Introduction. Symptoms typically peak around the sixth week of life and resolve spontaneously by 4–6 months of age, which is why colic is generally considered a benign and self-limiting condition. The need for treatment arises from the negative impact of excessive crying on the infant’s family, as well as the potential long-term consequences of colic. The effectiveness of Lactobacillus reuteri DSM 17938 in breastfed infants has been demonstrated. Recently, there has been growing interest in the LR92 strain; however, its mechanism of action remains unclear.

Aim. To study the urine metabolome in 1–4 month-old breastfed infants receiving Lactobacillus reuteri LR92 probiotic (Maxilac^® Baby drops) for the treatment of infantile colic, identify probable mechanisms of action of this probiotic, and assess its safety.

Materials and methods. A clinical post-registration open observational prospective single-center study with minimal intervention and a comparison group was conducted: 38 children aged 1 to 5 months who were breastfed and diagnosed with infantile colic. Patients were divided into two groups: the main group (17 children) received Maxilac^® Baby probiotic drops for oral administration, the comparison group (21 children) did not receive probiotics. Urine metabolome analysis was performed using gas chromatography-mass spectrometry (GC-MS) with modern chromatographic equipment.

Results and discussion. Children with colic showed significant changes in urine metabolome, reflecting impaired intestinal absorption, energy metabolism, and microbiocenosis. Following treatment with probiotic, complete resolution of colic by day 14 was observed in 100% of children in the main group (compared to only 20% in the comparison group); decreased urine content of short-chain fatty acids; changes in neurotransmitter levels indicating suppression of excitatory and stimulation of inhibitory neurotransmitters; absence of side effects.

Conclusions. Maxilac^® Baby probiotic demonstrated high efficacy and safety in treating infantile colic, confirmed by clinical and metabolomic studies. The mechanism of action is associated with normalization of microbiocenosis, metabolic processes, and neurotransmitter status.

The colour perception of the world has been an intense topic of interest for scientists and philosophers for thousands of years. Historically, the colour has been considered a philosophical category, it was used to investigate the perception of reality, and it also revealed the semantic foundations of the culture. Scientific paradigms explaining the mechanisms of colour vision have changed, but the recognition of the impact of colours on the psychological development of the personality has remained unchanged. Historical aspects of colour vision support the value of visual experience, as colour therapy provided the basis for medical concepts in ancient civilizations. The development of methods for obtaining knowledge about the world around us has formed a modern concept of colour perception patterns. Advances in understanding neurogenesis allowed scientists to identify critical periods in nervous system development when sensory stimulation plays a crucial role. There appeared new emerging popular tendencies to form standards of parenting behaviour. It is important for a pediatrician to understand the main aspects of the popular concept of beige motherhood, as this tendency reflects not only the aesthetic component, but also characterizes the psychological and emotional component of the motherhood. The positive and negative aspects of this popular tendency are a subject of discussions. In the article, the authors raise the issues of negative impact of this concept in the form of limiting the sensory experience and creative craving of the child. Increased awareness among pediatricians about such popular tendencies can help prevent negative consequences. Building trust and establishing a constructive dialogue with parents, the pediatrician can effectively communicate potential risks and offer alternative approaches that ensure harmonious development of the personality. That is why it is necessary to scientifically substantiate the advisability of the popular tendency of beige motherhood in the context of its impact on the neuropsychic development of the child.

In pediatric practice, bronchitis is a group of the most common diseases of the bronchopulmonary system. The usual simple attitude towards bronchitis as a mild nosological form has now been revised and requires serious adaptation of the global medical community to more careful consideration of symptoms due to the isolation of recurrent bronchitis of various etiologies and prolonged bacterial bronchitis. Of particular importance is the potentially negative impact of prolonged bacterial bronchitis on long-term respiratory health due to the formation of bronchiectasis. First of all, in real clinical practice, the attention of primary care pediatricians should be focused on these features. This review analyzes the data of modern scientific literature on the electronic databases PubMed, EMBASE database, Cochrane Library, Wiley, PUBFACTS, Springer Link platform, Elsevier scientific publishing house, Cyberleninka. The analysis of 42 full–text reviews combined the differential diagnostic criteria of various forms of bronchitis, including those that are secondary. The important role of the duration of bronchitis symptoms and the features of the clinical picture is emphasized. In the context of prolonged bacterial bronchitis, attention is drawn to the high risks of the formation of a chronic bronchopulmonary process in the late diagnosis of this form of bronchial lesion. The issues of the use of antibacterial therapy for bronchitis in world practice are considered, the main causes of irrational therapy are highlighted. The approaches to mucoactive therapy are analyzed, taking into account the positive prognostic effect on longterm respiratory health in the light of functionally active mucociliary clearance. Potentially high clinical efficacy of bronchitis therapy with multicomponent phytopreparations has been shown.

Introduction. Most acute respiratory infections are accompanied by a cough. Therefore, it is important to promptly determine whether the cough is a symptom of inflammatory diseases of the upper or lower respiratory tract or has a different origin, which will allow for the selection of an appropriate diagnostic and treatment plan. The article focuses on the issues of symptomatic treatment of cough in children using a modern herbal preparation with complex action in the standard treatment regimen.

Aim. To study the possibilities of rational cough therapy using a herbal preparation Gedelix based on ivy in children.

Materials and methods. The study included 62 patients of both sexes from 2 to 6 years, who were in the children’s hospital of the Central City Clinical Hospital No. 18 in Kazan, with a symptom of cough that was nonproductive at the time of screening/ unproductive nature, against the background of acute bronchitis without concomitant somatic diseases.

Results and discussion. The analysis of the conducted study showed high clinical efficacy of the studied herbal medicine based on ivy. The drug is included in the standard of treatment. The results of the recommended treatment option were analyzed. During the study, the drug demonstrated high efficacy in reducing inflammation, liquefying and facilitating sputum discharge, restoring mucociliary clearance and stimulating the regeneration of the respiratory mucosa. The absence of adverse drug reactions showed safety and good tolerability.

Conclusions. The herbal preparation has shown its effectiveness and safety, which allows us to recommend it as the drug of choice for the symptomatic treatment of cough in children from infancy as part of standard treatment.

Acute tonsillopharyngitis is a common condition in children, accounting for 5–15% of visits to primary care pediatricians. Acute tonsillopharyngitis is characterized by the sudden onset of characteristic symptoms: sore throat (with or without difficulty swallowing), enlarged and swollen tonsils, enlarged cervical lymph nodes, fever, and general malaise. In most cases, acute tonsillopharyngitis is caused by a viral infection. Rhinovirus, coronavirus, and adenovirus account for at least 30% of all cases, while influenza or parainfluenza viruses account for approximately 4%. Other viral infections that cause ATP include Epstein- Barr virus (EBV), enteroviruses (Coxsackie B), respiratory syncytial virus, herpes viruses, cytomegalovirus, and human immunodeficiency virus. Pediatricians must differentiate between bacterial (Streptococcus pyogenes) and viral tonsillopharyngitis to determine the need for antibacterial therapy. Diagnostic scales (McIsaac, Centor) and a throat swab (strep test or bacteriological examination) are used for this purpose. In cases of GABHS tonsillitis, antibacterial therapy is administered for 10 days. For tonsillopharyngitis of any etiology, symptomatic and topical therapy are prescribed. Among topical antiseptics, the most studied and safe is ambazone (Faringazon), which is prescribed to children aged 3 years and older for 3–4 days. Ambazone has a bacteriostatic effect against Streptococcus haemoliticus, Streptococcus viridans, and Pneumococcus. This article presents a treatment algorithm for patients with ATP for practicing primary care pediatricians, based on the approved Clinical Guidelines for “Acute Respiratory Viral Infection (ARVI)” and “Acute Tonsillitis and Pharyngitis (Acute Tonsillopharyngitis)”.

