Pediatrics. Consilium Medicum

In recent years there has been a deterioration in demographic indicators: a decrease in the birth rate, an increase in adult mortality, etc., due to numerous causes. In this context, the article addresses demographic issues related to subcultures and ideologies, such as childfree. The main characteristics of people classified as rejecters, aficionados, refusers, and postponers are discussed. We present the first results of a study conducted at the Khimki regional hospital. The study included 25 pregnant women. The survey results showed that most were planning a pregnancy before 30. A survey of expectant mothers indicated a positive attitude towards breastfeeding. The article discusses the issues of breastfeeding as an essential stage in forming a child's immunity and the factors of breastfeeding success. Women's nutrition during pregnancy and breastfeeding should be diverse and rich in vitamins and micronutrients. Special maternal drinks, such as Amalthea, based on New Zealand goat milk, can benefit breastfeeding. In the absence of breast milk, the selection of formula for the baby is one of the most challenging issues. It is important that the infant formula meet the child's nutritional needs to the maximum extent possible, including the functional milk components. For instance, the Nanny formula is based on New Zealand goat milk, using a single heat treatment process without separating milk into fractions, which preserves the native functional components of goat milk (oligosaccharides, nucleotides, milk fat).

Postpartum depression (PD) is a worldwide issue. Researchers believe the high risk of depression after childbirth persists for the first 6 months. The rate of PD varies from 13 to 20%. This psychiatric disorder has been shown to have a negative impact on the quality of life not only for mothers (difficulty breastfeeding, changing relationships with their husbands, including intimacy) but also for children, initiating immediate effects (infant colic, lack of weight gain, sleep disturbances) and long-term effects on the cognitive and emotional development of the child. Due to a woman's busy schedule, she does not always have the opportunity to visit a doctor. In addition, she may not be aware of her mental health disorders. Often the pediatrician observes that the woman, due to inappropriate behavior, not only fails to cope with maternal responsibilities but may also be a danger to her child. A practical and simple screening technique that allows early detection of PD is the Edinburgh PD Scale. Its use will help women to receive professional care.

The highest frequency of acute respiratory infections occurs in children aged 3–7 years (preschoolers), when the child begins to meet with an increased infectious load in children's organized groups. Vitamin D deficiency or insufficiency is often detected in children with recurrent respiratory infections. At the same time, vitamin D is a complex regulator of innate and adaptive immunity, has an immunomodulatory and anti-inflammatory effect, and protects from a severe infection. The results of international and Russian studies demonstrate the feasibility of using vitamin D for the prevention and treatment of a number of respiratory infections in children and adults.

Background. The issue of acute respiratory infections in children remains one of the most urgent. Therefore, in the pandemic due to the new coronavirus SARS-CoV-2, the search for effective treatment regimens for this disease is necessary.

Aim. To compare the change of clinical symptoms, terms of virus elimination and disease-related economic cost as well as utilization of outpatient healthcare services in children with new coronavirus infection using the herbal medicine Tonsilgon® N, oral solution, added to standard therapy.

Materials and methods. A prospective open comparative cohort study of the effectiveness of coronavirus infection treatment in children using the standard of care alone and the standard of care with Tonsilgon® N was conducted. Group 1 children (n=720) received the standard therapy for COVID-19 and Tonsilgon® N oral solution for 10 days, and group 2 patients (n=670) only received the standard therapy for COVID-19. Treatment efficacy was evaluated according to the change of clinical symptoms in the observed patients, the results of SARS-CoV-2 coronavirus RNA detection in nasopharyngeal smears by polymerase chain reaction, the utilization of healthcare services, temporary disability of parents, the economic cost of the disease.

Results. Studied patients of both groups had a typical clinical presentation of mild to moderate severity new coronavirus infection. Fatigue (96.5–99.7%) and sore throat (93.8–93.9%) were the most frequent symptoms. Posterior pharynx hyperemia was noted slightly less frequently. Low-grade fever was noted in 85.7–86.6% of the patients, equally often in patients of both groups. The significant therapeutic effect of the herbal medicine containing extract of marshmallow root, chamomile flowers, horsetail herb, walnut leaf, yarrow herb, oak bark, and dandelion herb includes reducing the time of sore throat relief in 93.2% of main group patients. After 10 days of treatment, sore throat persisted only in 6.8% of group 1 and 68.1% of group 2 patients (p=0.0001). These results indicate that Tonsilgon combined with standard of care is a promising way to improve the quality of life of children with the new coronavirus infection. The addition of Tonsilgon in therapy for new coronavirus infection in children shortens the time of acute inflammation resolution and reduces the duration of inflammatory intoxication. The therapy of new coronavirus infection under the provisional guidelines leads to a reduction in the time for clinical recovery and virus elimination in children and adolescents (p=0.0001) and a decrease in the utilization of outpatient healthcare services are observed: 3/4 of Group 1 patients and 1/2 of Group 2 patients (p=0.0001) applied for medical help twice during the observation period, 14.6% of Group 1 patients and 29.1% of Group 2 parents applied for medical help more than 3 times (p=0.0001). Thus, the direct and indirect economic costs of the disease decreased. The lower economic cost for parents of children in Group 1 was due to less need for medication and a lower reduction in family income due to temporary disability compared to those for parents in Group 2 (p=0.0001). No treatment-related adverse events was reported.

