The paper discusses the most topical issues of medical support of children and adolescents engaged in physical exercises and sports. Much attention is paid to different views on the etiology, pathogenesis, diagnosis, and principles of therapy of pathological transformation of the heart in child athletes. The problem of sudden cardiac death in sports and the possibility of a relationship between connective tissue dysplasia and its development are touched upon. Electrocardiographic and morphological criteria for cardiac maladaptation in athletes are discussed. The problem of early and accessible diagnosis and Russia’s tactics for the diagnosis of health changes in athletes and approaches to their prevention and treatment are covered. Different ways to prevent the pathological transformation of the cardiovascular system in athletes and sudden cardiac death as its extreme manifestation are discussed.

The article presents an excursion into the history of breastfeeding by the example of children’s eating patterns in Udmurtia and highlights the current requirements of the World Health Organization for breastfeeding maintenance. The Udmurts’ familial rites supporting a pregnant and lactating woman and the high prevalence of free breastfeeding have contributed to a decrease in infectious morbidity and mortality rates. The physiological type of carrying Udmurt babies has a positive effect on lactation. The current researches indicate that breastfeeding is the ideal diet that has numerous benefits to baby and mother. Therefore, there must be a collective social responsibility for supporting breastfeeding and lactating mothers.

Skin lesions in diabetes mellitus may be caused by metabolic disorders and develop due to insulin injections as a result of concurrent infection or in syndromic forms of diabetes. The skin lesions caused by metabolic disorders include diabetic dermopathy, diabetic bladder, necrobiosis lipoidica, granuloma annulare, eruptive xanthomas, scleroderma, and vitiligo. Children and adolescents with diabetes mellitus have frequently skin infections, such as cutaneous and mucosal candidiasis (stomatitis, vaginitis, onychomycosis, paronychia, perleche, and candidiasis ofskin folds and interdigitalspaces), and bacterialskin infections. The sequels of insulin injections include post-injection lipodystrophies, swelling, and allergic reactions. Early referral to a dermatologist assistsin identifying skin changesin the early stage of diabetes and in using timely combination therapy.

The article analyzes the preventive and therapeutic possibilities of using probiotic fermented dairy products (baby curds, yoghurts, biolacts) in children with various pathological conditions. It outlines their effect in preventing respiratory and intestinal infections in children of different ages. Incorporation of probiotic strains with proven efficacy (including those as probiotic fermented dairy products) into the combination treatment of pathological conditions associated with Helicobacter pylori is shown to significantly increase the efficiency of eradication therapy and to prevent the development antibiotic-associated diarrhea.

Based on the data of clinical and anamnestic examination, cardiointervalography, electrocardiography, and Doppler echocardiography, the investigators examined the features of the cardiovascular system in children born by women with compromised somatic and gynecological histories in the outcome of complicated pregnancy. Groups 1 and 2 included 72 and 69 infants with and without fetal growth restriction, respectively. Group 1 comprised Subgroup 1a of 57 infants with asymmetrical intrauterine growth restriction and Subgroup 1b of 15 children with symmetrical one; of them there were 13 and 2 infants with hypoplastic and dysplastic types. Apparently healthy infants born by apparently healthy mothers in the outcome of physiological pregnancies made up Group 3 (n = 25).

There is proof that there are significantly important features of autonomic regulation of cardiac activity and morphofunctional characteristics of the heart. The infants with symmetrical intrauterine growth retardation, unlike those with asymmetrical one, were observed to have impaired autonomic regulation of cardiac activity, which was less obvious at birth, deteriorating over time. At birth, the babies had morphological features of the heart and a greater frequency of functioning of fetal communications. Impaired myocardial metabolic processes prevailed within the first month of life and there was a large frequency of changes similar to those in hypertrophic cardiomyopathy by the end of the first half of life.

The featuresrevealed in the infants with different types of intrauterine growth restriction require electrocardiographic and ultrasound examinations, a pediatric cardiologist’s consultations at a maternity hospital, and a subsequent personalized follow-up with corrective measures at an outpatient setting. 

Objective: to improve the diagnosis of fetal hemolytic disease.

