Tatiana V. Kartseva

Background . The prevalence of chronic tonsil diseases is constantly increasing among children of different ages. To date, the treatment of pediatric patients with chronic diseases of the upper respiratory tract remains controversial and requires new therapeutic approaches. Aim . To study the clinical and anamnestic characteristics of chronic adenoiditis in children aged 3-6 years and to evaluate the effectiveness of including a probiotic drug in postoperative rehabilitation. Methods. A total of 100 children aged 3–6 years with chronic inflammatory processes of the nasopharynx were examined. The patients were divided into 2 comparable groups, depending on the treatment and rehabilitation measures received. A parent survey was conducted to assess the severity of clinical symptoms before treatment and 30 days after adenotomy. Results. The frequency and duration of viral infections in children with chronic adenoiditis were assessed. Before surgery, 62 % of children had acute respiratory infections (ARIs) once every 2 months or more, and 62 % had ARI episodes lasting more than 7 days. According to the survey results, after treatment there was a statistically significant decrease in the frequency of the following symptoms in children in both study groups: difficulty in nasal breathing, snoring, cough, and bad breath. In the main group, there was a marked decrease in the intensity of nasal breathing difficulty (by 84 %) and in the frequency of sleep disorders (by 58 %) after probiotic treatment. Conclusion . The post-treatment survey data demonstrate regression of clinical symptoms in both groups. However, with respect to symptoms such as decreased intensity of nasal breathing and reduced frequency of sleep disorders, higher therapeutic efficacy was observed when a probiotic was used as an adjunct to adenotomy.

Obesity is a global health problem whose incidence is steadily increasing. Modern lifestyles, characterized by changing dietary preferences and low levels of physical activity, are key factors in the development of obesity and overweight. Obesity increases the risk of numerous gastrointestinal (GI) diseases, such as gastroesophageal reflux disease, inflammatory bowel disease, functional digestive disorders, and others. The pathogenesis of these conditions includes chronic low-grade inflammation, increased intestinal barrier permeability, and changes in the intestinal microflora. The purpose of this article is to describe and systematize high-calorie diets and to study the morphological and pathophysiological mechanisms by which these diets influence the gastrointestinal tract. This review examines the main types of diets used to model obesity in laboratory animals: high-fat, high-carbohydrate, with a choice of fats or carbohydrates, combined (“cafeteria diet”, “Western diet”), and models of psychogenic overeating. Histological features of the gastrointestinal tract wall of obese rats are represented by changes in the mucosa (a decrease in the number of PAS-positive goblet cells) and the lamina propria (an increase in the number of neutrophils, lymphocytes, macrophages, and collagen fibers). In addition, increased concentrations of IL-1β, IL-6, IL-8, TNF and monocyte chemotactic protein (MCP-1), and malondialdehyde (MDA) were detected in the colon wall. Obesity and excess body weight have been shown to impact structural components of the nervous system (hyperactivation of enteric ganglia, disruption of the autonomic nervous system, etc.), leading to impaired gastrointestinal motility. Experimental studies demonstrate that high-calorie diets alter the histological characteristics and motility of the gastrointestinal tract in laboratory animals, causing structural damage and disruption of innervation of the digestive organs. This indicates the need for further research to identify the mechanisms underlying the development of obesity complications and develop effective preventive measures.

