Respiratory syncytial virus (RSV) infection is the leading cause of lower respiratory tract disease in young children worldwide. The high incidence of bronchiolitis, hospitalizations, and the risk of developing long-term respiratory disorders, including bronchial asthma, determine its significance in pediatric practice. The article presents current data on the molecular biology of the virus, pathogenesis of bronchiolar lesions, immunopathological mechanisms, clinical course, and long-term consequences of the infection. Special attention is paid to treatment and prevention issues, including the use of recombinant interferon alfa-2b with antioxidants (Viferon®). The therapeutic effect of the drug is due to its antiviral, immunomodulatory, and membranestabilizing properties. Clinical studies confirm the feasibility of using Viferon® for a wide range of infections, including RSV infection and acute respiratory infections (accelerating virus elimination, relieving catarrhal and obstructive syndromes, shortening treatment duration), especially in newborns and young children. Key words: RSV, bronchiolitis, bronchial asthma, young children, interferon alfa-2b, antioxidants
Liver cirrhosis is a major cause of mortality in children, and liver transplantation is the only effective therapy. Patients with severe chronic liver disease, particularly decompensated cirrhosis, may experience distinct pulmonary problems. Objective. To evaluate the frequency of hepatopulmonary syndrome (HPS) in children with liver cirrhosis hospitalized at Namazi Hospital. Patients and methods. This study included all children under 18 years of age with liver cirrhosis who were hospitalized at the Pediatric Gastroenterology Department of Namazi Hospital in Shiraz between the beginning of 2021 and the end of 2022. Blood oxygen saturation was measured using a pulse oximeter; if it was less than 97%, an arterial blood gas (ABG) test was performed. In patients with blood oxygen levels below 70 mm Hg, color echocardiography was performed to confirm or exclude HPS. Results. The study included 35 participants with a mean age of 64.45 ± 63.47 months, including 20 (57.1%) boys and 15 (42.9%) girls. HPS was diagnosed in 6 (17.1%) individuals. Most patients did not have underlying diseases, such as biliary atresia, autoimmune hepatitis, or metabolic disorders. There was a favorable link between HPS and age, but no statistical significance was found. The sex of patients did not indicate any meaningful association. The study also discovered a positive but not significant association between liver disease severity and HPS. Conclusion. Although a positive correlation was observed between HPS and the patients’ age and sex, it was not statistically significant. Patients with HPS had a higher mean MELD score than those without the syndrome, although the difference was not significant. Additionally, digital clubbing was noted in 50% of patients with HPS. These findings highlight the importance of comprehensive assessment in children with liver cirrhosis to support early detection of HPS. Key words: hepatopulmonary syndrome, HPS, liver cirrhosis, pediatrics
The review summarizes current knowledge on the staged formation of the child's gut microbiota as an important participant in programming the child's somatophysical and neuropsychological health. Data are presented analyzing associations between gut microbiota characteristics and specific disorders of child health and development, as well as information on microbiotaprotective and neuroplastic substrates in human milk that shape a healthy microbiota. The final section of the review presents data on the possibility of incorporating protective substrates from human milk into infant formula, primarily goat milk-based formula. Key words: gut microbiota, human milk, goat milk, health programming, neuropsychiatric development, oligosaccharides, lutein, choline, docosahexaenoic acid
Analysis of the epidemiological situation in the Russian Federation for the period 2022–2024 indicates the significance of neuroinfections in the structure of childhood morbidity, with up to 78% occurring in children under 6 years of age. An increase in the incidence of meningococcal infection among the population is noted, along with persistently high mortality rates in purulent meningitis – from 15 to 30%, despite the fact that >80% of such conditions are currently vaccine-preventable. Severe damage to the brain parenchyma, the diversity of the etiological spectrum with a predominance of herpesviruses, and an increase in the frequency of chronic disease course up to 25% reflect the features of encephalitis in children. Concurrently, a steady increase in enteroviral infections is observed, with children under 17 years accounting for up to 90% of all cases, as well as an increase in the number of group outbreaks with fecal-oral transmission mechanism. Vector-borne diseases such as ixodid tick-borne borreliosis and tick-borne viral encephalitis, which are prone to chronic course, cause particular concern. The final data confirm that timely vaccination, early diagnosis, adequate therapy, and adherence to sanitary and hygienic standards remain key factors in preventing severe damage to the nervous system in children. Keywords: infectious diseases, children, purulent meningitis, meningococcal infection, encephalitis, borreliosis, tick-borne encephalitis, enteroviral infections, meglumine acridone acetate
