Obesity is one of the most acute issues of medicine at the present stage due to the steady increase in morbidity, high risk of complications and comorbid conditions that entail significant financial costs. At the same time, many different etiopathogenetic factors are involved in the formation of obesity. The article presents a literature review concerning the main risk factors and etiologic aspects of the development of overweight and obesity in adults and children. The most relevant pathogenetic mechanisms are considered, including imbalance of adipokines (decrease in adiponectin level and increase in leptin content), formation of low activity chronic inflammation as a result of proinflammatory cytokines, changes in the features of neuroimmune-endocrine interactions, the impact of chronic stress on the human body, vitamin D deficiency, disorders of the “gut – brain” axis, quantitative and qualitative changes in the composition of intestinal microbiota. The main therapeutic approaches and surgical methods in the treatment of obesity are presented. The data available in the literature at the present stage on methods of rehabilitation of patients with obesity, as well as persons with excess body weight, indicating the need for a comprehensive approach and combination of lifestyle modification, physiotherapeutic methods, psychological counseling to achieve positive results are summarized.

Introduction. The emergence of new strains of the SARS-CoV-2 virus and an increase in the number of cases around the world requires further study of the epidemiology, clinical peculiarities of the course and complications of this disease. Aim. Revealing the characteristic of spread, clinical picture and significance of clinical manifestations of a novel coronavirus infection in outpatients. Materials and methods. An analysis was carried out of 387 outpatient records of children with confirmed coronavirus infection (COVID-19) (group 1), as well as records of 9 children followed-up by a cardiologist for pericarditis with effusion who had previously had coronavirus infection or positive results of a rapid test for coronavirus infection (group 2). Results. When identifying possible sources of infection, we have found that half of the children in group 1 became got infected through contacts with members of their family. In 345 children (89.1%) of group 1, a rise in body temperature was noted, and mild systemic intoxication syndromes were observed in 316 children (81.7%). Gastrointestinal manifestations had 81 (21%) patients, skin syndrome such as exanthema on the trunk and limbs – only 20 (5%) patients, hemorrhagic events such as nosebleeds ¬– 5 (1.3%) patients. Patients of group 2 had more pronounced systemic intoxication with a predominant neurotoxic effect. Conclusion. The most common route of COVID-19 infection for children was intrafamilial transmission. Older children tolerated the infection more easily. The most common manifestations were fever, nonproductive cough, and signs of intoxication (myalgia, nausea, weakness). In complete blood count, neutropenia with lymphomonocytosis was a common finding. A complicated course occurred in 9 children with diagnosed pericarditis with effusion.

Obesity and diseases of the gastrointestinal tract are widespread among the children and have common developmental mechanisms. The article provides a literature review on the relationships between certain pathological conditions of the digestive system (gastroesophageal reflux disease, gastritis, functional intestinal disorders, Crohn’s disease, diverticular disease) in children with overweight and obesity. Excess body weight and obesity can become risk factors for the development of gastrointestinal pathology. The data available in modern literature on changes in the composition of the intestinal and stomach microbiocenosis with increasing body weight are summarized (changes in enterotype, increase in the Firmicutеs/Bacteroides ratio, increase in the number of bacteria Methanobrevibacter, Escherichia coli, Lactobacillus rhamnosus, Lactobacillus delbrueckii and Lactobacillus reuteri). The strains of bacteria that contribute to the anorexigenic effect are considered: Lactobacillus gasseri, some strains of Bifidobacterium, Saccharomyces, Streptococcus and Enterococcus. The pathogenetic aspects of obesity and overweight caused by microbiota are presented: activation of lipid synthesis, breakdown of polysaccharides, absorption of mono- and disaccharides, development of metabolic endotoxemia, etc. Features of the functioning of the autonomic nervous system in obesity in children are presented, indicating the predominance of the hypersympathicotonic variant of autonomic reactivity.

The impact of the new coronavirus COVID-19 infection on the course of pregnancy, maternal and child health is largely unclear and controversial. The presented literature review analyzes changes in the immune, cardiovascular, and endocrine systems in women in physiological pregnancy. The peculiarities of the course of infection caused by SARS-CoV-2 virus in pregnancy, depending on the virus variant, are presented, the issues of infection pathways into immune and non-immune cells, including placental cells, as well as the issues of transplacental transfer of the virus – the key moment of infection of the embryo or fetus, on which the outcome of pregnancy also largely depends, are considered. Promising approaches to COVID-19 therapy are presented: use of inhibitors of transmembrane serine protease 2 (TMPRSS2), furin, angiotensin-converting enzyme (ACE2) and RNA-dependent RNA polymerase, amnion epithelial cells and their exosomes. At the same time, the potential use of mesenchymal stem cells in patients with severe COVID-19 pneumonia is reviewed. Difficulties and questions regarding the use of the above therapeutic methods in pregnant women are highlighted. Aspects of the use of surfactant preparations in newborns at risk of new coronavirus infection are considered.

