Objective of the Review: to draw the attention of pediatricians and pediatric surgeons to a possibility to cut down the volume of invasive interventions in children with complicated pneumonia.

Key Points. Apart from the main task — to cure a child, an important aspect is to achieve it with as low traumatization as possible — to make its stay in hospital, as formulated by WHO, children-friendly. This task was pursued by a research in Russia that confirmed the efficacy of antibiotic-only treatment of the majority of the destructive (necrotizing) pneumonia with or without synpneumonic pleurisy. In this article we included 3 clinical cases illustrating the effectiveness of conservative therapy.

Conclusion. Immunopathological character of metapneumonic pleurisy makes it amenable to a short-course steroid therapy with a full recovery, and it renders redundant such interventions as drainage, video-assisted thoracoscopy and intrapleral fibrinolysis. Review clinical recommendations and publications of pediatric surgeons shows that they have not yet adopted pain-sparing interventions and do not compare their results to those of pediatricians who use less invasive methods.

We call on pediatric surgeons to test the sparing treatment methods proposed bi us? Cutting down on pleural punctions and limiting invasive procedures only if they are inavidable.

Study Objective: Compare the effectiveness of the preventive action of a slightly hypertonic seawater solution with brown algae extract and isotonic seawater solution concerning respiratory diseases in children; evaluate the safety.

Study Design: Comparative observational clinical study.

Material and Methods. A study included 100 patients aged 1 to 13 years: 50 patients received a slightly hypertonic seawater solution with brown algae extract and 50 patients received isotonic seawater solution. The course included 3 cycles of 15 days with 15-day intervals between them, 1 insufflation 2 times a day. Frequency, duration, severity of respiratory diseases, duration of antibiotic treatment were assessed, and adverse reactions were monitored.

Study Results. In slightly hypertonic seawater solution with brown algae extract group, there were 1.00 [1.00–2.00] episodes of respiratory diseases per patient during the observation period, in comparison group — 2.00 [1.25–3.00] (p = 0.001). The duration of respiratory symptoms in seawater solution with brown algae extract group was 8.00 [5.00–14.00] days, in comparison group — 16.5 [9.25–22.0] (p < 0.001). Antibiotic was prescribed to 1 child from seawater solution with brown algae extract group, and to 12 children in comparison group. The duration of antibiotics in the two groups did not differ significantly. There were no adverse events associated with irrigation therapy in any group.

Conclusion. Irrigation therapy is a safe method of preventing acute respiratory infections. The addition of brown algae extract to the seawater solution can improve the effectiveness of irrigation therapy, reduce the duration of inflammation, promote restoration of the mucosa, and reduce the need for antibiotic therapy.

Study Objective: To analyse the vaccination coverage of children with chronic cardiovascular disease hospitalized to the National Medical Research Centre of Children Health during previous for 2018–2019, assess the safety and epidemiological effectiveness of pneumococcal vaccination of children with chronic cardiovascular disease.

Study Design: Retrospective analysis of medical records and vaccination cards; prospective comparative observation one-center study.

Material and Methods. For the period 2018–2019, we analysed 82 cases of children with congenital heart defects (CHD) and cardiomyopathy; 30 children with CHD were vaccinated with conjugated pneumococcal vaccine, and their post-vaccination period and respiratory infections per year after vaccination was analysed.

The study included 82 children aged from 1 month to 7 years, who were on examination and/or treatment in the departments of cardiology and cardiac surgery National Medical Research Center for Children’s Health in the period from January 2018 to January 2020. The parents' questionnaire included questions on the availability/absence of information on the need for vaccination against pneumococcus; the age when vaccination was first carried out; the reason for the lack of vaccination in the child; existence/absence of revaccination within the specified time. All children underwent a standard examination to determine the extent of chronic heart failure (CHF): 72 (87.8%) children had a degree of 2A, 10 (12.2 %) degree of 2B. 30 of 82 children had congenital heart defect, and the remaining 52 had some form of cardiomyopathy. A 13-valent conjugated pneumococcal vaccine was used.

