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REBOUND SYNDROME IN INFANTILE HEMANGIOMAS
N.P. Kotlukova, N.K. Konstantinova, N.D. Telezhnikova, T.R. Lavrova, T.S. Belysheva, E.Yu. Gavelja, S.A. Zhitkova, V.E. Menshikov, E.V. Karelina

Summary. The article is devoted to the analysis of rebound syndrome, one of the complications that may occur after the completion of drug therapy for infantile hemangiomas. On a large clinical material (654 patients) who were treated at the Competence Center for the Treatment of Infantile Hemangiomas on the basis of the Department of Cardiology of the Children's State Clinical Hospital named after Z.A. Bashlyaeva with propranolol, including the oral solution Hemangiol^®, a low percentage (3.6%) of the formation of relapses was shown. A table with clinical data of all 25 patients is presented, followed by an analysis and discussion of possible causes, factors and risk groups for the formation of rebound syndrome, management tactics in the event of this complication and, most importantly, preventive measures for its development. The article also provides a clinical case, which is a visual addition to the material presented.
Keywords: infantile hemangioma, rebound syndrome, treatment, propranolol, risk factors, risk groups, Hemangiol^®

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ACUTE TONSILLITIS IN CHILDREN: FEATURES OF THEIR COURSE AND EFFECTIVENESS OF TOPICAL THERAPY
T.G. Malanicheva, N.V. Ziatdinova, G.S. Gataullina

Summary. In outpatient practice acute tonsillitis (AT) refers to common conditions among children and most often has a viral and bacterial etiology. In most cases AТ of viral etiology is accompanied by catarrhal symptoms, such as rhinitis, conjunctivitis, cough. An important place in AT therapy is occupied by a local antibacterial therapy, which has a number of advantages: the direct effect of the medication on the infection focus, the optimal concentration of the medication in the focus of inflammation, the absence of systemic effects on the body and a lower risk of selection of normal microflora resistant strains. Effective medicinal products for external application are Miramistin and Okomistin, the active substance of which is benzyldimethyl [3-(myristoilamine)propyl] ammonium chloride monohydrate. These medicinal products have a wide range of antibacterial, antiviral and antimycotic effects. We have accumulated our own extensive clinical experience in the use of Miramistin and Okomistin in the treatment of AT of viral etiology. Thus, one of the recent observations showed that the prescription of these medications in the complex treatment of AT significantly reduces the period of catarrhal symptoms’ manifestation, – in particular, the manifestations of rhinitis disappear on average 3 days earlier, the symptoms of conjunctivitis – by 2.5 days, the symptom of sore throat – by 3.5 days; besides, the total duration of the disease is reduced by 13%, and the need for additional prescribing of antibiotics is reduced by 2 times. These medications can be recommended as a part of AT complex therapy in children.
Keywords: acute tonsillitis, children, Miramistin, Okomistin

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MODERN METHODS OF STOPPING NOSEBLEEDS IN CHILDREN
A.Yu. Ivoilov, V.V. Yanovsky, P.L. Chumakov, A.S. Tovmasyan, A.E. Kishinevsky, N.V. Shvedov

Summary. The presented article is devoted to the problem of epistaxis in children. The purpose of this paper was to analyze the modern views of Russian and foreign authors on issues of etiology, pathogenesis, diagnosis and complex treatment of epistaxis in childhood. We observed the most common causes of epistaxis in children, typical problems that pediatrics usually deal with. We discussed advantages and disadvantages of all currently used methods to stop epistaxis, our proposals to improve the efficiency of medical care in pediatrics. Considering the prevalence of epistaxis this article may be of interest not only to otorhinolaryngologists, but also to specialists of other medical specialties, also students.
Keywords: epistaxis, nasal packing, pediatric otorhinolaryngology

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A COMPREHENSIVE APPROACH TO THE CORRECTION OF PSYCHOLOGICAL DISORDERS IN CHILDREN WITH POSTCOVID SYNDROME
L.A. Balykova, S.V. Kiryukhina, N.A. Kalmykova, G.N. Kukina, M.V. Shirmankina, Yu.A. Buldygina

Summary. The development of neuropsychiatric disorders after a coronavirus infection in children and adolescents determines the need to search for psychological and medicinal ways to correct these disorders. Materials and methods. To conduct a comparative analysis of the dynamics of somato-vegetative parameters and indicators of mental functions against the background of non-drug treatment with the use of rehabilitation psychological techniques (group 1), as well as their combination with the course administration of the drug Elkar^® (group 2) children and adolescents who have had COVID-19 were examined using diagnostic scales and psychological tests on the first day of seeking medical help and on the 20th day of therapy. Results. During the post-COVID syndrome, children and adolescents develop psychopathological and somato-vegetative disorders, the severity of which was more than 2,5 times higher than the results of the control group. A comparative analysis of the dynamics of the studied indicators after a course of rehabilitation treatment revealed an improvement in both study groups. At the same time, patients who received Elkar^® in addition to rehabilitation psychological techniques had a more pronounced clinical effect, especially with regard to indicators of psychophysical activity, ideatory and somato-vegetative functions. The use of this drug helped to improve the general well-being of patients and reduce the rehabilitation period after a coronavirus infection. Conclusion. Comprehensive rehabilitation of children and adolescents who have suffered a new coronavirus infection should include medical and psychological counseling in order to identify the degree of impaired functions, including mental and somato-vegetative disorders, as well as the development of an individual program of corrective measures. The use of the drug Elkar^® in the complex rehabilitation of children and adolescents with post-COVID syndrome allows the most complete restoration of the psychological and social status of patients.
Keywords: Elkar^®, COVID-19, children and adolescents, post-COVID syndrome, psychological disorders, rehabilitation

