-C589T (rs2243250), IL6-C174G (rs1800795), IL10-G1082A (rs1800896), IlL10-C592A (rs1800872), IL10- C819T (rs1800871), IL12B-A118 8C (rs3212227) , TNFα- G308A (rs1800629), serum cytokine levels: IL4, 5, 6, 7, 8, 9, 10, 18 and TNFα; standard immunogram indicators: subpopulations of lymphocytes, neutrophil phagocytosis and levels of Ig A, M, G, E.

Results and discussion. It was determined that each of the clinically significant mononucleotide substitutions forms a unique cytokine and immune profile that is phenotypically realized in the clinical manifestations of the disease. It has been proven that mononucleotide substitutions IL10-C592A, TNFα- G308A contribute to better control with a tendency to milder asthma; children with the IL6-C174G polymorphism experience more severe disease with a tendency toward decreased control. In addition, mononucleotide substitutions in the genes of signaling molecules of the immune system modify atopic inflammation, weakening (IL10-C592A, TNFα- G308A) or enhancing (IL6-C174G) it, which leads to a change (decrease or increase) in the dose of TGCS, respectively.

Conclusion. Thus, determination of IL6-C174G (rs1800795), IL10-C592A (rs1800872), TNFα- G308A (rs1800629) polymorphisms in children with ВА helps to identify a risk group for severe and uncontrolled disease, as well as to personalize therapy. 

Foreign bodies in the gastrointestinal tract remain one of the significant problems in pediatric practice. Ingestion of foreign bodies is typical for children of all ages, but especially for the first 5 years of life. Due to the anatomical features of children, foreign bodies are often located at the level of the first physiological narrowing – in 68% of cases. The mortality rate from foreign bodies is 1%, but with the development of severe complications, this figure increases to 45%. A disc-shaped battery is the most dangerous one for health, as it is capable of causing local infiltrative-necrotic changes, perforation of the esophagus. Disc-shaped batteries as FB (foreign body) form up to 10% of the total number of foreign bodies of the gastrointestinal tract in children. Unfortunately, parents do not immediately seek medical help, since the symptoms indicating the presence of FB are often absent or may manifest as non-specific symptoms. Endoscopic examination serves as a key method in the diagnosis of ingested FB among children and its removal less than 24 hours after ingestion, since any delay reduces the probability of successful intraluminal extraction. This article discusses the clinical observation of a prolonged presence of a foreign body in the esophagus of a toddler child. The clinical course manifested itself in the form of nonspecific symptoms, a foreign body was detected only after a number of studies and was removed by endoscopic method. During the examination of the patient, in addition to the chest X-ray, esophagogastroduodenoscopy and a number of bronchoscopies were performed. Accessible and highly informative methods of instrumental diagnostics available in each clinic of the regional scale, today remain the first stage of the diagnosis of foreign bodies.

Primary sarcopenia characterizes frailty of old age. Secondary sarcopenia can occur in both adults and children with severe somatic or surgical pathology. A model for studying sarcopenia in children can be patients with cerebral palsy, whose muscle development differs from typically developing children. The lecture presents the mechanism of the development of sarcopenia, diagnostic criteria for adult patients presented in consent documents, as well as analogues of diagnostic scales used in pediatric practice. The diagnosis of sarcopenia in children has something in common with the diagnosis of the patient’s nutritional status. Diagnosis of sarcopenia in children using bioimpedansometry method was proposed by the authors, and a Eurasian patent was received. Based on the volumes of adipose and active cellular tissue in the component composition of the body: with a combination of a percentage of fat mass of 40.5% and above and a percentage of active cell mass of 37% and below, sarcopenia is diagnosed, and with a combination of a percentage of fat mass of 30.5% and above and percentage of active cell mass from 37% to 43.5% is diagnosed as presarcopenia. Options for preventing sarcopenia are presented, including patented ones. A multidisciplinary approach to working with a patient with sarcopenia includes, while treating the underlying disease, nutritious nutrition, restoration of the intestinal microflora and motor activity of the patient.

Plastic bronchitis is a rare disease. Despite the fact that the clinical signs of plastic bronchitis were first described by Galen more than 1800 years ago, the pathogenesis of the disease remains poorly understood to this day. As a result, it is not always possible to choose a therapy that allows for complete clinical and laboratory remission or complete recovery of the patient. Treatment of plastic bronchitis should be multifaceted, including the appointment of medications, hardware and physiotherapy methods. Despite the increasing relevance of the topic, the number of published works dealing with the problems of plastic bronchitis, both in world literature and domestic, is small. This review presents historical information on the study of plastic bronchitis, discusses the pathogenesis of the disease, taking into account the results of research over the past decades, lists the main and secondary clinical signs and symptoms, discusses the principles of modern therapy, including both invasive and non-invasive, physiotherapy, and treatment methods. As a clinical example, a case of plastic bronchitis in a 3-year-old boy who was treated in the intensive care unit and then in the infectious diseases department of the Z.A. Bashlyaeva State Clinical Hospital with a diagnosis of Idiopathic plastic bronchitis during one of the relapses of the disease from March 7, 2020 to March 22, 2020 is given. The diagnosis was previously made at the Morozov City Clinical Hospital.

