No 3 (2025)

Priority in the preparation of a pediatrician at a medical university is practice-oriented training. In pediatric education, modern innovative methods, an interdisciplinary approach and improving the practical activities of students are important. At the department of faculty pediatrics, along with traditional forms of training (lectures, seminars, practice, patient supervision), the emphasis is on practical clinical training, preventive orientation in pediatrics, the social role of the doctor, which are instilled through the formation of clinical thinking, mentoring and teachers’ personal example.

Abstract

School adaptation disorders are a common multifactorial problem in pediatric and neurological practice, exacerbated in recent years by new psychosocial stressors. Early diagnosis and comprehensive treatment of this condition are key factors in the prevention of severe anxiety and depressive disorders in the future. The review highlights current views on the etiology, neurobiological mechanisms, and comprehensive approaches to addressing adaptation disorders to school stress in children. A review of modern Russian and foreign literature data on the problem of school stress, maladaptation, and the role of emotional competence and executive functions in the adaptation process was conducted. The root cause of school maladaptation is a complex of stress factors (significant life changes, academic stress, social difficulties, and environmental exposures). The development of emotional competence (the ability to recognize and regulate emotions) and executive functions (inhibition control, working memory, cognitive flexibility), which are closely interrelated, play a key role in successful adaptation. A practical care approach should include both non-pharmacological methods (such as psychological and pedagogical interventions, as well as work with the child's family) and adequate pharmacotherapy. The nootropic agent nicotinoyl γ-aminobutyric acid (Picamilon), which has a complex, autonomous, stabilizing, anxiolytic, vasoactive, and neurometabolic effect, is considered a pathogenetically justified and safe pharmacological option. The importance of timely detection of school maladjustment signs and the use of an integrated approach combining psychological support and, if necessary, modern nootropic agents with a favorable safety profile is emphasized. It enhances children's ability to adapt to school and improves their long-term mental health outcomes.

Caries is one of the most common chronic diseases in children. The unmet need for dental care of baby teeth is high and has an adverse effect on the growth, sleep, nutrition, and quality of life of the child and their family. It is clinically proven that fluoride-containing toothpastes prevent caries and contribute to its control. The anti-caries efficacy of these products is determined by three key factors: fluoride concentration, frequency of hygiene procedures, and post-brushing procedures, including the use of mouthwash upon completion. In the event of improper use of such pastes (ingestion and excessive use), there is a risk of dental fluorosis. Proper use of fluoride-containing oral hygiene products can increase preventive efficacy and minimize the risk of fluorosis. This review systematizes the evidence supporting the routine use of fluoride-containing toothpaste to maximize prophylactic benefits while reducing associated risks. In accordance with the amendments to the Order “On the Procedure for Preventive Medical Examinations of Minors” of the Ministry of Health of Russia dated August 10, 2017 No. 514н, which come into force on September 1, 2025, dental examinations must be carried out annually, starting from the age of 12 months; therefore, the pediatrician needs to participate in the fostering the proper attitudes and practices in the child’s oral care, local fluoride application and limiting sugar consumption.

For many years, doctors and patients have been concerned about drug safety due to the need to use highly effective drugs and minimize adverse effects. The establishment of pharmacovigilance systems has a century-long history, marked by tragic events that led to reforms in drug safety. Modern medicine is characterized by the rapid development and introduction of innovative technologies into clinical practice, which still dictates the need to control the profile of the effectiveness and safety of drugs. In pediatric practice, fever is the most common symptom and the primary reason for outpatient pediatrician visits. Understanding the pathogenesis of fever helps to prescribe antipyretic agents more reasonably. Paracetamol and ibuprofen meet the basic requirements; they have proven safety and efficacy. However, cases of antipyretic drug poisoning are still reported all over the world, which emphasizes the need to optimize approaches to their use in children. One of them is the use of combination drugs, which offer higher clinical effectiveness and a high safety profile.

Background. Congenital alveolar dysplasia (CAD) and alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) are rare, fatal, genetically determined interstitial lung diseases in infants, associated with pulmonary hypertension.

Aim. Clinical, instrumental, and pathomorphological characteristics of patients with CAD and ACD/MPV.

Materials and methods. Fifteen patients with CAD (9) and ACD/MPV (6) were included in a multicenter study. The following examination methods were used: echocardiography, chest X-ray, and chest computed tomography, angiopulmonography, catheterization of the right heart, whole-exome sequencing, and histological autopsy.

Results. CAD and ACD/MPV were diagnosed in term infants (13/15) and manifested in the first 3 days of life with high pulmonary hypertension resistant to therapy. Deaths were recorded in the first 3 months.

Conclusion. CAD and ACD/MPV have similar clinical presentations. Diagnosis can be verified through histological examination of the lungs and whole-exome sequencing.

Background. Currently, cardiovascular diseases (CVD) retain their leading positions in the structure of morbidity and are not only the leading cause of mortality, but also the main factor in population disability. The main pathogenetic link in CVD of atherosclerotic genesis is atherogenic dyslipidemia. Familial hypercholesterolemia (FH) plays a special role. Identification of family history is a prerequisite for timely diagnosis and prevention of CVD.

Aim. To conduct a comparative analysis and quantitative assessment of the frequency of cardiovascular events among relatives of children suffering from FH, as well as dyslipidemia of other genesis (DOG).

Materials and methods. The study was conducted at the Bashlyaeva City Clinical Hospital of the Moscow Health Department from January 2022 to August 2024. The study included 1,163 children diagnosed with hypercholesterolemia of various origins. Of these, 446 children with FH and 717 children with DOG.

