Purpose of the article it consists of studying the incidence of allergic diseases in children with constitutional exogenous obesity living in the Astrakhan region. Materials and methods. During the study, allergy history data was copied from 167 children: 134 patients with constitutional exogenous obesity (median age 13 [3.9; 17] years) and 33 patients from the control group (median 14 [1.5; 17] years) from “Child Development Stories” (f.112/u) and “Dispensary Observation Control Cards” (f.030/u). Results. Using these methods, significant differences were identified (χ 2 = 8.151; p = 0.005); When comparing a group of children with constitutional exogenous obesity and a control group, it was revealed that in obese children, food allergies are registered more than three times more often (67.4 %) than in children without obesity (23.0 %). Conclusion. Our study showed that obese children are more likely to develop multivalent (food and / or drug) allergies, which are registered three times more often than in children with normal body weight.

To compare blood creatinine levels in children with constitutionally exogenous obesity and in children without obesity. Materials and methods of research. The analysis of serum creatinine levels (Jaffe colorimetric method) was carried out in 162 children with constitutionally exogenous obesity, including overweight children, grade 1–4 obesity and 178 children of the control group who were treated in the Department of endocrinology of the Regional Children's Clinical Hospital of Astrakhan in the age range from one and a half to 17 years. The study period was more than 10 years. The criterion for exclusion from the study was the absence of concomitant pathology of the urinary system. The results and their discussion. When comparing serum creatinine levels in two groups of children (obese and non-obese), a significant increase was found in the group of children with constitutionally exogenous obesity. Thus, creatinine in the blood ≥ 120.0 mmol/l was recorded in 25 children out of 162 examined with constitutionally exogenous obesity and in 3 children out of 178 without obesity (χ 2 = 19.43; p < 0.00001). The highest serum creatinine levels were recorded in children with obesity of 1–2 degrees. Conclusion. Constitutionally exogenous obesity is associated with chronic impairment of nitrogen excretion function of the kidneys.

ПАТОЛОГИЯ ОРГАНОВ ЗРЕНИЯ У ДЕТЕЙ С КОНСТИТУЦИОНАЛЬНО-ЭКЗОГЕННЫМ ОЖИРЕНИЕМОтто Н.Ю., Безрукова Д.А

ОСОБЕННОСТИ УГЛЕВОДНОГО СТАТУСА У ДЕТЕЙ С ОЖИРЕНИЕМБезрукова Д.А., Джумагазиев А

The article describes a clinical example of iron deficiency anemia in an adult patient, taken from the outpatient practice of a hematologist. The given clinical case reflects not only the diversity of the course of the disease, but also the difficulties in interpreting the results of the study.

Obesity in pregnancy poses health risks to both the woman herself and the developing fetus, newborn, child, and adult offspring. High maternal body weight in early pregnancy is associated with an increased risk of neonatal mortality. Inflammatory factors secreted by maternal adipose tissue enhance the differentiation of stem cells into adipocytes, thereby accelerating the development of fetal adipose tissue, which is transformed into obesity in offspring. Leptin resistance in offspring at an early age is a direct consequence of maternal obesity. Children born to obese mothers are more likely to develop leukemia in early childhood. High maternal BMI during pregnancy is associated with higher BMI, blood pressure, insulin and triglyceride levels, abdominal obesity, and lower levels of «protective» lipids in offspring. Increased maternal body weight during pregnancy, especially in the early stages, correlates with cardiovascular diseases in offspring in adulthood. Data on the influence of changes in the intestinal microbiome in the form of high concentrations of Bacteroides spp. and Staphylococcus on the development of maternal obesity during pregnancy and on fetal health are presented, which is associated with increased assimilation of energy sources, increased pro-inflammatory processes, and reduced synthesis of several essential factors, particularly folic acid, which may explain the growth of congenital anomalies in offspring. A number of genetic polymorphisms that are relevant to the development of childhood obesity, especially the genes PPAR, MC4R, TMEM18, GNPDA2, NEGR1, KCTD15, ETV5, and among others FTO, are considered. Key words: inflammation, genetic polymorphisms, FTO gene, children, gut microbiome, maternal obesity, pregnancy pathology

The article describes clinical examples of hemorrhagic rash in children of various genesis, taken from the outpatient practice of a pediatric hematologist. The presented clinical cases reflect the variety of causes of hemorrhagic rashes in children.

