The article is devoted to the historical continuity in the field of protection of children’s health in the Imperial, Soviet and modern Russia. Moscow Founding Hospital, which was established by Catherine the Great, gave a rise to development of state service of maternal and children healthcare in our country. After the October Revolution Moscow Founding Hospital was reformed into the House of Infant Protection, and then — into the State Scientific Institute of Maternity and Infancy Protection. In 1962 in the new building of the Institute situated at Lomonosovsky prospect for the first time in Russia the departments of nephrology, allergology, surgery, gastroenterology and functional diagnostics, as well as laboratories of clinical immunology, virology, cytochemistry and the department of therapeutic physical training and sports medicine were set up. Nowadays the Scientific Centre of Children Health of RAMS is a chief pediatric institution of Russia and leading scientific school. The article covers the main scientific priorities of the Centre, which aim at the development and introduction of effective methods of early diagnostics, prophylaxis, treatment and rehabilitation of children and have medical, social and economic significance. At the same time, the Scientific Centre of Children Health of RAMS is multifield clinical institution for high-technological medical healthcare for children. Year after year research workers of the Centre make their significant contribution into development of pediatric science, children healthcare, hygiene and protection of children’s and adolescents’ health in Russian Federation.

Aim: to improve interdisciplinary care (medical, social and psychological) in children's polyclinics. Materials and methods: at first, authors selected interdisciplinary departments in polyclinics with effective medico-psychosocial care for children. Secondly, the common algorithm of this type of care was described (sociological methods — participant observation, in-depth interviews, experts interviews — were used). Thereby, the draft version of guide for medico-psychosocial care in children’s polyclinics appeared. The draft version was discussed and obtained by experts. Results: the basic guide for organization of medico-psychosocial departments in children’s polyclinics was suggested. Main goals and objectives of these departments were determined. The structure and personnel regulations were developed. The structured guideline was suggested: 1) early identification of vulnerable children and adolescents (difficult situations); 2) development of individual interdisciplinary (medico-psychosocial) care programs; 3) providing integrated interdisciplinary care for children and their families. Conclusions: organization of interdisciplinary (medico-psychosocial) department in children’s polyclinics will improve and protect the quality of life and health of vulnerable children and adolescents.

This review of current literature summarizes results of scientific studies on the structure of the intestinal microbiota both of adults and infants. It is shown, that all intestinal microbiota of an adult consists of 395 phylogenetically isolated groups of microorganisms, among them 244 are absolutely new. Based on the RNA-sequencing of genes the most common among Caucasians enterotypes were detected. It was demonstrated, that specific structure of intestinal microbiota of an adult individual is unique and stable and that genetic background of the macroorganism is a base of intestinal microbiome formation. The article covers the issues of special characteristics of microbiocenosis development at the early stages of ontogenesis. It is emphasized, that prevalence of «infantile» species of bifidobacteria in the structure of intestinal microbiota of breast-fed infants is due to the presence of certain nutritive substances in the milk: oligosaccharides of the breast milk, which are natural prebiotics. The authors give criteria for including the nutrients into the group of prebiotics and show new experimental and clinical data on influence of prebiotics on different levels of immunological defense system.

Key words: intestinal microbiota, enterotypes, prebiotics, oligosaccharides, inulin, immune response.

The article deals with the terminology, classification, etiology and pathogenesis of the most common digestive functional disorders in infants. The causes of digestive functional disorders are closely related to the anatomical and physiological peculiarities, child’s growth, gradual maturing of the neural regulation and motoric function of the digestive tract and the sphincters, as well as to its morpho-functional immaturity. Coupled with motor-evacuation dysfunction and neural disorders (mainly of the hypoxemic etiology) these factors lead to abdominalgia and dyspepsia. Appropriate treatment and prophylaxis in infants, including special diet regimens and recommendations, as well as psychological correction of children-parental relationships, allow to prevent development of chronic disorders of the digestive tract in future life.