Herpesvirus infections remain an urgent problem in pediatrics due to their widespread prevalence and frequent relapses. Herpesviruses are able to persist and reproduce in cells of the immune system, which leads to their death or functional exhaustion, causing secondary immunological insufficiency, maintaining long-term persistence of the virus. The mechanisms leading to the latent state and reactivation of herpesvirus, as well as the factors controlling these processes on the part of the virus and the host organism, have not been fully studied. The authors analyze current literature data based on evidence-based medicine regarding herpesvirus infections, their effect on the immune system, and innovative methods of treatment and prevention. The insufficient effectiveness of traditional methods of treatment and prevention of herpesvirus infections leads to the need to consider the search for methods of immunocorrection. One of the drugs of choice for these infections is inosine pranobex, especially in children with a complicated premorbid background and in cases where a complex antiviral and immunomodulatory effect is required. Inosine pranobex has direct antiviral and immunostimulating effects, effectively relieves acute manifestations, and significantly reduces the frequency of relapses in herpesvirus infections. It is emphasized that the drug has a favorable safety profile, has a low risk of developing resistance, and can be used in children from 3 years of age. Combination therapy of inosine pranobex with antiviral drugs is more effective than monotherapy with antiviral drugs alone. Pharmacoeconomic analysis confirms the expediency of prescribing therapy using inosine pranobex. If there is no effect from the ongoing therapeutic and preventive measures for 3 months, an in-depth examination of the child in a polyclinic or hospital setting, and an individual selection of appropriate treatment are indicated.

Introduction. The new coronavirus infection has left an indelible mark on the history of global and national healthcare. Many studies are currently based on the desire to define the consequences of the pandemic and be prepared for similar situations in the future.

Aim. To examine clinical laboratory features of the Post-acute COVID-19 Syndrome in children aged 7 to 18 years under the medical supervision of a district pediatrician.

Materials and methods. The study involved 120 children aged 7 to 18 years who had mild COVID-19 in 2021–2022. The study was divided into 2 groups: the main group (n = 29) – children with the post- COVID syndrome and the comparison group (n = 91) – children without post- COVID syndrome. A physical examination, functional, laboratory and special methods of examination were performed.

Results and discussion. Clinical aspects of post- COVID syndrome: asthenic reaction (manifested by fatigue and/or anxiety) – 24.14% and cognitive deterioration (decreased memory and academic decline) – 13.78%. Respiratory effects (lingering cough) were observed in 17.24%, prolonged subfebrile fever not associated with other diseases – 10.34%, exacerbation of chronic diseases, neuropsychiatric changes, cardiac disorders, dermatological consequences – 6.9%, renal dysfunctions and multi-systemic dysfunctions – 3.45%. Average values of IgG to Anti- SARS-CoV-2 is 6.5 IU/l (min 0.72 – max 13.3), above the average value in 58.6% of cases. IL-6 is elevated in 7% of cases in children with comorbidity and 3% with post- COVID manifestations. No increase in IL-4 and TNF-_α was detected. A correlation between the initial health status of the child and the post- COVID syndrome probability was defined. All children were under supervision for a year. Additional examinations and consultations with specialists were conducted. The treatment is expected, immunomodulatory, vitamin therapy.

Conclusions. This research showed that children who have a light disease may suffer post- COVID syndrome. When children have a medical check pediatricians can see the risks of post- COVID syndrome in them during the recovery phase.

Acute respiratory infections remain one of the leading causes of pediatric department visits, which places a substantial financial burden on healthcare system and generates high socioeconomic costs. Cough, one of the most common symptoms of acute respiratory infections in children, is a complex pathophysiological reflex intended to maintain airway clearance and patency by removing secretions and foreign objects. Respiratory tract infections in children often give rise to bronchial hyperresponsiveness characterized by bronchial smooth muscle contraction, edema of the bronchial mucosa, and mucus hypersecretion, which may be a manifestation of broncho-obstructive syndrome. Effective treatment of cough depends largely on the accurate and timely diagnosis of the underlying condition. Cough medicines fall into two main categories: cough suppressants (antitussive agents) and cough clearance promoters (mucoactive agents). This article discusses the physiological aspects of cough occurrence in respiratory diseases, and presents the causes of bronchial hyperresponsiveness as a key factor requiring a sensitive attention to choose treatment strategy. Special attention has been given to the modern approaches to the treatment of cough in children due to acute respiratory infections, including the use of combination mucoactive drugs and herbal medications. These agents have a multi-target effect: they may augment mucociliary clearance, supress cough intensity, reduce inflammation, and alleviate symptoms. The use of such medications helps reduce polypharmacy, mitigate the risk of side effects, enhance medication adherence, and avoid unnecessary antibiotic therapy. These drugs have been shown to be highly effective and safe in children with infectious diseases associated with coughing.

This article presents a brief account of the problem and clinical case reports of the use of modern aminopenicillins in the treatment of upper respiratory diseases in children. Respiratory viruses are the main factor behind acute upper respiratory diseases. However, opportunistic bacteria also play a significant role in the etiology of such most common nosological entities as acute otitis media, acute tonsillitis, and acute rhinosinusitis. The most common of these are Streptococcus pneumoniae, Haemophilus influenzae, and Streptococcus pyogenes. Amoxicillin has kept the same spectrum of activity as ampicillin against major respiratory bacterial pathogens. Streptococcus pyogenes retains 100% sensitivity to amoxicillin, as it does to all _β-lactams. At the time of its invention, the vast majority of Streptococcus pneumoniae and Haemophilus influenzae strains were highly susceptible to amoxicillin. However, the level of acquired resistance to penicillin drugs in general and to amoxicillin in particular has increased over the past 40 years. The growth rates of resistant Streptococcus pneumoniae proportion are particularly alarming. Among the challenges associated with the growth of acquired antibiotic resistance, practicing physicians should adhere to existing indications and approved algorithms for systemic antibacterial therapy of common conditions such as acute rhinosinusitis and acute otitis media. The use of amoxicillin as a drug of initial therapy in systemic antibacterial therapy regimens for the most common acute upper respiratory diseases, such as acute tonsillitis, acute otitis media, and acute rhinosinusitis still holds relevance as noted in the current clinical guidelines. Inhibitor-protected amoxicillin should not be used unreasonably instead of pure amoxicillin due to the high risk of adverse drug reactions.

Introduction. Today, complex drugs are used as effective medications to relieve broncho-obstructive syndrome. Due to their composition, they can effectively influence mucociliary clearance, relieve bronchospasms, and improve sputum rheology.

Aim. To conduct a comparative evaluation of the efficacy and safety of a complex mucolytic drug and other cough treatment options in children with broncho-obstructive syndrome.

Materials and methods. A total of 167 children aged 3 to 15 years with obstructive bronchitis (mean age 7.9 ± 1.4 years) were observed. Children aged 4 to 8 years (91 children [54.5%]) represented the largest portion of the sample. The patients were divided into 2 groups: Group 1 (93 children) received Jocet® as their sole cough drug; Group 2, the control group (74 children), received a combination of mono-preparations: a bronchodilator combined with an expectorant and/or mucolytic drug.

Results. The study investigated the safety profile of a complex mucolytic drug (Jocet®). The analysis of clinical observations showed no reported adverse events in 97% of patients, which evidenced high tolerability of the drug. On Days 6–7 of treatment, the severity of clinical symptoms in Group 1 was significantly lower than in Group 2. Group 1 also demonstrated faster improvement in auscultation findings and transformation of cough into productive wet cough; Group 2 showed a similar effect on average 0.9 days later.

