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One of new methods for the physiotherapeutic treatment in pediatrics is the application of the pulsed low-frequency electrostatic field the action of which is based on the effects of deep resonant vibration on the affected tissue region with the minimal mecha-nical impact. Under the influence of the electrostatic field, the tissues at the site of interest become tightened and descend which causes their vibration due to the alternation of the pulses and intervals between them. The fast consecutive repetition of this process results in rhythmical deformation of the tissues. The electrostatic pulses are responsible for the increased friction between separate parts of the tissues while in the intervals between the pulses the tissue elastically resists their influence. In this way, the tissues subjected to such influence 'are pumped over' throughout their depth. It leads to the restoration of elasticity and mobilization of separate fibers and layers inside the tissue as well as to the development and improvement of the blood flow in the tissues and their blood supply. During the recent years, a large number of reports have been published in the literature concerning the possibilities of application of the pulsed low-frequency electrostatic field for the treatment and prevention of various di-seases in the children, including both monotherapy and its combination with other therapeutic modalities. The favourable action of the pulse low-frequency electrostatic field on the clinical course of bronchial asthma, mucoviscidosis, I and II degree scoliosis in the young children, remittent multiple sclerosis in the adolescents has been demonstrated. The data obtained give evidence of the high effectiveness of the proposed method, its excellent tolerance, and a wide range of beneficial effects on the main pathogenetic components of the diseases which creates the good prerequisites for the further active introduction of the therapeutic phy-sical factors in the practical work of the children's medical organizations.

This article is focused on the modern possibilities for the application of halotherapy with a view to prevention, treatment and rehabilitation of the children with special reference to the main bio-physical properties of the principal active factors of halotherapy including dry finely-dispersed sodium chloride aerosols and specific features of the mechanism of their therapeutic action. The extensive studies have been underway in the recent years for the purpose of development of the new effective methods for the reconstitution of the aerodispersive environment. Halotherapy can be provided either on an individual (haloinhalation) or a group (exposition in the halochambers and halorooms basis. Halotherapy has been shown to produce well apparent anti-inflammatory, draining, mucolytic, immunomodulatory, and sanogenetic action. The high effectiveness of halotherapy for the prophylactic application in the frequently ill children is emphasized together with the possibility of its extensive use for the treatment of acute respiratory diseases and combined medical rehabilitation of the children presenting with chronic ENT disorders, respiratory and skin diseases. The optimal technologies for the clinical application of various types of halotherapy are discussed.

Extrahepatic portal vein obstruction is a major cause of pediatric symptomatic portal hypertension and can lead to profuse variceal hemorrhaging. Purpose - to evaluate the role of primary prophylaxis of the variceal bleeding in children with extrahepatic portal vein obstruction. Materials and methods. A one-center prospective cohort clinical study involved 120 patients with extrahepatic portal vein obstruction who underwent primary or secondary variceal bleeding prophylaxis in 2016-2021. The laboratory, ultrasound, and endoscopy data before and after treatment were collected and evaluated. Results. Variceal bleeding episodes occurred in 5.8% (n=3) of patients who underwent primary prophylaxis and rebleeding occurred in 27.9% (n=19) of those who underwent secondary prophylaxis. Bleeding episodes occurred less frequently in patients from primary prophylaxis group (p=0.013). In patients treated endoscopically (n=53, 44.17%) Variceal bleeding appeared less frequently (n=3, 5.66%) after treatment compared to patients who underwent surgery (n=67 (55.83%), 19 had rebleeding (28.35%)) (p=0.001). In 69.17% patients (n=83) esophageal varices eradication was achieved: in 53.01% (n=44) patients from the primary prophylaxis group and 46.99% (n=39) from the secondary prophylaxis group. Bleeding episodes occurred less frequently after the eradication achievement (p

The main cause of heel foot is muscle imbalance due to dysfunction of the triceps femoris muscle. Literature data indicate the need to study issues related to changes in the anatomy and function of the foot flexor muscles and calcaneus and to determine indications for optimal methods of correction of heel foot. Purpose - to study the anatomical and functional changes in the calf muscle and bones in children with heel foot to determine the optimal methods of diagnosis and correction of deformity. Materials and methods. We analysed the results obtained during the treatment of 14 patients (28 cases) aged 11 to 17 years with cerebral palsy complicated by calcaneal foot formation. Two groups were formed: the main group of 6 patients (12 cases), in which posterior calcaneal osteotomy with Achilles tendon plasty and transposition of the tibialis anterior tendon was performed; the comparison group of 8 patients (16 cases), in which only soft tissue surgery was performed. The comparative group was divided into 2 subgroups, which differed in radiological parameters of Bohler and Kite Danilov angles: the subgroup A - 3 patients (6 cases), the subgroup B - 5 patients (10 cases). Clinical and radiological methods were used to examine patients. Results. The structure and shape of the calcaneus change in the presence of heel foot, which leads to changes in the Danilov angle and the angles between the trabecular lines. Correction of the shape of the calcaneus is a prerequisite for creating optimal biomechanical gait conditions. Transplantation of the tibialis anterior tendon eliminates the pathological effect of its retraction; achilloplasty eliminates the functional deficiency of the triceps tendon. Conclusions. The results of surgical correction on soft tissues showed effectiveness at Bohler, Kite

Asthma remains the most common non-communicable disease among children, which often has a chronic course and leads to disability. Particular attention should be paid to the diagnosis of asthma in young children. To date, the calcium-sensing receptor (CaSR) is considered to be one of the specific markers in the development of bronchial obstructive diseases. Purpose - to assess the level of CaSR protein and its significance in preschool children with asthma. Materials and methods. The study included 37 patients divided into 3 groups. The Group 1 - children with mild persistent asthma (n=20), the Group 2 - children with moderate persistent asthma (n=17), the Group 3 - almost healthy children (n=20). The study of CaSR protein levels in the blood serum of patients with asthma was performed twice - in the first 2 days of clinical manifestations of the disease and when remission was achieved. The level of CaSR protein in the blood serum was analyzed by enzyme-linked immunosorbent assay (ELISA). All statistical analyses were performed using StatSoft STATISTICA version 8.0 (Tulsa, Oklahoma) and MedCalc version 17.2 statistical software. Results. There was no significant difference in CaSR protein levels between the Group 1 and the Group 2. The level of CaSR protein was significantly lower in the Group 1 and the Group 2 both in the period of acute and remission than in the control group. The level of the marker in the period of disease flare-up in the Group 1 and the Group 2 was significantly lower than in children of the same groups in the period of remission. Conclusions. In all patients with asthma, the level of CaSR protein at the acute stage of the disease is lower than at the remission stage, which is obviously associated with its redistribution from the peripheral blood to the smooth muscle of the lungs. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Recurrent respiratory infections (RRIs) in children remain a pertinent issue in modern medicine. According to literary data, the prevalence of this phenomenon can reach up to a quarter of the child population. RRIs adversely affect a child’s physical development, social adaptation, and give rise to intra-family conflicts. Purpose - to investigate the contribution of psychological predictors from the mother’s perspective in the development of recurrent courses of respiratory infections in their young school-age children. Materials and methods. The study included surveys of mothers (Spielberger-Hanin State-Trait Anxiety Inventory, the Varga-Stolin Parenting Attitudes Test) and their children (R. Temple, M. Dorki, E. Amen “Choose a face” projective test). The main group comprised children aged 5-7 years with RRIs according to the criteria of the 2021 Inter-Society Consensus. The control group consisted of children aged 5-7 years who experienced occasional acute respiratory infections. Results. In our study, 40 families (mothers and children) participated. We found that mothers of children with RRIs had significantly higher levels of state and trait anxiety, as well as a higher score in the “Cooperation” parenting attitude model compared to the control group. In the structure of the anxiety phenomenon in mothers of children from the main group, 43% of cases exhibited high anxiety levels. Additionally, a high score in maternal personal anxiety correlated with a predominant choice of ineffective parenting models. Conclusions. Mothers of children with a RRI have significantly higher levels of situational and personal anxiety (p

