Modern childhood neurodietology affects so many neurological and somatoneurological conditions that it would not be entirely correct to focus on some of them and ignore the rest. Epilepsy, migraine and headache, neurometabolic diseases, hereditary neuromuscular pathology, demyelinating and autoimmune diseases of the central nervous system, sleep disorders, as well as behavioral disorders – all of them are not a complete list of conditional «targets» of neurodietology. Its role in the formation of an adequate cognitive and emotional development of the individual is also important, which is of particular importance in childhood. It should be noted that neurodietology and approaches to the choice of therapeutic nutrition every year occupy an increasingly strong position in the world of clinical medicine. Russian and foreign basic publications of recent years are considered in the review of literature, dedicated to neurodietological and nutritional therapy issues for neurological diseases and pathological disorders in patients of pediatric age. Attention deficit/hyperactivity disorder, stroke, migraine, headaches, sleep disorders, epilepsy, glycogen storage disease type VII (fructokinase deficiency), multiple sclerosis, variable neuromuscular pathologies (spinal muscular atrophy – SMA and others), as well as various neurometabolic disorders (methylmalonic acidemia, propionic acidemia, isovaleric acidemia, mitochondrial cythopathies) etc. can be listed among above-mentioned nosological forms of pathology. The role of neurodietology is stressed in particular for stimulation of neurocognition development in infants and children of various age groups. Variability of nutritional approaches to practical management of neurological disorders in patients of pediatric age reflects the versatility of contemporary neurodietology.

Goat milk protein-based formulas for feeding babies of the first year of life have been used since the 80s of the last century. A new generation of infant formula is made using whole goat milk, in which the natural ratio of whey protein: casein is maintained at 20:80, milk fat and carbohydrate components are preserved, which allows translating the benefits of goat milk into an adapted formula to approximate the composition of breast milk (BM). Protein and milk fat obtained from whole goat milk are highly digestible due to the structural and compositional characteristics: protein with low αs1-casein forms a soft clot in the stomach, which facilitates its easy diges- tion, and the fat globules of goat milk are smaller and larger surface area comparable to BM. Goat milk fat in the formula is the source of the main donor energy – fatty acids with a short and medium carbon chain length, β-keto acids, and palmitic acid in the sn-2-position in the glycerol molecule. In the composition of the formula during the production process, the goat's milk fat globules membranes (MFGM) are preserved. The components of MFGM have different physiological functions. MFGM proteins contribute to the development of intestinal microbiota, immune functions, have antimicrobial and antiviral effects. Lipids MFGM improve the barrier functions of the intestinal epithelium, maintain its structural integrity, and also participate in the construction of cell membranes of the mucous membrane of the gastrointestinal tract and the rapidly developing nervous tissue of the child. In whole goat milk, oligosaccharides (OS) are present in a smaller amount and variety in comparison with BM, which dictates the need to supplement the infant formula with OS or prebiotics that repeat the functions of BM OG. Clinical studies have shown evidence of the safety and clinical efficacy of using whole goat milk formulas in promoting the proper growth and development of infants in their first months of life.

In a certain group of children, the eruption of deciduous teeth has a negative effect on the general condition. This physiological process often gives the child uncomfortable sensations ‒ pain, hyperemia of the mucous membrane, hypersalivation, burning, itching in the mouth, an increase in the general body temperature. The symptoms of teething can be relieved at home. Dentists recommend the use of special gels and ointments that have not only analgesic effect, but also antiseptic properties. The article discusses the use of gel based on an extract of Boswellia serrata resin, juice of aloe vera leaf and an extract of chamomile flowers in the eruption of temporary teeth in children. The aim of this work was to evaluate the effectiveness of the use of gel in the eruption of temporary teeth in children. At the Department of Pediatric Dentistry and Orthodontics of the E. V. Borovsky Institute of Dentistry of the I. M. Sechenov First Moscow State Medical University 67 children aged from 5 months to 3 years (the period of eruption of temporary teeth) were under observation. Вased on the obtained results of clinical changes in local and general symptoms associated with teething of temporary teeth in 67 children, when using gel, a significant decrease in symptoms was observed already on the 3rd day of use in 30-50%, on the 5th day in 50-80%, on the 7th in 90-100%. According to the survey of parents, the effectiveness of gel is 91% of respondents who had the use of gel for teething of temporary teeth, which corresponded to a high level of effectiveness of the drug.

