Pediatrics. Consilium Medicum

Neurogenic bladder, which is accompanied by urinary incontinence and causes numerous complications resulting in chronic kidney disease, is one of the most severe consequences of malformations and spinal injuries in children. They limit the child’s ability to live, even to the point of total disability, and the problem of impaired bladder emptying has no universal solution. The staff of the Department of Pediatric Urology of the Moscow Research Institute of Pediatrics and Children’s Surgery of the Russian Ministry of Health started working on the strategy of urinary tract function recovery in children more than 50 years ago, and the main inspirer and ideologist of the whole pleiad of scientists was E.L. Vishnevsky. For the first time, separate developments in the treatment and socialisation of spinal patients were brought together in a unified system of medical care, which remains relevant today. E.L. Vishnevsky initiated the creation of the unique scientific and practical centre «Pathology of Urinary Drainage» on the basis of Speransky Children’s City Clinical Hospital №9. Under the leadership of E.L. Vishnevsky defended 15 candidate theses and 5 doctoral theses. Evgeny Leonidovich is an author of 10 inventions, 180 scientific publications, including 7 monographs. On the initiative of E.L. Vishnevsky and with his direct support similar centres were established by his students and associates in Vladivostok, Omsk, Petrozavodsk and Kazan. Having unquestionable authority in this field, E.L. Vishnevsky has forever remained a classic of the national school of pediatric neurourology, which has no equals in the world.

The article presents the concept of functional nutrition through which general health improvement of the organism takes place. The functional components of nutrition are vitamins, carotenoids, micro- and macronutrients (calcium, magnesium, sodium, potassium, iron, iodine, selenium), dietary fiber, protein hydrolysates, polyunsaturated fatty acids, probiotics and prebiotics. The concept of functional nutrition has been developing in Russia since 1993, and these ideas were enshrined in law in 1998. Specialized products for children are created taking into account age, safety of ingredients, balance of fats, proteins and carbohydrates, vitamins, microelements, with addition of pro- and prebiotics.

Relevance. The new coronavirus infection caused by the SARS-CоV-2 virus remains relevant all over the world and is an important medical, social and economic problem. For more than a year, the COVID-19 pandemic is preserved, the disease is characterized by high contagiousness and significant level of mortality among adult patients. According to the researchers of the whole world, children more often tolerate coronavirus infection in lungs and asymptomatic forms. However, many COVID-19 questions in children require deep analysis, in particular the polymorphism of the clinical picture of the disease.

Aim. Study of the characteristics of the clinic of a new coronavirus infection in children of the Samara region according to the data of the Samara Regional Children’s Infectious Hospital.

Materials and methods. 338 children were studied with a diagnosis of U07.1 (confirmed coronavirus infection) aged 2 months and up to 18 years.

Results. Children are more often infected in family foci of infection (72.6%). 23.4% of patients had an adverse premorbid background and concomitant diseases. Among hospitalized children prevailed patients with a slight course of the disease (72.5%), manifested by respiratory or gastrointestinal symptoms. Bilateral interstitial pneumonia is diagnosed in 93 patients (24.8% of moderate severity, 2.7% is heavy). Frequently frequent syndrome in children was excreted (12.4%). Critical flow of illness and deaths among children is not marked.

Conclusion. According to the results of the study, the main syndromes of the disease characteristic of childhood are revealed. Polymorphism of the clinical picture of the new coronavirus infection in children require further study.

The role of pathology of the adenoid in the development of otitis media of effusion (OME) is currently being discussed. OME is a disease of the middle ear, which is characterized by the accumulation of exudate behind the tympanic membrane in the absence of perforation for three months or longer, leading to hearing loss, increasing the risk of delayed formation of correct speech in the child and behavioral problems. The question of the development of OME, in view of the presence of an infectious focus in the adenoid and further spread to the auditory tube, is ambiguous. In some works, the possible spread of the inflammatory process to the Eustachian tube with long-term preservation of pathogenic microorganisms in the structure of the lymphoid tissue, which is characteristic of persistent viral infections, and the further development of OME are considered. The mucous membrane of the nasopharynx is inhabited by many microorganisms: representatives of an indigenous microbiota, opportunistic and pathogenic.

Aim. To study the microbiome of the mucous membrane of the nasopharynx and middle ear in children with chronic adenoiditis (CA) and OME.

Materials and methods. The study included 174 children with OME and CA (114 boys and 60 girls) aged 3 to 14 years (6.9±0.5 years). We have developed a staged diagnostic algorithm, including the collection of a life history, illness and complaints of the child (or his parents), as well as ENT examination, endoscopy of the nasopharynx, otoendoscopy, audiological examination, microbiological examination by real time PCR, whole genome sequencing NGS.

