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METABOLIC-ASSOCIATED FATTY LIVER DISEASE IN CHILDREN. THE ROLE OF LIVER ELASTOMETRY
S.N. Borzakova, I.M. Osmanov, I.N. Zakharova, N.V. Grushina, I.G. Kolomina, T.R. Lavrova, E.A. Goncharova, M.A. Khachaturyan, A.E. Gabrielyan

Summary. Objective: to assess the prevalence of hepatic steatosis and fibrosis among obese children aged 10–17 years. Materials and methods. The study included 78 children with grade 1–4 obesity, aged 10–17 years (14 on average). Liver elastometry (transient elastography) on the iLivTouch device (China). Results. The gender distribution was dominated by boys, M/F = 18/17. Larger share of children included in the study were children with obese class 3 – 36/78 (46.2%). Of obese children, 42.3% (33/78) had significant hepatic steatosis (S3), 24.4% (19/78) had moderate steatosis (S2), 23.1% (18/78) had minor steatosis (S1), and 10% (8/78) had no steatosis (S0). The proportion of children with no steatosis decreased in parallel with the increase in the obesity grade, and the proportion of children with significant steatosis increased in parallel with the increase in the obesity grade. The vast majority (50/78; 64.1%) of obese children showed no liver fibrosis according to elastometry, while 28/78 (35.9%) showed signs of liver fibrosis, of which 15/78 (15%) children had F2 fibrosis according to the METAVIR score, 9/78 (11.5%) of the children had F2–F3 stage, 3/78 (3.8%) of the children had F3–F4 stage. With the increase in obesity, the proportion of children with fibrosis and its severity increases. Conclusion. As the degree of obesity increases, the share of children with liver steatosis and fibrosis increases, which, in the absence of weight loss, can lead to liver cirrhosis at an older age. Thus, obese children are at risk of the development of fibrosis and subsequently cirrhosis.
Keywords: overweight, obesity, children, fatty liver disease, liver elastometry, liver fibrosis, hepatic steatosis

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NUTRITIONAL PREDICTORS OF THE FORMATION OF BRONCHOPULMONARY DYSPLASIA IN PREMATURE INFANTS
E.V. Tolokolnikova, E.Y. Bryksina, G.M. Letifov, E.D. Teplyakova, V.S. Bryksin

Summary. The purpose of the study: to assess the nutritional status of newborns of different gestational ages and its role in the development of bronchopulmonary dysplasia (BPD) for the subsequent optimization of the nutrition program. Materials and methods: 123 children aged 1 to 2 months of life with gestational ages from 26 to 36 weeks were included in the study. During the observation, general clinical laboratory and instrumental research methods were used with a dynamic assessment of mass-growth parameters, nutrient levels and daily fluid volume. Results: children with BPD received a higher mean of daily fluid volume (152.0 ± 11.8 mL/kg/day; in children without BPD – 122.4 ± 12.5 mL/kg/day, p = 0.00039), by the end of the 1st month of life, as well as lower protein and caloric levels. Children with BPD had a higher incidence of multiple organ failure. Conclusion: low caloric content and daily protein load, high daily fluid volume, can contribute to the development of pulmonary hypertension, delayed growth and maturation of lung tissue, as well as the surfactant system, impaired trophia and postnatal growth of the central nervous system and other systems. All of the above requires optimization of nutritional tactics in patients of this category.
Keywords: bronchopulmonary dysplasia, prematurity, nutrition, protein-energy insufficiency

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RESPIRATORY DAMAGE IN DOWN SYNDROME: A SERIES OF CASES
I.O. Shmeleva, S.V. Starevskaya, S.I. Melnik

Summary. Down’s syndrome is the most frequent chromosomal abnormality. In addition to phenotypic expression and damage of organs and systems, respiratory involvement is also observed and can be associated with features of the development of respiratory tract or functional features of other organs and systems. Six patients with Down’s syndrome (trisomy chromosome 21) and damage to respiratory organs were observed. Detailed observation review of one patient is provided. In group, interstitial changes in lungs and clinical manifestation has been noticed during first year of life. By age three-four partial regress has been observed. Severe course of lower respiratory tract diseases requires monitoring by a pulmonologist from an early age. Pathogenetic therapy is required in order to avoid the progressive development of disease. Early diagnostics and treatment strategy are decisive to ensure best results in treatment respiratory involvement of patients with Down’s syndrome.
Keywords: Down syndrome, children, respiratory system