Conclusions. The use of Joсet® allowed to effectively and safely achieve the intended effect in children with broncho-obstructive syndrome as compared to children, who received a combination of drugs (a bronchodilator and an expectorant). Based on the study results, we would advise to include this drug in pediatric practice as an effective pathogenetic agent to treat obstructive bronchitis. 

Introduction. Despite the active use of continuous glucose monitoring (CGM), including flash monitoring (FM), by patients with type 1 diabetes mellitus (T1DM), the use of a glucometer is still actual. According to current clinical guidelines, blood glucose measurements with a glucometer should be performed at least 4 times a day when using CGM and at least 2 times a day when using FM.

Aim. To study the usage of glucometers simultaneously with CGM in children and adolescents with type 1 diabetes in real clinical practice.

Materials and methods. In 12.2024–07.2025, 100 patients (43 girls, 57 boys) 13.0 (9.0; 15.0) years with type T1DM for 4.5 (3.0; 6.6) years and glycated hemoglobin (HbA1c) level 7.0% (6.2; 8.1) answered a questionnaire about the usage of CGM and glucometers. The results were compared with a similar survey in 2016 and 2020–2021.

Results. All patients use CGM and glucometers. Inconsistent use of CGM (17% of patients) and measuring glucose with a glucometer less than once a day (10%) were associated with non-target HbA1c levels – OR 2.068 (95% CI 0.700–6.116) and 2.550 (95% CI 0.620–10.492), respectively.

We detected an increase in the percentage of patients with the target HbA1c level (50%) compared to 2016 (26%; p = 0.019) and 2020-2021 (27%; p < 0.001).

Patients recheck with a glucometer their glucose level measured by the CGM more often (p < 0.001) at high and low values, when changing the sensor, during ARVI and when the values do not correspond to their well-being; the percentage of those who do not recheck the CGM readings decreased from 14% to 2% (p = 0.003).

Conclusion. Comparison of the 2016, 2020–2021 and 2025 survey results demonstrated a significant increase in the percentage of patients achieving self-monitoring goals; the role of every-day use of CGM in combination with daily glucose testing with a glucometer.

In this article, we report two cases of obesity in sibs associated with a leptin receptor (LEPR) gene polymorphism (LEPR: с.233A>G, p.Arg223Gln (rs1137101)). To date, more than 9 thousand polymorphic variants of this gene have been identified. The p.Arg223Gln polymorphism leading to an amino acid substitution in the extracellular domain of a receptor that is common to all its isoforms is one of the best-investigated polymorphisms. An association was found between this polymorphism and increased weight and obesity. Several dozen cases of LEPR mutations in patients with early onset of rapidly progressive severe morbid obesity and hyperphagic eating behaviour have been described in foreign literature. We discuss the features of the course of this obesity “phenotype”, the choice of further follow-up strategy, and treatment options based on the clinical cases that we studied. Currently, both patients continue to be followed up in outpatient settings. The doctor gave their mother a talk about the need for strict adherence to a healthy dietary pattern, and restricting children`s access to food products. A low-calorie diet with a low carb and fat content for 6 months has been recommended. The total caloric content of food recommended for a boy is 1700 kcal/day, and for a girl – 1200 kcal/day. The family was referred for psychotherapy to change their eating behaviour. An individual 12-month program including pediatric endocrinology follow-up appointments and clinical examinations of children was created.

Introduction. The prevalence of obesity in the pediatric population has reached epidemic proportions, necessitating the development of effective therapies. Studying the effect of pharmacotherapy on regulatory peptides such as adipokines and incretins is of significant scientific and practical interest.

Aim. To assess the dynamics of adipokine and incretin levels during 12-month therapy with the glucagon-like peptide-1 (GLP-1) receptor agonist liraglutide in children with obesity.

Materials and methods. A single- center prospective study included 20 children aged 12–18 years with obesity grades II–III and morbid obesity (SDS BMI ≥ 2.5). All patients received liraglutide at a standard dose of 3.0 mg for 12 months. Anthropometric parameters (body weight, SDS BMI) and levels of adipokines and incretins (leptin, spexin, ghrelin, obestatin, GLP-1, glucagon, glucose-dependent  insulinotropic polypeptide (GIP), glicentin, oxyntomodulin) were assessed before treatment, after 1, 4, and 12 months of therapy.

Results. Liraglutide therapy resulted in a significant reduction in body weight and SDS BMI (p < 0.05). A significant decrease in the concentration of spexin, glucagon-like peptide-1, and obestatin in blood plasma and an increase in the concentration of glucose-dependent  insulinotropic polypeptide and oxyntomodulin in blood serum were detected. Significant correlations were found between SDS BMI dynamics and levels of leptin (r = 0.558; p < 0.001), GLP-1 (r = 0.366; p = 0.026), and obestatin (r = -0.364; p = 0.023).

Conclusions. Liraglutide therapy leads not only to weight loss but also to significant changes in the adipokine and incretin profile in children with obesity. The dynamics of the studied biomarkers, particularly leptin, glucagon-like peptide-1, and obestatin, can be used to predict the effectiveness of glucagon-like peptide-1 analog therapy.

Introduction. In adult practice, video capsule endoscopy is used much more often than in children, which is most likely due to the age and emotional characteristics of children, as well as the limited availability of this endoscopic examination in pediatric practice.

Aim. To determine the diagnostic value of video capsule endoscopy in children with inflammatory diseases of the gastrointestinal tract.

Materials and methods. Between 2021 and 2025, 58 video capsule studies were conducted on 58 children, including 42 (72%) boys and 16 (28%) girls, with an average age of 9.7 years. Of the 58 children, 12 patients underwent video capsule endoscopy as part of a grant (agreement No. 1209-11/25) for inflammatory bowel diseases, with an average age of 12.25 years, including 7 (58%) boys and 5 (42%) girls. The children were divided into two groups: Group I consisted of 46 children who did not have any abnormalities in the small intestine or hidden sources of bleeding, while Group II included 12 children with inflammatory bowel diseases (as part of the grant). The youngest child underwent a video capsule study at the age of 3.

Results and discussions. When analyzing the results, patients were divided into groups according to the pathology identified. In 24% of cases, mucosal changes in the small intestine were detected in the form of hyperemia and edema; smoothness of folds, which corresponded to enteropathy, the second most common pathology was Crohn’s disease of the small intestine (22%). Peutz- Jeghers syndrome was detected in 9% of cases and in familial polyposis in 5% of cases; a rare pathology was detected in 3% of cases.

Conclusions. Video capsule endoscopy as a diagnostic method of the small intestine can be used in patients of child age from three years. The diagnostic value of video capsule endoscopy in detecting pathology of the small intestine is from 60% to 72%.

Celiac disease has gradually become an epidemiologically significant phenomenon, attracting the attention of the scientific community. The review of the materials of the 56^th ESPGHAN 2024 Annual Meeting, held in May 2024 in Milan (Italy), considered new directions in diagnostics, identification of risk factors, targeted treatment and prevention of celiac disease in children Presentations were made by leading celiac disease researchers from Italy, Germany and the USA. In particular, Professor R. Tronconi (Italy) outlined the following areas as priority directions in celiac disease research: prevention/reduction of celiac disease progression, screening forearly diagnosis, non-invasive markers, paediatric features of new treatment, indications for target therapy. Prof S. Koletzko (Germany) presented the positions of the European and North American Society of Paediatric Gastroenterologists, Hepatologists and Nutritionists on the target treatment of celiac disease in children. A special place is occupied by data on the diagnosis of celiac disease in children on a gluten-free diet. New directions in conducting gluten provocation and the possibility of performing a biopsy of the retrobulbar part of the duodenum without provocation, based on immunophenotyping of lymphocytes using flow cytometry, are considered. The review also summarizes the data of modern literature on the topics discussed at the 56^th ESPGHAN 2024 Annual Meeting. 