Gut microbiota is one of the main components that influence human health status. The gut microflora begins to establish as early as the prenatal period, however, the most intensive colonization of the infant by maternal and environment microorganisms occurs during the intranatal and postnatal periods. The mother-placenta-fetus system lays the foundation for early formation of microbiota. The maternal microbiota starts changing during pregnancy in order to modify metabolism to make it more favourable to the fetus, and continues throughout pregnancy, influencing the incubation of the fetus's own microbiota. The development of the fetal microbiome is also affected by the microbiome of the uterus, amniotic fluid and umbilical cord, although these organs were previously thought to be sterile, like the fetal gut. Multi-year research findings refuted these assertions and proved the existence of a separate meconium microbiome, which does not coincide with the maternal microbiota. The postnatal factors, such as mode of delivery and type of infant feeding, also influence the development of the gut microbiota. Vaginal birth exposes infants to maternal vaginal microbiota. During cesarean section, infants are exposed to environmental microbiota, which disrupts natural microbial colonization. Breast milk has its own microbiome, which can change and adapt to the infant needs. Exclusive breastfeeding affects Bifidobacterium and Bacteroides colonization rates, which metabolize breast milk oligosaccharides, producing short-chain fatty acids as a byproduct. Probiotic therapy can be used to maintain sufficient levels of Bifidobacterium to form a healthy microbiota. This review presents the stages and conditions for the formation of the infant’s gut microbiota, as well as the relationship between them in the course of ontogenesis. 

Fevers in children is a pressing challenge in paediatrics, as they are one of the most common symptoms people seek medical help. Autoinflammatory diseases (AIDs) constitute a group of diseases, where fever is one of the main symptoms, and fever attacks have a certain frequency and duration. Autoinflammatory diseases are rooted in the systemic aseptic inflammation associated with activation of the innate immune system, without elevated levels of autoantibodies. The most common autoinflammatory diseases include hereditary periodic fevers, among which are familial Mediterranean fever (FMF), HIDS/MKD, CAPS-, TRAPS-syndromes and rarer diseases (deficiency of natural interleukin receptor antagonists). The pathogenesis of this group of diseases is based on the process of accelerated formation of a supramolecular protein complex (inflammasome), which subsequently leads to the transition of the inactive form of IL1_β into its active form. The clinical presentations of these diseases may be similar and include episodes of fever, abdominal pain, arthralgia, various rashes, etc., as well as an increase in acute phase parameters. These diseases are characterized by symptoms at certain intervals; they usually have intervals without showing any symptoms. Familial Mediterranean fever is characterized by a certain ethnic background (Armenians, Turks, Arabs, Jews). Today, molecular genetic testing is the most accurate method for diagnosing familial Mediterranean fever. Current therapy aims to prevent attacks of the disease, but it is also important to use symptomatic therapy to relieve the child’s condition when an attack has already developed. Modern treatment strategies include both drugs that have long been used in paediatric practice (colchicine, non-steroidal anti-inflammatory drugs (ibuprofen), glucocorticosteroids) and novel genetically engineered biological drugs (interleukin antagonists and tumour necrosis factor inhibitors, etc.).

Introduction. The relevance of studying community-acquired pneumonia in children is associated with its high prevalence, despite timely prevention and effective approaches to the treatment of respiratory diseases. Factors influencing the severity of pneumonia are diverse and include comorbid pathology, early age of the child, the state of the immune system, etc.

Objective. To identify and rank risk factors for severe community-acquired pneumonia in infants and preschool children.

Materials and methods. This article presents the results of a retrospective analysis of 291 medical histories of children from 3 months to 7 years with community-acquired pneumonia. 83 children had severe CAP, of which 63 patients were hospitalized in the ICU.

Results and discussion. The average age of a patient with community-acquired pneumonia was 33 months. Children from families with two or more children fell ill more often. On average, children were hospitalized for 4–5 days of illness. Concomitant diseases in children with CAP were quite common and often complicated the course of pneumonia. According to the results of our study, more than 70% of children were not vaccinated against pneumococcus, Haemophilus influenzae and influenza. We established significant linear relationships between the presence of bronchial obstruction and complications of CAP such as respiratory failure and transfer to the ICU (odds ratio (OR) 7.1; Cramer coefficient 0.40; relationship 0.005). It was shown that patients who received outpatient antibiotic therapy were less likely to require transfer to the ICU.

