Among the diseases of the gastrointestinal tract, inflammatory bowel diseases occupy a special place and are the subject of a thorough, comprehensive study, attracting the attention of scientists and doctors around the world. The relevance of numerous studies is due to the steady increase in incidence, the presence of severe disabling forms, a variety of extraintestinal and systemic manifestations. Social and economic importance is determined by the manifestation of inflammatory bowel diseases mainly among young people of working age. At the same time, the mechanisms that trigger the inflammatory process have not been studied enough. The selection of risk factors also seems to be very arbitrary, which significantly reduces the possibility of preventing these conditions, predicting relapse and, as a result, the quality of life of patients. This literature review is an attempt to collect together the available data on the role of acetylcholine, serotonin, substance P and the vasoactive intestinal peptide in the development of the inflammatory response and modulation of the immune response in Crohn's disease and ulcerative colitis. The study of the content of neurotransmitters in the blood of patients and colon biopsy specimens can be important in developing criteria for laboratory diagnostics, assessing the degree of activity of the pathological process, making a forecast about the effectiveness of the therapy and the outcome of the disease. Key words: acetylcholine, Crohn's disease, inflammatory bowel disease, neurotransmitters, serotonin, substance P, ulcerative colitis, vasointestinal peptide

Diabetes mellitus continues to be the most common endocrine-metabolic pathology. In childhood, type 1 diabetes mellitus prevails - an autoimmune, genetically determined disease, as a result of which this type of diabetes is often combined with other autoimmune diseases. Autoimmune gastritis, the marker of which is antibodies to the parietal cells of the stomach, is quite rare in the children’s population, but with type 1 diabetes, its frequency increases significantly. The article presents the results of recent studies of the relationship between type 1 diabetes mellitus and autoimmune gastritis in children. The results of a study of the prevalence of antibodies to parietal cells of the stomach in type 1 diabetes mellitus in children, factors affecting this indicator are presented. The pathogenetic aspects of the relationship of these diseases are analyzed.

Objective. To evaluate the vaccination coverage in children aged 10 months to 3 years, identify the causes of non-adherence to vaccination schedule, and suggest strategies to ensure timely vaccination of children residing in two districts of Saint Petersburg. Materials and methods. We analyzed vaccination coverage (according to the National calendar) in 90 children aged 10 months to 3 years using the data from medical registration forms: child development cards (f.112/y) and vaccination cards (f.063/y). Parents of these children were asked to fill in online questionnaires to analyze their reasons for non-adhering to vaccination schedule. Fifty-two parents agreed to answer. Data analysis was performed using the Microsoft Excel 2010/DataAnalysis software. Results. The vaccination coverage varied between 71% (rubella) to 99% (tuberculosis). Many parents delayed vaccination. Completed vaccination with other vaccines was detected in 57% (pneumococcal vaccine) and up to 80% (hepatitis B) of patients. Revaccination was also delayed in many children. For example, 30% to 41% of children were revaccinated against diphtheria, pertussis, tetanus, polio, and pneumococcus later than it was planned in the schedule. We identified the mean age of children with completed age-appropriate vaccination. The time of delay was usually 1–3 months for different vaccines. Conclusion. The most common causes of non-adhering to vaccination schedule were as follows: untimely visit to a polyclinic (n = 61; 67.8%), temporary medical contraindications (n = 25; 27.8%), and parents' refusal to vaccinate their children 4.4% (n = 4; 4.4%). None of the participants had absolute medical contraindications to vaccination. The analysis of parents' questionnaires demonstrated the following results: 2 out of 52 parents refused to vaccinate their children (3.9%); 37 parents (71.2%) answered that they did not visit polyclinic in time because the child had mild respiratory infection; 3 parents (5.7%) reported that they had come in time; and 10 parents (19.2%) said that they had delayed vaccination for family reasons. We suggested special sanitary, educational, and organizational measures to increase the vaccination coverage among young children. Key words: vaccination, children, vaccine-preventable diseases, vaccination status

Oral allergic syndrome is a manifestation of an acute allergic reaction from the mucous membrane of the oropharynx in the form, itching and tingling on the oral mucosa, dysphonia, itching in the auricles, some patients may experience classic manifestations of hay fever in the form of rhinoconjunctival syndrome. Diagnostics of this disease includes collection of allergic anamnesis, allergy examination. The only pathogenetic method of therapy is carrying out specific immunotherapy with causally significant allergens.