Treatment of developmental disorders, correction of learning disabilities and behavioral problems in children should be prompt, complex and include pharmacotherapy with nootropic agents. The results of recent studies shown in this review proved effectiveness of pharmacotherapy with pyritinol in children with perinatal injury of central nervous system and its consequences, psychomotor and speech development delay, dyslexia, attention deficit/hyperactivity disorder, cognitive disorders and learning disabilities (including manifestations of epilepsy, chronic tic disorders and Tourette syndrome). Due to its ability to optimize metabolic processes in central nervous system, pyritinol is used in treatment of vegetative dysfunction in children and adolescents, especially associated with asthenical manifestations, as well as in complex therapy of exertion headache and migraine. The drug is effective in treatment of cognitive disorders in children and adolescents with epilepsy, pyritinol was administered without changing of the basic anticonvulsive therapy and no deterioration (increase of severity of seizures or intensity of epileptiform activity on electroencephalogramms) was observed. Significant nootropic effect of pyritinol, including neurometabolic, neuroprotective, neurodynamic and other mechanisms, in association with safety and rare side effects of this drug determines its wide usage in pediatric neurology.

Aim: to assess efficacy and safety of hypodermic methotrexate injections in children aged from 1,5 to 16 years old with juvenile idiopathic arthritis (JIA) without extra-articular manifestations. Patients and methods: the results of treatment of 104 patients with JIA without systemic manifestations (61 girls and 43 boys) aged 5,0 (1,5–16) years old being followed-up in the rheumatology department of FSFI «SCCH» of RAMS were analyzed. The mean duration of the disease at the moment of methotrexate first administration was 6 months. Efficacy of methotrexate therapy was assessed according to the pediatric criteria for improvement of the American College of Rheumatology. The percentage of non-active stage and medicinal remission achievement were considered to be the target characteristics of therapy efficacy. Results: 61 patients (59%) were maintained in the study during 1 year. In 12 months of treatment remission according to C. Wallace criteria was induced in 39 of 104 (38%) children. In 22 (21%) of patients who failed to achieve remission in 1 year of treatment, 70% improvement was observed. Side effects were found in 45 (43%) of children: mild and moderate — in 33 (32%), severe — in 12 (12%) of patients. In 9 patients methotrexate was withdrawn due to intolerance of the drug. These patients as well as 34 children with resistance to performed treatment were administered genetically engineered biological agents. Conclusions: hypodermic injections of methotrexate are highly efficient in patients with JIA without extra-articular manifestations. Early administration at the dose of 15 mg/m² of body surface as well as appropriate selection of administration form induced remission and allowed to prevent of disability development in 38% of children.

Aim: to develop a system of evaluation of liver failure stage in children based on the International classification of functioning, disability and health (ICF). Patients and methods: based on the retrospective analysis of 14 biochemical markers, characterizing hepatic role in proteins, lipids and carbohydrates metabolism, of 115 children without liver diseases, 15 children who died of liver failure and 220 patients with various hepatic disorders, being followed-up in the SCCH of RAMS, a score system of evaluation of liver failure stage in children as an additional diagnostic tool was developed. Each of the biochemical markers was assessed according to the 5-point rating scale in dependence of its changes intensity. Results: the sum of points was considered to be a criterion of liver failure stage. According to the ICF recommendations, decrease of points on 0–4% (54–56 points) corresponds with absence of liver failure; 5–24% (43–53 points) — as mild dysfunction, 25–49% (29–42 points) — as moderate; 50-95% (3–28 points) — as severe; and 96–100% (0-2 points) — as absolute failure. Conclusions: score system of evaluation of liver failure stage can be applied at any step of diagnostics and treatment of children of any age, due to independence of the used markers from the age. It can be used in assessment of the severity of disorder in dynamics, in determination of the prognosis and as criterion of indications to liver transplantation, as well as during medico-social examination.

