Modifications in treatment guidelines of hemophilic arthropathy changed the role of diagnostic X-ray imaging methods. Diagnostic methods are used both for determination of the degree of joint destruction and long-term evaluation of the joint conditions and therapy adequacy and effectiveness. Aim. Magnetic resonance imaging (MRI) dynamics for joint condition assessment in children with hemophilic arthropathy receiving prophylactic factor replacement therapy concentrated rolling VIII. Materials and methods. We studied 13 boys aged 5 to 14 years (mean age 8.9 years) with hemophilia type A severe form of the disease (factor VIII deficiency <1%) at the baseline. The average age of appearance of hemarthrosis is 2.1 years (from 1.8 to 2.9 years). The frequency of bleeding into the joints of patients older than 1 year was 2-3 times per year. Magnetic resonance imaging (ToshibaExcelArtVantage, 1,5 T) was performed in 13 patients, 35 joints were examined, 57 studies were executed. Control study of joints was conducted in 1, 2 or 3 years depending on the frequency of hemarthrosis during the year and the severity of joint damage primarily identified. Results. The results included both the improvement along with the stabilization of intra-state structures and the negative dynamic shifts. MRI showed that the reduction of bleeding in the joints on the background of hemostatic replacement therapy led to subsiding inflammation in the joints and significant decrease in the amount of intra-articular effusion (n = 11; p = 0.03), decrease in the number of joints with symptoms of bone marrow edema (n = 8), the absence of observations with negative changes in the form of increasing the thickness of the synovial membrane. Negative dynamics of joint condition presented as increasing of the depth and length of erosive process (n = 5; 22.7%), degenerative changes in ligaments and menisci (n = 2; 9%) under the condition of regular administration of clotting factors was associated with the development of the inhibitory form of the disease which was confirmed by laboratory data. Conclusions. Magnetic resonance imaging evaluates the effectiveness of replacement therapy in children with hemophilia.

Background. It is known that obesity may influence the state of respiratory function and it is associated with a number of diseases of the respiratory system. Obesity in itself, even in the absence of other known causes, can cause a feeling of shortness of breath at rest. At the same time, the cardinal symptom of respiratory muscle weakness is shortness of breath, which promotes the reduction of exercise tolerance. At the moment the problem state of respiratory function and respiratory muscles in children with different degrees of obesity is relevant and understudied. Aim. Investigation of lung function and respiratory muscle strength in obese in children. Methods. 46 children with obesity were examined, with a prevalence of obesity of mixed origin with progressive, aged 7 to 16 years. We evaluated the lung function and strength of respiratory muscles in the form of maximum inspiratory pressure at the mouth (MIP), maximal expiratory pressure at the mouth (MEP) and nasal inspiratory pressure in the sniff-test (SNIP). Results. The children with obesity complained of dyspnea. The respiratory muscle dysfunction observed in the form of reduction of its forces. Reduced respiratory muscle strength ( 80% of the norm) was in 44% of patients on the MIP and 38% on the MEP and was increased with increasing body mass index. Conclusion. Children with obesity need to monitor the lung function and evaluate the strength of the respiratory muscles for early detection of functional disorders of the respiratory system.

Relevance. Allergic pathology in particular, a hay fever, can lead to decrease in cognitive functions at children. Earlier it was established that antihistamine preparations of I generation influence cognitive functions of patients. Тhe patients with this nosology receive for a longtime courses of antihistamine preparations of II generation, so the analysis of influence of different AH preparations of II generation on cognitive activity of children with a hay fever is necessary. Purpose. Studying of influence of II generation antihistamine preparations in a complex with the specific allergen immunotherapy on cognitive functions at children with a hay fever. Patients and methods. Using the psychophysiological computer complex «Psihomat» the condition of cognitive functions was established. In total the 81 child with a hey fever were investigated. The persons under consideration were divided on subgroups depending on antihistamine which they received. For the patients in the main group of investigation the cognitive functions have been studied in 3 points. Results. The patients had changes in the attention and psychomotor activity more often, than in other conitive activity. It is not obtained distinct data on characteristic contribution of antihistamine preparations of a second generation in improvement of cognitive activity as a whole at complex treatment of hay fever with specific allergen immunotherapy. Antihistamine preparations (desloratidine and cetirizine) are improved by indexes of visual and space perception at children with a hay fever. From the 3 antihistamine preparations the cetirizine has the most carried out positive effect concerning the psiho-motoric activity in the combined ASIT. Conclusion. Padding express researches in the field are necessary for receiving the definite answers to problem questions.

