Background. Mobile flat foot etiology and its correlations with postural imbalance remain topical issues for now, especially in children with generalized joint hypermobility. Additionally, it is poorly known that complaints prevail in children with mobile flat foot and joint hypermobility, and whether existing complaints are associated with foot deformation.

Objective. The aim of the study is to estimate medium-term effects of body balance trainings on the height of longitudinal arch of the foot and on the complaints structure in primary school-aged children with generalized joint hypermobility.

Methods. The study included 114 primary school-aged children (7–11 years old) with mobile symptomatic flat foot who were divided into four groups: I — control group of children who did not perform training; II — children who performed standard complex of rehabilitation exercises recommended for flat foot; III — children who performed a specially designed complex of exercises for body balance training; IV — children exercised on unstable platform. The foot examination included: clinical assessment of feet shape and position (FPI-6 scale), visual and manual mobility tests, computer scanning with calculation of anthropometric indices (basic anthropometric parameters were calculated from scanned foot images). Clinical evaluation of balance was carried out according to the BESS (Balance Error Scoring System) scale and computer pedobarometry. Assessment of complaints structure was carried out according to the Oxford Child Foot Condition Questionnaire.

Results. Children of control group significantly increased the number of errors in performing tests compared to the baseline data (p = 0.034) according to the BESS scale. No statistically significant changes were obtained in children of the second group (p = 0.08). Total number of errors committed by children of third and fourth groups on unstable platform decreased by 2.9 times and 3.4 times, respectively (p = 0.022 and p = 0.044). Decrease in partial load on medial longitudinal arch of foot in step cycle in average by 2.0–3.5 times compared to baseline parameters was revealed in children of third and fourth groups. Moreover, children of third and fourth groups have shown improvement in parameters regarding the shape and position of the feet by average of 1.3–1.7 times higher compared to the parameters of the feet of children performing standard complex of rehabilitation exercises (p = 0.036).

Conclusion. This study has shown the efficacy of body balance training in increasing the height of longitudinal arch of the foot and good dynamics in the structure of complaints in primary school-aged children with generalized joint hypermobility and symptomatic mobile flat foot.

Background. Antimicrobial resistance is one of the most crucial problems in human health care worldwide. The main cause of this crisis is the excessive and misuse of antibacterial drugs (ADs). The highest rate of improper antibiotics' prescriptions in pediatric practice is observed at treatment of respiratory tract infections in outpatient clinics.

Objective. The aim of the study is to analyze the clinical practice of management of patients with acute respiratory infections (ARI) and the use of ADs in children's outpatient clinics across the regions of Russian Federation.

Methods. Multicenter retrospective study was conducted. All ARI cases documented in 969 medical records (form 112/y) of children born in 2015–2017 yy. in 16 regions of Russian Federation (selected randomly) were analyzed.

Results. Acute viral infection was diagnosed in 79.6% cases of referencing to doctor with ARI symptoms. Systemic ADs were prescribed in 23% cases of ARI. Antibacterial therapy was received by 14% of children diagnosed with acute respiratory viral infection, 35% with acute laryngotracheitis, 80% with acute bronchitis, 76% with acute rhinosinusitis, 94% with ARI associated with otitis media, 52% with tonsillopharyngitis, and 100% with community-acquired pneumonia. Amoxicillin (35%), amoxicillin/clavulanic acid (24%), azithromycin (20.2%) were prescribed most often. Parenteral administration of ADs was prescribed in 3.9% of cases, mostly for children with community-acquired pneumonia. Prescribed antibacterial therapy was unreasonable in 84% of analyzed cases. Polypragmasy occurred in 50.5% of cases. Clinical protocols violations were mostly common for management of patients with laryngotracheitis and tonsillopharyngitis.

Conclusion. There is favorable trend towards the decrease in ADs prescribing frequency in outpatient clinics for children with ARI. Thus, polypragmasy and irrational choice of antibacterial therapy frequency remains quite high.

Objective. The aim of the study is to identify the most significant factors influencing the audio-verbal rehabilitation outcomes in preschool children.

Methods. The study included 104 children, 3–7 years of age, with hearing loss who underwent course of audioverbal rehabilitation in audiology center: 50 children after cochlear implantation, 51 children with hearing aids, 3 children without hearing care. The following data was collected at the beginning of the course: gender, type and degree of hearing loss, comorbidities, method and age of hearing care, family structure, preschool organization type. The scale of social and psychological diagnostics was filled in. The dynamics of indicators were estimated at the end of the course. The overall result was rated as high, good, medium or low. Correlations between clinical, audiological, social, psychological data and different rehabilitation outcomes were estimated.

Results. Degree and type of hearing loss, method of hearing care, gender, age, and social aspects do not affect the rehabilitation outcomes. Hearing aid was performed before 3 years of age in 67% of children, and after 3 years of age in 33% of children in the group with high and good results. Hearing aid was performed after 3 years of age in 61% of children, and before 3 years of age in 39% of children in the group with medium and low results (p < 0.01). Burdened anamnesis and comorbidity was determined in 28% of children with high/good outcomes and in 59% of children with medium/low outcomes (p < 0.01). Children with medium results rarely have previous audiology therapy, 43.8% of cases (p < 0.01). Children with medium and low outcomes have statistically worse score according to the scale of social and psychological diagnostics (p < 0.05 and p < 0.01, respectively).

