Relevance. Allergic pathology, particularly, pollinosis, may reduce cognitive functions in children. Objective: study effect of allergen-specific immunotherapy on cognitive functions in children with pollinosis and relation of cognitive functions dynamics to repeated ASIT courses. Patients and methods. We determined condition of cognitive functions in 97 children of 8‑17 years of age with pollinosis in comparison with their healthy peers using a psychophysiological computer complex “Psychomath”. Results. We revealed reduction in cognitive activity parameters in most children with pollinosis during remission. Concurrent persisting allergic rhinitis aggravated reducing in cognitive functions parameters. Conclusion. We confirmed positive effect of allergen-specific immunotherapy: cognitive functions improve significantly in children with pollinosis; the effect becomes more pronounced after repeated courses.

Introduction. Biclotymol [bis(chloro-4-thymol)methyl] is a biphenol derivative used for local treatment of pharyngeal inflammatory diseases. It is an antiseptic drug with bacteriostatic and bactericidal effects. Objective: evaluation of the drug’s antibacterial activity towards opportunistic and normal oropharyngeal microflora and identification of its minimum bactericidal concentration for the main bacterial pathogens of the upper respiratory tract. Results: we revealed that antibacterial effect of biclotymol on mouth cavity microbiota manifests itself with elimination of such species and genera of opportunistic microflora as Staphylococcus aureus, Streptococcus pyogenes, Haemophilus spp. and anginosus streptococci. We also revealed antibacterial activity of biclotymol against normal microbiota representatives, which included viridans streptococci. Out of this group of streptococci, only 1/3 of the initial amount of Streptococcus salivarius remained in place. Alongside identification of the minimum inhibitory concentration (MIC) of biclotymol against opportunistic microflora we revealed the most sensitive bacteria requiring the lesser drug concentration for the antibacterial effect to take place – Streptococcus pneumoniae and Haemophilus influenzae; intermediate – Moraxella catarrhalis, S. pyogenes and S. aureus; and resistant – non-pathogenic Neisseria species. Among the strains that survived biclotymol exposure, MIC was the highest in Neisseria spp. – 20 mg/ml after a 30‑minute-long exposure. Conclusions: results of a study of antibacterial effect of a topical antiseptic containing biclotymol demonstrated that the drug’s bactericidal activity is primarily aimed at gram-positive cocci represented both by opportunistic and non-pathogenic microbes. Non-pathogenic Neisseria species abundantly inhabiting mouth cavity mucosae and gram-negative rod-like microbes, which are uncharacteristic of the biotope under study, appeared to be resistant to bactericidal effect of biclotymol. Preservation of these microbes may somewhat prevent oropharyngeal colonization by undesirable pathogenic species.

Editorial note. Dear colleagues! We continue introducing opinions of the leading foreign specialists in the sphere of specific
immunoprophylaxis on the issues of pneumococcal infection and vaccination. In this issue we present to you an interview
with Zsofia Meszner — MD, Professor of children’s infectious diseases and pediatrics at the Faculty of Medicine of the
Budapest University.

Spread of vitamin D deficiency in children of various ages has not been studied in the Russian Federation. Numerous studies of foreign authors indicate high importance of this issue in many regions of the world, including southern territories with high level of insolation. The review analyzes issues of optimal calcidol level and vitamin D deficiency effect on the immune system. The authors support the hypothesis that vitamin D deficiency results in derangement of congenital and adaptive immunity and may be considered one of the etiological factors of frequent respiratory morbidity in children.

Prevention of development of bronchopulmonary dysplasia (BPD) and possibility of preventing severe course of the disease are the first-priority areas of neonatal pulmonology. Use of modern medical technologies allows protecting a premature infant’s respiratory system from as early as antenatal period of development. Use of the newest neonatal resuscitation protocols may prevent development of BPD. International experience and clinical data gathered by the authors demonstrate that seasonal palivizumab immune prevention of severe course of a respiratory syncytial viral infection in children with BPD results in rarer cases of hospitalization, resuscitation measures and fatal outcomes. The article presents modern preventive strategies used in this category of patients.

This article is dedicated to the issue of infant feeding. It is universally recognized that the best product for neonatal and infant feeding is breast milk. On the basis of the worldwide literature data, the authors give a detailed account of breast milk advantages from various (biological, clinical and psychological) perspectives. They convincingly demonstrate that knowledge of preventive and medical aspects of breast feeding benefits allows conducting effective educational programs regarding motivation, struggle for breast feeding and long-term maintenance among medical personnel, mothers and their families. It is especially important to provide premature infants and sick children, who are often born unable to suck adequately, with breast feeding. The authors provide results of a study conducted at the SCCH demonstrating that special medical devices (nipples, feeding bottles) developed on the basis of studies of maternal breast sucking physiology facilitate a gradual transition from tube feeding to breast feeding.

