Pediatrics. Consilium Medicum

Background. Acute respiratory infections (ARI) in pediatric practice remain one of the most relevant problems, therefore, it is necessary to search for effective prevention schemes in terms of pandemic caused by the new SARS-CoV-2 coronavirus.

Aim. To evaluate preventive effect of one of the Polyoxidonium drug regimens in respect to SARS, influenza and COVID-19, compared with the absence of drug prophylaxis in children attending children's organized groups.

Materials and methods. A prospective open comparative cohort study of the effectiveness of Polyoxidonium used as a preventing treatment against acute respiratory viral infections (ARVI), influenza and coronavirus infection in children attending organized groups was carried out. In the 1st group children (n=300) received Polyoxidonium 1/2 tablet of 12 mg once a day for 7 days, then 21 days drug-free interval (3 courses over a period of 3 months), in the 2nd group children (n=300) received Polyoxidonium 1/2 tablet of 12 mg 1 time per day for 10 days, then 4 days drug-free interval (6 courses over a period of 3 months), group 3 (n=300) control – children did not receive prophylactic drugs. The effectiveness of prevention regimen was assessed using morbidity rate and changes in sIgA and lysozyme activity in the nasal secretion.

Results. In the active groups with Polyoxidonium treatment a significant decrease in the number of cases of ARI and COVID-19 was recorded compared with the control group. The beneficial effect of the preventive use of Polyoxidonium on the likelihood of developing ARVI, COVID-19 and their clinical course was more significant in group 2 (p=0.0001) than in group 1. A positive preventive effect of Polyoxidonium on the development of ARVI, COVID-19 and their clinical course in group 1 was noted when compared to the control group (p=0.0001). In group 2, none of the participants developed pneumonia, while in group 1 one case of pneumonia was registered, and in the control group pneumonia was noted in seven children (2.3%); p=0.0327, 0.0078. The use of Polyoxidonium led to a significant increase in local immunity of the mucous membranes of the upper respiratory tract lysozyme and sIgA in groups 1 and 2 [1 group sIgA 0.24±0.14 g/L (p=0.0085), lysozyme 60.9±18.53% (p=0.0084); 2 group sIgA 0.24±0.14 g/L (p=0.0024), lyzozyme 65.0±16.62% (p=0.0001)].

Conclusion. The use of Polyoxidonium drug as a preventing care for ARI and COVID-19 meets up to date requirements and can serve as an additional protection line against infection in children in organized groups.

Background. In developed countries more than 20% of children have atopic dermatitis (AD). Clinical guidelines unite in the recommendation to use moisturizers/emollients as therapy mainstay. Deeper understanding of AD pathogenesis stimulates development of new, therapeutic moisturizers. To such moisturizers belong ceramide-containing moisturizers, in particular foam for moisturizing and nourishing dry sensitive skin with ceramides and a cholesterol-phytosterol complex.

Aim. To study effects of foam for moisturizing and nourishing dry sensitive skin with ceramides and a cholesterol-phytosterol complex on the course mild to moderate severity AD.

Materials and methods. In this prospective cohort study 30 children 3 to 17 years of age with mild to moderate severity AD were enrolled. They applied moisturizing foam skin lesion, surrounding skin and dry skin areas for 4 weeks. For all participants severity of AD was scored with SOCARD, EASI, IGA, skin pH, moisture and transepidermal water loss (TEWL) were measured and severity of itching and xerosis was elicited with visual analogue scale.

Results. Severity of AD in children who applied foam decreased on 22.8 score points with SCORAD, and on 3.1 points with EASI (for both indices p<0.001). Skin moisture during treatment period increased (23.5% to baseline; p<0.001), and TEWL decreased (for 5.45 g/h×m²; p<0.001); skin pH decreased 0.2 unit to normal values (р=0.002). It was found that skin moisture and TEWL correlate with AD severity so that less severe AD associated with moisture increase and TEWL decrease. As “good” and “excellent” rated foam smell 100% (95% CI 88.4–100%) respondents, consistence – 90% (95% CI 73.5–98.0%), and ease of use – 97% (95% CI 82.8–99.9%) respondents.

