ISSN (print): 2658-6630, ISSN (online): 2658-6622 Founder: Meditsinskie izdaniya Editor-in-Chief: Zakharova Irina Nikolaevna, Doctor of Medical Sciences, Professor Frequency / Access: 4 issues per year / Open Included in: Higher Attestation Commission List, RISC
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Interactive forms of practical training of students in the specialty "Pediatrics" (Experience of the department of faculty pediatrics, Orenburg State Medical University)
Priority in the preparation of a pediatrician at a medical university is practice-oriented training. In pediatric education, modern innovative methods, an interdisciplinary approach and improving the practical activities of students are important. At the department of faculty pediatrics, along with traditional forms of training (lectures, seminars, practice, patient supervision), the emphasis is on practical clinical training, preventive orientation in pediatrics, the social role of the doctor, which are instilled through the formation of clinical thinking, mentoring and teachers’ personal example.
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Forewarned is forearmed: extravasation as a risk in pediatric infusion therapy. A literature review and clinical cases
Extravasation is the unintentional entry of drugs into the intervascular space. Depending on the substance, it can lead to tissue necrosis associated with certain complications. Extravasation is reported in up to 46% of children, especially newborns; soft tissue necrosis develops in 4% of those affected, leading to the formation of cicatricial contractures, deformities, and subsequent restriction, and in some cases even to loss of limb function. Currently, there are no guidelines for the management of extravasation injuries in children. In our paper, we highlighted the latest literature using PubMed and Google Scholar resources, as well as our own clinical experience in providing care to patients with adverse events as a result of extravasation. The lack of randomized controlled trials for the treatment of children with extravasation complications and the reluctance of health professionals to report this condition in the medical records alter the evidence-based statistics. Depending on the substance, the volume of fluid injected, and the extent of damage to the surrounding tissues, treatment options can be varied, including surgical and non-surgical methods. Non-surgical therapies include the injections of antidotes, hyaluronidase, or vasodilators, and the procedures for draining and lavage of the lesion. Each clinical case requires an individualized approach, and the care provided should be both sufficient and timely to reduce the frequency of severe complications with disabling outcomes.
Disorders of adaptation of children to emotional and physical stresses associated with learning: A modern view of the problem and treatment options. A review
School adaptation disorders are a common multifactorial problem in pediatric and neurological practice, exacerbated in recent years by new psychosocial stressors. Early diagnosis and comprehensive treatment of this condition are key factors in the prevention of severe anxiety and depressive disorders in the future. The review highlights current views on the etiology, neurobiological mechanisms, and comprehensive approaches to addressing adaptation disorders to school stress in children. A review of modern Russian and foreign literature data on the problem of school stress, maladaptation, and the role of emotional competence and executive functions in the adaptation process was conducted. The root cause of school maladaptation is a complex of stress factors (significant life changes, academic stress, social difficulties, and environmental exposures). The development of emotional competence (the ability to recognize and regulate emotions) and executive functions (inhibition control, working memory, cognitive flexibility), which are closely interrelated, play a key role in successful adaptation. A practical care approach should include both non-pharmacological methods (such as psychological and pedagogical interventions, as well as work with the child's family) and adequate pharmacotherapy. The nootropic agent nicotinoyl γ-aminobutyric acid (Picamilon), which has a complex, autonomous, stabilizing, anxiolytic, vasoactive, and neurometabolic effect, is considered a pathogenetically justified and safe pharmacological option. The importance of timely detection of school maladjustment signs and the use of an integrated approach combining psychological support and, if necessary, modern nootropic agents with a favorable safety profile is emphasized. It enhances children's ability to adapt to school and improves their long-term mental health outcomes.
Hyperbilirubinemia syndrome in infants: Clinical cases
To date, neonatal jaundice has raised numerous questions for both pediatricians and neonatologists. Since the timing of newborn discharge from the maternity hospital has changed in recent decades, primary care pediatricians and other specialists must make a differential diagnosis between various causes of an increase in bilirubin and, consequently, jaundice. Conditions such as jaundice of a healthy newborn (physiological and breast milk jaundice), jaundice due to hemolysis, impaired hepatic clearance of bilirubin, abnormalities of the biliary tract development, congenital metabolic disorders, and infectious and inflammatory liver diseases are well known. In all cases, the pediatrician must determine whether jaundice is a consequence of a life-threatening disease. Unfortunately, to date, mistakes occur that can be avoided by following simple recommendations and using routine and cost-effective examination methods. Our clinical cases illustrate the main challenges associated with neonatal jaundice.