Aim: to study the content of serum soluble cell adhesion molecules in children with ulcerative colitis that mediate the initial and final stages of the migration of leukocytes to the focus of inflammation: sP-selectin (soluble platelet selectin) and Specam-1 (soluble platelet-endothelial cell adhesion molecule 1) as well some earlier unexplored factors associated with their level. Patients and methods: we examined 107 patients with ulcerative colitis aged from 6 up to 17 years. The diagnosis was set on the base of a comprehensive examination. The content of serum soluble adhesion molecules sP-selectin and sPECAM-1 as well cytokine status and neopterin were evaluated by ELISA. Respiratory metabolism was investigated by using chemiluminescent reactions. Results: it was shown that the content of sP-selectin and sPECAM-1 is significantly higher in patients than in the control group, which may influence on the migration of leukocytes into tissues for realization of their effector potential. It is confirmed by morphological analyses of the intestine biopsies, where it was observed the increasing of the number of leukocytes in vascular endothelium and epithelial layer. At the same time strengthening of the oxygen-dependent metabolism of neutrophils, the increase of the concentration of neopterin and tumor necrosis factor α were noted. Conclusions: the correlation of the studied adhesion molecules with a number of inflammatory markers (TNFα (tumor necrosis factor α), free radicals, neopterin) was revealed, which indicates the diagnostic value of serum levels of the membrane antigens. The increase of the concentration of adhesion molecules sP-selectin and sPECAM-1 may be one of the links of the pathogenesis of ulcerative colitis.

 

In order of assess the results of introduction of the programs aimed at maintenance and support of the breast-feeding it is necessary to use uniform indicators, which guarantee consistency, reliability and comparability of the data. Aim: to perform complex medical and social assessment of the prevalence and duration of the breast-feeding by the example of the Chechen Republic (CR) and the Republic of Ingushetia (RI). Patients and methods: mothers of children aged 12–36 months old were interviewed (n =2200). Statistical analysis was performed with the means of the software «SPSS.17». Results: the mean duration of the breast-feeding in the CR was 9,5±0,22 months among urban population and 10,8 ± 0,29 months among rural population (p <0,01); in the RI these figures were — 8,5±0,26 months and 8,7±0,20 months, respectively (p >0,05). Up till the age of 6 months 17,6% of urban infants and 36,8% of rural infants of the CR (p <0,001) and 19,1% of urban and 19,7% of rural infants in the RI (p >0,05) received exclusive breast-feeding. It was established, that duration of the breast-feeding was influenced by the mothers' attitude to the issue or the dominant mothers’ ideology, as well as by the duration of the only breast-feeding itself. Besides, prolongation of the breast-feeding period is contributed by introduction of the modern medico-organizational measures aimed at support and maintenance of the breast-feeding. Conclusions: complex medical and social research allowed to assess prevalence and duration of the breast-feeding in the CR and the RI, in accordance to modern recommendations of the WHO experts. The main social and medico-organizational factors and predictors of the breast-feeding long duration and the exclusive breast-feeding were revealed.

Aim: to assess efficacy and safety of abatacept usage in children and adolescents with polyarticular juvenile idiopathic arthritis without systemic manifestations. Patients and methods: 15 patients aged 13 (11; 14,5) years old were included into the study; the mean duration of disease course was 4 (3; 5) years. The disease was diagnosed based on the ILAR criteria. All the patients were performed routine clinical and laboratory examination. Efficacy of treatment was assessed according to the pediatric criteria for improvement of the American College of Rheumatology (ACR_pedi). Target characteristics of treatment efficacy were: the number of patients with 30/50/70/90% improvement according to the ACR_pedi criteria during first 4 months from the therapy administration, and then – every 2 months; percentage of non-active stage and remission achievement. Results: in 4 months after beginning of treatment improvement according to the ACR_pedi 30/50 criteria was observed in 60/30% of patients; in 6 months according to the ACR_pedi 30/50/70 criteria — in 80/40/40%, respectively; in 12 months according to the ACR_pedi 70 criteria — in 80% of patients. Non-active stage of disease in 6 and 12 months was confirmed in 6/15 (30%) and 10/15 (60%) of patients, respectively. Remission was confirmed in 10/15 (60%) of children in 12 months of therapy. Side effects were observed in 6/15 (40%) of children and were mild. Three patients had relapses of Herpes labialis infection, 3 other had acute respiratory tract infections. Conclusions: abatacept is effective for treatment of polyarticular juvenile idiopathic arthritis, resistant to steroids, methotrexate and combined immunosuppressive treatment.

