No 2 (2020)

The pediatrician is often the first doctor to deal with the onset of various diseases. Deep and constantly updated knowledge are very important in the daily practice. Often observed, the most common symptoms, for example, fever, rash, feeding disorders, are the primary signs of a serious diseases. In such cases, when careful anamnesis and microsymptomatics may suspect a disease, pediatrician could competently examine the patient and refer him to experts. In this article, we present three clinical cases when, despite all the observed manifestations, due to the joint work of specialists, histiocytosis and specific infectious diseases were detected in a timely manner, which makes it possible to start adequate therapy in a positive time frame.

The bulk of publications devoted to coronavirus infection (COVID-19) is devoted to lung damage, less often to neurological and gastroabdominal disorders. Significantly less attention is paid to eye damage. Conjunctivitis is usually described. Considering the pathogenesis of COVID-19, the eye is defined as the entrance gate to infection. However, the anatomical and immunological characteristics of the eye allow us to talk about the essential role of the eye in the spread of infection throughout the body and damage to the eye as a target organ. COVID-19 has a tropism for eye tissue. The eye has a large surface in contact with virus-containing microaerosols in the air and contaminated hands. Attachment of the virus occurs on the conjunctiva, cornea, retina due to angiotensin converting enzyme 2 (ACE2) receptors and some other receptors, lipophilic periocular skin and superficial tear film. From there, through the tear-nasal duct, the virus enters the nose under the lower nasal concha, from where it is transferred through the nasopharynx and oropharynx to the lungs and intestines. Simultaneously with the transfer of the virus, a specific inflammatory process in the form of conjunctivitis and lacrimation is also played out. The hematogenous introduction of the virus into the retina is manifested by microthrombosis of its vessels, edema. In children, the density of the receptors that ensure the fixation of the virus is significantly lower than in adults. COVID-19 eye damage may be the debut of systemic manifestation. Therefore, ophthalmologists who are in close contact with patients with conjunctivitis, initially perceived as adenoviral, are most at occupational risk. Given the adhesive, transmissible and pathogenetic significance of the eye in the development of COVID-19, it is necessary to evaluate the importance of aerosols reaching the eyes and drops (ACE2 receptor blockers, zinc, azithromycin, etc.) for the prevention and treatment of COVID-19.

Since atopic dermatitis is a chronic disease with recurrent course having a significant negative effect on the quality of life of patients and their families the important attention in clinical practice should be given to measures aimed to maintaining of disease remission and flares prevention. Key measures are: systematic rational skin care, exclusion of the impact of allergenic and non-allergenic triggers, timely use of topical anti-inflammatory drugs at first sign of an exacerbation. The goal achievement is possible only through close interaction with parents of children suffering from atopic dermatitis, patient’s therapeutic education and their active involvement into disease control process.

The article describes the main protective mechanisms of the mucous membrane of the respiratory tract (epithelial barrier, mucociliary clearance, antimicrobial peptides, immunoglobulin A, microbiota), which prevent the penetration of respiratory infections. Mucociliary transport slows down the low humidity of the inhaled air and mucous membrane, as well as drugs such as benzalkonium chloride, naphazoline, oil drops, astringents. Carbocysteine, macrolides, salbutamol, saline solutions accelerate the work of the ciliary epithelium. Features of infants are underdevelopment of cavernous tissue in the nasal cavity, inability to breathe through the mouth with nasal congestion, and the presence of various, including intestinal, microflora in rhinitis. A feature of the course of rhinitis in young children is often the absence of a fluid secretion in the nose, and noisy labored breathing is caused by dry crusts of accumulated secretion in the posterior nasal cavity, which are practically not removed by aspiration. These features determine the low effectiveness of decongestants in the treatment of rhinitis, which can also lead to undesirable side effects, such as tachycardia, lethargy, and coma. Maintaining normal protective factors for the nasal cavity plays an important role in preventing acute respiratory viral infection in young children. This is facilitated by environmental humidity, which can be ensured by the use of special air humidifiers, as well as by irrigation of the nasal cavity of young children with saline solutions. The article describes the objectives, indications and methods of irrigation therapy for the prevention and treatment of rhinitis in infants.