Lithuanian society actively supports Ukraine and is very close to the threat of extended war. How to communicate with preschool children about cruel war events is a problematic question for many parents and educators. Purpose - to study the attitude of parents to communicate with children about the war, to determine the ways of thinking and perception of military events by children through drawings. Materials and methods. The study was conducted in 5 kindergartens in Vilnius with the participation of 113 parents of 36 children. Results. Results revealed that 54.9% parents noted that they are talking about the war with their preschool-age child. 31.8% parents gave permission to speak and draw with their children about the war. The average age of children was 5.3±0.7 years. 72.2% of parents who permitted to talk about the war in Ukraine with their children indicated that they speak to their children about the war, and only 46.7% of parents who not gave permission indicated that they speak to their children about the war (p=0.006). Data showed that even children not directly impacted by war violence often are aware of current war events. Children’s drawings demonstrated a concrete understanding of war events and emphasized war’s negative emotions and destructive consequences. The predominant theme of the drawings were weapons, war events, falling bombs, destroyed houses, dying people, soldiers, and frightened faces. Conclusions. The study revealed that only half of the parents talked to their children about the war in Ukraine. Analysis of the form and content of the drawings show that the experienced war events left a robust impression on the children. It is essential to know the feelings and experiences of preschool children, to react appropriately according to their age and respond to their needs. It is necessary to talk to children about the war, trying to understand their worldviews, imaginations, and fears, because war experiences at an early age are a severe factor for the child’s further development. No conflict of interests was declared by the authors.

According to the Rome IV consensus (2016), functional gastrointestinal disorders (FGIDs) are disorders of the interaction between the gut and the brain. A crucial role in the realization of this mechanism is played by the key neurotransmitter serotonin. Aim - to investigate the influence of serotonin on the formation of clinical symptoms in children with FGIDs. Materials and methods. Under observation were 72 children aged 10-18 years with FGIDs. The Group I consisted of 30 children with combined functional dyspepsia (FD) and irritable bowel syndrome (IBS), the Group II included 42 children with FD. A control group of 20 healthy children was established. The diagnosis of FD and IBS was established based on the analysis of clinical symptoms according to the Rome IV criteria (2016). The severity of clinical symptoms was assessed using the Likert scale from 0 to 5 points. The study of serotonin content in whole blood was conducted using a fluorometric method after adsorption on carboxymethylcellulose. Results. The intensity of abdominal pain and the severity of dyspeptic syndrome in children with combined FD and IBS is higher than in children with FD (p

Purpose - to present a clinical case of a particular complication of post-COVID multisystem inflammatory syndrome (MIS) - pulmonary embolism (PE) which developed due to primary hereditary thrombophilia in a child for better understanding of the MIS evolution and prognosis in children (MIS-C). Case report. In an 11-year-old boy who previously had no hemorrhagic manifestations, the first symptoms of the disease occurred in the form of fever and a hemorrhagic rash on the lower extremities. Later, he developed signs of respiratory failure, his condition worsened, and bilateral community-acquired viral pneumonia caused by COVID-19 was diagnosed. The child presented with post-COVID MIS manifested as PE, which caused further genetic examinations for hereditary thrombophilia. Primary thrombophilia was detected (F2 gene - prothrombin (20210 G>A) D68.5). Concomitant hereditary pathology was probably the reason for a severe course of the infection and the development of a complication in the form of PE requiring intensive and long-term anticoagulant therapy. Conclusions. In case of PE detection, especially in young patients, examinations to confirm or rule out hereditary or acquired thrombophilia are required, that defines recurrent venous thromboembolism prevention programs. This clinical case report is a contribution to the study on the issues of MIS-C, defining links between pulmonary complications (transient or persistent) and serious sequelae in the future. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Coronavirus infection in childhood is a common disease and has a number of features of the clinical course. There remain quite a lot of problems related to the variety of clinical symptoms, the severity of the course and treatment tactics in different age categories. Purpose - to study the epidemiological and clinical features of the coronavirus disease COVID-19 in adolescents compared to the younger age group in order to predict the severity of the course and determine treatment tactics. Materials and methods. A single-center retrospective open cohort study of 188 patients under the age of 18 hospitalized in the infectious disease department of the Chernivtsi Regional Children’s Clinical Hospital with a confirmed respiratory infection caused by SARS-CоV-2 was conducted. This cohort of patients is divided into 2 clinical groups. The Group I consisted of children aged 12 to 18 years (43 children), the Group II included children aged 0 to 11 years (145 patients). Results. Epidemiologically, extrafamilial sources of infection prevail in adolescence in the range of 44.2% (n=19), which is explained by greater social activity compared to children from birth to 11 years of age. For the 1st observation group, symptoms of damage to the lower respiratory tract are more characteristic, in particular, cough 81.4% (n=23), shortness of breath 51.1% (n=22), hypoxemia 14.2% (n=6) and symptoms of associated with intoxication syndrome (general weakness, asthenia 97.6% (n=42), decreased appetite, refusal to eat 74.4% (n=32), myalgia 11.6% (n=5), headache 14,2% (n=6)). The severity of the course of the coronavirus infection in adolescence is due to the dominance of lower respiratory tract lesions with the development of pneumonia in 58.2% (n=25) of cases, which required longer and more intensive treatment. Conclusions. The share of adolescents hospitalized due to COVID-19 was 22.9% (n=43), among them with a severe degree of impairment of the general condition - 16.4% (n=7), which is due to the predominance of damage to the lower respiratory tract with the development of pneumonia in 58.2% (n=25) of cases. This cohort of patients is characterized by a longer intoxication syndrome, the epidemiological role of family contacts with regard to COVID-19 decreases, and the value of unidentified non-familial sources of infection increases - 44.2% (n=19). The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of parents or their guardians was obtained for conducting research. No conflict of interests was declared by the authors.

Asthma is one of the most common chronic non-communicable diseases among adults and children. Recent studies have paid special attention to endothelial dysfunction in the mechanism of development and progression of asthma, on the one hand, and the occurrence of long-term consequences of endothelial damage, on the other hand. Endothelial dysfunction in the modern sense is not only a pathology of the vascular wall but also a deep, complexly organized system of disorders and compensatory and adaptive reactions that originates at the molecular genetic level. Purpose - to improve the knowledge of assessing the levels of von Willebrand factor (VWF) as a marker of endothelial dysfunction in the blood of children with partially controlled asthma. Materials and methods. 94 children participated in the study. Patients were divided into 4 groups: the Group 1 - children with mild persistent asthma (n=59), the Group 2 - moderately severe persistent asthma (n=10), the Group 3 - severe persistent asthma (n=12), and the Group 4 - control group (n=13). The study of VWF was carried out by a standard enzyme-linked immunosorbent assay (ELISA) using the Human VWF ELISA Kit. Data were analyzed using Statsoft Statistica version 8 (Tulsa, OK) and MedCalc statistical software version 17.2. Results. It was found that children with asthma had significantly increased levels of VWF in the blood serum compared to the control group. The highest levels of serum VWF were found in patients with severe asthma. Conclusions. Elevated levels of VWF indicate the presence of endothelial dysfunction. Increased levels of VWF depending on the severity of asthma indicate more severe endothelial damage in children with severe asthma. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of parents or their guardians was obtained for conducting research. No conflict of interests was declared by the authors.