Viral infections of the respiratory tract are the most common cause of infectious diseases, especially in children. In most cases, especially when the upper respiratory tract is affected, acute respiratory viral infections are mild to moderate and often stop spontaneously. Pharmacological agents for the treatment or prevention of these infections in children are currently limited. Numerous studies have proven the effectiveness of probiotics in the treatment and prevention of diseases of the gastrointestinal tract, such as infectious and antibiotic-associated diarrhea, traveler's diarrhea, necrotizing enterocolitis, Helicobacter pylori infection, as well as atopic diseases. It is becoming urgent to study the effectiveness of probiotics as prophylactic agents for acute respiratory infections. among children and adults. In vitro data demonstrate that probiotics have strain-specific immunomodulatory effects on immune cells. Probiotics have been shown to be effective in suppressing the replication of various respiratory viruses, including influenza viruses and respiratory syncytial virus. Similar effects have been demonstrated in mice with the ability of probiotics to reduce viral titers in lung tissues and modulate the expression of antiviral and pro-inflammatory genes before and after viral infection. Preclinical studies also show improvement in symptoms in mice, indicating potential clinical benefit. Literature data on the use of probiotics and synbiotics for viral infections of the respiratory tract show that their use is associated with a lower frequency and duration of mild forms of respiratory infection in both children and adults. It is advisable to further conduct research necessary to obtain adequate conclusions about the effectiveness of probiotics and synbiotics in acute respiratory infections.

Since the direct etiological factors of developmental abnormalities are not known, the main groups of causes contributing to the formation of brain malformations are identified in the work. Great importance is given to the early diagnosis of malformations, which allows us to timely resolve the issue of the possibility of prolonging pregnancy, which is determined by the type of defect, compatibility with life and the prognosis for postnatal development. In the study of the considered malformation, such modern methods as prenatal ultrasound diagnostics, neurosonography, X-ray computer and magnetic resonance imaging of the brain, which have a sufficiently high informative value, play an important role. The terms of gestation are indicated, which make it possible to identify structural defects of the brain. Medical and genetic counseling helps to identify the risk of the appearance of sick offspring. The differential diagnosis of semilobar with other forms of holoprosencephaly was carried out. Possible clinical manifestations of the nosology under consideration are also noted. This article presents a clinical case of semilobar holoprosencephaly diagnosed in a boy at the age of 1 month. Upon admission, the mother complained of regurgitation and periodic anxiety of her son. The scope and results of the child's examination are set out below. Concomitant pathology was revealed in the form of an umbilical hernia, a congenital abnormality of the development of the urinary system: a horseshoe kidney; dropsy of the testicles and a cephalic form of hypospadias. After a course of maintenance therapy, the patient was discharged in a stable condition. Currently, there is no specific treatment for holoprosencephaly. Surgical interventions on the brain are rarely performed due to the severity of the patients ' condition, and therefore, the treatment of this pathology is possible only with the help of surgical correction of symptoms. Prolonged respiratory and cardiovascular dysfunction determines the fatal outcome of the disease.

Perinatal pathology of the Central nervous system (CNS) occupies a leading position in the structure of childhood morbidity, which dictates the need to find optimal approaches to the early diagnosis of hypoxic-ischemic and traumatic CNS lesions, including using mathematical modeling technologies. Objective: to create and test a mathematical model for differential diagnosis of hypoxic-ischemic and traumatic lesions of the nervous system in children using the karyometry method. The study included 290 full-term infants of the first year of life: the first comparison group included 120 newborns with hypoxic – ischemic CNS damage, the second group-120 newborns with traumatic CNS damage, the control group included 50 healthy children. All children aged 1, 3, 6, 9 months and 1 year were evaluated for physical and neuropsychic development, motor functions according to the method of L. T. Zhurba. In the first month of life, neurosonography of the brain, x-ray examination of the head and cervical spine in two projections were performed. Morphological examination of lymphocytes (karyometry) was performed at the ages of 1, 3 and 6 months. To create a mathematical model for differential diagnosis of hypoxic-ischemic and traumatic lesions of the nervous system, 12 indicators of neurosonography and 4 indicators of peripheral capillary blood lymphocyte morphology (area and perimeter of the nucleus, area and perimeter of the cell) were taken. A self-learning artificial neural network was used in the construction of the diagnostic model, the operation of which was reproduced using the created software application. The study showed that the model we obtained is easy to use, saves time for diagnosis, and has a high degree of recognition: the model specificity is 89,2%, and the sensitivity is 92%.