What a pediatrician needs to know about teeth in children: caries, fluorosis, basic care protocols: A review
Caries is one of the most common chronic diseases in children. The unmet need for dental care of baby teeth is high and has an adverse effect on the growth, sleep, nutrition, and quality of life of the child and their family. It is clinically proven that fluoride-containing toothpastes prevent caries and contribute to its control. The anti-caries efficacy of these products is determined by three key factors: fluoride concentration, frequency of hygiene procedures, and post-brushing procedures, including the use of mouthwash upon completion. In the event of improper use of such pastes (ingestion and excessive use), there is a risk of dental fluorosis. Proper use of fluoride-containing oral hygiene products can increase preventive efficacy and minimize the risk of fluorosis. This review systematizes the evidence supporting the routine use of fluoride-containing toothpaste to maximize prophylactic benefits while reducing associated risks. In accordance with the amendments to the Order “On the Procedure for Preventive Medical Examinations of Minors” of the Ministry of Health of Russia dated August 10, 2017 No. 514н, which come into force on September 1, 2025, dental examinations must be carried out annually, starting from the age of 12 months; therefore, the pediatrician needs to participate in the fostering the proper attitudes and practices in the child’s oral care, local fluoride application and limiting sugar consumption.
Pediatric dysphonia: what can help? A review
The prevalence of voice disorders (VDs) in children is relatively high (up to 38%) and does not tend to decrease. VDs can be related to a variety of reasons and always require endoscopic examination of the ENT organs. Vocal fold nodules and laryngitis are the most common causes of dysphonia in children. Predisposing factors for VDs include a tendency towards increased talkativeness/vociferousness, frequent episodes of nasopharyngitis/laryngitis (as manifestations of acute respiratory viral infections), and pharyngeal tonsil hypertrophy or inflammation. Pediatricians play a paramount role, as they often come into contact with the patient's family, manage patients with VDs, record the detected changes and their trends in medical documentation, and identify candidates for further work-up by a specialist (otorhinolaryngologist). The final diagnosis of persistent VD can be made only based on the endolaryngoscopy results; however, the pediatrician can provide care to a patient with VD, including vocal rest and prescribing a drug indicated for VDs (Homeovox).
Safety of antipyretic therapy in pediatric practice as the basis for choosing a drug: A review
For many years, doctors and patients have been concerned about drug safety due to the need to use highly effective drugs and minimize adverse effects. The establishment of pharmacovigilance systems has a century-long history, marked by tragic events that led to reforms in drug safety. Modern medicine is characterized by the rapid development and introduction of innovative technologies into clinical practice, which still dictates the need to control the profile of the effectiveness and safety of drugs. In pediatric practice, fever is the most common symptom and the primary reason for outpatient pediatrician visits. Understanding the pathogenesis of fever helps to prescribe antipyretic agents more reasonably. Paracetamol and ibuprofen meet the basic requirements; they have proven safety and efficacy. However, cases of antipyretic drug poisoning are still reported all over the world, which emphasizes the need to optimize approaches to their use in children. One of them is the use of combination drugs, which offer higher clinical effectiveness and a high safety profile.
Choice of bacterial lysate in the treatment and prevention of respiratory tract infections: A review
Respiratory tract (RT) infections are among the most common infections in both children and adults, and they can lead to complications involving the ears, nose, throat, and lower respiratory tract. Doctors, patients, and their legal representatives prioritize the treatment and prevention of respiratory tract infections. A broad range of therapeutic and preventative drugs is available, and many current clinical guidelines recommend the use of systemic bacterial lysates for patients with recurrent ENT infections and respiratory diseases, as well as for at-risk groups. The article addresses the types and mechanisms of action of the bacterial lysate produced using the mechanical lysis method, with an emphasis on its immunological and clinical benefits (Ismigen). Sublingual administration of this drug prevents its antigenicity decrease by gastric juice, provides the rapid onset of action and longer contact with the oral and oropharyngeal mucosal membranes. Studies have shown that the use of Ismigen leads to an increase in the concentration of specific antibodies targeting the pathogens it contains. Also, it significantly reduces both the frequency and duration of respiratory infections (RI) in both children and adults. The use of Ismigen to reduce the incidence of RI in children with recurrent RI, as well as in patients with adenoiditis, has been justified. Comparison of the composition of the microbiome of healthy children and children with acute tonsillopharyngitis supports using Ismigen for prophylaxis and as part of complex therapy (to normalize the oropharyngeal microflora), especially in patients with recurrent tonsillopharyngitis.