So far, the possible influence of single nucleotide variants (SNV) of the cholecystokinin (CCK) gene on the likelihood of developing obesity and metabolic disorders in children has not been demonstrated. The aim of the study SNV associations of the CSK gene to predict the probability of obesity and personalize the development trajectory of various metabolic disorders associated with obesity in children. Materials and methods. 252 obese children aged 6-18 years were examined. The main group (n=152) was represented by children with metabolically unhealthy obesity (MUO). The control group (n=100) consolidated of children with metabolically healthy obesity (MHO). Whole genome sequencing (CeGat, Germany) was performed in 31 children of the main and 21 children of the control group. Serum levels of interleukin-1β were measured using a chemiluminescent immunoassay (CLIA) method, interleukin-6 - by enzyme-linked immunosorbent assay (ELISA), Synevo, Ukraine. Results. The G allele of SNV rs754635 of the CCK gene was significantly more frequent among children with both MHO (t=10.93; p

Purpose of the research is to evaluate the impact of the torus tubarius correction by microdebrider technique on the eustachian tube function in children without middle ear pathology. Materials and methods. 115 children aged 3 to 12 years participated in the study. All children underwent endoscopic modified microdebridement adenotomy for the first time, which, in the case of tubal hypertrophy (we analyzed the frequency of this phenomenon), was combined with its correction by the microdebridement method. For the next stage of the research, we selected 19 children, who had preoperative intratympanic pressure monitoring results more than -100 daPa and who hadn’t concomitant tonsil hypertrophy (19 children). Control measurement was done on days 1 and 8-10 after the intervention. Depending on the presence/absence of concomitant hypertrophy of the torus tubarius, patients were divided into the main (11 patients) and control (8 patients) groups. The analysis was carried out using the STATISTICA program. Results. 36 patients were diagnosed with torus tubarius hypertrophy. When comparing intratympanic pressure on the 1st day after the intervention in patients of the main and control groups, a significant difference in values was found (-144.37±41.09/-95.00±27.90 daPa). On day 8-10, the intratympanic pressure data in patients of both groups did not differ from each other (-39.15±14.85 daPa in the main and -33.87±19.57 daPa in the control groups) and preoperative values in both groups. Conclusions. Hypertrophy of the torus tubarius is noted in 31.3% of patients with primary adenotomy. The microdebrider technique method of torus tubarius correction is safe in view of the equipressor function of the auditory tube. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of parents or their guardians was obtained for conducting research. No conflict of interests was declared by the authors.

Providing intensive care for critical conditions in pediatric hematological malignancies has its features and remains one of the most urgent tasks of pediatrics. Purpose - to assess the features of critical conditions in children with acute leukemia (AL) and to review the literature for their correction. Materials and methods. An analysis of the results of clinical, laboratory, and instrumental examination of 70 children treated in the Intensive Care Unit with AL aged from 1 month to 18 years has been carried out. Statistical analyses of data were conducted by STATISTICA 8. Results. Among the complications of cytostatic therapy, the following ones have been recorded: neutropenia (in 62 cases), agranulocytosis (16), hyperleukocytosis (1); critical thrombocytopenia (15) with the development of severe hemorrhagic syndrome (10) and hemorrhagic shock (2), disseminated intravascular coagulation syndrome (1); anemia of II-III degree (12), involvement of gastrointestinal tract in the form of stomatitis/esophagitis/gastroenterocolitis (16), hepatitis (21), pancreatitis (2), cardiopathy (2), cardiovascular failure (1), interstitional pneumonia (1), respiratory failure (6), acute renal failure (2), focal neurologic signs/seizures (2). Infectious complications included pneumonia (22), including one with acute lung destruction (5), pneumonia complicated by pleurisy (2) or pneumothorax (3), pyelonephritis (3), otitis media (3), contact peritonitis (2), meningitis (2), central vein phlebitis (4) with superior vena cava syndrome (2). The combination of pneumonia with other infectious foci was determined in 17 patients. Sepsis was diagnosed in 6 cases. Conclusions. In the examined patients there was a significant proportion of complications on the background of chemotherapy treatment of AL. The timely diagnosis and adequate correction of the complications can potentially reduce the mortality of AL. The research was conducted according to principles of Declaration of Helsinki. Protocol of research was proved by local ethical committee, mentioned in institution’s work. An informed consent was collected in order to carry out the research. No conflict of interests was declared by the authors.

Purpose - to evaluate personal and situational anxiety levels in overweight and obese children. Materials and methods. 153 children (72 girls and 81 boys) aged 12-17 were involved in the study at the Odesa Regional Children’s Clinical Hospital. Anthropometric indicators (weight, height, body mass index (BMI)) were assessed taking into account the sex and age of children. Based on BMI values, 3 groups were selected: 1 - children with a body weight corresponding to age and gender - 47 persons (Control); 2 - children with excessive body weight - 50 persons (Overweight); 3 - children with obesity - 56 persons (Obesity). The state of personal and situational anxiety was determined using the Spielberger-Khanin questionnaire. Statistical data analysis was carried out using packages STATISTICA 12.0, MedCalc 20.0, Microsoft EXCEL 2003. Results. In children with obesity, the most common comorbidities were biliary dyskinesia (14.28%), arterial hypertension (10.52%), skin infections 4% and obstructive sleep apnea syndrome 2%. In the studied groups of children, the level of anxiety increased in proportion to the degree of increase in body weight. Personal anxiety in children with obesity compared to control was noted at a higher level - 50.1±1.04 and 30.27±0.98, respectively (χ2=49.9, p=0.0001). Situational anxiety also increased in children with obesity, but the differences were expressed to a lesser extent - 38.94±0.74 and 33.91±0.93 (χ2=5.49, p=0.019). Conclusions. The obtained results indicate the feasibility of further study and monitoring of the psycho-emotional state and quality of life of overweight and obese children and adolescents for individual psychological support and correction of psycho-emotional disorders. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.

Basis. Allergic rhinitis is a common chronic disease. The significant increase in incidence among children alarms doctors and parents. We have only isolated epidemiological data on the frequency of occurrence, prevalence and morbidity among children of early and preschool age. The allergic rhinitis incidence depends on the patients’ age, residence, atopic heredity, and other factors. Local studies on the spectrum of sensitization have great practical value. The data gathered from region of residence helps to identify and eliminate clinically significant triggers at an early stage and to prevent the development of comorbid diseases and co-conditions. The aim is to analyze the sensitization profile of 2–4- year- old children with allergic rhinitis living in two neighboring territories: Magnitogorsk (Chelyabinsk region, Russia) and Beloretsk (Republic of Bashkortostan, Russia). Methods and research material. We examined 107 children from two to four years old with diagnosed allergic rhinitis. All patients were divided into two groups according residence: 1st group — 71 kids (average age 3,2 ± 0,7 years) from Magnitogorsk (Chelyabinsk region, Russia), 2nd group — 36 kids (average age 3,1 ± 0,8 years) from Beloretsk (Republic of Bashkortostan, Russia). The children were tested for total IgE and eosinophilic cationic protein, specific IgE (sIgE) to house dust mites, allergens of trees, weeds and grasses, epidermal allergens (ImmunoСap, Phadia). The rate of sensitization to sIgE was estimated in kU/l. The scale of antibodies level is from undetectable (less than 0,35) to extremely high (more than 100). Results. The received data shows that children in both groups have high sensitization level to cat and dog allergens, as well as to birch pollen. In addition, patients from Beloretsk have significally more confirmed cases of sensitization to house dust mites (genus Dermatophagoides) than ones from Magnitogorsk (р < 0,01). Summary. To get more accurate idea of sensitization spectrum and level among regions of Russia, it is necessary to examine local areas and regions of residence. Local detailed information will help to design an algorithm of treatment aimed to prevent severe forms of allergic diseases in a particular region or territory.

