No 4 (2024)

Every year, a seasonal increase in the incidence of respiratory infections is registered in the Russian Federation, primarily among children. It significantly increases the burden on the outpatient pediatric service. It is especially important to optimize the daily practice of pediatricians by developing algorithms and updating treatment protocols, as well as creating and conducting training programs. Fever is a leading symptom in acute respiratory viral infections and one of the most common reasons for seeking help in outpatient pediatric services. Leading experts in the field of therapy of respiratory infections in pediatrics have repeatedly discussed the problems of management of feverish children with acute respiratory infections, routing, personalized choice of therapy regimens at the outpatient stage of medical care. As a result, a number of positions concerning the individual use of antipyretic drugs in children over 3 years of age were agreed upon, “alarming” symptoms requiring immediate assistance/hospitalization were listed, and an algorithm for prescribing antipyretic therapy in children over 3 years of age was agreed upon.

Background. Coughing is an important defense mechanism of the respiratory system to remove mucus, harmful substances and infectious agents from the respiratory tract. There are pharmacological ways to influence different loci of the cough reflex arc. The most physiologic approach is to act at the level of cough receptors in order to preserve clearance function while maintaining a high quality of life for patients. This goal can be achieved by using combinations of substances of plant origin, in particular cumin fruit, ginger rhizome extract, althea root extract and ivy leaf extract, carob syrup, dried black currant extract due to antiviral, anti-inflammatory, antioxidant, cytoprotective, moisturizing, soothing effects.

Aim. To determine the clinical efficacy and tolerability of the syrup based on extracts of althea roots, plantain leaves, chamomile flowers, thyme herb, mint leaves, and ascorbic acid "Kidz syrup with althea and plantain" for cough during acute respiratory infection (ARI) in children.

Materials and methods. The study included 70 primary school children aged 7 to 11 years with diagnosed ARI accompanied by cough; all children received standard symptomatic therapy for ARI. Of these, 35 children received the dietary supplement “Kidz syrup with althea and plantain” (study group), and 35 children received an alternative plant-based drug with the same indications for medicinal use (control group).

Results. The addition of the dietary supplement "Kidz syrup with althea and plantain" to the standard therapy made it possible almost to halve the rates of all intoxication and respiratory symptoms. By the end of the study, 25 (71.4%) children did not have a cough, and 6 (17.1%) had a mild short-term cough, which did not disturb their well-being. In the control group, cough was absent in only 8 children (22.9%).

Conclusion. This study shows that "Kidz syrup with althea and plantain" is highly clinically effective. The complex of plant-based components contributed to the activation of the protective functions of the body, confirmed by the improvement.

Congenital aniridia (CA) is a rare congenital genetic disorder. Currently, more than 20 congenital hereditary (chromosomal and monogenic) syndromes include CA. It is divided into a nonsyndromic type involving all eye structures (75% of cases) and a syndromic type (20%, including WAGR syndrome). The syndromic types of aniridia include CA aggravated by the involvement of the central nervous system, endocrine, genitourinary, and other systems and organs (<10%); WAGR syndrome (<10%) and atypical rare forms of CA that occur with other complex monogenic or chromosomal diseases. The difficulty in identifying and confirming CA using DNA-based diagnostic methods is due to multiple causes that lead to the PAX6 gene dysfunction (intragenic PAX6 mutations and large chromosomal rearrangements involving the 11p13 chromosomal region). Patients with CA require a comprehensive approach, including both early diagnosis and treatment of complications. Ophthalmologists and pediatricians face the problem of predicting the disease course since there are many variations in the state of structures and functions of the eye and comorbidities since birth, as well as the diversity of their course, which is due to both genetic factors and the adequacy of therapeutic and preventive measures. The article presents epidemiology, ophthalmic examination data, related syndromes, and the latest advances in genetics related to CA. It also describes the routing of medical support for patients with CA, in which a single pediatrician or a specialist who deals with problems of visual impairment, who has knowledge of CA and works with a specialized team, observes and manages the patient for many years.

Antibiotic-associated dysbiosis is a disorder of the intestinal microbiota caused by antibiotics, which can contribute to the development of antibiotic-associated diarrhea and other complications. Disorder of a previously stable, functionally complete microbiota can lead to adverse health effects in both the short and long term, with a potential increase in the risk of various non-communicable diseases, as well as neurological, behavioral, and psychological disorders. Current microbiota recovery strategies include specific probiotics such as Saccharomyces boulardii CNCM I-745 and Lactobacillus rhamnosus GG. Systematic reviews and meta-analyses of clinical studies confirm the strain-specific efficacy of these probiotics in the treatment and prevention of antibiotic-associated diarrhea in both children and adults and also demonstrate that timely administration of an adequate dose of a probiotic (from day 1 of antibiotic therapy) can help prevent or eliminate the consequences of antibiotic-associated dysbiosis and contribute to the preservation of the resilience of the intestinal microbiota, returning it to the state preceding the use of antibiotics.

Hepatomegaly is one of the most common symptoms in children. Liver enlargement can be observed in any infectious and non-infectious inflammatory disease, be an early clinical sign of acute leukemia, systemic connective tissue disease, liver neoplasms, congenital metabolic disorders, circulatory and respiratory failure, helminthiases, toxic effects of drugs, abnormalities of the biliary tract, etc. In the vast majority of cases, the simple examination methods that have long become routine in pediatrician practice help to identify the cause of hepatomegaly: abdominal ultrasound, complete blood count, and blood chemistry. The article presents a rare case of infantile multifocal hepatic hemangioma in a girl in early infancy, which required a long diagnostic search involving various specialists.

Eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) are chronic immune-mediated diseases with complex pathogenesis. Little is known about overlap of EoE and IBD in pediatrics.A 17-year-old male patient was admitted to the endoscopy department of the Research Institute of Emergency Pediatric Surgery and Trauma (Moscow) with dysphagia that had been lasting for a year. For the first time EoE was diagnosed and histologically confirmed in this child 2 years ago. Since that time the patient didn’t receive any treatment and follow-up. Endoscopy confirmed eosinophilic esophagitis with esophageal stricture (E2R1E1F2S1) which was successfully corrected by the endoscopic balloon dilatation. The symptoms of dysphagia disappeared completely, but 3 months later the patient complained of blood in the stool and an anal fissure. Esophagogastroduodenoscopy revealed decreased activity of EoE (E1R0E1F1S0) without strictures. Crohn's disease was diagnosed by ileocolonoscopy with biopsy. An anal fissure was epithelized within treatment of Crohn's disease. Comorbid complicated forms of eosinophilic esophagitis and Crohn's disease in children are uncommon. Endoscopy allowed timely minimally invasive treatment of esophageal stricture as well as diagnostics of a rare combination of immune-mediated chronic diseases of digestive tract.