Introduction. Cytokines (CC) play an important pathogenetic role in the development of autoimmune diseases. Over the past decade, there  has appeared a huge number of biological drugs that target certain cytokines. The main problem remains the choice of a suitable biological drug, as up to 40% of patients do not respond to treatment or become resistant to it.

Aim: to identify informative cytokine complexes in children with psoriasis, MS, and IBD with different efficacy of biological therapy.

Materials and methods. Two hundred eighty eight children with autoimmune diseases were examined against the background of supportive biological therapy. Patients were divided into groups of exacerbation and remission depending on the lesion area index PASI for psoriasis (PS), clinical activity indices PUCAI for ulcerative colitis (UC), PCDIA for Crohn’s disease (CD), by the pre­sence of foci of demyelination on MRI for patients with multiple sclerosis (MS). All patients underwent a study of 25 cytokines in serum samples using multiplex analysis (X-MAP technology).

Results. In PS, MS, UC, and CD patients, an increase in pathogenetically significant cytokine profiles associated with cells (c) and functions (f) of M1 cells, Th1, Th2, Th17 was revealed in the exacerbation of diseases relative to the groups in remission. There was a significant decrease in the levels of cytokines and cytokine complexes in patients with MS relative to patients with PS, UC and CD, with the exception of cTh1. Threshold values of the level of cytokine complexes above which the development of an exacerbation of the disease can be expected were obtained: for PS — 1431.1 pg/ml (fTh22 — IL13 + Il22), for PC — 33.1 pg/ml (cTh1 — IFN-γ + IL12p70 + TNF-β + IL2), UC — 20.9 pg/ml (M1 — IL-1 + IL-6 + TNF-α), CD — 1986 pg/ml (fIL12 — IL12 + IL23 + IL27).

Conclusion. To assess the effectiveness of biological therapy and to predict the condition of patients, it is possible to evaluate specific cytokine complexes for a specific pathology.

Contribution:
Radygina T.V., Petrichuk S.V. — research concept and design of the study;
Radygina T.V., Petrichuk S.V., Kuptsova D.G., Kurbatova O.V., Potapov A.S., Murashkin N.N., Bursagova B.I., Abdullaeva L.M., Freydlin E.V. — collection and processing of material;
Radygina T.V. — text writing;
Radygina T.V., Petrichuk S.V., Kuptsova D.G., Potapov A.S., Kurbatova O.V., Abdullaeva L.M., Semikina E.L., Fisenko A.P. — editing.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment.  The study was conducted within the framework of the state assignment of the Ministry of Health of the Russian Federation, No. AAAAA-A19-119013090093-2.

Conflict of interest. The authors declare no conflict of interest.

Received: November 14, 2023
Accepted: November 28, 2023
Published: December 27, 2023

Introduction. The incidence and prevalence of inflammatory bowel disease (IBD) in children is increasing steadily. The diagnosis is often delayed that can lead to an increased risk of complications and significantly decrease the quality of life in the child. The identification of reasons associated with prolonged diagnostics must bring down healthcare costs, reduce the frequency of surgical interventions and use of biological agents.

The aim of our study was to determine the duration of diagnosis and associated factors in IBD children.

Materials and methods. The research held at the National Medical Research Center for Children’s Health included the analysis of three hundred sixty four medical records of children diagnosed with ulcerative colitis (UC) or Crohn’s Disease (CD). This investigation assessed the time of onset of the first symptoms, the first visit to a doctor, the time of establishing the diagnosis, and the first symptoms. The diagnostic time and delay for all IBD were determined.

Results. The study included 286 patients, including 157 CD and 129 UC. The diagnostic delay was 18 months for CD, and 6 months for UC. The manifestation of the disease with extraintestinal symptoms in CD was found to increase the chance of a diagnosis duration of more than 18 months by 8.88 times (95% CI 3.4–23.06, p < 0.001), and in UC — more than 6 months by 4.98 times (95% CI 1.52–16.3, p = 0.009). Moreover, the absence of liquid stools, blood in the stool, low-grade fever, and abdominal pain in CD can lead to an increase in diagnostic time. It was also found that UC boys are diagnosed much longer.

Conclusion. CD requires more time to make a diagnosis than UC, which is due to the peculiarity of the clinical course of the di­sease. Despite the fact that a doctor has consulted patients in time, a delay in establishing a diagnosis occurred at the examination stage, so that requires additional alertness from the specialist’s side.