The article provides an analysis of capabilities of magnetic resonance imaging with delayed contrast enhancement in diagnosing fibrotic alterations of varying severity. A hyperintense signal in the setting of myocardial delayed contrast enhancement programs indicates alterations of myocardial structure. Localization, severity and hyperintense signal size facilitate correct diagnosis and prognosis of complications development.

Objective: comparative analysis of objective hearing function examination methods in children and identification of the factors affecting examination results. Patients and methods. We studied hearing in 473 children of 3 months – 5 years of age with sensorineural hearing loss and surdity. The control group was comprised of 30 children with normal hearing. Along with the standard clinical examination of ENT-organs, we performed tympanometry and reflexometry, examination of delayed evoked otoacoustic emission and reflection-source frequency otoacoustic emission, registered short-latency auditory evoked potentials and auditory steady state response (ASSR) in all children. We also conducted behavioral audiometry in children of 2-3 years of age and play audiometry in older children. Results. Various hearing loss risk factors are revealed in anamneses of most children (77%) with sensorineural hearing loss and surdity. The most sensitive (Se = 100%) and specific (Sp = 98.3%) method of diagnosing hearing level in children is the registration of short-latency brainstem auditory evoked potentials. Conclusions. The most reliable results of hearing thresholds identification are obtained when classic psychoacoustic hearing function examination methods are combined with modern electrophysiological examination method and hearing loss grade verification using surdopedagogic tests.

The authors present a rare case of vertebral anomaly resulting from a defect in the endplate of the vertebral body – Limbus vertebra (slipped vertebral apophysis). The diagnosis is established in an adolescent with complaints of lumbal pains with a fracture and inflammatory diseases of the skeletal system, involving the spinal column, on the basis of a differential diagnosis. Magnetic resonance imaging served for ultimate identification of this pathology.

The article presents a case of successful use of an interleukin-1 monoclonal antibody drug (canakinumab) for severe systemic juvenile idiopathic arthritis refractory to treatment with classic immunosuppressants and genetically engineered biopharmaceuticals with a different mode of action. Canakinumab treatment shortly provided reduction in clinical and laboratory parameters of the disease activity, life quality improvement, development of an inactive disease stage and allowed reducing the prednisolone dose by 90% and avoiding intravenous and intraarticular administration of glucocorticoids.

This article presents a case of severe course of polyarticular juvenile idiopathic arthritis. Active articular syndrome, high laboratory parameters of disease activity, severe incompetence were observed in a child by the therapy initiation. Successful use of intramuscular methotrexate in the dose of 15 mg/m² of body surface per week is described. Exudative articular alterations, arthralgiae, morning stiffness duration reduced as early as one month after the therapy initiation in a child. Acute inflammatory articular alterations cut off, range of motions recovered completely in 4 out of the 6 affected joints, laboratory parameters of disease activity reduced and normalized (ESR and CRP), inactive disease stage was registered after 6 months of treatment. We did not observe any undesirable phenomena in the setting of methotrexate therapy.

Wilson-Mikity syndrome is an interstitial pulmonary disease of unknown etiology developing in neonatal period and characterized by late oxygen dependence development. The article cites data the possible etiological factors, pathogenesis, pathomorphology, clinical, X-ray and CT presentation of this rare disease. Having analyzed observations of patients with this syndrome (n=61) found in literature from 1960 to 2008, we identified relation of the syndrome’s manifestation to age and degree of prematurity and disease outcomes. We present results of our observations of 6 patients with Wilson-Mikity syndrome, including data of high resolution computed tomography.

This article is dedicated to one of the most widespread pathologies in children – acute tonsillitis, which is a daily routine for both otolaryngologists and pediatricians. The authors analyze etiology and morphology of acute tonsillitis in children of various age groups. They revealed that the main complaint of pediatric patients is a sore throat. The authors present modern approaches to diagnostics and treatment of acute tonsillitis induced both by Group A β-hemolytic streptococcus and various viruses. In this article, they consider the possibility of using local treatment to treat inflammatory oropharyngeal diseases in combination with systemic antibacterial drugs and as monotherapy of acute throat pain. The authors substantiate use of throat lozenges with antiseptic and analgesic effects. They note effectiveness, safety and pharmacoeconomic advantages of a local antiseptic, anti-viral and anti-fungal drug. These aspects are of utmost importance to the choice of an antiseptic given that it is a non-prescription drug.