Relevance. Currently, pyelonephritis (PN) remains one of the most common bacterial infections in children. Treatment of chronic PN (CP) should be based on the principles of staging, continuity and continuity. Purpose. Evaluation of the advisability of prescribing anti-relapse therapy, its tolerability and the effectiveness of various regimens to prevent relapse in children with acute and CP. Materials and methods. The study involved 167 children from 2 to 12 years old, including 139 (83.2%) girls and 28 boys (16.8%). Children were divided into the following groups: 1A (n=32) with the onset of acute PN, received cephalosporins (CS) of the third generation for 10-14 days; 1B (n=35) - with the onset of acute PN, received third-generation CS for 10-14 days, then for 1 month - a combination of standardized extracts of BNO 1040; group 2A (n=32) with recurrent CP received third generation CS for 10-14 days, then furazidine for 14 days; group 2B (n=34) with recurrent CP received third generation CS for 10-14 days, then furazidin for 14 days, then a combination of standardized extracts of BNO 1040 for 1 month; group 2B (n=34) with recurrent CP received third-generation CS for 10-14 days, then a combination of standardized extracts of BNO 1040 for 3 months. Results. During anti-relapse therapy, all patients in group 1B showed no recurrence of the disease in the first 6 months after the end of antibiotic therapy, as well as a tendency to increase the duration of the remission period when compared with group 1A. Among patients with CP, the least effective treatment regimen was used for group 2A; it was statistically significantly (p<0.05) inferior in anti-relapse effect to groups 2B and 2C. No significant differences were found between group 2B and group 2C. Conclusion. The use of anti-relapse therapy in children with acute PN reduces the likelihood of relapse in the first 2 years from the onset of the disease. Among patients with CP, the optimal results for an increase in the remission period were obtained with a combination therapy furazidine + a combination of standardized extracts BNO 1040 or long-term herbal therapy with a combination of standardized extracts BNO 1040.

The formation of bone mineral density and its maximum peak mass is associated with the provision of the body with osteogenic micronutrients - vitamin D, calcium, magnesium and trace elements involved in the synthesis of bone matrix and its mineralization. Aim. To study the provision of adolescents with vitamin D, micro- and macroelements (calcium, magnesium, zinc, copper, manganese, boron) with an assessment of the state of metabolism and bone mineralization. Methods An open prospective study was carried out with the participation of adolescents aged 10-17 years of the 1-2 health group. The concentration of 25(OH)D, calcium, magnesium and zinc in the blood serum, the content of magnesium, zinc, boron, copper, manganese in the hair, calcium excretion in the urine, the level of osteocalcin, C-terminal telopeptides of type I collagen (beta-cross laps) in blood. A densitometric study of the lumbar spine was carried out. The effect of a combined preparation containing vitamin D, micro- and macroelements on the level of 25(OH)D, microelements and bone mineral density was analyzed. Results. In the autumn-winter period, 100 teenagers were included in the study. Vitamin D deficiency was found in 96 out of 100 adolescents, inadequate provision - in 4 people. The normal content of all studied trace elements was observed only in 4 out of 100 adolescents. Urinary calcium excretion was decreased in all adolescents. A low level of osteocalcin was found in 46 (48%) of 96 adolescents, an increased content of beta-cross lars - in 17 (18%). 46 out of 100 adolescents are diagnosed with osteopenia. Against the background of corrective therapy (n=73), there was a positive dynamics of the supply of vitamin D, micro-and macroelements, as well as bone mineralization. Conclusion. In adolescents, a high prevalence of vitamin D deficiency, diselementosis, combined with disturbances in the processes of bone tissue remodeling, was revealed.