The article discusses the role and place of the medical college teacher in preparing a pediatrician. It gives an analysis of academic, medical, methodical and scientific load. It is concluded that there is an imbalance in the types of activities that affects the quality of teaching.

The lecture describes basic types, causes, and main development mechanisms of various forms of pathology in red blood cells, their main manifestations and principles of elimination.

Background: Treatment of patients with juvenile idiopathic arthritis (JIA) is one of the most complex and urgent problems of rheumatology.

Objective: Our aim was to evaluate the efficacy and safety of adalimumab therapy combined with immunosuppressants in patients with JIA without systemic manifestations.

Methods: A monocentre observational comparative study was held. We studied the results of treatment of patients with JIA being treated with adalimumab combined with immunosuppressants (n = 215) and methotrexate (n = 200). The efficacy of the therapy was evaluated using the paediatric criteria of the American College of Rheumatology (ACRpedi) and remission criteria by C. Wallace during 5 years.

Results: After 6 and 12 months the remission of articular syndrome was registered in 72 and 81% of patients treated with adalimumab combined with immunosuppressants, and in 53 and 65% treated with methotrexate. Laboratory indicators of the disease activity corresponded to the reference values after 6 months in 73 and 48%, after 12 months — in 94 and 68% of patients in the comparison groups, respectively. After 6 and 12 months of supervision the activity according to the CHAQ questionnaire was fully recovered in 63 and 79%; 47 and 62% of children. After 1 month the improvement according to the ACRpedi30/50/70 criteria was registered in 87/54/25% of the observed treated with adalimumab. After 6 months the ACRpedi30/50/70 index was 93/89/76% and 63/57/47% for adalimumab therapy with immunosuppressants and methotrexate, respectively. Adalimumab combined with immunosuppressants more quickly than methotrexate induced the stage of inactive disease/remission — after 5 (3; 8) and 12 (6; 18) months, respectively (p < 0.001). After 6 and 12 months of supervision the stage of inactive disease/remission was reported in 43 and 47% of patients treated with adalimumab combined with immunosuppressants, and in 9 and 38% of patients receiving the methotrexate therapy. Adalimumab and methotrexate were well tolerated by 58 and 73% of patients with JIA without systemic manifestations. The adverse events were reported in 42 and 27% of patients, but became the reason for drug dechallenge only in 6 and 10% of patients.

Conclusion: Adalimumab combination therapy combined with immunosuppressants has faster and more evident anti-inflammatory effect than the treatment with classical immunosuppressant methotrexate.

Background: Uveitis is one of the most common extra-articular manifestations of juvenile idiopathic arthritis (JIA). Currently, the possibility of reducing the risk of uveitis in children with JIA by using methotrexate has been studied.

Objective: Our aim was to analyze the results of treatment of children with JIA by studying the relation between the use of methotrexate and the risk of uveitis.

Methods: A retrospective uncontrolled study. The case histories of patients with JIA who were treated for at least 2 years after the onset of the disease were studied. The results of treatment of patients who received and who did not receive methotrexate were studied (standard therapy — non-steroidal anti-inflammatory drugs and intra-articular injections of glucocorticoids). The established cases of uveitis were taken into account.

Results: The study analyzed the results of observation of 281 children with JIA. In the methotrexate group, uveitis was detected in 22/191 (11.5%), and in the control group — in 42/90 (46.7%) of patients (OR 6.7; 95% CI 3.7–12.3). The time period between the onset of JIA and development of uveitis in two groups under study was the same and equal to 24 (12; 67) and 17 months (7; 35), respectively (p = 0.232). Multivariate regression analysis showed that the main predictors of uveitis were oligoarticular course of JIA (HR = 1.89), positive antinuclear antibody test (HR = 2.14), onset of JIA under the age of 5 (HR = 2.56), female gender (HR = 1.82),
and the absence of methotrexate in the therapy (HR = 0.24).

Conclusion: The treatment with methotrexate may reduce the risk of uveitis in patients with JIA. To confirm this hypothesis, randomized studies are needed.

Objective: Our aim was to evaluate the efficacy of an ectoine nasal spray in treating children with seasonal allergic rhinitis.

Methods: An open randomized study of children aged 3–17 with the aggravation of early spring hay fever. All participants received oral antihistamine, and the children of the treatment group — oral antihistamine plus ectoine nasal spray. The symptoms of the disease and the amount of additional drug therapy were analyzed on the 1st, 10th and 21st day of treatment.

Results: The group with patients who received an ectoine nasal spray (n = 24) showed a significant, if compared to the control group (n = 18), decrease in the severity of all symptoms of rhinitis — nasal congestion from the 14th day of treatment (p = 0.010), nasal discharge — from the 15th day of treatment (p = 0.036), nasal irritation and sneezing — from the 17th day of treatment (p = 0.020), as well as the symptoms of allergic conjunctivitis such as itchy eyes — from the 18th day of treatment (p = 0.020) and conjunctival hyperemia — from the 19th day of treatment (p = 0.040). The use of an ectoine nasal spray was accompanied by a decrease in the frequency of the assignment of drugs for the additional rhinitis treatment.