Objective: to develop a model for predicting the severe course of bronchial asthma (BA) in children. Materials and methods. A comprehensive examination was conducted of 213 children aged 3 to 12 years suffering from atopic asthma (mild course was observed in 85.0 %, moderate — in 10.3 %, severe — 4.7 %). A statistical analysis of clinical and laboratory parameters was performed using the logistic regression method, which allowed us to identify a number of factors that increase the probability of developing a more severe course of BA in children. Results. A mathematical model for predicting the risk of severe bronchial asthma in children has been developed, including such factors as the child’s age, the degree of respiratory failure, the value of the peak expiratory rate, the duration of the disease, and the presence of an association of exacerbations of the disease with changes in the weather and physical activity. A computer program has also been developed that allows you to automatically calculate the amount of risk after entering the child’s data. Conclusion. The use of this model makes it possible to predict the further course of BA with a high degree of confidence, and, consequently, to correct the basic therapy in time to prevent the development of complications in a sick child.

Objective. To determine the diagnostic significance of methods of allergological diagnostics: skin prick tests (SPT), quantitative determination of specific immunoglobulin E (sIgE) and nasal provocative test (NPT) in children with allergy to house dust mites (HDM) diagnosed with allergic rhinitis (AR) or AR in combination with asthma. Methods. Patients underwent a targeted history taking for possible domestic sensitization, SPT with HDM allergens, NPT with HDM, and sIgE to HDM allergens was determined by the ImmunoCAP method. Results. The statistical processing group included 109 children (67 boys, 42 girls, aged 5 to 17,9 years (mean age 8,9 ± 2,52 years)), in whom sensitization to HDM was confirmed by at least one of the methods used in the study. A higher sensitivity of SPT then of sIgE was determined (96,3 % and 81,6 %, respectively). According to SPT and sIgE results, sensitization to both types of mites (D. pteronyssinus and D. farinae) is more common than isolated. Coincidence of positive results of SPT and sIgE was obtained in 84 cases (77,1 %). Conclusion. SPT can be considered as the first line of investigation. The use of a complex of examination methods is necessary to determine the role of sensitization to HDM, if NPT is taken as the «gold» standard of diagnosis.

Introduction. In light of the available data on the unjustified use of antibiotics in children with acute respiratory viral infections, the frequency of prescribing antibacterial drugs to children with a new coronavirus infection in real clinical practice is of great practical and scientific interest.The aim of the study was to study the frequency of antibiotic therapy and identify factors that increase the risk of needing antibiotics in children with coronavirus infection at the outpatient stage.Materials and methods. A retrospective cross-sectional study was conducted on the basis of children's polyclinics in Samara from November 2021 to July 2022, which included a survey of parents and an analysis of outpatient records of 100 children who were under outpatient observation and treatment for COVID-19. An analysis was made of the frequency of prescribing antibiotics to them and potential factors predisposing to their prescribing to children with COVID-19. The obtained data were subjected to statistical processing using the IBM SPSS Statistics 25 program and a comparative analysis.Results. The frequency of use of antibiotic therapy according to the results of the study was 11 % and did not exceed the Russian average data (14.3 %). When analyzing the factors influencing the doctor's decision to prescribe an antibiotic to a child with coronavirus infection, the most important were a history of recurrent respiratory infections (children from the FIC group), as well as the presence of concomitant diseases and background conditions in children, primarily chronic bronchopulmonary diseases. and nervous system.Discussion. The prescription of antibiotics for children with a new coronavirus infection at the outpatient stage remains empirical due to the limitations of the use of laboratory and instrumental methods for additional examination of the child, which objectifies the likelihood of a secondary bacterial infection. Despite this, the frequency of antibiotic use according to the results of the study was 11 % and did not exceed the Russian average data (14.3 %), as well as the average frequency of antibiotic use for acute respiratory viral infections in children in the Russian Federation (21.5-23.3 %).

Bronchial asthma (BA) and allergic diseases such as allergic rhinitis (AR) and atopic dermatitis (AtD) are the most common chronic diseases, the prevalence of which is growing among the child population with the urbanization and industrialization of society. These diseases place a heavy burden on patients, their families and society as a whole, which is associated with a chronic course, frequent exacerbations and the need for long-term therapy of these diseases. Traditionally, data on the prevalence of BA and allergic diseases among children are based on the results of the program «International Study of Asthma and Allergies in Childhood», focused on school-age children 6–7 and 13–14 years. Standardized international epidemiological studies of the prevalence of BA and allergic diseases in preschool children have not been conducted and to date, few foreign data have been published demonstrating a high prevalence among children of this age. Studies on the epidemiology of asthma and allergic diseases among preschoolers in Russia are few. The purpose of this article is to systematize the currently available information on the prevalence of BA and allergic diseases among children. Data sources: A comprehensive literature search was conducted using the PubMed database.

Objective. Based on literature data and own research, on the selection of pediatric patients for the treatment of allergen immunotherapy (AIT) with house dust mite (HDM) allergens, to develop an Algorithm for selecting patients for AIT with HDM allergens in children with bronchial asthma (BA) and allergic rhinitis (AR). Methods. Data from our own studies included 420 patients with AR and complaints indicating domestic sensitization (256 boys, 164 girls), aged 5 to 17,9 years (mean age 8,44 ± 3,06), of which 176 have had BA. Patients underwent skin prick tests (SPT) with household allergens, determination of sIgE for HDM allergens by the ImmunoCAP method, and nasal provocative test (NPT) with HDM. If the results were negative, the allergological examination was repeated again in 12–18 months. Results: The Patient Selection Algorithm was constructed on the basis of the obtained data on the significance of the examination methods used. The primary role of SPT, the possibility of repeating the examination in case of negative results, indications for NPT with HDM allergens were taken into account. The algorithm makes it possible to organize an examination of a patient with HDM allergy in order to develop indications for AIT.

