This article presents an analysis of current clinical guidelines for the management of patients with eosinophilic esophagitis (EoE) — a chronic immune-mediated disease of the esophagus characterized by eosinophilic infiltration of the mucosa (≥ 15 eos/hpf) and clinical manifestations of esophageal dysfunction. The review highlights key changes in diagnostic approaches and discusses contemporary treatment strategies, including dietary therapy (starting with the least restrictive diets), pharmacological treatment (proton pump inhibitors, topical steroids, biologic therapy), and endoscopic dilation for strictures. The authors emphasize the need for comprehensive monitoring (clinical, endoscopic, and histological) to assess treatment response and for long-term maintenance therapy given the chronic nature of the disease. Special attention is paid to pediatric aspects of patient management.

Background. Long QT syndrome is hereditary disease, cardiac canalopathy variant, characterized by syncope and high risk of sudden cardiac death due to occurrence of polymorphic ventricular tachycardia (VT), torsade de pointes, and ventricular fibrillation. Acute respiratory viral infection may aggravate clinical course of primary electrical heart diseases. Clinical case description. 14-year-old female patient was transferred to infectious diseases hospital from another hospital with positive PCR test on new coronavirus infection (COVID-19) after loss of consciousness in November 2021. Syncope was first noted at the age of 12, however then did not recur, and their examination and treatment were postponed due to the COVID-19 pandemic. Syncopal states continued during COVID-19. Cardiac examination was performed at infectious diseases hospital: recurrent VT, torsade de pointes, was diagnosed along with QT interval prolongation. The girl's condition has improved after the treatment and selection of antiarrhythmic therapy. 15 days later negative PCR test for SARS-CoV-2 was received, and the patient was transferred to specialized hospital, where the long QT syndrome was confirmed, and dual-chamber cardioverter defibrillator was installed. Conclusion. This clinical case demonstrates that ARVI can aggravate the course of existing primary arrhythmia and emphasizes the crucial role of timely diagnosis and integrated approach to the management of patients with genetically determined cardiac arrhythmias.

The clinical guidelines for asthma provide a systematic approach to the diagnosis and treatment of this chronic inflammatory disease of the respiratory tract. The article provides a detailed description of current diagnostic methods, including history taking, physical examination, pulmonary function tests, and inflammation measurements. The focus is on individualizing therapy based on the severity and control of the disease, as well as the presence of comorbidities. The authors emphasize the importance of using inhaled corticosteroids as the foundation for long-term control and the use of fast-acting bronchodilators for symptomatic relief. The guidelines also cover non-pharmacological measures, such as avoiding allergens, lifestyle changes, and teaching patients how to properly use inhalers and monitor their symptoms. An important aspect of the guidelines is the “supportive therapy” strategy and the plan of action for exacerbations, which helps to respond promptly and reduce the risk of severe conditions. The guidelines emphasize the need for regular monitoring of treatment effectiveness and the adjustment of therapy based on the progression of the disease. The goal of these clinical guidelines is to improve the quality of care for patients with asthma, reduce the frequency of exacerbations, and enhance their quality of life through the implementation of evidencebased diagnostic and treatment methods.

Atopic dermatitis is a common chronic skin disease that is always accompanied by itching and has a significant impact on the patient's quality of life. The goal of therapy for atopic dermatitis, like any chronic dermatosis, is to achieve stable remission, which, given the nature of the disease, can be achieved with the help of a drug that has anti-inflammatory potential and a high safety profile. The therapeutic options for the use of pimecrolimus in patients with atopic dermatitis are observed in the Article.