Among the main pathologies of childhood, respiratory tract lesions dominate, with a significant proportion of this category of diseases being chronic inflammatory processes localized mainly in the pharyngeal tonsil (adenoids) and palatine tonsils. Due to the prevalence of these pathologies, it is necessary to develop new approaches to the treatment and rehabilitation of patients. The aim of the study was to conduct a study of the microbiome of the upper respiratory tract and gastrointestinal tract in paediatric patients with chronic adenoiditis for a comparative analysis of the clinical effectiveness of various treatment approaches. Material and methods . We checked out 150 kids aged 3-6 years with chronic inflammation in their nasopharynx. We split the patients into 3 comparable groups based on the treatment and rehabilitation measures carried out. Group 1 included patients who underwent surgery under general anesthesia. Children in groups 2 and 3 received nasopharyngeal irrigation with a probiotic solution for 30 days after surgery or without surgery, respectively. All children underwent bacteriological testing of the oral and nasopharyngeal microbiome, as well as qualitative and quantitative analysis of the luminal intestinal microflora. Results and discussion . In groups 2 and 3, after treatment, the number of cultures positive for Streptococcus salivarius (by 20 and 28 %, respectively), S. mitis (by 14 and 18 %, respectively) in washings from the mouth and nasopharynx statistically significantly increased, in group 3 − cultures containing Neisseria spp. and S. oralis (by 38 and 20 %, respectively). In groups 2 and 3, a decrease in the number of transient and accessory microflora, including Staphylococcus aureus and S. pyogenes , was detected. The composition of the intestinal microbiome significantly improved: in groups 2 and 3 normal microflora was determined in 94.0 % of patients in group 2 (before treatment – only in 8 %) and in 96.0 % of children in group 3 (before treatment – in 16 %). Conclusions. The data obtained indicate the significant effectiveness of probiotic therapy in the postoperative period, as well as in combination with conventional conservative treatment methods for the correction of the microflora of the upper respiratory tract and intestinal biocenosis in children with chronic infectious and inflammatory processes of the nasopharynx.

Obesity is one of the most acute issues of medicine at the present stage due to the steady increase in morbidity, high risk of complications and comorbid conditions that entail significant financial costs. At the same time, many different etiopathogenetic factors are involved in the formation of obesity. The article presents a literature review concerning the main risk factors and etiologic aspects of the development of overweight and obesity in adults and children. The most relevant pathogenetic mechanisms are considered, including imbalance of adipokines (decrease in adiponectin level and increase in leptin content), formation of low activity chronic inflammation as a result of proinflammatory cytokines, changes in the features of neuroimmune-endocrine interactions, the impact of chronic stress on the human body, vitamin D deficiency, disorders of the “gut – brain” axis, quantitative and qualitative changes in the composition of intestinal microbiota. The main therapeutic approaches and surgical methods in the treatment of obesity are presented. The data available in the literature at the present stage on methods of rehabilitation of patients with obesity, as well as persons with excess body weight, indicating the need for a comprehensive approach and combination of lifestyle modification, physiotherapeutic methods, psychological counseling to achieve positive results are summarized.

Obesity is one of the largest non-infectious pandemics of the 21st century, affecting both adults and children on the planet. Due to the enormous impact of obesity on human health and the global economy, there is a need for a more in-depth study of the etiology and pathogenesis of this disease. The least studied aspect of obesity formation is the change in the composition of the intestinal microbiota. The review presents data from modern domestic and foreign literature on the relationship between the qualitative and quantitative composition of the intestinal microbiota and the development of obesity. There is data, repeatedly confirmed in research papers, proving the influence of intestinal microorganisms on the metabolism of adipose tissue. This article presents the composition of the colon microbiota that contributes to weight gain (the ratio of Firmicutes/Bacteroides, Prevotella spp., Methanobrevibacter smithii, Мethanosphaera stadtmanae, Ruminococcus spp., Escherichia coli, Roseburia spp., Acinetobacter spp., the ratio of Bacteroides fragilis to Faecalibacterium prausnitzii, Fusobacterium spp., Sutterella spp., etc.), and summarizes the pathogenetic mechanisms (reduced expression of short-chain fatty acids, disruption of the integrity of the intestinal epithelium, the occurrence of metabolic endotoxemia, increased synthesis of pro-inflammatory cytokines, the formation of chronic low-level inflammation, etc.).

