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STRESS GENESIS OF CONNECTIVE TISSUE DYSPLASIA
E.V. Neudakhin, T.V. Kozhanova, A.V. Petrichenko, A.A. Abramov

Summary. The article examines the leading role of chronic stress in the development of connective tissue dysplasia (DST). The morphological structure of connective tissue and its functional purpose are presented. Much attention is paid to the clinical and pathogenetic aspects of DST, discussion of controversial issues of its terminology. It is argued that DST should be considered as a process. A lot of space in the article is devoted to the description of hormonal and metabolic mechanisms characteristic of chronic stress, which play a leading role in the development of DST. Considering that DST is associated with chronic stress, mitochondrial and energy deficiency, the article substantiates the indications for the appointment of energotropic drugs, especially L-carnitine drugs.
Keywords: children, chronic stress, mitochondrial dysfunction, connective tissue dysplasia, L-carnitine, Elkar^®

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DISORDERS OF CEREBRAL HEMODYNAMICS IN ABNORMALITIES OF THE STRUCTURE OF THE CRANIOVERTEBRAL JUNCTION (ARNOLD – CHIARI), DEEP VEINS OF THE BRAIN
A.F. Abramova, M.I. Pykov

Summary. Risk factor (increase) for cerebrovascular pathology include dysplasia connective tissue syndrome (DCT).
Manifestations of DCT are recorded as structural abnormalities: structure of the vascular system of hypoplasia/aplasia deep cerebral viens (sinuses) of the brain, abnormalities of craniovertebral junction and they are predisposing factors of dyscirculatory hemodynamic cerebrovascular disturbances.
The radiodiagnosis (ultrasound) methods (TCD) are one of the key non-invasive methods in management algorithm of patients with cerebrovascular disturbances.
Objective. Evaluation of clinic and diagnosis indicators in structural abnormalities deep veins of the brain and craniovertebral transition as the factors of cerebrovascular pathology in children.
Materials and methods. The clinic and diagnosis ultrasound (TCD) examination of 1200 children aged from 3 to 17 years with complains of Headaches has been carried out. The control group consisted of 95 healthy children aged from 3 to 17 years.
The results. Headaches, caused by cerebral hemodynamic disturbances were noted in 27% of patients, of which 112 patients were diagnosed with (MRT, CT) abnormalities in structure of the brain deep viens and abnormalities of craniovertebral transition. Characteristic headaches, nazal bleedings and vegetatic disorders were recorded in all of the patients.
Clean abnormalities of velocity characteristics of venous outflow in the brain deep veins during TCD were established.
Conclusions. The statistically reliable data obtained by us make it possible to recommend set limit values of blood velosigy in straight venous sinus (27,5 m/sec.) and 30,5 m/sec for Galen vien (v.cerebri magna) for determination of probability of pathology, for detection and timely therapy of patients with structural abnormalities: the brain deep viens, with abnormalities of cerebral tonsils lower location of the large occipital foramen – malformation Arnold – Chiari I (MAI) and at the level (МА0) of the large occipital foramen.
Keywords: headaches, cerebral hemodynamics, deep veins of the brain, Arnold – Chiari anomaly, hypoplasia of venous sinuses, ultrasound methods, ultrasound transcranial dopplerography (TCDG) and duplex scanning (TCDS)

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CYTOKINE PROFILE IN CHILDREN WITH CHRONIC TONSILLITIS AND CONCOMITANT ALLERGIC PATHOLOGY
V.A. Belov, O.I. Belova, E.P. Karpova, A.I. Asmanov

Summary. Chronic tonsillitis in children remains one of the leading problems of otorhinolaryngology. Taking into account the role of viral infections as the trigger mechanisms of most exacerbations of chronic diseases of the upper respiratory tract, the study of cytokine secretion is an important area of clinical and immunological research. Of course, when examining children with chronic tonsillitis, it is necessary to pay attention to the condition of the body as a whole, i.e. it is necessary to take into account the presence of concomitant pathology. In our study, we tried to assess the state of interleukin-4 and the interferon system in children with chronic tonsillitis and concomitant bronchial asthma.
Keywords: chronic tonsillitis, cytokines, interferon, interleukin-4, IL-4, children

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LOW-ACTIVITY INFLAMMATION IN THE INTESTINE AS THE BASIS OF FUNCTIONAL DIGESTIVE DISORDERS OF THE FIRST YEAR OF LIFE
I.V. Berezhnaya, O.V. Kuznetsova, D.K. Dmitrieva, I.N. Zakharova

