The review of modern literature presents the results of studies characterizing the development mechanisms of latent tuberculosis infection and residual post-tuberculous changes in children. It was  noted that with the introduction of new technologies (computer  programs, immunological tests) into the practice of a  phthisiopaediatrician, small calcified foci in the intrathoracic lymph  nodes and lungs, previously invisible with traditional radiation  methods of examination (plan radiography, fluorography), began to  be detected more often. The authors concluded that the special state of mycobacteria, which form in individuals with a special type of  immune system, is essential. This determines the state of latent  microbism underlying the development of latent tuberculosis  infection and residual posttuberculous changes in children.

Homocystinuria is a genetically heterogeneous hereditary disease from the group of aminoacidopathies caused by a metabolic disorder of  sulphur-containing amino acids, primarily methionine. The article  presents the etiopathogenetic, diagnostic and therapeutic aspects of this disease and covers modern opportunities of biochemical and molecular  diagnostics. The approach to dietary and pharmacological correction of  metabolic disorders in homocystinuria and the general strategy of  patients’ management are described in detail. Important information is given for physicians of various disciplines and parents of patients.

The lecture for the postgraduate medical education system analyzes the etiology, species, key links in pathogenesis, manifestations of diabetes mellitus and its complications in children. Case problems and multiple choice tests are given.

Deterioration of development conditions in the perinatal period (starvation of the mother, excess sodium ions in her diet, exposure to glucocorticosteroids, placental insufficiency) programs significant  changes in the excretion of sodium ions in the newborn and leads to the development of hypertension. Studies on experimental animals show  that unfavourable conditions of intrauterine development can reduce the effective area of glomerular filtration and its rate. These circumstances  increase the expression of membrane carriers of sodium ions in the  apical membranes, the production of superoxide radicals and enhance  the reabsorption of sodium. The article discusses the potential mechanisms of perinatal programming of renal hypertension in humans.

An increase in the prevalence of diseases resulting from disorders of metabolism and immune system functions is largely due to disturbances in the intestinal microbiota composition at an early age. The review  considers the stages and conditions of the natural development of the  intestinal microbiota, starting from the intrauterine period. We  conducted the analysis of possible risk factors for the intestinal  microbiota composition disorders in the pre- and postnatal periods. The  results of modern studies on the association between the intestinal  microbiota composition in infancy and the development of «civilization  diseases» at older ages are given. A separate section is devoted to a  discussion of the efficacy and appropriateness of taking probiotic drugs for disease prevention.

Background. Patients with juvenile idiopathic arthritis (JIA) have an increased risk of being infected. Approximately half of all serious infections in children with JIA are associated with airway involvement.

Objective. Our aim was to study the efficacy and safety of the pneumococcal 13-valent conjugate vaccine (PCV) in children with JIA.

Methods. In a prospective cohort study, 5 groups were formed:  children with JIA in the remission phase on methotrexate therapy  (group 1) or etanercept (group 2), with JIA in the active phase prior  to the appointment of methotrexate (group 3) or etanercept (group  4), control group (conditionally healthy children). 0.5 ml of the 13-valent PCV was administered once subcutaneously during therapy in patients in the remission phase or 3 weeks before the appointment  of methotrexate or etanercept in patients in the active phase. The  main study outcome was the proportion of patients with a protective  ( 40 mg/L) level of specific anti-pneumococcal antibodies (anti-SPP) IgG to Streptococcus pneumoniae 4 weeks after vaccination. In  addition, we assessed the incidence of infectious events before and  after vaccination as well as changes in the content of a high-sensitivity C-reactive protein, S100 protein, and post-vaccination period.

Results. The study included 125 children. Four weeks after  vaccination, the protective level of anti-SPP IgG was established in  21 (84%) patients in the 1st, 23 (92%) in the 2nd, 22 (88%) in the  3rd, 24 (96%) in the 4th and 5th groups (p =1.0). Increase in the  concentration of S100 protein and high-sensitivity C-reactive protein  after vaccination was not noted. JIA exacerbation episodes were not  recorded in any patient. After immunization, the total number of infectious events decreased in all observed groups (p 0.001). Serious adverse events were not registered during the study.

Conclusion. Vaccination with the 13-valent PCV in children with JIA  is highly effective and is not accompanied by the development of serious adverse events.

Background. Destructive joint damages in juvenile arthritis inevitably lead to persistent disability in adulthood. These consequences can be avoided by resorting to early therapy of the disease.

Objective. Our aim was to assess the dynamics of destructive joint changes in juvenile idiopathic arthritis (JIA) in children, depending on a basic therapy.

Methods. We studied the treatment results of children with systemic-onset JIA with active joint syndrome without active  systemic manifestations hospitalized in the regional clinical  cardiological health center. JIA activity criteria at the time of  hospitalization: 3 joints with active arthritis; the assessment of the disease activity by a doctor 3 points out of 10; the assessment of  wellbeing by the patient or a parent 3 points out of 10; the  appointment of basic therapy no later than 6 months from the  disease onset. Treatment results were compared in the groups of  methotrexate (hospitalization from January 2008 to December 2010) and methotrexate + tocilizumab (January 2014 — September 2016). The main outcome of JIA therapy was the severity of joint  destruction in 6, 12 and 24 months as determined by the modified  Sharpe ratio according to radiographs obtained from patients' medical records.