Early childhood caries (ECC) remains a global problem with a prevalence of up to 88% in the Russian Federation. Effectiveprevention is impossible without the participation of pediatricians, but the level of their involvement remains low. Objective. To identify key areas for interdisciplinary interaction to reduce the incidence of early childhood caries based on a comparative analysis of questionnaire data from parents and pediatricians. Patients and methods. An anonymous questionnaire survey of 170 pediatricians and interviews with 399 parents of children aged 5-6 years (St. Petersburg) were conducted. Knowledge of etiopathogenesis, dietary control, and timing of the first visit to the dentist were analyzed. Statistical analysis was performed using Pearson's χ2 test and Cramer's V coefficient. Results. Only 24.7% of pediatricians have comprehensive knowledge of the multifactorial nature of caries. A critical gap in dietary recommendations was identified: 68.8% of physicians insist on homemade complementary feeding, while 84.0% of parents use industrially produced products. Only 47.7% of pediatricians refer the child to the dentist within the mandated timeframe (1 year) regardless of the presence of complaints. A correlation was found between the pediatrician's attention to the oral cavity condition and the frequency of referrals for preventive examinations (Cramer's V coefficient 0.348, p < 0.001). Conclusion. Low awareness of pediatricians about ECC risk factors and the lack of unified protocols for nutritional counseling reduce parental compliance. It is necessary to integrate a dental component into pediatricians' continuing education programs and to develop joint interdisciplinary reference materials on infant and child nutrition. Key words: early childhood caries, primary prevention, pediatricians, interdisciplinary interaction
The efficacy and safety of therapies for juvenile idiopathic arthritis (JIA), along with the selection of appropriate medications, remain a relevant issue due to physicians’ dissatisfaction with treatment outcomes. Golimumab is the most recent tumor necrosis factor inhibitor approved for pediatric use. Its efficacy and safety have been studied less extensively in real clinical practice compared to other medicines in this group. Objective. To evaluate the therapeutic outcomes of golimumab in patients with JIA in real clinical practice. Patients and methods. This two-center retrospective cohort study included data from 62 patients with JIA who received golimumab between 2008 and 2025. Inclusion criteria were: 1) confirmed diagnosis of JIA (RF-positive and RF-negative polyarthritis, oligoarthritis, enthesitis-related arthritis, psoriatic arthritis, systemic-onset JIA); 2) age over two years at initiation of golimumab therapy. Exclusion criteria were: 1) lack of patient data that could affect the analysis; 2) combination therapy with Janus kinase inhibitors. The study assessed the frequency and time to achieve remission of arthritis and uveitis, as well as treatment safety. Results. Enthesitis-related arthritis (n = 26; 42%) and polyarthritis (n = 25; 40%) were predominant. JIA-associated uveitis was present in 11 (18%) patients, HLA-B27 antigen was detected in 11 (18%), rheumatoid factor in 2 (3%), and antinuclear antibodies in 20 (32%) patients. Before initiating golimumab therapy, 56 (90%) patients had received non-biologic anti-rheumatic therapy, and half of the patients had prior experience with biologic agents. Golimumab therapy led to remission in 41 (68%) patients, including 7 (88%) with oligoarthritis, 17 (68%) with polyarthritis, and 16 (62%) with enthesitis-related arthritis. All patients with ocular involvement achieved uveitis remission at last follow-up. Treatment also significantly reduced laboratory markers of inflammation and the number of joints with active arthritis (p < 0.001). Efficacy was similar in biologic-naïve patients and those with prior biologic experience (p = 1.0). No adverse events were observed. Conclusion. Golimumab demonstrated high efficacy in the treatment of JIA, including in patients with uveitis, and was associated with a favorable safety profile. The retrospective design and small sample size highlight the need for larger cohort studies with longer follow-up periods. Key words: golimumab, uveitis, juvenile idiopathic arthritis, juvenile arthritis