Results. When assessing the family history of 446 patients with FH, 161 children (36.1%) were identified whose relatives died as a result of acute cardiovascular events (ACVE) [n = 211]. 143 relatives of 127 patients (28.48%) with FH suffered ACVE but remained alive. As a result of the analysis of the family history, it was revealed that 71 relatives of 79 children (17.71%) with FH underwent surgery. The family history of relatives of patients (n = 717) with DOG showed that 160 relatives of 136 patients (18.97%) also died as a result of ACVE. 231 relatives of 193 patients (26.92%) with DOG suffered ACVE but remained alive. Surgical intervention was in the anamnesis of 30 relatives of 22 patients (3.07%) with DOG.

Conclusion. The study showed that 64.57% of patients with FH had relatives who suffered or died from ACVE, while in the group of individuals with DOG this figure was 45.89%. The frequency of ACVE among relatives of patients with FH was 18.68% higher than in the group of patients with DOG. These data indicate a higher expression of familial risk within FH compared to other forms of dyslipidemia. Thus, systematic analysis of family history in all children with hypercholesterolemia, regardless of its genesis, contributes to early identification of high-risk groups and allows timely implementation of preventive measures and prescription of targeted treatment.

Background. Autoimmune hepatitis (AIH) in children is characterized by chronic hepatic inflammation, which may lead to organ enlargement, fibrosis progression, and development of portal hypertension. However, objective assessment of liver and spleen volume changes, and their association with laboratory parameters and fibrosis stage, remains insufficiently studied.

Aim. To evaluate liver and spleen volume dynamics in children with AIH and their correlation with laboratory activity and fibrosis stage.

Materials and methods. The study included 98 children with a confirmed diagnosis of AIH who were followed for 2 years. 62 of them had isolated AIH and 36 had AIH with overlapping cholangitis. All patients underwent laboratory tests (ALT, AST, GGT, albumin), MRI-based volumetric assessment of liver and spleen, and liver elastography with fibrosis staging according to the Metavir scale. Correlation, comparative and multivariate regression analyses were performed, including dynamic changes in parameters. The study was conducted with follow-up assessments at 1 year and 2 years.

Results. Liver enlargement was more frequently observed in children with cholangitis (38.9%), while most patients with isolated AIH had liver volumes within the normal range or reduced. Significant correlations between liver volume, laboratory indicators, and fibrosis stage were found only in the cholangitis group. In children with isolated AIH, a positive dynamic trend was noted, including decreased ALT, AST, GGT levels and reduced liver stiffness on elastography. Spleen volume increase correlated with signs of inflammation and fibrosis but showed no statistically significant change over two years. According to regression analysis, a significant correlation was found between fibroelastography parameters and albumin levels, liver and spleen volumes, ALT and GGT levels, particularly in the group with cholangitis (R² = 61.4%).

Conclusion. Changes in liver and spleen volumes in children with autoimmune hepatitis may be associated with both disease activity and the degree of fibrosis. Patients with AIH combined with cholangitis more frequently exhibit liver enlargement, lower treatment sensitivity, and a lack of reduction in liver stiffness over time. Measuring liver and spleen volumes, along with assessing fibroelastography parameters, allows for a more comprehensive characterization of the clinical course of AIH in children.

Background. Childhood obesity is still a trending healthcare problem. The incidence of obesity is growing worldwide regardless of any ongoing measures. Inefficiency of behavior, especially the eating behavior, intervention is one of the reasons of poor disease management. Kappa opioid receptor ligand dynorphin (DYN) and coupled KNDy mediator neurokinin B (NKB) seem not to be investigated enough as obese adolescents' behavior modulators.

Aim. The study was aimed to examine the modulating role of DYN and NKB on adolescent boys with obesity behavior.

Materials and methods. The study involved 84 adolescents aged 14–17 years: 57 with obesity (code E66.0, International Statistical Classification of Diseases and Related Health Problems 10th Revision) and 27 practically healthy individuals. The Achenbach System of Empirically Based Assessment (ASEBA) was utilized using Youth Self Report scales (YSR 11-18) to evaluate depressive, anxiety, somatic, attention deficit/hyperactivity, oppositional defiant and conduct problems. The Dutch Eating Behavior Questionnaire (DEBQ) was used to assess alterations. Laboratory studies included DYN and NKB blood levels evaluation using ELISA Kit for Big DYN and ELISA Kit for NKB correspondingly. Network analysis was performed to emphasize and visualize most relevant associations.

Results. The DYN level showed a significant negative correlation with attention problems and a positive correlation with NKB level. Network analysis showed that DYN level was strongly linked with negative bond to attention problems as, with a bit less strength, NKB also was. NKB and DYN levels were strongly linked in between either.

Conclusion. DYN is likely to play a modulating role in eating behavior, deviant and aggressive behavior especially in obese adolescents, acting as an additional obesity heterogeneity factor.

3-M syndrome is a rare hereditary disease with an autosomal recessive type of inheritance, characterized by intrauterine and severe postnatal growth retardation, phenotypic and radiological features with no intellectual disability. A little more than 200 cases of this syndrome have been described in the world. 3-M syndrome is the only disease to date that is associated with pathogenic biallelic variants in the genes CCDC8, CUL7, OBSL1. Short stature is the main clinical manifestation of 3-M syndrome. Until now, the issue of treating short stature with growth hormone remains controversial due to the small number of patients with this disease and the lack of large-scale clinical studies.