Introduction. Serological methods remain the main tool for screening for celiac disease. The most sensitive and specific markers of the disease are anti-tissue transglutaminase and anti-endomysium IgA antibodies, but the possibility of their use is limited by the concentration of serum total IgA. Due to the frequent association of celiac disease with selective immunoglobulin A deficiency, the search for diagnostic markers in this group of patients is relevant.

Аim. Тo evaluate the diagnostic value of serological markers of celiac disease in children with decreased serum immunoglobulin A.

Materials and methods. The sensitivity, specificity, positive and negative predictive value of IgG antibodies to anti-tissue transglutaminase (anti-tTG IgG), deamidated gliadin peptides (anti- DPG IgG) and gliadin (AGA IgG) were analyzed in a group of 166 children aged 1 to 17 years, average age 6.04 years, with varying degrees of immunoglobulin A deficiency.

Results. The incidence of celiac disease in symptomatic patients with decreased serum immunoglobulin A concentrations was 13.2%, increasing up to 20% in the group of patients with selective IgA deficiency. Anti-tTG IgG demonstrated high values of sensitivity, specificity and positive predictive value as 85%, 97.3% and 85%, respectively. With comparable sensitivity and specificity, anti- DPG IgG were significantly worse with positive predictive value (26.7%). AGA IgG showed the lowest diagnostic value. When analyzing the dependence of the degree of histological changes on the concentration of tTG IgG, no statistically significant correlation was determined.

Conclusions. Frequent association of gluten enteropathy with hypogammaglobulinemia A determines the need for active screening for celiac disease among children with these type of humoral immunity. Anti-tTG IgG demonstrate high diagnostic value in children with IgA deficiency, however, verification of the diagnosis of celiac disease in patients with hypogammaglobulinemia A requires mandatory endoscopic and histological studies.

Homozygous familial hypercholesterolemia (HoFH) is a rare inherited condition associated with extremely elevated levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), leading to early vascular atherosclerosis. Here we report a clinical observation of a girl with early-onset multiple xanthomatosis (the age of clinical symptom onset was 1.5 years) and a genetically confirmed homozygous variant, c.1729T>C, in the LDLR gene (p.W577R). The diagnosis was established at the age of 3 (TC up to 25 mmol/L; TC level time profile remained at 23.5 mmol/L, LDL-C 22.1 mmol/L). However, a targeted lipidlowering diet was not arranged in a consistent manner, and the drug therapy was not conducted, which reflected physicians' poor awareness and lack of routing of patients. The patient has been followed at the Z. A. Bashlyaeva Children's City Clinical Hospital of the Moscow Health Department (Competence Center for Screening and Treatment of Lipid Disorders in Children and Adolescents) since the age of 6.5 years. All attempts to choose any beneficial combination lipid-lowering pharmacotherapy (rosuvastatin, ezetimibe, evolocumab) have not yielded a clinically significant effect. Due to refractory hyperlipidemia, regular therapeutic apheresis (1–3 procedures per month; 62 sessions by July 2025) was initiated on December 22, 2022, which resulted in acute decreases in total cholesterol and LDL-cholesterol by 40–70% after each procedure. Significant regression of xanthomatosis, a decrease in the intima-media thickness of the common carotid arteries, coronary artery stabilization, and achievement of target blood pressure values were observed. This case stresses the utmost importance of early routing of patients, family screening, and combined treatment with high-intensity pharmacotherapy and regular lipoprotein apheresis to reduce cholesterol deposits on any part of the body in patients with impaired mechanisms of clearance of cholesterol and to stabilize vascular changes in children with HoFH.

Necrotizing enterocolitis is a severe, multifactorial disease manifests by transmural necrosis of the intestinal wall. Recent studies propose new concepts regarding the etiology and pathogenesis of necrotizing enterocolitis. There are numerous risk factors for the development of this condition, including the immaturity of the immune system in premature neonates, impaired colonization of the gut microbiota, underdeveloped intestinal barrier functions, and reduced tolerance to enteral nutrition. Both risk factors and the etiological microbial agent plays an equally important role in the development of this disease. The most commonly isolated bacteria that damage the intestinal wall in children include Escherichia coli, Klebsiella pneumoniae, Cronobacter spp., Staphylococcus aureus, Enterococcus spp., Clostridium perfringens, Pseudomonas aeruginosa, and Proteus mirabilis. In infants under one month of age with immunodeficiency of various etiologies who are receiving antimicrobial therapy, Candida species are identified as causative agents. Viral agents, such as Coronaviruses, Rotaviruses, and Coxsackieviruses, also play a role in the development of necrotizing enterocolitis. However, the disease most commonly results from the damaging action of bacterial agents. Each bacterial strain has its own genetic determinants, which influence the pathogenicity of the agent and the severity and duration of the disease. This review summarizes data from both domestic and international publications on the virulence factors of the Enterobacteriaceae, such as Cronobacter spp., Klebsiella spp., and Enterobacter spp., which are primary causative agents of necrotizing enterocolitis. Enterobacteriaceae bacteria possess a variety of virulence factors, including adhesive activity, invasiveness, survival within macrophages, exotoxin production, and biofilm formation.

The lecture presents definitions of malnutrition from historical to modern concepts. A comparison was made of the diagnoses presented in ICD-10 and ICD-11, as well as generally accepted diagnostic criteria for malnutrition. Definitions are given of kwashiorkor, alimentary marasmus, cachexia and sarcopenia as the main severe manifestations of malnutrition. Treatment of patients with malnutrition is presented depending on the severity stage, using modern formula of enteral nutrition. Methodological approaches to the treatment of patients with kwashiorkor, alimentary marasmus and marasmatic kwashiorkor are presented in detail. The standards of needs for essential nutrients, liquids and energy for children of different age groups are presented, as well as modern and historical formulas for personalized calculation of the energy value of the diet. The coefficients of conversion of the basal metabolic rate in children are presented taking into account physiological and pathological processes. Preferred options for dietary proteins, fats and carbohydrates are described for children with varying degrees of nutritional deficiency depending on their metabolism in the body. A classification of enteral nutrition products is given, as well as options for their use depending on the severity of nutritional deficiency. Indications for tube feeding have been determined: from the use of temporary feeding tubes to gastrostomy. The timing of the transition from an oro- or nasogastric feeding tube to the installation of a gastrostomy, and possible complications of prolonged use of a feeding tube are explained from a pathophysiological standpoint. Treatment of severe nutritional deficiency is presented separately for patients with kwashiorkor, alimentary marasmus and marasmatic kwashiorkor. Modern approaches to the treatment of kwashiorkor have changed in recent years. The transition to parenteral nutrition, causes and options for parenteral nutrition products have been identified

Increasing prevalence of children's cognitive impairment is becoming a significant public health problem with individual and socioeconomic consequences. Modifiable factors, among which nutrition plays a central role, along with an increase in life expectancy and environmental changes are probably the largest contributors. Individual dietary components, including carbohydrates, lipids, and hormonal regulators of energy metabolism, have been reported to be associated with cognitive function scores. Like any other organ, the brain depends on a continuous supply of critical nutrients from the food — vitamins, minerals, plant- and animal-sourced amino acids, and polyunsaturated essential fatty acids, including omega-3. The idea that diet is not able to modify the brain structure and ultimately its function are currently being re-evaluated: some micronutrients have been studied for its effects on neurohumoral processes and cognitive outcomes. The human gut microbiota, a community of symbiotic microbes, plays a crucial role in the maturation and functioning of brain systems by interacting with the central nervous system through bidirectional neural, endocrine, immune, and metabolic axes. Recent neurobiological studies demonstrate the correlation between dysbiosis changes in the microbiota and its metabolites and a wide range of neuropsychiatric conditions, including autism spectrum disorders, anxiety and depressive symptomatology, schizophrenia, eating disorders, and neurocognitive deficits. The “critical window” of the first 1000 days of life from conception to a child’s second birthday, when the neurogenesis, myelination, and cognitive development sensitive to nutritional deficiencies and excesses occur especially intensively, acquires particular prominence. In this period, provision of adequate macronutrient and micronutrient intake during pregnancy and lactation, the quality of breastfeeding, and the timely and scientific-based introduction of complementary feeding become crucial factors shaping the long-term trajectories of brain development, metabolic health, and behavioural phenotypes.

