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Erythema nodosum (EN) is a delayed-type hypersensitivity reaction that most often presents as erythematous, tender nodules on the shins. Common triggers for EN include infection, drugs, pregnancy, malignancy, and inflammatory conditions, such as sarcoidosis or gastrointestinal diseases; however, many cases are idiopathic. We present clinical case of 12 y.o girl with EN associated with EBV.

There is a difference between MIS-C and KD. This is probably a postinfectious inflammatory response manifested with elevation of inflammatory markers and signs of myocardial damage. So, MIS-C could be an analogue of late phase COVID-19, which we are seeing in adult patients. This phase is also characterized by “cytokine storm” and can include severe myocardial disfunction, renal damage and laboratory changes consistent with MAS. Despite growing numbers of children with MIS-C, it still remains as rare condition and has good outcome in majority of cases. Children with MIS-C need special care of rheumatologist, infectious disease and intensive disease specialist collaboration.

Aims: To evaluate whether chronic lung disease (CLD) without concomitant brain lesions influences cognitive and motor development in early ears. Method: Congitive, receptive and expressive language, gross and fine motor skills were evaluated by Bayley III Scales of Infant and Toddler Development in 32 preterm infants with CLD (without IVH or PVL) and 36 preterm infants without CLD, IVH and PVL and 30 term healthy infants. Developmental asessment was conducted at 9 an 24 months of corrected age. All groups have similare birth weight, gestational age and demographic and social charactheristics. Results: From evaluated 90 children 54.4% (n=49) were male, and 6.6% (n=6) were SGA. In comparison with Term born infants premature infants show lower cognitive, expressive language and fine motor scores on both assessment. 9 and 24 months, 32,2% (n=29) children presented with different delays in one or more areas, from them 48,2 % (n=12) show delay in one sphere, in other cases there were delay in 2 and more areas. At 9 months of age children with CLD show the lower fine motor scores compared with preterm group without CLD. At 24 months of corrected age preterm born children with LCD show lower scores in fine motor, expressive language and cognitive skills compared with preterm born infants without LCD, but difference was not significant, that can be explained by a small sample. Conclusion: CLD have an influence on child development, especially on fine motor (visual motor) and cognitive skills. There is the need for careful developmental follow-up of infants with CLD to see if the problems have long lasting effects.

The aim of our study was to evaluate the clinical characteristics and differences between the allergic (AR) and non-allergic (NAR) rhinitis in children. The study involved 98 patients admitted ion ambulatory department of Iashvili central clinical hospital. The clinical picture, allergic evaluation including blood eosinophil counts, serum total IgE, specific IgE, and skin prick test were assessed and personal and family history were collected. The mean age of patients was 8,2+ 2,4 and there were no significant differences in age and sex between the AR and NAR group. The study shows that 63,2 % (n=63) of children had AR, whereas 36,8 % (n=35) had NAR. Nasal pruritus was more frequent in children with AR (61,9% (n=39) vs. 25,7% (n=9) P P

A link between atopic dermatitis (AD,eczema) and emotional and behavioral dysfunction is more or less well recognized but concern still exists. Children with a chronic health condition have long been considered at excess risk for psychosocial morbidity. But psychosocial morbidity is less linked and studied in connection with other disease, especially AD. As mentioned before, AD is the most prevalent chronic disease in young children. The aim of the study was assessment of incidence of atopic dermatitis in children of 5-6 years with developmental and behavioral problems. The cross sectional study was conducted. Children with developmental and behavioral problems according to medical records and aged five to six years were recruited consecutively from a preventive care register in M. Iashvili Childrens Hospital Child Developmental Center in 2010-2014 years. Recruitment was done according developmental and behavioral assessment performed on the basis of team approach by pediatrician and psychologist. Parents evaluation of development status: developmental milestones (PEDS:DM) and Pictorial Checklist ( PIK -17) was used for assessment. 639 children with language delays, problems of externalization and internalization were enrolled in study. Children were examined by pediatricians based on the presence of at least three major and three minor criteria of Hanifin and Rajka's diagnostic criteria(HR) and by semi structured, one-to-one interview with the parents. According our study: 1. Significant amount of children with developmental and behavioral problems and symptoms are developing AD(36%). 2. Children with language delay were more frequently developing AD symptoms than children with behavioral problems.3.There was not significant difference in children with language delay and behavioral problems in terms of impact on QL. In both cases everyday activities, sleep and recreational actives were affected and there more affected then in children with developmental and behavioral problems and symptoms with AD comparable to children without AD, especially sleep.4. Date represents that boys are more likely to develop AD than girls, this information is in correlation with known facts about dermatitis. Both boys and girls were similarly affected by QL problems in case of AD and developmental and behavioral problems and symptoms. Chronic diseases and development and behavior of children in further dilemma for researchers. Our study gives us further impulse for more deep insight in factors affecting children with delays and behavioral problems and prospective studies in group with developmental and behavioral problems and symptoms and AD.