Predictors of positive virological response to interferon therapy in children have not been established, which is why it is necessary to identify them and subsequently develop individualized treatment regimens yielding the best possible results. Objective: form personalized chronic hepatitis C treatment regimens in children on the basis of identification of virological response predictors and retrospective evaluation of the conducted interferon therapy efficiency. Study participants: 98 children of 3-18 years of age (mean age – 10.0±0.8 years) with chronic hepatitis C: 65 of them had HCV 1 genotype (66.0%), 33 – HCV 2-3 genotype (34.0%). We measured anthropometric parameters (weight, height), determined viral load level in blood serum (polymerase chain reaction (PCR)), performed HCV genotyping (before the therapy) and analyzed lymphocytic immunophenotype parameters of all children before the interferon therapy course and over time (4, 12, 24 and 48 weeks after the therapy initiation). Results: Analysis of the obtained results demonstrated that the recombinant IFNα-2a therapy efficiency improves if recombinant IL2 (roncoleukin) is added to the treatment regimen: double increase in the rate of achievement of the primary virological remission (PVR) and sustained virological response (SVR) (p < 0.05). Use of a pegylated IFNα-2b in combination with ribavirin did not yield any significant difference in comparison with treatment with recombinant IFNα-2a and recombinant IL2. Interferon therapy is more effective in children of at least 30 kg of body weight and 134 cm of height without physical developmental delay than in younger children (of smaller weight and height) at the moment of interferon therapy initiation (p < 0.001). Thus, anthropometric parameters of patients may serve as PVR predictors regardless of the HCV genotype at the treatment initiation. If lymphocytes ≥ 2,500/mcl, the PVR achievement rate is 85.0%; if lymphocytes ≤ 2,000/mcl – 5.0% (p = 0.000). If the total amount of lymphocytes is 2,000-2,500, the examination should be repeated 12 weeks after the therapy initiation: increase in the number of lymphocytes in comparison with the initial values by 10.0% or more is positive prognostic SVR predictor. Conclusions: It is necessary to take into consideration parametric data and the child’s age at the moment of therapy initiation in order to schedule the launch of interferon therapy and choose a therapy regimen for chronic viral hepatitis C in children. Total amount of blood lymphocytes, child’s body weight and height at the moment of treatment initiation are predictors of positive virological response to treatment.

Objective: specify peculiarities of calcium and phosphates excretion in neonates of various gestational ages and types of feeding in neonatal period. Patients and methods. Calcium-creatinine (Ca/Cr) and phosphate-creatinine (P/Cr) ratio concentrations were determined in 96 healthy neonates of 38-40 weeks of gestational age and 146 premature infants of 28-37 weeks of gestational age of various types of feeding. Results. The Ca/Cr ratio concentration in healthy term infants in the early neonatal period amounted to 0.9-2.2 (median – 1.8), the P/Cr ratio concentration – 0.8-2.1 (median – 1.6). The Ca/Cr ratio concentration in premature infants (28-37 weeks of gestational age) amounted to 0.9-2.4 (median – 1.9), which is comparable to this parameter’s value in term infants. The P/Cr ratio concentration amounted to 0.7-3.1 (median – 2.4), which exceeds this parameter’s value in term infants. The lesser the gestational age and birth weight, the higher the Ca/Cr and P/Cr ratio concentrations. The authors revealed hypercalciuria and hyperphosphaturia in premature infants with a very low body weight fed with specialized formulas. Conclusions. Use of specialized formulas in small premature infants (gestational age < 33 weeks) with VLBW results in excessive calcium and phosphates excretion. It is reasonable to monitor their concentrations using a non-invasive and informative method of determining Ca/Cr and P/Cr ratios. Feeding of premature infants with BW > 1,500 g with breast milk only (in case of the mother’s adequate lactation) allows avoiding hypercalciuria and hyperphosphaturia and preventing risk of a renal pathology.

This article is dedicated to the issue of studying drug efficacy and safety in pregnant women, i.e. to their participation in clinical studies. The authors emphasize that lack of evidence base on drug use makes physicians helpless against diseases and gestational pathological conditions. The authors demonstrate results of the completed clinical studies involving pregnant women. In this article, they analyze possible risks and ethical complications of pregnant women taking part in clinical studies, as well as modern possibilities of medicine and legislative base of a range of countries, which allow minimizing risks of taking part in a study both for mothers and their fetuses. The authors demonstrate that the international experience of resolving ethical and legal issues of clinical studies among children may facilitate settlement of many problems of this issue.

This article is dedicated to dependence of psychological and somatic well-being of sick children on the quality of social environment at an inpatient hospital. The authors emphasize the crucial role of the nurse’s personality in the formation of a favorable unit environment regarding the child’s psychological condition. They cite data of a study of risk factors reducing quality of labor activity of the nursing staff. The authors describe psychological aspects of teaching professional communication skills to senior nurses in order to form health promoting environment at a pediatric inpatient hospital. They evaluate efficiency of communicative competence improvement of senior nurses.