Conclusion. The above data indicate that Tonsilgon therapy is an affordable way to optimize the treatment of new coronavirus infection in children.

Hypertrophy of the nasopharyngeal and/or palatine tonsils is a common condition in children that reduces patients' quality of life. Surgical treatment is widely used in the Russian Federation and worldwide, but some patients experience a relapse of the disease. From 0.55% to 25.79% of children with a history of surgery undergo repeat adenotomy; in 0.12–11.9% of patients, repeat tonsillotomy/tonsillectomy is performed. The reasons for the re-growth of lymphoid tissue in the pharynx in some patients remain unclear. It is difficult to estimate the recurrence rate due to the lack of definite clinical and diagnostic criteria for the concept of "recurrence" itself. Factors associated with a higher frequency of re-growth of lymphoid structures in the pharynx include some conditions (allergy, bronchial asthma, gastroesophageal reflux), the history aspects (tonsillitis, multiple courses of antibiotic therapy), and early age at the time of primary operation and adenotomy without visual monitoring. The issues discussed are relevant to E.N.T. specialists and pediatricians in predicting and reducing the risk of recurrence in children before primary surgery.

Microcirculatory changes play an important role in the pathogenesis of allergic diseases. The definition of microcirculation includes the movement of fluid between the circulatory and lymphatic networks through intracellular systems, the transmembrane exchange of substrates, gases, including metabolic products and signal molecules. Due to the complexity of the pathogenesis of microcirculatory changes, it is necessary to use sensitive methods for diagnosing the degree of capillary blood flow disorder and associated changes in the microvessels of the arteriolar and venular parts of the microvasculature. Today, there is an available non-invasive method for assessing microcirculation using capillaroscopy of the nail-fold, which allows assessing the structure of microvessels in real time in vivo. Evaluation of capillaries by nail-fold capillaroscopy is the safest method for children and does not cause them concern during the study. With the help of capillaroscopy of the nail-fold, it is possible to assess the quantitative parameters of microcirculation, the width and length of the capillaries, the diameter of the arterial and venous sections, the outer and inner diameters, the width of the apex and the distance between the capillaries. The speed of blood flow in the arterial and venous sections is also taken into account. It is important to note that capillaroscopy also assesses the presence of avascular zones, the appearance of which indicates tissue hypoxia, and therefore can be considered as an important prognostic factor. Capillaroscopy is of great diagnostic value, as it allows developing tactics for treating patients, and, most importantly, assessing the effectiveness of the therapy and predicting the outcome of the disease. The presented clinical observation convincingly demonstrates the need to assess microcirculation during nail-fold capillaroscopy in children with aggravated allergic anamnesis.

The review presents current data on the interaction between the human body and the community of microorganisms inhabiting its gastrointestinal tract. The terminology and methods for analyzing quantitative and qualitative characteristics of gut microbiota are presented. The review also focuses on the concepts of eubiosis, dysbiosis, and the possibilities of correcting dysbiosis with probiotics and probiotic foods.

Celiac disease is one of the oldest human diseases, dating back to the Neolithic Era with the advent of the farming culture. In over 10,000 years, celiac disease has evolved from an unknown and frightening "sickness of the coeliac" to one of the most common genetically determined conditions with a thoroughly understood pathogenesis and effective treatment. Current epidemiological data suggest that the global prevalence of celiac disease averages 1%, with most cases unrecognized. Given the diversity of clinical manifestations, a selective screening program for celiac disease among patients with some suspicious symptoms proved its value only partially. Most experts point to the need for universal screening to effectively detect asymptomatic forms of celiac disease and early initiation of nutritional therapy to avoid serious complications.

Osteogenesis imperfecta (OI) is a rare disease characterized by frequent fractures and deformities of the bone skeleton due to collagen abnormalities. Clinically, OI is heterogeneous in its features and varies in severity. Frequent fractures as a result of brittle bones lead to malunion and deformity, which increases the risk of refraction. Surgical treatment of children with imperfect osteogenesis is aimed at reducing the number of fractures, the formation of deformities and improving the quality of life of the child. According to the literature, two main methods of intramedullary osteosynthesis in the surgical treatment of children with OI can be distinguished: static rods and a “growing” metal structure.

Aim. To compare the frequency of revisions and complications when using titanium elastic rods (TEN) and the Fassier-Duval telescopic system (FD) in the treatment of fractures and deformities of long bones in children with OI type I (mild disease) and type III (severe disease).

