Administration of essential vitamins A, C and D in vitamin-mineral complex in common dosage is efficient for immunity formation, harmonious physical and neuropsychic development, rickets prevention. Dosage of components at the physiological daily maintenance in basic vitamin complexes for infants is integral for nursing mother supplementation and fortification of the food used for infant weaning. If necessary, and specifically in immature infants, the basic vitamin complex (vitamins A, C and D) can be extended with other required micronutrients (vitamin D, for example, can be extended up to 1000 ME). It depends on feeding type, intake of vitamin-mineral complexes for nursing mothers, seasonal prevalence, region and many other factors.

Background. Nonsteroidal anti-inflammatory drugs safety profile (NSAIDs) is well-studied in clinical trials. Meanwhile, the monitoring of adverse effects (AEs) of this drug class and analysis of AEs structure in pediatrics is essential. Our aim was to study AEs related to NSAIDs in children. Methods. Retrospective analysis of doctor reports about AEs associated with drugs from N02B and M01A groups (according to Anatomical Therapeutic Chemical Classification System) administration in patients under 18 years old in healthcare facilities or outpatiently (self-medication included) was carried out. Data source — regional database (Republic of Crimea) of spontaneous reports about AEs. Recall period — January 2010–December 2018. Results. 201 AEs cases were registered during research period. Most commonly AEs on NSAIDs were reported in infants — 87 (43.3%) cases, and in children at 1–3 years old — 65 (32.3%). Development of 126 (62.7%) AEs cases were associated with administration of Ibuprofen drugs, and 53 (26,4%) cases — with Paracetamol drugs. Significance level of cause-effect relationship was estimated in compliance with WHO Collaborating Centre method. For most cases AEs have started with such hypersensitivity reactions (193 cases, 96%) as hives, hyperemia, skin itching. Much less often AEs have presented with respiratory and gastrointestinal disorders. AEs were slight and posed no threat to children in 57% of all cases. Conclusion. AEs development on NSAIDs administration was associated with Ibuprofen and Paracetamol drugs in most cases. Immediate hypersensitivity reactions were the main clinical manifestations of AEs on NSAIDs.

Background. Cardiovascular system recovery after physical activity with explosive exercises is essential for cardiovascular pathology prevention. The efficiency of short-term biofeedback training (BFB training) in such conditions in adolescents have not been studied earlier. Objective. Our aim was to study the effect of BFB training on cardiovascular rehabilitation after speed and power training in adolescents according to general heart rate variability (HRV) spectrum total power parameter. Methods. The research has included healthy eighth-grade students (14–15 years old boys) from regular school. Inclusion in experimental and control groups was regulated by researches. Such indicators as total power (TP) of HRV spectrum, tension index (TI), systolic and diastolic arterial blood pressure (ABP), heart rate (HR) were registered initially, after three standing long jumps with double take-off and after recovery. All members of experimental group performed BFB training in order to increase TP (3 min) during recovery period. Members of control group were resting. Results. Initially all members of experimental (n = 17) and control (n = 10) groups were compared on age, height, weight and TP, TI, ABP and HR indicators. The TP level in boys of experimental group was higher than in control group during recovery period after BFB training: 3.22 (1.96; 6.13) against 1.36 (1.15; 1.84) X 1000 ms2 respectively (р = 0.041). There were no differences in TI, ABP and HR levels between two groups during recovery period. Conclusion. Implementation of short-term BFB training according to general HRV spectrum total power parameter in 14–15 years old boys after speed and power training perpetuates vagal impact on heart rate during recovery period.

Background. Acceptability of routine immunization with vaccine to meningococcus serogroups A, C, W, Y in Russian children have not been studied earlier. Objective. The aim of the study was to understand the safety of polyvalent meningococcal conjugate vaccine administration in two years old children in actual clinical practice. Methods. The vaccination of two years old children against meningococcal disease has been performing in Sakhalin region since April 2018. All children who received single 4-valent meningococcal conjugate vaccine to A, C, W, Y serogroups in the period from April to November 2018 were included into the research. The vaccine safety in general group was estimated by local pediatricians visiting due to general and local adverse effects on vaccine injection in one month period. Safety study for children vaccinated in the period from September to October 2018 was carried out by questioning parents. Results. 1250 children were vaccinated during this research. Local paediatricians has recorded 11 (0.9%) appointments due to adverse effects within 1 month after vaccination. All of them were mild: infiltrates in the vaccine injection site (4 cases), high temperature up to 38°C (7 cases). Survey of 100 parents has shown that at least one adverse effect in 4 weeks period was noted only in 23 children: local reactions (induration, redness at the injection site) in 14 cases, general reactions (temperature increase up to 38.7°C) in 9 cases. No adverse effects needed medical intervention. Conclusion. Adverse effects were recorded in less than 1% of all cases according to local paediatricians appointments and in every 4th case according to parents questioning among all two years old children who undergone immunization with 4-valent meningococcal conjugate vaccine to A, C, W, Y serogroups.