Introduction. Growing antibacterial resistance of urinary tract infection pathogens in children and the risk of relapses necessitate finding the safest ways to improve treatment outcomes.

Aim. To evaluate the effectiveness of taking Canephron^® N in combination with antibacterial therapy in children aged 1 to 3 years with acute uncomplicated pyelonephritis to increase the effectiveness of therapy with a reduced risk of parenchyma damage and faster recovery of renal function.

Materials and methods. A prospective, open, randomized study was conducted in 2 groups of sick children: Group 1 (50 children) received antibacterial therapy and Canephron^® N for 10–14 days, Group 2 (50 children) – only antibacterial therapy. The duration of observation of patients was 60 days, the period of active treatment was 10–14 days, follow-up was 1.5 months. Clinical and laboratory data, partial renal functions, enzymuria (ALP, LDH, GGT), metabolic disorders were assessed.

Results and discussion. The average duration of clinical manifestations and urinary syndrome in Group 1 was 2–3 days less than in patients in Group 2. A decrease in the inflammatory process was accompanied by normalization of the functional state of the kidneys by day 15 in 85% of patients in Group 1, which was significantly better (p < 0.05) than in Group 2 (49%). In patients of Group 1, in contrast to patients of Group 2, the excretion of oxalates and calcium in urine also decreased (p < 0.05). Particular attention should be paid to the faster normalization of the level of fermenturia in patients of Group 1.

Conclusions. Combination therapy with the inclusion of a herbal preparation contributed to a faster elimination of clinical manifestations of the disease, a decrease the activity of the inflammatory process and the severity of urinary syndrome, reduced fermenturia, oxalate-calcium crystalluria and improved the processes of tubular reabsorption.

The history of the scientific study of urolithiasis goes back many centuries. The treatment of urolithiasis has evolved from severe mutilating surgeries to modern minimally invasive procedures. Epidemiological data show that the global incidence rate of urolithiasis keeps steadily growing. Urolithiasis is endemic, which is determined by the influence of various modifiable factors, including socioeconomic and climatic factors. Statistics indicate that the incidence of urolithiasis in the Russian Federation has increased by 35.45% from 2005 to 2019, which necessitates the development of effective preventive measures. Preventive measures for urolithiasis are primarily based on lifestyle modification and pharmacotherapy. Current evidence supports the paradigm that the human microbiome constitutes a full-fledged organ, as changes in its qualitative and quantitative composition in different loci can have a significant impact on metabolism and immunity. Modern scientific research has established the mechanisms through which certain components of the urinary microbiome can both inhibit and stimulate lithogenesis. Studies have shown that the urinary tract microbiome of healthy people is dominated by commensal bacteria, such as Lactobacillus and Streptococcus, which maintain microenvironmental homeostasis. Patients with urolithiasis have a significantly reduced diversity of the intestinal and urinary microbiomes, as well as changes in single taxa community levels. Studying the urinary and intestinal microbiome establishes a bridgehead for the development of new approaches to urolithiasis prevention. This article presents data on the relationship between the urinary microbiome and urolithiasis, and describes prospects for developing a new approach to its treatment and prevention.

Kerion Celsi is an acute inflammatory reaction that develops in response to the penetration of dermatophytes into hair follicles and is accompanied by a secondary bacterial infection and a reaction of the lymph nodes. The incidence of kerion in mycosis of this localization can vary from 15% to 57%. Despite the widespread distribution of dermatophytes in the pediatric population, studies in the field of etiology and diagnostics of kerion Celsi are limited and contradictory. The aim of this study is to analyze to analyze the clinical and laboratory features of kerion Celsi caused by Trichophyton tonsurans. The article describes a case of kerion Celsi caused by the anthropophilic fungus T. tonsurans. The patient received complex treatment in the conditions of the daily dermatovenereology hospital of the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology of Moscow Health Department. The development of kerion Celsi was caused by incorrect long-term use of topical glucocorticosteroids, and was also delayed due to incorrect diagnostic tactics in the outpatient setting. During the laboratory examination of the pathological material obtained from the patient, the growth of the T. tonsurans culture was not obtained. The etiological diagnosis was made based on the results of direct microscopy and PCR. Direct microscopy of the hair revealed the location of the spores as endothrix. After hospitalization in the pediatric dermatovenereology department, the patient quickly responded to treatment with oral antimycotics and antibiotics. Kerion Celsi is a difficult-to-treat form of scalp mycosis that negatively affects the quality of life of the child and family. The international and domestic experience in diagnosing kerion Celsi demonstrated in the article indicates the need to refer children with rashes on the scalp to a dermatovenereologist for timely diagnosis of mycosis and prevention of serious complications.

Introduction. Streptococcus pneumoniae infections remain one of the global public health concerns. The most vulnerable groups for pneumococcal infections include children in their first 5 years of life, as well as adults aged >60 years and patients with various severe chronic diseases and immunodeficiency disorders.

Aim. To study changes in S. pneumoniae carriage rates and its serotype composition structure due to pneumococcal vaccination of children attending preschool educational institutions (institutionalized children).

Materials and methods. We studied the trends of changes in S. pneumoniae carriage rates and its serotype landscape structure due to PCV13 vaccination in 1 350 institutionalized children aged 1 to 5 years 11 months and 29 days (the mean age was 4.43 ± 0.31 years). A total of 510 children were included in the study in 2016–2018 and 840 children in 2020–2022. The work was carried out within the framework of the international prospective multicenter study SAPIENS (Scientific Assessment of Pneumococcal Infection Epidemiology Networks) in the city of Khanty-Mansiysk.

Results and discussion. The overall S. pneumoniae carriage rates were found to be reduced from 55.9% to 34.2% (р < 0.05). The reduction in pneumococcal carriage rates was observed in all age groups: in children aged 1–2 years old – from 64.3% to 51.0%; 3 years – from 63.6% to 37.6%? 4 years – from 58.3% to 35.0%; 5 years – from 47.1% to 28.4% (before and after vaccination respectively). Thus, the importance of monitoring S. pneumoniae carriage rates with the necessary determination of its serotype structure for the timely replacement of the vaccine is discussed. We presented the literature data on the safety and immunological efficacy of the 20-valent pneumococcal polysaccharide conjugate adsorbed vaccine, which contains capsular polysaccharides (CPSs) in addition to the CPSs of the pneumococcal serotypes that were included in PCV13.

Conclusions. Pneumococcal vaccination within the national vaccination schedule has significantly (1.6 times (р < 0.05)) reduced the S. pneumoniae carriage rates in the institutionalized preschool children.

Introduction. Since the recombinant tuberculosis allergen test is currently one of the leading methods for diagnosing tuberculosis in children, evaluating its effectiveness is of particular interest until completely new diagnostic approaches are developed.

Aim. To evaluate the diagnostic and clinical characteristics of tuberculosis in preschool- and primary school-aged children in the Omsk Region over time and the diagnostic efficacy of a recombinant tuberculosis allergen test. To conduct a comparative analysis by age over a 20-year period.

