No 2 (2021)


The problem of teenage tobacco smoking: yesterday, today, tomorrow

Kozhevnikova T.N., Geppe N.A., Osmanov I.M., Gerasimenko N.F., Mashukova N.G., Il'enkova N.A., Malakhov A.B., Chepurnaia M.M., Odinaeva N.D., Savvina N.V.


The global prevalence of tobacco and nicotine-containing product use has now reached epidemic proportions, a problem particularly relevant when it comes to adolescents. Major trends in the prevalence of tobacco use among adolescents include the flattening of gender differences, the decreasing age of initiation of smoking, and the emergence of alternative uses of nicotine-containing products. The main provisions of the book devoted to tobacco use prevention among children and teenagers as the problem of the present time, edited by professors N.A. Geppe, I.M. Osmanov, N.F. Gerasimenko with the participation of a large group of authors, published in 2021 by MedCom-Pro Publishing House are presented in this work. The issues of negative influence of tobacco and nicotine-containing products not only on the somatic state of teenage smokers but also on their psychological status are reflected. Health risks associated with smoking electronic cigarettes and vape cigarettes by adolescents are described, and the correlation between smoking electronic cigarettes by adolescents and the use of other psychoactive substances is noted. As an example of Russian experience of express-prevention of smoking among adolescents the program developed at the Department of Children's Diseases of Sechenov First Moscow State Medical University (Sechenov University) by candidate of medical sciences N.G. Mashukova, candidate of medical sciences, "PARUS" (Teenage Anti-Smoking Russian Universal Training System), gave recommendations on prevention of tobacco smoking in children and teenagers in conditions of real pediatric practice, noted that introduction into practice of anti-smoking programs aimed at development of motivation to quit smoking is the most perspective measure in prevention of tobacco smoking in teenagers today.

Pediatrics. Consilium Medicum. 2021;(2):101-108
pages 101-108 views

Updated PRIMA consensus document to assist the practicing physician

Reviakina V.A., Astaf'eva N.G., Geppe N.A., Kaliuzhin O.V.


The PRIMA Consensus document developed by leading Russian experts reviews the principles of outpatient immunotherapy in children with frequent acute respiratory viral infections.

Pediatrics. Consilium Medicum. 2021;(2):109-112
pages 109-112 views

Therapy of bronchial asthma in children: age-related aspects

Geppe N.A., Kondiurina E.G., Reviakina V.A., Malakhov A.B., Kolosova N.G.


Bronchial asthma (BA) is a disease that is one of the most frequent chronic diseases of childhood. Characteristic clinical symptoms of BA are wheezing, cough, difficulty in breathing, shortness of breath and, of course, recurrent episodes of bronchial obstruction. They require mandatory clarification of family and individual allergoanamnesis, assessment of symptoms, differential diagnosis with other diseases that may occur with BA. The Global Initiative for the Treatment and Prevention of Bronchial Asthma (GINA 2020–2021) preserves and develops the ageappropriate approach to verification of diagnosis and therapy selection, which is supported in the Russian National Program "Bronchial Asthma in Children" and in the Russian clinical guidelines "Bronchial Asthma 2021 When the diagnosis of BA is made, therapy should be started as early as possible. Administration of low-dose inhaled glucocorticosteroids (IGCS) immediately after the diagnosis allows not only to control the inflammatory process, which is the basis of BA, but also to reduce the severity of exacerbations. IGCS are the most effective drugs for children of any age, they ensure control of the disease and reduce the risk of AD exacerbations.

Pediatrics. Consilium Medicum. 2021;(2):113-122
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Inhalation therapy for bronchial obstruction in children: traditional approaches and new opportunities

Kamaev A.V., Trusova O.V., Makarova I.V., Korostovtsev D.S.