The article discusses the main risk factors for the formation of insufficiency and deficiency of vitamin D in children. Particular attention is paid to the course and dietary preferences of the mother during pregnancy, the intake of vitamin and mineral complexes, the nutrition of the child after birth, the type of feeding, the subsidy of vitamin D preparations and complementary foods. 1246 children under four years of age with no history of vitamin D deficiency were examined. With clinical manifestations of rickets, 52 children were identified, who underwent determination of 25(OH) D in serum, while low availability was detected in 21.1%, vitamin D insufficiency — in 63.4% of children, deficiency — in 15.3% of cases. There was an interaction between the use of dairy products enriched with a vitamin-mineral complex containing vitamin D and Ca, the use of therapeutic doses of vitamin D, and an increase in the level of 25 (OH) D in the blood serum.

Журнал для непрерывного медицинского образования врачей ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ Содержание цитокинов в сыворотке крови детей, перенесших мультисистемный воспалительный синдром, связанный с SARS-CoV-2 1 Федеральное государственное бюджетное научное учреждение «Федеральный исследовательский центр фундаментальной и трансляционной медицины», 630117, г.Новосибирск, Российская Федерация 2 Федеральное государственное бюджетное образовательное учреждение высшего образования «Новосибирский государственный меди-

High prevalence of bronchial asthma among the population (about 300 million people all over the world) provides rationale for the search for candidate genes of disease. Human acidic chitinase (CHIA (AMCase)), encoded by the CHIA gene, is involved in the degradation of chitin, a component of the fungal cell wall and arthropod exoskeleton, which, if present in food or house dust, is a provoking factor for the bronchial asthma (BA) development. Functionally significant mutations in the CHIA gene may apparently increase the risk of susceptibility to BA.Aim. The aim of the study was to assess the associations of single nucleotide polymorphisms (SNPs) rs12033184 and rs3806448 in the CHIA gene with bronchial asthma in children in Novosibirsk.Material and Methods. The study was organized as case-control. A total of 537 blood samples were used. SNPs were determined by real-time PCR. The associations of polymorphic variants with the disease were assessed by the odds ratio.Results. No associations of rs12033184 and rs3806448 with BA were found.Conclusion. The role of acidic chitinase gene in the development of BA in residents of Novosibirsk was found to be less significant than in the Indian population where it was previously shown to be associated with the disease.

The relevance of research on a novel coronavirus infection is associated with an increase in the incidence among children since 2021, which may be due to the accumulation of mutations in the virus genome and its evolution towards increased contagiousness, replicative ability, and evasion of immune protection. While there are many studies in adults, data analyzing the clinical course of the disease in pediatric patients infected with SARS-CoV-2 are limited, particularly regarding adolescents. Objective. To study the clinical and laboratory features of the course of a novel coronavirus infection in hospitalized adolescents in Novosibirsk during the first, second and third waves of the pandemic. Мaterials and methods. A retrospective analysis of case histories of 125 children treated at Novosibirsk Children's Clinical Hospital No 6 with a confirmed diagnosis of coronavirus infection during three pandemic waves was carried out (June–August 2020, October–December 2020, June–August 2021). Based on these time intervals, three groups of adolescents admitted to the hospital during the first, second, and third waves of coronavirus infection were formed. SARS-CoV-2 RNA in nasopharyngeal and oropharyngeal scrapings was determined using the PCR-RT method. Biochemical and general clinical studies were performed in accordance with the guidelines of the Ministry of Health of the Russian Federation. Statistical processing was carried out using the Satistika 7.0 software package (StatSoft, USA). Differences between the groups were assessed using the Z-test and the Mann–Whitney U test. Differences between the compared series were considered statistically significant with a probability level of 95%. Results. It was shown that during three pandemic waves (June 2020 – August 2021), more than half of the hospitalized children were adolescents. At the same time, regardless of the pandemic wave, intoxication, catarrhal and intestinal syndromes predominated in hospitalized adolescents. CNS injury symptoms were significantly less frequent in the first wave, as were skin rashes. Cough in the third wave was observed in 100% of hospitalized adolescents. The average values of the parameters of complete blood count, as well as CRP, D-dimer and ferritin had no statistically significant differences in different pandemic waves, but there was a significant variation in individual values within the groups in each wave. Key words: adolescents, coronavirus infection, COVID-19, clinical manifestations, laboratory parameters

The article presents modern ideas of the issue of Epstein-Barr viral infection (EBVI) in children. Features of possible clinical course both of acute EBVI, which more often manifests as infectious mononucleosis, and of chronic forms, which, in recent years, are taking special role among persistent infections, were presented. The modern schemes of the therapeutic approach were given, including rehabilitation therapy and dispensary observation.

The health basis and correct lifestyle habits, including proper nutrition, are formed in the childhood and adolescence. An excess or deficiency of certain nutrients can cause chronic forms of alimentary-dependent pathology. Childhood obesity results in both short-term and long-term unfavorable effects on physical and psychosocial health. The article presents modern ideas about the pathogenesis of the metabolic syndrome in children and adolescents, diagnostic, prevention and treatment methods.