Materials and methods. A retrospective study was conducted among 733 children aged 4 to 11 years in the Omsk Region who had tuberculosis and received inpatient treatment between 2001 and 2020. The study consisted of two stages. The first stage reviewed the characteristics of tuberculosis and its clinical forms, as well as the diagnosis of tuberculosis in children aged 4 to 11 years over time. In the second stage, the cohort of children was divided by age. Diagnostics were compared across age groups.

Results. It turned out that the number of children diagnosed with tuberculosis peaked between 2001 and 2005. Slightly more than half of children aged 4–11 years with tuberculosis were identified through screening—annual tuberculin testing, followed by immunodiagnosis using the ATP skin test. However, the proportion of children identified through annual screening decreased slightly between 2016 and 2020. When evaluating the results at hospital discharge, a decrease in the number of hyperergic reactions was found. Thus, skin immunoassays can reliably detect tuberculosis in children; they are positive in the majority of all tuberculosis cases.

Conclusions. The study demonstrated the diagnostic significance of a test with a recombinant tuberculosis allergen and conducted a comparative analysis in the age aspect over a 20-year period.

Food allergies result from immune response that causes the body to react negatively to food products. These reactions can manifest as a wide variety of symptoms and disorders, including acute allergic reactions, anaphylaxis, food protein-induced allergic proctocolitis, enterocolitis syndrome, and pollen food allergy syndrome. In addition, food allergies contribute to the development of chronic inflammatory diseases such as eosinophilic esophagitis and atopic dermatitis. Food allergies are one of the most common forms of allergy in infants, and its prevalence has increased in recent years. Both individual and family QoL is seriously threatened by the presence of food allergies, which carry personal and societal costs. Understanding the diagnostic features of this condition is necessary for proper management of patients, prescription of an elimination diet, determining the optimal timing for an oral provocation test and expanding a diet. It is essential to know the diagnostic criteria to prevent overdiagnosis, reduce unnecessary restrictions, maintain breastfeeding or select the correct breast milk substitutes. The first step in management of food allergies is establishing an accurate diagnosis based on the clinical picture and exclusion of foods that may cause allergic reactions, most often cow's milk. This process is associated with difficulties and risks for nutrition; therefore, it requires special attention. The article presents a clinical case report of a patient (a girl aged 2 months) with complaints of a rash all over her body, predisposition to constipation, and breast refusal. The symptoms of food allergies and principles of diet and therapy are described in detail. The management of food allergies includes diagnostic algorithms in combination with the development of an individual nutrition plan and timely assessment of tolerance. All these measures are aimed at reducing the load on the body and minimizing the risks associated with nutrition.

Frequent acute respiratory infections in children are not only a medical problem but also a socioeconomic one for both individual families and the country as a whole. Identifying the causes and effective monitoring and treatment algorithms for patients with upper respiratory infections is crucial for developing comprehensive national prevention and control strategies, as well as for more efficient allocation and use of healthcare resources. The number of episodes of acute respiratory infection during the year may vary in children depending on age, climate zone, socialization of the child and many other factors. Children susceptible to recurrent (repeated) cases of acute respiratory infections were previously called “frequently ill children” in our country. Allergies, immunodeficiencies, persistent opportunistic infections, functional digestive disorders, chronic diseases of the ENT organs and some other problems may be hidden under the guise of a “frequently ill child” or a child with recurrent respiratory infections, as such a patient is called today. A pediatrician must identify the true cause of frequent episodes of acute respiratory infections in such a child, as this will allow determining the tactics of his observation, the algorithm of diagnostic examination and, if necessary, optimizing the methods of therapy. It is extremely important in children with recurrent infections to adequately approach the treatment of each episode of respiratory infection, using modern possibilities of antiviral therapy, including drugs based on a combination of normal human immunoglobulin and recombinant interferon _α-2b.

Introduction. The search for biomarkers involved in the formation of chronic viral hepatitis C in children will allow us to determine the further prognosis of the pathology.

Аim. To study and evaluate the levels of serum proinflammatory cytokines IL-1_β, IL-6, IL-18, TNF-_α in young children with perinatal contact for HCV infection.

Materials and мethods. A retrospective observational study was conducted: Group 1 included 59 children under 3 years of age with perinatal exposure to HCV infection; Group 2 included 28 patients with established chronic hepatitis C; and Group 3, a control group consisting of 30 "conditionally healthy" children. Serum levels of proinflammatory cytokines (IL-1_β, IL-6, IL-18, and TNF-_α) were measured using ELISA and the Vector-Best test system (St Petersburg).

Results. In children with perinatal HCV contact, there was a significant increase in IL-6 to 2.278 pg/ml (p = 0.003), while the concentration of IL-18 was significantly lower compared to healthy children (p < 0.05). IL-1_β and TNF-_α were at the level of control values, p = 0.115 and p = 0.448, respectively. The results of logistic regression determined that with an increase in IL-18 by 1 pg/ml in patients with perinatal contact for HCV infection, the probability of formation of perinatal contact decreased by 1.29 times. These results indicate the participation of IL-18 in the mechanisms of the implementation of chronic forms of HCV infection. Patients with the realized chronic viral hepatitis C had a significant increase in IL-1_β, IL-6, TNF-_α (p < 0.001), IL-18 (p < 0.05).

Conclusion. The imbalance of cytokines in the blood of children with perinatal HCV contact was characterized by an excess of IL-6 and a deficiency of IL-18, with normal levels of IL-1_β and TNF-_α. In patients with chronic viral hepatitis C, the levels of all studied cytokines were significantly higher than in the control group. Determination of serum concentrations can be used to monitor and predict the development of chronic hepatitis C.

CNOT3 syndrome is a rare genetic disorder with variable clinical manifestations associated with abnormalities in the 19q13.42 region. The CNOT3 gene encodes a protein involved in the regulation of gene expression and maintenance of RNA stability. Mutations in this gene can lead to multiple disorders, including mental retardation, clinical manifestations from the gastrointestinal tract, and characteristic dysmorphic facial features. In clinical practice, an important aspect is early diagnosis and a multidisciplinary approach to treatment, which may include a gastroenterologist, neurologist, and endocrinologist. In the presented clinical case, a 10-year-old girl was hospitalized in the gastroenterology department with complaints of abdominal pain, nausea, and headaches. She was born from her first pregnancy with normal parameters, but from the age of two she began to manifest atopic dermatitis and perianal dermatitis. In 2019, esophagogastroduodenoscopy revealed distal reflux esophagitis and gastritis. Further examination revealed mental retardation, and the girl is under regular medical observation by a neurologist. Physical examination revealed dysmorphic facial features and hirsutism. Laboratory tests revealed latent iron deficiency, and a normal hormonal profile. Due to excessive hair growth and increased appetite, the girl was referred to an endocrinologist to rule out congenital adrenal cortex dysfunction. Genetic testing revealed a microdeletion in the 19q13.42 region, which is associated with CNOT3 syndrome. This case highlights the importance of an integrated approach to diagnosing and treating children with rare genetic syndromes.

Sitosterolemia is a rare autosomal recessive dyslipidemia caused by a defect in sterol transporters, leading to excess absorption and insufficient excretion of plant sterols and cholesterol. The clinical picture ranges from xanthomatosis to early atherosclerosis and hematological disorders, often mimicking familial hypercholesterolemia. Three clinical observations are presented, illustrating the diagnostic difficulties and the effectiveness of pathogenetic therapy. Case 1: a 15-year-old female patient with severe hypercholesterolemia and negative results of testing for the classic genes of familial hypercholesterolemia; whole-genome sequencing revealed two variants in ABCG8 (c.1269G>T, p.Glu423Asp; c.322+456C>T). A diet low in phytosterols and ezetimibe ensured the achievement of target values of low-density lipoprotein cholesterol. Case 2: a 21-year-old patient with early generalized xanthomatosis and extremely high phytosterol levels; a nonsense variant of ABCG8 c.1083G>A, p.Trp361Ter was detected. Administration of ezetimibe in combination with a bile acid sequestrant resulted in a significant decrease in cholesterol. Case 3: a boy aged 2 years 7 months with multiple xanthomas; compound heterozygosity of ABCG8 (c.1715T>C, p.Leu572Pro; c.883G>A, p.Gly295Arg) was detected. Ezetimibe resulted in a significant decrease in low-density lipoprotein cholesterol and regression of xanthomas. These observations confirm the need for quantitative determination of phytosterols and extended genetic search in “atypical familial hypercholesterolemia” . Strict dietary restrictions and ezetimibe remain the basis of treatment; the effectiveness of statins is limited. Early recognition improves prognosis and reduces the risk of cardiovascular complications.