The review article discusses the problem of post-vaccination immune response in children obesity and adults with infections, in particular with COVID-19. Changes in various cellular and humoral immunity links in the experiment and in the clinic, associated with chronic inflammation and metabolic disregulation that accompanies obesity, are revealed. People with obesity, who are at higher risk of developing infections, may have an altered immune response to vaccination. Research is needed to study post-vaccination immunity in obesity, including an assessment of the possible impact of comorbidities on the vaccination of individual microbiota.

Obese people are at high risk of developing infections, including COVID-19, and are prone to a more severe course and a poorer prognosis of diseases. The review summarizes information on the post-vaccination immune response in obesity in children and adults with infections. The SARS-COV-2 pandemic further exacerbates this problem of the adequacy of the immune response to vaccination of obese people. The purpose of this review is to present and summarize information on the changes in various links of cellular and humoral immunity in the experiment and in the clinic during the immune response to vaccination in obesity. Results. The mechanisms of action of obesity and associated chronic inflammation and metabolic dysregulation on the post-vaccination immune response in various infections are discussed. The systemic inflammatory response that occurs in obesity represents a barrier to the induction of a sustained immune response. In obese individuals, innate and adaptive immune responses are slowed down and diminished, contributing to the spread of infections. Conclusion. In obesity, the differentiation and proliferation of cells of the immune system is impaired, and the immune response to vaccination changes. Further research is needed to study post-vaccination immunity in obesity, taking into account the effect on the vaccination of the microbiota of a particular person, the presence of possible comorbid conditions.

Growth retardation in children and adolescents occupies a significant place in the structure of endocrine morbidity. The article reveals the gender characteristics of growth retardation, comorbidities in children and adolescents who were examined in the endocrinology department of the Regional Children's Clinical Hospital in the city of Astrakhan for 12 months of 2017. Late diagnosis and, therefore, late treatment initiation worsen the growth prognosis, thereby preventing the patient from achieving socially acceptable growth.

The review article examined the problem of assessing the state of the pancreas in obesity in adults and children, reveals the definitions that are used in medicine for changes in the pancreas, indicates the inconsistency of terms related to the deposition of fat cells in the pancreas. Diagnostic possibilities of anamnesis, objective status, paraclinical data (laboratory, instrumental indicators) are shown, the close connection of pancreatic fat infiltration with non-alcoholic fatty liver disease and metabolic syndrome is emphasized. It is emphasized that the determining value in determining the fat infiltration of the pancreas is given to ultrasound examination, which is assigned the role of screening, computed tomography and magnetic resonance imaging, with their high sensitivity and specificity. It is indicated that the literature data on the assessment of the state of the pancreas in children with obesity are few and ambiguous.

Objective of the research: to determine IgG antibodies (AB) to S. pneumoniae serotypes in overweight children after administration of a 13-valent pneumococcal conjugate vaccine (PCV13). Materials and methods: blood serum of 17 children with excess BW (main group) and 40 children with normal BW (control group) aged 3 to 7 years, vaccinated with PCV13 were examined. The method of solid phase ELISA was used for determination of IgG AB levels to a mixture of capsular polysaccharides (CPS) of pneumococcus contained in PCV13 and serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F S. pneumoniae, after 6 months after vaccination with PCV13. Results: all children had post-vaccination specific AB to pneumococcal serotypes in the value higher than the negative control. In the main group, the mean values of IgG AB to 5 of 13 S. pneumoniae serotypes 7F, 9V, 18C, 19A, 23F and to the mixture of CPS in the vaccine were higher than in the control group, as well as the proportion of children with high (more than 100 cu) levels of IgG AB to the mixture of PCV13 CPS and to the pneumococcal serotype 18C in comparison with the control. Further study of the immune response to pneumococcal vaccination in children with metabolic disorders is needed.