Contribution:
Potapov A.S., Prokhorenkova M.O., Nosenko K.M. — research concept and design of the study;
Prokhorenkova M.O., Nosenko K.M., Orlova M.A., Kazakova V.A., Dorogov A.Yu. —collection and processing of material;
Prokhorenkova M.O., Nosenko K.M., Orlova M.A., Koroleva O.A. — statistical processing;
Prokhorenkova M.O., Nosenko K.M., Orlova M.A., Kazakova V.A., Koroleva O.A., Vinokurova A.V. — writing the text;
Potapov A.S., Prokhorenkova M.O. — editing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: November 10, 2023
Accepted: November 28, 2023
Published: December 27, 2023

Introduction. Community-acquired pneumonia (CAP) is a leading cause of children mortality and morbidity worldwide. The introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) had a very good effect on the CAP prevalence. However, serotype 19A remains the leading cause of severe pneumococcal disease in both vaccinated and unvaccinated children.

The purpose of the work. To analyze the clonal epidemiology and sensitivity to antibacterial drugs of pneumococcus serotype 19A strains in the post-vaccination period for monitoring and control of vaccination.

Materials and methods. The study included twenty six isolates of pneumococci serotype 19A isolated in children in Moscow between 2015 and 2022. Serotyping was carried out using the Neufeld capsule swelling test. Sensitivity was determined using the microdilution method. Resistance genes and multilocus sequence typing was performed using the PCR method.

Results. By 2019–2022 the detection rate of serotype 19A decreased from 61.5% to 38.5%. A total of 12 different sequence types were identified. Most isolates belonged to 2 clonal complexes: CC230 (n = 15), CC320 (n = 6). Sixteen isolates exhibited a multidrug resistance phenotype (MDR). The dominant phenotype was extremely drug-resistant in the combination of β/Eri/Cli/TMP/Tet (43.8%). The most of MDR isolates belonged to clonal complexes: CC230 (8/16), CC320 (6/16) and Singleton 16988 (12.5%).

Conclusion. After the introduction of PCV13, the prevalence of serotype 19A decreased, but MDR isolates of this serotype continued to increase. These results highlight the need for continued monitoring of the pneumococcal population exhibiting high resistance to reduce the risk of severe disease caused by this organism.

Contribution:
Alyabieva N.М., Lazareva A.V. — research concept and design of the study;
Alyabieva N.М., Komyagina T.M., Tryapochkina A.S., Lazareva A.V. — collection and processing of material;
Alyabieva N.М. — statistical processing, writing the text;
Alyabieva N.М., Lazareva A.V. — editing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: November 14, 2023
Accepted: November 28, 2023
Published: December 27, 2023

Introduction. The state of children had suffered from COVID-19 causes various persistent symptoms affecting on patient well-being and quality of life which is a significant healthcare issue.

The aim of the work. To assess health and well-being of children following COVID-19 and other acute respiratory infections.

Materials and methods. This is a case-control study including children with history of PCR-confirmed COVID-19 (n = 261) and other acute respiratory infections (n = 198). Patients were assessed 6 months and 1 year after the infection using the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 questionnaire for children. The prevalence of symptoms including fatigue, weakness, lack of energy, as well as the emotional well-being, social relationships, and social activity of children was evaluated.

Results. Children with history of COVID-19 in six months had significantly higher rates of weakness and decreased school attendance compared to children with other acute respiratory infections. 12 months after infection, children in the case group were significantly more likely to experience poor concentration, weakness, a decreased sense of belonging and school attendance. However, 12 months after infection, control group had significantly higher rates of fatigue.

Conclusion. Children with a history of mild COVID-19 and other acute respiratory infections may experience ongoing health problems for 1 year after the infection, requiring greater attention from healthcare professionals and family members.

Contribution:
Chernyavskaya A.S., Simonova O.I. — study concept and design;
Chernyavskaya A.S., Rumyantsev M.A., Baymukhambetova D., Yezhova A.A., Pavlova M.S., Petrova P.Yu., Asanova R., Gripp M.R. — collection and processing of material;
Chernyavskaya A.S. — statistical processing of material and writing the text;
Simonova O.I. — editing.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: October 31, 2023
Accepted: November 28, 2023
Published: December 27, 2023

Introduction. The multifactorial nature of the occurrence and phasing of inflammatory changes in the gastric mucosa determine the need to search for conditions that can affect the slowing of the progression of gastritis in children.