Goal: to compare the main parameters of toilet skills formation in between children of the common population and those from families with a high social and economic status. Methods: 1068 parents with children 2–5 years of age were questioned using a specially developed questionnaire. Results: 1012 children from the common population (CP) and 56 children from families with a relatively high economic and social status (RHESS) were studied. The average age at the beginning of toilet training appeared to be the same 15,17 ± 0,23 months (CP) and 15,6 ± 0,8 months (RHESS). In the CP group 29.5% of parents started toilet training before their children reached the age of 1 year — which is twice more often than in the RHESS group. The RHESS children finish toilet training approx. 1.9 months earlier. The overall training turned out to be shorter in the RHESS group by more than 2 months: 10,5 ± 0,6 against 12,88 ± 0,41 months (р < 0,05). Serious differences were discovered in the teaching methods: parents from the CP group are more inclined towards forced placement of the child onto the pot and to more active actions demonstrating at the same time more variety in methodology, while in the RHESS group the methodology is more homogeneous with techniques oriented at the child’s choice and a moderate parental activity are dominating. Conclusion. The methods of child toilet training in families with a high economic and social status is different from those most popular in the general population. The training in the RHESS group is slightly faster and is concluded earlier.

Substantiation. The Juvenile Idiopathic Arthritis (JIA) is the most frequent rheumatic disease at children and is characterized by primary damage of joints, and also pathology of other bodies and fabrics with formation of polyorgan insufficiency of various degree of expressiveness. Research objective. A comparative assessment of efficiency and safety of a tocilizumab in a combination with a methotrexate in comparison with therapeutic efficiency only a methotrexate at patients with polyarticulary option of JIA. Methods. Kliniko-laboratory, biochemical, immunological methods of a blood test in dynamics of a disease against the carried-out therapy were used. Results. Tocilizumab in combination with a methotrexate has the expressed anti-inflammatory effect at the children sick with polyarticulary option of JIA. At treatment only a methotrexate efficiency of the carried-out therapy was much lower and not always than the effective. Conclusion. Tocilizumab is a perspective preparation for treatment of juvenile arthritis, refractory to standard immunosupressivе therapy.

The article is concerned with the issue of a standardized approach to determining the effectiveness of allergen-specific therapy (AST) in children. AST has a special role in treating allergy: only this method can induce clinical and immunological tolerance to the cause-significant allergen; is safe enough and highly effective; reduces the duration of acute conditions; reduces the necessity for both basic therapy medicines and additional symptomatic therapy; is capable of preventing the progression of allergic diseases by reducing the sensibility spectre and the formation of bronchial asthma in those suffering from allegic rhinitis; improves the control over the disease and has a positive effect on the patient’s and his family quality of life. At the moment evaluating the effectiveness of medical technologies is one of the most important tasks in medicine while the effectiveness and safety of any medical intervention should be obtained in accordance with the requirements of evidence-based medicine. In order to determine the effectiveness of AST in children, a combined clinical and pharmaceutical evaluation should be performed and as a secons point — determine the patient’s life quality and also evaluate the gravity of symptoms according to the visual analogue scale, and to count the number of days with the symptoms and without them. 

The article is devoted to the actual problem of modern pediatrics and neurology ― a comprehensive diagnosis and correction of sleep disorders in children. Detail the features of the clinical manifestations of sleep disorders in childhood (insomnia and parasomnia), great attention is paid to sleep apnea syndrome as a risk factor for somatic and psychopathological disorders in children. Highlight the current capabilities of complex instrumental diagnosis of sleep disorders with the use of highly effective methods of polysomnography and pulse oximetry. The actual dimensions as non-drug and drug treatment of sleep disorders in children, taking into account the pathogenetic features of their occurrence. From the standpoint of evidence-based medicine demonstrate efficient methods of herbal medicine, developed on the basis of traditional Chinese recipes, as well as modern nootropics and magnesium preparations. It is shown that sleep disorders in children not only lead to a deterioration of emotional mood, cognitive function, health and school performance, but also are associated with increasing risk of somatic disorders, which determines the need for timely diagnosis and comprehensive differentiated medical and psychological data correction of pathological conditions, taking into account the neurophysiological and biochemical mechanisms of their development, as well as polymorphism of clinical manifestations, in order to increase the effectiveness of treatment and quality of life of patients.

