Background. When allergic to cow's milk proteins and lactase deficiency, the clinical symptoms of the gastrointestinal tract often have great similarities, so neonatologists and pediatricians often have serious difficulties in making a diagnosis. Surveys among professional societies have shown that pediatricians are not sufficiently aware of cow's milk protein allergy and lactase deficiency in infants and need more information on diagnosis and dietary therapy. Clinical difficulties are also related to the fact that with the gastrointestinal form of allergic to cow's milk proteins, secondary lactase deficiency is possible due to immune damage to enterocytes. Due to the difficulties in diagnosing allergic to cow's milk proteins and lactase deficiency, both unnecessary dietary restrictions and insufficient dietary adjustments are recommended.

Objective. To provide up-to-date data on clinical manifestations, differential diagnosis and diet therapy in children with allergy to cow's milk proteins and lactase deficiency. This publication will help medical professionals to make a differential diagnosis of allergic to cow's milk proteins and lactase deficiency in children and prescribe proper diet therapy.

Conclusion. The choice of therapeutic nutrition in children requires an individual approach. In case of lactase deficiency that is not related to allergic to cow's milk proteins, breastfeeding should not be discontinued in the child and a dairy-free, low- or lactose-free diet should not be prescribed to the mother. Lactose-free and low-lactose milk mixtures, as well as fermented milk mixtures and comfort mixtures containing reduced amounts of lactose, are used in formula-fed infants. With allergic to cow's milk proteins in breastfed infants, products containing cow's milk proteins should be excluded from the mother's diet. Children on artificial feeding are prescribed amino acid and deeply hydrolyzed mixtures. Infants with allergic to cow's milk proteins should not be prescribed lactose-free, low-lactose, fermented milk formulas and comfort mixtures due to the content of cow's milk proteins in the composition. In children with the gastrointestinal form of allergic to cow's milk proteins, dietary therapy is started with deeply hydrolyzed lactose-free mixtures. As intestinal dysfunction is relieved, deeply hydrolyzed lactose-containing mixtures can be gradually introduced into the diet of children with allergic to cow's milk proteins.

Background. Kawasaki syndrome (mucocutaneous lymphonodular syndrome) is an acute systemic disease with damage to small and medium arteries and the development of destructive-proliferative vasculitis, which occurs mainly in children under five years of age. Its etiology and pathogenesis are still unclear, but it is believed that the disease is a manifestation of a combination of complex interactions of genetic factors, infections and immunity. Due to the peculiarities of the clinical picture (multiple organ damage and complexity of diagnosis), the disease occupies a special place in the work of a practicing pediatrician.

Objective. The purpose of the work is to present the features of the course of a case of Kawasaki syndrome in a 3-year-old child based on clinical observation.

Materials and methods. Analysis of the medical record of an inpatient f.003/u, clinical and genealogical method, functional research methods (ultrasound of the abdominal organs, lymph nodes, electrocardiography, heart ultrasound), clinical and biochemical analysis of blood and urine. A literature review based on the results of a search of literary sources in the eLIBRARY.RU, PubMed databases. The analysis included literature reviews, scientific articles, monographs, and clinical studies.

Conclusion. The case we presented confirms the need for pediatricians to be alert to children with the following clinical manifestations: fever, conjunctival injection, changes in the mucous membranes (dry, cracked lips; raspberry tongue, hyperemia of the lips and oropharynx), rash (polymorphic – maculopapular, urticarial, scarlet fever-like, or even morbilliform without vesicles or crusts). Kawasaki syndrome can occur under the "mask" of an acute respiratory infection, endocarditis, and a number of rheumatological diseases. Children who have catarrhal (catarrhal symptoms of the mucous membrane of the oropharynx, conjunctivitis), articular, skin syndromes in combination with fever, as well as cervical lymphadenitis, must undergo heart ultrasound.

Background. It has been found that even mild forms of viral meningitis can have in the outcome of the disease the presence of neurologic deficits that remain undetected at the time of patient discharge from hospital and during follow-up. Consequences of viral neuroinfections (meningitis, meningoencephalitis) they occur quite often in children and not only in patients with severe forms of the disease.