Results. The main microorganisms of the nasopharyngeal mucosa in children with CA and OME of different age groups are described.

Conclusion. In the treatment of children with CA and OME, it is necessary to take into account the features of the normal microbiota of the nasopharynx; it is important to understand that by acting on opportunistic and pathogenic microorganisms, it is necessary to remember to create favorable conditions for stimulating the growth and development of representatives of the indigenic microbiota, which in turn will contribute to the patient’s speedy recovery and absence of relapses in the future.

Introduction. Inflammation of the mucous membrane and lymphoid structures of the oropharynx (tonsillopharyngitis – TP) occurs frequently in paediatric practice, both against the background of acute respiratory infection and outside catarrhal manifestations. The main focus of the medical treatment of TP is on the indications for systemic antibacterial agents, and the choice of pathogenic and/or symptomatic agents is not strictly regulated and is left to the discretion of the physician. At the same time data on anti-inflammatory activity of different topical drugs for local treatment of TP are practically absent, though inflammatory process affects oropharyngeal mucosa, which is a part of mucosal immunity system (NALT-level MALT system) and can be of different genesis and connected to formation of different cytokines (both pro- and anti-inflammatory).

Objective. To determine cytokine levels in patients with acute TP (ATP) before and after administration of various topical medicines used for the treatment of ATP.

Materials and methods. Patients diagnosed with uncomplicated ATP over 3 years of age who agreed to be examined, treated and biomaterial (scraped oropharyngeal mucosa) were included in the study. All patients underwent routine ENT examinations, a rapid test for BHSA-positive TP and biomaterial sampling for proinflammatory cytokines. Patients included in the study were randomly allocated into 2 groups: Group 1 patients used benzidamine and Group 2 patients used benzyl dimethyl ammonium chloride monohydrate. Both drugs are indicated for the treatment of ATP in patients over 3 years of age and are available in the form of a throat spray.

Results. Forty-nine patients with BHSA-negative ATP were included. Forty-five of them received benzidamine and 24 received benzyl dimethyl ammonium chloride monohydrate by random assignment (both drugs were applied to the oropharyngeal mucosa). There was a significant reduction in the proinflammatory cytokine interleukin (IL)-1 in patients in whom benzidamine was used compared to the group of patients where benzildimethyl ammonium chloride was used. A similar trend was detected in the analysis of the proinflammatory cytokine IL-6. A marked decrease in the level of IL-8 under the influence of benzidamine compared to benzildimethyl ammonium chloride was also observed. The general dynamics of the proinflammatory cytokine level reduction was traced at the evaluation of the tumour necrosis factor α level.

Conclusion. The data obtained suggest that the use of benzidamine has a more pronounced anti-inflammatory effect. This aspect is important for the practitioner (otorhinolaryngologist, paediatrician) when choosing a topical drug for the treatment of TP, especially at the first symptoms of the disease.

The article discusses the issues of complex therapy of urinary tract infection (UTI) in children on the basis of a discussion of modern features of etiology, pathogenesis, and clinical manifestations. The emergence of microbial biofilms and the increasing resistance of pathogens that cause the development of UTI dictate the need to search for new methods of treatment. To overcome the persistence of bacteria and reinfection, rational antibiotic therapy is required, taking into account the sensitivity of the sown flora to antibiotics, the rejection of the use of long-term antibiotic prophylaxis, the elimination of organic and functional disorders of urodynamics, as well as the use of herbal medicines. If the child does not have severe abnormalities or there is a functional obstruction, then alternative methods should be considered as a preventive anti-relapse measure. After courses of antibiotic and uroseptic, or simultaneously with them, the herbal medicinal product Canephron® N can be prescribed, which contains parts of three plants – the roots of lovage, herb centaury and rosemary leaves. The drug has antimicrobial, anti-inflammatory, antispasmodic and diuretic effects. Its use can increase the effectiveness of complex treatment of exacerbations and preventive therapy for recurrent UTI.

Asthenic syndrome is a common pathological condition of the child population, which the pediatrician has to deal with first of all. The results of our studies revealed the presence of asthenic varying degrees of severity in 59% of schoolchildren. From a pediatric perspective, the article highlights the main clinical manifestations of asthenic syndrome and its features, pathogenetic mechanisms of development, rational research methods to exclude «masks», outlines the importance of various therapy options for eliminating the manifestations of asthenia.

The heading is headed by Doctor of Medical Sciences, Professor I.N. Kholodov, Department of Pediatrics. G.N. Speransky.