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The OBJECTIVE was to analyze the results of endoscopic transsphenoidal removal of neoplasms of the chiasmalsellar region in children.MATERIALS AND METHODS. We studied 23 patients aged 3 to 17 years who underwent endoscopic transsphenoidal removal of neoplasms of the chiasmal-sellar region. Neurological, ophthalmological, endocrine disorders and otorhinolaryngological pathology were evaluated. Neuroimaging data (MRI and CT), results of laboratory tests were studied. In addition, the analysis of surgical treatment including intraoperative and early postoperative complications was performed.RESULTS. In 39.1 % of cases, neoplasms of supraparainfracellar localization were diagnosed. In 34.8 % of patients, the size of the neoplasms did not exceed 2 cm. In 1 patient, the volume of neoplasm was 53.7 cm3. According to the type of pneumatization, the sellar type prevailed. Сonch type was observed in 1 child. Hemostatic material «Surgicel Fibrillar» was used more often (86.9 %). Plastic surgery of the skull defect was carried out on a floor-by-floor basis with «Tachocomb» plates (62.5 %). Total tumor removal was achieved in 75 % of children. The majority of neoplasms were represented by craniopharyngioma – 30.43 %. In the early postoperative period, there was a significant regression of neurological disorders – by 69.6 %, as well as ophthalmological – by 34.8 % and endocrine – by 37.8 %. There were no cases of nasal liquorrhea and epistaxis in children.CONCLUSION. Our study demonstrated the success of removing neoplasms in children from 3 years old, regardless of the size of the nasal cavity and pneumatization of the sphenoid sinus. It is possible to use endoscopic transsphenoidal access in children to remove the neoplasms of the chiasmal-sellar region of more than 5 cm, since the risk of intra – and postoperative complications is minimized.

The objective of the study: to evaluate the efficacy and safety of short course chemotherapy regimens for multiple/extensive drug resistant tuberculosis of the respiratory system (MDR/XDR) in older children and adolescents.Subjects and Methods. A cohort prospective controlled study (2017 to 2019) included 23 patients from 13 to 17 years old with various clinical forms of respiratory tuberculosis with multiple/extensive drug resistance.Results. In 22 out of 23 cases, the following chemotherapy regimen was used: 6 months - the intensive phase / 6 months - the continuation phase, in one patient – 3 months of the intensive phase / 9 months of the continuation phase. In 15 out of 23 cases, the chemotherapy regimens in the intensive phase, taking into account the MBT drug sensitivity test, consisted of 5 drugs, in 8 cases – of 4 drugs. During the continuation phase, all patients received 3 drugs. Of the 23 patients, 8 patients used bedaquiline in short course chemotherapy regimens: 2 – 1 course, 6 – 2 courses.Conclusion. The possibility of reducing the main course of chemotherapy for MDR/XDR TB in children and adolescents to 12 months instead of 18-24 months has been proved.

The analysis of the influence of predictors on the probability of retinal detachment in children of the Minsk region was carried out on the basis of a study of the medical records of 660 children's patients treated at the Health care Institutions "4th Children's City Clinical Hospital" and “Minsk Regional Children's Clinical Hospital” for the period 2009–2019. Of these, 313 patients were older than 1 year with an established diagnosis of retinal detachment, 107 children under the age of 1 year, 240 children older than 1 year without retinal detachment at the time of treatment and the presence of predictors of its development (comparison group). To assess the influence of factors, a methodology based on the calculation of the odds ratio was used. The most significant risk factors were assigned a score equivalent from one to four, which allowed quantifying the probability of retinal detachment and identifying risk groups depending on the total score. The use of the proposed method allowed the children of the comparison group to identify changes in the vitreoretinal interface, which required primary laser preventive treatment in 46.7% of cases (113 eyes) during the three-year follow-up period, in 45.4% of children (109 eyes) it was limited only to dynamic observation without treatment. In 95.0% of children in the comparison group, it was possible to prevent the development of retinal detachment.

Due to the increase in the weight of allergic diseases in the general pathology of childhood, the diagnosis and treatment of allergic rhinitis in children and the management of these patients at the outpatient stage have not lost their relevance. The period of preschool and school age is characterized by a high frequency of acute respiratory diseases of the upper respiratory tract, especially acute rhinitis, rhinopharyngitis, rhinosinusitis. This daily poses to the district pediatrician the tasks of differential diagnosis of allergic rhinitis and acute rhinitis with a prolonged course. Allergic rhinitis most often does not require hospitalization and, with timely diagnosis, does not lead to serious consequences. It is known that children who are prone to allergies suffer from acute respiratory viral infections more often and more severely than their peers. An integrated approach to the diagnosis and treatment of such children with the participation of an allergist, an otorhinolaryngologist, under the constant supervision of a district pediatrician, the rational use of drug therapy can reduce the duration of the disease, improve the quality of life of the patient.The article presents generalized principles of management of patients with allergic rhinitis from the point of view of domestic and international recommendations, describes in detail the rules of life for children with allergic rhinitis, emphasizes the role of the district pediatrician in teaching parents to ensure a hypoallergenic environment of the child. The authors present a clinical example of the effective use of a combined decognensant and an antihistamine for the treatment of acute respiratory viral infections in a child with allergic rhinitis.

Introduction. Tonsillopharyngitis often accompanies the course of acute respiratory infections in children (up to 12-15%). The use of systemic antibacterial drugs for viral etiology of the disease has not been shown, therefore, the interest of researchers in the use of herbal products is increasing. In numerous clinical trials conducted around the world, the liquid extract of the roots of Pelargonium sidoides EPs® 7630 has been shown to be effective and safe in the treatment of acute respiratory infections, acute tonsillopharyngitis, rhinosinusitis, acute bronchitis in adults and children.Objective of the study: assessment of the efficacy and safety of the drug EPs® 7630 (Umckalor) in acute tonsillopharyngitis of non-streptococcal etiology in children 2-6 years old on an outpatient basis.Materials and methods. A prospective analysis of cases of treatment with Umckalor for acute tonsillopharyngitis of non-streptococcal etiology against the background of acute respiratory infection in children 2-6 years old (n = 23, group 1) was carried out.The comparison group (2) consisted of children receiving standard therapy (n = 22). Systemic antibiotics and antiviral drugs were not used in all patients. The study was conducted over 6 months (2019-2020). The research results were processed using the Statistica 7.0 software (StatSoft, USA).Results and discussion. Therapy with Umckalor in children with acute tonsillopharyngitis contributed to the elimination of the main clinical symptoms of the disease on the 4th day of treatment (efficiency was 69.9%, p < 0.05). The most persistent symptom was hyperemia of the tonsils and oropharynx. The period of convalescence occurred 2 days earlier than in the children of group 2 (p < 0.05). Umckalor was well tolerated, no side effects of the drug were identified.Conclusions. The drug Umckalor can be recommended for monotherapy for 7 days in patients with acute non-streptococcal tonsillopharyngitis on an outpatient basis with mild and moderate disease.

Histamine is one of the key endogenous mediators involved in the regulation of essential physiological and pathological processes in the human body. Its effects are implemented through several types of specific cell surface histamine (H)-receptors. H1-receptors are the most studied ones. The main clinical effects of their stimulation are vasodilation, bronchoconstriction, pituitary gland stimulation of hormone production, increased mucus production by the nasal glands, etc. Histamine H1 receptor antagonists of two generations are pathogeneticaUy justified agents for the treatment of most allergic diseases in accordance with the current clinical guidelines. The second-generation antihistamines that are devoid of sedative effects and are clinically more effective than the first-generation drugs have been currently introduced into the allergic disease treatment practice. They are the main drugs for the treatment of allergic diseases, especially in acute symptoms of the disease. Dimetindene maleate is the drug of choice for the symptomatic treatment of skin lesions, especially in infants. The article presents the result of the analysis of 26 out-patient medical records of infants (aged from 4 to 12 months) with a verified diagnosis of “atopic dermatitis, limited form, in the exacerbation phase”. A mild course of the disease was observed in 17 children, and a moderately severe course in 9 children. The duration of treatment was 7 to 16 days. Against the background of therapy (group 1), the following results were obtained: on day 3 of treatment the SCORAD-TIS index decreased to 16.4 ± 1.6 and on day 7 to 9.1 ± 1.3 points in children with a moderate course, and to 6.7 ± 0.8 and 4.1 ± 0.9 points in children with a mild course, respectively. In the children from group 2, the decrease in SCORAD-TIS was less significant: 19.5 ± 1.5 points on day 3, 12.2 ± 1.1 points on day 7 in children with a moderate course, respectively. Similar values decreased to 9.0 ± 0.9 on day 3, and to 6.9 ± 1.2 points on day 7 in children with a mild course of atopic dermatitis. The conducted analysis demonstrates the high clinical efficacy, good tolerance and the absence of tachyphylaxis of dimetindene maleate, drops. No side effects including those associated with anticholinergic properties (dry mouth, agitation) were identified.