Subjects and methods. A study group consisted of 42 pregnant women whose newborn infants had varying degrees of hemolytic disease. The women were divided into 3 subgroups according to the severity of neonatal hemolytic disease: 1) pregnant women whose neonates were born with severe hemolytic disease (n = 14); 2) those who gave birth to babies with moderate hemolytic disease (n = 11); 3) those who delivered infants with mild hemolytic disease (n = 17). A comparison group included 42 pregnant women whose babies were born without signs of hemolytic disease. Curvesfor blood flow velocity in the middle cerebral artery were analyzed in a fetus of 25 to 39 weeks’ gestation.

Results. The peak systolic blood flow velocity was observed in Subgroup 1; however, the indicator did not exceed 1.5 MoM even in severe fetal anemic syndrome. The fetal middle artery blood flow velocity rating scale was divided into 2 zones: 1) the boundary values of peak systolic blood flow velocity from the median to the obtained midscore; 2) the boundary values of peak systolic blood flow velocity of the obtained values of as high as 1.5 MoM.

Conclusion. The value of peak systolic blood flow velocity being in Zone 2, or its dynamic changes by transiting to this zone can serve as a prognostic factor in the development of severe fetal hemolytic disease. 

One of the most common types of birth injuries is locomotor trauma: cephalohematomas of the parietal and occipital regions, injuries of the clavicles and tubular bones. The main clinical manifestations of birth trauma are subperiosteal hemorrhages, fractures, local swelling, limited movements; common symptoms (a negative response and a baby’s crying, changes in heart rate, cardiac auscultatory pattern, blood pressure, pale skin, etc.). The purpose of this study is to improve the quality of medical care for the newborns, by monitoring the clinical manifestations of birth trauma.

Sixty-seven newborn infants with skeletal birth trauma were examined. Significant changes were found in the function of the cardiovascular system (reduced systolic and diastolic blood pressure, increased pulse pressure, tachycardia, more rarely bradycardia, pale skin, and muffled heart sounds); indicators of pain syndrome (moderate and severe pain according to the Neonatal Infant Pain Scale (NIPS) in one-third of the patients); electrocardiographic changes (shortening of the QT and RR intervals, extension of the QRS complex, increased systolic index); neurosonographic changes (periventricular edema and hypoxic changes in all newborns with birth trauma).

The findings are objective criteria for the severity of neonatal conditions and will assist in optimizing combination therapy for little patients with skeletal birth trauma. 

The optimal course of biochemical processes needs adequate dietary intake of vitamins involved in the body’s metabolic reactions. The basis for the pathogenesis of neonatal hemorrhagic disease is deficiency of vitamin K, the level of which in the North-Western Region of Russia was estimated for the first time.

Objective: to measure umbilical cord blood vitamin K1 levels in newborn infants.

Methods. Forty full-term newborns were examined. Vitamin K1 levels were determined using high performance liquid chromatography-tandem mass spectrometry.

Results. The mean umbilical blood cord level of vitamin K1 was very low and amounted to 0.05 (<0.03; 0.15) µg/l. This study revealed no relationship between the level of the above trace element and neonatal sex (p=0,854), maternal age (p=0,913), abortions (p=0,568), threatened abortion (p=0,109), smoking (p=0,923).

Conclusion. The umbilical cord blood concentration of vitamin K1 in the newborns was found to be very low, which increases the risk of hemorrhagic disease and requires exogenous replenishment of the above vitamin after birth. 

Hypertension is a modifiable risk factor for cardiovascular diseases. The data of  24-hour ambulatory blood pressure monitoring (ABPM) largely correlate with target organ lesions; however, the availability of 24-hour ABPM remains low in clinical practice.

Objective. to determine the diagnostic value of a single office blood pressure measurement for the detection of latent hypertension in children with chronic kidney diseases

Subjects and methods. A single office blood pressure measurement and 24-hour ABPM were carried out in 359 children (boys/girls, 0,51/0,49; median age, 13 years (5; 17) with chronic kidney diseases (a glomerular filtration rate of 84,18±29,6 ml min/1,73m2 (median, 86 ml/min/1,73m2 estimated using the Schwartz equation). To rule out the impact of antihypertensive and/or immunosuppressive therapy on the results of the study, the investigators identified a group of 108 patients (boys/girls, 0,52/0,48; median age, 12 years (5; 16), estimated median glomerular filtration rate, 84 ml/min/1,73m2 ) who did not receive the above treatment.

