There is a stable trend to decrease of adolescents’ fitness to military service during last ten years. Authors analyzed modern tendencies in health state of youths by evaluation of State Statistics of Bashkortostan Republic in 1999–2008. Analysis showed that there is a trend to worsening of health state in youths 15–17 years old: common morbidity increased up to 30,8%, morbidity with diagnosis determined for the first time — up to 30,5%, coverage with prophylactic medical examination — up to 19,4%. There is significant growth of tumors detection (5,1 times higher), congenital malformations (3,1 times higher), diseases of musculoskeletal system and connective tissue (2,9 times higher). Common level of disability decreased up to 13,9%, initial disability — up to 30,2%. Taking into account growth of morbidity, it can be described by early diagnostics of diseases and timely administration of rehabilitation measures. Conversion of medical service of adolescents into pediatric area favored to improvement of youth’s diagnostics and treatment.

Key words: adolescents, health state, morbidity, disability.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):13-20)

So-called dynamical studies of health state including ?models of health status indexes? are actively performed in public health. Quality adjusted life year (QALY) is universal index of the result of treatment, and it can be used in estimation of all age groups and nosologic forms, it allows comparison between different diseases, strategies of health care and outcomes. Development of methods of QALY receipt in pediatrics is able to widen our opportunities and to improve an evaluation of effectiveness of treatment and prophylactic interventions. These measures may influence to the choice of more significant medical technologies for the treatment of diseases.

Key words: quality adjusted life year, children, result of intervention, quality of life related to health.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):22-25)

In conditions of orphanage, neuropsychological development is estimated of children aged from 3 months old up to 3 years 4 months old, without central nervous system damage and without major development defects, examined, correspondingly, in 2001 (n = 87) and in 2007 (n = 59). The estimation was performed with the use of two computer methods. The analysis of neuropsychological development estimation results by ?Profile of development? program and ?GNOM? program gave comparable results: neuropsychological development pathology group accounted for 85% and 86% correspondingly, moreover, violations are notified in all spheres of neuropsychological development without gender or age differences. However, ?Profile of development? program provides deviations in specific activity of a child in the form of a diagram, thus enabling to monitor all spheres of neuropsychological development in detail. This gives a pediatrician an opportunity to coordinate medical, psychological and pedagogic activities aimed at rehabilitation of children in conditions of deprivation.

Key words: children, neuropsychological development, computer program, deprivation.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):26-28)

The article presents results of a study of effectiveness and safety of infliximab — monoclonal antibodies to the tumor necrotizing factor (TNF) in treatment of 100 patients11 months — 17 years old with early and late articular types of juvenile rheumatoid arthritis. The duration of treatment was 3 months — 2 years. Infliximap was delivered intravenously by scheme: infusion on 0, 2nd, 6th weeks and then every 8th week. The single dose of infliximab in patients with early rheumatoid arthritis was 6.7 (5.5; 9.0) mg/kg, with late type — 6.0 (5.0; 7.0) mg/kg of body weight. 102 weeks of treatment with anti-TNF-agent provided development of clinical remission, decrease and normalization of laboratory tests of disease’s activity, total restoration of joint’s function, increase of quality of life (on 97% in patients with early type, and 72% 0 in ones with late type). The drug was abolished in 39 (39%) of patients, 23% — due to the development of secondary inefficiency, and 11% — due to the development of unfavorable effects.

Key words: children, early and late rheumatoid arthritis, treatment, infliximab.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):30-42)

Heart lesions in systemic lupus erythematosus (SLE) are detected in a half of patients, but in most cases it has no clear clinical symptoms and can be revealed only during instrumental diagnostics. 40 children with SLE and 40 conditionally healthy children were examined in this study. The signs of pericardium lesion were detected in 50% of children with SLE, cardiac valves (aortal and mitral) — in 23% of patients, hypertrophy of myocardium of left ventricle — in 33%, dilatation of its camera — in 20%, disorders of diastolic function — in 12,5%, and decrease of contractility of myocardium — in 15%. In total, the signs of myocardium lesions were detected in children and adolescents with SLE more frequently, and valvulitis — rarely than in adults (according to literature data). Revealed differences in heart structure may reflect peculiarities of disease in children and adverse effects of immunosuppressive therapy.

Key words: children, systemic lupus erythematosus, echocardiography, pericarditis, myocarditis, endocarditis.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):43-49)

The cross-sectional study of schoolchildren from Tomsk (the region with low prevalence of opisthorchiasis) and Tomsk region (rural places with high prevalence of opisthorchiasis) with Russian version of standardized questionnaire ISAAC was performed. The study included questionnaire poll and allergological diagnostics with standardized panel of allergens. Prevalence of atopic dermaitits (AtD) symptoms was not differing, but the peculiarities of clinical course of disease were revealed depending on the place of living and gender. The onset of AtD was earlier in schoolchildren from Tomsk compared to schoolchildren from rural places. Despite the absence of statistically significant differences in symptoms’ prevalence, the level of sensitizing in children from the city was much higher than in village (60% and 30% correspondingly, p<0,001). This fact shows modification of allergic inflammation during opisthorchiasis invasion and it needs further study.

