No 3 (2023)

The research on the microbiome and microbiota of different human ecological niches and their impact on human health showed a significant breakthrough in the last decade. It is known that minor microbial contamination is present even in the fetus in utero, inducing immunological resistance. Immediately after birth, the baby rapidly becomes colonized by maternal and environmental microorganisms. The mode of delivery impacts the number of microbes and species composition and subsequent changes in the infant's immune response. A high risk of early onset of atopic march has been reported in children born by cesarean section and treated with antibacterial drugs in early life. This paper reviews the results of recent studies of the effect of the probiotic based on the two most studied strains of Lactobacillus rhamnosus GG and Bifidobacterium lactis BS01 (Probielle Baby) on intestinal microbiota development and the prospects of its use for correcting disorders in children at high risk of atopy.

Pediatricians incidentally treat patients with asthenia (asthenic syndrome – AS, asthenic condition). The etiology of this disorder is highly diverse. Asthenia is a universal response of the body to various distresses, leading to energy deficiency. The most common AS symptoms are weakness, fatigue, sleep disturbances, increased irritability, muscle pain, headache, etc. AS, including post-infectious AS, significantly worsens the quality of life of the child and his family, so it is necessary to report the manifestations promptly to make a differential diagnosis with other diseases with similar presentation. There are many therapies to treat asthenia, including biologically active additives. Thus, recent clinical studies showed the effectiveness of Kidz syrup with choline, which improves the manifestations of asthenia, increases resistance to psycho-emotional stress, improves focus and memory, and helps to cope with increased mental stress.

Background. The oropharyngeal microbiota is important in maintaining resistance, eliminating viruses and regulating local protective reactions in response to inflammation in acute respiratory infections.

Aim. To evaluate of the effect of topical etiotropic therapy on clinical manifestations, elimination of viruses and on oropharyngeal microbiota in the treatment of acute infectious inflammation of the throat that occurred as part of acute respiratory infections in children aged 5–10 years.

Materials and methods. 120 outpatient patients randomized into 3 equal groups were treated for 7 days: in Group 1 – 0.2% hexethidine-containing aerosol, in Group 2 – 0.03 mg combined spray gramicidin S and 0.1 mg cetylpyridinium chloride, in Group 3 – 0.01% topical solution containing benzyldimethyl-myristoylamino-propylammonium. Changes in the severity of clinical manifestations were compared (integral indicator – modified Tonsillopharyngitis Severity Score – TSSm for children, the severity of the "sore throat" symptom on the Wong–Baker scale, the severity of local signs of inflammation according to pharyngoscopy data) in groups at Visit 2 (day 5±1) and Visit 3 (day 12±1) compared with the Visit 1. The elimination of acute respiratory infection pathogens was evaluated: polymerase chain reaction (PCR) of oropharyngeal smears obtained on days 1, 3 and 5 (±1) – PCR-1, PCR-2, PCR-3 respectively, with the detection of 12 respiratory viruses, including SARS-CoV-2. The state of the microbiota was assessed by sequencing the full-size 16S gene in samples obtained before and after treatment 1st and 12th (±1) days, and compared with 19 indicators in healthy.

Results. By Visit 3, the decrease in TSSm indicators was: 4.0±1.07 in Group 1; 5.0±1.48 in Group 2 and 4.0±1.02 in Group 3. The intergroup differences between Group 2 and 1, Group 2 and 3 were statistically significant (p<0.05). The severity of sore throat by Visit 3 decreased in groups 1, 2 and 3 respectively by 2.0±0.90, 2.5±0.61 and 2.1±0.60, intergroup differences between groups 2 and 1, 2 and 3 had statistical significance at p<0.05. The time to achieve complete relief of the disease according to the TSSm indicator was (day, M±SE): 16.6±1.47 in Group 1; 11.9±1.13 in Group 2 and 12.4±1.38 in Group 3, intergroup differences (groups 1 and 2) are significant, p<0.05. The time of complete relief from sore throat for groups 1–3 was 12.6±0.96, 8.0±0.87 and 9.4±1.01 respectively, intergroup differences (groups 1 and 2) were significant, p<0.05. By Visit 2, the proportion of patients with a negative PCR result increased in Group 1 by 25%, in Group 2 by 43% and in Group 3 by 38%, which corresponded to the elimination of 81, 92 and 74% of viruses detected in groups according to PCR-1 and PCR-2. The microbiota of participants in all groups before treatment differed from the microbiota of healthy in terms of alpha and beta diversity, as well as in terms of indicators obtained by the NearesBalance method. After completion of treatment, changes in the microbiota in terms of beta diversity were observed in all groups compared to the initial state. In contrast to groups 1 and 3, in Group 2 there were statistically significant changes in species-level balances between groups of microbes that distinguish between sick and healthy, towards indicators of healthy.