The most clinically significant causes and the main links of mechanisms of development of neurogenic pathological syndromes are discussed in this lecture. The article also contains tests and situational tasks for evaluation of the learning of the information, as well as reasoned variants of answers for them.

Kawasaki syndrome is an acute systemic vasculitis with unknown etiology, affecting primary children at the age of 0–5 years old, which can be of a real threat for health and life not only during acute stage of the disease, but also many years after. The main prognostic factor is involvement of the coronary arteries with aneurisms development and high risk of consequent thrombosis and/or stenosis of the coronary arteries, which can lead to myocardial ischemia/infarction and sudden death syndrome in young patients. Different variants of long-term pathological changes of the coronary arteries are discussed in the article. Aneurisms regressed in 50–60% of involved segments of the coronary arteries within first 2 years after active stage. The probability of regression of aneurisms depends on their diameter, form, localization and patient’s age. Gigantic sizes of aneurisms have the highest risk of coronary thrombosis and stenosis. Clinical consequences of coronary thrombosis vary from asymptomatic course to myocardial infarction, depending on thrombus size and localization. The risk of coronary stenosis depends on aneurism size and increases with time passed from the onset of the disease. The authors give information on diagnostic possibilities of instrumental methods of investigation of the coronary arteries, management of follow-up and treatment of reconvalescents in order to decrease risk of life-threatening conditions. The shown data are based on the literature review and own experience of observation of 90 patients with Kawasaki syndrome with the onset of the disease between 2004 and 2010 years.

The article covers the issue of the most important product among additional food for infants — baby porridges. It includes historical data on usage of various cereal crops in human nutrition. A special significance of porridges in culture of food and traditions of Russian population is highlighted. The authors give information about nutritional value and chemical composition of different cereals — buckwheat, rice, pearl-barley, millet, oats etc. A special attention is given to differences in concentrations of nutrients and micronutrients manufactured by different ways from the same kind of cereal. The necessity to feed infants with commercial baby porridges is based in the article. There are also represented characteristics of various commercial porridges for nutrition of infants: hypoallergenic, glutenfree and containing gluten, enriched with pre- and probiotics. The article also contains data on nutritional value of milk and milk-free porridges. The authors raised a discussion on possibility and standards of usage of different additional components, such as sugar, maltodextrin, honey, vanillin, vegetable oils in production of infant porridges. The selection of certain type of porridges as additional food for healthy and infants with different diseases and digestive disorders is based.

In recent years there has been significant progress in pediatrics, including pediatric pulmonology and endoscopy, which led to marked achievements in diagnostics, treatment and prophylaxis of respiratory tract disorders in children. The wide spectrum of various questions of anatomical and physiological peculiarities of the children respiratory tract is discussed in this article. The authors give a systematical review of indications and contraindications for bronchoscopy and offer the algorithm of choice of the optimal and most informative method of investigation. The modern conceptions of preparation and anesthesia methods for the bronchoscopic procedures in children are shown. The importance of complex analysis of the revealed during bronchoscopy structural and functional disorders of the respiratory tract depending on the nosological issue and characteristics of the disease clinical course is accentuated. The article contains descriptions of endoscopic patterns of the most common trachea and bronchi abnormalities in children, as well as detailed techniques of the bronchoalveolar lavage, forceps and brush-biopsy. The unique original data on newest endoscopy method — confocal laser endomicroscopy (alveoscopy) in older children, which had never previously used before neither in the Russian Federation, nor in the other countries, are of the most interest. The article is illustrated by demonstrative endoscopic images.