Background. Premature ventricular contractions (PVCs) are a common heart rhythm disorder in children, often following a benign course. However, in rare cases, antiarrhythmic therapy is required for managing this arrhythmia. Limited data is available regarding the effectiveness of such therapy specifically in children. Objective. To evaluate the efficacy and safety of propafenone administration in children with idiopathic PVCs. Methods. The study enrolled 33 children aged 11.1 ± 4.8 years (29 days — 17 years) with idiopathic PVCs. Propafenone dose was titrated from initial (5–7 mg/kg/day) to effective (no more than 15 mg/kg/day) dose under clinical and electrocardiographic control to monitor for proarrhythmias and other side effects. An increase in PQ interval duration and a widening of the QRS complex no more than 25% compared to baseline was considered acceptable. Results. The incidence of PVCs before propafenone administration was 36.3 ± 10.1 (22.0–60.6) thousands/day or 33.2 ± 8.4% (20.5–50.0). Complex forms of PVCs were observed in 25 (75.8%) children: 25 (75.8%) had frequent paired PVCs, 6 (18.2%) had polymorphic PVCs, 20 (60.6%) had short runs of ventricular tachycardia (VT), and 19 (27.6%) had a combination of various forms of PVCs. The starting dose of propafenone was 5.6 ± 2.2 mg/kg/day with subsequent increases to 10 ± 0.8 mg/kg/day. Propafenone was employed as the initial therapy in 23 (69.7%) children and as a second line therapy in 10 (30.3%) children, following the ineffectiveness or adverse effects of beta-adrenoblockers. The duration of propafenone therapy was 95.8 ± 62.8 days. Propafenone was effective in 25 (75.8%) children. The average reduction in the number of PVCs during therapy was 71.7 ± 32.6% (13.0–100.0) during therapy. One (3%) child developed proarrhythmia — sustained VT and 1 (3%) child had gastrointestinal side effects. Conclusion. Propafenone is an effective antiarrhythmic drug in children with idiopathic PVCs, including patients with poor response to beta-adrenoblockers. Arrhythmogenic and extracardiac side effects are possible during propafenone therapy, which require clinical and electrocardiographic observation in the process of selecting an effective dose of the drug.

Patients with immune-inflammatory rheumatic diseases (IIRDs) often present with non-inflammatory musculoskeletal pain associated with nociceptive dysfunction, central sensitization, and secondary fibromyalgia (FM). In recent years, an increasing number of publications have appeared dealing with FM in rheumatoid arthritis and systemic connective tissue diseases in adult patients, while this problem is little discussed in pediatric rheumatology, partly due to the differences between the existing diagnostic criteria in children and adults, which complicate the diagnosis of juvenile secondary FM. The consequence of this is often the unfounded prescription or switching of synthetic disease-modifying antirheumatic drugs (DMARDs) or biologic DMARDs in patients who do not require intensified antirheumatic therapy, but rather psychotherapy and psychopharmacotherapy, as well as the wider use of physical and rehabilitation medicine methods. In a brief narrative review, we tried to trace the investigation of FM in a rheumatological clinic, including children with IIRD, from a historical perspective, to summarize current literature data on this problem and to point out possible solutions.

The prevalence of concomitant mental disorders in children with rheumatic diseases is notably higher than in the overall population. However, psychiatric comorbidity in pediatric rheumatology remains poorly understood, whereas approaches to mental disorders therapy in children with rheumatic diseases are not clearly defined. The review article considers currently available data on the mental disorders prevaling in patients with juvenile idiopathic arthritis, juvenile-onset systemic lupus erythematosus and juvenile primary fibromyalgia. The article provides data on the efficacy and safety studies of psychotherapy and psychopharmacotherapy. It also discusses application prospects of biological disease-modifying antirheumatic drugs for treatment of comorbid depression in children with rheumatic diseases.

Atopic dermatitis is a hereditary inflammatory skin disease characterized by pruritus, a long recurrent course and certain evolutionary dynamics. Atopic dermatitis of moderate and severe severity is considered a systemic disease that exacerbates the course of associated pathologies, including cardiovascular, neuropsychiatric, and malignant diseases. The current paper presents the essentials about moderate and severe severity atopic dermatitis, statistical epidemiologic and pathogenetic data is thoroughly processed, the issues of the quality of life of such patients are especially accentuated. It is known that a few years ago the therapy of moderate and severe atopic dermatitis was based on systemic corticosteroids and classical immunosuppressants, but they had limited efficacy and were not suitable for long-term treatment due to their safety profile. This article highlights the development of new effective and easy-to-use therapies for atopic dermatitis, which led to the emergence of selective Janus kinase inhibitors. The review presents the way selective inhibitors of Janus kinases works and their effect on the barrier function of the skin. The paper provides the research data on the very first drug from the group of selective inhibitors - upadacitinib, which proved its efficacy on a par with a high degree of safety. The authors presented their own clinical observation of the use of upadacitinib in adolescents with severe atopic dermatitis. The use of upadacitinib in the described clinical cases led to a decrease in the severity of subjective and objective symptoms of inflammatory skin diseases.