Cystic adenomatoid malformation of the lung is a developmental defect constituting 25% of all bronchopulmonary anomalies and characterized by adenomatoid proliferation of immature bronchioles with the formation of macro- or microcysts lined by columnar or cuboidal epithelium and the absence of cartilage and bronchial glands. The article presents a description of a clinical observation of a preterm newborn patient with the main diagnosis: congenital developmental anomaly: cystic adenomatoid malformation of the right lung, type 1; concomitant diagnosis: severe neonatal respiratory distress syndrome. Prematurity 29 2/7 weeks. Low body weight. Severe anemia. Blood transfusion. Bilateral grade 1 intraventricular hemorrhage. The difficulties of providing timely radical high-quality medical care to a patient with a congenital developmental anomaly against the background of multiple comorbid pathologies accompanying prematurity are described, with the aim of improving clinical thinking and broadening the horizons of doctors of various specialties providing care to preterm infants. The authors hope that this clinical case description is valuable in terms of applicability in practice both for clinicians working in maternity institutions and for research scientists. Key words: infants, newborns, developmental defects, lungs, cystic adenomatoid malformation of the lung, congenital developmental anomalies, respiratory distress syndrome
Effective planning of medical care for juvenile idiopathic arthritis (JIA) requires accurate regional data. Until now, there has been no unified tool for comprehensive monitoring of such patients in the Moscow region. Objective. To evaluate the regional features of the epidemiology, onset, course, and pharmacotherapy of JIA in the Moscow region for the period from March to December 2025. Patients and methods. The study was conducted in two stages. At the first stage, a retrospective analysis of data from reporting form No. 12 for 2012–2024 was performed. At the second stage, a cross-sectional study was conducted based on the formed regional register (n = 1102). Due to the retrospective nature of data collection, analysis of individual indicators was performed on actually available samples. Results. Primary incidence in the region is stable (Me = 15.63 per 100,000 children), while total incidence showed a linear increase, reaching 76.9 per 100,000 by 2024. The structure of JIA was dominated by oligoarticular (41.2%) and polyarticular seronegative (39.7%) variants. The median age of onset was 6 [3; 9] years, with the disease onset being significantly earlier in girls (p < 0.001). The majority of patients had grade 2 activity (62.0%) and stage I radiological changes (50.7%), grade 2 functional disorders (79.9%). Antirheumatic therapy was received by 97.1% of patients, of whom 39.2% received combination treatment. In the structure of genetically engineered biological therapy (GEBT), TNF-a inhibitors predominated (73.4%). The proportion of children in drug-free remission was 2.9%. Conclusion. In the Moscow region, an increase in the prevalence of JIA is observed against the background of stable primary incidence. The creation of a regional register allowed, for the first time, to detail the structure of the disease and therapy in the region. The high proportion of GEBT use (57.4%) reflects the severity of the patient cohort and the availability of modern targeted therapy in the region. Key words: juvenile arthritis, antirheumatic therapy, juvenile idiopathic arthritis, epidemiology, regional register, pharmacotherapy, biological agents
The development of modern medicine is inextricably linked to genetic research, which has become the foundation for the advancement of personalized medicine. To develop individualized pharmacotherapy from the perspective of pharmacogenetics and pharmacogenomics, polymorphisms of xenobiotic biotransformation genes are being actively studied. Additionally, the contribution of polymorphic variants of detoxification genes to the development of several diseases is being considered; however, the number of such studies remains limited. Objective. To identify possible associative links between polymorphisms of the N-acetyltransferase 2 (NAT2) and aldehyde oxidase 1 (hAOX1) genes and acute lymphoblastic leukemia (ALL) in children. Patients and methods. An observational, single-center, retrospective, case-control, non-randomized study was conducted, including 275 individuals: the main group (n = 75) consisted of children with ALL, and the control group comprised 200 individuals. The groups were comparable in terms of sex; all participants belonged to the ethnic group of the indigenous Russian population of the East Siberian region. Real-time polymerase chain reaction was used to determine NAT2 and hAOX1 gene