Aim: to determine the manifestations of Helicobacter pylori-associated antrum gastritis in adolescents with hypovitaminosis D.

Material and methods. Ninety three 12–17 years adolescents with a morphologically confirmed diagnosis of gastritis were exa­mined. The content of vitamin D in the blood was determined using the ELISA method. Adolescents were divided into groups depending on the level of vitamin D supply and the period of solar insolation at the time of the examination.

Results. H. pylori infection in adolescents with hypovitaminosis D had a pronounced tendency to increase — 75% (53.6% in child­ren with sufficient vitamin D levels; p = 0.067).

The frequency of H. pylori among adolescents examined during low solar insolation was higher than during high solar insolation (p = 0.015). During the period of low solar insolation, the highest rates of H. pylori infection in children were found among adolescents with vitamin D deficiency (88.2% compared to 62.1% among children with a normal vitamin D supply; p = 0.057). During the period of high insolation, H. pylori infection was approximately the same (p = 0.82).

Antral gastritis with high activity was predominantly detected in adolescents infected with H. pylori and its frequency did not depend on the level of vitamin D in the blood.

Conclusion. Hypovitaminosis D is associated with H. pylori-associated gastritis, characterized by greater activity of the inflammatory process and has a clear relationship with the intensity of solar insolation.

Contribution: 
Anikina K.A., Polivanova T.V. — concept and design of the study;
Anikina K.A., Vshivkov V.A. — data collection and processing;
Anikina K.A. — statistical processing of the data, writing the text;
Polivanova T.V., Vshivkov V.A. — editing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: November 10, 2023
Accepted: November 28, 2023
Published: December 27, 2023

Relevance. Acute intestinal infections in children retain a high value in the structure of child morbidity and mortality, which necessitates the search for means and methods for their active treatment and improvement of prognosis.

Aim: to determine the effectiveness of the use of synbiotics in the complex therapy of acute intestinal infections in children at the outpatient stage.

Materials and methods. Fifty 6–17 years children with mild or moderate acute intestinal infections were examined. The patients were divided into the main group (30 children) and the control group (20 children), the groups were comparable. Patients from the main group, along with pathogenetic therapy, received a combination of Lacticaseibacillus paracasei DG I-1572 DSM 34154
(L. casei DG) and fructooligosaccharides (FOS), and children from the control group received only pathogenetic and symptomatic treatment. Clinical symptoms were evaluated over following up included temperature, frequency and, nature of stool, presence and severity of dyspeptic manifestations, nausea, frequency of vomiting, presence and severity of abdominal pain syndrome. Statistical data processing was carried out using statistical analysis Statistica v. 13.0 (StatSoft Inc., USA).

Results. The combined use of L. casei DG and FOS in the pathogenetic therapy of acute intestinal infections reduces the time of relief of clinical manifestations. The severity of abdominal pain syndrome regresses significantly faster when using this synbiotic. Normalization of the frequency and nature of stool occurs significantly faster with the simultaneous appointment of pathogenetic therapy and the synbiotic. The combination of L. casei DG and FOS has demonstrated a high safety profile, side effects have not been reported.

Conclusion. It is advisable to prescribe the combination of L. casei DG and FOS from the first day of acute intestinal infections alongside with pathogenetic and symptomatic therapy to achieve a clinical effect more quickly.

Contribution: Sutovskaya D.V. — concept and design of the study, editing; Sutovskaya D.V., Litvinov D.I. — collection and processing of material, writing the text, approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: November 02, 2023
Accepted: November 28, 2023
Published: December 27, 2023

Introduction. Idiopathic hypercalciuria (IH) is one of the most common metabolic disorders in children and can lead to the development of urolithiasis over childhood. In this regard, studying the etiology of this pathological condition will help to prevent the development of IH and reduce the risk of developing urolithiasis.

Study purpose: to study the role of genetic polymorphisms of the VDR gene in the development of IH in children and their relatives of the first and second lines of kinship.