Acute respiratory infections are widespread in the pediatric population and represent a significant burden to the health care system and families of patients. Anatomic ans physiological features of preschool children and individual predisposition, especially atopic phenotype, determine high risk of complicated course of acute respiratory infections with bronchial obstruction syndrome. The etiological factors of recurrent AR are quite diverse – from chronic infections to foreign bodies of the bronchi or genetically determined diseases, but the most common cause of recurrent AR in children remains bronchial asthma. Therapy of acute obstructive episode in real clinical practice is most often similar to therapy of bronchial asthma attack and includes effects on the main components of pathogenesis: contraction of smooth muscles, mucus hypersecretion and inflammatory edema of the bronchial wall. There has been accumulated a great practical experience of using combined preparation of fenoterol and ipratropium bromide, which currently exists also in the form of domestic medicinal product Astmasol®-SOLOpharm. In addition to standard bronchodilator and mucoconstrictor therapy, hypertonic solutions, in particular Ingasalin® 3%, are an important component of therapy of prolonged obstruction and relapse prevention. The possibilities of this remedy in shortening of terms of obstructive disorders and decrease of risk of antibiotic therapy are demonstrated by clinical example.

Pediatrics. Consilium Medicum. 2021;(2):123-128
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Biological drugs in the therapy of atopic dermatitis and bronchial asthma: focus on dupilumab

Reviakina V.A., Geppe N.A., Malakhov A.B., Kaliuzhin O.V., Astaf'eva N.G., Kolosova N.G., Malakhova-Kapanadze M.A.


Significant progress has been made over the past decade in the treatment of allergic diseases such as atopic dermatitis and bronchial asthma. Dupilumab, which targets interleukin IL-4 and IL-13, has become an innovative targeted therapy. Immunobiologic therapy with the interleukin inhibitor is indicated for patients with moderate to severe uncontrolled atopic dermatitis, moderate to severe eosinophilic phenotype of uncontrolled Bronchial asthma and patients with poorly controlled severe chronic polyposis rhinosinusitis. A clinical case and recent data on the use of dupilumab for the treatment of type 2 inflammatory disease and prospects for its use are discussed.

Pediatrics. Consilium Medicum. 2021;(2):129-137
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Current trends in the prevalence of asthma-like symptoms in elementary school children

Ermakova M.K., Matveeva L.P., Kapustina N.R.


Aim. To study the prevalence of bronchial asthma (BA) symptoms among elementary schoolchildren in the Udmurt Republic in the dynamics over 20 years.

Materials and methods. A comparative study of the prevalence of BA was carried out. A questionnaire was administered to 2899 parents of first-graders, using the international standardized ISAAC program.

Results. The prevalence of BA symptoms on the ISAAC program among elementary schoolchildren in the Udmurt Republic in 2020 was 7.7±0.2%, being significantly lower than in the previous studies of 2002 and 2009 (p<0.001).

Conclusion. There was a further downward trend in the prevalence of AD symptoms in younger schoolchildren. The difference between the current symptoms of the disease and the established diagnosis remained rather significant. Reliable (p1<0.001) increase in the number of children with dry cough, not related to cold, and children with bronchospasm connected with physical load was revealed.

Pediatrics. Consilium Medicum. 2021;(2):138-140
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Allergic diseases at an early age

Melnikova K.S., Kuwshinowa E.D., Reviakina V.A.


In recent years, there has been a sharp increase in the incidence of allergic diseases (ADs), mainly in countries with a high level of development. Particularly noted is the increase in the prevalence of AZs in young children, among which cutaneous and gastrointestinal manifestations of allergy are the most common. These include atopic dermatitis (ATD), urticaria, gastrointestinal manifestations associated in most cases with food allergy, as well as contact allergic dermatitis, and insect allergy. The leading mechanism of development is immunoglobulin E (IgE)-mediated reactions. There are three main factors that predispose to AZ: genetic, direct contact with an allergen, and external environmental factors. The article deals with the causes, manifestations, therapy and diagnosis of a number of allergic diseases: urticaria, allergic contact dermatitis, insect allergy and some methods of therapy.

Pediatrics. Consilium Medicum. 2021;(2):141-145
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Respiratory sound recorder – continued Innovation

Starostina L.S., Geppe N.A., Malyshev V.S., Valieva S.I., Ginesina I.L., Malakhov A.B., Bukharov D.G., Shatalina S.I., Zubareva T.V.