Objective. Evaluate the possibility of using a cream with 5 % filagrinol ("Admera") in children (0-18 years old) as an emollient in atopic dermatitis (AtD) and receive hardware measurements of skin hydration.Materials and methods. Open interventional study in parallel groups of children with AtD 0-18 years old (n = 72, median age 6 [3.75; 7.0] years). 2 equal groups: group 1 received methylprednisolone cream 1 time daily on lesions for 14 days + Admera emollient on the other skin; group 2 received the same treatment + cream with filagrinol 5 % applied from day 5 on the lesions.Results. Standard therapy with topical steroids and emollients was effective. The severity indices during steroid + emollient treatment decreased significantly: EASI 11.5 [6.0; 17.0] vs 2 [1; 3.8] scores, p < 0.001; skin lesion area from 17.5 % [10.0; 26.8 %] to 3.5 % [1.25; 6.0 %], p < 0.001; IGA score — 2 [2; 3] vs 1 [1; 2], p < 0.01.The total itching score for AtD (max 10) became significantly lower with therapy: nocturnal itching decreased from 3 [1; 7] to 1 [1; 3] and daytime itching from 4 [3; 7] to 2.5 [1; 4] points, p < 0.01.The mean values of hardware-measured skin hydration outside the lesion areas were 8 [6.0; 12.0] units at baseline. After 14 days of emollient, hydration of dry clear skin increased to 10 [8.0; 15.0] units (p = 0,017). The hydration of the skin on the affected areas increased significantly from 8 [6; 10] to 12.0 [8; 15] units (p = 0.001).The patients' organoleptic evaluation of the cream was 4.48 (max 5). No serious or moderate adverse events (AEs) were reported in this study. In 11.3 % of cases, the skin itching was detected, but resolved rapidly without treatment.Conclusion. The cream with 5 % filagrinol (“Admera”) significantly improved skin hydration, as measured instrumentally, in the area of dermatitis and dry skin without ones. The cream caused no significant adverse reactions and could be used together with topical steroids.

This article discusses the features of skin lesions and the clinical course of a new coronavirus infection in children. Among the extrapulmonary signs associated with COVID-19, dermatologic manifestations have increasingly appeared in the past few months. The aim of the study was to correlate available data in the literature on variants of dermatological manifestations of COVID-19 in children with clinical examples of skin lesions associated with this infection in patients seen by a specialized dermatologist. We used PubMed and Cyberleninka search engines for the period 2020–2021 Systematized variants of dermatological syndromes in children who had undergone COVID-19 described in reviews of materials by domestic and foreign researchers. The authors analyzed the primary medical records and photographic archives of children admitted to the outpatient clinic of a dermatologist at Yekaterinburg municipal clinical hospital No. 9 for 1 month after the established family contact with a new case of coronavirus infection. Analysis of scientific literature data showed that SARS-CoV-2 virus-associated skin lesions in children were more frequent in the mild course of infection, presumably with the implementation of an immunocomplex mechanism of vascular and epithelial damage. The pronounced vascular damage is a distinctive feature of COVID-19-related exanthemas, especially when localized on the fingers of the lower extremities. This article presents 5 clinical cases of children with various forms of acute dermatoses: urticaria, frostbite-like exanthema of the fingers, onychodystrophy, alopecia, and generalized pustular psoriasis of Zumbush. Only three children had laboratory confirmation of SARS-CoV-2 infection.

Introduction. Techniques of Transanal Endorectal Pull-Through (TEPT) with and without laparoscopic assistance have been widely used in pediatric surgery for correction of Hirschsprung’s disease (HD) in children with. Many clinics in their studies have noted the positive features of this approach compared to classical methods, but the long-term results after such operations in children are still debated. Purpose - to study and compare the clinical results of TEPT with and without laparoscopic assistance in children with HD. Materials and methods. We analyzed the experience of TEPT approach with laparoscopy (n=65 (29.41%)) and without laparoscopic assistance (n=144 (70.59%)) in childreb for correction of HD. For confirmation diagnosis we used the results of general clinical and special procedures (barium enema, anomanometry, histological, determination of acetylcholesterase activity). Results. Overall, among 55 (26.32%) of 209 patients who underwent TEPT, postoperative in long term follow up we found intestinal problems like - moderate stenosis of the colo-anal anastomosis without incontinence 4 (1.91%), constipation 9 (4.31%), partial faecal incontinence 20 (9.57%) and enterocolitis (EC) 22 (10.53%). There was no significant difference in the clinical results of TEPT with laparoscopy and without laparoscopic assistance in our patients. After TEPT without laparoscopic assistance, 6 (4.17%) of 144 patients had constipation, 11 (7.64%) had partial fecal incontinence, and 16 (11.11%) had enterocolitis (EC). And among 65 children after TEPT with laparoscopy, 3 (4.62%) patients were diagnosed with constipation, 9 (13.85%) with partial fecal incontinence and 6 (9.23%) with EC. All children with postoperative intestinal problems were treated conservatively. There was no need for redo surgical interventions in these patients. Conclusions. The technique of TEPT with laparoscopy and without laparoscopic assistance is a modern method of surgical correction of HD, which has significant technical advantages compared to other existing methods. In 26.32% of children with HD who were operated by the TEPT method, persistent intestinal problems continue in the long term follow-up period. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all institutions mentioned in the work. Informed consent of the children’s parents was obtained for the research. No conflict of interests was declared by the authors.

Introduction. In pediatrics, regional anesthesia is one of the most valuable and safest means of perioperative pain management and chronic pain prevention. Pediatric Quality of Life Inventory 3.0 General Well-Being Scale and Pediatric Pain Questionnaire allow for assessing the impact of pain on children and their families via studying changes in Quality of Life scores for the scales of Present Pain and Worst Pain, General Well-Being and General Health. Purpose - to assess the impact of regional analgesia on the prevention of chronic postsurgical pain using PedsQL™ 3.0 questionnaires. Materials and methods. Following the inclusion and exclusion criteria, a total of 80 children were enrolled in the study. Among them, there were 60 children who underwent anterior abdominal wall surgery with various types of anesthetic management and were treated at the surgical department of a Communal Non-Profit Enterprise “Ivano-Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council”. All patients were divided into 4 groups. The Group 0, the control group, included 20 children who had no surgical pathology and met inclusion criteria. The Group I comprised 20 children who underwent anterior abdominal wall surgery under general anesthesia using the transversalis fascia plane block combined with the quadratus lumborum block-4 via a single injection. The Group II included 20 children who underwent anterior abdominal wall surgery under general anesthesia using morphine. The Group III comprised 20 children who underwent anterior abdominal wall surgery under general anesthesia using the transversalis fascia plane block. Results. The prevalence of chronic pain syndrome in children who received conventional analgesia was the highest - 19.81±0.21%. Children who underwent conventional analgesia, while staying in the surgical department, had significantly higher the Face, Legs, Activity, Cry, Consolability scale and Visual Analogue Scale scores as compared to those who received other forms of regional analgesia. Discussion. Three and six months after surgery, in patients who received conventional analgesia, quality of life significantly reduced (p