This article is concerned with the problem of obtaining control over bronchial asthma in children. The goal of treating any allergic disease is to gain control over the symptoms and a maximum decrease in future risks (both aggravations and negative therapy side effects). The authors present an algorithm of determining the level of control over bronchial asthma. A complex approach towards treatment is shown. It has been noted that, despite a significant movement towards the understanding different aspects of child asthma and the current efforts in creating guides concerning its treatment, a great number of patients are still incapable of controlling the illness. One of the main reasons is the lack of adherence demonstrated by the patients and their parents towards medical recommendations. This article deals with the main reasons why the patients do not follow the recommendations of doctors. The authors no only discuss the ways of increasing the patient-doctor collaboration, but also offer modern and innovative solutions which should help to increase the adherence to the designated therapy and thus the control over child asthma.

Relevance. Acute tonsillitis is one of the most prevalent infectious diseases in children starting from the 6th month of live. Acute tonsillitis is more often triggered by viri rather than bacteria. Among the latter, the most significant etiological agent is the ß-hemolytic streptococcus of group A (BHSA). The difficulty of bacterial confirmation of a BHSA infection out-patient conditions, the fear of complications produce an excess usage of antibiotics while treating acute tonsillitis. It is possible to avoid the drawbacks of cultural studies (connected with a late response — around 4–5 days — and with the logistics of the material to the bacteriological laboratory) by using the highly specific and sensitive express-test, which allows to determine a BHSA etiology of the acute tonsillitis right at the patient’s bed in 5–10 minutes. Aim: to optimize the diagnostics and treatment of acute tonsillitis in children in out-patient conditions. Patients and methods. In the conditions of a single paediatric district with 935 children aged 0 to 18 years 79 cases of acute tonsillitis were registered over the period of 1 year of surveillance. The criteria were: hyperemia of the back side of the throat, inflammation of the tonsils in the form of hyperemia/impositions. Along with general clinical methods all children received and additional express-test. Results. The population prevalence of acute tonsillitis was 84 per 1000 children, while the prevalence of BHSA-induced tonsillitis was 7.3 per 1000. The overall percentage of BHSA tonsillitis among other types of tonsillitis was 8.8%. Children with an acute BHSA-induced tonsillitis were prescrived with amoxicilline 50 mg/kg for 10 days. Conclusion. Using the express-diagnostics of the BHSA infection allows for a reduction in antibiotics usage in children with acute tonsillitis to 8.8%.

Sepsis is one of the leading causes of child lethality. Timely diagnostics is the most important condition for treating sepsis successfully. This study contains analysis of recommendations on diagnosing the syndrome of systemic inflammatory response, sepsis, severe sepsis and septic shock of the Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012,
published in 2013. The modern perceptions of systemic inflammation during sepsis and sterile inflammation are highlighted.

Interleukin 1 (IL 1) is the main mediator for many auto inflammatory diseases (AID). Cryopyrin-associated periodic syndromes (CAPS) became the first diseases, for which the efficacy of IL 1 inhibitors was shown with a high degree of evidence. Canacinumb (totally human monoclonal antibodies to IL 1 is registered in Russia since 2011 for treating CAPS. At the moment research is being conducted to evaluate the efficacy and tolerance to IL 1 inhibitors in patients with other AIDs. The accumulated experience and scarce randomized
controlled studies demonstrate a successful usage of IL 1 inhibitors in colchicine-resistant patients with family Mediterranean fever with the cupping of inflammation attacks, reducing the acute phase activity and also in patients with other monogenic (TRAPS, HIDS and others) and multifactorial pathologies (systemic juvenile arthritis, Stilk disease in adults, gout etc.). Using the IL 1 inhibitors, especially canacinumab, in patients with different AIDs has shown good tolerance and a high efficacy in all patients with no correlation to the age, according to Russian and world research. Thus, canacinumab, thanks to its therapeutic abilities, has broad perspectives in terms of lightening the disease course, improving survival, life quality and the overall prognosis.