The article is republished in order to expand the audience. The article was published earlier in the Akusherstvo i Ginekologiya (Russian Federation): Sukhikh GT, Serov VN, Artymuk NV, Andreeva MD, Bazina MI, Baranov II, Bashmakova NV, Bezhenar VF, Belotserkovtseva LD, Geppe NA, Dolgushina NV, Zaretskaya NV, Zakharova IN, Zubkov VV, Enkova EV, Yesayan RM, Katkova NYu, Kvashnina EV, Kogan IYu, Korsak VS, Krasnopolskaya KV, Kukarskaya II, Molchanova IV, Nazarenko TA, Pestova TI, Podzolkova NM, Saveljeva IV, Sazonova AI, Semenov YuA, Tapilskaya NI, Tetruashvili NK, Tiselko AV, Fadeev VV, Shamugia NL, Shakhova MA, Shikh EV, Yarmolinskaya MI. The safety of hormone therapy during pregnancy. Joint statement by experts in reproductive medicine, obstetrics and gynecology, endocrinology, clinical pharmacology, neonatology and pediatrics Akusherstvo i Ginekologiya (Russian Federation). 2024;(8):196–206. (In Russ.) https://doi.org/10.18565/aig.2024.201.

The article presents current information on vitamin D. It considers not only well-known recommendations for the administration of vitamin D in paediatric practice, but also the clinical aspects of the new guidelines – Vitamin D for disease prevention: a clinical practice guideline of the Endocrine Society 2024. The document was created using the results of the review of prioritized randomized placebo-controlled trials in general populations, taking into account systematic reviews of electronic databases of patients and their representatives (without an established indication for vitamin D treatment or 25[OH]D testing). The work assessed the effect of “empirical supplementation” defined as vitamin D intake at a dose that exceeds the Dietary Reference Intakes (DRI). This article considers two sections of above guidelines (obstetric and paediatric), alongside with the results of the analytical review, which present some scientific interest, deserve the attention of practicing physicians, confirm the importance of prevention in childhood, as well as indicate the need for further studies on the assessment of vitamin D status using long-term follow-ups and a personalized approach to the groups of children and adolescents that exact very careful attention. Apart from the new guidelines, attention is drawn to the urgency of the Russian National Program for Vitamin D Deficiency in Children and Adolescents of the Russian Federation: Modern Approaches to the Management, which outlines current treatment and preventive strategies for managing vitamin D deficiency in our country using the results of the multicenter study. It is important that Russian paediatricians have an evidence-based, specific and structured document with a brief look at the main strategic issues and operational decisions on the treatment and prevention of vitamin D hypovitaminosis in contrast to ongoing discussions in different countries of the world.

Introduction. The microbiota of the oral cavity and oropharynx, actively interacts with the epithelium of the mucous membrane and the immune system, creates antagonistic conditions for the growth and reproduction of pathogens. Microbiocenosis-preserving therapy can provide conditions for maintaining colonization resistance and reduce the likelihood of adhesion of respiratory viruses.Aim. To evaluate the effect of local use of various antimicrobial drugs on the microbiota of the oropharyngeal mucosa in children with acute respiratory infection.Materials and methods. 120 children (5–10 years old) with acute respiratory infection were divided into three groups, in which they were used as part of complex therapy: in group 1st – hexetidine-containing aerosol, in group 2nd – a children’s spray containing gramicidin S and cetylpyridinium chloride, in the 3rd – 0.01% solution of benzyldimethyl-myristoylamino-propylammonium. On the 1st and 12th days of observation, participants had a throat swab taken to study the state of the oropharyngeal microbiota using 16S rRNA sequencing. The results obtained were compared with those of healthy peers.Results. According to sequencing data, the microbiota of participants in all groups before treatment differed from the microbiota of healthy peers in terms of alpha and beta diversity, as well as in the results obtained by the nearest balance method. Local use of antiseptic drugs influenced the microbiota at the level of species and genera of microorganisms. After treatment in the 2nd group, in contrast to the 1st and 3rd, statistically significant changes in the balances at the level of microorganism species were revealed towards the indicators of healthy peers.Conclusions. A combined drug containing cetylpyritinium chloride and the bacteriocin-like antimicrobial peptide gramicidin S demonstrated no negative effect on commensal microbiota and contributed to the stabilization of the regional microbiota.

