EDITORIALS

The article is dedicated to evaluating quality of medical care of children. Improvement of this parameter and public health indicators is the key goal of a healthcare system of any country at the moment. The authors analyzed different systems of evaluating quality of medical care of children and demonstrated their benefits and drawbacks. The article presents a complex algorithm of evaluating quality of medical care developed by the authors; it involves structural, procedural and effective components of this term and corresponds with a complex model of simultaneous control organization on the professional level as well as on the regulatory level with due regard to the degree of specialist/patient interaction. 

Relevance. Successful living relative donor (LRD) kidney transplantation is the most effective method of treating children with terminal chronic renal failure. Materials and methods. 148 living relative donor kidney transplantations to children were performed at the department of kidney transplantation of the Federal State Budgetary Research Institution “Academician Petrovskiy Russian Surgical Research Center” from December 2012 to March 2015. We used the following parameters to evaluate the factors affecting results of such an operation: recipient’s age and sex; living relative donor’s age and sex; antigen donor/recipient compatibility (system HLA-A, -B, -DR); type of induced immunosuppression; donor/recipient degree of kindred; presence or absence of rejection episodes throughout the whole observation period. Student’s test, Fisher’s test and Kaplan–Meier’s cumulative survival analysis of recipients and transplants were used for statistical processing. Results. 4 allokidneys out of 71 were rejected in group 1 (5.63%), in group 2 — 4 out of 77 (5.19%). The relative rates of transplant and patient survival were higher if LRD were 24–40 years of age than if LRD were 41–68 years of age. 12 patients out of 77 died in group 1 (15.58%), in group 2 — 3 out of 65 (4.62%). 7 allokidneys out of 67 were rejected in girls (7 fatal outcomes), in boys — 6 out of 81 (8 fatal outcomes). The highest rates of fatal outcomes and transplant rejection were observed in the group of patients prescribed daclizumab for induced immunosuppression, the lowest — in the group of patients prescribed methyl prednisolone. Conclusion. The conducted clinical material analysis led us to a conclusion that only two factors affect results of relative donor kidney transplantation in children — antigen donor/recipient compatibility (system HLA-A, -B, -DR) and presence of rejection episodes in the posttransplantation period. 

Goal. Study of vitamin D sufficiency in children of puberty and pre-puberty age in Moscow. Methods. We examined children aged from 10 to 17 years living in Moscow. In order to appraise seasonal changes in the blood vitamin D status, we determined the average level of the main vitamin D metabolite — 25(OH)D — in different months of the year. The criteria for involving children into a laboratory examination were age (11–17 years), absence of organic or genetic pathology, permanent residence in Moscow, no intake of calcium and active vitamin D metabolite preparations at the time of examination. Results. The study involved 360 children (i. e. 30 children were examined every month) aged from 10 to 17 years. Analysis of the obtained data demonstrated differences in vitamin D sufficiency in the examined children in winter, spring, summer and autumn months. The serum concentration of vitamin D was significantly higher in summer months than in winter months. We did not reveal sex-related differences in vitamin D sufficiency among Moscow adolescents. Diet evaluation demonstrated that children extremely rarely consume fish as the main food source of vitamin D. Conclusions. Special attention should be given to the development of effective methods of correction of low vitamin D status and prevention thereof. Maintenance of the optimal vitamin D status in winter is infeasible due to insufficient exposure to sunlight, short duration of children’s walking during the schoolyear and absence of cholecalciferol sources in children’s diets. Special attention should be given to vitamin D intake by means of prescribing enriched food additives. 

Global spread of allergic diseases due to both environmental degradation, uncontrolled drug use and dietary changes, appearance of new allergens is a severe burden for the healthcare budget not only of the developing, but also of the advanced countries. Devastating symptoms considerably reduce quality of life both of patients and of their family members; allergy is one of the most significant medical/social issues. The contemporary understanding is that a complex approach is required to achieve control over allergic diseases; at the same time, the only pathogenetic method of treating and preventing new allergy manifestations is allergenspecific immunotherapy. The accumulated experience of using this technology indicates clinical/economic advantages of the method; moreover, on-going studies have proved not only therapeutic, but also preventive action of ASIT. 