Congenital alveolar dysplasia and alveolar capillary dysplasia with misalignment of pulmonary veins: Results of a multicenter retrospective study
Background. Congenital alveolar dysplasia (CAD) and alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) are rare, fatal, genetically determined interstitial lung diseases in infants, associated with pulmonary hypertension. Aim. Clinical, instrumental, and pathomorphological characteristics of patients with CAD and ACD/MPV. Materials and methods. Fifteen patients with CAD (9) and ACD/MPV (6) were included in a multicenter study. The following examination methods were used: echocardiography, chest X-ray, and chest computed tomography, angiopulmonography, catheterization of the right heart, whole-exome sequencing, and histological autopsy. Results. CAD and ACD/MPV were diagnosed in term infants (13/15) and manifested in the first 3 days of life with high pulmonary hypertension resistant to therapy. Deaths were recorded in the first 3 months. Conclusion. CAD and ACD/MPV have similar clinical presentations. Diagnosis can be verified through histological examination of the lungs and whole-exome sequencing.
Probiotic therapy to correct the intestinal microbiota in children with a cow’s milk protein allergy: An observational open parallel case-control study
Background. The intestinal microbiota influences the occurrence, course, and outcome of allergic diseases, including those that develop in young children. Aim. To evaluate the effectiveness of the probiotic Acipol® Kid in the treatment of skin and gastrointestinal manifestations of food allergy. Materials and methods. The study included 153 children aged 1–6 months: 122 subjects diagnosed with cow’s milk protein allergy and 31 healthy subjects. Children with allergies were divided into two groups: Group 1 (n = 60) received elimination treatment (mother’s milk-free diet and/or therapeutic formula), and Group 2 (n = 62) received elimination treatment and the probiotic Acipol® Kid containing Lactobacillus rhamnosus ATCC 53103 1 × 109 CFU and Bifidobacterium longum CECT 7894 5 × 108 CFU. Healthy children comprised the comparison group. On Days 1, 45, and 90 of the study, symptoms were assessed, and feces were analyzed for fecal calprotectin on Days 1 and 45. Results. The use of the probiotic Acipol Kid contributed to a 25% reduction in crying frequency, a 76% reduction in the number of children with prolonged crying, and a 26% reduction in intestinal manifestations, as measured by the COMISS index. The probiotic demonstrated high activity against skin symptoms, reducing the severity of lichenification and excoriations by 13% and 9%, respectively, and decreasing intestinal mucosa inflammation by 41%. Conclusions. The use of the probiotic agent Acipol Kid, containing Lactobacillus rhamnosus ATCC 53103 and Bifidobacterium longum CECT 7894, in addition to basic therapy, helps eliminate symptoms in children with severe intestinal and skin symptoms of cow’s milk protein allergy. The obtained data on increasing the biodiversity of commensal microbiota and the potentiating effect on the synthesis of short-chain fatty acids and vitamins B1, B7, and K support considering the biodiversity an important therapeutic factor for the development of healthy intestinal microflora.
The importance of collecting a family history of severe cardiovascular diseases in children with familial hypercholesterolemia and dyslipidemia of other origins: A retrospective study
Background. Currently, cardiovascular diseases (CVD) retain their leading positions in the structure of morbidity and are not only the leading cause of mortality, but also the main factor in population disability. The main pathogenetic link in CVD of atherosclerotic genesis is atherogenic dyslipidemia. Familial hypercholesterolemia (FH) plays a special role. Identification of family history is a prerequisite for timely diagnosis and prevention of CVD. Aim. To conduct a comparative analysis and quantitative assessment of the frequency of cardiovascular events among relatives of children suffering from FH, as well as dyslipidemia of other genesis (DOG). Materials and methods. The study was conducted at the Bashlyaeva City Clinical Hospital of the Moscow Health Department from January 2022 to August 2024. The study included 1,163 children diagnosed with hypercholesterolemia of various origins. Of these, 446 children with FH and 717 children with DOG. Results. When assessing the family history of 446 patients with FH, 161 children (36.1%) were identified whose relatives died as a result of acute cardiovascular events (ACVE) [n = 211]. 143 relatives of 127 patients (28.48%) with FH suffered ACVE but remained alive. As a result of the analysis of the family history, it was revealed that 71 relatives of 79 children (17.71%) with FH underwent surgery. The family history of relatives of patients (n = 717) with DOG showed that 160 relatives of 136 patients (18.97%) also died as a result of ACVE. 231 relatives of 193 patients (26.92%) with DOG suffered ACVE but remained alive. Surgical intervention was in the anamnesis of 30 relatives of 22 patients (3.07%) with DOG. Conclusion. The study showed that 64.57% of patients with FH had relatives who suffered or died from ACVE, while in the group of individuals with DOG this figure was 45.89%. The frequency of ACVE among relatives of patients with FH was 18.68% higher than in the group of patients with DOG. These data indicate a higher expression of familial risk within FH compared to other forms of dyslipidemia. Thus, systematic analysis of family history in all children with hypercholesterolemia, regardless of its genesis, contributes to early identification of high-risk groups and allows timely implementation of preventive measures and prescription of targeted treatment.