Introduction.Clinical manifestations of rhinitis have a negative impact not only on the physical, social, and psychological health of children, but also on their parents, especially in families with a first child. Nasal congestion, nasal breathing difficulty cause problems with sleep and feeding.Aim of the study.To estimate the occurrence of rhinitis in children under two years old in the outpatient practice of otorhinolar-yngologists, to consider features of the course and differential diagnostics of various rhinitis types, to evaluate the effectiveness of nasal irrigation-elimination therapy in the treatment of acute rhinitis symptoms.Materials and Methods.Between September 2020 and July 2021, 220 patients between 0 to 18 years were managed: preschool-aged patients comprised 120 patients (54.5%), of whom 27 patients under two years old had symptoms of rhinitis, including those with symptoms lasting more than two weeks.Results.Among the patients referred to us, infectious rhinitis was diagnosed in the majority of cases - in 18 patients (66,7%), which can be explained not only by the timing of the study but also by the highest prevalence of this pathology among the diseases of the nasal cavity. Allergic and non-allergic rhinitis occurred in only 4 (14.8%) and 5 (18.5%) persons, respectively. Symptomatic irrigation therapy with saline solutions is just as necessary for young children as it is for older children and adults. Some difficulties in nasal cavity care during rhinitis are the anatomical narrowness of the nasal passages and lack of blowing skills in young children. In these situations, preference should be given to gentle, non-traumatic, gentle aspiration with prior irrigation of the nasal cavity with an isotonic saline solution. When a nasal aspirator was used, there was a decrease in the duration of nasal discharge during the illness and a reduction in the duration of the disease.Conclusion.Rhinitis in young children is a common but underestimated problem. Clinical manifestations are more often associated with typical symptoms: nasal congestion, discharge, nasal breathing difficulty, and sneezing. The use of irrigation-elimination intranasal therapy with the use of a nasal cavity aspirator can reduce the timing of clinical symptoms of rhinitis and reduce the overall duration of the disease.

The incidence of antibiotic-associated diarrhea, according to various authors, ranges from 5 to 39% and depends on the patient’s age and other contributing factors. Antibiotic-associated diarrhea can be caused by any antibiotic, regardless of dosage form or route of administration. In the pediatric population, the prevalence of antibiotic-associated diarrhea ranges from 6 to 70%. An urgent problem is the development of this disease against the background of a course of H. pylori eradication therapy, which significantly complicates tolerance and adherence to therapy. This article presents current data on the pathogenesis and risk factors of antibiotic-associated diarrhea in children. The clinical picture ranges from idiopathic enteritis to antibiotic-associated diarrhea caused by Cl. difficile - pseudomembranous colitis.The main principle of antibiotic-associated diarrhea treatment is cancellation of the antibacterial medicine that caused the diarrhea, or reducing its dose (if the course of the disease allows it). In complex treatment sorbents are used, correction of water-electrolyte balance is carried out. The use of probiotics seems quite logical for the treatment and prevention of antibiotic-associated diarrhea in terms of the pathogenesis of this condition. To correct dysbiosis, drugs are used to maintain and restore the quantitative and qualitative composition of the intestinal microbiota.Taking into account modern recommendations the main groups of drugs (probiotics, prebiotics, synbiotics) used for correction of intestinal microbiocenosis are presented. The mechanism of action of probiotics and mechanisms of their effect on intestinal microflora are considered. The basic requirements for bacterial strains that are part of the probiotic drugs are presented.The results of various randomized clinical trials and meta-analyses confirming the necessity of including probiotic complexes in antibiotic-associated diarrhea treatment regimens are presented from an evidence-based medicine perspective. The clinical effects of strains of Lactobacillusspp., Bifidobacterium spp.,Streptococcusspp. and Lactococcusspp. on the digestive tract microbiota are considered. The role of a synbiotic containing 9 probiotic strains of 4.5 * 109 CFU in one capsule and the prebiotic component fructooligosac-charides in the prevention of antibiotic-associated diarrhea in children is discussed separately. The results of microbiological studies confirmed the presence of microorganisms of genera Bifidobacterium, Lactobacillus, Streptococcus in the product, and the content of bacteria in one dose of the product was not less than 2 x 1010 CFU.

The respiratory diseases are consistently ranked first in the morbidity pattern among children and adolescents in the Russian Federation. Registry data show that 10-12% of children with pulmonary hypertension have PH-associated chronic lung pathology. Pulmonary hypertension as a life-threatening complication of such chronic lung diseases as hypersensitive pneumonitis, bronchiectasis, bronchial asthma, etc. aggravates the severity of their clinical course and has a great impact on the outcome of the disease. The article summarizes modern data on pulmonary hypertension in children of various ages associated with chronic bronchopulmonary pathology. The issues of classification, pathogenetic mechanisms, criteria and modern methods of diagnosis and treatment, as well as prognosis are considered. The authors come to the conclusion that despite the in-depth study of the pathogenetic aspects of the development of pulmonary hypertension in chronic bronchopulmonary pathology in children, which has recently made it possible to shed light on the understanding of many of its aspects, it should be admitted that the problem as a whole is far from being resolved. Early detection and treatment of pulmonary hemodynamic pathology is extremely important to prevent the formation of cor pulmonale. Pulmonary hypertension, which complicates the chronic lung diseases, is still incurable and is associated with high mortality. Now, young patients with pulmonary hypertension are still often examined and treated using guidelines for adult patients. However, differences in etiology, clinical presentations and diagnostic capabilities require a special approach to studying this problem in children, which raises the question of the need to develop separate clinical guidelines for pediatric practice.

Purpose: to identify the features of COVID-19 infection in children at different periods of the epidemiological rise in the incidence in the city of Moscow.Results. The article presents the observation of 1561 children hospitalized in the State Medical Institution «Children's City Clinical Hospital named after Z. A. Bash-lyaeva DZM» with a diagnosis of a new coronavirus infection COVID-19 during the periods of epidemiological rises in morbidity («2nd and 3rd waves of COVID-19»). An increase in the number of hospitalized children during the «3rd wave of COVID-19», early admission dates from the onset of the disease, due to the lack of treatment effect in outpatient settings, the predominance of school-age children and adolescents, the predominant course of infection with the development of viral pneumonia CT2-3, less often CT3-4, a 10-fold reduction in the number of children with MIS-syndrome, an elongation of the period of viral release in patients.

Introduction. In the context of a decrease in the tension of the epidemic situation on tuberculosis in Russia, it remains relevant to search for new ways to increase the effectiveness of preventive anti-tuberculosis measures among children and teenagers, taking into account an integrated approach to assessing all risk factors for tuberculosis in various age groups of the child population.Objective. Tо study the complex characteristics of groups at increased risk of tuberculosis among children of different ages who have positive results of a skin test with a recombinant tuberculous allergen (АТR).Materials and methods. The study retrospectively included 392 patients aged 2–17 years with a positive ATR test result. The рatients were randomized by age into 3 groups: in the 1st group there were 87 children 2–7 years old, in the 2nd group 182 children aged 8–14 years were included, in the 3rd group included 121 patients 15–17 years. The children did not have clinical and radiological signs of active tuberculosis and were HIV-negativ.Result. Among children and adolescents with a positive result of the test with ATR, social risk factors for developing tuberculosis (unfavorable living conditions, lack of permanent employment in 86.3% of parents) were determined. It was found that children living in families with low social status were dominated by contact with patients with multidrug resistance of the pathogen (MDR-TB), more than half of children (53.1%) had comorbidities. In 13.3% of children, small calcifications were detected in the lungs, in the intrathoracic lymph nodes.Conclusion. Among children 2–7 years old with positive results of the test with ATR, a complex of risk factors for the development of tuberculosis prevails: low material security in every second family, alcohol and drug dependence of parents in every third family, contact with MDR-TB patients in 56.5% of children, high incidence of concomitant pathology (in 67.4% of children).

The study of a new coronavirus infection (COVID-19) in children is relevant and of interest for practical health care.Purpose: to identify the clinical and laboratory features of COVID-19 in the context of the six-month dynamics of the pandemic in children of the Orenburg region and to formulate recommendations for optimizing the diagnosis of this disease.Materials and methods. A retrospective analysis of 2661 results of detecting SARS-CoV-2 RNA (including 170 children) was carried out on the basis of the microbiological laboratory of the Orenburg State Medical University. Age and sex, structure of preliminary diagnoses, main clinical manifestations, frequency of testing and dynamics of the PCR threshold cycle in September 2020 and January 2021 were assessed.Results. The proportion of children examined in the Orenburg region from September 2020 to January 2021 increased from 4.6 ± 0.6% to 8.1 ± 0.7%. At the same time, the number of PCR + results also significantly increased from 5.0 ± 2.8% to 8.2 ± 2.6% (χ2 = 54.81; p = 0). The average age of children was 9—10 years old. The main reason for referral was pre-hospitalization screening not related to COVID-19. The proportion of PCR + results in this cohort was significantly lower in children than in adults. Among the clinically manifested forms in adults, the leading diagnosis was «pneumonia», and in children «ARVI». In childhood, a predominantly asymptomatic course of the disease was recorded. In children, unlike adults, PCR Ct values did not correlate with the severity and duration of the clinical manifestations of COVID-19.Conclusion. Due to the low diagnostic value of symptoms in children, it is more expedient to focus on epidemiological data and data from the results of laboratory examination methods. When interpreting the results of PCR diagnostics of COVID-19 for prognostic purposes, it is important to take into account the patient's age.