Objective. The aim of the study was to determine the frequency of outcomes of viral meningitis and meningoencephalitis in children, depending on the duration of medical supervision.

Materials and methods. A prospective single-center observational cohort study was conducted. The cohort included 60 patients selected by simple randomized nonrepeatable method, including 50 (83.3%) who had viral meningitis and 10 (16.7%) who had meningoencephalitis. The outcomes of viral meningitis and meningoencephalitis were studied in 28 (46.7%) of moderate and 32 (53.3%) of severe forms of the disease, aged 7.6 ± 1.5 years within 36 months after the disease, and in 75% of patients in this group after 10 years, aged 16.9 ± 0.8 years.

Results. It was found that the predominant outcomes, 6 months after viral meningitis and meningoencephalitis, were: cerebrasthenia, hypertension syndrome, vegetative dystonia in 91.7%, severe neurological deficit in 4 (6.7%) patients. By the end of the late recovery period (36 months), neurological disorders persisted in 25%, including irreversible in 4 (6.7%) of the 60 children in the catamnesis group. Memory impairments in patients with viral meningitis were short-lived and occurred only during the period of early convalescence, unlike other disease outcomes that developed after 24 months or more (migraine, associated, epileptic reactions) and persisted even 10 years after meningitis. The incidence of vegetative dystonia in adolescents who had viral meningitis at the age of 7-8 years increased to 40% and was more often of a mixed type.

Conclusion. An increase in the number of patients with neurological deficits in the catamnesis group indicates the possibility of its development and manifestation in children discharged from the hospital with clinical and laboratory recovery at various times of the convalescence period.

Background. QT interval is an electrocardiographic index reflecting the processes of depolarization and repolarization of the ventricular myocardium, the electrophysiological basis of which is the state of ion channels of the cardiomyocyte membrane. Long QT syndrome (LQTS) is a life-threatening heart rhythm disorder and one of the reasons of a sudden cardiac death. Meanwhile, this term combines a diverse and extensive group of diseases which cause a deceleration of the repolarization phase of ventricular myocardium due to the pathology of ion channels of the cardiomyocyte membrane. The basis of the diagnosis of this condition is the ability of a doctor of any specialty to interpret the results of electrocardiography correctly before the occurrence of the first clinical manifestations.

Objective. The aim of the publication of this clinical case was the necessity to acquaint pediatric physicians with atypical manifestations of LQTS in a child and features of diagnostic screening and therapeutic measures. To enhance knowledge of the medical community and to raise awareness of patients will allow to reduce the number of some life-threatening conditions in children with LQTS.

Materials and methods. A 1,5-year-old child with a prenatally identified bradycardia and a dual chamber frequency-adapted pacemaker implanted on the third day of life. The detailed anamnesis of the child`s life, the results of a clinical, instrumental and genetic examinations and the peculiarities of the selection of the antiarrhythmic therapy are presented.

Conclusion. The peculiarities of the clinical case of LQТS (early manifestation of the disease, lack of genetic anamnesis, an atypical clinical picture with the accession of bradycardia due to an extremely long QT interval and conditions of manifestations of syncopal states, lack of a positive effect on the specific antiarrythmic therapy) testify to the polymorphism of the described syndrome. All of the above testifies to the necessity of a more profound study of the correlation of the clinical manifestations with the results of a genetic testing. 

Background. Whooping cough, a childhood infectious disease that can cause serious and potentially fatal complications, especially in very young children. The main challenge now is early diagnosis of the disease, which will ensure proper treatment and prevent transmission of infection to others.

Objective. The purpose of the study was to evaluate the clinical and laboratory manifestations of whooping cough in children of different age groups, taking into account the outpatient prescription of antibacterial drugs.