Conclusion. Risk factors for severe community-acquired pneumonia and hospitalization in the ICU were: male gender, age under 2 years, lack of vaccination against pneumococcus, Haemophilus influenzae and influenza, combination of bronchial obstruction with CAP, presence of ENT pathology, lack of antibacterial therapy during prehospital stage, as well as the presence of a serious condition already upon admission.

Acute appendicitis is the most common surgical pathology in paediatric practice. Surgical interventions in children with acute and complicated appendicitis are performed when urgently indicated at various stages of the disease. Laparoscopic appendectomy has become the current “gold standard” for providing emergency surgery care to children. Improvements in surgical techniques and post-operative protocols have reduced complications in children to 5–7%. The current discussion topics include the issues of argumentation of “incidental appendectomies” to be performed in minimal macroscopic changes in the vermiform appendix in children with nonspecific mesenteric lymphadenitis, intestinal indigitation, appendiceal lithiasis, justifications for indications and timing for surgical interventions in chronic appendicitis. The appendix has long been considered an “unnecessary” organ, just vestigial structures left over in the process of human evolution. Over the past two centuries, much work has been done to study the appendix. The structure of the vermiform appendix is unique. It has a narrow lumen, abundant mucosa-associated lymphoid tissue and valuable microbial composition. It has recently been hypothesized that the appendix has immunomodulatory functions and serves as a “safe house” for the microbiota, providing commensal bacteria that may restore the gut after infections or antibiotic therapy. Some studies suggest that removal of the appendix increases the risk of inflammatory bowel disease, including ulcerative colitis. However, mechanisms underlying such causal relationship remain unclear. This article considers current knowledge when addressing the appendix microbiome and the relationship between the appendix and ulcerative colitis.

Introduction. An urgent medical and social problem at present is the need to develop nationally adapted versions of the questionnaire for assessing dependence on social networks, which is due to the avalanche-like increase in the prevalence of this phenomenon, especially among adolescents and youth, and often associated with disorders of the neuropsychic and somatic spectrum.

Aim. Validation of the English-language Social Media Disorder scale (SMDS) questionnaire based on 9 criteria, including psychopathological aspects of engagement with social networking sites.

Materials and methods. After the procedures of direct and reverse translation of the questionnaire, the psychometric validation of the test was carried out on a Russian-speaking sample of 3074 adolescents aged 11–19 years (46.1% of boys and 53.9% of girls, median age 14 (13–16) years) – students of 10 educational institutions in Krasnoyarsk. The external validity of the SMDS- RU questionnaire was assessed using the following methods: Chen Internet Addiction Scale (CIAS) – to assess the presence of Internet addicted behavior; the Strengths and Challenges Questionnaire (SDQ) – to analyze the mental health of the subjects.

Results. Expiratory and confirmatory factor analyzes demonstrated good agreement between the test components. The results of confirmatory factor analysis confirmed its single-factor structure (CFI = 0.9, TLI = 0.9, RMSEA = 0.06), an acceptable Cronbach’s Alpha value (Cronbach’s Alpha = 0.7) indicates its sufficient internal consistency and reliability. The external validity of the SMDS-RU questionnaire was confirmed by established associations with the results of the Chen Internet Addiction Test (CIAS) and the Strengths and Challenges Questionnaire (SDQ) by R. Goodman. Test-retest reliability when measured at 6-month intervals also demonstrated acceptable results: the Spearman correlation coefficient between the sums of scores of two measurements was 0.66, p < 0.001.

Conclusion. The Russian-language version of the Social Network Addiction Questionnaire (SMDS-RU) developed for teenagers has sufficient information content, reliability, internal and external validity and can be actively used in the Russian adolescent population.

Currently, bronchial asthma is a global health problem, due to its high prevalence, economic component, as well as a violation of the social adaptation of children suffering from this disease. This article is devoted to a detailed analysis of the clinical case of a patient born in 2009 with an established diagnosis of Bronchial asthma, atopic form, severe persistent partially controlled course, which initiated therapy with a genetically engineered biological preparation of a humanized monoclonal antibody against IgE – omalizumab. However, in subsequent years, the patient’s condition was unstable, severe seizures were repeated, she was repeatedly hospitalized in the department where infusion therapy was performed and basic therapy was reviewed, dose adjustments and administration regimens of monoclonal antibodies to IgE (omalizumab) were carried out. A retrospective analysis of the results of objective, instrumental and laboratory examinations of the patient was also carried out over the past three years, when the child received the genetically engineered drug omalizumab without interruption. Taking into account the severe course of AD, the lack of control over the disease against the background of basic therapy with combined drugs in combination with therapy with monoclonal antibodies to IgE (omalizumab), it was decided to correct treatment and initiate therapy with a genetically engineered drug, recombinant human monoclonal antibody IgG4 (dupilumab). This clinical example once again shows how personalized the approach should be when prescribing therapy to patients with severe asthma, and also dictates the need to develop new diagnostic methods and management tactics for patients with uncontrolled forms of this disease.