The aim of our study was to detect factors that influence timing and adequacy of complementary feeding (CF) practices in Georgian families. The study was conducted at M. Iashvili Central Children's Hospital Child Developmental Center in 2013-2014 year. The data was collected from 389 mothers of infants' age ranging from six months to one year. Results of the study show that CF was started in time only in 30,2%, In 18,1% it was CF was introduced too early (4 month), in 27,3 early (4-6 month) and in 11% - late. 13.4% of children haven't started CF at all. Most of mothers received information about CF and semi-solid and solid food used for CF from pediatricians and family-doctors. Timing of complementary feeding was related to maternal age, young mothers started CF too early, early or late. In urban areas early CF was significantly high (51.1%) than in rural (29.7%) areas (P0,05). Proportionally employed mothers and students also started CF earlier (51.4%) than housewives (33%) (P0.01). Mothers who had 2 and more child introduced CF timely compared to those who had the first child (P0.01). Our research study showed that educated women started complementary feeding of their infants at appropriate ages as compared to those who were uneducated (P0.001) among women who introduced CF in time most were educated (91%). The data from the study shows that many infants are beginning complementary feeding earlier than WHO recommends (6 month). Findings from our study revealed that maternal knowledge, age, education level was directly related with timing of CF. Promotion of strong community based education and support to ensure optimal infant and young child feeding is recommended.

The aim of the study was assessment of the general nutrition knowledge and physical activity rate among the first grade school age children and evaluation of their diet and nutritional skills based on the parental interviews. Cross-sectional study was conducted in randomly selected schools of Tbilisi. In each school was selected one group of the second grade children and their parents by cluster selection method. A population of 290 children aged 6-8 years and their parents were interviewed. The statistical analysis was carried out by means of the SPPS 17. Questionnaires, except those with incomplete answers (n=30), were used for the analytical data. The study shows that in general, the level of knowledge related to rich sources of nutrients was poor. The most of the children can't identify the role of calcium (72,6%), proteins (68,1%) and iron (84,6 %). Children prefer to eat and select foods which they like (71,8%), such as sweets and cakes, hamburgers, chips and etc. The study showed that the most of the children (83,3%) have normal weight for age, underweight was revealed in 3,1% of children, more frequent was overweight (12,3%) and obesity (1,4%). There wasn't significant difference of overweight and underweight distribution in boys and girls. The assessment of child dietary intake show, that intake of fruits and vegetables, as well as milk and milk products is quite low, while intake of bread and pastry, and sweets and cakes are quite high. Daily consumption of sweets and snacks was significantly higher in girls (64.2%) than in boys (47.5%) (p0.01). The study revealed that only 62 % of children eat the breakfast, in frequent cases children eat very fast (26,1%), 47,8 % of children need to remind to wash hands before eating, most children 60,4% view TV during the meal time or play computer games. The most of the children play the active games approximately 30-60 minutes, quite often children play active games only 20-30 minutes that is much less then WHO recommendations. The parent questionnaires reveal that most frequent problem that influenced child nutrition is lack of information about healthy feeding (55%), lack of time for preparation of food (33%), inability to control child's feeding (36%), financial deficit (4%). The dietary intake of children does not correspond to WHO recommendations. It is recommended on the one hand to conduct country wide assessment of dietary intake of children and adolescent and on the other hand to implement nutrition education programs.

Purpose of the work was to investigate clinical-allergic peculiarities of allergic rhinitis, together with bronchial asthma in school-age children. There were studied random representative group of children, in total 3000 subjects from 6 to 17. According to the results of epidemiological research in school-age children's population, prevalence of allergic rhinitis was 13,2%. In 19,1% of cases, allergic rhinitis was accompanied with bronchial asthma and in 8% of the patients there was indicated bronchial spasm of physical load (verified as clinically, also through the test with physical load), coughing version of asthma was observed in 4,5% of children. Thus, in children with allergic rhinitis, within the structure of clinical versions (by the criteria of severity) of rare bronchial asthma prevailed (69,8%, among which 65% - intermitting form and 4,8% - persisting form), without statistically significant difference between the boys and girls. Combination of inherited predisposition to allergy with the atopic dermatitis, in the in the anamnesis of children with the increased level of general IgE in the blood serum may be considered as early diagnostic predictor of atopic phenotype as for the allergic rhinitis, also for its combination with the bronchial asthma.