High prevalence of acute enteric infections in children, the majority of which affects infants, determines the necessity of development of modern recommendation on diagnostics and treatment of such conditions. The authors show data on etiology of enteric infections and results of various Russian and international research on efficacy of treatment of acute gastroenteritis, including information about sorbents, probiotics, antiemetic agents and antibacterial drugs usage. Recommendations on treatment of acute gastroenteritis are based on the modern protocol of the European Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists (ESPGHAN), which was published in 2008. According to these recommendations, oral rehydration is one of the main components of treatment, decreasing children’s mortality rates. However due to the absence of the effect of this measure on the intestinal peristalsis, duration of the diarrhea and concomitant symptoms (abdominal pain and distension), additional therapy is necessary. In Russia combinations of enterosorbents and probiotics are used in order to relieve such conditions.

Since the Federal Law № 323 «On the Basics of Russian Federation Population Health Protection» (2011) and the Order № 1175n «On Confirming the Procedure of Appointing and Prescribing Medicines» (2012) were administered, the legislative field of pediatricians' and pharmacists' activity has been changed. The present situation, especially at the initial stage of the mentioned laws realization, requires the necessity of patients' complex consulting as instead of the prescription with a definite medicine's name they will receive the one with the international nonproprietary name which might cause many questions. Modern complexes of vitamins and minerals have their own specific features as a medicinal group and a commodity. Based on the mentioned aspects, the article provides a practical example of complex consulting on the problem of vitamin and mineral correction in children and adolescents' nutrition and explains the necessity of vitamin and mineral complexes application, as well as details their administration peculiarities and the criteria of the quality of the products provided by the chemists.

The article analyzes modern data on risk factors of severe course of atopic dermatitis in children: the role of alimentary and inhalant allergens, cutaneous infections, allergic reactions to drugs used in the treatment of disease. The most important questions of differential diagnosis of atopic dermatitis in children and the distinctive features of the illness, which may be mistaken for atopic dermatitis (primary immunodeficiencies, keratosis pilaris, psoriasis, enteropatic acrodermatitis; cutaneous bacterial and fungal infections, and drug-induced contact dermatitis to topical creams and ointments) are discussed. Treatment of atopic dermatitis is based on modern approaches and includes recommendations on the use of emolents, anti-inflammatory drugs (topical glucocorticoids) and calcineurin inhibitors. The article provides indications and contraindications to the administration of anti-inflammatory drugs. Special recommendations for use of cleansers and emolents at all degrees of severity of atopic dermatitis, which helps reduce the risk of side effects of topical corticosteroids, complications such as cutaneous infections and helps to maintain remission of disease are given. The importance of training programs patients is emphasized. Compliance of patients and/or their parents contributes to the achievement of the desired effect of the treatment of atopic dermatitis, which will improve the patients’ quality of life.

The article deals with the cough treatment options with mucolytic agents administration at the first several days of acute respiratory tract infections in children. Efficacy of treatment with secretolytic and secretomotoric drugs significantly depends on certain factors. The article contains the criteria of therapeutic efficacy of expectorants. A special attention is given to N-acetylcysteine — a direct acting mucolytic agent, which effect is caused by presence of free sulfhydryl groups, disrupting disulfide bonds between molecules of acid mucopolysaccharides and glycoproteins therefore changing the structure of sputum. Acetylcysteine is active against every type of sputum (mucous, muco-purulent, purulent), that is especially important in treatment of bacterial infections, when it is necessary to quickly decrease sputum thickness, eliminate it from the respiratory tract and prevent dissemination of the infection. High efficacy of acetylcysteine is caused by its unique triple action: mucolytic, antioxidant and antitoxic. Mechanism of action of acetylcysteine is discussed in detail. Timely administered treatment will improve sputum discharge and therefore eliminate one of the main factors of bronchial obstruction and decrease the risk of microbial colonization of the respiratory tract. The article also includes indications, contraindications and dosage regimens of acetylcysteine in children. The most common mistakes and specific aspects of mucolytic drugs in pediatrics are listed in the conclusion.