Background. Vaccination coverage in patients with rheumatic diseases remains extremely low. Moreover, infections are the leading cause of death in such patients. Respiratory infections mortality is 2–5 times higher in adults with rheumatoid arthritis than in overall population. The most frequent infectious complications in patients receiving Tocilizumab (first-line drug for treatment of patients with systemic juvenile idiopathic arthritis (SJIA)) are pneumonia and acute sinusitis. Their clinical course differs: slight clinical presentation, reference ranges of laboratory tests of disease activity (ESR, C-reactive protein), significant changes in lungs and paranasal sinuses according to the computer tomography. Infectious complications development can cause aggravation of prior disease itself or due to temporary immunosuppressive therapy cessation. Clinical Case Description. The experience of immunization with 13-valent pneumococcal conjugate vaccine (PCV13) and haemophilus influenzae-tetanus toxoid conjugate vaccine in the 1,5 years old boy with SJIA receiving interleukin-6 receptor monoclonal antibody Tocilizumab is presented. The result of such vaccination was increase of pneumococcal and haemophilus influenzae antibodies levels by more than two times. Meanwhile vaccination had no negative impact on the prior disease course: the levels of predictors of prior disease aggravation such as protein S100 and highly sensitive C-reactive protein did not increase significantly in comparison with the period before vaccination. Conclusion. The efficiency and safety of immunization with PCV13 and haemophilus influenzae-tetanus toxoid conjugate vaccine in the child with SJIA receiving Tocilizumab is presented.

Homocystinuria is rare autosomal-recessive monogenic disorder associated with disturbance of methionine metabolism due to liver enzyme cystathionine--synthetase (CBS) deficit. That in turn causes elevated concentration of homocystein and its metabolites in blood and urine. The main clinical manifestations of homocystinuria are: myopia, ectopia lentis, psychomotor retardation, learning difficulties, mental retardation, mental illnesses, behaviour problems, paroxysms, extrapyramidal symptoms, skeletal anomalies (body height), long limbs — dolichostenomelia and arachnodactylia (Marfan Phenotype), pectus carinatum, valgus lower limbs, scoliosis, osteoporosis, thromboembolic disorders. Diagnostics of homocystinuria is based on clinical findings and laboratory changes (increase of methionine and homocysteine levels in serum). There is prenatal and DNA-diagnostics (genetic variants in CBS gene). Revealing of homocystinuria demands examination of first-degree relatives. Therapy of patients with homocystinuria includes not only diet therapy but also pyridoxine, folic acid, betaine administration. Syndromic concomitant therapy is also used. The description of the patient with severe B6-resistant form of homocystinuria is given in this article.

Mucopolysaccharidosis type I (MPS I) is the hereditary disease characterized with alpha-L-iduronidase activity decrease and further accumulation of heparan and dermatan sulfate in lysosomes. MPS I is rare autosomal recessive disorder with incidence of 0.5–4 cases on 100.000 live-birth infants. Meantime there two approaches in MPS I treatment: hematopoietic stem cell transplantation (HSCT) and enzyme replacement therapy (ERT). HSCT can be the best option for treatment of patients with severe MPS I (Hurler syndrome). Successful engraftment moderates such clinical signs as obstructive airway diseases, hepatosplenomegaly, cardiovascular system dysfunctions. HSCT prevents cognitive functions decline and other pathologic features of central nervous system. Presented clinical cases show various clinical courses according to age of diagnosis, ERT onset and HSCT implementation.

Background. Vaccination of infants with 13-valent pneumococcal conjugate vaccine (PCV) was implemented in national immunization schedule in 2014. In this regard epidemiological monitoring of routine immunization results with vaccination coverage and efficiency control is required. Objective. Our aim was to study correlation between pneumococcal disease routine immunization in infants and morbidity and mortality rates due to community-acquired pneumonia in children under 18 years of age and morbidity rate due to acute otitis media in children under 14 years of age. Methods. Morbidity (Form № 2, 2011–2017 yrs) and mortality (Form № 51S, 2009–2017 yrs) rates due to community-acquired pneumonia, morbidity rate (Form № 12, 2009–2017 yrs) due to acute otitis media, vaccination coverage rate (Form № 5, 2014–2017 yrs, and Form № 6, 2016–2017 yrs) were analysed according to the data of Forms of Federal Statistical Monitoring. Medical exemptions and refusals to vaccinate rates were estimated according to the data from doctors who was performing infants vaccination. Results. During PCV routine vaccination within national immunization schedule in Russian Federation the 35% reduction of mortality due to community-acquired pneumonia in children under 1 year of age as well as reduction of morbidity with acute otitis media have been established. Moreover, low percentage of etiology clear community-acquired pneumonias (29%) complicates the estimation of vaccination efficiency. It has been revealed that despite the high pneumococcal disease vaccination coverage rate of infants under 2 years of age (87%), considerable part of children (73%) are vaccinated untimely in most Russian Federation regions. 9.3% (3.4% due to medical exemptions) of children (among 1st year infants) remained unvaccinated due to medical exemptions and refusals to vaccinate in 2016, and 8% (3.4%) in 2017 respectively. Conclusion. Implementation of PCV routine immunisation for three years in a row leads to reduction of morbidity rate due to acute otitis media among children under 14 years of age and infant mortality rate due to community-acquired pneumonias. Though, the estimation of routine immunisation efficiency can be difficult due to such factors as untimely start of vaccination, medical exemptions and refusals to vaccinate and limited laboratory diagnostics of community-acquired pneumonias etiology.

The polypharmacy as the reason of iatrogeny is topical problem of health care both in Russia and in the world. Clinical aspects of polypharmacy come out as pharmacotherapy efficiency decrease and development of severe adverse drug effects as well as health care cost increase. There is no uniform definition of polypharmacy in pediatric practice. However quantity and duration of medicine administration, medicine class, medicine eligibility, medical conditions and clinical conditions are usually considered. The correlations between existing medicines prescription models and health problems in children appears relevant. The results of recent researches on this problem are presented in the review.