Study Results. During the analysis of the vaccination cards it was found out that the majority of children (66) did not have a single vaccination against pneumococcus, and therefore he carried out the first vaccination in the National Medical Research Centre of Children Health. The remaining children received a second or third dose of the vaccine, or were reacted against pneumococcus, respectively. No child had a full pneumococcal vaccination before the trial. No post-vaccination complications were reported in vaccinated children. Twelve children had elevated body temperature to sub-febrile figures lasting from a few hours to two days, and 13 had low to moderate local responses. The standard follow-up survey did not show an increase in the CHF degree or CHF functional class after vaccination. Before vaccination all children were in the group of the most frequent patients, and during the first year after vaccination, the incidence of acute respiratory viral infections decreased by more than half. No child diagnosed with acute otitis, meningitis, no aggravation or aggravation of the underlying disease.

Conclusion. Pneumococcal vaccination has proven to be safe and effective in healthy children and in children with chronic pathologies, including those with CHF-related cardiovascular disease. Relevant is the development of recommendations for vaccination of this category of patients earlier, including before the operative treatment.

Study Objective: To identify the risk factors of uveitis associated with juvenile idiopathic arthritis (JIA), and to demonstrate the efficacy of Adalimumab in the management of refractory JIA-associated uveitis.

Study Design: Open single-site observational cohort study.

Materials and Methods. The study enrolled 43 patients aged 4.5 to 17.5 years old with JIA and associated rheumatoid uveitis refractory to baseline therapy. All children required genetically engineered biologic drugs (GEBDs). A detailed case report is presented to support the efficacy of Adalimumab in the management of JIA with uveitis.

Study Results. During the original study, patients with JIA-associated uveitis refractory to baseline therapy demonstrated a number of patterns: predominantly girls, early onset, oligoarticular and polyarticular JIA seronegative for rheumatoid factor, positive antinuclear factor (ANF). These patterns correlate with the data from reviewed literature sources. The case report also reveals the results. In the case report analysis, it is demonstrated that uveitis remission, active polyarthritis arrest, improved clinical, laboratory and instrumental values in the female patient were achieved with Adalimumab therapy.

Conclusion. Early manifestations, female sex, oligoarticular and polyarticular JIA, ANF positivity are the risk factors for uveitis. Adalimumab is the most efficient drug for the management of JIA-associated uveitis. Concurrent uveitis usually requires genetically engineered biologic therapy, as evidenced by the study and case report.

Study Objective: Determine the demographic factors, clinical manifestations and features of Takayasu arteritis (АТ) in children observed at the I.M. Sechenov University Children's Clinical Hospital.

Study Design: A non-randomized retrospective study.

Material and methods. 51 children with a reliable diagnosis of AT were observed. The data that we evaluated in all children included gender, age, duration of the disease before diagnosis and type of AT. In addition to this, we also evaluated the clinical manifestations (systemic and local), laboratory (hemoglobin, leukocytes, platelets, ESR, CRP), instrumental studies (DUS, CT-angiography, catheter angiography) and a modifying Indian Takayasu Activity Score (ITAS.A).

Study Results. There were no significant gender differences in the age groups up to 7 years (the ratio M:D 1 : 1.25, versus 1 : 7.4 in the group of patients older than 7 years), while the average duration of AT before diagnosis in this group was higher than in children older than 7 years (29.33 ± 28.66 months and 14.86 ± 11.95 months). The most frequent variants of AT were type 5 (70,6%), 4 (11,8%) and 1 (7.9%). At the time of the diagnosis, malaise (90%) and fever (67.5%) were the most common systemic symptoms, along with vascular pain (37.5%), claudication of extremities (35%) and pulse absence/weakening (35%). The delay of diagnosis in 12 patients (30%) with arterial hypertension was longer than in the general group (26 ± 11.67 months). This led to 9 children out of 12 to require surgical treatment. DUS was the first imaging in all 40 patients with AT, supplemented subsequently by CT-angiography in 30, and catheter angiography in 10 children. The common carotid arteries on the left (65%), the abdominal aorta (52.5) and the subclavian artery on the left (50%) were most often affected. At the time of diagnosis, the median ESR was 48 mm/h (min 28, max 74), median CRP was 33.5 mg/l (min 4, max 200), anemia and leukocytosis were observed in 80%, thrombocytosis in 42.5%, median ITAS.A activity index was 12.5 (min 7, max 20). Basic therapy was prescribed to all patients after confirmation of the diagnosis of AT.