Introduction. Pulmonary complications are common in children with acute lymphoblastic leukemia (ALL). The assessment of phospholipids (PL) in the exhaled breath condensate can provide more information about pathological processes in the lungs in children with ALL. Purpose - to assess the level of PL in the exhaled breath condensate (EBC) in children with ALL and its prognostic value. Materials and methods. 40 children with ALL aged 6-17 years were examined. 1st group included newly diagnosed children with ALL (n=18). 2nd group involved ALL survivors, who had completed the total course of chemotherapy (n=22). The control (С) group consisted of 15 healthy children. The levels of PL in the EBC were investigated by spectrophotometric thin-layer chromatography using an SPh 46 spectrophotometer. Results. The frequency of pulmonary complication was 82.5% during chemotherapy protocols and 18.4% in ALL survivals. The statistically significant increase in the level of phospholipids in 1st (150.75 (137.62; 158.45) mmol/l) and 2nd (130.12 (120.59; 138.34) mmol/l) ALL groups compared with the group C (54.80 (48.30; 60.80) mmol/l) has been detected (p1-C=0.0000; p2-C=0.0000). Children of the 1st group had significantly higher levels of PL in the EBC than children of the 2nd group (p1-2=0.002911). PL level in EBC collected during induction phase of chemotherapy >132.15 mmol/l can be prognostic for the development of acute pulmonary complications (Sensitivity 93.75%; Specificity 100%). PL level in EBC collected after a complete course of chemotherapy >133.28 mmol/l can be predictive for persistent pulmonary complications (Sensitivity 100.00%; Specificity 83.33%). Conclusions. PL level in EBC can be prognostic for the development of pulmonary complications, both during chemotherapy and in long-term remission after completed chemotherapy course. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Introduction. One of the important and unresolved issues of pediatric gastroenterology remains study of inflammation mechanisms of the stomach’s mucosa, as well as factors that regulate inflammatory reactions. Nowadays, there are many studies devoted to the research of the nuclear role of factor kappa B (NF-kB) in the regulation of the level of gene expression that control proliferation, cell apoptosis, angiogenesis, and determine the nature and expressiveness of the inflammatory process in adults. However, there are no conclusion regardless the role of NF-kB in the regulation of the mechanisms of inflammation development in the stomach’s mucosa of chronic gastritis (CG) in children. Purpose - to study the level of NF-κB activity depending on the degree of gastric mucosa inflammation of chronic gastritis in children. Materials and methods. We observed 76 children aged 8-16 years with verified chronic gastritis. To verify the diagnosis, all children underwent a morphological examination of the stomach’s mucosa in the fundal and antral departments of the stomach. An indirect streptavidin-peroxidase method of protection using polyclonal antibodies to NF-kB was used for immunohistochemical research. Results. On the basis of the morphological study of gastric biopsies, we discovered inflammatory changes based of lymphocytic infiltration, microcirculatory disorders of the stomach’s mucosa with the subsequent development of stroma lamina propria fibrosis. During the immunohistochemical study of gastric biopsies, a high level of NF-kB expression was noted in the cytoplasm with a pronounced degree of inflammation, atrophy, and lymphocytic infiltration of the stomach’s mucosa. Conclusions. The results of the study indicate the morphological signs of the formation of an early chronic inflammatory process in gastritis in children. The transcription factor NF-kB determines the level of inflammatory activity and plays a leading role in the mechanism of development of chronic gastritis in children. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

Information on the essential aspects of prevalence, etiology and pathogenesis of coronary heart disease, which is the leading cause of death in the world, is given in this article. It is emphasized that the incidence of ischemic coronary events is the result of a complex sequence of pathogenetic links, which involves the formation of atherosclerotic lesions and destabilization as the primary provoking factor. Purpose - the attraction of the medical community attention to the problem of ischemic heart disease in children. A clinical case of recurrent myocardial infarction in a child who was examined and treated at the MNPE «Ivano-Frankivsk Regional Children’s Clinical Hospital of the Ivano-Frankivsk Regional Council», is described here. The key points of the patient’s complaints, anamnesis of life and this disease are described, the data of the objective condition at the hospitalization and during dynamic observation of the child, which showed the signs of left ventricular overload, coronary blood flow disorder, dilatation of the left heart ventricles, decreased left ventricular contractility. The data of the main indices of laboratory and instrumental methods of research, including X-ray diagnostic methods, performed not only on the basis of the department, but also in the Scientific-Practical Medical Center of Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine (Kyiv). The treatment of this clinical case in the child is described in this article. The data of dynamic observation are given. The discussion and conclusions emphasize the problem of coronary insufficiency in pediatrics, which requires clinical understanding, the choice of the correct diagnostic algorithm and qualified medical care. The study was performed in accordance with the principles of the Declaration of Helsinki. Informed consent of the child’s parents was obtained for the research conduction. No conflict of interests was declared by the authors.

Objective. To assess the dynamics of bronchial asthma (BA) and allergic rhinitis (AR) caused by house dust mites (HDM) in children during 3 years of allergen specific immunotherapy (ASIT) with HDM allergens and 1 year after treatment cessation.Research methods. 50 patients completed an open, prospective, controlled 5-year study. 25 patients of the main group with BA and sensitization to HDM underwent a year of preliminary observation, 3 years of ASIT with HDM allergens, and 1 year of follow-up: 16 boys (64%), 9 girls (36%), 5 years to 13 years (8.3 [6.7; 11.5]) at inclusion. The control group of 25 patients, who did not receive ASIT, was selected as pairs copies. At inclusion, the concentration of periostin and thymic stromal lymphopoietin (TSLP) in blood serum and nasal material was determined in all patients. The dynamics BA and AR was assessed based on the total index of symptoms and medications for each year of observation.Results. During 3 years of treatment, a significant clinical effect of ASIT was formed, which persisted for 1 year of follow-up after the end of ASIT. At the end of the follow-up year, the overall index of symptoms and medications was 8.77 ± 1.06 points in the ASIT group and 22.01 ± 2.18 points in the control group (p=0.00001). The concentration of periostin before the start of treatment did not affect the effectiveness and features of the ASIT treatment course. A high serum TSLP concentration (>750 pg/ml) is characteristic of the subgroup with a higher incidence of adverse events associated with ASIT; the final effectiveness of ASIT does not depend on the concentration of this marker.Conclusion. ASIT with HDM sublingual drops is the method of first choice in the treatment of children with BA and AR, in cases where the role of HDM allergens in the genesis of the disease has been proven. A successful ASIT has a prolonged effect (at least 1 year of follow-up), which indicates the possibility of changing the natural course of asthma in children. The study of biomarkers does not allow us to predict the effectiveness of ASIT.

Introduction. Pain is a signal to any aggression that leads to cellular damage and requires a defensive response. Uncontrolled acute perioperative visceral pain can lead to the development of pain chronicity. By studying the characteristics of chronic pain, some scientists have identified relationships with single-nucleotide polymorphisms of the beta2-adrenergic receptor (ADRB2) gene. Purpose - to study the dependence of pain expression in the postoperative period in children on the polymorphism of the molecular structure of the ADRB2 receptor. Materials and methods. The study involved 42 children (20 boys and 22 girls) aged 7 to 18 years who were treated in the surgical department in 2020-2022 for acute appendicitis and peritonitis. Results. Based on the results of examining all the subjects under study, 13 children had the Arg16Gly polymorphism, 15 children had the Arg16Gly polymorphic variant, and 14 children were diagnosed with the homomorphic Gly16Gly polymorphism in the ADRB2. The data obtained confirmed the trend of the preliminary analysis and proved better body response to pain relief and reduced pain intensity in individuals with the Arg16Arg variant of the ADRB2. Analysis of the dependence between the polymorphism of the ADRB2 molecular structure and Visual Analogue Scale (VAS) scores in children in the postoperative period proved that the presence of Arg in the receptor phenotype had a strong negative correlation with the VAS score on discharge day (r=-0.822, p

Congenital anomalies of the aortic arch include a wide range of anatomic pathologies, which may be completely asymptomatic or accompanied by severe respiratory and/or esophageal symptoms, especially in the case of complete vascular rings (VR). Purpose - to draw the attention of pediatricians and family phisicians to possible clinical presentations of aortic arch anomalies, namely VR, to increase their awareness of this pathology, that will contribute to differential diagnosis. VR, are anomalies of the aortic arch that result from abnormal development of the embryonic aortic arches. The prevalence of VR is approximately 1%, of which 55% are double aortic arch. This congenital heart defect can be either isolated or combined with other congenital heart defects. Associated cardiac pathology occurs in 12.6%, and includes ventricular septal defect and Tetralogy of Fallot. Sometimes this defect is associated with DiGeorge’s and Turner’s syndrome. The timing of appearance of clinical symptoms varies from the early neonatal period to adulthood. However, most patients develop clinical symptoms in the first months after birth, and they indicate the need of cardiac surgery during the first year of life. Given the serious consequences of this anomaly, VR should be included in the list of differential diagnoses of wheezing, stridor, difficulty swallowing and bronchial obstruction syndrome in children, especially when these symptoms appear since birth, are persistent and respond poorly to standard therapeutical approaches. Therefore, it is important for pediatricians to be alert for a congenital heart defect such as VR as one of the possible causes of congenital stridor, wheezing, and swallowing disorders in infants. Contrast-enhanced computed tomography and magnetic resonance imaging of the heart are the diagnostic modalities of choice for VR diagnosis. These diagnostic methods provide accurate location, nature of branching and dominance of the aortic arch as well as the degree of compression of the airway and esophagus. Three-dimensional reconstruction helps to plan future surgical intervention. No conflict of interests was declared by the authors.