Optimal provision of children with micronutrients determines their normal growth, mental and physical development, as well as health in general. Even a sufficiently energy demand-adequate and calorie-excessive diet comprised of natural products for children does not provide a child’s body with a whole range of micronutrients. Due to insufficient stay of a child in the sun and long stay indoors, endogenous vitamin D synthesis in skin induced by ultraviolet exposure does not fulfill a body’s need in this vitamin. As vitamin deficiency is usually accompanied by mineral deficiency, it is reasonable to prescribe vitamin/mineral complexes (VMC). High prevalence of polyhypoavitaminosis substantiates the use of coformulated vitamin forms in children’s diets. Simultaneous vitamin intake is more physiologically natural; combination of vitamins is more effective than separate or isolated prescription of each of them. Preventive doses, i.e. the doses close to the physiological vitamin need of a child’s body ensure the diet’s vitamin adequacy, reduce the risk of vitamin deficiency and its consequences. Effectiveness of VMC use has been confirmed both for treatment and prevention of allergic diseases in children. The main requirement to VMC for children is the full range of vitamins and minerals, the deficiency whereof is identified especially often, in the doses fulfilling needs of a growing child. 

The article is dedicated is to the issue of respiratory syncytial virus (RSV) infection in children. Urgency of this issue is beyond any doubt. RSV prevalence in the children hospitalized due to infections of lower airways is 18–33% in the advanced countries; up to 30% of the population become infected in the seasonal period of morbidity rise; 70% of children undergo RSV infection in the first year of life; almost every child becomes infected within the first two years of life. Infants are characterized by severe course of RSV infection; the most commonly hospitalized age group is infants aged 2–5 months. Especially severe and life-threatening course is observed in premature infants and young children with immature and/or pathological cardiorespiratory system — in patients with congenital malformations and immunodeficiencies. Specialists of the professional association of pediatricians “Union of Pediatricians of Russia” formulated and briefly described the main peculiarities of RSV infection and characterized groups of severe course risk, as well as indications and patterns of passive immunization — the only reliably effective preventive technology available at the moment, which allows preventing incapacitating consequences of RSV infection — in accordance with principles of the evidence based medicine. 

It is known that before vaccination had been widely introduced pneumococcal infection was the cause of death of more than 1.5 mn people around the world annually, 40% of whom were infants. According to the World Health Organization (WHO), pneumococcal infection is the most dangerous of the vaccinally prevented diseases. Resistance of pneumococcus to antibacterial drugs is a global issue complicating control of pneumococcal infection around the world. Increasing resistance of the causative agent complicates treatment of patients with various forms of pneumococcal diseases, requires use of the second- and the third-line therapeutic antimicrobial drugs and increases duration of hospitalization and treatment costs. Vaccination is considered the main method of preventing antibiotic-resistant pneumococcus-induced infections. The authors present the newest opinions on vaccinal prevention of pneumococcus-induced diseases. 

Seborrheic dermatitis is a widespread erythematous/squamous disease associated with high secretory activity of sebaceous glands. This article presents epidemiological characteristics of the disease and ethiopathogenetic mechanisms of the process. Given high prevalence of the disease, we present clinical pictures of the pediatric and adult forms of the disease, detailed differential/diagnostic algorithm and contemporary recommendations on pharmacological treatment and follow-up management of patients with seborrheic dermatitis. 

It is known that a child cannot receive the sufficient amount of all vitamins and minerals with the regular contemporary (“Western”) type of diet. The issue of vitamin deficiency is characteristic of a considerable part of population of Russia, including children. Vitamin deficiency is even worse in children with allergic pathologies than in similar age groups. As use of vitamin/mineral complexes in children with allergic diseases raises specific concerns among physicians and parents due to possible adverse reactions, discussion of the need and safety of vitamin prevention and vitamin therapy in this category of patients was chosen as the topic of this review. The article presents the contemporary data on the role of vitamins in a child’s immune response formation, as well as in the pathogenesis of allergic diseases. The authors recount new data on numerous biological effects of vitamin D, including the immune system level, in detail. The review of clinical studies of use of vitamin/mineral complexes in children with allergies involved both foreign and Russian studies, including the considerable clinical experience accumulated right at the Scientific Center of Children’s Health. It has been shown that use of vitamins both for preventive purposes and for treatment of allergic diseases in children is reasonable not only because it reliably affects immune response, but also due to a deficiency of a range of vitamins in immunopathogenesis of an allergological pathology. 