Regulation of immune and inflammatory processes of the body is necessary to limit the pathogenic process induced by uropathogenic E. coli in the bladder and kidneys while limiting damage to epithelial barriers. This review presents modern ideas about the features of innate immunity of the epithelium of the urinary system (urothelium) as the first barrier to infectious agents. As the nature of immune responses in the urinary tract becomes clearer, this knowledge can be used to develop new and effective strategies for the treatment and/or prevention of urinary tract infection. Some of these strategies are aimed at enhancing innate immune responses, and some at adaptive immune responses. However, the effectiveness of these strategies is based almost exclusively on data obtained from experimental mouse models. Overall, these recent results continue to better illuminate the processes in the body that increase susceptibility to urinary tract infections and their severity. In addition to the isolation and characterization of the uropathogen, a key requirement in the diagnosis of urinary tract infection may be to determine the nature of a defect in the local urinary tract immune system. This information can eventually serve as a basis for the development of new possible therapeutic approaches to the treatment of acute and recurrent urinary tract infections and allow in the future to adapt treatment methods for individual patients in such a way that they are pathogenetically justified, as individualized as possible and reduce the risks of recurrence and chronization of urinary tract infections.

The review discusses the multifaceted effect of vitamin D on antiviral immunity, induction of antimicrobial peptides, functional activity of immunocompetent cells, autophagy processes, clearance of viruses and viral fragments. The relationship between vitamin D and allergic inflammatory cells, its modulating and tolerogenic potential is considered. The inhibitory effect of vitamin D on eosinophils, mast cells, the production of pro-inflammatory and proallergic mediators, and the synthesis of IgE has been shown. The protective role of vitamin D in the development of remodeling and hyperresponsiveness of the respiratory tract has been established by reducing the number of goblet cells, mucus hypersecretion, and the expression of metalloproteinases. The effects of vitamin D on the replication of respiratory viruses and experimental resistance to them through the induction of antimicrobial peptides and other mechanisms have been demonstrated. Data from clinical studies on the preventive effect of vitamin D on the incidence of respiratory infections and episodes of persistent wheezing in children are presented. Children with respiratory syncytial infection and vitamin D deficiency were more likely to require respiratory support and mechanical ventilation. The preventive role of vitamin D in the development of obstructive bronchitis in children and severe bronchiolitis in infants has been shown. It has been established that normal levels of 25(OH)D in the mother significantly reduce the risk of developing bronchial obstruction in the child. Alternative data that do not support a protective effect of vitamin D on respiratory morbidity and wheezing in children are discussed. Further monitoring studies that take into account geographic location and analysis of the dose of cholecalciferol used to assess its preventive role in the development of wheezing and bronchial asthma in children are advisable.

The prevalence of allergic diseases is increasing at rates corresponding to epidemic’s spread rates. Cow’s milk protein allergy (CMPA) is one of the most common food allergies in infancy. Its clinical variants remain hard-to-diagnose diseases due to their multiple clinical faces. Food allergy can develop along the pathway associated with both IgE and non-IgE, or mixed one. Non-IgEassociated variants of food allergies, due to the lack of accurate and specific laboratory markers, can cause significant difficulties in making a diagnosis. The search for new diagnostic markers continues. Faecal calprotectin, a calcium-binding leukocyte protein consisting of a complex of two monomers S100A8 and S100A9, may be one of them. Faecal calprotectin concentration is directly proportional to the number of leukocytes migrating into the intestinal wall, due to which faecal calprotectin becomes an accurate, non-invasive and sensitive indicator reflecting the level of inflammation in the intestines. Today, serum and faecal calprotectin are used as laboratory markers, and the latter, being more accessible and not critical for collection material is widely known as a diagnostic marker of inflammatory bowel diseases. Some studies suggest that faecal calprotectin may be used to diagnose cow’s milk protein allergy in young infants when other diagnostic tests are not available. Data from various studies remain contradictory. Further studies to investigate the possibilities of using faecal calprotectin as a marker of the gastrointestinal food allergy in young children is needed.