Materials and methods. A retrospective and prospective analysis of the results of surgical treatment in 38 children with OI using two different methods of intramedullary osteosynthesis was carried out. Among them, 26 children (68% of all studied patients) were of type III and 12 (32%) children of type I. The mean age of the patients was 7.8 years [5.2, 10.8]. The 1st study group (retrospective) included 17 patients (45% of all patients) who underwent surgical treatment with the installation of titanium elastic rods (TEN). A total of 46 surgical interventions were performed. Surgical treatment with the installation of titanium elastic rods (TEN) for patients was carried out in other medical institutions before hospitalization at the National Medical Research Center for Children's Health. The 2nd study group (prospective) included 21 patients (55% of the total number of patients in the study), who were implanted with FD telescopic rods, 53 surgical interventions were performed. Patients of the prospective group received surgical treatment on the basis of the neuroorthopedic department of the National Research Center for Children's Health. The study groups were structured as follows: Study Group 1 consisted of 2 subgroups. Subgroup A included 6 patients with OI type I, subgroup B included 11 patients with OI type III; The 2nd study group was represented by two subgroups. Subgroup C included 6 patients with OI type I, and subgroup D included 15 patients with OI type III. A total of 228 segments of the upper and lower extremities (humerus, femur and tibia) were examined. Surgical treatment using intramedullary osteosynthesis was performed on 99 segments. The average period of postoperative follow-up was 20 months (from 16.5 to 24.5 months), the data collection of the retrospective group was carried out in the period from 2015–2022, the prospective group from 2017–2022. Analysis of the results of surgical treatment according to the following criteria: the frequency of migration of metal structures, the formation of bone deformities, the number of bone fractures with an installed metal fixator in two different methods of osteosynthesis, as well as the number of revisions in OI types I and III. The results of motor activity in the retrospective and prospective groups were assessed using two scales (the Hoffer–Bullock scale, the Gillette Functional Assessment Questionnaire score scale), before the start of surgical treatment and after 20 months. The statistical analysis was performed using the Matplotlib, SciPy, Pandas и NumPy modules in Python 3.8. In all cases, the distribution was different from normal. The comparison of the independent groups was carried out using the Mann–Whitney test (in the case of comparing two samples), while the comparison of the dependent groups was carried out using the Wilcoxon test. To compare the distribution of the categorical features, the Pearson chi-square test and Fisher's exact test (with the number of observations in one of the cells in the table $2\times 2\le 5$) for the independent groups, and McNemar’s test for the dependent groups were used. In all cases, when the multiple comparisons were made, the level of the significance of p was recalculated using the Bonferroni correction. Hypothesis testing was two-sided; the values of p<0.05 were considered statistically significant.

Results. According to the comparison of two subgroups of the 1st study group, it was noted that fractures in two subgroups after the installation of static intramedullary nails occurred with an equal frequency (p-value>0.999). Among patients with OI type I, migration was observed in 13% of cases (2 segments), with OI type III in 48%. Deformity in type I OI was formed in 13% of cases, in type III in 39%. Revisions in children with type I OI were required in 13% of cases, in children with type III in 32%. According to the comparison of two subgroups of the 2nd study group, it was noted that fractures and migrations in two subgroups after the installation of a telescopic metal structure occurred with equal frequency (p-value>0.999). Deformity in type I OI was not formed, in type III it was 18%. Revisions in children with type I OI were required in 7.7% of cases, in children with type III in 15%. A comparative analysis of the results of surgical treatment of children with type I OI who underwent TEN osteosynthesis and children with type III OI who used a telescopic metal fixator demonstrates the absence of statistically significant differences in deformities, migrations, and revisions (p-value>0.999). Also, in the group of children with OI type III, osteosynthesis of which was performed by FD, there is a decrease in the risk of re-fracture by 10%, in comparison with the group of children with OI type I, osteosynthesis of which was performed by TEN. Also, according to the data of statistical processing, surgical treatment of children with OI type III using an intramedullary telescopic system makes it possible to achieve a level of motor activity comparable to the group of patients with OI type I (p-value=0.344), where osteosynthesis was performed using TEN.

Conclusion. The TEN method is a reliable method of treatment in children with OI type I, it is comparable to the method of telescopic metal construction in children with OI type I in terms of the frequency of migrations (p-value>0.999). However, the risk of repeated surgical interventions is increased by 5.3% compared with FD, the frequency of fractures is higher by 12.3%, the formation of deformities by 13%. The use of “growing” hardware in children with type III reduces the risk of possible refracture by 9%, migration by 36%, deformity by 21% and the number of revisions by 17% compared with static rods. Patients who underwent FD osteosynthesis showed higher results of motor activity than patients who underwent TEN osteosynthesis. The results of the frequency of complications and revisions in the group of patients with OI type III, in which osteosynthesis was performed by the telescopic FD system, are comparable with the group of patients with OI type I, in which osteosynthesis was performed with TEN static rods. The quality of life and motor activity of children in the group with a severe course, whose osteosynthesis was carried out with a “growing” metal structure, reaches the level of patients with a mild course of the disease, whose osteosynthesis was performed using TEN (p-value=0.344). The method of choice in the surgical treatment of children with OI, both in type I and type III, is a “growing” intramedullary metal structure. The use of static rods is acceptable in OI type I, however, it should be taken into account that this metal structure is effective for the first 12 months, later, due to the inability to reinforce the bone throughout its entire length, the risk of possible complications increases.