polymorphisms. Genotype and allele distributions were assessed for compliance with the Hardy–Weinberg equilibrium using the χ2 test; allele frequencies were compared using Fisher's exact test. Odds ratios for ALL development were calculated under three inheritance models. Logistic regression was employed to analyze the association between genotypes of the polymorphic loci of the studied genes and ALL. The level of statistical significance was set at p < 0.05. Results. The frequency of the A/A genotype of the rs3731722 polymorphism of the hAOX1 gene in the main group was 37.3% under both codominant and dominant inheritance models, compared to 69.6% in the control group (p < 0.001). The A/G genotype was statistically significantly more frequent in the main group (61.3% vs. 28.8%, respectively; p < 0.001). According to the overdominant inheritance model, the risk of developing ALL was higher in heterozygous carriers of the rs3731722 polymorphism of the hAOX1 gene (p < 0.001), while no significant differences were observed under the recessive model. The frequency of the NAT2 genotype associated with the slow acetylator phenotype predominated in all study participants and did not show statistically significant differences between the groups (p > 0.05). According to Model 1 of logistic regression analyzing the association of genotypes of polymorphic loci rs1495741 of the NAT2 gene and rs3731722 of the hAOX1 gene with disease status, a significant increase in the odds of developing ALL was found in carriers of the rs1495741 G/G genotype (OR = 2.71), with the highest risk (OR = 4.06) observed for the rs3731722 A/G polymorphism. According to Model 2 of logistic regression, when the interaction between the rs1495741 and rs3731722 polymorphisms was included in the model, the combination of G/G (rs1495741) and A/G (rs3731722) genotypes also remained statistically significant (p = 0.01). Conclusion. The key marker of predisposition to the development of childhood ALL is the SNP rs3731722 of the hAOX1 gene. The maximum increase in ALL risk is observed in heterozygous carriers of the rs3731722 A/G polymorphism of the hAOX1 gene in combination with the rs1495741 G/G genotype of the NAT2 gene. Key words: children, lymphoblastic leukemia, NAT2, hAOX1, single nucleotide polymorphisms
Chylopericarditis (CP) is a condition in which lymph accumulates in the pericardial sac. Primary (idiopathic) and secondary CP are distinguished. Secondary CP develops after cardiac surgery or thoracic interventions (9%), chest trauma, radiation therapy, mediastinal neoplasms (6%), systemic diseases, lymphangiomatosis, and tuberculosis. Primary CP is a diagnosis of exclusion after ruling out all the above causes. The majority of CP cases are idiopathic (56%). To date, no more than 100 cases of this disease have been described in the literature. The article presents a brief literature review and a clinical case important for practicing pediatricians, given that the correct diagnosis was established after 9 years of follow-up of a child with significant pericardial effusion in various clinics. Key words: thoracic duct, lymph, pediatrics, cardiac tamponade, chylous effusion, chylopericardium
A 13-year-old child with HIV infection, stage IVB, developed immune reconstitution inflammatory syndrome (IRIS) shortly after initiating highly active antiretroviral therapy. This manifested as multiple opportunistic infections: disseminated cryptococcosis involving the central nervous system and lungs, Pneumocystis pneumonia, and subsequently generalized tuberculosis affecting intrathoracic lymph nodes, lungs, pleura, peripheral lymph nodes, and bones. This case illustrates the diagnostic challenges, including differential diagnosis, the need for multi-stage examination, and verification of tuberculosis. A comprehensive approach, including repeated laboratory and instrumental investigations and morphological verification, enabled confirmation of the disease etiology (Mycobacterium tuberculosis and Cryptococcus neoformans) and successful etiotropic therapy. Key words: HIV, children, immune reconstitution inflammatory syndrome, opportunistic infections, tuberculosis, cryptococcosis, pneumocystis pneumonia