Summary. The article considers the leading mechanisms of etiopathogenesis of functional gastrointestinal disorders (FGIDs) of the first year of life. Infantile colic is quite common in children as a phenomenon of excessive crying, which is mysterious and excruciating. Despite the frequent occurrence of colic, there is currently no agreement on the definition of pathogenesis or the optimal treatment strategy for infant colic. This condition is described as multifactor syndrome. Various factors that may contribute to the pathophysiology of childhood colic are considered: neurogenic, gastrointestinal, microbial and psychosocial. Recently, an active discussion has been devoted to the influence of dysbiotic disorders and the phenomenon of activation of local inflammatory response in patients with FGIDs, which is described as «lowgrade inflammation» (lowactive inflammation). In this regard, the effect of these mechanisms on the occurrence of infantile colic and the search for a therapeutic target to restore the barrier function of the mucous membrane in patients is of great interest. In experimental and clinical studies, the possibility of bioactive components of children’s formulas (for example, a prebiotic mixture of scGOS/lcFOS 9:1) to reduce the intensity of FGIDs by modulating microbiota, improving digestive biomarkers and effects on immune response. The aspect of the possible influence of the prebiotic component of the mixture on the process of normalization of microbiota in the intestine of the infant to reduce the dysbiotic effects is considered.
Keywords: low-active inflammation, infant colic, dysbiosis, prebiotic oligosaccharides scGOS/lcFOS 9:1

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RISK FACTORS IN THE FORMATION OF NEPHROCALCINOSIS IN CHILDREN BORN WITH VLBW AND ELBW: A LITERATURE REVIEW
O.I. Potyanova, A.K. Mironova, I.M. Osmanov

Summary. The symptom of "hyperechogenic pyramids", nephrocalcinosis and concretions of the kidneys are frequent findings during ultrasound examination of the organs of the urinary system among premature infants born with extremely low body weight. The article presents an overview of modern literature sources devoted to the anatomical and physiological features of the organs of the urinary system in children born with extremely low body weight, as well as risk factors involved in the formation of nephrocalcinosis in premature infants.
Keywords: premature infants, extremely low body weight, nephrocalcinosis, symptom of "hyperechogenic pyramids", urinary system, kidneys

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A CLINICAL CASE OF FUROSEMIDE-ASSOCIATED NEPHROPATHY IN A CHILD WITH AN EATING DISORDER
O.B. Kolbe, G.B. Bekmurzayeva, E.V. Vnukova, S.G. Semin, E.V. Tambieva

Summary. Most children and adolescents with eating disorders (ED) hide their problem from family and doctors for a long time. At the same time, they need not only the supervision of a psychiatrist, but also the participation of other specialists, due to the development of a wide range of somatic complications.
One of the manifestations of eating disorder is long-term self-administration of laxatives and diuretics. The lack of awareness of doctors about the patient’s medication intake leads to the fact that clinical manifestations of complications of drug abuse are interpreted as independent diagnoses and unsuccessful treatment is carried out.
One of the main problems of taking diuretics is the development of furosemide-associated nephropathy, the consequences of which require complex therapy.
The article describes a clinical case of furosemide-associated nephropathy, as one of the clinical complications of uncontrolled use of diuretics in patients with an eating disorder.
Keywords: children, drug-induced nephropathy, furosemide, eating disorder

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ACUTE KIDNEY INJURY IN NEWBORNS OF DIFFERENT GESTATIONAL AGE: ETIOLOGY, PATHOGENESIS, FEATURES OF CLINICAL AND LABORATORY DIAGNOSTICS
O.L. Chugunova, S.V. Dumova, A.A. Khanmagomedova, S.I. Zhogin, P.V. Shumilov

Summary. At present, against the background of decreasing infant mortality rate, the number of pathologic conditions diagnosed in newborn children from many organs and systems, including acute kidney injury, is increasing. Most often this most severe condition, which increases the risk of unfavorable outcome, is noted in patients, especially deepterm newborns, of neonatal intensive care units. The article summarizes the data on the classification and diagnostic criteria of acute kidney injury used at the present stage, considers possible links of pathogenesis and factors in the development of chronic kidney disease in children who have suffered acute kidney injury in the period of neonatal adaptation, presents studies that allow early and reliable diagnosis of AKI in the neonatal period.
Keywords: acute kidney injury (AKI), neonatal period, profound premature neonates, urinary markers of AKI, cystatin C, NGAL, КIM-1, chronic kidney disease

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MODERN ASPECTS OF SURGERY OF THE LOWER NASAL CONCHA IN CHILDREN WITH NASAL BREATHING DISORDERS: A COMPARATIVE STUDY
M.B. Makhachev, M.M. Polunin, A.I. Asmanov, E.I. Shabelnikova

Summary. Most surgical methods for correcting pathology in case of nasal breathing disorders in children with vasomotor rhinitis are effective, but the choice of one or another method is not always based on an analysis of the degree of its traumatism and its effect on mucociliary transport of the nasal mucosa. In this study, we compared the cervical turbinoplasty and the superficial radio wave destruction of the lower nasal concha from the point of view of evaluating the function of the ciliary apparatus of the mucous membrane of the lower nasal concha. The aim of the study was to compare the effectiveness of cervical turbinoplasty and surface radiowave destruction of the lower nasal concha (NNR) from the point of view of the effect on the function of mucociliary transport of the nasal mucosa in children with vasomotor rhinitis. Materials and methods. The study included 118 children aged 8 to 17 years with a diagnosis of vasomotor rhinitis. Group I included 63 (53.4%) children aged 9 to 17 years with a diagnosis of BP who underwent cervical turbinoplasty (PCs), the average age was 14 ± 3.8 years (p ≤ 0.05). Group II included 55 (46.6%) children aged 9 to 17 years who underwent superficial radio wave destruction of the lower nasal conchs (LvRD NPR), the average age was 15 ± 2.6 years (p ≤ 0.05). Results. After surgery, minimal changes in the work of the ciliary apparatus of the NPR mucosa were observed in group I compared with patients of group II. The frequency of cilia beating in points in the first group was 3 months later – 3.3 ± 0.8; 6 months – 4.0 ± 0.4; 12 months – 4.1 ± 0.5. In group II, the same indicator was: 3 months – 2.1 ± 0.9; 6 months – 2.9 ± 0.9; 12 months – 3.3 ± 0.8, respectively (p ≤ 0.05). Conclusion. Cervical turbinoplasty is an effective, minimally invasive surgical method for the treatment of vasomotor rhinitis in children, which does not significantly affect the function of the ciliary apparatus of the mucous membrane of the lower nasal concha.
Keywords: vasomotor rhinitis, turbinoplasty, mucociliary transport