Materials and methods. Clinical cases of whooping cough in patients treated in a children's infectious diseases hospital (n = 114) were analyzed. Inclusion criteria: age from 0 to 17 years, characteristic clinical manifestations of whooping cough, a sample of patients treated on an outpatient basis during the first week of the disease. The average age of the patients was 3.79 ± 4.9 years. Taking into account the age criterion, the patients were divided into 3 groups. Licensed software version Statistica 13 was used. Discriminant analysis was carried out.

Results. Before hospitalization in the infectious diseases hospital, the duration of cough in children was 15.4 ± 10.3 days. 63.2% sought outpatient medical care. PCR diagnostics was carried out by the local pediatric service in half of the cases. Treatment with antibacterial drugs was prescribed to 39.5% of patients. In the hospital, patients up to a year had a more severe course, with frequent complications. At the age of up to 3 years, a severe course was observed in 20.0% of patients, and in the group of patients aged 3 years and older – in 5.7% of children. A comparison of changes in the general blood test in children is provided. The results of laboratory examination of patients are described: bacteriological method, PCR diagnostics and results of enzyme immunoassay. The dependence of antibody registration on the duration of the disease in children with whooping cough has been clearly confirmed. The influence of early administration of antibacterial therapy on clinical manifestations and the development of complications in children with whooping cough was revealed.

However, the laboratory diagnosis of whooping cough was not affected by outpatient treatment.

Conclusion. Early diagnosis and treatment of whooping cough with antibacterial drugs before the paroxysmal stage of the disease can help mitigate the effects and reduce the spread of this highly contagious disease.

Background. Mucocutaneous lymphonodular syndrome (Kawasaki syndrome/disease) occurs most commonly in children under 5 years of age. Approximately one-third of patients who fail therapy form coronary artery aneurysms. Timely administration (before day 10 of the disease) of intravenous immunoglobulin and acetylsalicylic acid significantly reduces this probability.

Objective. To assess the relationship between timely therapy with intravenous immunoglobulin and the development of coronary artery aneurysms, to analyze the effectiveness of ntravenous immunoglobulin therapy; features of gender, age differences in children with Kawasaki disease according to the database of patients from 0 to 17 years old observed in the Clinic of Children's Diseases of the Sechenov Center for Maternal and Child Health with a diagnosis of Kawasaki disease from 2010 to 2023.

Study design. Retrospective cohort study.

Materials and methods. This study included a consecutive sample of 104 individuals from the Kawasaki disease patient database residing in the Russian Federation. Children were observed at the Sechenov Center for Maternity and Childhood from January 1, 2010, to December 31, 2023.

Results. Among 104 patients with established diagnosis of Kawasaki disease, 95 (91.3%) patients received intravenous immunoglobulin and acetylsalicylic acid, among them 37 (38.9%) children developed coronary aneurysms. Of the 9 (8.7%) patients who did not receive intravenous immunoglobulin therapy, 6 developed coronary aneurysms, 4 of which were giant. Among 43 patients with coronary aneurysms, boys predominated – 34 (79%), respectively, there were 9 (21%) girls. All patients with coronary aneurysms over 60 months were boys. Conclusion. The results obtained coincide with the data of similar studies conducted in other countries, despite, at a minimum, racial differences.

Background. DDiagnosis of various forms of diabetes insipidus in childhood causes significant difficulties, as it is a complex multi-part process. The young age of patients often does not allow for a number of diagnostic tests, which makes it difficult to make a diagnosis.

Objective. To carry out a comparative characterization of different forms of non-sugar diabetes in children on the example of three patients.

Materials and methods. The results of observation of three patients hospitalized with complaints of polyuria and polydipsia are presented. The anamnesis and clinical manifestations of the disease were studied. The examination included a general blood and urine analysis, Zimnitsky's test, biochemical blood analysis, ABB, ultrasound of the urinary system, MRI of the pituitary gland, tests with fluid deprivation and desmopressin, molecular genetic study.