Key words: children, atopic dermatitis, ISAAC, Opisthorchis felineus, sensitisation.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):50-53)

The article presents literature review on the role of B-lymphocytes in pathogenesis of rheumatologic diseases and on the administration of chimeric anti-CD20 monoclonal antibodies — rituximab — for treatment of systemic lupus erythematosus, systemic vasculitis, juvenile dermatomyositis, and juvenile arthritis in children. Results of studies showed that rituximab has good tolerability, efficacy and safety in children’s rheumatologic practice.

Key words: children, B-lymphocytes, rituximab, treatment, depletion.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):54-62)

The article presents modern point of view on the problem of functional constipations in infants. It describes peculiarities of digestion, intestinal micro biocenosis in healthy infants, the ways of its correction. Author indicates principles of choice of defined drugs effective on early stages of postnatal development. The advantages of osmotic laxative — macrogol 4,000 (Forlax) in treatment of functional constipations in children are presented.

Key words: infants, large intestine, functional disorders, nutrition, laxatives, macrogol, prebiotics.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):63-69)

The article presents the description of main types of complementary and alternative medicine (CAM) which are used in treatment of atopic dermatitis (AD) in children and adults. Despite widespread use of CAM, its proper mechanisms are unknown. In Russia the most popular methods of CAM are climatotherapy and homeopathy, while dermatological medicines for external use remain main treatment of AD.

Key words: children, atopic dermatitis, complementary and alternative medicine.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):70-72)

Author brings modern conception of extreme and terminal states, their types, likenesses and differences, etiology, key common chains of pathogenesis, principles and methods of their treatment. Pathophysiological data on one of extreme states — collapse — is described in details. Next publications will present the data on shock and coma.

Key words: extreme and terminal states, vicious circle of pathogenesis, extreme regulation, principles of treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):74-80)

Perfection of Immunization Calendar during last 15 years had resulted in ending of poliomyelitis and elimination of measles, and sharply decreasing of morbidity with diphtheria, hepatitis B, rubella, parotitis, in a less degree — with whooping cough and tuberculosis. Morbidity with seasonal influenza was reduced too. These achievements must not hide from view the necessity of inclusion of vaccination against hemophilic and pneumococcal infections, chicken pox, papilloma virus and rotavirus, effectively used in developed countries. Widening of Calendar sharpens question of penta- and hexavaccines use, otherwise the number of needed injections can become outrageous. Author describes possible schemes of vaccination in infants with the use of combined vaccines, registered in Russia. Also the data on frequency of vaccination complications in Russia is presented.

Key words: children, vaccination, Immunization Calendar.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):81-87)

The article presents a case report of early debut and severe clinical course of polyarticular type of juvenile rheumatoid arthritis which was refractory to the treatment with classical immunosuppressants and secondary inefficiency of chimeruc monoclonal antibodies to tumor necrotizing factor (TNF). Authors described successful administration of soluble receptors to TNF — etanercept in dose 0,4 mg/kg of body weight. Patient receives etanercept during 12 weeks. In 4 weeks after the onset of treatment there was lessening of painfulness and exudative alterations of joints, increase of range of motions in them. The quality of life of child and child’s family significantly improved in 3 months of treatment.

Key words: children, juvenile rheumatoid arthritis, etanercept, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):88-96)

Dietotherapy along with medicinal and external treatment is one of components of complex treatment of atopic dermatitis (AD) in children. Severe forms of alimentary allergy are treated with special formulas based on casein hydrolisates. Clinical effectiveness of such formula was studied in 20 patients 2–7 months old intolerant to proteins of cow’s and goat’s milk. Treatment resulted in remission achievement, lessening of external therapy and cancellation of medicinal one in all children including those with cutaneous and gastrointestinal symptoms of AD.

Key words: children, atopic dermatitis, dietotherapy, casein hydrolysate, SCORAD.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):97-101)

The results of combined therapy of acute intestinal infections in children with lactulose and pancreatine in prebiotic dose are discussed in this article. Authors showed advantages of combined treatment: significant shortening of terms of symptoms stopping and children’s recovery.

Key words: children, acute intestinal infections, lactulose, pancreatine.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):102-106)

Authors studied peculiarities of specific composition of bifidus bacteria in infants (n = 32) with viral diarrhea and effectiveness of prebiotic product Immunofortis (formula ?Nutrilon Comfort?) in treatment of prebiotic disorders. Analysis of copro filtrate in acute period of viral diarrhea showed decrease of bifidus bacteria concentration and change of specific composition of intestinal micro flora. Bifidum bacteria B. catenulatum and B. adolescentis were detected in intestinal micro flora though it is not common in children. Dietotherapy with prebiotic formula resulted in restoration of age-specific parameters of specific composition of bacteria (B. bifidum, B. longum) and increase of secretory IgA concentration in coprofiltrate. Authors made a conclusion that Immunofortis has immunobiological effect in children with acute diarrhea.

