No 3 (2020)

Aim. The purpose of this work was to analyze the vitamin D sufficiency in children of the first three years of life, living in southern Russia and in the north-west of the Kingdom of Saudi Arabia during the period of minimal insolation. Materials and methods. In the period from October to March, 132 children from the Tabuk city of the Kingdom of Saudi Arabia (28°23'50 " N 36°34'44" E) and 262 patients living in Stavropol of Russian Federation (45°02' N 41°58' E) were examined. The assessment of vitamin D availability was based on the determination of serum calcidiol [25(OH)D] by competitive chemiluminescent immunoassay. Results. The level of calcidiol [Me (Q25-Q75)] of children in Tabuk was 28.0 (21.9-35.9) ng/ml, in Stavropol - 23.7 (16.2-32.7) ng/ml (p=0.0003). Vitamin D deficiency was detected in 26 (19.7%) children from Saudi Arabia and 97 (37.0%) from Stavropol (p<0.02), insufficiency (from 21 to 29 ng/ml) in 42 (31.8%) and in 87 (33.2%) cases, and normal provision in 64 (48.5%) and 78 (29.8%) children, respectively (p<0,0005). The availability of cholecalciferol in children from 1 to 5 months was 24.2 (18.7-31.9) ng/ml in Tabuk and 25.3 (14.8-34.1) ng/ml in Stavropol, patients from 6 to 12 months - 34.3 (27.4-37.8) ng/ml and 31.9 (22.1-39.9) ng/ml, children from 12 to 24 months - 31.7 (25.1-41.6) ng/ml and 22.9 (15.8-28.8) ng/ml (p=0.0002), patients from 2 to 3 years old -24.1 (19.5-30.3) ng/ml and 18.2 (14.2-24.8) ng/ml in Tabuk and Stavropol, respectively (p=0.0003). The availability of cholecalciferol in children not receiving vitamin D preparations in Tabuk was 27.8 (21.0-34.6) ng/ml, in Stavropol 19.4 (12.7-25.5) ng/ml (p=0.0003). Against the background of prophylactic intake of vitamin D preparations, the level of calcidiol in children in Tabuk was 32.9 (26.1-34.3) ng/ml, and without taking - 27.8 (21.0-34.6) ng/ml (p=0.05); in Stavropol - 29.0 (21.6-39.4) ng/ml against the background of taking and 19.4 (12.7-25.6) ng/ml without it (p=0.000000001). Vitamin D deficiency was detected in 13 (24.1%) patients of Tabuk without taking, and against the background of pharmacological prophylaxis there was not a single child with a level of 25(OH)D below 20 ng/ml. Stavropol children without taking cholecalciferol preparations had a vitamin D deficiency in 70 (52.6%) cases and in 27 (20.9%) against a background of taking it (p<0.0005). Conclusion. Vitamin D provision for children in the first three years of life living in the south of the Russian Federation was significantly worse than in a similar age cohort of children from the north-west of the Kingdom of Saudi Arabia. The age trends in vitamin D provision were the same for Saudi and Russian children; in the first year of life, a large proportion of patients in southern Russia maintain vitamin D status commensurate with Arabian, in the second and third years of life, vitamin D availability decreases in both countries, but in Russia Vitamin D deficiency is more common. The level of natural insolation in Tabuk allows maintaining the number of children with vitamin D deficiency at about 20%, while in the south of Russia, without drugs prophylaxis of hypovitaminosis D, more than half of children have vitamin D deficiency.

In the article, the author provides data on the features of the course of the new COVID-19 infection and its relationship with the course of various acute respiratory viral infections (ARVI). Emphasis is placed on the need for timely prevention of ARVI in connection with the proven fact that a previous illness with influenza or ARVI can significantly increase the risk of developing COVID-19. It has been shown that at present, specific prophylaxis is carried out only for influenza, while it does not always allow achieving good results, and in relation to other viruses (adenoviruses, parainfluenza viruses, rhinoviruses, etc.) it is not carried out at all. In this regard, it is of particular importance to carry out the so-called non-specific prophylaxis. As the latter, it is proposed to use homeopathic medicines with proven efficacy. One of them is Oscillococcinum. The data of experimental and clinical justification (randomized placebo-controlled trials) of the use of this drug in ARVI prevention programs are presented. Its effectiveness and safety in both adults and children are underlined.