Introduction. Mother’s breast milk is considered to be the best source of infant nutrition and, paradoxical as it may sound, the only product of the infant diet, which composition is still poorly known to us. This article presents the findings of a study on the breast milk microbiota conducted in the Russian Federation for the first time.Aim. To study the composition of the breast milk microbiota of healthy women living in the Russian Federation and identify the impact of various factors on its diversity.Materials and methods. A molecular genetic study on 56 colostrum samples and 12 mature breast milk samples from 56 healthy donors using a method based on sequencing of bacterial 16S rRNA gene was conducted.Results. In a batch of 56 colostrum samples, 22 species and 242 genera of bacteria were identified. Firmicutes, Proteobacteria, Actinobacteriota were the most predominant species of bacteria in healthy women with a normal body mass index, from a physiological pregnancy, who did not take antibiotics, after natural delivery at term; Streptococcus, Staphylococcus and Gemella were the most predominant at the level of delivery. Statistical analysis of the impact of nationality, age, number of children in the family and duration of hospitalization (PERMANOVA) showed no significant differences in the proportions of bacteria in the colostrum of women (p > 0.05). The gender of the child was the only factor that turned out to be significant. The biodiversity of colostrum of girl-delivered mothers were higher (Shannon index) than that of boy-delivered mothers. In addition, the mature breast milk microbiota (1 month after delivery) has lower alpha diversity as compared to colostrum.Discussion. The analysis of our results and reports from foreign colleagues showed significant similarities and differences, which, certainly, were explained by a number of reasons related to methodological and geographical differences, the method, timing and even the time of day when breast milk samples were collected.Conclusion. In general, the colostrum of healthy women had a fairly stable bacterial composition, and its rich biodiversity fully demonstrated high quality of the first microbial inoculum for the newborn intestine. Our results provide valuable insights into the healthy breast milk microbiota in women living in the Russian Federation and can be used as reference ranges, as well as for comparison with similar indicators in women from other countries.

Aim: to optimize outcomes of the treatment and prevention of gastrointestinal diseases in adults and children. Key points. The Methodological Guidelines contain sections on the terminology, classification, mechanisms of action, requirements for sale in the Russian Federation, requirements for proving the efficacy and safety of probiotics, prebiotics, synbiotics and metabiotics, as well as functional foods enriched with them. An overview of relevant data allowing to include these drugs and products in the treatment an d prevention of gastrointestinal diseases in adults and children is presented. Conclusion. The clinical efficacy of probiotics, prebiotics, synbiotics and metabiotics depends on the specificity and quantity of their components, the dosage form, the regimen and duration of treatment. Products and functional foods with proven efficacy and safety are recommended for the treatment and prevention of gastrointestinal diseases in adults and children.

Comorbid conditions in pediatric and adolescent phthisiology determine the need for interdisciplinary collaboration between healthcare professionals in different areas of expertise both at the stage of disease diagnosis and during tuberculosis treatment. This review is aimed to systematize the knowledge of pediatricians in different areas of expertise about comorbid conditions in tuberculosis (causes, risk factors for their development, options for timely diagnosis, impact of forced polypharmacy on the development of drug complications). The data of available methodological documents and published articles on the issue are systematized. The article presents groups at high risk for developing TB disease among patients with somatic pathology, the possibilities of modern diagnostic techniques based on a comprehensive medical examination with due account for the diagnostic algorithm and treatment regimen for a particular disease. If there is a reason to suspect tuberculosis in primary health care facilities and prior to prescribing immunosuppressive drugs, the minimum mandatory diagnostic examination in risk groups is set forth. The importance of key techniques for the detection and diagnosis of tuberculosis in children and adolescents including those with immunocompromised diseases is emphasized: Mantoux test using 5 tuberculin units (TU) of purified protein derivative (PPD)-L, a test with recombinant tuberculosis allergen (RTA), diagnostic tests assessing release of interferon gamma by T-lymphocytes in vitro during selective screening), computed tomography, detection of Mycobacterium tuberculosis in any diagnostic samples. Attention is paid to the impact of forced polypharmacy on the drug complications and treatment failures in patients with comorbidities, which requires collaboration between healthcare professionals in different areas of expertise to provide adequate selection of anti-tuberculosis therapy taking into account comorbidities. This approach to the management of patients with chronic somatic pathology allows for the prevention or early detection of tuberculosis.