Conclusion. Topical etiotropic medications provide rapid relief of complaints and local signs of inflammation in the treatment of patients aged 5–10 years with sore throat in acute respiratory infections and contribute to the rapid elimination of pathogens of acute respiratory infections. A combined preparation containing an antiseptic and a bacteriocin-like antimicrobial peptide gramicidin S provides a more pronounced therapeutic effect at an earlier time and the elimination of 90% of all respiratory viruses, including SARS-CoV-2, by the fifth day of therapy, and also has the most sparing effect on the oropharyngeal microbiota compared to antiseptic monopreparations, which may explain its more pronounced anti-inflammatory effect.

The literature review, written on the basis of world literature data and the results of the authors' own research, is devoted to an important pathogenetic mechanism of development and progression of chronic obstructive pulmonary diseases in children and adults – dysanapsis, which is understood as a mismatch in the size or growth of the airways to the volume or growth of the lung parenchyma, while the diameter of the airways is disproportionately smaller than the volume of the lung parenchyma. Modern methods of diagnosis of dysanapsis are based on the use of computed tomography of the chest organs, spirometry (accounting for the volume of forced exhalation in 1 second, forced vital capacity of the lungs, calculation of the coefficient of dysanapsis). Dysanapsis, which has genetic and age-dependent mechanisms of formation, makes an important contribution to the development of bronchial hyperreactivity and bronchial asthma, especially in combination with overweight and obesity, determining the uncontrolled course of asthma. The phenomenon of dysanapsis can be explained by the clinical and functional indicators of the respiratory system (hypoxemia, bronchial obstruction) in premature infants, including patients with bronchopulmonary dysplasia, patients with postinfectious obliterating bronchiolitis. In addition, imbalance is an important pathogenetic component of chronic obstructive pulmonary disease, causing the defeat of patients with this disease, regardless of the presence and length of smoking.

The high incidence of acute respiratory viral infections (ARVI), including influenza, warrants the need for effective and safe methods of ARVI treatment and prevention. Due to the limited options for specific prevention of highly pathogenic and highly virulent viral infections (influenza, SARS-CoV-2), the non-specific prevention and complex therapy of influenza and other ARVI are relevant. Immunostimulating agents with a dual mechanism of action, including endogenous interferon (IFN) inducers, have both antiviral and immunocorrective effects. A detailed review of recent literature on the prophylactic and therapeutic efficacy of the IFN inducer Kagocel® is presented, as well as the authors' own experience. A significant evidence pool allows the use of the drug to treat and prevent acute respiratory viral infections and influenza in children from 3 years of age.

The article addresses various aspects of dietary nutrition of children with diarrheal diseases (DDs). Dietary adjustment in pediatric DDs is detailed. Nutrition is the most essential part of the treatment of such patients. The approach to dietary adjustment in DDs depends on the child's age, the nature of previous feeding, the severity and phase of the underlying disease, and the presence of comorbidities. Lactase deficiency is the most common enzymatic insufficiency; its symptoms in infectious diarrheas should be considered when choosing a diet both in the acute phase of the disease and in convalescence. The article discusses in detail the benefits of fermented foods based on dairy vs. oatmeal in DDs.