Results. In a child aged 1.7 years, after elimination of the habit of almost constant liquid consumption through a pacifier, normalization of daily diuresis and increase in relative urine density up to 1015 were obtained. This made it possible to diagnose psychogenic polydipsia. In a 7.4-year-old patient with a family history of nonsugar diabetes, polyuria and low relative urine density persisted on the background of fluid deprivation, desmopressin prescription did not lead to a positive result. Nephrogenic non-sugar diabetes was diagnosed, which was subsequently confirmed by molecular genetic examination, and the child was placed under the supervision of a nephrologist. Early onset of the disease, increasing thirst and polyuria with age, impaired well-being, persistence of polyuria and low relative urine density, as well as a tendency to improvement of the indicators against the background of desmopressin use, made it possible to establish the diagnosis of central non-sugar diabetes. The patient was recommended free access to fluids, treatment with desmopressin was prescribed, under control of the child's well-being, thirst, daily diuresis volume, electrolyte composition of blood serum, blood pressure, body weight dynamics.

Background. Compression of the lumbar or first crural roots of the spinal nerves by altered disc components is the basis of radiculopathies manifested by back pain, movement and sensory disorders. The spondyloarthrosis often observed in this case accompanies not only the elderly, but is also observed in 25-30 year olds. Here, congenital anomalies, vertebral instability, spondylolisthesis and spondylolysis, inadequate distribution of loads on the spinal compartments and, finally, degenerative-dystrophic changes themselves are considered as causes. The latest revision of clinical recommendations confirms the expediency of using non-drug methods of treatment against the background of drug correction. In particular, in order to enhance analgesic, anti-inflammatory, anti-edema and myorelaxing effects, methods of physiotherapy, reflexology, massage, physical therapy and balneotherapy are used.

Results. The paper presents the features of clinical manifestations of herniated discs of the lumbosacral spine and options for correcting the resulting conditions. Among the techniques of non-drug therapy used for a given purpose, the methods of physiotherapy, reflexology, massage and therapeutic exercise are distinguished. Here, for obvious reasons, preference is given to equipment that includes various technologies of influence. One of these devices are massagers that combines the therapeutic possibilities of massage, electrical stimulation, thermotherapy and traction effects. In this regard, a separate part of the work is devoted to the detailing of these approaches, with the clarification of mechanisms and their effectiveness. At the same time, a series of his own works confirmed the effectiveness of the noted therapeutic approaches for "back pain", used even as a monomethod. In this case, the use of a combined technique, characteristic of this type of massager, can even cause potentiation of effects in the correction of conditions associated with herniated discs of the lumbosacral spine. 

Background. Back pain is a clinically heterogeneous syndrome that requires a differentiated approach to therapy. The main origines of nonspecific back pain are the outer parts of the anulus fibrosus (fibrous ring) of intervertebral disks, facet joints, sacroiliac joints, as well as ligamentous and fascial formations.

Results. Modern elaborated approaches of neuro-orthopedic examination enable to determine the cause of back pain due to сomprehensive clinical evaluation of biomechanical and neurological impairments. Significant differences in clinical manifestations in patients are due to the variability of pathophysiological mechanisms of pain and the possibility of combining different pain phenotypes. The key aspect is pain phenotyping with the allocation of mechanical, inflammatory, neuropathic components, muscle spasm and signs of central sensitization. Signs of inflammatory pain may be detected in patients with nonspecific low back pain due to the development of osteoarthritis in facet joints, sacroiliac joints, as well as vertebral osteitis. When inflammatory pain patterns are present in the sacroiliac joints region, it is mandatory to rule out sacroiliitis within the spectrum of seronegative spondyloarthritis (including ankylosing spondylitis and others) using a specialized diagnostic algorithm. Muscle-tonic syndrome requires differentiation from myofascial pain syndrome, another common form of musculoskeletal pain, as they have fundamental differences in pathogenesis, clinical presentation and treatment approaches. Resistance to standard analgesic therapy warrants investigation for neuropathic pain and central sensitization features, which require the addition of anticonvulsants (gabapentin, pregabalin) and antidepressants (duloxetine, amitriptyline) to the treatment regimen.

