Introduction. Inflammatory activity in ulcerative colitis (UC) and Crohn’s disease (CD) is assessed comprehensively using endoscopic, clinical, and laboratory parameters. Mucosal friability (MF), verified during colonoscopy, is an indicator of mucosal healing — the therapeutic goal in inflammatory bowel disease (IBD) and a significant prognostic factor for UC clinical outcomes.
Aim: To evaluate the role of MF in determining IBD activity in children.
Materials and methods. A clinical, prospective, observational cohort study included 81 IBD child, of whom 42 patients comprised the UC group and 39 the CD group. Disease activity was evaluated using pediatric clinical activity indices for UC and CD, as well as the endoscopic activity index for UC and the simple endoscopic score for CD. MF was assessed with a scale where 0 points corresponded to the absence of pathological changes, 1 point to intramucosal hemorrhages, and 2 points to contact bleeding.
Results. In UC patients there were close positive correlations between the endoscopic activity of the disease and the severity of CD (p < 0.001; r = 0.713) and a moderate closeness between clinical activity and CD (p < 0.001; r = 0.503). In CD children, positive correlations of moderate crowding were found between the endoscopic activity of the disease and the severity of CD (p = 0.003; r = 0.464). However, in CD patients, the correlations between the clinical activity of the disease and CD are not significant (p = 0.184; r = 0.223).
Conclusion. The determination of the contact difference to determine the healing of the mucous membrane in IBD is an informative method and has diagnostic significance in UC patients, in which the inflammatory process is located superficially in the mucous layer. The clinical interpretation of contact vulnerability requires mandatory comparison with clinical and anamnestic data and laboratory test results.

The relevance of the analysis of functional disorders of the gastrointestinal tract in children is largely due to the possibility of early prevention of severe forms of its pathology.
The aim of the study was to determine changes in the activity of Helicobacter pylori-associated gastritis in schoolchildren with gastroesophageal reflux disease (GERD).
Materials and methods. One thousand seventy nine children aged of 7–17 years were examined. Clinical manifestations of gastrointestinal pathology were identified in all children. An endoscopic examination of the upper gastrointestinal tract with a biopsy of the gastric mucosa was performed in 115 schoolchildren with gastroenterological complaints. Morphological diagnosis of gastritis and H. pylori infection was GERD (34 schoolchildren with GERD and 81 child without pathology), which was diagnosed in accordance with the children’s consensus. The significance of the feature differences was analyzed using the Pearson χ2 criterion. The differences were considered to be significant at p < 0.05.
Results. The examined schoolchildren had gastritis of the 1st degree of activity, both in the antrum and even more often in the mucous membrane of the stomach body. At the same time, there were no changes in the activity of gastritis in both parts of the stomach in children, depending on the presence of GERD. Gastritis associated with H. pylori infection was detected in 53.8% of GERD children and 58.7% of cases without GERD (p = 0.672). In H. pylori-positive children, an increase in gastritis activity was detected. In infected with H. pylori children with GERD, there was no significant increase in the activity of the inflammatory process in both parts of the stomach. However, in H. pylori-positive schoolchildren without GERD, both in the antrum and in the stomach, increased gastritis activity was observed (p = 0.038), primarily expressed in younger schoolchildren (p = 0.044) and Tuvinians (p = 0.039).
Conclusion. An increase in the activity of inflammation in the gastric mucosa in schoolchildren, regardless of the presence of clinical manifestations of GERD, is observed in gastritis associated with H. pylori infection.

Introduction. Influenza and other acute respiratory viral infections (ARVI) account for a significant share in the structure of childhood infectious diseases. The determination of medium-weight molecules (MMM) and the calculation of leukocyte intoxication indices in respiratory pathology in children are of interest for studying and searching for informative markers.
The aim of the work: to determine the diagnostic significance of indices characterizing the state of endogenous intoxication in children with seasonal influenza and ARVI.
Materials and methods. One hundred twenty five patients were examined, of which 76 children diagnosed with influenza made up the main group (42 boys, 34 girls, average age of 5.2 ± 2.3 g), the comparison group consisted of 49 children diagnosed with acute respiratory viral infections (27 boys, 22 girls, average age 5.6 ± 2.5 yr). The control group consisted of 112 conditionally healthy children, groups of children being comparable in gender and age. The levels of MMM were determined by spectrophotometry. Statistical data analysis was performed with the Statistica 6.0 software.
Results. In patients with influenza, multiple correlations there were found between MMM and island-inflammatory proteins. The distribution coefficient in patients with influenza and ARVI did not differ significantly, while it significantly correlated in both groups with the rate of erythrocyte sedimentation and the level of C-reactive protein (CRP), (p = 0.000), the aromaticity coefficient and the peptide-nucleotide coefficient significantly correlated with the level of CRP in influenza (p < 0.05). The Garkavi index was higher in 67% of cases of influenza, 53% of cases of ARVI, the allergization index and the leukocyte intoxication index according to V.K. Ostrovsky’s was slightly elevated in children with ARVI.
Conclusion. The determination of MMM and the calculation of leukocyte intoxication indices in children with respiratory viral infection provides an objective assessment of the degree of endotoxicosis. The established correlations of the distribution coefficient with the indices of inflammation allow recommending its use in clinical practice.