Введение. Грудное молоко является лучшим выбором для вскармливания младенца первых лет жизни. Грудное молоко позволяет передавать сигналы от матери к младенцу в рамках тесно связанной системы «мать – грудное молоко – младенец». Примечательно, что изменения, происходящие в каждом компоненте этой триады, влияют на траекторию развития младенца. Помимо обеспечения необходимыми питательными веществами, грудное молоко содержит множество биологически активных компонентов, макро- и микроэлементов, способствующих здоровому росту и развитию, позволяющих сформировать здоровую микробиоту и стимулирующих развитие иммунной системы младенца. Однако в современных реалиях женщинам не всегда удается сохранить исключительно грудное вскармливание. Нередко встает вопрос о правильном выборе молочной смеси для смешанного или искусственного вскармливания младенца. С древних времен козье молоко привлекало внимание родителей как альтернативное питание для детей. Известно, что в Европе XVIII-XIX веков козье молоко использовалось для кормления младенцев, оставленных в больницах для подкидышей, а немецкий писатель Канрад А. Цвейрлян издал книгу под названием «Коза как лучшая и наиболее действенная кормилица», где рассказал о том, что ребенок, оставшийся без матери, был выкормлен именно козьим молоком. Сегодня козье молоко называют супермолочной пищей с уникальными лечебными, питательными, иммунологическими и биологическими свойствами. Оно является источником витаминов, белков и антиоксидантов, может быть использовано для создания искусственной смеси в качестве альтернативы грудному молоку. С точки зрения питательности козье молоко заметно отличается от молока других молочных животных, обладая большей буферной способностью. Цель работы. В настоящее время существует немало исследований, сравнивающих возможность использования молока разных видов животных (коровье, козье, буйволиное, ослиное, верблюжье и др.). В статье представлены особенности состава козьего молока, сделан акцент на молочных олигосахаридах, которые определяют часть его уникальных свойств, а также схожесть с грудным молоком. Background. Breast milk is the best choice for feeding an infant in the first few years of life. Breast milk allows for the transmission of signals from mother to infant within a tightly coupled mother-breast milk-infant system. Notably, the changes that occur in each component of this triad influence the infant's developmental trajectory. In addition to providing essential nutrients, breast milk contains many biologically active components, macro- and micronutrients that promote healthy growth and development, enable the formation of a healthy microbiota, and stimulate the development of the infant's immune system. However, in today's reality, women do not always manage to keep exclusively breastfeeding. Often there is a question about the right choice of milk formula for mixed or artificial feeding of the baby. Since ancient times, goat's milk has attracted the attention of parents as an alternative food for children. It is known that in Europe of XVIII-XIX centuries goat's milk was used to feed babies left in hospitals for foundlings, and the German writer Kanrad A. Zweirlian published a book called "Goat as the best and most effective nurse", where he told about the fact that a child left without a mother was fed with goat's milk. Today goat's milk is called a super milk food with unique therapeutic, nutritional, immunological and biological properties. It is a source of vitamins, proteins, and antioxidants and can be used to create artificial formula as an alternative to breast milk. From the nutritional point of view, goat's milk differs markedly from the milk of other dairy animals, having a greater buffering capacity. Objective. Currently, there are many studies comparing the possibility of using milk from different animal species (cow, goat, buffalo, donkey, camel, etc.). The article presents the peculiarities of goat milk composition, emphasizing on milk oligosaccharides, which determine part of its unique properties, as well as similarity with breast milk.