Conclusion. Determination of the pain profile and accurate analysis of markers determining the leading pathogenetic component allows personalizing back pain therapy. A promising direction in the complex therapy of back pain is vitamin B combinations (B₁, B₆, B₁₂) due to their ability to affect key pathogenetic mechanisms: reduce peripheral and central sensitization, suppress inflammation and stimulate the regeneration of nerve fibers. Clinical studies demonstrate their coanalgesic effect in combination with nonsteroidal anti-inflammatory drugs and anticonvulsants, which allows reducing the doses of the main drugs and minimizing side effects.

Background. Osteoporosis is one of the most common diseases among the elderly, while it often remains undiagnosed, as it can occur without clinical symptoms, and fractures that occur with minor injury or spontaneous, doctors do not always correlate with its presence in the patient.

Results. The review presents epidemiological data indicating the urgency of the osteoporosis problem, as well as information on normative documents regulating the procedure for observation patients with osteoporosis. Modern approaches to the diagnosis of osteoporosis are considered, including the causes of secondary osteoporosis, which must be excluded in the case of newly diagnosed patients. Current criteria for the diagnosis of osteoporosis are given: the presence of a history of low-energy fractures after 40 years of age or on the background of a disease affecting bone, and/or a high risk of fractures calculated using the FRAX algorithm (Russian version), and/or low bone mineral density. The options for using diagnostic and therapeutic intervention thresholds based on the possibility of conducting a dual-energy X-ray absorptiometry for the patient are presented. The issues of diagnosis of osteoporosis in young people – fertile women and men under the age of 50 are considered. Indications for the use of markers of bone turnover are given, which are recommended to be used only to assess the effectiveness of treatment and adherence to therapy. The article presents modern aspects of anti-osteoporotic therapy, provides practical recommendations for the use of antiresorptive (bisphosphonates, denosumab), depending on the presence of osteoporosis and low-energy fractures, and also presents the first biosimilar of denosumab in Russia. The issues of prescribing an anabolic medication (teriparatide), as well as supplements of calcium and vitamin D (colecalciferol, alfacalcidol) were discussed. The duration of anti-osteoporotic therapy depending on the medication used and the criteria for its effectiveness, as well as the algorithm for drug replacement in case of its ineffectiveness are considered.

Background. Viruses of the Herpesviridae family are DNA-containing viruses prone to latent lifelong persistence in various tissues of the body after primary infection. According to WHO, 64% of people in the world under the age of 50 are infected with the herpes simplex virus type I (HSV-1), and 13% are carriers of the herpes simplex virus type II (HSV-2). Such prevalence, as well as the diversity of clinical manifestations of the pathology they cause, emphasizes the importance of this topic for doctors of various specialties.

Objective. The purpose of the article is to increase the awareness of general practitioners about the immunopathogenesis of herpesvirus reactions, as well as to characterize the place of interferons in etiopathogenetic therapy.

Results. There are 8 types of human herpes virus, which are characterized by clinical manifestations of varying severity. One of the important components of the complex antiviral defense system for herpesvirus infections are interferons. Therapy for herpesvirus infections is aimed at limiting the extent of the lesion, preventing disease progression, preventing complications and generalization of the process, as well as accelerating recovery and preventing relapses. These effects are achieved by reducing the replicative activity of the virus, since its complete elimination from the body is currently not possible. An important role is given to the use of indirect-acting drugs, among which the leading place is occupied by type I interferon drugs, which have a combined etiotropic (suppression of virus replication) and pathogenetic (restoration of functions of various parts of the immune system impaired by the virus) effect.

Conclusion. A representative of this group of drugs is a drug of human recombinant IFN-α-2b, produced in the form of rectal suppositories and dosage forms for local use (gel, ointment). The available evidence base for the use of a drug of human recombinant IFN-α-2b in herpes infections of various localizations, the studied pharmacodynamics and pharmacokinetics allow us to recommend it for use in infections caused by human herpes virus, for which there are no antiviral chemotherapy drugs with proven efficacy, including the combined use of both its various dosage forms and a combination with direct-acting antiviral drugs.