Familial perinatal exposure to viral hepatitis B: A series of clinical cases
The development of chronic hepatitis B in children may be the result of vertical transmission of the virus during pregnancy. The article presents a series of three different outcomes of perinatal HBV infection exposure in children born to a woman with chronic hepatitis. The development of chronic disease in children resulted from the pregnancy of a woman with a high viral load (> 109 IU/mL) and the presence of HBsAg and HBeAg. In addition, the guidelines for the active and passive hepatitis B prophylaxis in newborns from pregnancy I and II were not thoroughly followed. Administered antiviral therapy with tenofovir during pregnancy III reduced the viral load in the mother; specific immunotherapy and vaccine prophylaxis on Day 1 of life reduced the risk of hepatitis B in the third child. The presented clinical cases demonstrate the need for careful monitoring of women with HBV infection during pregnancy and timely preventive measures for the newborn. The observation approach used can reduce the risk of HBV infection.
Liver and spleen volumes in children with autoimmune hepatitis: association with laboratory parameters and fibrosis stage. A single-center, ambispective, cohort, non-randomized study
Background. Autoimmune hepatitis (AIH) in children is characterized by chronic hepatic inflammation, which may lead to organ enlargement, fibrosis progression, and development of portal hypertension. However, objective assessment of liver and spleen volume changes, and their association with laboratory parameters and fibrosis stage, remains insufficiently studied. Aim. To evaluate liver and spleen volume dynamics in children with AIH and their correlation with laboratory activity and fibrosis stage. Materials and methods. The study included 98 children with a confirmed diagnosis of AIH who were followed for 2 years. 62 of them had isolated AIH and 36 had AIH with overlapping cholangitis. All patients underwent laboratory tests (ALT, AST, GGT, albumin), MRI-based volumetric assessment of liver and spleen, and liver elastography with fibrosis staging according to the Metavir scale. Correlation, comparative and multivariate regression analyses were performed, including dynamic changes in parameters. The study was conducted with follow-up assessments at 1 year and 2 years. Results. Liver enlargement was more frequently observed in children with cholangitis (38.9%), while most patients with isolated AIH had liver volumes within the normal range or reduced. Significant correlations between liver volume, laboratory indicators, and fibrosis stage were found only in the cholangitis group. In children with isolated AIH, a positive dynamic trend was noted, including decreased ALT, AST, GGT levels and reduced liver stiffness on elastography. Spleen volume increase correlated with signs of inflammation and fibrosis but showed no statistically significant change over two years. According to regression analysis, a significant correlation was found between fibroelastography parameters and albumin levels, liver and spleen volumes, ALT and GGT levels, particularly in the group with cholangitis (R2 = 61.4%). Conclusion. Changes in liver and spleen volumes in children with autoimmune hepatitis may be associated with both disease activity and the degree of fibrosis. Patients with AIH combined with cholangitis more frequently exhibit liver enlargement, lower treatment sensitivity, and a lack of reduction in liver stiffness over time. Measuring liver and spleen volumes, along with assessing fibroelastography parameters, allows for a more comprehensive characterization of the clinical course of AIH in children.
The experience of using liraglutide in adolescents with exogenous constitutional obesity. Analysis of clinical outcomes
Background. The prevalence of childhood obesity is increasing every year. If non-drug measures aimed at reducing body weight are ineffective, it is possible to use drug therapy with an analog of a glucagon-like type 1 peptide, liraglutide. Аim. To evaluate the effectiveness of therapy and frequency of adverse reactions in obese adolescents treated with liraglutide. Matherials and methods. 17 adolescents aged 12–17 years with exogenous constitutional obesity were examined with an assessment of physical development indicators (BMI, SDS BMI), laboratory parameters of fat (cholesterol and its fractions, triglycerides) and carbohydrate (glucose, insulin) metabolism. Liraglutide therapy was performed at a starting dose of 0.6 mg daily, dose titration according to the instructions, and the course of therapy was 12 months. Repeated examination after 1, 4 and 12 months. Statistical data processing – Statistics version 7.0. Results. The initial SDS BMI in patients was +3.07 [2.9; 3.39]. After a month, SDS BMI decreased to 2.9 [2.5; 3.17]. Against the background of therapy, patients most often complained of functional disorders of the gastrointestinal tract: by the end of the first month, in 35% of cases, by the 4th month, the frequency of side effects decreased to 23.5%. In the future, the complaints were spontaneously stopped and did not resume. During the entire follow-up period, 6 patients stopped therapy ahead of schedule: 2 patients due to side effects or individual intolerance to the medication, 2 patients due to dissatisfaction with therapy, 1 patient due to achieving target weight values and 1 patient due to fear of side effects. In patients who successfully completed the course of therapy (n = 11), there was a significant decrease in SDS BMI by 0.73 [0.4; 0.86] and an improvement in metabolic status. By the end of the course of therapy, 36% (4) of patients had been diagnosed with obesity, 9% (1) of patients had a reduction in the degree of obesity to the first, 27.5% (3) to the second, and 27.5% (3) retained the third degree. Conclusion. liraglutide therapy is an effective direction of drug correction of obesity in adolescents. Severe dyspeptic disorders reduce the effectiveness of therapy, which requires an in-depth examination of the patient and correction of existing background conditions before prescribing the drug.