Primary cardiac tumors are rare neoplasms affecting the tissues and membranes of the heart. The incidence is 0.002–0.03% in the general population, 0.027–0.08% in children, and 0.02% in adults. Classification of the World Health Organization (2021) distinguish benign and malignant tumors of the heart. In childhood, about 90% of cases are benign cardiac tumors, among them rhabdomyomas are frequent (60–70%). Most malignant neoplasms are represented by sarcomas. In 2% of malignant lesions, an extranodal lesion is diagnosed in non- Hodgkin’s B-cell lymphoma. The clinical picture depends on the size, consistency, localization, nature and growth rate of the tumor, and is represented by symptoms of heart failure, heart defects, rhythm and conduction disorders. There may be manifestations of systemic diseases: fever, weakness, malaise, decreased body weight. Diagnosis of cardiac neoplasms has certain difficulties. As a diagnostic standard, echocardiography and magnetic resonance imaging are used. Invasive diagnostic methods such as angiocardiography and endomyocardial biopsy are of great importance. We present a rare clinical case of cardiac neoplasm in a fourteen-year-old adolescent who was admitted to the oncology department of the Regional Children’s Clinical Hospital of Perm with complaints of chest pain. It is necessary to differentiate benign and malignant tumor with a significant degree of certainty and choose the optimal treatment tactics. In this situation, as salvage therapy, antitumor therapy may be attempted to reduce the tumor mass. A radical method of treatment is heart transplantation.

Foreskin pathology is a topical issue in the practice of not only a pediatrician, but also a pediatric surgeon, urologistandrologist, and dermatovenerologist. The concept of phimosis can be interpreted differently, which contributes to diagnostic errors and leads to unjustified surgical intervention. The term “non-retractable foreskin” is often used by authors in foreign literature. This position is justified by the anatomical and physiological features of the foreskin in children. The ontogenesis of the prepuce demonstrates high individual variability. Consistently across studies, in the mid-20th century scientists showed that the attachment of foreskin in infants is a physiological phenomenon and needs no intervention; the separation of the prepuce is a natural process. However, throughout centuries of history attitudes toward circumcision have been controversial, which has been influenced by cultural and religious reasons. A historical essay on circumcision will make it possible to trace the evolution of ideas about the need for this procedure, as well as to detect trends in therapeutic and preventive measures for the foreskin pathology. Currently, the issue of the advisability of circumcision remains a point of contention among specialists, some of whom emphasize the preventive aspect of the procedure, while others support a more cautious approach due to possible complications. The medical community acknowledges the value of the foreskin as an anatomically significant area with important functions. That is why when deciding on circumcision, the focus shifts from cultural reasons to medical indications. The proper care for the external genitalia in children with physiological phimosis remains a pressing issue, as preventive measures are a fundamental principle of pediatrics.

Rational nutrition plays a crucial role in ensuring the harmonious physical development and cognitive abilities of infants and young children, which is relevant in the context of pediatric oncology, at the outpatient stage. Children with cancer may have problems with feeding and nutritional status. These conditions require monitoring and often immediate intervention, as well as an individual approach to correction. The nutritional difficulties of young children suffering from cancer can be roughly divided into several categories. The first group includes difficulties with eating, such as impaired chewing, dysphagia, and changes in taste sensitivity. The second group is associated with appetite, including hyporexia and hyperrexia, selective appetite, and fear of eating. The third category includes disorders of the gastrointestinal tract and persistent metabolic changes. The fourth category is changes in the structure of nutrition and the formation of vicious eating habits. All these problems can significantly affect the nutritional status of children with cancer, which is reflected in tissue imbalance, lack or excess of body weight and negatively affects their health and quality of life. The causes of these disorders are diverse and can be related to both the direct effects of cancer, as well as side effects of treatment, as well as emotional stress. The development and implementation of personalized nutrition programs that take into account the needs of young children, meet all requirements in terms of composition, safety and taste, as well as those developed on the basis of scientific research, are the most important components of an integrated and multidisciplinary approach to monitoring such patients on an outpatient basis.

Left-sidedness is a characteristic of individual typological features of a person. Left-handedness can be considered as a clear marker of functional brain asymmetry, which determines the specificity of the cognitive features of a child. Archaeological evidence confirms the existence of left-handedness among early ancestors, predating modern humans and living over a million years ago. This suggests that the left-handedness, as a marker of asymmetry, persists at a certain level due to evolutionary mechanisms, which contributes to the stability and adaptability of the species. Historical data indicate a high left-handedness stigma degree ingrained in people’s heads. Fundamental scientific research allowed us to do away with an evil practice of “correcting” left-handed children. The awakened scientific interest in neurophysiology has spurred the development of numerous hypotheses and theories to explain the phenomenon of left-handedness. However, there is no single generally accepted theory of this phenomenon. According to modern concepts, left-handedness is considered a manifestation of functional asymmetry in the brain performance. Asymmetry is a phenomenon that is observed at various levels and has certain forms of expression. In the prenatal period, the ontogenesis of the brain reveals a number of functional and anatomical asymmetries, which reflects the dynamic, multifaceted process of brain lateralization. The article discusses possible causes of left-handedness with an emphasis on the method of assessing a child’s hand dominance. The discovery of the phenomenon of lateralization is a major step towards understanding the mental characteristics and cognitive functions of children. The concept of these aspects of development underlies the individual approach both in pedagogical activity and in the context of interactions between pediatricians, patients, and their parents.

Introduction. Heterozygous familial hypercholesterolemia (heFH) is a hereditary disease that leads to significantly elevated low-density lipoprotein cholesterol (LDL-C) levels developing from childhood.

Aim. To determine independent predictors of common carotid intima-media thickness (CC-IMT) in children aged 6–18 years with familial hypercholesterolemia based on genetic, biochemical and behavioural factors.

Materials and methods. A retrospective analytical case control study was conducted at the premises of GBUZ “Children’s City Clinical Hospital named after ZA Bashlyaeva, Moscow Department of Health” (Moscow). A complete analysis of electronic medical records of the Children’s Cardiology Centre patients for the period from January 2020 to March 2025 was performed. The total number of patients between 6 yr to 18 yr was 629; the treatment group (n = 471): 207/471 (43.9%) boys and 264/471 (56.1%) girls; the age of 12.6 [9.0-17.5] years — the patients with at-least-probable clinical or genetically confirmed diagnosis of FH according to the Simon-Broom criteria; the control group (n = 158): 76/158 (48.1%) boys and 82/158 (51.9%) girls; the age of 13.1 [11.2-15.5] years — patients of the same centre with excluded dyslipidemia based on the results of clinical and biochemical examinations. Patients in the control cohort were matched for gender and age, according to frequency. A comprehensive analysis of clinical, biochemical and behavioural factors determining early vascular ageing in children and adolescents with FH was performed.