Introduction. Against the backdrop of multiple and widespread drug resistance of Mycobacterium tuberculosis (MDR-TB), there has been a significant decline in the effectiveness of treatment of tuberculosis (TB) patients in Ukraine and globally. Therefore, in recent years, new antimycobacterial drugs, such as bedaquiline (Bdq), delamanid (Dlm) and pretomanid, have been introduced to improve treatment efficacy in adults, children and adolescents. The purpose - to study the effectiveness of complex treatment with bedaquiline (Bdq) and delamanid (Dlm) in children under 18 years old with multiple and extensively drug-resistant pulmonary TB (MDR/XDR-TB). Materials and methods. To study the clinical efficacy of chemotherapy with Bdq and Dlm, a retrospective cohort analysis of medical records was conducted. The main group consisted of 40 children with MDR/XDR-TB who received comprehensive antimycobacterial therapy with Bdq and Dlm; and the control group consisted of 27 patients who received treatment without Bdq and Dlm. Results. It was found that during the first three months of treatment, there was a decrease in bacilli in all patients treated with Bdq and Dlm and in the group of patients without these new drugs (control), but in the control group, the decrease was significantly slower, p

Relevance. According to the new orders and guidelines of 2022, radiography is not performed for all children. Therefore, the creation of a fully automated system of control and assessment of breathing sounds, without exposing patients to radiation, is currently an urgent task. Purpose - to determine the features of the acoustic signal in segmental and focal pneumonia in children with a new acoustic diagnostic device “Trembita-Corona”. Materials and methods. 76 children aged from 1 month to 18 years were examined. The children were divided into two groups: the Group 1 - 47 patients with segmental pneumonia; the Group 2 - 29 patients with focal pneumonia. All children were also examined using the “Trembita-Corona” acoustic monitoring device. Results. The acoustic signal was investigated in 12 octaves. The first 9 octaves were the most promising. Each octave was divided into third octaves. We found reliable differences in the average signal power in 0, 1, 4, 6, 7, 15, 20, 23-26 third octaves. When studying the average signal power between children with segmental and focal pneumonia, the main differences were found precisely in the frequency of peaks in 0-3,10,11,14-16, 18,20,22 third octaves. Conclusions. The use of the acoustic monitoring device “Trembita-Corona” in making a diagnosis is very promising method. The average signal power between children with segmental and focal pneumonia, the main differences were found precisely in the frequency of peaks in 0, 1, 2, 3, 10, 11, 14, 15, 16, 18, 20, 22 third octaves. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Introduction. Familial hypercholesterolemia (FH) is a genetically determined disease characterized by elevated low-density lipoprotein levels since birth and predisposes a person to develop atherosclerosis-induced cardiovascular disease. Healthcare providers should monitor the health status and physical activity level in pediatric patients with FH, as a high-risk group for cardiovascular disease. Purpose - to investigate the self-reported health-related quality of life (HRQoL) and physical activity energy expenditure based on the questionnaire data (PAEEq) in children with heterozygous FH compared with healthy peers to assess the health status. Materials and methods. The HRQoL scores were assessed using the KINDLR questionnaire in 15 patients with FH and 21 healthy peers. The physical activity level was evaluated using the C(Y)PAQ questionnaire. The KINDLR data together with other variables such as age, weight, height, sex, BMI and the PAEEq scores were analyzed in SAS® OnDemand for Academics. Results. HRQoL scores in FH children were similar to those of the control group (p>0.05). There was no association between PAEEq and the HRQoL scores in the FH (r=0.37, p=0.29) and the control group (r=0.43, p=0.20). The KINDLR Physical well-being score in the 5-9 years age group was significantly higher for FH children than for controls (p

Introduction. A topical problem in pediatrics is bronchial asthma, which is characterized by a high prevalence, contributing to the formation of disability and a decrease in the quality of life in children. Possible triggers for exacerbation of the disease include external biotropic weather conditions. In this connection, it is necessary to study and develop new technologies for the correction and prevention of increased meteosensitivity in children with bronchial asthma.Purpose. To study the regularities of the influence of biotropic weather conditions on the course of asthma in children with increased meteosensitivity and to assess the effectiveness of the meteorological influence of climatotherapy.Materials and methods. An assessment was made of the bioclimatic potential of the territory of the Vulan sanatorium, taking into account the thermal regime, the biological effect of solar radiation, the degree of favorable weather conditions for carrying out climatotherapy. The degree of sensitivity to biotropic weather conditions and the features of manifestation of meteopathic reactions were studied in 119 children with asthma at the age of 5 to 15 years. The studies were carried out in a comparative aspect in two groups of children: children in the main group (95 children) in complex spa treatment received dosed climatotherapy procedures; children of the comparison group did not receive climatotherapy.Results. The meteorological dependence of varying severity was found in all children. Weather-related exacerbations in most children developed during the formation of the hypoxic effect of the atmosphere caused by hyperthermia and high humidity, conditions of "stuffiness" and "overheating", increased symptoms of the disease, decreased physical activity, deterioration of the psychoemotional state of children, confirmed by a significant (p

The purpose of the work is to study the clinical and immunological effectiveness of using autoserotherapy, ultrasound, as well as their combined use in children with allergic bronchial asthma.Materials and methods. During the work, 102 children aged 6 to 18 years with bronchial asthma were examined. Group A included 19 patients who received autoserotherapy. Group B patients (19 children) received ultrasound therapy in the spleen area. In group C (32 children), autoserotherapy was combined with ultrasound treatment. 32 patients with group D bronchial asthma made up the comparison group. All children included in the study received basic treatment (inhaled glucocorticosteroids).Results. Carrying out autoserotherapy in patients with bronchial asthma caused a statistically significant decrease in CD4+CD25+ T-lymphocytes (p1-3 rel.

Relevance. Nasal allergen provocation test (NAPT) is useful for revealing the causative allergen in patients with allergic rhinitis (AR). Currently, NAPT is not sufficiently standardized, there is also doubt about its high safety.Aim of the study. Safety assessment of NAPT with house dust mite (HDM) allergens in children with AR and AR in combination with bronchial asthma (BA) in daily clinical practice.Materials and methods. For the analysis, cases of positive NAPT in 128 patients were taken: 69 boys (age 5 to 15 years, average 9.2±1.7) and 59 girls (age 5 to 17 years, average 11.6±2.1) with AR or AR in combination with BA, with positive skin prick tests with HDM. Positive NAPT was recorded according to clinical signs and a decrease in peak inspiratory flow rate through the nose at least 20% from baseline. The protocol of the test included the introduction of a control fluid into one nostril, then dilutions of the allergen 10–4, then 10–3, 10–2, 10–1, and the undiluted allergen. Post-trial follow-up included monitoring of complaints, adverse events, registration of required therapy, and control spirometry.Results. In 128 cases of positive NAPT with HDM, there were no serious adverse events, systemic reactions, bronchospasm, and cases of treatment requirements higher than the standard. In 1 case, a patient aged 13 years had a voice hoarseness 2 minutes after the introduction of an allergen at a dilution of 10-2. The reaction was stopped with cetirizine within 25 minutes after administration. In all patients, reactions to the allergen were completely resolved within 30 minutes of observation after the test.Conclusion. NAPT with HDM allergens is safe can be performed on an outpatient basis. It is safe to conduct NAPT according to a tested graduated method with a clinical and objective instrumental assessment of the reaction to an allergen and the observation of the patient after the test.