Conclusion. High results of audio-verbal rehabilitation in preschool children can be predicted by the age of primary hearing care (before 3 years of age), absence of comorbidities, previous audiology therapy, score at the scale of social and psychological diagnostics less than 17 points.

Background. Atopic dermatitis (AD) arouses high research interest these days due to its significant morbidity rate. The most crucial risk factor for its development is the intestinal microbiota composition. The correlation of this factor with the development of AD in children requires further study.

Objective. The aim of the study is to perform comparative analysis of the intestinal microbiota in 1–5 years old children with AD and conditionally healthy children via 16S-sequencing of ribosomal RNA (rRNA) of bacterial genes.

Methods. We have conducted cross sectional study. 60 children with diagnosed AD and 15 conditionally healthy children aged from 1 to 5 years were surveyed. Intestinal microbiota was examined via 16S-sequencing of rRNA of bacterial genes.

Results. The intestinal microbiota in children with AD and conditionally healthy children has statistically significant differences. Despite the absence of significant differences in species richness of compared groups, children with AD had the elevation in the metagenome of Proteobacteria; Bacilli and Gammaproteobacteria classes; Enterococcaceae and Veillonellaceae families; Eggerthella, Dialister and Enterobacter genus; as well as the decrease in the relative value of Actinobacteria, Bacteroidetes, Verrucomicrobia; Bacteroidales and Bifidobacteriales orders; Bifidobacteriaceae, Bacteroidaceae, Erysipelotrichaceae families; Lachnoclostridium, Roseburia, Prevotella, Coprococcus, Ruminococcus, Faecalibacterium, Bifidobacterium, Bacteroides genus; decrease of Bifidobacterium longum, Faecalibacterium prausnitzii, Bacteroides fragilis.

Conclusion. It was revealed that the intestinal microbiota of children with AD has significant differences in taxonomic composition with the microbiota of conditionally healthy children. Elevation of Proteobacteria, Bacilli and Gammaproteobacteria classes, Eggerthella, Dialister and Enterobacter genus can be the risk factor for this disease development, whereas decrease of such bacteria as Verrucomicrobia, Bacteroidales and Bifidobacteriales can aggravate atopic symptoms. Thus, the need for further study of intestinal microbiota in children with AD is justified to establish the correlation of these bacteria with the disease course. 

Background. T-cell response is shifted towards Th₂-type predominance in newborns. This makes them particularly vulnerable to exposure of various external pathogens, development of severe infections, moreover, it is also a risk factor for allergic diseases development. Various methods of switching the immune response to Th₁-type are currently under research, and one of them is vaccination.

Objective. The aim of the study is to provide data on the prevalence of allergic pathology among children vaccinated against tuberculosis and hepatitis B, as well as the effect of vaccines on immune response type.

Results. Data on both increase and decrease in the prevalence of atopic conditions in children vaccinated with BCG and against hepatitis B were analyzed, thus, most of them cannot be considered reliable. The results of several large studies do not reveal any correlation between vaccination and the presence of allergic disease in children. There is data that BCG and hepatitis B vaccines shift the immune response towards Th₁-type activation.

Conclusion. Vaccination in the early neonatal period may affect switching of the immune response towards Th₁-type. That, in turn, can affect the prevalence of allergic pathology in vaccinated children. However, the data available for now is not sufficient to reliably estimate the possible effect of vaccination on atopic conditions manifestation in the future.

Background. Vaccination is the most effective method for reducing morbidity, disability, mortality from of various infections. However, there was a view for a long time that vaccines are ineffective and unsafe to use in people with rheumatological diseases, including juvenile idiopathic arthritis (JIA). Objective.

The aim of the study is to analyze literature data on safety and efficacy of vaccination for JIA patients with live and non-live vaccines.

Methods: literature analysis was based on data from medical databases PubMed and Google Scholar.

Results. Both live and non-live vaccines are safe and immunogenic enough for children with JIA. Most studies confirm vaccination efficacy in patients with JIA when using glucocorticosteroids (GCS) and methotrexate, while therapy with disease-modifying antirheumatic drugs (DMARD) can reduce antibody titers over time. In general, antibodies levels preservation in previously vaccinated children with JIA is less than in global population. This indicates the need to administer booster doses for such patients. No adverse effects on the course of primary disease after vaccination and no post-vaccine complications were revealed.

Conclusion. Vaccination of patients with JIA should be performed with reference to the therapy that the patient already receives, under the control of antibodies level. Booster doses should be implemented in case of titers decrease below the protective levels.

Background. Studies of the economic impact of disease on society or the social and economic burden, known as developmental disease cost analysis, are equivalent to public health epidemiological studies. Spinal muscular atrophy (SMA) has significant social and economic burden according to various studies.