The article is devoted to a review of the literature on the study of intestinal microbiota in chronic viral hepatitis in children. The results of recent studies of microbial diversity of colon contents using 16S ribosomal RNA sequencing are presented. Scientific research in recent years has proven the influence of changes in the microbiota and its individual representatives on the formation of complications in patients with chronic viral hepatitis, the development of fibrosis/cirrhosis. Changed quantitative and species ratios of microorganisms can lead to the launch of pathological reactions in the intestinal-liver axis system. A significant reduction in the number of bacteria such as Clostridia and Bacteroidia (Faecalibacterium, Roseburia inilinivorans, Roseburia intestinalis, Coprococcus comes) causes low production of short-chain fatty acid butyrate, which can interfere with the functioning of tight junction proteins. Leaks and increased intestinal permeability create conditions for the formation of inflammation due to the activity of pro-inflammatory cytokines. Violation of the intestinal barrier function creates the opportunity for the penetration of bacteria, lipopolysaccharide complexes, bacterial ligands and metabolites, leading to the development of immunopathological reactions. These changes in the pediatric population are less noticeable than in the adult cohort of patients, since the clinical course of chronic viral hepatitis in children has a smoother course. However, periods of exacerbation, which are characterized by clinical and laboratory changes, may maintain the risk of developing fibrogenesis activity in older age groups. Data on intestinal microbial diversity in adult patients with chronic viral hepatitis B and C are presented separately. The possibilities of using pre- and probiotic therapy in the complex treatment of chronic liver diseases in adults and children are considered.

Breast milk is the “gold standard” for feeding infants for the first years of life and affects the children health both at an early age and in subsequent periods of their life. However, there are times when women are unable to breastfeed for the following reasons: a woman cannot make milk or has health problems, or lose interest in breastfeeding, or should be back at work, etc. This brings up a legitimate question: how to choose among a large number of infant formulas for healthy infants the one that will fit and be safe for a child to use, taking into account their gestational age, as well as a large number of individual “risk facts” such as high or low body mass and height parameters, features of a childbirth (“vaginal”, operative delivery), etc. Most often, the choice falls on cow-milk-based infant formula. After all, one should not forget about alternative options such as goat-milk-based formulas. Historical evidence shows that patients with rickets were fed with goat milk and it was believed to affect brain functions. Interest in the beneficial effects of goat’s milk has been steadily increasing to this day, given that the biological active substances present in goat’s milk are also present in women’s milk in larger quantities. The β-casein fraction is its main component, which makes it as similar to breast milk in structure as possible. In addition to proteins, fats are components that contribute to the excellent digestibility of goat milk. Their distinctive feature is smaller size as compared to milk fats from other animals. This article explores all the benefits of goat milk and its effect on all aspects of infant health.

Gut microbiota is one of the main components that influence human health status. The gut microflora begins to establish as early as the prenatal period, however, the most intensive colonization of the infant by maternal and environment microorganisms occurs during the intranatal and postnatal periods. The mother-placenta-fetus system lays the foundation for early formation of microbiota. The maternal microbiota starts changing during pregnancy in order to modify metabolism to make it more favourable to the fetus, and continues throughout pregnancy, influencing the incubation of the fetus's own microbiota. The development of the fetal microbiome is also affected by the microbiome of the uterus, amniotic fluid and umbilical cord, although these organs were previously thought to be sterile, like the fetal gut. Multi-year research findings refuted these assertions and proved the existence of a separate meconium microbiome, which does not coincide with the maternal microbiota. The postnatal factors, such as mode of delivery and type of infant feeding, also influence the development of the gut microbiota. Vaginal birth exposes infants to maternal vaginal microbiota. During cesarean section, infants are exposed to environmental microbiota, which disrupts natural microbial colonization. Breast milk has its own microbiome, which can change and adapt to the infant needs. Exclusive breastfeeding affects Bifidobacterium and Bacteroides colonization rates, which metabolize breast milk oligosaccharides, producing short-chain fatty acids as a byproduct. Probiotic therapy can be used to maintain sufficient levels of Bifidobacterium to form a healthy microbiota. This review presents the stages and conditions for the formation of the infant’s gut microbiota, as well as the relationship between them in the course of ontogenesis.