Results. A significant increase in the common carotid intima-media thickness (IMT) compared to the age-appropriate reference ranges was identified as early as at preschool and primary school age. Almost half of the boys and every fifth girl with FH by teen age (15–18 years) had an IMT greater than the 90th percentile of the reference range. The construction of a multivariate regression model allowed to explain 48% of the total variability of IMT. Pathogenic LDLR and APOB mutations, elevated levels of non-HDL cholesterol, lipoprotein (a), homocysteine, as well as smoking and low level of physical activity made the greatest contribution to the acceleration of vascular ageing.

Conclusion. The authors emphasize that early identification of children with FH is critical, and the personalized approach to prescribing lipid-lowering therapy with due account for identified genetic and metabolic characteristics, and individual behavioural factors is required. This approach can help timely identify patients who are at highest risk of developing CVDs.

Introduction. Acute bronchiolitis is one of the most frequent manifestations of viral infection of early age, in particular in children under 1 year of age. The course of acute bronchiolitis is characterized by a marked variability of the clinical picture in the direction of aggravation in separate groups of patients.

Aim. To reveal the peculiarities of cytokine profile and vitamin D concentration in blood serum of children with acute bronchiolitis depending on respiratory distress (RD) severity.

Materials and methods. In the pulmonology department of the Morozovsky Municipal Children Clinical Hospital in 2021–2022, 56 patients aged from 1 to 12 months with the diagnosis of acute bronchiolitis with different degrees of RD were examined. In addition to the standard methods of investigation (anamnesis, physical examination, general and biochemical blood tests, assessment of CRP concentration), all patients underwent determination of interleukin-6 (IL-6), interleukin-4 (IL-4) and vitamin D concentrations in blood.

Results. With a mean vitamin D concentration of less than 14.8 ng/mL, the number of acute respiratory infections (ARIs) suffered was more than 3 episodes, and with a value of less than 21.5 ng/mL, the number of ARI episodes was 2. The level of proinflammatory cytokine IL-6 and anti-inflammatory cytokine IL-4 decreased with increasing degree of RD. A direct moderate correlation between vitamin D and IL-4 concentration in blood (r = 0.44) was revealed, respectively, a higher level of vitamin D will result in a higher level of IL-4.

Conclusion. In patients with acute bronchiolitis, changes in cytokine concentrations correlate with the degree of respiratory failure: a decrease in IL-4 and IL-6 concentrations is observed with an increase in the degree of RD. Patients with low vitamin D concentration have lower resistance to upper respiratory tract infections.

Surgical correction of congenital heart defects (CHD) is an important step in the child’s recovery, but after discharge from the hospital, there remains a risk of developing a number of postoperative complications that require timely diagnosis, multicomponent therapy, and sometimes repeated surgery.The article demonstrates a clinical observation of pericarditis in a child after surgical correction of a congenital heart defect. At the age of five months, the child was diagnosed with the following pathology according to echocardiography: Congenital heart defect: Secondary atrial septal defect. HF 1B st. At the age of 9 months, the child underwent plastic surgery of the atrial septal defect. After discharge from the cardiac surgery hospital, the child was transferred to the pediatric department of the State Budgetary Healthcare Institution of the Arkhangelsk Region “Regional Children’s Clinical Hospital named after N.N. Silishcheva”. In a hospital setting, in addition to a regular clinical examination, clinical and biochemical tests, electrocardiography, echocardiography with Doppler cardiography, and X-ray examination were performed. Despite the full range of medical care provided, the child began to show signs of complications after the correction of congenital heart disease. According to the blood test, inflammation markers were verified, namely, leukocytosis, increased ESR and increased CRP. Echocardiography revealed fluid in the pericardial space. Against the background of the therapy, a positive effect was obtained, confirmed by EchoCG data – separation of pericardial leaflets up to 2 mm. Observation in a hospital setting allowed for timely diagnosis and treatment of postoperative complications. Thus, physicians of many specialties need to be aware of the risks of developing a number of postoperative complications after cardiac surgery and promptly prescribe diagnostic measures to patients to verify the diagnosis, taking into account the stages of pericarditis development.

Introduction. The success of the children's further social activity largely depends on their well-being during adaptation period when starting school.

Aim. To analyse the emotional and behavioural reactions of first-graders during the school year to optimize activities aimed at reducing maladaptive behaviours in school-aged children.

Materials and methods. The first-graders from 10 comprehensive schools located in different districts of Krasnoyarsk were examined. A survey of 32 class masters was conducted to assess the emotional and behavioural reactions of 775 first-graders at the end of each academic term using a special scale that included nine items (mood, social contacts, cognitive activity, discipline, reactions of aggression and anger, fear, play activity, motor activity during recess, general state of health). Associative non-verbal testing of children was performed to assess emotional attitudes. A survey of parents of 643 first-graders was aimed to detect signs of neurotic disorders in the form of sleep disturbance, loss of appetite, headache, abdominal pain, remarkable motor disinhibition, repetitive obsessive movements, decreased attention, fears, tearfulness, petulance, striving for disobedience, rudeness.

Results. The features of the psycho-emotional state of schoolchildren were established, and the key manifestations of unfavourable emotional and behavioural reactions were identified. The negative perception of the key elements of school life at the end of the school year, observed in relation to teachers accounted for 11.3% (95% CI 7.7–14.9), in relation to classmates – 11.6% (95% CI 8.0–15.2), in relation to school as a whole – 9.9% (95% CI 6.5–13.1). Also worth noting was that detection and signs of neurotic disorders were recorded in 51.5% (95% CI 47.5–55.5) of children upon admission to school. In addition, during the school year, especially in the first academic term, aggravation in condition with increased number of astheno-neurotic complaints was noted in 27.5% of first-graders, whereas overlay of new complaints on top of the existing ones was identified in 16.6% of children. Moreover, the significant prevalence rates for neurotic symptoms were found in boys as compared to girls.

Conclusions. The presented data claim attention of pediatricians, psychologists, teachers and parents as they point toward much needed early detection, timely correction and preventive measures directed at preventing conflicts and building constructive school relationships.

Introduction. In terms of prevalence, helminth-protozoal infection (HPI) occupies one of the leading positions in pediatrics, and in modern medicine it is diagnosed in every fifth adolescent.

Aim. To study the clinical manifestations of HPI in school-age adolescents.

Materials and methods. A study was conducted on 167 adolescents (male – n = 91 or 54.5%, female – n = 76 or 45.5%) from 10 to 15 years old (mean age 11.4 ± 0.9), who had clinical and laboratory-confirmed  infections with HPI. Along with standard methods of clinical and laboratory examinations, coproovoscopy and examination for enterobiasis using perianal scraping with adhesive tape were carried out.

Results. In 35.3% (59/167) an association of several types of HPI pathogens was diagnosed. At the same time, the most frequently encountered parasites were Necator americanus – 38.3% (64/167) and Ascaris lumbricoides – 31.7% (53/167). All patients had astheno-neurotic and dyspeptic disorders against the background of iron deficiency anemia. At the same time, the most common clinical manifestations were unstable stool (97.3%), periodic abdominal pain (93.2%), episodes of flatulence (75.7%), and other symptoms of dyspepsia up to 46.6%. Adolescents showed a tendency to allergic diseases – 83.2%. The highest manifestations of immunoallergic pathology in adolescents with HPI were recorded in the younger adolescent group – 86.8%. In comparison, in adolescents from the middle and older age groups, these figures were 80.6%, and 74.4% cases, respectively.

Discussion. Modern scientific studies have confirmed that HPI predicts many somatic diseases in adolescents, including pathologies of the respiratory and digestive systems. However, the clinical picture of GPI may differ depending on the place of residence and age.

Conclusion. The clinical manifestation of HPI in adolescents is characterized by iron deficiency anemia, dyspeptic, astheno-neurotic disorders against the background of a high incidence of immuno-allergic diseases. Consequently, HPI can be a predictor of somatic and immunoallergic pathology, or aggravate its course.