Results. Office blood pressure measurements revealed prehypertension in 14,5% of cases, hypertension in 27,5%, which was consistent with white coat hypertension in 5% of cases. According to 24-hour ABPM, hypertension was present in 48,7% of the children, including those with latent hypertension (26%). Children with latent hypertension (56,4%) had more frequently elevated blood pressure only at night. The level of office blood pressure was weakly correlated with that of the mean diastolic blood pressure during the day, regardless of the presence/absence of antihypertensive and/or immunosuppressive therapy. Latent hypertension was detected in approximately one-fifth of children with different blood pressure levels in the normal range and its frequency significantly increased 1,5–2-fold in patients with higher-normal blood pressure (90‰ ≤ AP <95‰). The children who did not receive antihypertensive and/or immunosuppressive therapy showed a close correlation between the level of a single office blood pressure measurement and the parameters of 24-hour ABPM, as well as a lower frequency of latent hypertension. The risk of latent hypertension increases significantly when the level of a single office blood pressure is more than 75‰.

Conclusion. The normal level of a single office blood pressure reading does not allow latent hypertension to be ruled out in children with chronic kidney diseases. The risk of latent hypertension was significantly higher in patients with a single systolic/diastolic blood pressure measurement of more than 75‰ by gender, age, and height. Regardless of the level of a single office blood pressure measurement, 24-hour ABPM should be therefore carried out in all children with chronic kidney diseases. 

Sixty-five children aged 1 month to 15 years with a diagnosis of viral encephalitis, who had been admitted to the Clinic of the Pediatric Research and Clinical Center for Infectious Diseases, Federal Biomedical Agency, in 2013-2016 were examined.

Objective: to establish the frequency of mixed herpesvirus infection in children with viral encephalitis, by using the current diagnostic methods to determine the role of reactivation of herpesvirus infection on the development of viral encephalitis.

The investigators identified anti-herpesvirus antibodies and their avidity using an enzyme immunoassay and anti-cytomegalovirus antibodies specific for antigens by immunoblotting applying the kits. Herpesvirus DNA was detected in the biological material (blood, cerebrospinal fluid) by real-time polymerase chain reaction (PCR) and by electrophoresis using the PCR kits (Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare (Moscow). Young children were shown to develop the disease as a result of primary infection more commonly as monoinfection in the old age groups during the persistence of one or two herpesviruses in the body. In encephalitis caused by herpes simplex virus type 1 and type 2, reactivation of cytomegalovirus that could be a cofactor in the development of brain inflammation was proven by the current diagnostic technique immunoblotting. The comprehensive laboratory approach to the etiological diagnosis of viral encephalitis, which encompassesthe determination of antibody classes, avidity, and antibodiesto individual protein determinants of viral particles, makes it possible to specify the activity of different herpesviruses in mixed infection and to determine the stage of the infectious process, which is important for the choice of therapeutic policy. 

The abilities of tilorone to modulate an inflammatory response in acute respiratory viral infections (ARVI) and proofs of its clinical efficacy were the basis for investigating the effect of tilorone (Amixin) on the cytoimmunological parameters of induced sputum and on the frequency of asthma exacerbations caused by respiratory viral infection in children.

Objective: to evaluate the clinical course of the disease and the cellular composition and immunological indices of induced sputum in children with an asthma exacerbation in the presence of the acute respiratory disease on addition of Amixin to standard basic therapy. Thirty children aged 7 to 16 years with an asthma exacerbation in the presence of ARVI were examined. Pharyngeal and nasal swabs were tested by PCR forrespiratory viruses; externalrespiratory function was determined before and after a pharmacological test; and nasal secretions and induced sputum were also cytologically investigated. A follow-up group (n=19) received treatment with Amixin according to the regimen.