 

Natural antioxidants can be used in prophylaxis and treatment of respiratory infections in frequently ill children. When administered together, vitamins and antioxidants have synergetic action, which allows not to use dosages, exceeding physiological daily requirements. Provitamin A, vitamins E and C are the part of specialized complex for children, which along with antioxidant action, has immunomodulatory, anti-inflammatory and adaptogenic effects. β-carotene does not dissolve in water and its oil solutions have very low concentration (< 0,1%), hence its assimilation from pelleted forms and oil solutions significantly depends on alimentary fats content and condition of the digestive tract. Water solubility of the studied drug provides high degree of the assimilation of active substances. Liquid form for oral administration is convenient for dosing and can be used in infants. The presented analysis of clinical trials showed, that usage of antioxidant complex led to health and functional state improvement, appetite and sleep normalization. The markers of non-specific immune protection improved in the majority of children, which correlates with decrease of prevalence and duration of diseases. Such microelements as zink and selenium can also be used as general-stimulating and immunomodulatory components. There are publications, confirming efficacy of vitamin and mineral complexes usage in order to lower the risk of acute respiratory tract infection, in the medical literature.

One of the most urgent problems of Russian pediatrics — high prevalence of acute respiratory infections — is analyzed in this article. The author characterizes a special group of «frequently ill children». Patients of this group are the most prone to recurrent bronchopulmonary diseases, due to special features of their immunological statuses. The article also contains a short literature review on pidotimod trials, which have proved this drug to be effective and safe in acute and recurrent bronchopulmonary diseases as well as in bronchial asthma. In the patients who were administered pidotimod the frequency of relapses of acute respiratory tract infections decreased, the duration of the disease course shortened significantly, as well as these patients required antibacterial and antifebrile agents more rarely and did not have complications of allergic diseases. Children with recurrent bronchopulmonary diseases and bronchial asthma receiving pidotimod were shown to have lower rate of relapses and normalization of immunological characteristics. It is important to mention that pidotimod do not affect results of peak flowmetry and improve results of «Asthma Control Test». Pidotimod usage during vaccination guaranteed uneventful course of post-vaccination period and stimulation of immune response. Long-term study of clinical efficacy and safety of pidotimod allowed to recommend this drug as preventive and medicinal measure in pediatric practice.

Cough is one of the most common symptoms of respiratory tract diseases, especially — of infectious etiology, various types of airways and pleura disorders. Cough can accompany cardiovascular, gastrointestinal and metabolic disorders. Correct interpretation of cough and establishment of its cause can contribute to appropriate treatment of underlying diseases.. Phytotherapy in cough treatment is very spread in Russia. But administration of such drugs requires pathogenesis-based approach. The article deals with the issue of herbal drugs of secretomotoric expectorant group, allowed to use in children older than 2 years. The author gives comparative characteristics of these drugs, covers pharmacological action of the drugs components and discusses the questions of their efficacy and safety.

Aim: to determine the role of lactase insufficiency (LI) and microbial imbalance (MI) in functional disorders of the gastrointestinal dysfunctions (GIF) in infants. Patients and methods: 102 children from the observed population of 268 infants aged 0–6 month old were examined more thoroughly. They were divided into 2 groups: control group of healthy children (n = 40) and 62 patients corresponding the Rome criteria III on GIF in children (study group). Results: regurgitation and intestinal colic predominated among GIF, in 71% of cases they were associated. LI was found in 37% of children with GIF У 37%.Clinical manifestations of GIF were similar both in patients with and without LI. In all children with LI and in 85% of children without LI there was complicated pregnancy history. Intestinal microbiocenosis imbalance (increased amount of conditionally pathogenic flora) was found in all children with GIF, however the results of cultural investigation of faeces and polymerase chain reaction did not coincide with each other. Calprotectin concentration was increased in all children with GIF, especially in LI (522,21 ± 27,84 mcg/g). Treatment management depended on feeding type and presence of LI: in cases of LI patients were administered β-galactosidase, in infants without LI probiotic strains included into milk formulas or drugs were used. In all cases clinical improvement, decrease of calprotectin concentration and improvement of microbiological signs were observed. Conclusions: transitory LI was found more than in 1/3 of the patients with GIF symptoms, moreover the clinical manifestations are similar, which requires additional examination. The optimal diagnostic test is lactose hydrogen breath test. All children with GIF have intestinal microbiocenosis imbalance and symptoms of mild intestinal inflammation. Correction of GIF should be performed in accordance with LI. Lactase enzyme effectively eliminates both LI symptoms and inflammation signs.