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THE SPECTRUM OF SENSITIZATION IN PATIENTS WITH ATOPIC DERMATITIS, DEPENDING ON THE SEVERITY
E.A. Glukhova, O.B. Tamrazova, V.A. Revyakina, A.G. Sukhotina

Summary. Objective: to evaluate and scientifically substantiate the role of polyvalent sensitization as a risk factor for the development of severe persistent atopic dermatitis. Materials and methods. The study included 308 children aged 8 to 17 years and 11 months with an established diagnosis of atopic dermatitis. Group 1 included 152 patients with mild course, group 2 156 patients with severe course. In all children, a retrospective analysis of data on the presence of sensitization to 15 allergens (8 food, 3 pollen, 2 epidermal, 1 household and 1 fungal) was carried out at the age of 3 years and at the age of 3 to 7 years based on the processing of medical documentation data and the application of the basics of comparative statistics. Results. In patients with mild course, sensitization to food allergens was most common (21.1%), in patients with severe course – to pollen (84%), epidermal (69.2%) and household (60.9%). When comparing the frequency of sensitization cases in the study groups to each of the 15 allergens in each of the studied time period (and at the age of up to 3 years, and at the age of 3–7 years) revealed: in all cases, the frequency is significantly higher in the group of severe course (for each allergen p < 0.05). In patients showing polyvalent sensitization at the age of 7 years, severe recurrent AtD was observed 4.4 times more often after the age of 8 years compared with patients who did not have polyvalent sensitization. Conclusion. In a child with atopic dermatitis, the presence of polyvalent sensitization to food, pollen, epidermal and household allergens up to 7 years old may be one of the risk factors for the persistence of a severe course of the disease in adolescence.
Keywords: atopic dermatitis, polyvalent sensitization, risk factors

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ANESTHESIOLOGICAL SUPPORT FOR THORACIC OPERATIONS IN CHILDREN
O.A. Rogacheva, B.D. Babaev, I.V. Turishchev, D.V. Haspekov, A.S. Sar

Summary. This descriptive review outlines an approach to the management of pediatric patients who have undergone non-cardiac thoracic surgery in the perioperative period, starting with preoperative evaluation, methods of singlelung ventilation, lung protection strategy, modern methods of regional anesthesia will also be considered.
Keywords: one-lung ventilation, pediatric anesthesia, thoracic surgery, thoracic wall nerve blocks, fascial plane blocks

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MODERN APPROACHES TO ASSESSING THE STATE OF THE HEMOSTASIS SYSTEM IN CHILDREN WITH CONGENITAL THROMBOGENIC RISK FACTORS
A.S. Rogova, A.Ya. Ilyina, A.L. Mishchenko, L.A. Levchenko, M.V. Shabliy, A.A. Martynov, E.A. Akhalova, I.V. Solovyova, I.V. Blokhnina

Summary. Timely diagnosis of permanent (genetic) and temporary thrombogenic risk factors and adequate assessment of the hemostatic system in children born to women with thrombophilia are decisive in preventing the development of thrombohemorrhagic complications in children in the 1^st year of life. Purpose of the study: to develop an algorithm for studying the parameters of the hemostatic system over time in children of the 1^st year of life with congenital thrombogenic risk factors. Children of the 1^st year of life with congenital thrombogenic risk factors were divided into 2 groups: group 1 included children (n = 30) born to women with thrombophilia (D68.5, D68.6), and group 2 included children (n = 30), born to women with carriage of thrombogenic risk factors. Methods for studying the hemostasis system: standard (coagulogram and clinical blood test with determination of platelet counts) and special (thromboelastogram, aggregogram, determination of markers of thrombinemia and fibrin formation). Results. For the first time, special tests of the hemostatic system in children with congenital thrombogenic risk factors were determined in the dynamics of the 1^st year of life. It was found that the coagulogram parameters of the examined children were not changed, but thrombocytosis was detected in a clinical blood test. Therefore, special tests were used to study the hemostatic system, which revealed an increased coagulation potential in all children in the form of chronometric and structural hypercoagulation and platelet hyperaggregation. Also, children of group 1 were characterized by an increase in the coagulant activity of platelets and the presence of markers of fibrin formation, and for children of group 2 – a decrease in indicators of coagulant and functional activity of platelets. Conclusion. By the 1^st year of life, the examined children born to women with both thrombophilia and the presence of thrombogenic risk factors retained an increased blood clotting potential. This circumstance necessitates the development of a specific algorithm for monitoring children in this group in the future in order to prevent thrombohemorrhagic complications.
Keywords: children of the 1^st year of life, hemostatic system, thrombogenic risk factors, polymorphisms of hemostatic system genes, thromboelastogram