Background. Currently, urogenital chlamydia occupies the first place in terms of prevalence among all bacterial sexually transmitted diseases. Along with chlamydia, other intracellular pathogens, mycoplasmas and ureaplasmas, are attracting increasing attention in the etiology of urogenital diseases. Inflammatory diseases of the pelvic organs cause significant damage to the health of women, contribute to the violation of reproductive function, reduce the quality of life, as well as the formation of life-threatening conditions in severe course. The issues of timely diagnosis of inflammatory diseases of the reproductive system present many difficulties, justified by the vagueness of clinical symptoms, the variety of causative agents, as well as the different course of the inflammatory process. Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis are the leading etiologic factors of inflammatory diseases of pelvic organs, up to 60% of cases of inflammatory diseases of female genital organs are the result of microbial associations of Chlamydia trachomatis, Mycoplasma genitalium. These infections are most dangerous during pregnancy. Difficulties in diagnosis lead to delayed treatment, which contributes to an increase in the number of chronic forms of diseases and unfavorable outcomes associated with a complicated course of diseases. Therapy of inflammatory diseases of the genitals requires a comprehensive approach and causes a lot of discussion, the main link of treatment is the rational selection of antibacterial therapy.

Results. This review demonstrates current data on the high efficacy and safety of the use of josamycin in the treatment of these diseases. The use of the domestic drug with active substance josamycin in the treatment of inflammatory diseases of the pelvic organs, urogenital chlamydia and mycoplasmosis, especially during pregnancy, is effective and safe, and will reduce the frequency of adverse pregnancy outcomes and infectious and inflammatory complications.

Background. Fundamental differences in the scale, overall picture of tick-borne encephalitis, the structure and quality of its clinical variants determine the need for regular analytical work and competent dynamic accounting of clinical, epidemiological and genetic data to make coordinated decisions on the prevention, diagnosis and therapy of tick-borne encephalitis.

Objective. The epidemiological and clinical manifestations of tick-borne encephalitis in adults hospitalized in the City Infectious Clinical Hospital No. 1 of Novosibirsk in 2014-2023.

Materials and methods. A retrospective clinical and epidemiological analysis of 870 cases of tick-borne encephalitis in adults for the period 2014-2023, an analysis of the results of sequencing of the sequencing material of patients who died from severe tick-borne encephalitis and a retrospective assessment of the effectiveness of specific prevention measures according to data from the state reports of Rospotrebnadzor of Novosibirsk region.

Results. Over the past 10 years, 870 adult patients with tick-borne encephalitis have been treated at City Infectious Clinical Hospital No. 1 of Novosibirsk. Every fifth case was characterized by the development of a focal form of tick-borne encephalitis with a severe course and high mortality (5,6 ± 0,6%). When analyzing the manifestations of the early tick-borne encephalitis period, it was revealed that the clinical forms retained the typical nature of the disease. Changes in cerebrospinal fluid are represented by two to three-digit cytosis with a predominance of lymphocytes (42%) or mixed pleocytosis. In the focal course of the disease, pleocytosis in half of the cases was polynuclear in nature. Late seroconversion was observed in 57.5% of fatal cases. According to sequencing of the sequencing material of deceased patients, in most cases, the Siberian subtype of tick-borne encephalitis was identified. Over the past 10 years, cases of tick-borne encephalitis have been reported annually among individuals receiving emergency immunoglobulin prophylaxis, of which 17% of patients subsequently developed focal forms. There were no tick-borne encephalitis vaccinees among these patients.

Conclusion. The incidence rate of tick-borne encephalitis in Western Siberia remained consistently high with a predominance of forms with CNS damage, in 58.6% of those who died from tick-borne encephalitis in the Novosibirsk region, a Siberian subtype was identified. The combination of clinical symptoms of the early tick-borne encephalitis period did not allow to determine the clinical variant of the course of the disease, severity and prognosis in the first days. A reliable method of prevention of tick-borne encephalitis is vaccination, prophylactic administration of anti-tick immunoglobulin does not protect against the development of focal forms and death.