Dear friends, colleagues!

Not so much time has passed since my last published review on this topic, bit so many news has appeared that has completely changed our vision of the disease and its treatment! It is interesting in both, medical and philosophical way. From philosophical point of view: 1–2 months of our previous pre-COVID life flew quick as lightning but now it is long period while we are observing this new infection and looking for new ways of management and its control. Then as now we are going to discuss its medical part.

Background. The number of people infected with SARS-CoV-2 causing COVID-19 is growing worldwide. It is necessary to study features of prevalence and clinical signs in pediatric population considering the fact that this disease is rather new.

The aim of the study is to analyze the features of prevalence and clinical signs of pathologic process of COVID-19 in pediatric patients according to the results of practical experience of primary care medical facility (Children’s City Outpatients Clinic № 133) under the conditions of pandemia.

Methods. Pediatricians of Children’s City Outpatient’s Clinic № 133 have examined certain categories of pediatric patients (especially who came from abroad or contacted with infection) for the presence of a new coronaviral infection in February 2020. Doctors have been examining children with catarrhal symptoms and hyperthermia since March 2020. The survey of children in February and March was carried out in accordance with algorithms (uniform for adults and children) approved by the Moscow City Health Department. Later, the survey was carried out in accordance with the guidelines for children prepared by the Ministry of Health of the Russian Federation. The throat and nose swabs on SARS-CoV-2 were performed for all patients on the 1st, 11th and 13th day of the disease.

Results. 1,900 children (or 3.1% of total attached pediatric population) have been examined in our outpatient’s clinic with the polymerase chain reaction (PCR) method on the presence of the new coronavirus RNA since the beginning of the COVID-19 pandemic in Russia. The course of disease was analyzed in first 100 patients with the confirmed COVID-19 diagnosis: 58 (58%) boys and 42 (42%) girls. In 81% of cases we revealed the source of infection, in 19% – we did not. The disease was asymptomatic in 11 (11%) children examined after the contact with ill relatives; 89% had mild COVID-19 disease with light catarrhal signs. The most numerous group of patients who had COVID-19 consisted of children over 10 years of age (42%); in 20% of cases it was pupils from 7 to 10 years old. Smell disorders were reported in children over the age of 10 in 50% of all cases.

Conclusion. New coronaviral infection COVID-19 in children is taking mild course, without complications, under the «mask» of common viral infection. Thus, it is unknown either those who have undergone COVID-19 asymptomatically remain healthy or they need special rehabilitation. The timely development of clear algorithm with step-by-step instructions for various situations for every health professional is crucial during these difficult times.

The Ministry of Health of the Russian Federation jointly with professional association and experts in the field of pediatrics, infectious diseases and resuscitation has developed guidelines “Clinical Features and Management of the Disease Caused by New Coronaviral Infection (COVID-19) in Children” in order to provide the child population with effective medical care during the pandemic of the new coronaviral infection. The practical experience of specialists from various countries was considered during the development of this document. Special attention should be given to the evidence base of the presented data, as well as to the efficiency and safety issues of medications used in treatment of coronaviral infection and its complications. The authors highlight the problems of prevention, diagnostics and management of pathological conditions caused by COVID-19 in the article according to the presented guidelines. Patient’s management is presented depending on the age and severity of the disease itself. The therapy is considered with regard to etiological, pathogenetic and symptom focus.