The review of the literature is mostly based on its own research and is devoted to the influence of natural (bottomland, 28 m below sea level, climate conditions with severe changes in temperature during the year, biogeochemical province with moderate iodine deficiency) and anthropogenic (increased air, water and soil pollution) environmental factors on children’s health in the Astrakhan region. The impact of the Astrakhan gas condensate field on the health condition is shown: growing number of children with physical and psychomotor disorders, imbalance in cellular and humoral immunity factors, growing number of frequently ill children with problems in adaptation to kindergartens and schools. The influence of vehicles on environmental pollution, frequency of allergic diseases among children (asthma, allergic rhinitis, atopic dermatitis), and degraded quality of life was noted. There is the negative situation with water sources: samples from main Volga riverbed show both non-organic and organic contamination. Contamination of drinking water is considered as serious factor increasing the incidence of atopic pathology. The correlation between the prevalence of atopic dermatitis and soil contamination with benzapyrene on the territory of these children residence was revealed. Complex influence of iodine deficiency and adverse anthropogenic factors leads to abnormal children’s blood composition: development of erythrocytosis, leukocytosis, inhibition of hemoglobin synthesis function, lymphopenia. The incidence of diffusenodular endemic goiter, subclinical hypothyroidism and thyroiditis can increase as well. It is necessary to develop prevention and rehabilitation measures for children diseases associated with combined adverse effect of natural and anthropogenic factors in the Astrakhan region.

With the using a binary logistic regression analysis, a representative model it was constructed that allows in 80,7 % of cases to predict the risk of developing bronchial asthma in children of early and preschool age with recurrent wheezing and an initially low Asthma Predictive Index (API) in school age with a high discriminatory ability (AUC = 0,901).

Маркеры транзиторного и персистирующего фенотипов синдрома бронхиальной обструкции у детей

We studied the role of excess body weight and obesity in mothers during pregnancy in the development of therisk of obesity in children. Feeding habits of women during pregnancy were estimated in groups. The data on physicaldevelopment of the children born from mothers with excess body weight and obesity during the first 2 years of life areprovided. According to the results of the study, by 6 months of life these children have an increased and high growth, anincreased body weight; by the age of 2 years, already 37,5 % of the studied in the main group had obesity. The resultsof the world long-term researches prove the adverse influence of the mother’s obesity during pregnancy on the fetus.Longer observation of children is required, as the risk of obesity goes far beyond the second year of life, increasing thelikelihood of health problems in subsequent age periods of a child’s life.

The article presents the author's own data on the determination of predictors of phenotypes of recurrent wheezingin children of early and preschool age, taking into account the instability of the phenotype after the expiration of timeand transformation into bronchial asthma (BA). The study included 83 children with the diagnosis of recurrent bronchitis(RB) at the age of 1 to 6 years. Based on the follow-up study which lasted for a six-year period, the children understudy were divided into 2 groups, taking into account the phenotypic characteristics. The first group included 39 (46,9 %) children with a favorable outcome of the disease, the second one – 44 (53,1 %) children diagnosed withbronchial asthma (BA) over the past period. When assessing risk factors for recurrent wheezing, it was revealed thatfood sensitization (p = 0,021), drug allergy (p = 0,021), eosinophilia (p = 0,034), increased IL-1β (p = 0,003), IL-4(p = 0,034), IL-6 (p = 0,009), IL-8 (p = 0,008) significantly affect the formation of the persistent wheezing phenotype.For the transient phenotype, the most significant predictors were comorbidities of the upper respiratory tract:rhinosinusitis (p = 0,008), adenoiditis (p = 0,008).The discovered predictors make it possible to identify the phenotypes of recurrent wheezing in children of earlyand preschool age, which will allow personalizing therapy and predicting the outcome of the disease.