The study of external respiratory function (ERF) is important in the diagnosis of respiratory tract abnormalities in various diseases. In children, especially at an early age, there are many difficulties in conducting studies. In recent decades, due to the development of computer technology, there is great interest in the study of respiratory sounds, methods of their registration, processing and use in the assessment of the respiratory system in children and adults. Russian scientists have developed the method of respiratory airway sound investigation, which has proved its effectiveness, reliability and necessity of use in practice. Computer bronchophonography is based on the analysis of time and frequency characteristics of the spectrum of respiratory noises, arising from changes in the bronchial diameter due to increase in the stiffness of their walls or decrease in the inner diameter. Computed bronchophonography may be used for diagnostics of EFD disorders in patients of all age groups both in the in-patient and out-patient treatment.

Pediatrics. Consilium Medicum. 2021;(2):146-151
pages 146-151 views

Features of hypoxic resistance in children with bronchial asthma who have undergone a new coronavirus infection

Glazachev O.S., Geppe N.A., Timofeev I.S., Shakhnazarova M.D., Kolosova N.G., Samartseva V.G., Dudnik E.N., Malakhov A.B., Frolkova E.V., Kalinovskaya I.I.


Aim. To study the characteristics of resistance/sensitivity to normobaric hypoxia in 50 children with bronchial asthma (BA) from 9 to 12 years old, 24 of them after a previous coronavirus infection СOVID-19.

Materials and methods. A normobaric hypoxic test (HT) was carried out by creating hypoxemia (threshold level SpO2 80%) during mask inhalation of a gas mixture with 10–11% O2 by a child using a ReOxy Cardio apparatus (Ai Mediq S.A., Luxembourg). The data obtained were compared with the results in a group of healthy children the same age.

Results. It was found that the integral level of hypoxic resistance of children with BA was generally lower in comparison with the group of healthy children, which was manifested in lower values of the hypoxic index (3.1±1.4, in the group of healthy children – 4.9±2.8, p=0.005), a significantly increased level of tachycardia and a hypotonic response to dosed hypoxia.

Conclusion. When typing reactions to HT, it was found that in children with BA, the type of low resistance to hypoxia is more common (to a greater extent in children with BA after a coronavirus infection), which confirms the need to involve such children in comprehensive rehabilitation programs.

Pediatrics. Consilium Medicum. 2021;(2):152-157
pages 152-157 views

Сolloidal silicon dioxide use (Polisorb MP) at food allergy skin and gastrointestinal manifestations

Vavilova V.P., Vavilov A.M., Tsarkova S.A., Nechaeva I.A., Burmistrova E.I., Popilov M.A.


Background. At present, due to high prevalence of allergic diseases which start in early childhood, the search for new prevention and treatment methods is in great demand.

Aim. To study the effectiveness of the Russian-produced enterosorbent – colloidal silicon dioxide – in the treatment of patients with food allergies combined with atopic dermatitis and gastrointestinal manifestations.

Materials and methods. An open, randomized, comparative clinical study of the enterosorbent (colloidal silicon dioxide) effectiveness has been conducted in parallel groups of infants and preschool children with food allergy skin and gastrointestinal manifestations. The main groups (1 – 67 children with food allergies and atopic dermatitis skin manifestations, 3 – 60 children with food allergies and gastrointestinal manifestations) received, along with basic medication, colloidal silicon dioxide enterosorbent day at an age-specific dosage twice a for 10–14 days. Control groups (2 – 60 children with food allergies and atopic dermatitis skin manifestations, 4 – 60 children with food allergies and gastrointestinal manifestations) did not receive enterosorbent. All children underwent a clinical, functional and laboratory status assessment, including medical records analysis, a pediatrician clinical examination, narrow specialists (allergist-immunologist) examination, laboratory and instrumental research. The treatment effectiveness was being evaluated on the 14th day after the initiation of therapy and after 30 days. The therapy effectiveness was assessed based on regression of skin syndrome clinical and gastrointestinal manifestations, intoxication syndrome and laboratory parameters (IgE, hemogram eosinophilia duration). The study was conducted from 2017 to 2019. On the basis of LLC “Modern Medical Technologies Clinics” (Kemerovo).