Aims of this study were: to evaluate changes in lung function in wheezing children with detected MP and CP infection according to treatment; to measure the response to inhaled corticosteroids in children with significant wheezing who were selected as having a high risk of progressing into childhood asthma. 54 children were randomly assigned 2:1 into 2 groups-the main group (36 patients), in which inhaled corticosteroids were administered, and the control group (18 patients), without inhaled corticosteroids. Serum IgE levels were determined using the ELISA (reagents: IBL-Hamburg). Serologic studies were performed by the ELISA for IgM and IgG antibodies to MP and for IgG and IgA antibodies to CP (reagents: ImmunoLISA, Orgenics, Israel) on the Hiperion MRIII (USA). Pulmonary function testing was done with SpiroLab II (DEGO GmbH, Medizin-Elektronik, Germany). The patients of both groups were administered macrolides: azitromycin during five days. Patients of the first group received inhaled fluticasone propionate 125 mg twice daily. The parents were asked to record symptoms. Each symptom (wheezing, cough, and shortness of breath) were scored on a scale of 0 to 3--daily symptom score (DSS). Scores were calculated every 4 weeks for a total treatment period 16 weeks. The days within each period on which the DSS equalled zero were pointed as symptom free days (SFD). It had been shown an significant improvement in DSS, an increase in SFD and significant improvement of the lung functions following the treatment with inhaled fluticasone and macrolide in children with wheezing and documented MP or CP infection, compared to control group treated only with antibiotics. In conclusion, the use of ICS should be seriously considered in children with wheezing and the risk of persisting symptoms.

The aim of this study was to analyze Georgian health care practitioners' knowledge on management of acute diarrhea and its adherence to WHO treatment guidelines. A questionnaire-based, cross-sectional survey was carried out in hospitals and out-patient clinics of Georgia. 350 anonymously filled questionnaires were analyzed (27% - hospitals, 73% - out-patient clinics). Majority (65%) of interviewees defined diarrhea correctly, 74% correctly named main signs of dehydrations and classified severity of dehydration, 26% mixed up signs of moderate and severe dehydration. About 90% uses ORS during diarrhea, but only 51% follow WHO recommendations about fast rehydration. The most of responding staff (78%) don't know the benefits of low osmolarity ORS. 42% pediatricians who work at the hospital use IV rehydration in case of moderate dehydration. 78% of medical staff named recommended IV fluids either Ringer lactate solution or Normal saline, but 22% still choose 5-10% Dextrose solution. Almost all doctors (94%) use probiotics, either as monotherapy (22%) or in combination (78%). 35% of physicians prescribe antiemetics, 27% antidiarrheals, 45% antimicrobial drugs, from those 65% uses antibiotics only in case of presence of blood in stool. The majority of medical staff don't use Zinc. Study revealed that most respondents advise continuation of breastfeeding, in case of bottle feeding 32% prescribe lactose free formula, while others continue normal diet. In elder children some restrictions in diet is still in practice. The study revealed that primary level health care representatives adhered to the WHO recommendations better, than hospital doctors, that was statistically significant. The findings show a moderate adherence to standard treatment guidelines of diarrhea. The recommendations on using ORS and continuation of breast-feeding are most followed. The most problematic issues are excessive use of antibiotics and IV fluids, no use of zinc, unnecessary use of antidiarheals and antiemetics. To improve case management of acute diarrhea, continuing professional development program targeting the practitioners is necessary.

Lately the connection of Asthma and RSV drew the sufficient attention. The recurrent wheezing developed during the RSV in children is particularly frequent in the families having history of atopy. The decreased expression of INFgamma may play the role in the pathogenesis of RSV infection. The target of our research was the study of the rate of INFgamma during various clinical courses of RSV-infection and definition of its role in the pathogenesis of ARVI. 52 children with RSV-associated wheezing have been studied, who had first (32) or recurrent episode (20) of bronchial obstruction and whose families had occurrence of atopy. 52 children with non RSV-associated wheezing (III group) and 10 healthy children up to 12 months of age (IV group) were considered as the control groups. Children from all four groups were from families with the history of atopy. INFgamma was measured by enzyme immunoassay (ELISA). Comparison of two groups of wheezing children with RSV infection showed significant reduction of INFgamma level in the group of children with recurrent wheezing vs. the group with first episode of wheezing. INFgamma levels were significantly higher in the two control groups. During the acute respiratory infection induced by RS-virus, which proceeds with the obstruction of respiratory tract (wheezing), reduction of INFgamma was noted and higher frequency of wheezing episodes is associated with more prominent alteration.