The relevance of the disease is due to its prevalence ― for acute urticaria up to 20% with predominance in the paediatric population, for chronic spontaneous urticaria up to 0.5–5% of the population. The course of the disease is characterised by unpredictability of prognosis of duration, effectiveness of standard therapy, serious impact on the quality of life of the patient, his relatives, the burden on health authorities. The lack of accurate understanding of the mechanisms of disease development, a wide range of pathogenetic treatment complicates the possibility of rapid achievement of drug remission. The clinical Recommendations contain up-to-date information on epidemiology, pathogenesis, clinical picture, differential diagnosis, possibilities of examination and stage treatment, including immunobiological therapy. The procedure of medical care, prophylaxis and dispensary observation, criteria for assessing the quality of patient management and supporting material, including questionnaires to assess the severity of the condition and the effectiveness of treatment are outlined. Clinical recommendations on urticaria are intended for practicing physicians of all specialities, students, teachers of medical schools, residents, postgraduates and researchers.

The article presents literature review about arrhythmias in children with acute respiratory viral infections (ARVI). The search was carried out in such databases as PubMed, CyberLeninka, RSCI, etc. ARVI is the most common infectious disease in children and adults, and it can have severe course and various complications. Arrhythmias can be frequently revealed in children with ARVI, and most of them are transient. Life-threatening cardiac rhythm and conduction disorders (CRCD) may occur more rarely, especially in severe cases. Knowledge and interest in the pathophysiology of viral infections have increased significantly, including CRCD risk factors in ARVI, thanks to the data obtained during the analysis of COVID-19 clinical course and outcome. This review summarizes and analyzes data on CRCD prevalence and arrhythmogenesis causes in ARVI.

The article presents the review of 61 publications. The topic is highly relevant due to the fact that clinical trials of drugs and chemotherapy regimens usually enroll adults, while children participate only in a small number of them. Often in clinical practice, anti-tuberculosis drugs are prescribed to children off-label. The frequency of adverse reactions in children varies widely depending on approaches to their reporting. The most severe and frequent adverse events are associated with liver injury. In recent years, clinical trials of fluoroquinolones, bedaquiline, and delamanid were run in pediatric patients with drug resistant tuberculosis demonstrating satisfactory tolerability and safety of these drugs.

Impaired skin barrier plays a major role in the development of many skin diseases and conditions such as dry skin, sensitive skin, atopic dermatitis, contact dermatitis, etc. The topical therapy aims at not only suppressing the inflammatory response in the skin, but also at regenerating the destroyed protective epidermal lipid barrier in atopic dermatitis patients. Dexpanthenol was produced by synthesis in the middle of the last century and is a derivative of pantothenic acid. Topical dexpanthenol is well absorbed through the skin, where it is converted into pantothenic acid, a component of coenzyme A, and thus participates in the regulation of the synthesis of fatty acids and sphingolipids, components of the stratum corneum. Therefore, pantothenic acid is essential for the normal functioning of the epithelium. Topical dexpanthenol improves skin hydration due to its hygroscopic properties and ability to retain moisture. The hydrating effect is interrelated with its capacity to regenerate the epidermal barrier of the skin. Dexpanthenol also enhances the differentiation of corneocytes and lipid synthesis, stimulating the regeneration of the epidermis. Numerous studies show that the efficacy of dexpanthenol is comparable to the efficacy of glucocorticosteroids by a weak degree of activity. Dexpanthenol is the active ingredient of Pantoderm, which is available as cream and ointment. Pantoderm ointment and cream contain 5% dexpanthenol. The article presents its own clinical reports of the treatment of patients with atopic dermatitis and administration of the combination therapy. It may be concluded that the use of topical glucocorticosteroids combined with dexpanthenol can increase the effectiveness of therapy in patients with atopic dermatitis.