 In recent years, the incidence of food allergies in children has been steadily increasing. One of the most common causes of food allergy in infants is cow's milk allergy. The prevalence of food allergy correlates with a growing body of research and publications investigating the relationship of environmental factors and immune development inthe newborn. The «window of opportunity» is critical period of early immune development, and the key role belongs to the microbiota and its metabolites. During this period, environmental influences can have long-term effects on microbiota composition, immune regulation, and susceptibility to disease. Events during this critical window affect long-term human health. Early colonization by the microbial community within a certain critical time window is critical for the proper development of the immune system. Breast milk remains the gold standard for feeding, but its role in preventing food allergies has yet to be proven. A more detailed study of the immunological factors of breast milk and the mechanisms of microbiome-immune crosstalk, in particular, the action of certain components (probiotics, prebiotics and metabolites), helps to develop new preventive strategies. Prebiotics, probiotics and metabolites are of great interest today for managing allergies by accelerating the formation of immunological tolerance not only for primary, but also for secondary prevention in the treatment of allergy to cow's milk proteins.

 In critical conditions, one of the most common acid-base disorders is metabolic acidosis. At the same time, an undeservedly forgotten parameter in the diagnosis of metabolic acidosis is the plasma anion gap. Purpose of the study: to determine the possibility of using the plasma anion gap for differential diagnosis of metabolic acidosis in newborns with neonatal sepsis. To achieve this goal, the patients of the intensive care unit and intensive care unit for newborns were examined. Inclusion criteria: neonatal period, presence of neonatal sepsis, laboratory signs of metabolic acidosis. In total, 17 newborns with neonatal sepsis were under observation. The diagnosis of neonatal sepsis was established on the basis of a suspected or documented infection in combination with acute organ dysfunction, the development of which was judged by the pSOFA index by 2 points or more from the baseline value. Metabolic acidosis was identified in 5 patients. In newborns with neonatal sepsis, metabolic acidosis was more often recorded with an increase in the plasma anion gap, which is due to lactic acidosis as a result of the accumulation of lactic acid, as a marker of tissue hypoxia. A decrease in the plasma anion gap was detected less frequently and could indicate a loss of bicarbonate anion through the gastrointestinal tract or as a result of hypoalbuminemia. It has been shown that the plasma anion gap can serve as an additional information criterion for characterizing metabolic acidosis. Plasma anion gap calculation is an inexpensive and effective tool that can help differentiate metabolic acidosis in newborns with neonatal sepsis for adequate intensive care.

In recent years congenital heart diseases have taken a leading position in terms of prevalence in comparison with other malformations in children and remain the leading cause of their death. In addition, a further increase in the prevalence of congenital heart diseases is predicted. The aim of the study was to study the incidence of congenital heart diseases among children according to children's cardiologic departments nmts Republic of Tajikistan. For the period from 2010 to 2014, the total number of admitted patients with congenital heart diseases and who were hospitalized in the pediatric cardiorheumatology nmts Republic of Tajikistan was – 5100, of them, with congenital heart diseases – 1486. The age of the patients ranged from 2 months to 15 years. There were 57% of boys and 43% of girls. All children who were admitted to the hospital for examination and treatment, in addition to measuring anthropometric parameters, were carried out additional research methods to confirm the diagnosis. In the study of congenital heart diseases prevalence in the regions and districts of the Republic, in appealing and hospitalization in children's cardio-rheumatology, revealed a tendency to increase of confirmed congenital heart diseases in districts of Republican subordination – 620, in Khatlon 379, Dushanbe – 439. The average number of patients admitted from Sughd region was 43 patients and the lowest number of patients admitted for treatment was from Gorno-Badakhshan Autonomous Region – only 5 children. During the period from 2010 to 2014, the epidemiology of congenital heart diseases in young children was analyzed, which indicated a tendency to increase in sick children with congenital heart diseases by year throughout the republic. The most vulnerable, according to the prevalence of congenital heart diseases, was the southern region of the republic, the disease was least common in Gorno-Badakhshan Autonomous Region. The most common congenital heart diseases were ventricular and interatrial septal defects and Fallot's tetrad. The obtained data will contribute to the development of measures to improve early diagnosis and timely correction of the identified pathology. 