Results. Therapy with colloidal silicon dioxide increases the significance of food allergy skin manifestations positive dynamics, which makes it possible to reduce the volume of medication and the duration of topical glucocorticosteroids use to 5.34±0.35 days, in the compared group –10.52±0.85 days (p=0.002). All patients with food allergy combined with atopic dermatitis in the main and control groups noted positive clinical dynamics, appearing as decrease in the skin inflammatory reaction area and intensity. However, the of colloidal silicon dioxide use accelerates skin syndrome condition normalization significantly (group 1 – skin syndrome persisted in 2.9±2.0% after 14 days, in group 2 18.3±4.9%; p=0.003). Colloidal silicon dioxide use accelerates humoral immunity state normalization (IgE) and peripheral blood parameters (hemogram eosinophilia). Colloidal silicon dioxide therapy accelerates food allergy gastrointestinal manifestations positive dynamics in children. Two weeks after the sorbent therapy started, gastrointestinal tract lesions symptoms frequency is less than in patients in the compared group. Diarrhea frequency before treatment started was 48.3±6.5%, 45.0±6.4% in the compared groups. After two weeks it decreased to 6.7±3.2% with the Polisorb therapy and to 16.6±4.8% in the compared group (p=0.003). Abdominal pain was noted by patients of both groups equally often before the study began. After 2 weeks, abdominal pain was noted by ten percent 10.0±3.9% of patients taking colloidal silicon dioxide and 25.0±5.6% of the compared group (p=0.009).

Conclusion. Taking into account the composition of the colloidal silicon dioxide, it makes sense to include this medication in children’s food allergies complex treatment starting from infancy, which contributes to a more rapid relief of gastrointestinal system damage symptoms, life quality improvement for children and their parents, and decrease in medication load. When using colloidal silicon dioxide in children with food allergies, a faster dynamics of disease symptoms relief (p=0.003) was noted, which allows us to conclude that it is highly effective in the treatment of allergic diseases associated with food sensitization.

Pediatrics. Consilium Medicum. 2021;(2):158-164
pages 158-164 views

Otitis externa: applied issues


Interview with Valery M. Svistushkin, MD, Professor, Director of the Clinic of Diseases of the Ear, Throat and Nose and Head of the Department of Ear, Nose and Throat Diseases of the I.M. Sechenov First Moscow State Medical University, Chief Outpatient Otorhinolaryngologist of the Central Federal District of Russia

Pediatrics. Consilium Medicum. 2021;(2):165-169
pages 165-169 views

The use of decongestants in children in otorhinolaryngological practice

Egorova O.A.


The data about the prevalence of ENT organ diseases in children and the necessity of prescription of nasal forms of vasoconstrictors (decongestants) are presented. A review of the data about the mechanism of action of decongestants, safety and evidence base of their effectiveness in treatment of otorhinolaryngological diseases is presented. It is concluded that decongestants with a higher safety level are chosen – a modern combined preparation containing antihistamine (dimethinden) and vasoconstrictor (phenylephrine) components.

Pediatrics. Consilium Medicum. 2021;(2):170-176
pages 170-176 views

Immunity, breast milk and infant formula: finding the optimal balance

Meleshkina A.V., Geppe N.A., Chebysheva S.N., Velikoretskaia M.D., Dagbaeva D.V.


Mother's milk is a unique product for children in the first and second year of life. In addition to the components that provide the energy needs of the baby, breast milk contains many biologically active compounds, microorganisms, stem cells that influence the maturation of organs and systems, including the immune system. Even in the most advanced artificial formula, it is impossible to replicate the composition and effects of breast milk completely. Nevertheless, it is possible to introduce some components into the formula that have a positive effect on the developing immune system. These include fat components, in particular long-chain polyunsaturated fatty acids and β-palmitate, nucleotides, the most valuable of which are adenosine, guanine, uridine, cytidine and inosine monophosphates, oligosaccharides, probiotics, macro- and microelements. Goat's milk is an attractive natural product for the production of quality infant formula. Enriching milk formulas based on goat's milk with components with immunomodulatory functions homologous to those of breast milk makes it possible to significantly reduce the adverse effects of artificial feeding of infants, as well as to achieve a positive immunomodulatory effect. Kabrita® adapted goat milk formula contains all the beneficial natural components of goat milk, adapted by the manufacturer according to the protein, fat, carbohydrate, micro- and macronutrient composition, with the addition of probiotic complex BB-12 and lipid complex DigestX®.