The predominant inflammatory phenotype in children with an asthma exacerbation in the presence of ARVI was ascertained to be neutrophilic (53.9%). Pathogen identification revealed rhinovirus in two-thirds of cases. Addition of tilorone (Amixin) to standard basic therapy for an asthma exacerbation caused by ARVI declined the number of recurrent ARVIs over the next 6 weeks; the number of bacterial complications did reduce that of asthma exacerbations if the latter occurred. The children treated with Amixin showed elevated levels of macrophages, reduced concentrations of eosinophils and IL-8, IL-1β in the induced sputum, and improved spirometric parameters reflecting permeability at the level of small and medium-sized bronchi. 

The urgency of the problem of frequently ill children is associated with a significant number of patients who can be assigned to this category. Objective: to present the nosological and etiological structure of diseases in frequently ill children depending on age.

Subjects and methods. 243 children aged 1 to 17 years with recurrent respiratory infections were followed up. The children were examined using routine clinical, laboratory, and instrumental examinations. The etiological diagnosisincluded bacteriological examination of the upperrespiratory tract microflora; determination of IgM and IgG antibodies against Chlamydophila pneumoniae, Mycoplasma pneumoniae, Epstein–Barr virus(EBV), and cytomegalovirus(CMV) in blood by enzyme immunoassay and that of Chlamydia and Mycoplasma DNA in pharyngealswabs and that of CMV, EBV and human herpesvirustype 6 DNA in blood by polymerase chain reaction.

Results. Recurrentrespiratory diseases were found to be associated with herpesvirusinfection in 75% of the children aged 1 to 6 years, with Streptococcus, Mycoplasma, and Chlamydia infections in 16, 10, and 4% of those aged 3 to 6 years, respectively, and to be accompanied by abnormal lymphoid tissue proliferation in 84% of the children aged 3 to 6 years, with the abundant growth of bacterial opportunistic pathogensin one half of the patients. Despite the continuing importance of infectious agents(herpesviruses and streptococci in 29 and 20%, respectively), the chronically ill school-aged children displayed a high incidence of somatic diseases: chronic tonsillitis (43%) and chronic sinusitis (14%) in children aged older than 12 years and allergic rhinitis (23%) in those aged 7 to 17 years. The symptoms of autonomic vascular dystonia were observed in 21% of the patients; cardiac arrhythmias were diagnosed in 14%. 

Moyamoya disease is a rare chronic cerebrovascular disorder characterized by gradually progressive luminal stenosis of the intracranial segments of the internal carotid artery and the initial segments of the anterior and middle cerebral arteries, thus forming a network of minor vascular anastomoses. Impaired blood supply in the above vessels due to occlusion leads to the development of ischemic and hemorrhagic strokes in the respective beds, causing a variety of neurological and visual disorders.

Activation of herpesvirus infection in a 2-year-old infant provoked the onset of moyamoya disease. An abnormal posterior right eye segment (bindweed syndrome) detected by an ophthalmic examination, which is commonly concurrent with various cerebrovascular disorders, allowed cliniciansto adequately interpret mild transient neurologicalsymptoms and to rapidly diagnose moyamoya disease, by applying radiodiagnostic methods.

The treatment involved antibiotic and antiviral therapy, infusion of glucose-salt solutions and encephabol. The infant’s status improved; seizures were stopped; right muscle tone fully recovered; and right hand tone remained reduced. Revascularization of  the middle and anterior cerebral arteries were further performed. 

Objective: to determine the proportion of adenovirus gastroenteritides in the structure of acute enteric infections of uncertain etiology among the children of Baku.

Subjects and methods. A total of 155 children aged less than 14 years with acute enteric infections of uncertain etiology who had been admitted to the Clinic of Infectious Diseases, V. Akhundov National Research Institute of Medical Prevention, in 2014–2015, were examined. The etiological diagnosis of adenovirus gastroenteritis was made by immunochromatographic assay. To rule out the bacterial etiology of acute enteric infection, all the children underwent fecal bacteriological examination.

The examinees included babies under 6 months (17,4%), infants aged 7 months to 1 year (6,4%), those 1–2 years of age (29,6%), and children aged 2–14 years (46,4%). Adenoviruses in conjunction with rotavirus were detected in 7 (4,5%) patients. Adenovirus monoinfection was seen in 23 (15%) children.