The authors present a clinical case of asymptomatic spontaneous emphysema in a child with a severe course of Crohn's disease, which is a type of inflammatory bowel disease (IBD). The emphysema was diagnosed on the occasion, during the CT scan prior to the start of the immunobiological (Anti-TNF-α) therapy. The etiopathogenetic causes for this condition, its diagnosis and relationship with the severity of the underlying disease are discussed in the paper. A retrospective analysis of the prevalence of this pathology is also given. Conclusion: in the absence of an obvious cause (perforation), the pneumomediastinum can be explained by retroperitoneal air leak through microperforations in severe colitis, which is an unfavorable prognostic criterion for a severe course of the Crohn's disease and increases the risk of surgical treatment, colectomy as usual.

Introduction. The natural history of bronchial asthma (BA) in newly diagnosed children is not well understood.Objective. To determine the trends in the course of mild BA in children over 3 years from the date of initial diagnosis.Materials and methods. A prospective controlled study included 149 children (106 boys, 43 girls) aged 5 years to 5 years 11 months with mild BA diagnosed less than 1 year ago. During a 3-year follow-up, the severity of BA, the need for basic and emergency therapy were assessed. An increase in therapy and the severity of BA was regarded as progression of the disease; the spectrum and extension of sensitization to inhaled allergens were taken into account.Results and discussion. Of 149 children with persistent asthma, 103 were sensitized to one or more household allergens, most frequently to cat (36.2% in the cohort) and dust mites (30.9%). During 3 years of follow-up, the patients did not develop a stable remission of BA with the possibility of canceling basic therapy for more than 6 months in a row. In children receiving basic therapy, it is typical (up to 71% of cases) that the need for therapy remains, or the volume of therapy increases (up to 27% of cases). In children who initially did not receive basic therapy, an increase in therapy is typical (63% of cases). Disease progression was noted over 3 years of follow-up in 70 (47%) patients, most often in the group who initially did not receive basic therapy (73.5%) as well as among children with polysensitization to household allergens (88.9%).Conclusion. Dynamic observation of preschool age patients with BA shows a tendency to persistence or progression of the disease in the first 3 years from the diagnosis.

This article aims to give an up to date review of existing literature on the early manifestations of pathology accompanied by intrahepatic cholestasis in infants. Cholestasis is usually diagnosed in infants with some congenital disorders or some infectious diseases. Its early diagnosis will improve the prognosis for the rest of patient's life. The severity of clinical manifestations of congenital disorders is determined by the type of disorder, as well as by anatomical and physiological characteristics of the liver and biliary tract of infants. There are two types of cholestasis of newborns and infants associated with congenital liver diseases: intrahepatic and extrahepatic. Intrahepatic cholestasis is caused by impaired synthesis or excretion of bile acids observed in patients with progressive familial intrahepatic cholestasis (PFIC) types 1, 2, and 3, benign recurrent intrahepatic cholestasis, and Alagille syndrome. In this article, we discuss the approaches to differential diagnosis of cholestatic diseases at their onset in infants, when it is crucial to determine the management strategy and prevent severe complications, such as cirrhosis, portal hypertension, and liver failure. Key words: intrahepatic cholestasis, hyperbilirubinemia, infants, bile ducts, bile acids, liver

Due to the increase in the weight of allergic diseases in the general pathology of childhood, the diagnosis and treatment of allergic rhinitis in children and the management of these patients at the outpatient stage have not lost their relevance. The period of preschool and school age is characterized by a high frequency of acute respiratory diseases of the upper respiratory tract, especially acute rhinitis, rhinopharyngitis, rhinosinusitis. This daily poses to the district pediatrician the tasks of differential diagnosis of allergic rhinitis and acute rhinitis with a prolonged course. Allergic rhinitis most often does not require hospitalization and, with timely diagnosis, does not lead to serious consequences. It is known that children who are prone to allergies suffer from acute respiratory viral infections more often and more severely than their peers. An integrated approach to the diagnosis and treatment of such children with the participation of an allergist, an otorhinolaryngologist, under the constant supervision of a district pediatrician, the rational use of drug therapy can reduce the duration of the disease, improve the quality of life of the patient.The article presents generalized principles of management of patients with allergic rhinitis from the point of view of domestic and international recommendations, describes in detail the rules of life for children with allergic rhinitis, emphasizes the role of the district pediatrician in teaching parents to ensure a hypoallergenic environment of the child. The authors present a clinical example of the effective use of a combined decognensant and an antihistamine for the treatment of acute respiratory viral infections in a child with allergic rhinitis.