Conclusion. In children with suspected AT, it is necessary to palpate the pulse on all available arteries, measure blood pressure on 4 limbs, auscultation of available vessels, in combination with DUS. The delay of the diagnosis leads to a higher risk of ischemic complications.

Study Objective: To assess the postprandial glucose (PPG) and glycemic control quality in adolescents with type 1 diabetes mellitus treated with ultra-rapid insulin aspart (URiAsp).

Study Design: prospective open-label controlled clinical study.

Materials and Methods. We examined 21 adolescents with DM1 aged 12 to 15 years old, with the mean age of 13.2 ± 1.2 years old, including 12 (57.1%) boys (mean age: 13.3 ± 2.1 years old) and 9 (42.9%) girls (mean age: 12.9 ± 2.1 years old). Duration of the disease was 4.1 ± 1.3 years (1–8 years). The children were treated with multiple daily injections of insulin; basal insulin was Glargine and Degludec; for bolus injections, Lispro or Aspart were used. Glucose flash monitoring was used. Glycemic control was assessed on the basis of Time In Range (TIR), Time Above Range (TAR), and Time Below Range (TBR). Preprandial glucose levels and glucose 30, 60 and 120 minutes after meal at school were measured. Patients were transferred to URiAsp in outpatient settings. 3 months after the change in the insulin therapy, TIR, TAR and TBR at school, and preprandial glucose levels and glucose 30, 60 and 120 minutes after meal at school were measured.

Study Results. Transition to URiAsp therapy allowed avoiding the need in a preprandial break before meal at school. Also, it resulted in significant improvement in glycemic control. Both total TIR (from 58.1 ± 12.4% to 66.3 ± 11.6%; p < 0.001) and TIR at school (from 52.3 ± 13.1% to 67.6 ± 10.3%; p < 0.001) rose, primarily due reduction in TAR – total TAR (from 32.5 ± 11.9% to 26.1 ± 10.4%; p < 0.001) and TAR at school (from 37.4 ± 12.3% to 24.2 ± 9.5%; p < 0.001). There were no statistically significant changes in TBR. Significant reduction in the rate of PPG increase (p < 0.001) and mean PPG in 30, 60 and 120 minutes after meals was noted.

Conclusion. URiAsp therapy in schoolchildren with DM1 ensures improved glycemic control due to reduced TAR without the risk of hypoglycaemia.

Study Objective: To assess the impact of overweight on the quality of life of children aged 10 to 16 years old.

Study Design: Stage I — epidemiological study; stage II — retrospective case–control study.

Materials and Methods. At stage I, we examined 2,770 children aged 10 to 16 years old and measured their anthropometric parameters during an annual routine examination. During stage II, 156 overweight and obese children (group S) and 90 children with normal weight (group N) had their QoL assessed with the use of the Peds Quality Life PQ 4.0 questionnaire.

Study Results. In group S, the overall QoL value was 74.40 ± 11.35 points, while in group N it was 86.34 ± 8.26 points (p < 0.001). Statistically significant differences (р < 0.001) were also found in each questionnaire domain: physical, emotional, social welfare, and academic activity. Children in group N more frequently assessed their QoL as high or very high (78.9%), whereas in group S, the QoL was rather moderate (70.5%). Negative correlations between the body mass index and QoL (r = –0.28 in children aged 10 to 12 years old and r = –0.52 in children aged 13 to 16 years old), and moderate positive correlations between all QoL questionnaire domains (r = 0.46–0.55) show that obesity impacts all spheres of child’s activity.

Conclusion. Any actions concerning physical well-being of an overweight child should be accompanied by a comprehensive psychoemotional therapy. The time of the therapy is of importance as well since obesity gets worse with the age.

Study Objective: To assess the relationship between vitamin D level and bone ultrasonometry and bone metabolism markers in obese children.