Objective. The aim of the study is to compare Russian and international methodological approaches and results of health technology assessment (HTA) of SMA from the perspective of social and economic burden. Materials and methods. Literature searches were conducted using the Medline, PubMed, ClinicalTrials.gov, and Cochrane Library databases. Keywords and criteria for inclusion and exclusion have been used. The following parameters were used: costs, year of calculation, assessment method, primary and secondary results, type of economic assessment, perspective, time horizon, intervention, analysis of the sensitivity of the results. Both direct medical and non-medical costs were taken into account, as well as indirect costs.

Results. The analysis of SMA burden the USA, Germany, Spain, Australia, France, Great Britain, and the Russian Federation was carried out based on 8 international studies and one Russian study that described the costs of SMA. All costs, including indirect ones, were estimated only in 4 international studies and in Russian one. The main source of information was either patient registers or cross-sectional retrospective studies of patients diagnosed with SMA. The costs were higher for type I SMA in all countries. The highest total SMA costs were in the United States, and the lowest in Russian Federation and Spain. Costs excluded new disease-modifying drugs such as nusinersen, risdiplam, and onasemogen abeparvovec in all conducted studies.

Conclusions. The social and economic burden of SMA in Russian Federation in 2020 before the introduction of pathogenetic therapy into practice was 2.38 billion RUR/year. The costs of inpatient treatment and rehabilitation were 30.8 and 32.3% of total costs, respectively. These costs, before the introduction of pathogenetic therapy into practice, are lower than in Western Europe and United States, which is most likely since domestic studies used the standards of primary health care for children with SMA implemented in 2012, as well as low indirect costs for SMA in Russian Federation. Unified methodology for assessing the socio-economic significance of orphan diseases is required to carry out HTA of orphan diseases in Russian Federation. It should be based on domestic registries, otherwise on valid data, including those based on data from real clinical practice (RWD /RWE).

The article discusses the possible diagnostic errors in the hypoplastic left heart syndrome (HLHS) with mitral atresia and intact interventricular septum. “Atrioventricular canal defects” can be commonly and mistakenly diagnosed the prenatal period in such cases. The aspects and possibilities of differential diagnosis of these defects in the prenatal period are discussed. Ultrasound sign is presented in the article, we have named it “hockey stick with puck” that characterizes the retrograde blood flow in the aortic arch. This sign is diagnosed by color Doppler mapping of the sagittal section of the ductus arteriosus and can serve as a marker of mitral/aortic atresia.

Background. Russia is one of the top ten European countries with high level of bullying and ranks second in cyberbullying among adolescents. Involvement in bullying and virtual aggression has immediate and long-term consequences for all parties to the conflict, including witnesses. Immediate consequences can be manifested as violation in adaptation and socialization of children and adolescents; long-term consequences can be mental disorders in emotionally labile schoolchildren. School bullying is always distinguished by its cruelty and intransigence.

Objective. The aim of the study is to estimate the prevalence of bullying and cyberbullying among boys and girls aged 11, 13 and 15 years studying in educational organizations in Yekaterinburg and to create the complex of preventive guidelines.

Methods. Sociological cross-sectional study was carried out using the questionnaire with questions from the international questionnaire Health Behaviour in School-Aged Children (HBSC). Analysis of the results was carried out for different age and gender groups, the results of comparative analysis with the data of the international HBSC study are also presented.

Results. The main characteristics of bullying are presented: prevalence, age and social features. High involvement of adolescents in bullying (11.7%) and cyberbullying (18.2%) was revealed. The ratio of adolescents who have repeatedly been the victims of physical, psychological and virtual aggression was significantly higher (21.7 and 31.8%, respectively). Boys are more likely to be aggressors and victims of abusive behaviour (physical and psychological aggression) than girls. Moreover, number of schoolchildren who became victims of bullying decreases with age, this indicator is more significant among boys, while the number of cyberbullying victims increases among older adolescents.

Conclusion. The high prevalence of bullying in adolescents has negative impact on both, victims and aggressors. Bullying affects the physical and mental health of children and adolescents, leads to psychological and social maladaptation, as well as the development of sustainable models of problematic and most often aggressive behavior. Educational organizations have to become the basis for implementation of future programs on bullying and cyberbullying prevention. They should not only provide safe environment but also help children to establish open and friendly relationship with peers and adults and to clearly understand their actions and their consequences.

The number of people infected with the SARS-CoV-2 virus causing COVID-19 is steadily growing around the world. Given the fact that the disease is new, it is necessary to study the characteristics of its spreading and clinical course, including pediatric population. The article  presents clinical case of COVID-19 in 15-year-old child with the development of thrombosed basilar artery aneurysm that compressed the brain stem in the pons and subarachnoid hemorrhage, the development of a fusiform aneurysm of the right internal carotid artery. These pathologies were later complicated by right-sided hemiparesis. The importance of inter-clinical interaction of physicians of all specialties
and the need for early rehabilitation at the outpatient stage of treatment in the context of the COVID-19 pandemic were shown.