In the genesis of the development of chronic liver and liver diseases in childhood insufficiency, the leading place belongs to hereditary liver diseases. Timely diagnosis allows you to identify this pathology at an early age and choose the right treatment tactics, and improve the prognosis. The article presents a modern view of diseases such as alpha 1-antitrypsin deficiency, neonatal hemochromatosis, erythropoietic protoporphyria, cystic fibrosis. The treatment of such diseases should be comprehensive, based on the principle of an interdisciplinary approach.

In the genesis of the development of chronic liver and liver diseases in childhood insufficiency, the leading place belongs to hereditary liver diseases. Timely diagnosis allows you to identify this pathology at an early age and choose the right treatment tactics, and improve the prognosis. The article presents a modern view of diseases such as alpha 1-antitrypsin deficiency, neonatal hemochromatosis, erythropoietic protoporphyria, cystic fibrosis. The treatment of such diseases should be comprehensive, based on the principle of an interdisciplinary approach.

Screening health examinations of children are a powerful tool for monitoring the health of the younger generation, in other words, it is an active method of dynamic monitoring of children's health. The objective of screening is early detection of disorders with further linkage to care, follow-up care, and comprehensive treatment of patients. Currently, the Russian Federation has a regulatory document on the conduct of preventive periodic and preliminary examinations (Order of the Ministry of Health of the Russian Federation No.1346). The problem is the lack of time and resources, which leads to a formal approach to this necessary part of preventive measures. The article suggests ways out of the current situation that would satisfy both the heads and the district pediatricians themselves.

To reveal clinical and immunological features of bronchial asthma (BA) combined with thyroid gland pathology, sixty patients have been examined in five equal groups, i.e., BA; hypothyroidism; thyrotoxicosis; BA + hypothyroidism; BA + thyrotoxicosis. We assessed serum IgE, IgG levels, as wekk as IL-4/IFNγ, IL-4/IL-1, and IL-1/IL-6 ratios. Clinical exacerbations were observed more frequently in BA + hypothyroidism, as compared with BA patients. Remissions of BA were more prolonged in BA patients, than in groups with BA + hypothyroidism, or BA + hyperthyroidism. Serum IgE levels were much increased in the group with BA + hyperthyroidism. The lowest IL-4/IFNγ ratio was revealed in BA + hypothyroidism group versus BA and BA + hyperthyroidism groups. IL-4/IL-1 ratio was higher in BA + hyperthyroidism group, than in BA and BA + hypothyroidism. Co-existence of hyperthyroidism with BA seems to enhance Th2 immune reactions dominating in BA, whereas concomitant hypothyroidism may cause a reduction of Th2 immune response.

Aims of study: evaluation of immunological parameters in course of sublingual allergen-specific immunotherapy with tree pollen mixture in children with hay fever.Materials and methods: the study included one-hundred patients 5 to 18 years of age with hay fever (pollen rhinitis, rhinoconjunctivitis and/or asthma). Allergen-specific immunotherapy was administered pre-seasonally for three consecutive years. Cytokinechanges were studied in blood serum and in lavages from nasal cavity. Samples assessed before treatment and after 2nd and 3rd courses SLIT completion.Results: increased serum concentrations of IL-10, IFNγ, and decreased IL-4 contents were revealed in the course of treatment. No significant changes in cytokineconcentrations were detectable in nasal lavages.Conclusions: the changes revealed correspond to a shift of T cell response profile towards Th1 pathway, thus confirming pathogenetic effects of sublingual allergen-specific

A comparative study of effectiveness and safety of topical medications performed in two groups of children with moderate persistent allergic rhinitis. During treatment period of 2months and subsequent 1 month supervision treatment effectiveness was controlled with rhinoflowmetry. High effectiveness of intranasal corticosteroids in minimal daily dose was revealed. Intranasal corticosteroids safety was no less than that of cromoglycate. Their positive effect persisted 1month after treatment cessation

The results of pidotimod application in children with often respiratory infections are presented in the review and updated with the data collected by St. Petersburg Allergologic Society. The course application of pidotimod in children with allergic respiratory diseases (allergic rhinitis, bronchial asthma) is effective for often respiratory infections prophylaxis. Good medication tolerability and safety was noted in children with concomitant allergic diseases.

The article presents the results of a comparative study of efficacy and safety of sublingual allergen (study group) and allergoids (control group) for treatment of children with sensitization to pollens of trees. All participants underwent 2 courses of the pre-immunotherapy. The total cumulative dose in the study group was 145,982 ± 120,886 PNU. Adverse events in this group were mild and required no medical therapy. Sublingual specific immunotherapy is an effective and safe method of treatment of hay fever in children.