Improving quality of life (QoL) is a priority goal in the treatment of inflammatory bowel disease (IBD) in children. The impact of genetically engineered biological therapy (GEBT) on the psychosocial domains of QoL in the Russian population remains insufficiently studied, particularly in the context of family functioning. Objective. To determine the impact of biological therapy on the quality of life of children with inflammatory bowel disease and their families based on the analysis of data from the IMPACT-III, PedsQL 4.0 Generic Core Scales, and PedsQL Family Impact Module questionnaires. Patients and methods. A single-center, cross-sectional, prospective study was conducted involving 77 patients (8–17 years old) with a verified diagnosis of IBD (Crohn's disease – 44, ulcerative colitis – 33). Patients were divided into groups: group 1 (GEBT + baseline therapy, n = 31) and group 2 (isolated baseline therapy, n = 46). The disease-specific IMPACT-III questionnaire, the generic PedsQL 4.0 Generic Core Scales, and the PedsQL Family Impact Module (PedsQL FIM) for parents were used. Results. No statistically significant differences were found in the total IMPACT-III score between the GEBT and baseline therapy groups (76.0 (65.5; 85.0) vs. 71.0 (61.3; 79.8); p = 0.105). A significant advantage of GEBT was revealed in the “Emotional Functioning” domain (IMPACT-III): 76.0 (64.5; 84.0) vs. 66.0 (47.0; 75.0) points (p = 0.026; r = -0.30). No intergroup differences were recorded in general QoL indicators (PedsQL) and family functioning (PedsQL FIM) (p > 0.05). A strong correlation was found between IMPACT-III and PedsQL (ρ = 0.643; p < 0.001). No significant correlations were identified between subjective QoL and clinical activity indices (PCDAI/PUCAI) (p > 0.05). Conclusion. Biological therapy is associated with an improvement in the emotional status of children with IBD, which is more accurately captured by the disease-specific instrument. The absence of a correlation between clinical activity and QoL highlights the independent role of psychosocial factors, necessitating the integration of psychological support into standard patient management protocols. Key words: Crohn's disease, inflammatory bowel disease, children, quality of life, ulcerative colitis, biological therapy, IMPACT-III, PedsQL
Hypophosphatasia (HPP) is an orphan disease resulting from reduced levels of circulating alkaline phosphatase (ALP) due to pathogenic variants in the ALPL gene. The advent of pathogenetic enzyme replacement therapy (ERT) with asfotase alfa has radically changed the prognosis for patients with severe forms of the disease. Objective. To demonstrate the clinical features of the infantile and childhood forms of HPP during long-term therapy with asfotase alfa. Patients and methods. A multicenter retrospective study (case series, n = 6) was conducted. The group included 1 patient with the infantile form and 5 patients with the childhood form of HPP (age at diagnosis – 6.0 [4.0; 6.5] years). Patients received asfotase alfa at a dose of 2 mg/kg 3 times per week. Anthropometric data (height/weight SDS, Auxology program), radiological changes (RSS scale), neurological and respiratory status were assessed. Results. Initially, patients with compound heterozygous mutations had more pronounced growth retardation (height SDS from -2.54 to -2.46) compared to heterozygous carriers (p < 0.001). During ERT (duration 3.8 [1.5; 5.6] years), patients with initial growth retardation showed a statistically significant improvement in growth rates (p < 0.001) reaching normative values on average after 10 months; all patients had radiological confirmation of increased bone density and regression of rickets-like changes after 6–8 months of therapy; regression of muscle hypotonia, improved tolerance of physical activity, and reduced frequency of respiratory diseases (to <4 episodes per year) were noted. Adverse events were limited to local reactions at injection sites and did not lead to therapy discontinuation (except for temporary suspension in 1 patient). Conclusion. Long-term therapy with asfotase alfa in the infantile and childhood forms of HPP is characterized by sustained positive dynamics, ensuring regression of bone deformities, normalization of anthropometric and clinical parameters regardless of genetic status. Key words: hypophosphatasia, asfotase alfa, enzyme replacement therapy, orphan diseases, height SDS
The increasing prevalence of small intestinal bacterial overgrowth (SIBO) in the pediatric population necessitates the search for alternative therapeutic methods that can reduce the frequency of antibacterial drug use. One such alternative may be the use of the drug Enterol®, containing the non-bacterial probiotic strain Saccharomyces boulardii CNCM I-745. Despite its proven efficacy in adults, data on its use in children with SIBO are limited, which determined the objective of this study. Objective. To study the comparative efficacy of monotherapy for SIBO using the non-bacterial probiotic strain S. boulardii CNCM I-745 versus metronidazole in children. Patients and methods. The prospective study included 88 children (12–17 years old) with a verified diagnosis of SIBO. Patients were randomized into 2 groups: the main group (n = 43) received S. boulardii CNCM I-745 (the drug Enterol®, Biocodex, France) (1000 mg/day), the comparison group (n = 45) received metronidazole (20 mg/kg/day) for 14 days. The rate of small intestinal decontamination (according to hydrogen breath test data) and the dynamics of symptoms on a