Key words: children, viral diarrhea, bifidus bacteria, nutrition, Immunofortis.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):107-112)

The article considers pyelonephritis therapy in children. Authors have demonstrated in a controlled clinical study that combination therapy of antibiotic and herbal medicinal product Canephron N promoted normalization of leukocyte count, protein and malonic dialdehyde urine levels as well as interleukine 8 and tumor necrotizing factor serum concentrations.

Key words: children, pyelonephritis, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):113-116)

Authors present an experience of high-frequency oscillation of chest via apparatus ?The Vest Airway Clearance System? in 194 patients from children’s pulmonological hospital. The method was effective in complex treatment of acute and chronic bronchopulmonary pathology. Parameters of oscillations depending on age and type of respiratory pathology are proposed, its effectiveness according to the peak expiratory rate, excursion of chest, pulmonary radiograph are described. Authors give a description of possible unfavorable effects.

Key words: children, clearance of airways, high-frequency oscillation of chest.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):117-120)

Prebiotics play significant role in life support of microorganisms of human gastrointestinal tract, and normal functional state of intestinal biocenosis is sufficient condition for human health. Intestinal microbiocenosis is a component of regulation of proteins and lipids metabolism, vitamins synthesis, detoxication process in intestine, etc. prebiotics include a number of disaccharides (lactulose), oligosaccharides and polysaccharides (inulin, cellulose, etc.). Fructose polymer — inulin — provides growth of bifido- and lactobacteria, improves metabolism and has immunomodulating activity. Formation of intestinal micro biocenosis in infant is provided by prebiotics of breast milk. Further state of micro biocenosis, which is necessary for growth and development of child, is determined by adequate intake of prebiotics from fruits, vegetables and cereals. It is reasonable to use special baby foods fortified with prebiotics (for example, inulin).

Key words: prebiotics, intestinal microflora, inulin.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):121-125)

Deficiency of vitamins and microelements is very frequent in children, especially with ones with allergic diseases. The article demonstrates main functions of these substances and consequences of their deficiency. Authors describe clinical cases of administration of modern complex of vitamins and minerals Pikovit in children with different allergic diseases.

Key words: children, allergic diseases, vitamins, microelements.
(Voprosy sovremennoi pediatrii — Current Pediatrics. 2010;9(3):126-130)

Authors described modern epidemiological peculiarities of hepatitis A in Russia. They prove reasonability of mass vaccination implementation against this infection. Results of a vaccination in children after its inclusion in Regional Calendars of Prophylactic Immunization are analyzed.

Key words: children, hepatitis A, vaccinal prophylaxis, posvaccinal immunity.                 (Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):131-135)

The article describes advantages of new combined drug Foster — formoterol (6 ?g) and beclometasone) (100 ?g) in treatment of patients with bronchial asthma. It was marked that the drug is based on original delivery technology «Modulite» allowing creation an aerosol with extra fine-dispersed particles. Due to this technology medication passes into airways deeper and evenly, resulting in decrease of dose of medication, necessary for achievement of clinical effect and significantly lessen the risk of adverse effects.

Key words: children, bronchial asthma, fixed combination, formoterol, beclometasone.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):136-139)

The article presents a case report of an early debut and severe clinical course of juvenile rheumatoid arthritis with eyes’ lesion. Authors describe successful administration of human monoclonal antibodies to tumor necrotizing factor (TNF) — adalimumab. In 2 weeks of treatment the morning joint stiffness was stopped, in 4 weeks exudative alterations in affected joints were vanished, and the range of their motions increased. Results of laboratory tests: ESR and concentration of C-reactive protein in plasma were normalized in 6 weeks. Adalimumab initiated development of remission of bilateral uveitis in 8 weeks.

Key words: children, juvenile rheumatoid arthritis, rheumatoid uveitis, adalimumab, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):140-146)

This is a case report of severe juvenile idiopathic arthritis in child, conditioned as by main disease as by inadequate hormonal treatment. Therapy with cyclosporine furthered development of clinical and laboratory remission of disease, inhibition of process of anatomical destruction and activation of reparation of femoral head, bone tissue in acetobular region of iliac and sciatic bones.

Key words: juvenile idiopathic arthritis, cyclosporine, treatment.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):147-150)

The article presents basic literature data on rare, potentially incompatible to life malformation of airways — agenesia or trachea. Two clinical descriptions of newborns with this pathology are presented.

Key words: agenesia of trachea, tracheoesophageal fistula.
(Voprosy sovremennoi pediatrii — Current Pediatrics. – 2010;9(3):151-153)