Pediatrics. Consilium Medicum. 2021;(2):177-184
pages 177-184 views

Acute febrile syndromes in children

Bakradze M.D.


Infectious pathology in childhood is the leading cause of morbidity and mortality. Not long ago all over the world (unfortunately, in some places even now) up to 1/4 or more of all born children didn't live till the age of 5 and died because of infections. And the fact that now they have lost their importance – the merit of immunoprophylaxis. Fever is the most common symptom of illness in children and a frequent reason for prescribing medication. Fever during infection is a regulatory process due to cytokines. The temperature level does not always correlate with the severity of the infection. Thus, non-life-threatening respiratory viral infections often occur at a higher temperature, at least initial than life-threatening pneumonia. For most patients, fever is not dangerous. The article highlights the current knowledge about the nature of high fever – above 38ºC – in children, and considers rational ways of diagnosing and treating diseases in which fever is the only symptom, at least at the beginning of the disease. The main questions of the necessity of prescribing antipyretic drugs are covered. To this end, the literature data obtained by the methods of evidentiary medicine and reflected in the agreed recommendations of authoritative professional societies are used.

Pediatrics. Consilium Medicum. 2021;(2):185-192
pages 185-192 views

Clinical heterogeneity and molecular genetic causes in a cohort of patients with disorders/differences of sex development

Nikitina I.L., Sarakaeva L.R., Kostareva A.A., Kudryashova E.K.


Background. Disorders of sex development (DSD) are a group of rare congenital conditions. Clinical management of patients with DSD is often difficult and requires multidisciplinary approach.

Aim. Analysis of the frequency of establishing genetic causes in various forms of DSD by using an original targeted sequencing panel with subsequent establishment of associations of the identified genetic variants with the nature of clinical manifestations.

Materials and methods. Conducted a clinical examination, karyotype analysis followed by the next generation sequencing (NGS) using MiSeq (Illumina) with the twenty-eight patients with different forms of 46, XY DSD were included. We designed HaloPlex (Agilent) gene panel that included coding regions of 80 candidate genes associated with DSD. All variants identified by NGS were confirmed by Sanger sequencing. We performed bioinformatics analysis using OMIM, “1000 genomes”, ESP6500, Genome Aggregation Database projects. To assess the clinical significance of the identified variants we used ClinVar database and American College of Medical Genetics and Genomics criteria.

Results. Out of 28 patients pathogenic, likely pathogenic, variants with unknown significance were identified in 11 patients (39%). In combination with clinical phenotype these variants were determined as causative for DSD. Nine patients (82%) had likely causative variants in one gene (of monogenic origin), while 18% had variants in two genes simultaneously (of oligogenic origin). 43% of the identified gene variants have not been previously reported. The variants in NR5A1 were associated with gonadal dysgenesis in two patients; the variants in MAP3K1 were also found in another two patients with gonadal dysgenesis, variants in AR – in three patients with CAIS, variant in MAMLD1 was associated with proximal form of hypospadias, variant in CYP17A1 was associated with testosterone biosynthetic defect. Among the two patients with variants of oligogenic origin, one had variants in MAP3K1 and MAMLD1 genes and was clinically characterized by hypospadias; the second had variants in AR and SEMA3A and was diagnosed with PAIS. There were also two patients with variants in NR5A1 of familial inheritance.

Conclusion. NGS-based targeted sequencing is a promising technique to improve the differential diagnosis, genetic counseling and management strategies for patients with DSD. Complex clinical examination followed by molecular genetic analysis improves the diagnosis, genetic counseling, and management strategies for patients with DSD including the assignment of sex of rearing.

Pediatrics. Consilium Medicum. 2021;(2):194-202
pages 194-202 views

Clinical tasks

Kholodova I.N.


The column is written by Doctor of Medical Sciences, Professor I.N. Kholodova, G.N. Speransky Department of Pediatrics,  Russian Medical Academy of Continuing Professional Education of the Ministry of Health of Russia

Pediatrics. Consilium Medicum. 2021;(2):203-204
pages 203-204 views

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