В рутинной педиатрической практике не-IgЕ-опосредованные формы гастроинтестинальной пищевой аллергии по-прежнему остаются плохо распознаваемыми. Это обусловлено многообразием клинических проявлений, отсутствием достоверных лабораторных диагностических методов, неочевидной ассоциацией со временем и причинно-следственной связью с аллергеном. Незрелость барьерных механизмов, ранний перевод ребенка на искусственное вскармливание увеличивают проникновение в организм значительного количества чужеродных белков и способствуют развитию пищевой сенсибилизации. Принято выделять следующие клинические формы гастроинтестинальной не-IgE-опосредованной пищевой аллергии у детей – синдром энтероколита, индуцированного пищевыми белками, индуцированная пищей энтеропатия и индуцированный пищей проктоколит. В случае не-IgE-опосредованных реакций со стороны желудочно-кишечного тракта диета остается универсальным диагностическим и лечебным мероприятием. Элиминация значимого аллергена позволяет обеспечить иммунологический покой и формирование пищевой толерантности. В этой связи принципиально важными становятся строгость и продолжительность соблюдения элиминационной диеты (комплаентность). В статье описываются клинические фенотипы гастроинтестинальной пищевой аллергии, приводится дифференциальный диагноз в зависимости от уровня аллергического воспаления, описываются принципы и протоколы диагностической и элиминационной диеты. In routine pediatric practice, non-IgE-mediated forms of gastrointestinal food allergy are still poorly recognized. This is due to the variety of clinical manifestations, the lack of reliable laboratory diagnostic methods, the unclear association with time, and the causal relationship with the allergen. Immature barrier mechanisms and early transition to formula feeding increase the penetration of allergen proteins, leading to sensitization. The article discusses three clinical forms of non-IgE-mediated gastrointestinal food allergy in children: food protein-induced enterocolitis syndrome, food protein enteropathy, and food protein-induced proctocolitis. In these cases, diet is a universal diagnostic and therapeutic measure. Eliminating the allergen allows for immunological reset and the induce the food tolerance. Therefore, strict adherence to elimination diets is crucial. The article also provides a differential diagnosis based on the level of allergic inflammation of the intestine and outlines principles and protocols for diagnostic and elimination diets.

Experts of the Union of Pediatricians of Russia have developed modern guidelines on management of children with acute respiratory viral infection. The term “acute respiratory viral infection” (ARVI) combines following nosological forms: acute nasopharyngitis, acute pharyngitis, acute laryngitis, acute tracheitis, acute laryngopharyngitis, upper respiration tract infection (unspecified). The issues of epidemiology, diagnosis, treatment, and prevention have been considered in detail.

Photodermatoses represent a heterogeneous group of disorders characterized by the development of pathological skin reaction to solar radiation. The development or intensification of inflammatory skin reaction after exposure to ultraviolet or electromagnetic spectrum that is visible to the human eye is a distinctive feature of all photosensitive photodermatoses. Although photodermatoses are less common in children than in adults, they are often associated with genetic or congenital metabolic disorders, and may also point to diffuse connective tissue diseases. Paediatric photodermatoses are often the result of genetic or congenital metabolic disorders, and may also indicate diffuse connective tissue diseases. The epidemiological studies have showed that the global prevalence of photodermatoses diagnosed with photopatch tests is above or equal to 5.7%. The authors presented a modern classification of photosensitive dermatoses according to the etiological factor. The article provides up-to-date information about photosensitive dermatoses, including statistical epidemiological data, pathogenesis features, and also emphasis is placed on the issues of the quality of life of children and their parents. The authors described the clinical presentations of the most common paediatric photosensitive dermatoses and the basic principles of their therapy. Among topical glucocorticosteroids, methylprednisolone aceponate has proven itself in the treatment of paediatric photodermatoses as it has not only a pronounced anti-inflammatory effect, but also is easy-to-use. The timely diagnosis of paediatric photosensitivity will help to minimize the development of complications associated with delayed treatment and insufficient prevention (photoprotection).

To date, there has been a steady increase in allergic diseases, which is a heavy burden on the population and the health care system. The high prevalence, chronic course and pronounced impact on the quality of life require specialists to take a rational approach to the treatment of allergic pathology. From the moment of its appearance to the present, antihistamines have been widely used in real clinical practice, without losing their relevance. This article examines the place of antihistamines in modern therapy of the most common allergic and other histamine-dependent diseases.