Conclusion. Moisturizing foam with ceramides and a cholesterol-phytosterol complex might be used in AD therapy.

Background. Six months after coronavirus disease (COVID-19), more than half of the children have various clinical manifestations of post-covid syndrome. In adult patients without a history of diabetes mellitus, cases of carbohydrate metabolism disorders against the background of COVID-19 and in the long term after the disease have been described. Coronavirus infection in adult patients with lipid disorders is associated with a high risk of severe COVID-19. A 12-year follow-up of patients with severe acute respiratory syndrome (SARS) caused by SARS-CoV showed that they were at an increased risk of developing dyslipidemia. For patients who have undergone SARS-CoV-2, there are no such data due to the short follow-up period. Studies in children evaluating the impact of coronavirus disease on the state of carbohydrate and lipid metabolism are isolated and contradictory.

Aim. To compare indicators of carbohydrate and lipid metabolism in children after a coronavirus disease with a control group of healthy peers without a history of COVID-19.

Materials and methods. The study included 108 children aged 3 to 17 years, divided into two groups. The study group included 50 children (mean age 12.0 [7.4; 14.5] years) after a coronavirus disease. The average follow-up period after the disease was 6 months (from 3 to 12 months). The control group consisted of 58 healthy peers (mean age 12.5 [7.5; 15.1] years) without a history of COVID-19. All children underwent an assessment of the level of glucose in the blood serum, lipid metabolism and the calculation of the triglyceride-glucose index (TyG index).

Results. The frequency of impaired fasting glycemia in children after a coronavirus disease was 2% and was comparable to the control group of healthy peers without a history of COVID-19. The TyG indices in the study groups did not differ significantly (4.46 [4.11; 4.65] vs 4.33 [4.0; 4.47]; p=0.37). None of the children included in the study showed an increase in the TyG index to values corresponding to the criterion of insulin resistance. An assessment of the state of lipid metabolism also did not reveal significant differences in the levels of total cholesterol, LDL, HDL and triglycerides, depending on the presence of a history of coronavirus disease.

Conclusion. In children six months (3–12 months) after coronavirus disease, there was no increase in the frequency of impaired fasting glycemia and insulin resistance compared to healthy peers without a history of COVID-19.

Aim. To assess clinical, hormonal and metabolic characteristics of adolescent boys with constitutional delay of growth and puberty.

Materials and methods. One hundred teenage boys aged 15 were examined. The main group (n=70) – patients with constitutional delay of growth and puberty (inclusion criteria: height SDS -2.0 and below, Tanner 1); comparison group (n=30) – healthy adolescents of the same age. Objective examination: height SDS score, BMI SDS, puberty score. Laboratory diagnostics: IGF-1, testosterone, luteinizing hormone, follicle-stimulating hormone, inhibin B, anti-Mullerian hormone; stimulating tests: clonidine test, triptorelin test. Instrumental methods: radiography of the bones of the wrist of the left hand with the wrist joint to assess bone age using the Greulich–Pyle method, ultrasound examination of the scrotum, assessment of the component composition of the body by bioimpedancemetry. Statistical data processing: XL Statistics version 7.0, Microsoft Excel, 2010. Nonparametric statistical methods were used. Data are presented as a median indicating the values of the 1st and 3rd quartiles ([Q1; Q3]), the Mann–Whitney test was used.

Results. Patients with constitutional delay of growth and puberty had significantly lower rates of physical development compared with healthy peers (p=0.003). Most patients of the main group were found to be underweight, accompanied by a persistent decrease in the proportion of active tissues and a significant, paradoxical increase in the proportion of fat mass according to bioimpedancemetry. The identified deviations indicated metabolic disorders and indicated the formation of sarcopenia syndrome in adolescents with CIGR. The level of sex hormones corresponded to the degree of biological immaturity of the patients, low values of inhibin B in combination with an increased level of AMH indicated Sertoli cell deficiency.

Conclusion. The pronounced deviations in the clinical, hormonal and metabolic status of patients with constitutional delay of growth and puberty obtained during the study were traced in the clinical picture of most adolescents, which is a significant deviation in the child's health and requires medical correction.