In recent decades, obesity and overweight have become one of the significant problems of global public health. The steady growth of morbidity, development of complications and comorbid conditions, disability and an increase in mortality in obese patients indicate the need to develop new methods of treatment and prevention of this disease. It has been proven that some probiotics contribute to weight loss. The review presents an analysis of data from modern domestic and foreign studies concerning the use of certain bacterial strains in obese and overweight people for preventive and therapeutic purposes. Both classic probiotics with anorexigenic effect (Bifidobacterium spp., Lactobacillus spp., Saccharomyces boulardii) and next-generation ones (Akkermansia muciniphila, Enterococcus spp., Faecalibacterium prausnitzii, Bacteroides spp., Streptococcus spp., Eubacterium rectale, Blautia spp., Christensenella minuta) are considered. The main pathogenetic aspects of weight loss when using these probiotics (reduced permeability and enhanced protective functions of the intestinal epithelium, effects on the gut microbiome, anti-inflammatory activity) are described.

The impact of the new coronavirus COVID-19 infection on the course of pregnancy, maternal and child health is largely unclear and controversial. The presented literature review analyzes changes in the immune, cardiovascular, and endocrine systems in women in physiological pregnancy. The peculiarities of the course of infection caused by SARS-CoV-2 virus in pregnancy, depending on the virus variant, are presented, the issues of infection pathways into immune and non-immune cells, including placental cells, as well as the issues of transplacental transfer of the virus – the key moment of infection of the embryo or fetus, on which the outcome of pregnancy also largely depends, are considered. Promising approaches to COVID-19 therapy are presented: use of inhibitors of transmembrane serine protease 2 (TMPRSS2), furin, angiotensin-converting enzyme (ACE2) and RNA-dependent RNA polymerase, amnion epithelial cells and their exosomes. At the same time, the potential use of mesenchymal stem cells in patients with severe COVID-19 pneumonia is reviewed. Difficulties and questions regarding the use of the above therapeutic methods in pregnant women are highlighted. Aspects of the use of surfactant preparations in newborns at risk of new coronavirus infection are considered.

Introduction. The emergence of new strains of the SARS-CoV-2 virus and an increase in the number of cases around the world requires further study of the epidemiology, clinical peculiarities of the course and complications of this disease. Aim. Revealing the characteristic of spread, clinical picture and significance of clinical manifestations of a novel coronavirus infection in outpatients. Materials and methods. An analysis was carried out of 387 outpatient records of children with confirmed coronavirus infection (COVID-19) (group 1), as well as records of 9 children followed-up by a cardiologist for pericarditis with effusion who had previously had coronavirus infection or positive results of a rapid test for coronavirus infection (group 2). Results. When identifying possible sources of infection, we have found that half of the children in group 1 became got infected through contacts with members of their family. In 345 children (89.1%) of group 1, a rise in body temperature was noted, and mild systemic intoxication syndromes were observed in 316 children (81.7%). Gastrointestinal manifestations had 81 (21%) patients, skin syndrome such as exanthema on the trunk and limbs – only 20 (5%) patients, hemorrhagic events such as nosebleeds ¬– 5 (1.3%) patients. Patients of group 2 had more pronounced systemic intoxication with a predominant neurotoxic effect. Conclusion. The most common route of COVID-19 infection for children was intrafamilial transmission. Older children tolerated the infection more easily. The most common manifestations were fever, nonproductive cough, and signs of intoxication (myalgia, nausea, weakness). In complete blood count, neutropenia with lymphomonocytosis was a common finding. A complicated course occurred in 9 children with diagnosed pericarditis with effusion.

The article discusses the main risk factors for the formation of insufficiency and deficiency of vitamin D in children. Particular attention is paid to the course and dietary preferences of the mother during pregnancy, the intake of vitamin and mineral complexes, the nutrition of the child after birth, the type of feeding, the subsidy of vitamin D preparations and complementary foods. 1246 children under four years of age with no history of vitamin D deficiency were examined. With clinical manifestations of rickets, 52 children were identified, who underwent determination of 25(OH) D in serum, while low availability was detected in 21.1%, vitamin D insufficiency — in 63.4% of children, deficiency — in 15.3% of cases. There was an interaction between the use of dairy products enriched with a vitamin-mineral complex containing vitamin D and Ca, the use of therapeutic doses of vitamin D, and an increase in the level of 25 (OH) D in the blood serum.

Содержание цитокинов в сыворотке крови детей, перенесших мультисистемный воспалительный синдром, связанный с SARS-CoV-2