binary scale (0–1 points) were assessed 1 month after treatment. Results. The decontamination rate in the group of patients taking Enterol® was almost 2 times higher, amounting to 83.7% (36/43) versus 42.2% (19/45) in the comparison group (p = 0.0001). Both groups showed a decrease in the total symptom index, but the regression was more pronounced in the main group (from 6 to 2 points). After therapy, nausea, vomiting, belching, dyspepsia, and diarrhea were completely resolved in both groups. Complaints of abdominal pain, bloating, and feeling of fullness persisted significantly less frequently in the main group (16.3%, 9.3%, and 4.7%, respectively) than in the comparison group (53.3%, 42.2%, and 31.1%, respectively; p < 0.05). Conclusion. The use of the drug Enterol®, containing the non-bacterial probiotic strain S. boulardii CNCM I-745, in children with SIBO demonstrates higher decontamination and clinical efficacy compared to metronidazole. The obtained data allow this probiotic to be considered as a means of correcting dysbiosis in SIBO. Key words: small intestinal bacterial overgrowth, Saccharomyces boulardii CNCM I-745, metronidazole, children, hydrogen breath test
With the growing number of obese adolescents, research into sleep disorders as an aggravating factor in metabolic deterioration is an important link in the development of effective preventive and treatment strategies. The objective of the study is to investigate the characteristics of sleep architecture and their relationship with metabolic parameters in obese adolescents. Patients and methods. Twenty-five adolescents aged 12–16 years were examined. The main group (n = 10) consisted of patients with exogenous-constitutional obesity, and the comparison group (n = 15) consisted of adolescents without obesity. Physical and sexual development were assessed, and laboratory diagnostics of carbohydrate and fat metabolism indicators were performed. Sleep quality was assessed by recording polysomnograms. Results. When assessing subjective sleep characteristics through a questionnaire, 8 (80%) of 10 obese adolescents reported poor sleep quality, which differed significantly from the comparison group (ϕ*emp = 3.152). When assessing the qualitative characteristics of sleep, a significant decrease in sleep duration was revealed: 399.5 [382; 407] min and 482 [474; 487] min in the main and comparison groups, respectively (p < 0.0001). A detailed analysis of the hypnogram in the group of obese patients showed a decrease in the latency of stage N1 (p = 0.005) and stage N3 (p < 0.0001) of slow-wave sleep and a significant increase in the latency of the REM phase: 135 [124.75; 143] min and 82 [79;84] min in the main and comparison groups, respectively (p < 0.0001). Analysis of sleep stage duration relative to total sleep time also revealed significant differences between the groups: obese patients showed an imbalance in the duration of slow-wave sleep stages, manifested by a significant shortening of stages N1 and N2 and a significant increase in the duration of stage N3 – 32.55 [25.3; 45.1] min and 9.7 [8.5; 11.5] min, respectively (p < 0.0001). Thus, obese patients had significant sleep architecture disturbances, indicating inadequate nighttime rest. Qualitative sleep disturbances correlated with the degree of excess body weight: negative correlations were found between latency (r = -0.87; p = 0.05), sleep efficiency (r = - 0.65; p = 0.05), and SDS body mass index, indicating a deterioration in sleep quality as obesity progressed in adolescents. Conclusion. Adolescents with obesity have been found to have sleep pattern abnormalities, and a correlation has been established between dyssomnia and metabolic and hormonal markers at various degrees of obesity. Key words: dyssomnia, obesity, adolescents, polysomnography, sleep
The effectiveness of delivery of pharmaceutical sprays containing the same active substance in the same concentration to the focal point of inflammation in the treatment of throat diseases depends on the quality of spraying of the drug. Objective. Comparative analysis of the spray parameters of 8 benzidamine drugs produced in the form of a metered-dose spray to select a drug with optimal spray quality characteristics. Materials and methods. The study included 8 drugs in the form of metered-dose sprays for topical use containing benzydamine and approved for use in children aged 3 years and older: Tantum® Verde (marketing certificate holder Angelini Pharma SpA, Italy), Oralsept® (marketing certificate holder Gedeon Richter Plc., Hungary), Lorangin® (marketing certificate holder Penta Group Research and Production Association LLC, Russia), VERTUM-LOR (VERTEX JSC, Russia), Faringosprey (marketing certificate holder Sun Pharmaceutical Industries Ltd., India), FARINORM® Benzydamine (marketing certificate holder YuzhPharm LLC, Russia), INLARTEX (marketing