Introduction. Acute respiratory infections cover majority of pediatric outpatient visits and hospitalizations, especially during the cold and flu epidemic season. Aim. To evaluate the effect of Baс-Set Cold/Flu probiotic on the clinical manifestations and severity of acute respiratory infections (ARI) along with standard symptomatic therapy during periods of increased morbidity (November 2023 – March 2024). Materials and methods. This study was an open-label, observational, multicenter study. The number of subjects was 234: 111 volunteers in the first group (experimental) and 123 volunteers in the second group (control) aged from 2 to 10 years inclusive (mean age 5.79) with a diagnosis of ARI. Patients of the first group took Bac-Set Cold/Flu probiotic along with standard symptomatic therapy in comparison with control group which took a standard symptomatic therapy only. Statistical analysis was performed using the R programming language. Results and discussion. The use of probiotic significantly reduced the number of complications and the prescription of antibiotic therapy by more than three times (5% in the probiotic group versus 17% in the control group). A significant difference was revealed in the total duration of the disease (the maximum period from the first symptom of fever to the fact of complete recovery, – absence of fever within last 48 hours) between groups (Mann- Whitney test, p-value = 0.017). In the experimental group, the average duration of illness was 6.2 ± 3.7 days, in the control group – 7.2 ± 3.1 days. A statistically significant difference in the duration of fever was also revealed (Mann-Whitney test, p-value = 0.006). In the control group, on average, fever lasted 1 day longer. The median maximum temperature in the probiotic group was 0.5 degrees lower at the 2nd visit compared to the control group. The use of the probiotic did not affect the symptoms of cough, nasal congestion and the color of nasal discharge, but a trend was recorded for the effect on the symptoms of sore throat. Conclusion. The use of a probiotic reduced the number of complications and the prescription of antibiotic therapy by more than three times, the duration of the disease and fever.

Монография посвящена актуальной для педиатрии проблеме недостаточности и дефицита витамина D, данная тема рассматривается авторами для совершенстования оказания медицинской помощи детям по профилю «Педиатрия». Монография освещает современные представления о механизмах формирования недостаточности витамина D, профилактических стратегиях у здоровых детей и терапевтических подходах у пациентов с различными заболеваниями. Подробно описана история открытия и изучения витамина D, представлены современные данные о механизмах метаболизма и его генетического контроля. Состояние обеспеченности витамином D рассматривается авторами через призму комплексного анализа эпигенетических факторов, как экзогенных (сезон года), так и эндогенных (возраст, пол, заболевания). Учитывая роль витамина D как фактора, модулирующего процесс воспаления, в монографии проведен анализ обеспеченности им в крупных когортах детей и взрослых различного возраста на территории РФ и за рубежом, в связи с негативными долгосрочными эффектами его низкого содержания. Приведены результаты исследований по уточнению профилактических доз витамина D для практически здоровых, а также детей с хроническими заболеваниями, поскольку без таргетных профилактических стратегий шансы на успех в нормализации уровня витамина D у детей практически минимальны. При подготовке данной монографии обобщены достижения мировой науки, а также собственный клинический опыт всех авторов. Авторский коллектив надеется, что монография будет полезна практикующим врачам различных специальностей, научным сотрудникам, а также студентам медицинских вузов, всем тем, от кого зависит, насколько успешной будет борьба за здоровье и улучшение качества жизни детей.