Atopic dermatitis is an inflammatory skin disease that is most frequently occurred in children, but also common in adults. The disease is characterized as chronic, but only 20% of children have severe atopic dermatitis, while the other 80% achieve a longterm remission by the age of 8 and earlier. The article summarizes the main details about atopic dermatitis including statistical epidemiological and pathogenetic data, and places special emphasis on the issues of patients’ quality of life and steroidophobia. It is known that combination treatment regimens are often used in the treatment of atopic dermatitis. The article highlights approaches to the tactics of choosing topical therapy according to the European guidelines for the treatment of atopic dermatitis 2018. Despite the fact that topical calcineurin inhibitors were made available for the treatment about 15 years ago, this group of drugs take the lead in the treatment of atopic dermatitis due to a pronounced anti-inflammatory mechanism of action with a steroid-sparing effect. The review presents the main mechanisms of action of topical calcineurin inhibitors and their effect on the skin’s barrier function. Literature data on the proven efficacy and high safety profile of Tacrolimus, the very first drug from the topical calcineurin inhibitor group, are presented. In the article, the authors described examples of the successful use of Tacrolimus, which can suppress the T-lymphocyte activation and reduce the production of pro-inflammatory cytokines in patients with moderate to severe atopic dermatitis, as well as with other chronic allergic dermatoses. The use of Tacrolimus in the presented clinical cases led to a reduction of severity of subjective and objective symptoms of the inflammatory skin diseases.

Mental health disorders in pediatric rheumatologists’ practice are often unrecognized and insufficiently taken into account by pediatric rheumatologists when managing patients suffering from juvenile idiopathic arthritis (JIA). The chronic pain syndrome, which complicates the course of JIA, largely has a psychosomatic basis and is associated both with the severity of mental disorders in the patients themselves and with the characteristics of parent-child relationships. The purpose of the research was to study the severity of manifestations of mental disorders, emotional regulation and parent-child relationships in pediatric patients with JIA with chronic pain syndrome in comparison with patients with acne. Materials and methods used: a single-center simultaneous study of adolescents aged 11 to 17 y/o was conducted in Oct.-Dec. 2022. Using a visual analogue scale, the severity of pain was assessed separately by the participants in the study and their parents; patients assessed their general condition, whilst the physician determined the overall assessment of the current activity of the disease. All of the participants had completed the Difficulties in Emotion Regulation Scale (DERS), Parental bonding instrument (PBI) and Strengths and Difficulties Questionnaire (SDQ) questionnaires. Results: the main group consisted of 30 suffering from JIA with chronic pain syndrome. The comparison group consisted of 40 with acne. In patients with JIA, the values in the scales “Behavioral problems” (p=0.001), “Hyperactivity” (p=0.001), “Problems with peers” (p=0.001), “Emotional detachment” (assessment of mothers and fathers, p=0.001) and “Hyper care” (assessment of mothers and fathers, p=0.001) were statistically significantly lower, whilst higher in the values for “Prosocial behavior” (p=0.026), “Awareness of own emotions” (p=0.001), “Emotional warmth” (assessment of mothers and fathers, p=0.001) and “Encouraging independence” (assessment of mothers and fathers, p=0.001). Conclusion: JIA patients with chronic pain syndrome demonstrated more favorable mental health outcomes compared to patients with acne, which is traditionally considered as a factor in the mental adjustment disorder of adolescents that negatively affects the emotional state, self-esteem and the quality of life.

The Union of Pediatricians of Russia together with the Russian Association of Allergologists and Clinical Immunologists and the Russian Society of Dermatovenerologists and Cosmetologists have developed new clinical guidelines for the urticaria in adults and children. Urticaria is a common disease; its various clinical variants are diagnosed in 15–25% of people in the global population, and a quarter of all cases belongs to chronic urticaria. The prevalence of acute urticaria is 20%, and 2.1–6.7% in child population, whereas acute urticaria is more common in children than in adults. The prevalence of chronic urticaria in adults in the general population is 0.7 and 1.4%, and 1.1% in children under 15 years of age, according to the systematic review and meta-analysis, respectively. This article covers features of epidemiology, etiology, and pathogenesis of the disease with particular focus on differential diagnostic search. Guidelines on treatment and step-by-step therapy scheme (both based on principles of evidencebased medicine) for pediatric patients were presented. Clarification on the analysis of the therapy efficacy and the degree of disease activity was given.

Experts of the Union of Pediatricians of Russia have developed modern guidelines on the management of children with acute obstructive laryngitis and epiglottitis. Croup is the most common cause of acute upper respiratory obstruction in children aged from 6 months to 6 years. Usually respiratory viruses are the pathogenic agents of the disease. The etiological factor of epiglottitis is Haemophilus influenzae type b in the vast majority of cases (> 90%). However, nowadays, epiglottitis caused by this pathogen agent is more common in adults in countries with mass immunization against hemophilic infection. This article considers in detail etiology, pathogenesis, and classification issues. Special attention is given to diagnosis, differential diagnosis, and therapy (via evidence-based approach) of acute obstructive laryngitis in children.