Introduction. Hypertrophic and polyposis changes in the synonasal mucosa (SNM) in patients with bronchial asthma (BA) and allergic rhinitis (AR) negatively affect the course of these diseases. The debut of their formation can be observed already in childhood, but there is currently no precise information about the course of this pathology in children with BA and AR. The features of systemic immune regulation in these patients are also not studied. Purpose of the study. To study the effect of hypertrophic and polyposis changes in SNM on the clinical characteristics of AR in children with BA and on their relationship with the content of serum immunoglobulins A, M, G and E. Materials and methods. We examined 137 patients with atopic BA and AR at the age of 10.0 [7.0; 13.0] years, of which boys — 75.2% (103/137). Patients underwent routine examination of ENT organs and video endorhinolaryngoscopy, if indicated — CT scan of the paranasal sinuses. Determination of the content of total IgE, as well as IgA, IgM, IgG in blood serum was carried out by the enzyme-linked immunosorbent assay "VectorBest" (Russia). Results. In 19.7% (27/137) children, changes in SNM were revealed in the form of local hypertrophy of the medial surface of the turbinates, in 10.9% (15/137) polyposis changes in SNM. These changes in SNM were statistically significantly more frequent in patients with moderate and severe AR (χ2=57.7; p

Food anaphylaxis is a severe life-threatening reaction to food. In recent years, there has been an increase in the number of such reactions. The ability to recognize the symptoms of food anaphylaxis surrounding a sick person by people is the key to a saved life. This article on the basis of modern data on epidemiology, etiology and pathogenesis of food anaphylaxis discusses the problems that are currently in the diagnosis and treatment of children with food anaphylaxis, suggests ways to solve them.

Atopic eczema (atopic dermatitis, AD) — chronic recurrent inflammation of the skin, arising as a result of a violation of the epidermal barrier and entailing its further dysfunction. Maximum development atopic dermatitis reaches on the background of predisposition to IgE-mediated hypersensitivity, implemented in sensitization to surrounding allergens.The diagnosis of atopic eczema is clinical. An obligatory clinical symptom is itching in combination with 3 other criteria: typical morphology and distribution; a history of atopy; chronically xerosis; AD debut up to 2 years. The phase of the disease and the severity of skin lesions are of practical importance for clarifying the stage AD. Changes characteristic of different phases can be observed simultaneously. Morphological and age-related classifications of AD are conditional and have little effect on the therapeutic strategy. Clinical variants of AD (allergic and non-allergic) are a single nosological form that requires common approaches to therapy. The prevalence of AD is greatest in children a 1-st year of life (up to 30%) and significantly decreases in adolescence.Point and inherited mutations in genes (for example, filaggrin) are a key point in the pathogenesis of AD. Immune disorders are not limited to IgE-dependent reactions and occur with the participation of many cytokines (IL-4, IL-5, IL-13, IL-25, IL-31, TSLP). Bacteria and fungi act as infectious agents or superantigens for lymphocytes.Food allergies are detected in 30–40% of children with AD causing aggravation of the disease. The children in the first year dominated by sensitization to food allergens: milk, eggs, cereals, fish. An allergological examination using skin prick tests or specific IgE is informative and necessary, but the presence of sensitization should be clarified using an elimination-provocation test with this product.

Chronic renal failure (CRF) remains an important problem in childhood. We have studied patients with chronic kidney disease (CKD) at the 3–5 stages at the stages of conservative treatment, dialysis therapy and kidney transplantation (n=72). The main reason for development is defined CRF in children — CAKUT-syndrome. The main clinical-anamnestic features at different stages of CKD are shown. Clinical-immunological correlations were carried out, hypoimmune state of both cellular and humoral links of immunity was detected in CRF.

Local studies of various types of domestic sensitization in patients are in demand and have practical value.Objective: to study the spectrum of domestic sensitization in children with allergic rhinitis (AR) and bronchial asthma (BA) in St. Petersburg, in connection with the main clinical data. Materials and methods. The study included 360 patients with perennial allergies, 216 boys, 144 girls, aged 5 to 17.9 years (mean age 9.13 ± 3.41 years). Skin prick tests on the front surface of the forearm with water-salt extracts (joint stock company Biomed, Russia) were carried out and evaluated according to the standard method with allergens: house dust, D. pteronyssinus, D. farinae, cat, dog, horse, pillow feather. The test was considered positive with a maximum wheal diameter of ≥3 mm 15 min. after application.Results. In the structure of domestic sensitization in children with AR and BA, house dust mite allergens were in the lead; the most common sensitization was to D. farinae (70.3%) and D. pteronyssinus (60.8%), as well as to a cat (54.2%) and a dog (52.8%). In children with moderate asthma, the cat allergen was in the lead, exceeding the level of sensitization to house dust mites. The frequency of sensitization to various allergens increased significantly with the increase in the allergic disease duration.Conclusion. The high significance of house dust mite allergens, as well as epidermal allergens in children with perennial AR and BA, should be taken into account when planning allergological evaluation and treatment measures..

The postvaccination immunity to bacterial toxins in preschool-age children with atopic dermatitis before the second revaccination has been studied. It was determined that protective immunity against Cl. tetani toxin is kept in 100% cases and against C. diphtheriae in 86,7% ones. High level of antitoxic IgG is detected in more than half of all children.

Atopic dermatitis (AD) is a diagnosis with precise criteria described by Hanifin & Rajka. A differential diagnosis should be considered at the discrepancy of the symptoms or torpid eczema. The list of diseases is genetic syndromes with the impaired epidermal barrier, metabolic diseases, skin infections, psoriasis and others. Skin infections in the diagnostic search should be considered the first time.The basis of therapy allergic eczema is the elimination of allergenic and non-allergenic triggers, topical steroids and inhibitors calcineurin with uses of emollients in the skincare process. This therapy is sufficient for most patients.Systemic therapy of dermatitis consists of short courses of steroids (up to 1 week) with the ineffectiveness of external preparation. If long-term therapy is necessary, it is proposed to consider the possibility of prescribing dupilumab and cyclosporin A. Antihistamines can be considered as a drug for stopping itching in the early days of the disease. With a sufficient effect of external anti-inflammatory drugs, the use of antihistamines is not required.Exclusion of culpable food allergens leads to rapid remission of the disease. Non-specific hypoallergenic diets reduce the quality of life of patients and should not be used for a long time. The main formula for feeding children with allergies to cow's milk protein is extensively hydrolysed formula. The amino acid-based formula is reserved for severe cases.During the period of remission, it is important to provide skincare and regular use of emollients, as well as a complex to eliminate causative allergens from the patient’s environment.Specific immunotherapy can be recommended for patients with a proven role of the allergen in the development of exacerbation AD and with a combination of eczema with allergic rhinoconjunctivitis and asthma.