The contribution of adenoviruses in the etiological structure of acute enteric infections in children was 19,3%. There was no significant difference in the frequency of adenoviruses depending on gender. Adenovirus monoinfection wasregistered in the children all year round. Adenovirus monoinfection occurred as moderate diarrhea whereas mixed adenovirus-rotavirus infection was characterized by the severe course of diarrheal syndrome and catarrhal manifestations. 

Objective: to evaluate cellular energy metabolism in children with pathological gastroesophageal reflux, by determining the levels of free and bound carnitine in dry blood spot specimens and lactate and pyruvate in plasma.

Characterization of children and methods. A total of 49 patients from the Diagnostic Department, Republican Children’s Clinical Hospital, Ministry of Health of the Republic of Tatarstan, were examined. A study group included 29 patients diagnosed as having reflux esophagitis. A control group consisted of 20 somatically healthy children without signs of gastrointestinal tract diseases. The investigators determined the levels of lactate and pyruvate in plasma by the Umbreit method and those of free and bound carnitine in the dried blood spot specimens by liquid chromatography-tandem mass spectrometry.

Results. There were significant changes in the lactate-to-pyruvate ratio in children with reflux esophagitis accompanied by motility disorders. The values of free carnitine were higher than normal in 41% of the study group representatives. The mean values of lactate, pyruvate, and carnitines were within the acceptable range in the examined groups with significantly high values in the children with pathological gastroesophageal reflux.

Conclusion. Gastrointestinal tract motility disorders are an indication for the detection of  energy-deficient diathesis in children and the early correction with energy-rich medications that will potentially affect the rate of recurrences and the severity of clinical manifestations of the disease. 

Objective: to identify and develop methods for the prevention of common dental diseases in teenagers with hypertension. The paper presents the results of dental examination in a group of teenagers with hypertension and in a control group before and after preventive measures. The Fedorov-Volodkina hygiene index modified by Pakhomov was used to assess their oral hygienic status. The periodontal tissue status was evaluated using the comprehensive periodontal index. Calcium glycerophosphate and magnesium chloride were used as preventive agents. After training in oral hygiene techniques and completing a prevention course, there were positive changes in the hygienic and periodontal tissue status, which is important for the further maturation of dental tissues and for the formation of healthy periodontal ones in both groups.

The paper gives an update on the biological role of vitamin D in the human body, its metabolic pathways, and potential abnormalities resulting in reduced provision.

Objective: to determine vitamin D provision in the children of Kazan during the winter season.

Examinations were made in 309 children, including 171 infants aged 1 month to 3 years and 138 children 6 to 18 years of age. Serum 25(OH)D levels were determined by chemiluminescence immunoassay at the EFiS Research Center (Moscow). In infants under 3 years of age, the mean 25(OH)D values were 18,2±1,0 ng/ml, while only 14,8% of the patients were found to have normal 25(OH) D values of (more than 30 ng/ml) and the rest had vitamin D metabolite insufficiency or deficiency. The winter vitamin D level was consistent with the normal ones in 11,2% of the schoolers, lower in 122 (88,8%) children; the provision of vitamin D was at its deficiency level (less than 10 ng/ml) in 33 (24%) children. The findings suggest that it is necessary to prescribe vitamin D for all children under the age of 18 during winter and autumn. It is best to determine the initial level of the metabolite and to use its dose corresponding to that of vitamin D. 

Corrected transposition of the great arteries is a congenital heart defect that is rarely encountered in medical practice. The problem of diagnosing this abnormality of the cardiovascular system is due to the absence of hemodynamic disorders and clinical manifestations for a long time. The paper describes a clinical case of a complex heart defect occurring virtually asymptomatically. Echocardiography that allows timely diagnosis and adequate treatment plays a crucial role.

The paper discusses the role of the school Professor A. V. Mazurin’s to the development of contemporary problems of pediatric gastroenterology. It considers the origins of pediatric gastroenterology as one of the relevant areas in pediatrics. The development of this area is favored by laboratory, morphological, and instrumental studies. Their use in children, including young ones, has improved the early diagnosis of diseases of the esophagus, stomach, duodenum, intestine, pancreas, and hepatobiliary system. Тhe works of Russian pediatricians have improved significantly the treatment of diseases of the digestive organs in childhood.