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ASSESSMENT OF THE PROVISION OF MEDICAL CARE TO CHILDREN WITH RESPIRATORY TRACT DISEASES WITH REFUSALS TO HOSPITALIZATION
N.B. Gomboeva, A.S. Boronoev, E.A. Batysheva

Summary. In recent years, the number of visits to the emergency rooms of pediatric hospitals of outpatient patients with acute respiratory diseases has increased. The purpose of the study is to analyze the tactics of providing medical care by an emergency room doctor to patients who do not need inpatient care. Methods: 302 patient cards of the admission and diagnostic department of the Children's Republican Clinical Hospital in Ulan-Ude, who treated independently with symptoms of respiratory disease, were analyzed. Results. With a tenfold increase in self-referrals over the past 5 years of patients with symptoms of acute respiratory diseases, the validity of such referrals to specialized hospitals is low. All patients needed outpatient care, not related to emergency or emergency. A viral infection was diagnosed in 81.5% of cases with acute respiratory diseases symptoms. Additional studies were conducted in 22.5% of patients. Antibacterial therapy was prescribed in 30.4% of cases, with diagnoses of "pneumonia", "acute sinusitis", "acute tonsillitis" – antibiotics were prescribed in 100%, with acute otitis media – in 37.2%, with acute respiratory viral infection and acute bronchitis – 0%. When choosing antibacterial therapy, preference was given to aminopenicillins. Conclusion. The growth of selfreferrals of patients to the emergency room who do not need hospitalization continues, entailing the irrational use of health resources. There is a favorable tendency to decrease and increase the validity of the appointment of antibacterial therapy in diseases of the respiratory tract in comparison with the 2020 study. 27% of otorhinolaryngologists prescribe cephalosporins at the outpatient stage. In practical healthcare, for the effective use of resources, organizational measures are needed to expand emergency departments in children's polyclinics, as well as to increase parents' awareness of routing for acute respiratory diseases using modern information technologies. Conclusions. It is necessary to limit the flow of non-core patients to specialized hospitals by increasing the availability of primary care. For the selection of rational therapy of acute tonsillitis, it is necessary to provide doctors of reception and diagnostic departments with express tests for the diagnosis of group A β-Streptococcus haemolyticus monitoring compliance with clinical recommendations when prescribing antibacterial therapy for diseases of the respiratory tract.
Keywords: respiratory infection, children, self-treatment, emergency room

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SUBCLINICAL MYOCARDIAL INJURY AND HEMODYNAMIC DISORDERS IN CHILDREN WITH IDIOPATHIC VENTRICULAR EXTRASYSTOLE
A.S. Sharykin, D.V. Zamaraeva, A.N. Grishkin, N.D. Telezhnikova, E.V. Karelina, I.I. Trunina

Summary. Premature ventricular contractions (PVCs) are often benign in children, but in some cases, they can lead to cardiac dysfunction. Variation in laboratory tests (troponin I) and instrumental parameters (left ventricular ejection fraction, stroke index in sinus rhythm, rate pressure product (RPP)) evidences such abnormalities and precedes clinical changes. Objective – to identify subclinical myocardial damage and its causes in children with frequent idiopathic PVCs, accompanied by a decrease in stroke index and myocardial contractility. Materials and methods. The study included 44 children diagnosed with premature ventricular contractions (Me of PVCs frequency 20 478; Q1–Q3: 13 190–34 517, Me of PVCs density in a 24-hour period 13.0%; Q1–Q3: 8.0–22.4%). We compare clinical and laboratory-instrumental data due to reveal most significant factors influencing on myocardial function in children with PVCs. Echocardiographic parameters were measured in sinus rhythm. Results. Normal cardiac function was observed only in 15 (34%) patients. 21 (47.7%) patients had a high level of troponin I, 13 (29.5%) patients had systolic dysfunction of the left ventricle, 18 (40.9%) patients had low stroke index, and in 39 (88.6%) patients the actual RPP (Me 111.6, Q1–Q3: 96,9–128,3) was significantly higher than the expected RPP for such age and gender (Me 88.9, Q1–Q3: 85.2–109.0), p = 0.0001). Thus, 29 (66%) children had subclinical myocardial damage or dysfunction, which can be a cause of heart failure in the future. The chances of developing myocardial dysfunction increased with a PVCs density of more than 10% (OR = 1.63, CI: 1.23–2.16, p = 0.009). Conclusion. The risk of developing myocardial dysfunction is significantly increased in children with a PVCs density more than 10% in a 24-hour period. It leads to systolic dysfunction of the left ventricle and a decrease in cardiac index. The most likely reason for this is the relative myocardial ischemia that occurs due to higher myocardial energy requirements in patients with PVCs. Laboratory markers of myocardial injury are elevated in almost half of children with frequent PVCs.
Keywords: premature ventricular contractions, children, troponin I, left ventricular ejection fraction, stroke index, double product