Study Design: Prospective controlled trial.

Materials and Methods. We examined obese (study group, n = 31) and normal (control group, n = 40) children aged 4 to 15.

We reviewed medical records of children (form No. 112-1/у-00); conducted physical examination including assessment of physical development; and measured bone density (ultrasound osteodensitometry) and serum 25(ОН)D concentration (chemilumescent analysis).

Study Results. The study group demonstrated statistically significant (р < 0.05) reduction in vitamin D levels and bone density vs controls. All obese children had vitamin D insufficiency or deficit. The deficit of vitamin D was associated with a lower bone density, reduced markers of osseogenesis and increased markers of bone resorption: osteocalcin concentration was 19.8 [14.5; 23.6] ng/mL vs 84.0 [68.9; 102.9] ng/mL in controls (р < 0.001), β-CrossLaps — 2.0 [0.9; 4.2] vs 0,5 [0.3; 0.5] ng/mL (р < 0.001), alkaline phosphatase — 457 [277; 581] vs 262 [232; 453] U/L (р < 0.05).

Conclusion. Paediatric obesity is a risk factor of vitamin D deficit. which, in turn, is a risk factor of osteoporosis. Therefore, prevention of vitamin D deficiency is essential.

Study Objective: To evaluate the efficacy and safety of the long-acting insulin degludec in children with type 1 diabetes mellitus with the use of continuous daily glucose monitoring.

Study Design: Single-center, interventional, dynamic, prospective, single-sample, uncontrolled study.

Material and methods. A total of 20 children aged 5 to 15 years who were treated by intensive insulin therapy with the use of basal insulin analogs glargin 100 and detemir, who were admitted to the pediatric endocrinology department with non-adequate control of type 1 diabetes mellitus without ketosis, were examined. HbA1c determination and continuous glucose monitoring (CGM) were performed before and 3 months after switching patients to insulin degludec. CGM was performed in both cases for five days. During its implementation, the number of episodes of hypoglycemia, distributed by se-verity and time of day, was assessed.

Study Results. During degludec therapy, the mean HbA1c level has significantly decreased from 10.83 ± 1.34% to 8.81 ± 1.99% (t = 2.084; p = 0.041); the mean time of glycemia in the target range significantly increased from 58.7 ± 6.44% to 65.7% ± 4.33% (t = 2.070; p < 0.0429). The improvement of these two indicators during degludec therapy was achieved by avoiding nocturnal hypoglycemia and by 2.2 times reducing the number of episodes of mild hypoglycemia episodes, as well as significantly reducing the SD indicator (assessment of glycemic variability) from 4.91 ± 2.08 mmol/l to 4.06 ± 1.23 (p < 0.04).

Conclusion. The use of long-acting insulin degludec provides more effective and safer glycemic control compared to previous generation of basal insulin analogues.

Objective of the Paper: To demonstrate a clinical example of a combination of two autoimmune diseases in an adolescent: type 1 diabetes mellitus (DM1) and juvenile idiopathic arthritis (JIA).

Key Points. A combination of two or more autoimmune diseases in one patient is not casuistic. The most common autoimmune diseases that occur in childhood include JIA and DM1.

In this observation, JIA and DM1 manifested within a year, and the onset of DM1 occurred several months after prescription of a cytostatic drug. Of note, DM1 manifested with hyperglycemia without the clinical pattern of diabetes mellitus.

Conclusion. This clinical case is an example of a combination of two severe autoimmune diseases — DM1 and JIA, requiring life-long insulin therapy and immunosuppression, respectively.

Study Objective: To study the somatic features and the effect of elimination diets (gluten-free and casein-free, GFCF) on the somatic and neuropsychiatric status of children with delayed speech development (PVDD) of the autistic spectrum.

Study Design: Randomized open prospective study.