Treatment of young children with atypical or recurrent purulent soft tissue infections (PSTD) that do not respond well to surgery and antibiotics is most challenging. PSTD occurs against the background of impaired functioning of the immune system and, first of all, the system of neutrophilic granulocytes (NG). The vector effect of immunotropic therapy on a specific NG subsets may allow the correction of NG dysfunctions without compromising host protection, including strategies to enhance, inhibit or restore their functions.The aim of study: to evaluate in vitro the modulating effects of arginyl-alpha-aspartyl-lysyl-valyl-tyrosyl-arginine (HP) on the transformed phenotype of 4 NG subsets, as well as on the functional activity of NG in children with purulent-inflammatory soft tissue diseases.We studied samples of peripheral blood (PB) from young children 2-4 years old: 17 children with atypical acute PSTD and 10 apparently healthy children. At stage I, a comparative assessment of the content and phenotype of 4 NG subsets CD16+CD62L+СD63- , CD16+CD62L+СD63+, СD64- CD16+CD32+CD11b+, СD64+CD16+CD32+CD11b+, phagocytic and microbicidal functions of NG was carried out. At stage II, the in vitro system determined the effects of HP on NG in children with PSTD according to the studied parameters. By the method of flow cytometry (FC500 “Beckman Coulter” (USA), conjugates of MkAT “Beckman Coulter International S.A.” (France)), the relative number of NGs of the studied subsets and the density of receptor expression (MFI) were determined. To assess the phagocytic function of NG a microbiological method was used to assess the completeness of phagocytosis with S. aureus (strain 209). The activity of NG NADPH oxidase was investigated in the NBT-spontaneous test (NBTsp.) and in the in vitro NBT-induced test (NBTind.). A comparative study of PB samples from conventionally healthy children and children with PSTD made it possible to identify various variants of transformation of the phenotype of the studied NG subsets, associated with defects in their functional activity. In the in vitro system the effects of HP were demonstrated, manifested by a decrease in the amount of CD16+CD62L+CD63+NG and an increase in CD16+CD62L+CD63- NG, modulation of the negatively altered phenotype of subsets CD64- CD32+CD16+CD11b+NG and CD64+CD32+CD16+CD11b+NG, aimed at restoring phagocytic function and maintaining the tension of NADPH oxidases.As a result of the study it was found the immunomodulatory effects of HP, which is manifested in the reorientation of NG from the pro-inflammatory phenotype to the anti-inflammatory one, which can be used in the future when creating personalized targeted immunotherapy aimed at correcting defective functioning NG in early children, suffering from PSTD.

The aim of the study was to evaluate the diagnostic markers in children with HIV —encephalopathy (HIVE) with varying degrees of severity.Material and methods of research: The study included 260 children (153 boys — 58.85% and 107 girls —41.7%) with HIV-positive status and receiving antiretroviral therapy according to an individually selected scheme for at least 6 months. All children included in the study showed signs of HIV encephalopathy. The activity response was assessed by the concentration of IL-6, IL-10, TNF-alpha, C-reactive protein, C3, C4 components of the complement (immunofelometric analysis).Results: The study of the activity response in children with HIV encephalopathy found that the concentration of TNF —alpha and IL-6 were increased, compared, to the reference values (12.67±0.25 PG/ml and 23.04±0.64 PG/ml, respectively, with reference values of less than 8.1 PG/ml and 7pg/ml, respectively), and the concentration of IL-10 was reduced (5.93±0.10 PG/ml with a reference value of more than 9.1 PG/ml). The study analyzed the predictor significance of various parameters response in the aspect of the development of symptomatic HIV- encephalopathy. A comparative analysis of the concentration markers was performed, and the incidence of symptomatic HIV —encephalopathy was determined depending on the diagnostic concentration of the diagnostic marker. This finding is probably explained by the effector role of systemic inflammation in the development of damage to the Central nervous system.Conclusion. The maximum predictor significance in the aspect of the development of symptomatic HIV -encephalopathy was found in proinflammatory cytokines: an increase in IL-6 concentration above 19.6 PG / ml is associated with an increase in the risk of developing symptomatic HIV encephalopathy by 9.14 times, and an increase in TNF -alpha concentration above 12.5 PG/ml by 4.07 times (p

Protein-induced enteropathyis a common manifestation of gastrointestinal food allergy in young children. Non-invasive diagnostic methods are especially relevant for the timely diagnosis and prevention of exacerbations.Objective. To evaluate serum, fecal and urinal levels of the intestinal fraction of fatty acids-binding proteins in children with protein-induced enteropathy and their clinical and diagnostic significance.Material and methods. The authors examined 29 children with protein-induced enteropathy aged from 1,5 to 12 months and 20 healthy children (control group). For differential diagnosis with congenital diseases of the gastrointestinal tract, all patients underwent esophagogastroduodenoscopy with morphological examination of biopsies. The Cow’s Milk-related Symptom Score (CoMMiS) was used to assess clinical symptoms. In all children, the intestinal fraction of the protein binding fatty acids (I-FABP) was determined in blood serum, urine, coprofiltrate byenzyme-linked immunosorbent assay.Results. The scientists found an increase in the protein level in the blood 125,20±23,79 pg/ml, in coprofiltrate 0,36±0,05 ng/ml, in urine 0,164±0,031 pg/ml compared with those in the control group (19,21±4,94pg/ml, 0,18±0,02 ng/ml and 0,039±4,62 pg/ ml, respectively; p,05). The authors found direct strong relationship between the degreeof morphological changes, clinical severity of gastrointestinal manifestations and the concentration of fatty acid binding protein in serum and urine, moderate relationship with the indicators in coprofiltrate (pConclusion. An increase in serum, fecal and urinal levels of I-FABP in children with protein-induced enteropathy confirms the clinical and diagnostic significance of this biomarker in all biological fluids. Its high sensitivity and specificity of determination in urine is promising for pediatric practice.

Otitis media, including exudative otitis, is one of the most common childhood diseases. Almost asymptomatic course in children of early and preschool age leads to undiagnosed hearing loss. In such cases the minimal auditory deficit significantly affects the auditory-speech development and the formation of higher cortical functions in children. It is pediatricians who are the first to deal with the manifestations of exudative otitis media. Consequently, their knowledge and understanding of the disease, including the most common causes and risk factors, is important. The first part of the literature review considers the theories of the exudative otitis media formation, the role of viral and bacterial flora in the development of the disease, the effect of obstruction of the auditory tube against the background of nasopharyngeal neoplasms, craniofacial anomalies (including chromosomal aberrations), allergic diseases, rhinosinusitis and adenoiditis.

The frequency of underweight in children with cerebral palsy is about 60–70%. A benefit of nutritional support in children with cerebral palsy are underestimated. The use of nutritional support during active physical rehabilitation can have a positive effect on not only body weight, but also the component composition of the body and their rehabilitation potential.The aim of our study was to evaluate the effectiveness of nutritional support – a hypercaloric (1,5 kcal/ml) polymer formula with fibers (Pediashure 1,5 Fiber, Abbott) in children with cerebral palsy.Characteristics of children and research methods. Anthropometric indicators (body weight, height, body mass index, triceps skinfold thickness, subscapular skinfold thickness, mid-upper arm circumference, shoulder muscle circumference) and body composition were studied in 15 underweight children with cerebral palsy aged 4–10 years with the level of motor disorders GMFCSIII–IV. They were prescribed of nutritional support with a hyper caloric mixture (1,5kcal/ml) with fiber lasting 3months during active physical rehabilitation.Results. Against the background of nutritional support, there was a significant increase in body weight, height, z-score of body weight, mainly due to musculoskeletal, active cell and lean mass. In addition to correcting the nutritional status of children with cerebral palsy, an improvement in their motor abilities was noted.