The aim of the study was to study the characteristics of the content of certain cytokines in serum as indicators of the immune response in viral infections accompanied by diarrhea syndrome in children. Materials and research methods. A survey was conducted of 92 children aged 3 months to 15 years with acute respiratory viral infections hospitalized in hospital No. 6 in Novosibirsk in the first 2 days from the onset of the disease. Two groups were formed — group 1 — patients with diarrheal syndrome and signs of respiratory system damage. Group 2 — children with isolated lesions of the respiratory tract. In all children, the genetic material of viruses was determined by polymerase chain reaction (PCR) in the nose and throat washes. Also, in all children, the determination of serum levels of IL-8, IL-17, IFN-ã by ELISA was performed. Results and discussion. When studying the levels of cytokines (IFN-ã, IL-8, IL-17) in patients with signs of gastrointestinal tract lesions in comparison with isolated respiratory manifestations, no statistically significant differences were found. However, when analyzing the levels of the studied parameters in patients with diarrheal syndrome in different age groups, significant differences in the levels of IFN-ã and IL-8 were revealed.

The article presents modern ideas of the issue of Epstein-Barr viral infection (EBVI) in children. Features of possible clinical course both of acute EBVI, which more often manifests as infectious mononucleosis, and of chronic forms, which, in recent years, are taking special role among persistent infections, were presented. The modern schemes of the therapeutic approach were given, including rehabilitation therapy and dispensary observation.

The article presents current data on the features of the nutritional status of children with chronic nutritional disorders such as hypotrophy, paratrophy, etc. The authors describe the principles and timing of the complementary foods, as well as the advantages of a certain complementary feeding, depending on the type of nutritional disorder. Often, pediatricians pay close attention to the organization of nutrition of children in the first 12 months of life, as a more vulnerable period, while the age period of 12–36 months is also characterized by a significant growth rate and high demands in a number of micronutrients. The article provides recommendations on the nutritional prevention of alimentary-dependent conditions, as well as for a child with a “problematic” appetite (poor eater). It provides the approaches to the treatment of chronic nutritional disorders in children through the correction of eating behavior and diet therapy, including motivational training with the involvement of parents and family members.

Forthe harmonious development of the child at any age, the dietshall be balanced in terms of the proteins, fats and carbohydrates, and it shall include the sufficient amount of the macro- and microelements as well. The micronutrients are necessary for the functioning of all organs and systems, are part of many enzymes, hormones, immune factors. Numerous domestic and foreign studies indicate to the insufficient attention to this problem; that contributesto the development of deficiency conditions. The article considersthe issues associated with the introduction of products of industrial production enriched with the mineral elements in the nutrition of children.

The article presents modern ideas about disorders of hydroionic metabolism in children. Many diseases of different etiologies can lead to the development of disturbances in the exchange of water and ions. Depending on the prevailing losses, the main types of dehydration are identified: isotonic, hypotonic and hypertonic. Approaches to the treatment with the help of enteral and parenteral rehydration aimed at correcting not only dehydration but also microelemental disorders are presented. Basic solutions for oral rehydration (ORS-200, Regidron Bio, Humana Electrolyte), as well as special children’s water for use in medical practice and nutrition are presented. The indications for carrying out the infusion therapy are justified.

Each period of childhood is characterized by its own peculiarities of growth and development, the degree of morphological and functional maturity of individual organs and systems, the specifics of physiological and metabolic processes. Rational feeding and nutrition play a significant role in a child’s health. The authors presented modern approaches to the complementary food for children, its timing, taking into account the child’s readiness to receive new food, the composition of the dish, feeding technique, the formation of proper eating habits and behavior. The literature actively discusses the problem of the formation of taste preferences at early age; thisisthe period for the first acquaintance with varioustastes. The article demonstratesthe advantages of using products of industrial production. It is particularly important to overcome the negative attitude to new products – it determinesthe attention of the specialists to the problem of the introduction of complementary foods.Conflict of interest: The authors of this article confirmed the lack of conflict of interest and financial support, which should be reported.

The article presents current data on an important role of vitamin D in an organism and possible disorders leading to the provision decrease. Research objective: to determine the sufficiency of vitamin D in children staying in hospital with bronchopulmonary pathology without diagnosed rachitis, to show the role of dairy products in a diet for correction of lack of the vitamin D. A total of 120 children from the 1 month to 3 years were examined, in 20 of them 25(OH)D level in a blood serum was detected via the enzyme-liked immunoassay. The average values in infants were 13,3±0,6 ng/ml, in patients in comparative group 25,9±1,1ng/ml. Findings indicate the necessity of correction of vitamin D for children, in particular using dairy products. Enriched milk products provide children’s organism with vital nutrients as a factor supporting their health.

A total of 150 Novosibirsk adolescents aged 15 to 17 years of both sexes (75 boys and 75 girls) were examined. The aim of the study was to identify the likely predictors of chronic somatic pathology in 15-17-year-old adolescents according to the data of a comprehensive survey involving the evaluation of physical, mental, and reproductive health. The use of a mathematical modeling method could provide logistic classification models to assess the risk of chrome somatic diseases in adolescents in relation to gender. Psychological factors are of precedence in the development of chronic somatic diseases in adolescents, which is important to be taken into account in the teaching, clinic;) I examination, and rehabilitation of children of this age.