Material and Methods. 105 children (71 boys and 34 girls) with PVDD of various genesis aged from 1 year 6 months to 6 years 7 months were under observation. The observed children were randomly divided into two groups: 53 children (the first group) received a GFCF diet, 52 (the second group) received regular preschool meals. Laboratory and paraclinical parameters of all patients of both groups were evaluated before the start of follow-up, as well as 6 and 12 months after that. The analysis of anamnesis data, objective examination using specialized scales Integrative Medicine Assessment Scale (IMAS) 1 and 2, Childhood Autism Rating Scale, Autism Treatment Evaluation Checklist (ATEC), IntegrativeMedicine Patients Parent Scale, laboratory and instrumental diagnostics, including immunological blood testing for total immunoglobulins of classes A, M, G, E, antibodies to tissue transglutaminase of classes A and G, antibodies to casein of class G, genetic analysis, if necessary, ultrasound examination of abdominal organs, kidneys, heart, transcranial ultrasound dopplerography of cerebral vessels, magnetic resonance imaging of the brain. All the children were consulted by a neurologist, a psychiatrist, a geneticist, a surdologist.

Study Results. There was a decrease in the levels of antibodies to transglutaminase after 12 months (from 5.3 ± 1.7 U/ml to 4.8 ± 1.5 U/ml; p < 0.009) and to casein (from 6.7 ± 1.3 mg/l to 6.0 ± 1.2 mg/l). The results of clinical and laboratory observation showed significant positive dynamics in the group receiving diet therapy: after 6 and 12 months from the start of observation, the number of children without stim increased (by 1.5 and 2.3 times), as well as without digestive problems; after 6 months, the proportion of pronounced stereotypes decreased by 2.3 times; after 12 months the number of patients with stereotypes decreased by 4.2 times, problems with chewing were reduced, according to the IMAS somatic status assessment scale, the total score was 1.25 times less.

Conclusion. The effectiveness of the GFCF diet in children with autism spectrum ASD in a modern clinic under the control of clinical and laboratory data is shown. The absence of antibodies to transglutaminase, casein or their normal level does not exclude the need to follow a diet that positively affects the neuropsychiatric and somatic status of children with PVDD.

Objective of the Review: To provide information on the etiology, clinical manifestations of asthenic syndrome in children and to identify medicines used for its treatment in children's practice, including after the COVID-19 disease.

Key Points. Asthenic syndrome is one of the clinical variants of functional somatic disorders in children and adolescents, it is an urgent problem of modern medicine. Asthenic disorders developing after a coronavirus infection are noted in 23–48% of patients. At present, in our country and abroad, the peculiarities of the course of postcovid syndrome in children and adolescents are being actively studied. For the treatment of asthenic syndrome in children, adaptogens, nootropics, general toning, metabolic and vitamin-mineral agents are used. In pediatric practice, the effectiveness of such drugs as acetylaminoantaric acid, citrulline malate, deanol aceglumate, aminophenyl butyric acid has been proven in asthenia, including in post-infectious conditions.

Conclusion. Asthenia is not a life-threatening condition, but it significantly worsens the quality of life of the child. In most cases, asthenia has a favorable prognosis, which is associated with the ongoing processes of brain maturation and the inclusion of compensation mechanisms due to its high plasticity. But it is possible that periods of decompensation may occur during age-related crises, the frequency of occurrence and persistence of asthenia manifestations in the post-ovoid period are high in children, which requires special attention to them. The choice of an antiasthenic drug, including in convalescents of coronavirus infection, should be determined by the spectrum of drug activity caused by side effects, taking into account the somatic condition of the patient who underwent COVID-19. All drugs should be prescribed, according to the indications and contraindications available to them, in doses appropriate for children.

Objective of the Review: To analyse the information on the physical development of paediatric population, including also during the COVID-19 pandemic.

Key Points. The article summarises and analyses the information from research literature both in Russian and English in the electronic search systems eLIBRARY, PubMed, in the international databases Scopus, Web of Science for 2016–2021 concerning the health of the paediatric population and their motion activity. We reviewed the impact of limitations caused by the coronavirus pandemic for the physical development of children and adolescents as an example of a heavy stress factor. Motion activity of children prior to and after the coronavirus pandemic was analysed.

Conclusion. The material demonstrates the need in constant monitoring of the physical development of children and adolescents, especially during the COVID-19 pandemic. Changes in social and hygienic environment underlined the need in healthcare measures in order to prevent possible health problems in children.