Materials and methods. The study included 68 people, including 35 children aged of 3 to 17 years with identified hypercalciurine and 33 first- and second-line relatives with IH and urolithiasis. A study of the level of 25-OH vitamin D in blood plasma and a genetic study for the presence of polymorphisms of the vitamin D receptor gene VDR were carried  out including: BsmI Polymorphism IVS10+283G>A, A-3731G (Cdx2), FokI Polymorphism; Ex4+4T>C. To compare the frequency of occurrence of vitamin D receptor (VDR) genotypes, samples of conditionally healthy individuals permanently residing in Kemerovo and natives of the European part of the Russian Federation were taken. At the same time, for the VDR G283A (BsmI) gene, a healthy sample consisted of 232 people from Kemerovo and 96 cases from the European part of Russia, for the VDR A-3731G gene — 269 and 243 people, and for the VDR FokI TC gene — 172 and 96 people, respectively.

Results. Reducing the content of 25(OH)D in the blood of less than 30 ng/ml was detected in 33 (48.5%) IH children. 25 (OH)D level below 20 ng/ml was detected in 15 (22.1%) patients. In IH patients and level 25(OH)D in the blood of less than 20 ng/ml, the homozygous variant 283 GG of the VDR gene (BsmI) was found in 20% of the examined versus 51% (p = 0.028) of conditionally healthy individuals. The heterozygous genotype of 283 PA of the VDR gene (BsmI) was determined in 73.3% of IH patients versus 41.7% of conditionally healthy individuals (p = 0.027). The heterozygous Ex4+4TC genotype of the VDR Fokl gene was recorded in 66.7% of the examined IH patients and low serum vitamin D levels (< 20 ng/ml) when compared with the level in conditionally healthy individuals (p = 0.030). In patients with low vitamin D levels against IH background, the proportion of the minor allele A 283 of the VDR gene (BsmI) was determined significantly more often than in healthy individuals (p = 0.044).

Conclusion. A relationship was identified between polymorphism of the vitamin D receptor gene VDR (polymorphic marker BsmI (rs1544410) of the VDR gene 283G>A; polymorphic marker Fokl (rs2228570) of the VDR gene Ex4+4T>C) with IH and deficiency of 25(OH)D levels in the blood serum of children.

Contribution:
Strozenko L.A. — concept, study design, statistical data processing; writing text;
Micheeva N.M. — collection and processing of material, statistical data processing, text writing;
Lobanov Yu.F., Zverev Ya.F. — editing the text;
Tekuteva N.A. — collection and processing of material.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study was conducted within the framework of a grant from the Governor of the Altai Territory in the field of medical prevention, rehabilitation and health protection of the population (agreement No. 3 of November 30, 2022). Registration number of the grant in EGISU R&D 123062600011-6.

Conflict of interests. The authors declare no conflict of interest.

Received: October 19, 2023
Accepted: November 28, 2023
Published: December 27, 2023

Introduction. Pathology of the digestive organs is one of the factors influencing the health indicators in children.

Purpose of the work: to characterize current trends in the epidemiology of digestive diseases in children in the Udmurt Republic (UR).

Materials and methods. The epidemiological features of digestive diseases in 0–14 and 15–17 years children were studied on the base on official statistics for the period from 2012 to 2022. The polynomial approximation method was used for forecasting.

Results. There is a decrease in the prevalence of pathology of the digestive organs in 0–14 years children from 153.0 in 2012 to 75.0 in 2022 per 1000 children of the corresponding age, the average annual rate of decline was –6.3%. The predicted indicator will be 32.3 per 1000 children of the corresponding age in 2025. Similar trend in the prevalence of gastroenterological pathology were noted in the age group of 15–17 years: since 2012, this indicator has decreased by 1.9 times from 187.4 to 93.8 per 1000 children of the corresponding age with an average annual rate of decline of –6.3%. The predicted prevalence of gastroenterological pathology in 15–17 years children in the region will be 69.8 per 1000 children of the corresponding age in 2025. Since 2012, the trend in morbidity is characterized by a decrease in rates in both age groups with a higher rate of decline in the UR: from –10.6% in 0–14 years (Russia: –5.5%) to –7.7% in 15–17 years old (Russia: –3.0%). The predicted incidence rate in the UR will be 19.2 in 2025 for children 0–14 years old; 18.6 for children 15–17 years old.

Conclusion. The established patterns indicate a decrease in the prevalence and morbidity of digestive organs among the child population of the UR.