Aim: to study clinical efficacy, tolerance and safety of a new pelleted ibuprofen form for children in treatment of fever in patients with acute respiratory tract infection. Patients and methods: children aged from 6 to 12 years old with clinical manifestation of respiratory tract infections and requiring antipyretic treatment were included into the study. Children (n = 50) were administered ibuprofen at a single dose of 5–10 mg/kg of body weight, not more than 3–4 times per day. The efficacy assessment included time needed for temperature decrease (assessment was performed in 15, 30 and 60 minutes) and duration of the antipyretic effect (assessment in 6, 8 and 12 hours). Rapidity of analgesic effect in children with ear ache, headache and myalgias was performed in 15, 30, 60 minutes and 6, 8 and 12 hours after the drug intake. Results: antipyretic effect of pelleted ibuprofen for children begins in 15 minutes after its intake. Stable temperature decrease during the first 6 hours was observed in 58% of children (the mean temperature was 37,1 ± 0,3) and maintained up for 12 hours. Relief of pain intensity was established in 62,1% of patients during the first 3 hours, and in 37,9% the pain syndrome was arrested completely. Conclusions: the new pelleted form of ibuprofen for children was proved to have high clinical efficacy and safety in treatment of fever in children with acute respiratory tract infections.

Aim: to assess clinical efficacy of polietilenglicol (macrogol) with molecular weight 4000 kDa in children with chronic constipation. Patients and methods: clinical efficacy was assessed in 30 children aged 2–12 years with chronic constipation. The follow-up was performed on an out-patient basis, patients and their parents kept diaries, noting stool characteristics according to the Bristol stool scale. Coprological analysis and abdominal ultrasound were carried out. The duration of the follow-up after the withdrawal of the studied drug was 6 months. Results: during the 1st week of treatment the frequency of stool increased in 23 (76,6%) children, normalization of stool frequency to the 4th week of treatment was achieved in 93,3% of patients. Stool consistency in 1 month of treatment met criteria of the 3d and 4th types according to the Bristol stool scale in 27 (90%) children. Painful defecations have been arrested by the 3d week of treatment. Conclusions: the drug was shown to be highly effective in treatment of chronic constipation in children, arresting such symptoms as «fear of the potty» and painful defecations and having a strong positive dynamics after its withdrawal.

Being one of the most common representatives of malabsorbtion syndrome celiac disease has been diagnosed more and more often in Russia. Celiac disease is a hereditary condition with high prevalence and different symptoms called «Great Mimic». The article deals with diagnostics based on testing the antibodies to tTG, DPG, biopsies of the duodenum and gluten free diet. There is given an example of severe case of celiac disease in a 17-years-old boy with weight loss, delayed sexual development and severe gastrointestinal symptoms. Gluten free diet and proper treatment led to permanent remission.

A history case of severe juvenile arthritis with uveitis as manifestations of Crohn’s disease, resistant to standard immunosuppressive therapy and treatment with chimeric anti-tumor necrosis factor-alpha monoclonal antibody is represented in this article. Adalimumab — recombinant monoclonal antibody, which peptides sequence is identical to human IgG1, allowed to arrest active stage of inflammatory process, uveitis and intestinal manifestations of Crohn’s disease, as well as to restore function of involved joints almost completely. This history case confirms high efficacy of adalimumab in patients with Crohn’s disease manifested with juvenile arthritis complicated with uveitis, and allow to recommend this medicine as first-line genetically-engineered biological agent in treatment of such patients.