Anastasiya E. Karavozova

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 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.

Familial hypercholesterolemia (CGHS) is a monogenic disease with a predominantly autosomal dominant type of inheritance, accompanied by a significant increase in the level of low-density lipoprotein cholesterol in the blood, and as a result, premature development and progressive course of atherosclerosis, usually at a young age. One of the common causes of the disease is a mutation in the PCSK9 gene. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is the main link in the regulation of blood lipid metabolism due to its direct participation in the degradation of LDL receptors. Currently, only evolocumab is used as PCSK9 inhibitors in children over 12 years of age in the Russian Federation, which has proven the safety and steady reduction of LDL cholesterol in pediatric patients with HES. Another representative of this pharmacological group is alirocumab, which is currently indicated only for people over the age of 18, due to the lack of evidence in children.

Background. Sodium glucose cotransporter type 2 (SGLT2) inhibitors, established over the past decade, including dapagliflozin, empagliflozin, and canagliflozin, have demonstrated significant reductions in hospitalization and mortality in patients with diabetes mellitus and chronic heart failure in a series of randomized trials. Drugs in this group have a unique hypoglycemic mechanism of action, restoring renal regulation of blood sugar levels, and are also characterized by a low risk of developing undesirable effects and are well tolerated by patients. Along with a wide range of positive effects of gliflozins on the condition of patients and an improvement in the overall prognosis of the disease, data on a decrease in iron levels in the blood during long-term use of drugs in this group have increasingly appeared in the literature. Objective. To evaluate the pathogenetic aspects of the influence of gliflozins on erythropoiesis and iron metabolism in patients suffering from chronic heart failure and diabetes mellitus. Materials and methods. An analysis of foreign sources was carried out, which studied the effect of the use of SGLT2 inhibitors on erythropoiesis and iron metabolism in patients with chronic heart failure. This review examines the pathogenetic basis of the dynamics of hematopoiesis in patients with diabetes mellitus and chronic heart failure. Changes in hematocrit, hemoglobin, reticulocyte count, and erythropoietin reported in prospective analyzes are analyzed. Conclusion. The increase in hemoglobin levels observed when taking gliflozins improves tissue oxygenation, thereby providing some protective effect (in particular, cardioprotective and nephroprotective effects). However, the active use of iron in the process of erythropoiesis leads to an increase in the levels of soluble transferrin receptors and iron-binding capacity of the blood serum in combination with a decrease in ferritin, transferrin saturation coefficient and hepcidin. Thus, long-term use of SGLT2 inhibitors, with a positive effect on hemoglobin levels, can lead, at a minimum, to latent iron deficiency, which requires monitoring of a clinical blood test and a biochemical blood test to study iron metabolism in patients taking gliflozins. To understand the significance of this problem, it is necessary to initiate large-scale cohort studies.

In a series of randomized trials, SGLT2 inhibitors have demonstrated a reduction in hospitalization and mortality in patients with chronic heart failure. However, more and more often, there is evidence of a decrease in iron levels in the blood while taking gliflozin. This review examines the pathogenetic basis of the dynamics of hematopoiesis in patients with diabetes mellitus and chronic heart failure. Changes in hematocrit, hemoglobin, reticulocyte count, and erythropoietin reported in prospective analyses are discussed. The increase in hemoglobin levels observed with gliflozins contributes to improved tissue oxygenation, thereby exerting some protective effect. Active iron utilization will result in increased levels of soluble transferrin receptors and iron-binding capacity, coupled with a decrease in ferritin, transferrin saturation index and hepcidin. Thus, long-term use of SGLT2 inhibitors, while having a positive effect on hemoglobin levels, can lead to latent iron deficiency. To understand the significance of this problem, it is necessary to initiate large cohort studies.

Application of SGLT2 (type 2 sodium/glucose cotransporter) inhibitors in a series of randomized studies contributed to the reduction of incidence of hospitalization and mortality in patients with diabetes mellitus (DM) and chronic heart failure (CHF). Nevertheless, there is a growing evidence of a decrease in the serum iron level on the therapy with glyphozine derivatives. A literature review for the last 5 years has been conducted. The search was carried out in the following databases: Clinical Evidence, Harrison’s Online, Medscape, Medical Matrix, Medical World Search, Clinical Practice Guideline, Evidence-based Medicine Reviews, Google Scholar, PubMed. Pathogenetic bases of dynamics of hemopoiesis indicators in patients with DM and CHF during drugs of this group administration has been considered. Changes in levels of hematocrit, hemoglobin, reticulocytes and erythropoietin count presented in prospective analyses have been analyzed. It has been noted that there is an increase in hemoglobin level after glyphozine derivatives administration in patients with DM and CHF, which contributes to improved tissues’ oxygenation. At the same time, active hemoglobin synthesis leads to rise of transferrin soluble receptors levels and increase of iron-binding capacity combined with reduce of ferritin level, saturation coefficient of transferrin and hepcidin. Thus, long-term administration of SGLT2 inhibitors with positive impact on hemoglobin level may lead to at least latent iron deficiency. The initiation of extensive cohort studies is necessary to assess the importance of this issue.