Plastic bronchitis is a rare disease. Despite the fact that the clinical signs of plastic bronchitis were first described by Galen more than 1800 years ago, the pathogenesis of the disease remains poorly understood to this day. As a result, it is not always possible to choose a therapy that allows for complete clinical and laboratory remission or complete recovery of the patient. Treatment of plastic bronchitis should be multifaceted, including the appointment of medications, hardware and physiotherapy methods. Despite the increasing relevance of the topic, the number of published works dealing with the problems of plastic bronchitis, both in world literature and domestic, is small. This review presents historical information on the study of plastic bronchitis, discusses the pathogenesis of the disease, taking into account the results of research over the past decades, lists the main and secondary clinical signs and symptoms, discusses the principles of modern therapy, including both invasive and non-invasive, physiotherapy, and treatment methods. As a clinical example, a case of plastic bronchitis in a 3-year-old boy who was treated in the intensive care unit and then in the infectious diseases department of the Z.A. Bashlyaeva State Clinical Hospital with a diagnosis of Idiopathic plastic bronchitis during one of the relapses of the disease from March 7, 2020 to March 22, 2020 is given. The diagnosis was previously made at the Morozov City Clinical Hospital.

Introduction. The basic research demonstrated an important role of vitamin D in strengthening the immune response to Mycobacterium tuberculosis and proved its effect on the production of antimicrobial peptides. However, the correlation between the levels of vitamin D and defensins (β1 and β2) in children and adolescents with different forms of pulmonary TB was not studied.Aim. To study the correlation between the levels of vitamin D and β1- and β2-defensins in children and adolescents with different forms of pulmonary TB.Materials and methods. We carried out a prospective study of 75 patients with pulmonary TB aged 2–17 years (52 new cases and 23 retreatment cases) in 2021–2023. The levels of 25(OH)D and β1- and β2-defensins were determined at admission to hospital.Results. Out of 75 patients 2.7% had adequate levels of vitamin D (more than 30 ng/mL), 13.3% had insufficient levels of vitamin D (20 to 30 ng/mL), 34.7% had deficient levels of vitamin D (10 to 20 ng/mL), and 49.3% had severe deficiency of vitamin D (less than 10 ng/mL). We established a direct correlation between 25(OH)D and β1-defensin levels (p = 0.004766) and lack of correlation between 25(OH)D and β2-defensin levels. We discovered significant differences in the levels of 25(ОН)D and β1-defensin between new and retreatment cases: 13.10 ± 1.04 ng/mL and 8.74 ± 1.07 ng/mL (p = 0.004644) and 6.66 ± 0.79 ng/mL and 4.0 ± 0.85 ng/mL (p = 0.024816), respectively.Conclusion. The differences in the levels of calcidiol and β1-defensin between new and retreatment cases witness an impaired function of one of the innate non-specific immunity components during long-lasting advanced pulmonary TB in children and adolescents.

Introduction. Studying the gut microbiota of C-section newborns and its correction is a topical problem at present.Aim. To study the process of gut microbiota formation in healthy C-section infants, and the option for its correction using a Lactobacillus reuteri strain DSM 17938 probiotic.Materials and methods. A total of 80 healthy newborns were included in the study. Of these, 59 completed the study: the treatment group consisted of 36 elective caesarean (EC)-section infants and the control group was made up of 23 vaginally delivered infants. Newborns of the treatment study group were randomized into subgroups, one of which received the L. reuteri strain DSM 17938 (L subgroup) probiotic, and the second one did not receive it (0 subgroup). During the entire period of the study, infants were exclusively breastfed. The gut microbiota was analysed with the 16S rRNA sequencing method, and the metabolic activity of the gut microbiota was additionally assessed using gas-liquid chromatography.Results and discussion. The metagenomic analysis showed that the taxonomic richness and biological diversity of the gut microbiota in L subgroup infants increased in time interval 3, which indicated the active effect of the strain on the infant microbiota by Exposure Day 30. The gas-liquid chromatography analysis showed more pronounced changes in short-chain fatty acids in infants of the L subgroup: they were more similar to the findings in the control group (vaginal delivery). Also, bowel problems and allergies occurred less frequently in infants of this subgroup and they less frequently suffered from respiratory diseases during the year. The study showed the association between the mode of delivery and changes in anthropometric measurements.Conclusion. The use of L. reuteri strain DSM 17938 probiotic had a significant effect on the formation of the microbiota by the 30th day of age. A daily long-term addition of a L. reuteri strain DSM 17938 probiotic can prevent early microbiota dysbiosis and have a protective effect in later age period.