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COMPLEX REGIONAL PAIN SYNDROME IN PEDIATRIC PRACTICE (LITERATURE REVIEW)
L.M. Petrushina, E.N. Trenina

Summary. Complex regional pain syndrome is a pathological condition that develops as a result of external factors and is characterized by pain, somatic and autonomic neurological disorders. In pediatric practice, it is rare, which leads to late diagnosis and untimely start of complex therapy.
The purpose of this study is to present current views on the etiology, pathogenesis, diagnosis and treatment of pediatric complex regional pain syndrome.
To purpose realization, a literature search was performed in the PUBMED, PUBMED CENTRAL, Google Sholar, eLIBRARY and CYBERLENINKA databases.
The predominant etiological factors are the lower extremities soft tissues damages. The pathogenesis remains mainly unclear, according to current concepts; the leading factors are inflammation and pathological changes in the nervous tissue. Psychological factors such as depression and psychological stress influence the severity and outcome of CRPS.
In clinics pain and autonomic disorders in the form of edema, cyanosis and coldness of the affected limb is dominated.
Management is aimed to pain relief and limb function restoration. The standard strategy is a combination of pharmacological, physical and psychological therapy. In inefficiency of conservative therapy invasive methods are used. Treatment outcomes are generally favorable, but accompanied with a high recurrence rate.
The results of the study can be used in the practice of a pediatrician, neurologist and pediatric surgeon.
Keywords: complex regional pain syndrome, chronic pain syndrome in children, allodynia, chronic pain, post-traumatic stress disorder

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POSSIBILITIES OF THERAPY OF RECURRENT NOSEBLEEDS IN CHILDREN
M.M. Polunin

Summary. Objective: to evaluate the effectiveness of GeloSitin nasal spray in the conservative treatment of children with recurrent nosebleeds. Materials and methods. There were examined and treated 85 children aged 3 to 17 years with a diagnosis of recurrent nosebleeds. The children were divided into 2 groups: the main one (47 children) and the control one (38 children). In the main group, GeloSitin nasal spray was used, in the control group, children received standard treatment (moisturizing isotonic and oil solutions for the nasal cavity and vitamins K).Results. The data obtained showed the advantages of using Gelositin nasal spray in the treatment of children with recurrent nosebleeds: relief of relapses from the start of using the spray, a persistent preventive effect for a year. Conclusion. Еhe use of GeloSitin nasal spray has shown high efficacy, which makes it possible to recommend it in the treatment of recurrent nosebleeds in children from 3 years old.
Keywords: recurrent nosebleed, childhood, conservative treatment, GeloSitin

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WHAT DO WE KNOW ABOUT POLYPOUS RHINOSINUSITIS IN CHILDREN?
D.A. Tulupov, E.P. Karpova, M.P. Yemelyanova

Summary. The article deals with the problem of nasal polyposis in children. Modern views on the epidemiology, etiopathogenesis and treatment of nasal polyposis. These recent clinical studies suggest that despite the advances in modern rhinosurgery and drug therapy, nasal polyposis remains a challenge in both adults and children. Children disease, is the most likely reason for the growth of nasal polyps include allergies and cystic fibrosis. Treatment of nasal polyposis in children is complex, which implies the rational use of drug therapy methods, and, if indicated, timely consideration of the issue of surgical treatment with subsequent continuation of conservative treatment of nasal polyposis.The most promising therapy nasal polyposis in children is seen using topical corticosteroid , especially nasal spray mometasone furoate. However, almost no clinical studies that confirm the efficacy and safety of this treatment in children that causes high need for clinical trials in this area.
Keywords: nasal polyposis, children, corticosteroids

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FEATURES OF PATHOLOGY OF ENT ORGANS IN CHILDREN WITH ACHONDROPLASIA: DIAGNOSTIC AND SURGICAL TACTICS
A.I. Asmanov, A.S. Kurbanova, N.D. Pivneva, V.A. Belov

Summary. Achondroplasia refers to congenital skeletal pathologies and is the most common cause of dwarfism. At the same time, in addition to stunting, skeletal features in children with achondroplasia can cause the development of pathology of the middle ear, upper and lower respiratory tract. Given the low incidence of this pathology, the pathogenesis of dysfunction of various organs remains poorly understood. Often, the observation and diagnosis of concomitant pathology of patients with achondroplasia causes difficulties in pediatric practice. A multidisciplinary approach to the management of achondroplasia is required. The article provides an overview of current literature data on diseases of the ENT organs in patients with achondroplasia. Modern approaches to diagnosis, treatment and following by specialists of this group of children are presented. Indications for surgical treatment of patients are listed.
Keywords: achondroplasia, otorhinolaryngologist, children, hearing, adenoids, adenoidectomy, sleep apnea