Introduction. Spinal cord (SC) injury without radiographic abnormalities, designated as SCIWORA, occurs in children with a frequency of 6 to 19% of all spinal injuries. Anatomical and physiological characteristics of children, SC contusions and impaired blood supply to the SC are decisive in the formation of SCIWORA. Given the existing connection between the degree of SC injury and clinical outcome, MRI results are an important area of SCIWORA research.
Aim: to determine role of magnetic resonance imaging in the study of SC injury with SCIWORA in children.
Material and methods. The study was performed in 22 children (13 boys and 9 girls) with clinical manifestations of SCIWORA, aged from 1 year to 17 years (mean age — 7.5 ± 4.5 years). All children in the acute period initially underwent computer tomography, then MRI in 9 of them. MRI was performed within the following timeframes: from 1 hour to 72 hours in the acute period and from 4 months to 36 months in the late period. MRI was performed on a Philips Achieva dStream 3 T scanner using the standard institute protocol for SC, which included: MR myelography, T2-Dixon, 3DT2-TSE, T1-WI, SWI, diffusion tensor images.
Results. According to the severity of injury using the ASIA classification, children with SCIWORA were distributed as follows: 8 — grade A (complete SC injury), 6 — grade B (incomplete sensory and motor). According to MRI data, damage to the cervical part of the SC was found in 7 patients; thoracic — in 12; the cervical and thoracic parts — in 3. In this case, hematomyelia was present in 13 cases, complete rupture — in 2 cases, contusion of SC — in 2, ischemia of SC — in 2. Small foci of hematomyelia up to 1/3 of the SC diameter or edema had a favorable prognosis and in most cases passed from 3 to 5 weeks after injury. Anatomical rupture of SC and/or large foci of hematomyelia (more than 1/2 of the SC diameter) had an unfavorable prognosis, visually manifested by atrophy, cystic-glial scars, in two observations syringomyelia, and in two cases there were additionally chronic epidural hematomas.
Conclusion. High-resolution MRI with sensitivity for soft tissue contrast is of great importance for identifying the location and size of all damaged spinal structures, including the SC. The algorithm for performing MRI in acute spinal injury should include T2- and T1-WI in the SE IP, STIR in the sagittal, T2-WI in the coronal and axial projections, 3D-SWI, and diffusion images. Contrast enhancement in acute spinal injury is also an element of the algorithm in some cases.

Introduction. Multifunctional glutamic acid (glutamate, Glu) is the main excitatory neurotransmitter in the central nervous system (CNS). By providing excitatory neurotransmission, Glu activates glutamate receptors (GluRc) associated with the intake of calcium (Ca2+). Acute and chronic Glu excitotoxicity and nitric oxide (NO) play a leading role in the mechanisms of neuron death during brain hypoxia, which accompanies cerebral circulatory disorders (CCD), strokes, epilepsy, traumatic brain injury (TBI), and neurodegenerative diseases. The aim of the study was to determine changes in the content of glutamic acid in the blood and cerebrospinal fluid (CSF) and the functional activity of GluRc receptors in children with various forms of hypoxic brain damage.
Materials and methods. Seventy nine CCD newborns, 36 children with congenital hydrocephalus, 58 children with acute lymphoblastic leukemia complicated by neuroleukemia, 42 children with epilepsy and paroxysmal conditions, and 159 children with TBI were examined. The content of Glu, glutamine (Gln), ammonia and biochemical markers of hypoxia (glucose, lactate) were determined in CSF and blood in CCD newborns using enzyme methods. The content of autoantibodies to NMDA and AMP GluRc was determined by enzyme immunoassay methods. The content of NO and its transformation products was estimated by the total content of nitrites and nitrates using the Griss method.
Results. As the severity of hypoxic brain damage increased, glucose levels decreased in the CSF of newborns, the content of lactate, protein, ammonia, and Glu increased, and the permeability of the brain-blood barrier increased. At the same time, the more pronounced brain damage was observed in children with various hypoxic CNS injuries, the higher the levels of Glu, total protein, and CA were observed in CSF.
Conclusion. The established patterns allowed determining the importance of NO and its conversion products in the functional activity of GluRc and showing the involvement of NO in protective and damaging processes in brain tissue.