Results. The study groups were comparable in terms of sex and age of the patients, JIA onset age, the disease activity at the time of  hospitalization, and the initial assessment of joint destruction —  (median) 165 (131; 187) and 162 (124; 171) (p = 0.116). Under  pressure of therapy, the modified Sharpe score in the group of  methotrexate monotherapy was higher than in the group of combined therapy: in 6 months — 142 (126; 163) and 87 (72; 112) (p < 0.001); in 12 months — 166 (121; 210) and 75 (29; 89) (p <  0.001); in 24 months — 165 (113; 198) and 52 (26; 73) (p <  0.001). At the first administration of tocilizumab, 4 children had nausea and abdominal pain, and 3 children had headache.

Conclusion. Basic therapy with methotrexate and tocilizumab  inhibits the destruction of joints in patients with systemic-onset JIA  with active joint syndrome without active systemic manifestations.

Background. Obesity develops as a result of interaction of genetic and environmental factors. The impact of environmental factors on the risk of obesity in children can be determined by socially conditioned causes.

Objective. Our aim was to identify the risk factors associated with  overweight/obesity in children of different ethnic groups living in  rural areas of the Republic of Buryatia.

Methods. The cross-sectional study included adolescents aged 11– 17 years. Overweight was considered to be the body mass index  (BMI) values exceeding the 85th percentile of distribution for a given sex and age, obesity was considered to be the BMI the 95th  percentile. We assessed the anthropometric measures of adolescents and their parents, socio-demographic characteristics, features of early history, eating behaviour, and lifestyle.

Results. The study included 151 adolescents of the indigenous Asian (girls — 39.7%) and 118 Slavic (girls — 42.4%) ethnic groups.  Overweight and obesity were detected in 53 (35%) and 36 (31%)  adolescents, respectively. Independent risk factors for  overweight/obesity in adolescents of both ethnic groups were BMI in  their mothers — odds ratio (OR) 1.2 (95% confidence interval [CI]  1.1–1.3) and 1.3 (95% CI 1.1–1.4), respectively; in adolescents of  indigenous Asian ethnic groups, infrequent food intake — OR 4.2  (95% CI 1.1–16.1), living in an incomplete family — OR 4.4 (95% CI 1.3–14.1), and motherhousewife — OR 3.6 (95% CI 1.3–9.7); in  adolescents of the Slavic ethnic groups — eating at night [OR 17.3  (95% CI 1.8–163.0)].

Conclusion. The risk factors for overweight/obesity in rural adolescents, regardless of their ethnicity, are overweight in mothers and irregular food intake of children. The risk factors for  adolescents of indigenous Asian ethnic groups include social (family- related) characteristics such as living in single-parent families and  families with non-working mothers.

Detection of a large number of oligosaccharides in breast milk predetermined their use in the composition of infant formula. The most studied prebiotic simulating the unique properties of breast milk oligosaccharides is the scGOS/lcFOS mixture. Its efficacy is confirmed in clinical studies. In 2017, the experts of the  International Scientific Association of Probiotics and Prebiotics  (ISAPP) adopted a new definition for «prebiotics», which greatly  expanded the concept of their application. The World Allergy  Organization (WAO) recommends the use of prebiotics in allergy- prone children. The guidelines are based on the results of studies of the influence of prebiotics on the intestinal microbi, a violation of the composition and functions of which predisposes to the  development of allergy. Currently, the search for more promising  technologies for the production of prebiotics continues. 

Food allergy is often the first manifestation of allergy in a child, and this problem is most relevant at an early age. With an allergic reaction to food, a seemingly not very significant pathology,  a so-called «atopic march» may begin with the development of  severe forms of allergic diseases in a child. At the same time, a favourable course of food allergy is possible with the disappearance of disorder signs with age. The disease prognosis depends on many factors, both genetic and environmental, but early diagnosis and adequate treatment of children with food allergies in most cases allow to  improve the prognosis of tolerance formation or, at least, to achieve  a mild course of food allergy manifestations. It is pediatricians who  first deal with early manifestations of food allergies, and adherence  to clinical guidelines for managing patients avoids the most common  mistakes. This article is addressed to practicing doctors. It considers  the most common mistakes of pediatricians in the management of  children with food allergies and discusses the surviving «myths»  about this pathology.

We present a case of late detection and course of the primary tuberculosis complex in a child who was previously in an unknown contact with a tuberculosis patient at the first year of life. The  disease onset simulating pneumonia took place at the age of 1 year  8 months. Hereafter, the child did not have any clinical signs of the  disease. At the age of 5 years, the child was examined in connection  with the hyperergic reaction to tuberculin: the results of computed  tomography revealed calcinated foci in the lung tissue and  calcifications in the intrathoracic lymph nodes; bronchoscopy  revealed infiltrative bronchial tuberculosis. Surgery was performed:  video-assisted thoracoscopy, resection of C9,10 part of the left lung  with precision removal of the focus in its C6 segment, extirpation of  bifurcation, and left bronchopulmonary lymph nodes. The results of  the histological examination indicated the chronic course of the  tuberculosis process with formation of bronchiectasis and presence  of bronchonodular fistulas. After surgery and the main course of  antituberculous therapy, a clinical cure with small residual changes was achieved.