Obesity is one of the most widespread chronic diseases around the world and may be considered a non-infectious epidemic. Virtually everywhere around the world the number of obese children doubles every three decades. Increase in the number of children with obesity and excess body weight is observed in Russia as well. Despite the statement that the main cause of obesity is energy expenditure/consumption imbalance, numerous data obtained in recent years indicate early factors of obesity forming, probably, during the period of intrauterine development and/or infancy and early childhood. The most active growth and maximum plasticity of metabolic processes is observed within 1,000 post-conceptual days, which cover the period of intrauterine development and the first 2 years of a child’s life. The number and quality of nutrients received during that period considerably affect cell differentiation and organ development by means of gene expression, determine the nature of metabolism and affect health condition throughout the whole subsequent life. Given significance of the issue of excess body weight in children and adults, we analyzed the current situation, examined 652 younger Moscow schoolchildren and determined parameters of their physical development. We analyzed anamnestic data, profoundly examined children with excess body weight and obesity and formulated diets for them. This article presents the first stage of our work and a literature review.

The article presents data on prevalence structure and causes of iron-deficiency conditions (IDC) in adolescents. The authors describe both literature data and the findings of their own study in the adolescents (n = 337) studying at Moscow comprehensive schools. Iron- deficiency anemia was revealed in 5.3% of the examined adolescents, latent iron deficiency — in 17%; vast majority of the last were females. The authors also determined the most common causes of IDC development in adolescents: growth spurt (according to the anamnesis), a source of chronic blood loss (prolonged and abundant menstruations [in girls], frequent nasal bleeding), vegetarianism, intense physical activity, diet compliance, excess weight, and obesity. 

Osteogenesis imperfecta is characterized by increased congenital brittleness of bones with a broad spectrum of clinical manifestations — from perinatal/lethal form and severe bone deformities to the mildest forms. In most cases, the disease is caused by autosomaldominant mutation in the collagen 1 gene. At present, the approach to patients with osteogenesis imperfecta is multidisciplinary. Bisphosphonate drug therapy is conducted to reduce the incidence of fractures in the process of treatment, which also involves active rehabilitation and surgical correction of bone deformities. A more profound understanding of pathogenesis of osteogenesis imperfecta may lead to a development of new and effective therapeutic approaches capable of improving functional outcomes in patients. 

The issue of contemporary diagnosis and correct management of patients with cystic fibrosis is relevant not only for Russia, but for the entire world. Despite achievements of the contemporary medical science, underdiagnosis of this systemic genetic disorder leading to severe incapacitation and death of pulmonary and heart failure in the vast majority of cases is still observed. The burden induced by this disease is so severe that neonatal screening has been introduced to suspect and detect disease and start pathogenetic treatment capable of stopping or slowing progression of the disease as soon as possible. Apart from the contemporary classification and diagnostic criteria, the article presents treatment goals and components requiring a multidisciplinary approach in detail. Specific attention is given to methods of kinesitherapy, use of antibacterial drugs and enzyme replacement therapy, which primarily determine prognosis of the disease. 

Recurrent respiratory infections in children lead to physical development disorders, formation of chronic nidi of infection, failure of adaptive mechanisms and degradation o immunobiological resisting barriers; this causes development of new diseases. Results of the presented non interventional clinical study confirm high safety profile and effectiveness of a therapeutic phytopreparation for recurrent respiratory infections. 

ALL-RUSSIAN THEORETICAL/PRACTICAL CONFERENCE WITH INTERNATIONAL PARTICIPATION «PHARMACOTHERAPY AND DIETETICS IN PEDIATRICS»