Relevance. In connection with the overdiagnosis of active forms of herpes viral infections and, as a consequence, polypharmacy and the appointment of im-munotropic drugs for a long time and off-label, the problem of the need and sufficiency of therapy for children with recurrent diseases of the respiratory tract, occurring against the background of reactivation of herpes viral infections, is urgent. Clinical studies have shown that children with monthly acute respiratory in-fections (ARI) and active forms of herpesvirus infections (Epstein-Barr virus, cytomegalovirus) are characterized by lower levels of immunoglobulin A, interfe-ron-α and γ. Aim. Analysis of the effectiveness of therapy with the inclusion of meglumine acridone acetate in children with monthly infections of the respiratory tract in outpatient practice. Materials and methods. The study included 75 patients over the age of 4 years who came to an outpatient clinic with complaints of monthly ARI within the last 6 months and had markers of herpes viral infections. Results. It has been demonstrated that the use of meglumine acridone acetate in children with monthly respiratory infections leads to a statistically significant increase in complete clinical recovery (67.3% in the main group versus 8.7% in the comparison group) and the transition of herpes viruses into a latent state (53.8 and 13% respectively). Prescribing meglumine acridone acetate significantly reduced the proportion of patients with active human herpesvirus-6A / B and Epstein-Barr virus infections. In addition, the appointment of meglumine therapy with acridone acetate has a positive effect on the level of neutrophils after tre-atment, which is significantly higher in the main group than in the comparison group (3.52×109 and 2.09×109 cells, respectively). Conclusion. The drug meglumine acridone acetate (Cycloferon®) can be recommended for patients over 4 years of age as an etiotropic therapy for herpes vi-ral infections in children with monthly ARI.

The article draws the attention of pediatricians to two rare forms of bronchopulmonary pathology in children: post-infectious obliterating bronchiolitis and hypersensitive pneumonitis, for which crepitant or moist small bubbling rales are typical persistent or appearing in the same areas of the lungs. The characteristics of each of these forms of pathology, including etiology, features of morphological changes in lung tissue, clinical and functional manifestations of the disease, treatment characteristics, course and prognosis, as well as accepted diagnostic criteria, are given. On a specific clinical example, the complexity of the diagnosis of the lobar variant of post-infectious obliterating bronchiolitis, due to the inconstancy of respiratory complaints, and differential diagnosis with hypersensitive pneumonitis, especially in young children, is shown. Dynamic monitoring of the patient with the implementation of a set of necessary research methods and monitoring the dynamics of the process allows avoiding errors in diagnosis and treatment with systemic steroids in the absence of signs of disease progression.

Reference values of the heart rate and of the heart rate coefficient of variation during different sleep phases based on the polysomnographic findings in 2073 infants are presented. Reference values were constructed using conventional LMS (lambda-mu-sigma) smoothing algorithm aimed at maximal approximation of the calculated values to the real ones. Reference centile curves and tables for infants aged 1 through 52 weeks at different sleep phases as a function of infant age and sex are provided. The reference values presented in this work are compared with known published data.

Interferons (IFN) were find about 65 years ago and during this time it was studied structure, types, cells producing this cytokines and genes coding of IFN. It was paid a great attention to IFN functions and biologic role in anti-viral and anti-tumor immunity, and in systemic inflammatory and autoimmune reactions. By biologic effects, which arise in organism by IFN, administrations for IFN clinical use were formed: viral infections and malignancies therapy. Currently, proposed clinical IFN use are scale down, because of not only new (including targeted) drugs, but also increased reports about long-term side effects, caused by IFN. One of the most serious side effects are autoimmune disorders, which make us reconsider IFN therapy to more safety drugs.