The article is devoted to modern approaches to the treatment of diabetes mellitus complicated by kidney damage. Diabetes mellitus is the most important problem of modern medicine, which is primarily due to the high prevalence of the disease among the working-age population. Diabetic nephropathy is one of the severe chronic complications of diabetes, which increases the disability and mortality of patients. Diabetic nephropathy is the main cause of the development of end-stage renal failure in developed countries and eventually affects about 30% of patients. Kidney damage in patients with diabetes occurs in 6-7% of cases out of the total number of nephropathies in patients receiving treatment in a specialized nephrological department of a multidisciplinary hospital. The first manifestations of diabetic nephropathy develop 3-4 years after the onset of the disease, and reach their peak in 15-20 years. The concept of «chronic kidney disease» includes kidney damage regardless of the primary diagnosis and is characterized by such basic diagnostic criteria as urinary albumin excretion and glomerular filtration rate values, which are markers of kidney damage. Methods for preventing the progression of diabetic nephropathy include general measures to change the lifestyle, control of glycemia and blood pressure, correction of lipid metabolism disorders in combination with nephroprotective therapy. Currently, when choosing therapy in patients with type 2 diabetes mellitus in combination with chronic kidney disease, along with taking metformin, preference is given to sodium-glucose cotransporter type 2 inhibitors and glucagon-like peptide-1 receptor agonists with a nephroprotective effect.

The article considers the combined infection of SARS-CoV-2 with other pathogens of lower respiratory tract infections. Special attention is paid to a mixed viral-bacterial infection that developed in an outpatient setting. The pathogenetic mechanisms of COVID-19 predisposing to the development of community-acquired pneumonia and their differential diagnostic criteria are considered. The necessity of reasonable prescribing of antibiotics is emphasized. The authors also point out the current lack of accurate data in the literature on the predominant pathogens of pneumonia in COVID-19. The algorithm of empirical antibacterial therapy of community-acquired pneumonia against the background of COVID-19 in outpatient settings is analyzed from the standpoint of modern methodological recommendations with an emphasis on dosage forms for oral administration. Indications for the appointment of macrolides, features of the clinical use of azithromycin, taking into account its spectrum of action, are considered. The advantages of azithromycin in comparison with other macrolides (clarithromycin, josamycin) are shown, its immunomodulatory and anti-inflammatory effects are considered. From the standpoint of pharmacokinetic / pharmacodynamic features, azithromycin (unlike other macrolides) has a concentration-dependent bactericidal effect, and therefore, the maximum eradication of microorganisms upon its administration is observed at a concentration that exceeds the minimum inhibitory concentration by about 10 times, while the time during which this concentration is retained, less significantly. On the one hand, this is associated with the possibility of its single use, and on the other, the degree and rate of absorption in the gastrointestinal tract directly determine the concentration of the drug in the tissues, and hence the clinical efficacy. The points of application of azithromycin in the treatment of SARS-CoV-2 infection are considered. The advantages of the dosage form of the dispersed tablet in comparison with traditional dosage forms for oral administration are evaluated. The pharmacokinetic advantages of dispersed tablets in the form of their improved bioavailability, their favorable safety profile and ease of use in various categories of patients, as well as potentially higher clinical efficacy are analyzed.

Atopic dermatitis is a common chronic dermatosis of multifactorial nature with prevalence of genetic component and complex pathogenesis. In the pathogenesis of atopic dermatitis, an important role is played by hereditary determinism, leading to a violation of the state of the skin barrier, defects of the immune system (stimulation of Th2 cells with subsequent overproduction of IgE); hypersensitivity to allergens and nonspecific irritants, colonization of the skin and mucous membranes by pathogenic microorganisms, as well as an imbalance of the autonomic nervous system with an increase in the production of inflammatory mediators. The genetic factors for the development of atopic dermatitis include the presence of a mutation in the filaggrin gene, leading to dysfunction of the epidermal barrier in atopic dermatitis, as well as a family history of atopic dermatitis and other atopic diseases. The development of an inflammatory reaction in the skin with the participation of T-lymphocytes is associated with defects in the immune system. In the acute phase of the disease, the Th2 response predominates, when Th2 cells are stimulated with subsequent overproduction of specific IgE; in chronic – there is a switch from Th2- to Th1-immune response. A number of interleukins and IFN-?, which require the participation of the JAK/STAT signaling system, including Janus kinase, are involved in the pathophysiological mechanisms of atopic dermatitis. The disease usually develops in the first 2 years of life, and in 2/3 of cases persists into adulthood, while 45% of all cases of onset of the disease occur in the first 6 months of life: in 60% of cases, the disease develops during the first year of life and in 85% cases under the age of 5 years. In adulthood, the skin process persists in 38-42% of patients. Over time, approaches to the treatment of thedermatosis have undergone significant changes. This article provides an up-to-date review of the results of clinical trials of the drug upadacitinib in the treatment of atopic dermatitis.