Background. Cardiac surgery in combination with hypothermia, ischaemia and reperfusion leads to an inflammatory response causing postoperative complications. Toll-like receptors are signalling molecules through which some functions of innate immunity can be activated, and polymorphic variants in the TLR-family genes can be predictors of complications after cardiac surgery.Aim. To study the associations of TLR-family genes with infectious and non-infectious complications of cardiac surgery for congenital heart defects.Methods. The study included 89 children (44 girls and 45 boys) with congenital heart defects who underwent cardiac surgery. Complications occurred in 47 children 47 days after cardiac surgery. There were no complications in 42 children. Genotyping was performed by real-time PCR using TaqMan probes.Results. A two-locus model of gene-gene interaction between TLR1 rs5743551 and TLR2 rs3804099 was the best fit, accounting for 4.01% of phenotypic entropy. The TLR2 gene polymorphic variant rs5743708 had the highest predictive potential (2.59%).Conclusion. The development of postoperative complications of cardiac surgical treatment for congenital heart defects can be due to the synergistic effect of the polymorphic variants rs5743551 in the TLR1 gene and rs3804099 in the TLR2 gene. This effect occurs through the features of TLR1 and TLR2 transcription, the subsequent expression of receptors on cells and signalling which activates the synthesis of proinflammatory cytokines and chemokines.Received 25 February 2021. Revised 11 May 2021. Accepted 12 May 2021.Funding: The work is supported by the complex program of fundamental research of the Siberian Branch of the Russian Academy of Sciences (No. 0554-2019-0002).Conflict of interest: The authors declare no conflicts of interests.Contribution of the authorsConception and study design: A.V. Shabaldin, A.V. Ponasenko, A.V. TsepokinaData collection and analysis: A.A. Anikeenko, A.V. Tsepokina, S.A. ShmulevichStatistical analysis: A.V. Shabaldin, A.V. TsepokinaDrafting the article: A.V. Shabaldin, A.V. Tsepokina, A.V. PonasenkoCritical revision of the article: A.V. TsepokinaFinal approval of the version to be published: A.V. Tsepokina, A.A. Anikeenko, S.A. Shmulevich, A.V. Ponasenko, A.V. Shabaldin

Obesity is one of the socially significant diseases of our time and is a generally recognized risk factor for the development of carbohydrate metabolism disorders, including type 2 diabetes mellitus (DM), the prevalence of which in the pediatric population is rapidly increasing.Aim of the study. To demonstrate the most frequent types of carbohydrate metabolism disorders in children and adolescents with obesity.Materials and methods. 123 obese patients under 18 years old were examined and the structure of obesity complications was analyzed.Results. Carbohydrate metabolism disorders were identified in 24 patients (19%): impaired fasting glycemia (IFG) (8 girls, 6 boys (11%)), type 2 DM (6 girls, 3 boys (7%)), and type 1 DM (1 boy (1%)). Descriptions of 4 clinical cases are given: 1) patient, 17 years old, with constitutional-exogenous obesity of 3rd degree, arterial hypertension (AH), dyslipidemia and nonalcoholic fatty liver disease (NAFLD) and a history of transient IFG; 2) patient, 16 years old, with morbid obesity, NAFLD, AH, polycystic ovarian syndrome (PCOS), type 2 DM, compensated on metformin therapy; 3) patient, 17 years old, with constitutional-exogenous obesity of the 3rd degree, AH, dyslipidemia, NAFLD, type 2 DM (on insulin pump therapy), complicated by diabetic nephropathy and diabetic polyneuropathy; 4) patient, 12 years old, with type 1 DM, manifested against the background of obesity.Conclusion. When screening for obesity complications in children and adolescents, carbohydrate metabolism disorders may be detected in one in five patients. Prediabetes in childhood can be transient. When a child with obesity is identified, differential diagnosis of type 1 and type 2 DM should be made. It is necessary to teach patients with type 2 DM the skills of self-monitoring on a par with patients with type 1 DM and motivate them to control glycemia regularly at home.

Introduction. Protein-induced enteropathy is one of the common manifestations of gastrointestinal food allergy in young children. The search of non-invasive methods for intestine estimation is especially relevant for early diagnosis and timely prevention of exacerbation.The aimof the study was to determine the serum and urinal levels of the intestinal fraction of the protein binding fatty acids in children with protein-induced enteropathy and to evaluate their clinical and diagnostic significance.Materials and methods. It was examined 36 children with protein-induced enteropathy aged 1.5 months to 1 year and 20 healthy children (control group). All patients underwent esophagogastroenteroscopy with morphological examination of biopsy specimens for differential diagnosis with congenital gastrointestinal diseases. The Cow’s Milk-related Symptom Score (CoMMiS) was used to evaluate clinical symptoms. The intestinal fraction of a fatty acid binding protein was determined for all children in blood serum, urine by enzyme- linked immunosorbent analysis.Results.It was found the increase its serum level (125.20 ± 23.79 pg / ml), and urinal level (0.164 ± 0.031 pkg / ml) compared with the control group (19.21 ± 4.94 pg / ml, 00.039 ± 4.62 pkg / ml, respectively, p Discussion.Epithelial barrier damage provides an increased penetration of intact food allergens. It plays a key role in allergic sensitization, and it is the first pathogenetic link of allergic inflammation in most cases. A statistically significant I-FABP increased level in all studied biological fluids correlates with morphological changes in the children with protein-induced enteropathy, as well as with clinical symptoms of gastrointestinal tract lesions. That confirms its high informational value for an indirect assessment of the state of the intestinal barrier.Conclusions.Thus, an increase in serum and urinal I-FABP levels in children with protein-induced enteropathy confirms the clinical and diagnostic significance of determining this biomarker in all biological fluids. Its high sensitivity and specificity of determination in urine are promising for use in pediatric practice.

Introduction. At the present time the expansion of the spectrum of urgent diseases of the abdominal cavity organs is registered due to the patients with complications of foreign bodies of the gastrointestinal tract. Development of rational treatment-diag nostic algorithm will promote to improve the results of surgical treatment of children with complications of foreign bodies of gastrointestinal tract.Aim. To determine the efficacy of laparoscopic techniques in children with complications of foreign bodies of the gastrointestinal tract..Materials and methods. 38 children with foreign bodies of the gastrointestinal tract of different characteristics, which required surgical treatment, were included in the study.Results and discussion. On the basis of analysis of clinical and medical history data, results of instrumental methods of preoperative diagnostics and laparoscopy three clinical stages of the disease were distinguished. Statistically reliable differences of the presented indicators in different terms of the disease were proved. Surgical intervention involved laparoscopy, during which the volume of surgical intervention was specified. Laparoscopic techniques were effective in the groups of patients with I, II and III stages of the disease in 100, 46 and 20% of observations, respectively.Conclusions. Clinical manifestations in complications of foreign bodies of the gastrointestinal tract are determined by the characteristics of the latter and the clinical stage of the disease. Laparoscopic techniques can be effective at initial stages of the disease. At a complicated course of the disease the required volume of surgical intervention can be performed during laparotomy. The variety of clinical manifestations of foreign bodies of the gastrointestinal tract complications is determined by the characteristics of the damaging agents and the clinical stage of the disease. Laparoscopic techniques of surgical treatment may be a priority in the absence of a complicated course of the disease; in late stages of the disease laparotomy is the operation of choice.Conclusion. Analysis of treatment results of children with complications of FBs of GIT revealed statistically significant differences in some clinical and anamnestic data, results of instrumental methods of preoperative diagnosis and intraoperative manifestations, which allowed us to define three clinical stages of the disease.

The objective: to identify factors of a higher risk to develop tuberculosis in children exposed to tuberculosis cases resistant or sensitive to rifampicin.Subjects 161 children under 6 years old exposed to tuberculosis in their families were enrolled in the retrospective study. The children were divided into 2 groups: Group 1 (n = 92) – children free of TB; Group 2 (n = 69) – children ill with TB. In each group, two subgroups were identified: those with index cases susceptible to rifampicin (RS) 1A (n = 40) and 2A (n = 43) and those with index cases resistant to rifampicin (RR) 1Б (n = 52) and 2Б (n = 26).Results. Exposure to isoniazid resistant tuberculosis increases the risk of TB in the child by 12 times, on the opposite, drug resistance to rifampicin provides no impact on the risk to develop tuberculosis. If the child is exposed to 2 cases of tuberculosis and more, the risk to develop tuberculosis increases by 2-14 times. BCG vaccination of the child exposed to tuberculosis reduces the risk to develop tuberculosis by 2-13 times.

Currently, in pandemic settings, the new coronavirus infection is the leading cause of adult fatalities and may cause death of children with comorbidities.The objective of the study is to identify predictors of the fatality of the new coronavirus infection in children.Subjects and Methods. 230 patients with the new coronavirus infections were examined. The main group of 94 patients with severe COVID-19, the fatal outcome occurred in 25 (26.6%) children. The comparison group consisted of 126 children with a moderate degree of severity, and there were no lethal outcomes.Results. Children older than 10 years of age (43%) prevailed in the study cohort. Every fifth patient in the main group suffered from shock, and 79 (84%) children had failure of two or more systems/organs. The presence of pronounced manifestations of the disease was associated with a 20-fold increase in the probability of a severe course of COVID-19 (OR = 0.04). Involvement of two organs and systems doubled the risk of death. An acceptable discriminatory ability of the pSOFA score for predicting COVID-19 outcomes in children was identified: sensitivity 83%, specificity 61%, cut-off point 5.6 points.Conclusion. Predictors of death in severe new coronavirus infection in children include failure of two or more organs and systems, acute renal injury and the pSOFA score above 5.