Conclusion: An ectoine nasal spray in combination with antihistamines induces a more rapid relief of major symptoms of seasonal allergic rhinitis and allergic conjunctivitis in children, as well as reduces the need for additional medical treatment of the disease, if compared to the antihistamine monotherapy.

Background: An issue related to the terms of assignment of genetically engineered biological agents to patients with juvenile idiopathic arthritis (JIA) still remains debatable in pediatric rheumatology.

Objective: Our aim was to evaluate the efficacy and safety of etanercept therapy in early and late JIA without systemic manifestations.

Methods: An observational comparative study. The participants were divided into 2 groups. Patients of the treatment group (n = 98) — with early arthritis (lasting less than 2 years), and patients of the control group (n = 99) — with late arthritis (lasting more than 2 years). All children received etanercept in a dose of 0.4 mg/kg body
weight 2 times per week subcutaneously. The efficacy of the therapy was evaluated for 3 years using the criteria of the American College of Rheumatology (ACRрedi), remission criteria by C. Wallace and JADAS71 index. Results: Total number of patients with JIA under the study is 197. After 6 months, the improvement according to the ACRpedi criteria 30/50/70 was recorded in 97/97/91% and 98/96/88%, and after 1 year — in 100/100/99% and 99/94/92% of patients with early and late arthritis, respectively. The efficacy of etanercept according to criteria by C. Wallace and JADAS71 index in early arthritis was higher than in late arthritis within 2 years of observation.

Conclusion: Etanercept is more effective in early JIA than in late JIA without systemic manifestations.

This article presents modern methods of intraluminal endoscopic procedures for diagnostics and treatment of upper gastrointestinal diseases in pediatrics. Authors refined indications and contraindications, considered aspects of an organizational and technical equipment supply, gave clinical guidelines for application of upper gastrointestinal endoscopy methods in patients with different age groups. All that can supplement and enhance the diagnostic capabilities, as well as improve effectiveness of mini invasive endoluminal methods of treatment of esophageal, gastric and duodenal diseases in children.

Cystic fibrosis is multiple organ pathology that requires a complex treatment. Its standardization and pharmacoeconomic analysis are absolutely necessary. We performed a retrospective analysis of the trends in life expectancy of cystic fibrosis patients who lived in
Moscow in 1993, 1998, 2003, 2008, and 2013. It was found that the survival rate of these patients depended on the choice of drug therapy (pancreatic enzymes, dornase alfa, intravenous and inhaled antipseudomonal antibiotics), changes in diet, active dispensary observation at a specialized center for cystic fibrosis, and neonatal screening. We determined the cost of drug therapy per patient. From 1993 to 2013, the survival rate of patients who lived in Moscow increased by more than 20 years (from 16 to 39 years, respectively). The average cost of therapy increased more than 10 times (from USD 1.8 to 21.9 thousand, respectively).

The article discusses the use of N-acetylcysteine in pediatric practice and examines various clinical effects of acetylcysteine, including in acute respiratory infections in children, and peculiarities of its application. The causes for the phenomenon of «lung bogging» in the course of treatment with mucoactive means are analyzed separately and the measures for its prevention are proposed. The article contains the results of multicenter studies and data of systematic reviews that show high therapeutic efficacy and safety of acetylcysteine in treating both acute and chronic infections of the upper and lower respiratory tracts. The drug can modify the rheological properties of the tracheobronchial secretion reducing its viscosity and accelerating the discharge processes from the bronchial tract, which results in a more rapid recovery of the patient.

Modern methods of respiratory support have led to the transformation of the course of bronchopulmonary dysplasia. A significant role is played by the use of surfactant preparations for the prevention of respiratory distress syndrome and subsequent formation of bronchopulmonary dysplasia in premature infants. In this connection, an objective assessment of the efficacy of surfactant replacement therapy is required. The article presents the results of studying the patterns of development of bronchopulmonary dysplasia in premature infants (n =121) of different gestational age. It was shown that a new form of moderate or mild bronchopulmonary dysplasia prevailed in extremely premature infants in the course of surfactant replacement therapy. Children of a gestational age greater than 32 weeks who do not require surfactant therapy usually have typical bronchopulmonary dysplasia.

The article presents the first case of simultaneous bilateral cochlear implantation for a 6-month child with IV degree sensorineural hearing loss after meningocephalitis in Russia. Despite partial ossification of the cochlear basal turns, the early timing of implantation allowed to fully implant active electrodes to both ears. The simultaneous bilateral cochlear implantation in young children, who had meningitis, is a minimally invasive and highly efficient procedure with good long-term results of oral-aural after-care.

Many orphan diseases in children require life-long and regular intravenous enzyme replacement therapy. The article describes the first Russian practice of implanting venous port systems in 12 patients with type I and II mucopolysaccharidosis and Pompe disease (6 months to 17 years old) to create long-term venous access. Currently, implantable venous port systems are used in 9 (75%) of 12 patients. 4 cases of thrombosis are observed in 3 patients. All of them have been successfully treated. 1 patient had a rotation of the port camera with a membrane facing downwards due to violation of an implantation technique. The camera was adjusted during the second operation.