certificate holder Tula Pharmaceutical Factory LLC, Russia), Anestojet (marketing certificate holder IRIS LLC, Russia). For all samples, the dose mass reproducibility (DMR), spray width and pattern, spray dynamic characteristics, and brightness profile were studied. Results. The AMD test showed that the mean dose masses differ insignificantly, and reproducibility is characterized by a relative error of only 1–2% for all drugs, indicating good dosing stability. The test for spray pattern and distribution, conducted on a simulation model based on the area of a single spray deposition, showed that the widest and most uniform spray, which promotes the most complete deposition of the drugs in the oral cavity, is achieved with Tantum® Verde and Oralsept®. A comparative analysis of the sprays by dynamic characteristics confirmed the conclusion of the previous test that these drugs have the most favorable spray mechanism for delivering the drug to the site of inflammation and correspond to classic sprays. Conclusion. The improved dynamic performance of the drug's spray mechanism facilitates more effective drug delivery to the site of action – the site of inflammation. Tantum® Verde and Oralsept® sprays exhibit the most favorable dynamic performance. Their performance is virtually identical across all tests. Key words: benzydamine, dose mass reproducibility, cone angle, cone shape, acute respiratory infections, metered-dose spray
Gastrointestinal tract (GIT) lesions occur throughout all stages of COVID-19 and significantly affect the course and outcome of the infectious process. In this regard, the impact of COVID-19 on the course of inflammatory bowel diseases (IBD), in particular ulcerative colitis and Crohn's disease, is of interest. The objective of the study is to establish the dynamics of the main clinical and laboratory symptoms of IBD in children after COVID-19. Patients and methods. In an observational retrospective single-center study, the clinical manifestations and laboratory diagnostic data of 28 children with IBD before and after COVID-19 were studied. Results and discussion. The study included data on children (15 boys) with IBD with an average age of 12.9 ± 3.4 years, and an interval between COVID-19 infection and subsequent hospitalization of 2.6 ± 1.3 months. An increase in cases of asthenic syndrome (fatigue, weakness, headaches) from 3 (8.5%) to 13 (46.4%) before and after infection, respectively (р < 0.05), and an increase in the frequency of pain and/or swelling in the joints of the limbs, spine, and muscles from 11 (39.3%) to 21 (75.0%) (р < 0.05). After COVID-19, a decrease in serum ferritin was observed (84.0 ± 18.7 μg/L and 23.4 ± 15.2 μg/L before and after infection, respectively, р < 0.05); anemia (Hb <110 g/L) – in 9 (32.2%) patients compared to 3 (10.6%) children before COVID‑19 (р < 0.05). A significant increase in serum and fecal lactoferrin concentrations was also found (5.1 ± 1.1 ng/mL and 10.4 ± 1.7 ng/mL, 159.4 ± 16.3 ng/g and 211.6 ± 17.7 ng/g before and after infection, respectively, р < 0.05), calprotectin (236.9 ± 24.8 μg/g and 331.2 ± 28.5 μg/g, р < 0.05) and a decrease in citrulline (67.0 ± 12.3 μmol/L and 33.2 ± 9.2 μmol/L, p < 0.05). Conclusion. Thus, COVID-19 affects the course of IBD, contributes to the increase in clinical symptoms, damage to the intestinal wall, the formation of iron deficiency states, and thrombocytopenia, which indicates the need for additional monitoring of the health status of children with IBD during the convalescence period after COVID-19 and correction of the developed disorders. Key words: SARS-CoV-2, post-COVID syndrome, inflammatory bowel disease, Crohn's disease, ulcerative colitis, intestinal wall inflammation markers
Alopecia areata (AA) is a disease that causes non-scarring hair loss, affecting both adults and children. It is the second most common disease (after androgenic alopecia) leading to hair loss. The key link in the pathogenesis is considered to be autoimmune damage to the hair follicles, and there are many factors that influence this process. This review highlights the pathogenetic features of AA, its comorbidity with other diseases, and treatment principles. Most studies analyzing markers of inflammation note an increased concentration of T-helper 1 (Th-1), Th-2, Th-17, and an increase in the level of cytokines they produce in the blood serum. There is comorbidity of AA with a number of autoimmune, metabolic, and other diseases. In addition, certain additional factors have a negative impact on AA: obesity, sleep disorders, stress, etc. Many drugs used to treat AA are only approved for use in adults, and are prescribed to children on an off-label basis. Local and systemic drugs are used, the main mechanism of action of which is aimed at suppressing immune responses. Janus kinase inhibitors are considered one of the promising drug groups for the treatment of AA. Key words: alopecia areata, comorbidity, inflammatory markers, metabolic disorders, sleep disorders, obesity, pathogenesis