Introduction. The annual number of endoscopic examinations in children has been steadily increasing in recent years against the background of stable morbidity rates. Endoscopy does not reveal any pathological changes in the colon in half of the examined children. This is due by the fact clinicians to pay little attention to optimizing the overall clinical load, substantiating indications, and financial costs associated with colonoscopy.
Aim: to determine the diagnostic significance of colonoscopy in the comprehensive examination of the colon in children.
Materials and methods. There were examined 500 children aged from birth to 18 years, underwent to colonoscopy with biopsy and histological examination of biopsies, and a retrospective analysis of 500 colonoscopies was performed. Statistical data processing with the SPSS 17.0 software package for Windows 10 (USA) was used to determine the indicators of norm and pathology.
Results. Pathological changes in the colon mucosa were detected in 89 (17.8%) patients. The most common indications for colonoscopy were abdominal pain (n = 356; 71.2%), juvenile rheumatoid arthritis (JRA) (n = 190; 38%), and chronic diarrhea (n = 155; 31.1%). Unchanged colon mucosa was observed in 78.3% of children with abdominal pain, 91% of JRA patients, 74.8% with chronic diarrhea, and in more than 70% of children with physical retardation and weight loss. The lowest rates of unchanged intestinal mucosa were observed in children with inflammatory bowel diseases (53.7%) and hemocolitis (59.4%).
Conclusion. In 82.2% of cases, colonoscopy in children revealed unchanged colon mucosa. This indicates to a significant number of endoscopic examinations could not be performed with a strict selection of JRA patients, recurrent abdominal pain and chronic diarrhea. In this regard, it is necessary to optimize the referral of sick children, standardize the assessment of children before endoscopic examination and identify patients in whom colonoscopy will be diagnostically effective.

Introduction. In children aged up to 14 years the prevalence of diseases of the digestive system in children in the Russian Federation is one of the highest, amounting to 4464.7 cases per 100,000 population in 2023. Pathology of the digestive tract contributes to weight deviations and affects the physical development in children.
The aim of the work: to determine the prevalence of digestive organs and body weight changes in preschool and school-age children.
Materials and methods. A retrospective analysis of data from electronic medical records of 456 preschool and school-age children (from 3 to 18 years old) observed in children’s polyclinics of the Moscow City Department of Health was carried out. The copying data was entered into the SPSS software, version 23 (USA), in which a statistical analysis was performed.
Results. I 328 (71.9%) children have a pathology of the gastrointestinal tract, 25 (5.5%) children were found to have several diseases at the same time (mainly cholecystitis in combination with gastritis). 71 (21.6%) children were diagnosed with gastritis, 68 (14.9%) had peptic ulcer disease, 47 (10.4%) had gastroesophageal reflux disease (GRD), 25 (5.5%) had cholecystitis combined with gastritis, 18 (3.9%) had cholecystitis, 15 (3.4%) — other forms of pathology of the gastrointestinal tract, and 7 (1.5%) — colitis. 145 (44.2%) children had unspecified forms of digestive pathology, coded according to ICD-10 as K31.9/K59.8/K59.9. Body weight changes were detected in 336 (73.7%) children, of which 192 (42.1%) children were diagnosed with overweight, 144 (31.6%) were underweight. 312 (68.2%) children had a burdened family history of digestive pathology.
Conclusion. The established patterns indicate to the need to increase the effectiveness of the prevention of eating disorders in preschool and school-age children and the importance of regular medical examinations of children during their rapid growth.