The aim of the study was assessment of incidence of allergic rhinitis and respiratory infections and evaluation of quality of life of first grade school age children with allergic rhinitis. The cross sectional study in randomly selected regions and schools was conducted using specially developed parent questionnaire and mini rhino conjunctivitis quality of life questionnaire (MiniRQLQ). On the first was used special questionnaire, and on the second phase MiniRQLQ was used in cases with allergic rhinitis. Total of 1530 parent of 6-8 years children were interviewed, 1499 first phase questionnaires and 174MiniRQLQ were analyzed by SPSS 19 program. From 1499 children 799 (53.3%) were girls and 700 (46.7%) - boys. The 810 (54%) live in urban, 524 (35%) in rural area and 165 (11%) in high mountains. The study revealed that 2.3% of children have respiratory infections 7-8 times per year, 19.9% 3-5 times, 53.4% 1-2 times and 24.2% became ill very rarely. There was statistically significant difference between the frequency of respiratory infection in rural and urban area (p0,001).The frequency of chronic diseases reported by parents is 18.3% (n=274), from those 201 (73.3%) are allergic disorders (asthma, rhinitis, atopic dermatitis), that is 13.4% of total respondents. The incidence of allergic rhinitis was 11.6%, most frequent symptom was rhinorrhea 168 (11.2%), recurrent sneezing episodes during last year was seen in 153 (10.2%), nasal pruritus was reported in 137 (9.1%), nasal obstruction in 117 (7.8%). The eye symptoms were reported in 62 (4.2%). The symptoms of allergic rhinitis is significantly higher in urban population then in rural area (P0.02), as well as in boys (P0.05). The 109 (62.6%) of respondents answer that symptoms and mostly nasal obstruction affected their quality of life, especially on recreational activities and sleep. In 91 (52.9%) patients with already diagnosed allergic rhinitis treatment was prescribed according international guidelines. In group with symptoms but non-diagnosed allergic rhinitis frequently was used I generation antihistamines 52 (62.6%) and decongestants 57 (68.5%). Incidence of allergic rhinitis in first grade school population is high and it is comparable to indices of developed countries. Allergic rhinitis affects quality of life of children especially outdoor activities and sleep. ARI does not show an impact on severity of allergic rhinitis symptoms.

The aim of the study was to assess nutritional status and anthropometric parameters in children aged 5-6 and to identify possible factors influencing the growth pattern of Georgian children. The cross-sectional study was performed on a sample of 754 children boys and girls aged 5-6 attending preschool facilities and their main caregivers in the study sites. The study covered children population from 16 kindergartens of 2 regions (Gldani-Nadzaladevi, and Vake-Saburtalo) of Tbilisi, with different social-economical status. The following anthropometric parameters were studied--body weight, height, head and mid arm circumferences and body mass index (BMI). Physical parameters were assessed using WHO/NIH standardized growth charts (percentile and Z scores). Collected data was analyzed using the computer program EPI INFO. High weight and height (95 percentile/2 Z score) was found more frequently than low (5 percentile/-2 Z score) parameters. Most children's weight according to their stature was in normal 5-95 percentile range. At the same time in girls was often met low weigh for their stature then in boys. The imbalance between the weight and height is more evident than between weight and age or height and age. The results showed that the abnormal Z scores more or below +/-2 scores were in less percents of children then high and low weight and height by the age in percentiles. The results showed a prevalence of children having normal indices of BMI between 5 and 85 percentiles, approximately 13%of children have low weight (less than 5 percentile), approximately 18% have risk of overweight and 16% have obesity. A multivariate analysis of personal and nutritional variables with the standard nutritional indicators identified age, sex, bottle feeding, and type of solid foods as significant risk factors for stunted growth. Stunting increases with age and males have poorer growth pattern than females. The results of the study emphasize that in Tbilisi 5-6 years old child population more frequent is problem of overweight and obesity than underweight.