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HLA-ASSOCIATIONS IN CHILDREN WITH ATOPIC DISEASES
Ya.Yu. Illek, I.G. Suetina, N.V. Khlebnikova, E.V. Suslova

Summary. The purpose of the study was to determine the features of the distribution of antigens of the major histocompatibility complex in patients with atopic diseases. Materials and methods. HLA-genotyping was performed in 137 children aged 5–10 years (34 patients with a moderate course of atopic dermatitis; 25 patients with a moderate course of atopic dermatitis with concomitant persistent allergic rhinitis; 25 patients with a moderate course of persistent allergic rhinitis; 53 patients with a moderate course of atopic bronchial asthma). Serological typing of lymphocytes for HLA class I was performed in a standard microlymphocytotoxic test using HLA-A and HLA-B histotyping panels (Gisans, St. Petersburg), which make it possible to identify 19 HLA antigens of the A locus and 35 HLA antigens locus B. Molecular typing of class II HLA genes was performed by polymerase chain reaction with a set of sequence-specific primers. The calculation of immunogenetic parameters was carried out using the formulas adopted in population statistics. Results. In patients with atopic dermatitis, a high frequency of HLA B15, DRB1*13 and DQB1*0602-8 alleles of the genes was stated, in patients with atopic dermatitis with concomitant persistent allergic rhinitis – HLA B12, B13 and DQB1*01, in patients with persistent allergic rhinitis – HLA A10 and DQB1*201, in patients with atopic bronchial asthma – HLA B18. Conclusion. The representation of these HLA alleles of the genes is associated with an increase in the relative risk of developing atopic diseases by 2.3–4.6 times.
Keywords: children, atopic diseases, major histocompatibility complex antigens

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COMPARISON OF THE POSSIBILITIES OF THREE-DIMENSIONAL VISUALIZATION AND STANDARD MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY IN THE DIAGNOSIS OF CHOLEDOCHAL CYSTS IN CHILDREN
O.V. Lukovkina, N.A. Sholokhova, Yu.Yu. Sokolov, A.M. Efremenkov, T.V. Utkina

Summary. The purpose of this study was to compare the capabilities of standard magnetic resonance cholangiopancreatography (MRCP) with the method of three-dimensional (3D) imaging to assess anatomical variants of choledochal cyst in children. The study included the results of MRCP in 69 children with congenital choledochal cyst. Of these, 24 are boys, 45 are girls. The age of patients is from 5 days to 17 years, the average age is 3 ± 1 years. 3D computer processing was carried out after obtaining layered images with subsequent assessment of the following visualization parameters: the possibility of determining the type of choledochus cyst in accordance with the Todani classification; the presence of aberrant ducts and abnormal pancreatobiliary junction (APBS); the condition of intrahepatic ducts; assessment of postoperative complications. There were no differences in the image quality of the common bile duct and the determination of the type of choledochal cyst in accordance with the Todani classification, as well as in postoperative complications and the condition of the intrahepatic ducts. Visualization of anatomical variants of intrahepatic duct fusion on the 3D model was significantly better (85.5%) than on MRCP images (40.57%). The 3D model clearly showed the fusion of each duct, while overlapping structures and variations in the bile duct hid the connection options in the MRCP images. The 3D visualization model provided clearer topographic visualization with respect to the type of APBS in 84% of children with 3D visualization and only 28% with MRCP. The construction of 3D models makes it possible to overcome the limitations of MRCP visualization in the form of a projection overlay of anatomical structures, by obtaining three-dimensional images with the possibility of removing objects layered on the visualization area and more clearly highlighting the zone of interest. Thus, the addition of a standard MRCP study with the construction of 3D models improves the effectiveness of the method for diagnosing choledochal cyst and evaluating variants of the structure of the biliary tract without radiation exposure and intravenous contrast.
Keywords: magnetic resonance cholangiopancreatography, choledochal cyst, 3D reconstructions, 3D magnetic resonance cholangiopancreatography

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NEW POSSIBILITIES FOR THE TREATMENT OF HOSPITAL INFECTIONS IN A PEDIATRIC HOSPITAL
N.V. Loban

Summary. One of the urgent problems of modern healthcare is the rapid growth of resistance of microorganisms to betalactam antibiotics, including carbapenems, which until recently were considered as the drugs of choice in the treatment of life-threatening infections. Enzymatic inactivation of antibiotics is the main mechanism of resistance of gram-negative bacteria. The treatment of these infections presents significant difficulties due to the extremely limited arsenal of effective drugs. A historically successful and currently promising strategy for overcoming microbial resistance associated with beta-lactamase production is the use of combinations of beta-lactam antibiotics with beta-lactamase inhibitors.
Keywords: antibiotic resistance, beta-lactamase inhibitors, Sulbactam, cephalosporins