Purpose: to establish the frequency and clinical significance of mutant variations of the HFE gene polymorphism in chronic hepatitis B (CHB) in children with iron overload syndrome (IOS).Materials and methods: 60 children with chronic hepatitis B with iron overload syndrome (IOS) were examined. When distributing children into groups, we took into account the criteria we developed for assessing the degree of life expectancy in children with CHB: CST>0.5 – mild degree of life expectancy (43,3% of children), CST˃0.5 – mild degree of life expectancy (43,3% of children), CST˂0,5 – moderate severity of life expectancy (31,7% of children) and CST˂0,2 – severe degree of SPL (25,0%). Virological verification of HBV was performed by ELISA and PCR. Using PCR Real Time and molecular genetic analysis, HFE gene C282Y, H63D, S65C mutations were detected from amplified DNA using the PRONTO Hemochromatosis reagent kit (Israel). The transferrin saturation coefficient (CST) was calculated using the formula CST = sTfR / log10.Ft. Results:Results: The study of the hemochromatosis gene HFE showed that the overwhelming majority (84,0%) of children with CHB with IOS were carriers of heterozygous, phenotypically different, mutant types. And only 16,0% of sick children were homozites of the wild (normal) HFE gene. Analysis of the phenotypic polymorphism of the hemochromatosis gene HFE revealed the presence of three point heterozygous mutations: H63D, S65C and combined variations in H63D / S65C, the latter of which is associated with severe forms of CHB and severe IOS.Conclusion. Children with CHB with IOS are characterized by a high incidence of heterozygous mutations in the HFE gene, the phenotypic manifestations of which were S65C, H63D, H63D / S65C. The comparability of the heterozygous combined mutation H63D / S65C with severe forms of CHB and a severe degree of IOS gives grounds to consider this phenotype of the HFE gene as a factor in the progression of the disease.

Introduction. Extrapulmonary tuberculosis (EPTB) still has many features: there is a different approach to its definition in different countries, there is no screening, diagnosis is extremely difficult and requires financial costs, and bacteriological verification does not exceed 46%, complex restorative and reconstructive operations are used in treatment. the proportion of patients with isolated extrapulmonary localizations among tuberculosis patients is low.Purpose of the study. To study the structure of tuberculosis (TB) in children with the accentuation of EPTB in the current conditions to determine the development areas of preventive and diagnostic measures.Materials and methods. A retrospective two-stage study was carried out in the period from 1989 to 2018 among in-patient children aged 0 - 14 yrs. At the first stage, the structure of clinical forms of TB was assessed in 2306 children. Three comparison groups were formed following ten-year periods. At the second stage, 4 groups were identified according to age: early age, preschool age, primary school age, prepubertal age. The data obtained in the course of the study were statistically processed using the Microsoft Office 2007 (Microsoft Corp., USA) and Biostat 2009 (AnalystSoft Inc., USA) software package. The differences between the groups were determined using the χ2 test, and significant differences were considered when the value of the p < 0.05 criterion.Results. It was found that throughout the entire observation period in the region, the predominant localization of the specific process was respiratory TB. The proportion of isolated extrapulmonary lesions in children decreased from 11.1% in the period from 1999 to 2008 to 3.4% in the period from 2009 to 2018 (p = 0.000). At the same time, the most frequent localization (60.4 - 77.8% of cases) among EPTB remains urinary TB. In the dynamics from 1989 to 2018, the number of cases of the disease with combined forms of tuberculosis increased (from 3.1% to 7.2%; p = 0.000), mainly due to the establishment of several localizations of the lesion. The frequency of bacteriological confirmation of the diagnosis was significantly different at various localizations of the specific process. In children of the compared periods of childhood, the predominant localization of the specific process was isolated respiratory TB. The isolated extrapulmonary process localizations were more common in the age groups 7 - 11 and 12 - 14 yo, where it accounted for 10.8 - 12.4% of TB cases (p = 0.000). The localization of the EPTB also depended on the children's age. So, young children often developed damage to the osteoarticular system, in preschool children - the genitourinary and lymphatic (peripheral lymphadenopathy) systems, in younger schoolchildren and preschoolers - the genitourinary system. The frequency of bacteriological confirmation of the EPTB increased with the age. The combined forms of a specific process were more often observed in the age group of 7 - 11 yo, in the other groups their share was 77.4%, 87.1%, and 95.0% of cases. Respiratory TB and TB of other organs was confirmed bacteriologically more often in the age group 7 - 11 yo (19.4%), and in the group 12 - 14 yo in 12.9%, 4 - 6 yo in 10.0%, early age in 9.7%, which is much more frequent than confirmation of isolated respiratory TB.Conclusions. EPTB in children has not lost its position and due to the widespread introduction of the recombinant TB allergen and CT into clinical practice. It has become more often detected in combination with respiratory TB. Among the EPTB, genitourinary tuberculosis prevailed, which can be verified in contrast to damage to other organs. Raising the level of awareness of paediatricians and phthisiatrician-paediatricians about the frequency of EPTB occurrence makes it possible to form alertness in terms of the possibility of their development and to timely detect the disease at an early stage.

The aimof the research is to study the features of the intestinal microbiota in children with parasitic invasions.Clinical and microbiological examination of 40 children aged from 9 months to 1 0 years with functional disorders of the intestine was carried out, in 20 of whom intestinal parasitoses were detected (15 of them — ascariasis, 5 — intestinal lambliosis) — the main group. The comparison group consisted of 20 other children with functional disorders of the intestine without intestinal parasitosis.All children underwent: assessment of the course of the ante-neonatal periods, the nature of feeding and clinical symptoms of intestinal parasitosis; triple study of feces for eggs of worms and protozoa in the enrichment environment of Turdyev, coprocytogram, biochemical analysis of feces, ultrasound of internal organs. To identify the quantitative content of the main groups of normobiota, species composition and spectrum of opportunistic bacteria and viruses, the method of gas chromatography-mass spectrometry of intestinal microbial markers was used.It was found that in children with intestinal parasitosis, already at the prenatal stage of the formation of the intestinal microbiota, risk factors were recorded that negatively affect the composition of the forming microbiota, associated with functional disorders of the digestive tract from the first days of life.The degree of deficiency of normobiota, as well as the spectrum of opportunistic bacteria in children with parasitic invasions, was greater: 14 types of bacteria in combination with herpes viruses versus 9 in the comparison group. Association Clostridium spp. — Herpes virus against the background of a deficiency of bifidobacteria and lactobacilli acts as a dominant association in the relationship with intestinal parasitosis.

Invasive meningococcal infection is a significant cause of death, reaching 80% in septic shock. The Pediatric Research and Clinical Center for Infectious Diseases (PRCCID) has developed an algorithm for the treatment of children with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome, which includes basic drug therapy with polymyxin hemoperfusion in combination with extended methods of extracorporeal hemocorrection.Purpose: to evaluate the effectiveness of extracorporeal hemocorrection operations in children with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome.Materials and research methods: to the intensive care unit of the PRCCID for the analyzed period 2006—2020 34 children were hospitalized with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome. Two groups were formed: Group 1 — children admitted to the PRCCID in the period 2014—2020 (n = 23), who underwent polymyxin hemoperfusion simultaneously with extended methods of extracorporeal hemocorrection, group 2 — children hospitalized in 2006—201 3 (n = 1 1), methods of extracorporeal hemocorrection were not performed. The Mann-Whitney U-test and ANOVA were used to evaluate the results.Results and discussion: the use of extracorporeal hemocorrection operations in the complex therapy of invasive forms of meningococcal infection with refractory septic shock and multiple organ failure syndrome in children provides stabilization of central hemodynamics, reduces clinical and laboratory inflammatory reactions, helps to reduce the dose of vasopressor drugs and parameters of respiratory support, and also increases patient survival rate by 82.6%.

Objective. To study predictors of bronchial asthma development in children of 3-4 years old with recurrent broncho-obstructive syndrome by 5-6 years of age.Material and methods. The authors conducted a prospective cohort study in 2018-2020 with the participation of 61 children aged 3–4 years with recurrent broncho-obstructive syndrome. Inclusion criteria: age 3–4 years; ≥ 3 episodes of broncho-obstructive syndrome in the past 12 months; informed voluntary consent. At the first visit the scientists determined the levels of serum periostin, specific inhalation allergens IgE, total IgE and the number of eosinophils in the blood. In 24 months, at the second visit, bronchial asthma was diagnosed based on the GINA criteria (updated 2019). Binary logistic regression analysis was used to study the predictors of bronchial asthma development.Results. In 24 months from the beginning of the study, bronchial asthma was diagnosed in 29 (47%) children with recurrent broncho-obstructive syndrome. The level of serum periostin and total IgE had no effect on the risk of developing bronchial asthma (p=0,194; p=0,269). According to binary logistic regression, the predictors of bronchial asthma development are burdened family allergic history (odds ratio – OR 3,81; 95% confidence interval – CI 1,14-12,74; p=0,015), allergic rhinitis (OR 4,94; 95% CI 1,37–7,80; p=0,0001), sensitization to the Dermatophagoides pteronyssinus (OR 1,80; 95% CI 1,36–1,13; p=0,045) and eosinophilia (OR 2,10 ; 95% CI 1,23-4,83; p=0,055).Conclusion. A burdened family allergic history, the presence of allergic rhinitis, sensitization to the Dermatophagoides pteronyssinus, eosinophilia are the predictors of bronchial asthma development in children with recurrent broncho-obstructive syndrome by 5-6 years of age.