Contribution:
Vikhareva E.G., Kovalenko T.V. — concept and design of the study;
Vikhareva E.G. — data collection and processing, statistical processing of the data, writing the text;
Kovalenko T.V.^­ — editing.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: October 22, 2023
Accepted: November 28, 2023
Published: December 27, 2023

Introduction. The review presents the characteristics of modern risk scales in pediatrics. A comparative analysis of the advantages and disadvantages of risk scales in pediatric cardiac surgery has been carried out. Early detection of high-risk patients was shown to be the basis for the prevention of adverse outcomes after cardiac surgery. The capabilities of the Aristotle School (Aristotle Basic Complexity (ABC) Score have been established as a tool for assessing the quality of surgical treatment of children with congenital heart defects (CHD). Its determinants are mortality, the complexity of the postoperative period, and the technical complexity of the operation. The correlation between the values of the ABC scale and its determinants was evaluated. If the values of all three determinants exceeded the upper limit of the 95% confidence interval (CI), the patient was included in the high-risk group. The quality of treatment was assessed by the performance index (IP). A close correlation between ABC and its determinants has been revealed. For the ABC school, a high accuracy of the prognosis of death, complications, and technical complexity was established with an optimal threshold value of 6.5 points. Patients with ABC above the threshold were more likely to die. The IP was 0.56, similar indicators of foreign clinics ranged from 0.46 to 0.62 points.

Conclusion. The basic Aristotle scale and new risk stratification scales after cardiac surgery in children are effective systems for evaluating the results of surgical treatment of CHD patients of different levels of complexity can be used to determine the quality of surgical treatment and identify high-risk groups.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The author declares no conflict of interest.

Received: October 20, 2023
Accepted: November 28, 2023
Published: December 27, 2023

Introduction. The review is devoted to the importance of lipids in the nutrition of premature infants with bronchopulmonary dysplasia (BPD). In recent years, the proportion of children born prematurely especially babies with very low and extremely low body weight, has been increasing due to the introduction of reproductive technologies that allow women with various pathologies and health abnormalities having children, as well as the use of modern neonatal intensive care and intensive care facilities. One of the most common diseases in such patients is BPD. An important component of the system of caring for prematurely born infants is adequate nutrition, which plays an important role in the development and maturation of all organs and systems, including lung tissue, changing its morphology. It is important to note that in severe BPD, there is a direct relationship between nutritional status, normal lung function, and psychomotor development of the infant. Therefore, the nutritional needs of premature BPD infants are increased and this imposes special requirements on their admission and individual dietary correction, taking into account all the features of the child’s development and the presence of concomitant pathology. The optimal nutrition for a premature baby is recognized as mother’s milk, which is enriched with breast milk. However, the fat component (the main energy substrate) is either absent in the fortifier, or lipids amounts in to fail to be sufficient. The use of specialized mixtures also does not overlap the caloric content of the diet to provide the growth rate of BPD infant against the background of increased energy needs by 15–25% when compared with patients without BPD) and the necessary restriction of the volume of injected fluid due to the high risk of hypervolemia of the small circulatory circle.

Conclusion. Thus, an additional supply of medium-chain triglycerides seems to be a promising direction that increases the fat component of the diet and, as a result, its energy value in conditions of limiting fluid intake in premature BPD infants.

Contribution:
Basargina M.A., Skvortsova V.A., Kharitonova N.A. — concept and design of the study, writing the text, editing the text;
Basargina M.A., Skvortsova V.A., Illarionova M.S., Pinaeva-Slysh E.L. — collection and processing of material;
Skvortsova V.A., Kharitonova N.A. — statistical processing.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: November 14, 2023
Accepted: November 28, 202
Published: December 27, 2023

Primary immunodeficiency conditions are a heterogeneous group of disorders caused by defects in various parts of the immune system, manifested in the form of recurrent infectious and autoimmune diseases of varying severity. The authors describe own clinical observation to determine the principles of diagnosis and treatment of primary immunodeficiency in children in modern conditions. The average age of diagnosis of an immunodeficiency condition has been established to be best over 30 days, but often this time increases to several years. The data of the enrolment of primary immunodeficiency states of the Republic of Dagestan on the diagnosis and permanent replacement therapy of immunodeficiency states is also presented.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Contribution:
Aliskandieva Z.A. — concept and design of the study, statistical processing of the material;
Idrisova R.M., Amirova K.M. — collection and processing of material;
Aliskandieva Z.A. — writing the text;
Aliskandiev A.M., Israilov M.I. — editing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Received: October 16, 2023
Accepted: November 28, 2023
Published: December 27, 2023