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ASSESSMENT OF VITAMIN D AVAILABILITY IN CHILDREN OF EARLY AND PRESCHOOL AGE. THE REPUBLIC OF SAKHA (YAKUTIA)
N.M. Zakharova, L.G. Marinova, S.V. Markova, A.N. Nakhodkina

Summary. One of the main causes of vitamin D deficiency is a decrease in the synthesis of vitamin D in the skin in winter with a reduction in daylight hours. The climatic and geographical features of the Republic of Sakha (Yakutia) play a key role in the development of deficiency and insufficiency of vitamin D. To assess the provision of children with vitamin D, 316 children aged 1 to 6 years, born and permanently residing in the Republic of Sakha (Yakutia), were examined in winter of the year. To determine the concentration of 25(OH)D in blood serum, the method of chemiluminescent immunoassay on microparticles was used. The study showed that a low supply of vitamin D in the winter season is observed in most children – 71.2% of children. With a low level of 25(OH)D in the blood, only every fifth child (22.4%) had clinical signs of rickets, almost half (47,4%) of the examined children with low vitamin D status suffer from caries. It has been established that the high prevalence of vitamin D insufficiency and deficiency in children in the Far North is associated not only with low insolation, but with insufficient drug correction of vitamin D first years, but also in later years of life. In the development of caries in children, low vitamin D levels play an important role.
Keywords: children, vitamin D, deficiency, 25(OH)D level, Far North

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THE EFFECT OF OMEGA-3 POLYUNSATURATED FATTY ACID DEFICIENCY ON THE LIPID PROFILE AND METABOLIC STATUS OF CHILDREN OF VARIOUS AGES WITH HETEROGENEOUS LIPID METABOLISM DISORDERS
I.N. Zakharova, I.M. Osmanov, Yu.V. Korchagina, I.I. Pshenichnikova, V.V. Pupykina, I. H.-B. Arselgova, A.V. Miroshina

Summary. In order to study the effect of omega-3 PUFA deficiency on the lipid profile and metabolic status of children of different ages with heterogeneous lipid metabolism disorders, 90 children aged 3–17 years who had not previously received subsidies from food and other omega-3 PUFA supplements were examined. In all patients, the following were determined: omega-3 erythrocyte index, lipid profile, anthropometric indicators (height, weight, waist circumference), body mass index, vitamin D level. The duration of follow-up was 6 months. The control of the omega-3 erythrocyte index was carried out by gas chromatography-mass spectrometry. Index values >8% corresponded to satisfactory values, 6–8% reflected insufficiency, 4–6% – deficiency, <4% acute deficiency of omega-3 PUFA. The following results were obtained: out of 90 children included in the study, 12 (13.3%) had adequate provision, 78 (86.6%) had a deficiency of omega-3 PUFA, of which 58 patients (64.4%) demonstrated a deficiency of omega-3 fatty acids, 20 (22.2%) had a moderate deficiency. No deep deficit was registered. After the donation of Norwegian fish oil by NFO, at a dose of 1000 mg per day in children with average BMI values and 2000 mg in obese children, the number of patients with normal values of the erythrocyte omega-3 index increased from 13.3% to 38.8%, which was more than 1/3 of the total number of subjects. The lipidogram was monitored three times throughout the study, the expected effect in the form of a decrease in the level of HDL-C was not achieved. However, visual indicators of a decrease in triglyceride levels were obtained, mainly in obese children without a potential effect on BMI and waist circumference. Probably, the standard dosage of omega-3 PUFA used by us was insufficient to meet the needs of a growing organism. Further research is needed to increase the subsidy of omega-3 PUFA in the diet of children and adolescents. Our data indicate the prevalence of omega-3 PUFA deficiency in the pediatric population. The use of high-quality dietary supplements of omega-3 PUFA can make a significant contribution to the prevention of deficiency conditions in children associated with insufficient intake of essential omega-3 PUFA from food, as well as be used in complex therapy in children with obesity, metabolic risk and hypertriglyceridemia.
Keywords: erythrocyte omega-3 index, deficiency of omega-3 polyunsaturated fatty acids, insufficiency of polyunsaturated omega-3 fatty acids, children, fish oil, hypertriglyceridemia, obesity