Rationale: Acute infectious diarrhea (AID) is the fourth leading cause of death among children < 5 years worldwide. Kidney damage is one of the poorly studied aspects of pediatric AID. The level of serum cystatin C is independent on gender and age, and it is highly informative even in the early stages of renal dysfunction.Aim: To optimize diagnosis of renal dysfunction in children with moderate AID through comparison of different methods of glomerular filtration rate (GFR) calculation and determination of serum cystatin C level.Materials and methods: Observational cross-sectional study enrolled 80 children in pediatric hospital with moderate AID not followed by hemolytic uremic syndrome. Serum creatinine and serum cystatin C levels were determined in all the patients in acute period with GFR calculating according to Schwartz equation in unmodified (1976) and modified (2009) versions. GFR was also calculated using a single-factor equation based on serum cystatin C level.Results: GFR in acute period, calculated according to unmodified and to modified Schwartz equation was in patients < 3 years (n = 40) 115.47 ± 3.33 ml/min/1.73 m2and 98.56 ± 2.84 ml/min/1.73 m2(p < 0.001), in patients 3-7 years 132.13 ± 4.2 ml/min/1.73 m2and 108.85 ± 3.84 ml/min/1.73 m2(p < 0.001), respectively. Increased serum cystatin C level (> 950 ng/ml) occurred in 18 patients (22%). In other patients level of serum cystatin C remained within the reference range or lower. The risk of acute kidney injury development based on two indicators - GFR according to the modified Schwartz equation and GFR according to the equation used cystatin C level - occurred in 4 (10%) patients aged 1-3 years and in 1 (2.5%) child in the age group 3-7 years; risk, based on one indicator - the calculation of GFR according to the formula using cystatin C - in 8 (20%) and 9 (22.5%) children, respectively, and based on the assessment of only GFR according to the modified Schwartz equation - in 3 (7.5%) children of both age groups.Conclusion: We have confirmed that the GFR values calculated with usage of unmodified Schwartz equation (1976) are higher than those calculated with usage of modified Schwartz equation (2009) and taking into account the level of cystatin C.Thus, usage of unmodified Schwartz equation for GFR calculation in infants and preschool children seems incorrect. Level of serum cystatin C is promising marker permitted to select patients with risk of acute kidney injury development among children in acute period of moderate AID.

The objective of the study: to develop criteria to evaluate the duration of the intensive phase of chemotherapy for respiratory tuberculosis in children without bacterial excretion and at no risk of multiple and extensive drug resistance of tuberculous mycobacteria.Subjects and methods. Totally, 93 patients with newly diagnosed respiratory tuberculosis without bacterial excretion and at no risk of multiple and extensive drug resistance of tuberculous mycobacteria. Their age varied from 2 to 12 years old. Regimen III was used: the intensive phase – 4 drugs (isoniazid, rifampicin, pyrazinamide, ethambutol – HRZE).Results. The intensive phase lasted for 2 months in 39.8% of cases – the main criteria were achieved (relief of intoxication symptoms, normal blood rates, positive or stable CT changes) after 2 months and there was no indication to extend the duration of it. The intensive phase lasted for 3 months in 37.6% of cases – the main criteria were achieved after 2 months and there was at least one additional indication to extend it (17.2%); and the main criteria were achieved after 3 months and there was no indication to extend the duration of it (20.4%). The intensive phase lasted for more than 3 months (4 to 6 months) in 22.6% of cases – the main criteria were achieved after 3 months and there was at least one additional indication to extend it (12.9%), as well as in the case of failure to achieve the main criteria after 3 months regardless of the presence/absence of additional indications to extend its duration (9.7%).Conclusion. Various combinations of the main criteria and additional indications made the basis for differential approach to determining the duration of the intensive phase of chemotherapy in children with respiratory tuberculosis

Acute otitis externa is a common disease in the pediatric population, characterized by diffuse inflammation of the external auditory canal. Typical symptoms of acute otitis externa include otology, itching, congestion, and a feeling of fullness in the sore ear. In the case of active inflammation, the process can go to the tympanic membrane, and acute otitis media will join the external one. Primary therapy for diffuse uncomplicated acute otitis externa should include a local antimicrobial drug, without systemic antibiotic therapy. Topical therapy with antibacterial drugs in combination with anesthetics is the most rational. A clinical case of a 12-year-old patient with acute diffuse otitis externa and otitis media with effusion; acute nasopharyngitis; and adenoiditis, which was established based on anamnesis and clinical data is presented. Complex therapy was prescribed, which included local antibiotic therapy with a complex topical drug for the treatment of imperforated otitis externa and imperforated otitis media. At reexamination 5 days later, the patient demonstrated positive dynamics, pain in the left ear was eliminated. In cases of uncomplicated diffuse otitis externa, as well as in cases of its combination with otitis media with effusion, topical antibiotic therapy is a major priority. It should be borne in mind that the topical medication is more effective with the cleansing of the external auditory canal from inflammatory secretion. If it is used correctly, it would provide positive dynamics without systemic antibiotic prescription. It preserves the microbiome and mobilizes the body’s defenses. The application of complex topical antibiotic drugs can be widely recommended in pediatric practice.

The problem of chronickidney disease is one of the urgent problems in nephrology. There is data on the multifaceted participation of cytokines in the development and prognosis of pathological conditions. The recent studies are focusedon the mechanismsoflocal inflammation with the analysis of interleukins level in the urine. Cytokines are mediators between nonspecific defense reactions and specificimmunity. Being synthesized in the focus of inflammation, cytokines influence almost all cells involvedin inflammation. In case of local defense failure, cytokines enterthe circulation and act at the systemic level, developing an acutephaseresponse in the body. The review presents data on the cytokine status in chronic kidney disease in children and its rolein the progression oft he disease. The authors emphasize the scientific and practical significance of studies of the cytokine status in chronic kidney diseases.

The article deals the possibilities of using early clinical and anamnestic data for the diagnosis of severe bronchial obstruction in children.The aim of the study was to search for informative indicators that affect the severity of bronchial obstruction against the background of acute respiratory viral infections, and to develop a mathematical predictive model for use at the stages of hospitalization.Materials and methods. The study was based on the examination and observation of 386 children aged 1 month to 5 years who were treated in the respiratory department and the intensive care unit with a diagnosis of bronchial obstruction syndrome. To search for informative indicators, 34 anamnestic signs were studied, including those in mother-child pairs. Comparison of indicators was carried out according to Student's t-test for independent samples and у 2 test to assess categorical differences. To assess the effect of each independent variable on the outcomes of interest, variables reaching P ≤ 0.25 in bivariate analysis were included in a multivariate logistic regression model.Results. Mathematical processing showed that only 1 9 factors were identified as significantly influencing the severity of the disease (p < 0.001), while others were not potential determinants of severity. For the main ones, diagnostic values were calculated and a mathematical forecasting model was built with a high level of reliability — 95%.

The authors present their own results of scientific research on the clinical and paraclinical characteristics of various stages of chronic kidney disease in children. They determine pathogenetic markers for the diagnosis and prognosis of chronic kidney disease in childhood with the assessment of the set of endothelial dysfunction markers. The authors proved diagnostic and prognostic value of a stepwise increase in arterial hypertension, urinary excretion of prosclerotic, pro-inflammatory cytokines and growth factors with a simultaneous decrease in urinary excretion of anti-inflammatory cytokines, an increase in the level of microalbuminuria, disturbances of urodynamics and intrarenal hemodynamics.The authors developed an algorithm for the diagnosis of chronic kidney disease in childhood, taking into account pathogenetic factors with an assessment of the complex of clinical and paraclinical, structural, functional parameters, hemodynamic changes in the kidneys in combination with the parameters of endothelial function and cytokine status.

Background. The mechanism of the immune response in patients with COVID-19 is still poorly understood and differs from other respiratory infections. Immunodeficiencies and age-related characteristics of immunity can be regarded as factors influencing reinfection and a predisposition to prolonged persistence of SARS-CoV-2. Most of the studies report about post-infection immunity to SARS-CoV-2 for adults and less for children. However, understanding the dynamics of antibody production to SARS-CoV-2 among children as well as other unique features of immune response is extremely important, because this provides to avoid possible complications and long-term outcomes of COVID-19, and predict the epidemic spread of the new coronavirus in the organized groups of children such as kindergartens, schools, study groups and clubs.Aim: to evaluate the humoral and cellular immunity after SARS-CoV-2 infection in children.Materials and methods. We reported data of the first phase prospective cohort study of immunity among 60 children living in Irkutsk, Russia within a month after SARS-CoV-2 infection, which took place in October and November 2020.Results. Immunity of children one month after SARS-Cov-2 infection was characterized by suppressed cell-mediated and humoral immunity, and phagocytosis dysfunction. Reduced phagocytosis by neutrophils was noted for 61.6 % of individuals.Conclusions. Children after COVID-19 had impaired immunity to SARS-CoV-2, which may be a predictor of chronic infection and other long-term outcomes of COVID-19.