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CLINICAL CHARACTERISTICS AND TACTICS OF COMPLEX THERAPY OF INFLUENZA AND OTHER ACUTE RESPIRATORY VIRAL INFECTIONS IN FREQUENTLY AND LONG-TERM SICK CHILDREN IN HOSPITAL SETTINGS
A.L. Zaplatnikov, I.N. Zakharova, L.N. Mazankova, I.M. Osmanov, A.N. Shuvalov, E.N. Vyzhlova, V.V. Malinovskaya

Summary. The article presents the results of evaluating the efficacy and safety of a new modified dosing regimen of VIFERON^®, rectal suppositories in the treatment of influenza and other acute respiratory viral infections in children with health problems and those classified as frequently and long-term ill in comparison with the standard dosing regimen. It has been established that a new dosing regimen for VIFERON^®, rectal suppositories using higher doses and with a longer duration of therapy can reduce the time for improvement and overall recovery of patients by 2.11 days and 2.50 days, respectively, and reduce the number of complications of influenza and other acute respiratory viral infections 2.39 times compared with the standard dosing regimen against the background of symptomatic therapy. The course of therapy of the VIFERON^®, rectal suppositories lasting both 5 and 10 days, prescribed in various dosages depending on the age of the patient, is safe for patients, no serious adverse events and other deviations of vital parameters were noted during treatment. A new modified dosing regimen for VIFERON^®, rectal suppositories, can be recommended for use in clinical practice for the treatment of influenza and other acute respiratory viral infections in children with health problems and those belonging to the category of frequently and long-term ill children, to reduce the risk of a long course of the disease and the formation of complications.
Keywords: influenza, ARVI, interferon alfa-2b, frequently and long-term ill children, VIFERON^®

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HOW TO ENSURE ADHERENCE TO DIET THERAPY OF A TEENAGER WITH OBESITY AND METABOLIC SYNDROME?
I.I. Pshenichnikova, I.N. Zakharova, I.M. Osmanov, I.I. Trunina, V.V. Pupykina, E.V. Skorobogatova, A.V. Miroshina

Summary. Acute hunger, the desire to have a snack and "overeat", craving for abundant fatty and sweet foods are manifestations of insulin resistance and compensatory hyperinsulinemia in patients with obesity and metabolic syndrome. Frequent snacking, the organization of the diet without taking into account the influence of the food taken on metabolic processes aggravate obesity, which leads to the rapid development of complications. To ensure effective dietary correction, a teenager with metabolic syndrome and obesity needs to give up snacking between meals. When planning a diet for the day, the satiety index and the density of nutrients in a portion should be taken into account, as well as the glycemic and insulin index of products. It is recommended to adhere to the "equator rule", according to which the first two meals fall before 15 o'clock in the afternoon, and dinner after 15 o'clock, while for the evening meal it is necessary to give preference to foods and dishes with the lowest glycemic and insulin indices. A very important factor in the formation and maintenance of metabolic health of adolescents is an adequate subsidy of omega-3 polyunsaturated fatty acid, which can be achieved by including fish and seafood in the daily diet, or by taking a nutraceutical supplement omega-3 polyunsaturated fatty acid . When choosing omega-3, it is important to take into account the TOTOX (total oxidation value), which reflects the quality and safety of the product.
Keywords: adolescents, obesity, metabolic syndrome, insulin resistance, glycemic index, insulin index, satiety index, omega-3, TOTOX