Introduction. The condition of the foot is one of the important indicators of the state of health of a growing organism. Deformity of the foot leads to violations of its functions, which reduces the quality of life in children and adolescents. Flat feet are more common among various types of deformity. The assessment of the prevalence of flat feet, taking into account various factors influencing its formation, is due to the need for scientific justification of preventive measures to prevent violations of the structure and function of the foot in children during their growth and development.
The aim of the work: to establish the features of the prevalence of flat feet among the 5th–9th grades students, depending on gender, class of study, and place of residence.
Materials and methods. There was conducted a mass survey in schoolchildren, attended by 70,470 students in the 5th–9th grades from 28 regions of Russia. The distribution by classes was approximately equal and amounted to 15–18%. The respondents answered the question “Did the doctors notice you to have flat feet?”. The answers included the following options: “No”, “I don’t know”, “Yes”. There was estimated the number of children whose doctors noted flat feet, depending on gender, class of education from 5th to 9th grades, and place of residence (city, urban-type settlement, village).
Results. Flat feet were detected in 23.7% of the respondents; 15.8% found it difficult to answer; 60.5% of the students replied that doctors had not identified flat feet. Boys were also shown to have no flat feet more often (27.4%) than girls (20.7%). 57.2% of boys and 63.2% of girls noted the absence of flat feet. The answer “I don’t know” was equally often noted by boys and girls, 15.4% and 16.1%, respectively. A greater number of children with flat feet live in the city (28%), a smaller number in rural areas (16.5%). The intermediate value is 21.3%, typical for children living in urban-type settlements.
Conclusion. The data obtained can be used in the development of preventive health-saving programs in the 5th–9th grades students, taking into account gender, class of study, and place of residence.

Introduction. Chronic heart failure (CHF) is a threatening complication of cardiovascular diseases or damage in other pathological processes. CHF is characterized by a significant risk of disability and mortality in childhood. The progression of CHF of any etiology is based on the process of cardiovascular remodeling associated with the activation of neurohormonal systems, sympathicoadrenal and renin-angiotensin-aldosterone. Aim of the review: to highlight the issues of the modern view of the etiology, pathogenesis, diagnosis and clinical features in CHF children to increase the knowledge in practitioners for better management of patients. A modern pharmacological treatment method that affects the prognosis and prevents the progression of myocardial damage is based on modulation of the activity of sympathicoadrenal and renin-angiotensin-aldosterone systems at the circulating, tissue, and cellular levels. When determining the treatment of children, the etiology of CHF should be established, concomitant diseases should be identified, the variant and severity of myocardial dysfunction should be determined, and the severity of clinical manifestations should be assessed.

Introduction. Magnetic resonance imaging (MRI) is a modern diagnostic method aimed at detecting pathological changes in tissues and internal organs. MRI possesses of significant diagnostic potential in inflammatory bowel diseases (IBD) in children. An alternative to endoscopic examination is MR enterography, a non-invasive technique that is not associated with ionizing radiation, which allows determining not only the condition of the intestinal wall throughout, including thickness and changes in the lumen, but also identifying extra-intestinal complications, as well as the response to treatment.
The aim of the work is to determine the diagnostic capabilities of magnetic resonance imaging in IBD in children. To analyze the literature, a search was conducted in the databases PubMed, MedLine, Google Scholar, and RSCI over the past 10 years. The most important advantage of MRI is its non-invasiveness, which is welcome when examining children of different ages. To improve the image quality during MRI, contrast is used, and various modes are used without a contrast agent. The indices for assessing intestinal inflammatory activity and perinatal complications on MRI closely correlate with the reference endoscopic data. MRI is widely used not only as a diagnostic tool for IBD in children, but also as a method of dynamic patient monitoring to evaluate the effectiveness of therapy.
Conclusion. MRI is one of the most accurate and informative diagnostic methods along with endoscopic examination. The advantage of the method is its non-invasiveness, which makes it more accessible for use in clinical practice, especially in children, as well as the ability to assess the condition of anatomical structures that are difficult to reach with an endoscope.

Crohn’s disease (CD) with isolated lesions of the upper gastrointestinal tract occurs in less than 5% of patients. In most cases, the complication of this form of the disease is gastroduodenal obstruction, which requires surgical intervention. Aim: to describe a clinical case of CD with an atypical onset mimicking Helicobacter pylori-associated gastric ulcer.
Materials and methods. A clinical case of CD simulating gastric ulcer in a 12-year girl is presented. A comprehensive laboratory and instrumental examination of the patient was performed. The diagnosis was made: CD A1b of the upper gastrointestinal tract, ileitis, colitis (L3+L4a), stricturating form (B2) with perianal changes (p), without growth retardation (G0).
Results. Taking into account the severe course and stenosing form of CD, severe protein and energy deficiency, to prevent complications, the patient initiated biological therapy with infliximab at the rate of 5 mg/kg, administration in the standard regimen in combination with azathioprine 50 mg/day (1.5 mg/kg/day). Against the background of the treatment and dietary correction, there was a positive trend in the form of relief of vomiting and weight gain (during the hospital stay, the patient gained 4 kg in weight).
Conclusion. The use of a multidisciplinary approach made it possible to establish the diagnosis of the stenosing form of CD with a predominant involvement of the upper digestive tract. Biological therapy using infliximab in combination with both azathioprine and diet therapy made it possible to avoid surgical intervention.