As some of the most common diseases in pediatric practice, acute respiratory, intestinal, and herpesvirus infections have a negative impact on patients' quality of life even after their main symptoms have been relieved. There has been virtually no research into objective indicators of quality of life for these diseases. Objective. To assess the quality of life of children who have suffered from acute respiratory infections (ARI), acute gastroenteritis, and Epstein–Barr virus infection (EBVI) during the period of clinical manifestation of the disease and during early convalescence. Patients and methods. In an observational, single-center, prospective, selective, uncontrolled study, we examined the quality of life indicators of 50 children aged 5–17 years who had suffered from ARI (n = 24), acute gastroenteritis (n = 11), and EBVI (n = 15). The HUI2 and HUI3 questionnaires, adapted and validated for Russian clinical practice, were used to assess quality of life. The questionnaires were administered in person on the 1st and 7th days of hospitalization, as well as 3 months after discharge from the hospital via telephone interview. The quality of life indicator after 3 months served as a control value for quality of life. Results. In patients with ARI, acute gastroenteritis, and EBVI, the HUI2 and HUI3 health indices in the acute period were significantly lower than in the control group: 0.88 ± 0.03 vs. 0.97 ± 0.01 (р < 0.05) and 0.84 ± 0.04 vs. 0.97 ± 0.01 (р < 0.01), respectively; 0.76 ± 0.04 vs. 0.97 ± 0.01 (р < 0.001) and 0.58 ± 0.10 vs. 0.97 ± 0.01 (р < 0.001); 0.82 ± 0.04 vs. 0.97 ± 0.01 (р < 0.001) and 0.74 ± 0.07 vs. 0.97 ± 0.01 (р < 0.01). Emotional disorders, incidence, severity, and ability to control pain were also noted. The most pronounced disturbances in quality of life were observed in patients who had suffered from acute gastroenteritis. Conclusion. Considering the data obtained in the study, practicing physicians should strive not only to relieve the symptoms of the infections in question, but also to normalize the quality of life of convalescents. Key words: quality of life, health indices, acute respiratory infections, acute gastroenteritis, Epstein–Barr virus infection, children
Adenoid hypertrophy is a common pathology in childhood associated with a high risk of developing exudative otitis media (EOM). EOM is characterized by the accumulation of secretions in the tympanic cavity without pronounced symptoms, which makes diagnosis difficult. Despite the availability of modern instrumental methods, the detection of EOM in patients with adenoid vegetations remains a clinically significant problem. Objective. To evaluate the diagnostic value of wideband tympanometry in determining the functional state of the auditory analyzer in patients with adenoid hypertrophy at various stages of perioperative management. Patients and methods. As part of a prospective study conducted between January and September 2024, we examined 57 patients (median age 6 [5; 7] years). Participants were divided into two groups: the main group (n = 29) consisted of children with grade II–III adenoid hypertrophy combined with damage to the auditory analyzer (eustachian tube dysfunction, exudative otitis media), and the control group (n = 28) – patients with isolated adenoid hypertrophy without signs of middle ear pathology. All patients underwent otomicroscopy, tonal threshold (over 6 years of age) or play audiometry (under 6 years of age), classical (probing tone frequency 226 Hz) and wideband tympanometry. Results. A significant decrease in the absorption coefficient was found in the main group of patients compared to the control group (p < 0.05), as well as an inverse correlation (r = -0.505, p < 0.01) between the absorption coefficient value and the bone-air gap value recorded during pure-tone threshold audiometry. The largest differences in the absorption coefficient at peak pressure and ambient pressure were observed in the main group of patients with Eustachian tube dysfunction (18.50 [13.38; 23.00]), which exceeded similar indicators both in the EOM (0.00 [0.00; 6.00]) and in the control group (1.00 [0.00; 4.50]), p < 0.005. Conclusion. The inclusion of wideband tympanometry in the audiological examination of patients with adenoid hypertrophy demonstrates significant clinical advantages, including increased diagnostic accuracy in the detection of EOM, optimization of treatment selection, objective assessment of the effectiveness of treatment, and the possibility of dynamic monitoring of the functional state of the middle ear after surgery. Key words: adenoid hypertrophy, adenoid vegetations, exudative otitis media, broadband tympanometry, wideband absorption, absorbance