Neurokinin B and dynorphin affecting obese male adolescents behavior
Background. Childhood obesity is still a trending healthcare problem. The incidence of obesity is growing worldwide regardless of any ongoing measures. Inefficiency of behavior, especially the eating behavior, intervention is one of the reasons of poor disease management. Kappa opioid receptor ligand dynorphin (DYN) and coupled KNDy mediator neurokinin B (NKB) seem not to be investigated enough as obese adolescents' behavior modulators. Aim. The study was aimed to examine the modulating role of DYN and NKB on adolescent boys with obesity behavior. Materials and methods. The study involved 84 adolescents aged 14–17 years: 57 with obesity (code E66.0, International Statistical Classification of Diseases and Related Health Problems 10th Revision) and 27 practically healthy individuals. The Achenbach System of Empirically Based Assessment (ASEBA) was utilized using Youth Self Report scales (YSR 11-18) to evaluate depressive, anxiety, somatic, attention deficit/hyperactivity, oppositional defiant and conduct problems. The Dutch Eating Behavior Questionnaire (DEBQ) was used to assess alterations. Laboratory studies included DYN and NKB blood levels evaluation using ELISA Kit for Big DYN and ELISA Kit for NKB correspondingly. Network analysis was performed to emphasize and visualize most relevant associations. Results. The DYN level showed a significant negative correlation with attention problems and a positive correlation with NKB level. Network analysis showed that DYN level was strongly linked with negative bond to attention problems as, with a bit less strength, NKB also was. NKB and DYN levels were strongly linked in between either. Conclusion. DYN is likely to play a modulating role in eating behavior, deviant and aggressive behavior especially in obese adolescents, acting as an additional obesity heterogeneity factor.
Hepatic complications of type 1 diabetes mellitus in children. A review
The prevalence of liver disease among patients with diabetes mellitus (DM) is estimated to range from 17% to 100%, depending on the selected diagnostic criteria. Hepatic complications of type 1 DM (DM 1) include metabolic dysfunction-associated steatotic liver disease (MASLD) and glycogenic hepatopathy as variants of storage diseases, as well as diabetic hepatosclerosis as a manifestation of liver microangiopathy. The most common hepatic complication of DM 1 is MASLD, which is associated with a further deterioration in glycemic control and the development of liver fibrosis. The “gold standard” for the diagnosis of MASLD, glycogen hepatopathy, and diabetic hepatosclerosis is a morphological examination of a liver biopsy specimen. The main method of prevention and treatment of hepatic complications of DM 1 is the optimal control of blood glucose based on the target level of glycated hemoglobin, as well as control of hyperglycemia episodes based on continuous blood glucose monitoring. The question of the need to use hepatoprotectors for hepatic complications of DM 1 remains open, since there are no relevant clinical guidelines. Practitioners should be aware of the hepatic complications of DM 1 in children for prevention, early diagnosis, and timely treatment of these diseases.
3-M syndrome: endocrinologist's view of a rare genetic disease. Case report
3-M syndrome is a rare hereditary disease with an autosomal recessive type of inheritance, characterized by intrauterine and severe postnatal growth retardation, phenotypic and radiological features with no intellectual disability. A little more than 200 cases of this syndrome have been described in the world. 3-M syndrome is the only disease to date that is associated with pathogenic biallelic variants in the genes CCDC8, CUL7, OBSL1. Short stature is the main clinical manifestation of 3-M syndrome. Until now, the issue of treating short stature with growth hormone remains controversial due to the small number of patients with this disease and the lack of large-scale clinical studies.