The COVID-19 infection caused by the new coronavirus SARS-CoV-2 has become the real pandemic. Children account for 1–6% of all diagnosed COVID-19 cases. Generally, children have mild disease in comparison to adults, and their mortality rates are extremely low. Despite the fact that all the main efforts of the medical and political community are now focused on preventing the pandemic spread and organizing medical care for patients with moderate and severe COVID-19 course, we still have to remember to implement adequate help for patients with chronic diseases, especially for children with allergic diseases. The pandemic period coincided with natural weather period of dusting of causative plants, that led to annual escalation of both allergic rhinitis and asthma in patient group with specific sensitization to tree pollen. Leading experts of allergology (adapting to modern conditions) have created key guidelines on management of children with allergic diseases during the COVID-19 pandemic. These guidelines are based on the data and results from the Union of Pediatricians of Russia, Russian Association of Allergologists and Clinical Immunologists, European Academy of Allergy and Clinical Immunology (EAACI), European Respiratory Society (ERS), American Thoracic Society (ATS), Global Strategy for Asthma Management (GINA), Initiative on Allergic Rhinitis and its Impact on Asthma (ARIA/MACVIA).

Familial hypercholesterolemia is autosomal dominant hereditary disorder developing in in humans since birth and it is characterized by low-density lipoproteins concentration increase in blood. Lack of timely diagnostics and therapy for familial hypercholesterolemia is associated with early development of atherosclerosis, cardiovascular pathology and mortality in first 30–40 days of life. Despite the fact that the optimal period for revealing of disease is childhood, diagnostics of the disease has extremely low quality among children. The article presents screening methods and criteria of familial hypercholesterolemia diagnostics among children.

The first thousand days of the child’s life are the critical window for formation of his health. Rationality, balance, availability of nutrition, creation of conditions for development of tolerance to food have the highest importance in this period. Healthy food and use of functional products can prevent the development of certain chronic non-communicable diseases such as cardiovascular diseases, metabolic syndrome, obesity, type 2 diabetes, allergies according to recent international studies. The unstable balance between formation of tolerance and effector immune reactions can be disrupted due to improper feeding during the implementation of supplemental feeding. Thus, functional gastrointestinal disorders can transform into pathological conditions. It is relevant to determine the range of supplemental feeding products that have functional properties, and so to use them during this window of tolerance in the diet of the child who has risk of development of allergies with functional gastrointestinal disorders.

The lecture presents modern views on the problem of myocarditis in pediatrics. Current ideas about the definition, prevalence, etiology and pathogenesis of inflammatory myocardial lesions in children are presented. Features of clinical manifestations of the disease in patients of different age groups, difficulties of diagnosis and treatment of myocarditis and its complications are disclosed in accordance with federal clinical recommendations. Special attention is paid to diagnostic approaches adjusted with the European society of cardiologists, including first and second level techniques, determination of indications for their implementation and diagnostic capabilities, as well as differential diagnosis of myocarditis with other cardiological diseases. Issues of heart failure treatment in myocarditis and indications for heart transplantation for patients under 18 years of age were also discussed. The lecture has illustrated clinical examples that clearly demonstrate the diversity of the clinical picture and the ambiguity of myocarditis prognosis in children and teenagers.

Background. The most common cardiac tumor in children is rhabdomyoma. Its frequency is 58.3% in the early neonatal period. Rhabdomyoma is associate with tuberous sclerosis pretty often (50-86% of all cases) and it be its diagnostic marker.

Clinical case description. This article presents case study of the newborn from the mother with burdened obstetric and gynecological anamnesis, type 1 diabetes, nicotine addiction. Multiple mass lesions were revealed in the child’s heart on the 31 st week of gestation. On examination: systolic murmur over the heart region, fibrous nodules on the skin all over the body up to 1-5 mm in diameter, indurated on palpation. Diagnosed echocardiographically: multiple attached, round masses were revealed in the cavity of left ventricle of 7.9×4.1 mm in size, in outflow track of left ventricle (near the aortic root) — 9.3×4.8 mm, in the cavity of right ventricle — 4.3×3.2 mm, in the cavity of right auricle — 5.1×5.0 mm. Pathologic activity of cardiac conduction system was presented only by single supra-ventricular and ventricular extrasystoles due to the results of 24-hour monitoring.

Conclusion. Children with cardiac rhabdomyoma diagnosed in prenatal period are threatened by tuberous sclerosis, thus, complex dynamic observation and molecular genetic testing is needed.