Objective. To estimate frequency of overweight, obesity, high blood pressure and hypercholesterolemia in children and adolescents – visitors of health centers. Material and methods. In a cross-sectional retrospective study there were analyzed different data: height, weight, arterial pressure, total cholesterol level in blood samples of 70.001 children (36.097 boys) aged 6–17 years from 17 regions of Russia. Overweight and obesity were determined by the WHO`s diagnostic criteria, z-score tables of body mass index, taking into account gender and age. Hypercholesterolemia was diagnosed as total cholesterol level > 5,2 mmol/l, high blood pressure as systolic and/or diastolic blood pressure > 95‰ of blood pressure curve in the population with the corresponding age, gender and height. Results. Frequency of overweight, obesity, high blood pressure and hypercholesterolemia were 18.2%, 6.9%, 5.2% and 3.0% in boys and 15.9%, 5.3%, 4.8% and 4.1% in girls. Frequency of hypercholesterolemia exceeded standard values in 17 regions of Russian Federation (3.5%), in Perm Territory (18.8%), Chuvash Republic (6.9%) and Vladimir Region (8.5%). The maximum frequency of overweight and obesity was observed in the Perm Territory – 39.1% and 17.1%. Frequency of high blood pressure exceeded average values in 17 regions of Russian Federation (4.9%) twice – in Voronezh Region (10.6%) and three times in Khanty-Mansyisk–Yugra Region (15.2%). Conclusion. This data confirm the necessity of prevention intensification of cardiovascular disease, life-style modification and food habits in those regions of Russia with high frequency of cardiovascular risk factors in children and adolescents.

Background. Despite the success in the treatment of children with mucopolysaccharidoses (MPS) as a result of the widespread of enzyme replacement therapy and hematopoietic stem cells transplantation, orthopedic manifestations continue to be a significant problem, while the pathology of the upper limbs in children with MPS is not sufficiently represented in the literature. The aim of this studywas to analyze orthopedic and neurological manifestations in the upper extremities of children with mucopolysaccharidosis based on a sequential case series. Materials and Methods. We carried out a comprehensive analysis of clinical and radiological involvement of the upper extremities in 49 patients with MPS. Results. The most common complaints reated to the upper extremities were difficulties in the daily activities (dressing, self-care, playing), impairment of the fine motor skills, and muscle weakness. The most frequent clinical manifestations related to the upper extremities were limited active shoulder abduction, impaired hand grip, flexion contractures of the elbow joint, ulnar deviation of the hand. All patients with MPS types I, II, and VI had limited active and passive extension and flexion of the metacarpophalangeal and interphalangeal joints. In patients with MPS IV, hypermobility of the hand joints prevailed. We noticed minimal presence of typical clinical manifestations related to compression of the median nerve secific for carpal tunnel syndrome. The majority of patients showed a decrease in tendon and periosteal reflexes. The most pronounced decrease in muscle strength was observed in to extensors (elbow, fingers) and shoulder abductors, which may contribute to the predominant formation of a flexion pattern of contractures. On radiographs of the hand, the “melting sugar” symptom and shortening of the metacarpal bones were observed in most patients. Conclusion.Clinical and radiological manifestations related to the upper extremities take place in all types of the mPS, and lead to functional disorders that complicate daily life and self-care. Upper limb pathology in children with MPS requires earlier detection and more active treatment after comprehensive risk assessment.

The objective: to establish the prevalence of postoperative delirium (POD) and the influence of various factors in intra- and postoperative periods on its occurrence in children with septal congenital defects requiring surgical interventions with cardiopulmonary bypass (CPB).Subjects and methods: 40 children from 6 to 36 months and weighing from 7.5 to 15 kg were enrolled in the study; they underwent planned radical surgery of septal CHD with cardiopulmonary bypass. In the postoperative period, all patients were tested using the Cornell Assessment for Pediatric Delirium validated for children of this age. Cerebral damage was also assessed using three specific serum markers: protein S-100-ß, neuron-specific enolase (NSE) and glial fibrillar acidic protein (GFAP) before the surgery, upon bypass completion, and in 16 hours after the operation.Results. The study revealed the incidence of delirium in 22.5%. When analyzing many factors of the intra- and postoperative period, it was found that the use of donor blood components in the primary volume of CPB filling was statistically significantly more often observed in patients with established delirium: 7 (78%) and 13 (42%) (p = 0.049). Also, it was found that levels of S-100-ß, NSE, and GFAP were significantly higher in patients with confirmed POD.The study described the incidence of POD in children after surgical treatment of congenital heart disease under cardiopulmonary bypass and showed that intraoperative transfusion was a risk factor for the development of delirium. The role of markers of cerebral damage in the diagnosis of POD was also proven.

Toxocarosis is a widespread geohelminthiasis in the world. In the body of children, the eggs of the parasite usually fall with the soil. Larvae enter the bloodstream through the intestinal wall and are carried by blood to various organs, where they cause inflammation and necrosis. The diseaseis characterized by non-specific clinical manifestations, as a result of which the diagnosis is not always timely. In children, toxocarosis often occurs againstthe background of various diseases of the respiratory, cardiovascular and gastrointestinal systems.The article presents a case of a combined course of gastric ulcer and visceral toxocarosis in a child of 2 years and 4 months. Taking into account the uncharacteristic disease for this age and the absence of risk factors for the development of stomach ulcers in this patient, it is suggested that toxocarosis may cause the development of stomach ulcers in children.

The paper presents data on the detection and role of cytomegalovirus infection (CMVI) in 146 children of certain groups aged from 3 months to 15 years who were hospitalized — frequently ill children with respiratory pathology, patients with shiga-toxin-associated hemolytic uremic syndrome (STEC-HUS) and schoolchildren with somatic diseases during rehabilitation in a sanatorium.The aim of the study was to determine the frequency of detection of CMVI in the presented groups, the originality of the main clinical manifestations in correlation with the markers of activity of herpesvirus type V infection. Clinical monitoring was carried out, oropharyngeal swabs, saliva,blood samples (serum and blood cells) were studied using a set of laboratory diagnostic methods:RCM (rapid culture method) on Vero- and M-19 cells, IIR (reaction of indirect immunofluorescence), ELISA to detect specific antigens and antibodies (IgM, IgG).The detection rate of CMV IgG in diagnostic values ranged from 6.4% in the group of frequently ill children with respiratory pathology to 31.7% in schoolchildren of the sanatorium, the acute course of infection was detected in3.2% and 6.4%, respectively, based on markers of acute infection (CMV IgM and cytomegalovirus antigen). In patients with STEC-HUS CMV IgG in diagnostic titers were recorded with the highest frequency — in 74.4% of patients.

The article presents a literature review, which provides data on the role of interferons in the immunopathogenesis of COVID-19 and the clinical efficacy of drugs based on recombinant interferon-alpha 2b in the treatment of children with new coronavirus infection. Shown the leading role ofinterferons as factors of the first line of defense against various viruses, including SARS-CoV-2. Numerous studies have proven the feasibility of including interferon preparations in COVID-19 therapyregimens in children, both as combinations with antiviral agents and as monotherapy.

The objective of the study: to assess the tolerability of anti-tuberculosis drugs (TB drugs) in children with respiratory tuberculosis and exposure to multiple and extensive drug resistant tuberculosis treated by individual chemotherapy (CT) regimens.Subjects and methods: Totally, 89 children (2-12 years old) with respiratory tuberculosis, they all were exposed to multiple and extensive drug resistant tuberculosis. Patients were divided into three groups: Group 1 (17 patients) – minor forms, the chemotherapy regimen consisted of 3 TB drugs, Group 2 (35 patients) – limited lesions, the chemotherapy regimen consisted of 4 TB drugs, Group 3 (37 patients) – the disseminated disease, the chemotherapy regimen consisted of 5 TB drugs. The following TB drugs were used in Group 1: Pto ‒ in 94.1%, Z ‒ in 76.5%, PAS ‒ in 76.5%, Am – in 35.3%, E – in 17.6%, and Cs – in 5.9% of cases. In Group 2: PAS – in 94.3%, Z – in 80.0%, Pto – in 68.6%, Am – in 48.6% and Fq – in 45.7%, Cs ‒ in 37.1%, and E – in 25.7% of cases. In Group 3: Z – in 97.3%, PAS – in 89.2%, Pto – in 81.1%, Fq ‒ in 73.0%, Am – in 70.3%, Cs – in 51.4%, and E – in 37.8% of cases.Results. In general, chemotherapy was well tolerated by 50.6% (45 people) of children, and poorly - by 49.4% (44 people), p> 0.05. Toxic reactions were observed statistically significantly more often versus allergic ones: 63.6 ± 7.3% (28 persons) and 36.4 ± 7.3% (16 persons), p

Background. Hemoblastoses treatment success in children made it possible to cure the vast majority of patients. The follow-up period exceeds tens of years, during which the problem of second tumors (ST) becomes urgent. The objective of the study was to characterize ST in patients who underwent a malignant tumor of hematopoietic and lymphoid tissues at the age of 0 to 18 years.Materials and methods. The study included 64 patients with ST development in the period from 1 to 38 years.Results. Most frequently ST developed after treatment of Hodgkin's lymphoma (45.3 %) and acute lymphoblastic leukemia (35.9 %), supported by high cumulative doses of alkylating agents and radiation therapy. Among STs, in 35.9 % of cases, thyroid cancer was diagnosed, in 10.9 % - acute leukemia, in 9.4 % - tumors of the central nervous system. The results of ST treatment are significantly worse than those of primary tumors. Thus, of 64 patients with ST, 46 (71.9 %) are alive, death from ST progression was noted in 18 (28.1 %) cases.Conclusion. Improvement of modern treatment protocols aimed at reducing the indications for radiation therapy and cumulative doses of alkylating agents, along with the development of effective follow-up programs for children cured of hematological malignancies, will probably help reduce the ST incidence.