Introduction. Serologic tests are the main tool to screen for celiac disease. The serologic tests for tissue transglutaminase (tTG-IgA) antibodies combined with the assessment of the total serum IgA concentration is recommended as a primary test. Other serological markers, in particular IgA and/or IgG antibodies against deamidated gliadin peptides (DGP-IgG/IgA) and native gliadin (AGA-IgA/IgG), are not recommended for use in diagnosing celiac disease in immunocompetent patients. Aim. To determine the diagnostic value of serological markers during the initial examination for celiac disease in children. Materials and methods. The sensitivity, specificity, positive and negative predictive value of tTG-IgA/IgG, DPG-IgA/IgG, AGA-IgA/IgG were calculated for a group of 1247 children. Results. Celiac disease was diagnosed in 101 patients of the study group. Tissue transglutaminase IgA antibodies demonstrated the highest sensitivity, specificity, positive and negative predictive values of 98.02, 99.48, 94.29 and 99.82%, respectively. DPG-IgA/IgG, AGA-IgA were inferior in sensitivity and specificity to tTG-IgA, the positive predictive value of DGP-IgG and AGA-IgA was 34.62 and 34.21%, respectively. AGA-IgG showed the worst specificity (40.3%) and positive predictive values (12.41%). Discussion The low predictive value of the positive results of AGA IgA and DPG IgG determines the extremely high percentage of false-positive results for these tests. In none of the cases of an isolated elevation in AGA and DPG antibodies the diagnosis of celiac disease was confirmed, if tissue transglutaminase IgA antibody concentrations were normal. Conclusion. The results of our study are fully consistent with the position of modern clinical guidelines, demonstrating the maximum diagnostic value of tissue transglutaminase IgA antibody during examination for celiac disease. Other antibodies are not recommended for use in the screening process to avoid unnecessary referrals of patients for endoscopic examination and to reduce healthcare costs.

Introduction. Currently, there are insufficient studies to demonstrate the effect of vitamin D status on the production of proinflammatory cytokines in children with allergic diseases, which precipitated this study. Aim. To analyse interferon - γ , interleukin-17A and 33 profiles in children with asthma according to serum calcidiol levels before and during cholecalciferol subsidies. Materials and methods. A total of 71 children aged 3 to 18 years were examined: 51 patients with asthma and 20 children in the control group. A 3-month cholecalciferol course at a prophylactic dose specified in the national program was prescribed to all children. 25(OH)D, interferon- γ , interleukin-17A and 33 levels were twice determined in the examined children. Results and discussion. Median 25(OH)D levels in patients with asthma did not reach the levels of healthy children either before or after cholecalciferol subsidies at prophylactic doses. Vitamin D intake led to a decrease in interferon- γ levels in healthy children from 3.07 [2.29; 4.81] pg/ml to 2.18 [1.74; 3.45] pg/ml (p < 0.05). In patients with asthma, such changes were not detected in the initial population, however, after cholecalciferol subsidies their interferon- γ levels were significantly higher than those in healthy children: 3.11 [0.89; 5.0] pg/ml and 2.18 [1.74; 3.45] pg/ml, respectively (p < 0.05). Assessment results of interleukin-17A levels in children with asthma showed that the median cytokine levels were significantly higher before the cholecalciferol subsidies than after them: 2.03 [0.1; 10.01] pg/ml and 0.96 [0.1; 12.87] pg/ml, respectively (p = 0.03). The median interleukin-17A levels in children with asthma were significantly higher than in healthy children, both before and during the cholecalciferol subsidies. The median interleukin-33 levels were significantly higher in children with asthma as compared to healthy children, both before and during vitamin D subsidies. Conclusion. Our results suggest that cholecalciferol has a modulatory effect on interferon- γ and interleukin-17A in patients with asthma. Interleukin-33 levels did not change significantly in children with asthma on cholecalciferol.