The objective of the study: to analyze the changes in tuberculosis incidence among children not vaccinated with BCG taking into account clinical and epidemiological indicators.Subjects and methods. The data of 66 children who were not vaccinated with BSG and developed tuberculosis were analyzed. The data were obtained from medical files of St. Petersburg TB Dispensary from 2006 to 2019 inclusive.Results. From 2006 to 2019 in St. Petersburg, 66 children not vaccinated with BCG fell ill with tuberculosis, of them, 44 (66.7%) cases were detected in 2013-2019, and the major reason (22.7%) of the lack of BCG vaccination was the unmotivated refusal of parents.The incidence of complicated course of tuberculosis in unvaccinated children made 45.4%. In the structure of medical contraindications to BCG vaccination, HIV infection was the most prevalent (58.2%), including both as prenatal exposure to the mother and HIV positive status of the child.In 61.4% of cases, unvaccinated children who developed tuberculosis were exposed to adult tuberculosis patients.The lethal outcome (for the period 2013-2019) was registered in 3/44 children, all under 1 year, all had a congenital pathology which made the cause of death.

Coronaviruses can cause damage to various parts of the respiratory system, gastrointestinal tract, and other organs and systems.The aim of the study: to monitor the circulation of seasonal coronaviruses in hospitalized children in the pre-pandemic period.Materials and methods: real-time multiplex PCR was used to test samples of nasopharyngeal mucus from 2188 patients aged 1 monthto 17 years, hospitalized with acute respiratory infection in 2014—2018. The results are presented with the indication of the fractions (%) and the calculation of the 95% confidence interval according to Klopper-Pearson. The differences between the groups were evaluated using the Pearson χ2 test. The differences in the groups were considered statistically significant at the level of the criterion p< 0.05.Results: monitoring of the circulation of pathogens of acute respiratory viral infection (ARVI) during 5 epidemic seasons showed that the appearance of a new subtype of coronavirus in 2019 was preceded by a gradual displacement of influenza, RS-and bocavirus infections from the circulation due to a statistically significant increase in the proportion of seasonal coronaviruses from 3.6% in 2014—2015 to 10.8% in the prepandemic season 2018—2019 (p= 0.007). The circulation of seasonal coronaviruses had a distinct seasonality (november-april)with the peak of registration in february (28.4%) and march (36.7%). Seasonal coronaviruses were detected in 7.3% of hospitalized children with ARVI, with a predominance in the age groups under 2 years (58.2%) and 3—6 years (25.4%). Hospitalization was more often required for patients with lower respiratory tract lesions (58.2%), a fifth of which was pneumonia (21.8%). In most children, ARVI caused by coronaviruses occurred as a monoinfection (79.9%), combined infection with other pathogens was observed in 20.1% of cases with fluctuations from 18.2% to 28.6% in different epidemic seasons. Viral associations are most common in young children (85.2%).

Danon disease is a rare hereditary disease with predominant damage to the heart and skeletal muscles. Danon disease is referred to lysosomal storage disorders with severe, progressive course and it often leads to an early mortality. The main cause of Danon disease is the mutations in the LAMP2 gene in the Xq24–q25 chromosome region. Danon disease has X-linked dominant nature of inheritance; women have a milder phenotype with older heart damage. For the first time the disease was described in boys with cardiomyopathy, severe skeletal myopathy and intellectual deficiency. The article presents up-to-date review on Danon disease and case reports of the cardiology department of the National Medical Research Center for Children’s Health, where 5 male patients were observed from 2014 to 2020, and the average age at diagnosis – 13,2 years. During the lab examination three patients demonstrated a significant increase of the heart failure marker (NT-proBNP) – more than 5 thousand pg/ml, the intracellular enzymes was more than 2,5 norms in 4 patients. The Wolff–Parkinson–White phenomenon is recorded in all patients on the ECG. Echocardiography in one patient showed a rare combination of myocardial hypertrophy and non-compact left ventricular myocardium. 2 patients had a combination of hypertrophic and dilated phenotypes with a reduced ejection fraction on Echo and severe myocardial fibrosis on MRI of the heart, which clinically manifested with chronic heart failure refractory to drug therapy, which required heart transplantation.

The authors analyzed the treatment results of 53 patients (106 eyes) with allergic conjunctivitis. All patients received Olopatadine 0.2 % (Visallergol) in drops once a day during 1 month. All patients underwent the same tests: scraping from the conjunctiva for the presence of eosinophils, evaluation of the inflammation symptoms using 4-ball scale, biomicroscopy of cornea and conjunctiva with staining by lissamine green and tear film stability (Norn’s method). All of the above-mentioned tests were performed before the treatment, on 14-th day and after the course of therapy. The inflammatory reaction of conjunctiva, the amount of discharge in the conjunctival cavity and the staining of the conjunctiva with lissamine green decreased in all patients starting from the 14-th day of treatment. The maximal effectiveness of the drop was registered in patients with the chronic type of allergic conjunctivitis. The manifestation of the disease reduced significantly after 1 month of treatment, but it does not disappear completely. So it is necessary to continue therapy after 1 month. The laboratory methods of diagnosis confirm the effectiveness of Visallergol by disappearance of eosinophils in the conjunctiva scrapings. The secondary dry eye syndrome developed in all types of the allergic conjunctivitis and needs a long-term treatment. The maximal intensity of dry eye syndrome was registered in patients with chronic type of the allergic conjunctivitis. The drop can be used starting from 2 years old.

The article presents modern data on the use of probiotic and prebiotic drugs to prevent the formation of secondary hyperoxaluria in children. The authors analyzed the literature data and generalized the available results of original studies on the use of probiotics and prebiotics to prevent the development and to reduce the laboratory manifestations of secondary hyperoxaluria by improving the state of the intestinal microflora involved in the degradation of oxalates. They demonstrated the ability of Oxalobacter formigenes, Lactobacillus spp. и Bifidobacterium spp. bacteria to participate in the metabolism of oxalates, to reduce the excretion of oxalates with the urine, thereby reducing the laboratory manifestations of secondary hyperoxaluria. The article shows the therapeutic correction of the disease by improving the state of the intestinal microflora with both probiotic preparations containing Lactobacillus spp. and Bifidobacterium spp. strains and prebiotic agents. The drugs that normalize the state of the intestinal microflora (probiotics and prebiotics) help to rationalize the management of patients with secondary hyperoxaluria and to reduce the manifestations of secondary hyperoxaluria.

Objective. To create a computer support system for pre-laboratory diagnosis of hereditary metabolic diseases with mental pathology. Material and methods. The authors used numerous literary sources to extract data for intelligent system. The initially formed database was supplemented by expert assessments for certain categories of age groups of children. Results. The experts determined the modality, confidence factors for the timing of manifestation and severity of signs for each clinical form at certain age periods. In the course of the study the authors built the models for a comprehensive assessment of signs and an integral assessment of diseases. The diagnostic algorithm is included in the database. It is used to compare the proposed hypotheses. The authors implemented a prototype of an expert diagnostic system based on a mucopolysaccharidosis model, which demonstrated 90% efficiency in a control sample of 20 patients.

Life-threatening exacerbation of bronchial asthma can occur in patients with any severity of the disease. The selection of predictors of a fatal condition can help to identify the groups with high-risk of asthmatic status development. For the moment the traditional intensive care for asthmatic status has been supplemented with innovative approaches in respiratory support, bronchodilator therapy, and basic support for the patients after life-threatening asthma. The predictors of life-threatening bronchial asthma include rhinovirus infection, severe exacerbation in the anamnesis, fungal sensitization and age of patients. This condition increases the risk of repeated life-threatening exacerbations by 25%, and it requires a special approach to therapy and monitoring of patients at the outpatient stage. This review draws attention to modern approaches to the treatment of such patients in order to unify the management of children with asthmatic status in the Russian Federation.