The results of historical and medical research reflecting one of the most tragic pages in the Soviet history and Stalinism era — the famine of 1932-1933 that covers several regions of the country — are presented. The aim of this research was the analysis of situation with children healthcare during the famine in the country in general and in the Middle Volga region (future Samara region) particularly. Publications of Soviet medical historians withhold the data about children’s healthcare problems during the famine of the 1930s. It has been established that the data of children mortality in national demographics of the 1930s was falsified (according to post-Soviet literary and declassified archive sources). The famine was accompanied by the increase of children morbidity and mortality due to outbreaks of highly infectious diseases (smallpox, cholera), typhus fever and typhoid fever, dysentery, childhood infections (scarlet fever, measles), septic angina, tuberculosis and malaria. If the level of infant mortality in 1932-1933 yrs could be the same as in 1928, it would be possible to save up to half a million (according to official statistical data) or even one million (according to estimated figures) children lives according to calculations of authors.

Functional and anatomical development coupled with functional immaturity of gastrointestinal tract present major risk factor for functional gastrointestinal disorders development in infants. The article discusses some aspects of aetiology, prevention and early treatments of gastrointestinal discomfort in infants.

This article is devoted to the most common bone tissue tumor among children — Ewing's sarcoma. The epidemiological data, most frequent afflicted zones of bones, clinical signs, diagnostics and treatment methods are analysed. The main focus is on the molecular genetic mechanisms of carcinogenesis initiation.

Background. QTc elongation is the risk factor of sudden cardiac death. Patients with type 1 diabetes (T1D) can have QTc elongation due to hypoglycemia and cardiac autonomic neuropathy (CAN). The separate role of this two factors in QTc elongation development in T1D patients is still unknown.

Objective. The aim was to study the role of cardiac autonomic neuropathy and hypoglycemia as independent risk factors of QTc elongation at night in adolescents with T1D.

Methods. Patients at the age of 10-17 years old with T1D were enrolled in the cohort study. All patients have undergone simultaneous 24-hour monitoring of electrocardiogram and glycemia. Results of nocturnal monitoring (23:00-07:00) were estimated. QTc elongation > 450 ms was regarded pathological. CAN was diagnosed at decrease of ≥ 2 time domain parameters (SDNN < 101 ms, SDNNi < 48 ms, SDANN < 85 ms, rMSSD < 25 ms). Hypoglycemia was classified as 1st (≥ 3.0 and ≤ 3.9 mmol/L), 2nd (≥ 2.2 and < 3.0 mmol/L) or 3rd (≤ 3.9 mmol/L along with cognitive defects and the need of acute hypoglycemia treatment) level. We also have distinguished prolonged (< 3.0 mmol/L and ≥ 120 min) and asymptomatic (≤3.9 mmol/L and no adrenergic symptoms) nocturnal hypoglycemia. We didn’t analyse hypoglycemia periods with > 9.0 mmol/L.

Results. QTc elongation > 450 ms was revealed in 28 out of 100 patients. All patients with QTc > 450 ms were similar on gender, age, HbA1C level with patients without any QTc elongation but they have longer history of T1D and higher frequency of 2nd level hypoglycemia and asymptomatic nocturnal hypoglycemia. According to the data from multivariate regression analysis independent predictors of QTc elongation were the following: CAN — odds ratio (OR) 9.0 (95% confidential interval [CI] 3.3-24.2), 2nd level hypoglycemia — OR 4.4 (95% CI 1.4-14.2), asymptomatic nocturnal hypoglycemia — OR 2.9 (95% CI 1.1-7.7) and T1D duration — OR 1.3 (95% CI 1.0-1.5).

Conclusion. CAN and hypoglycemia (both clinically significant and asymptomatic nocturnal) are independent predictors of QTc elongation in adolescents with T1D.

Background. Cryopyrin-associated periodic syndromes is a group of rare congenital autoinflammatory diseases such as familial cold autoinflammatory syndrome, Muckle-Wells syndrome and chronic infantile neurological cutaneous articular syndrome. These syndromes are considered as clinical variants of one disease with different intensity of clinical features and severity of pathologic process. The onset of these syndromes is usually on the first year of life, and they start with fever, urticarial rash, various variants of joint diseases (from arthralgia to residual and persistent arthritis) and nervous system disturbances. There are only single case reports of cryopyrin-associated periodic syndromes in Russia.

Clinical Case Description. The disease onset was at the age of 1 year 8 months with fever and rash as well as generalized joint syndrome. Autoinflammatory syndrome was suspected due to to results of blood tests, MRI, molecular genetic testing. Exons 2, 3 and 4 of TNFRSF1A gene and exon 4 of NLRP3 gene with nearby introns were studied with the method of direct automated sequencing. The c.943A>G variant in heterozygous state in NLRP3 gene was revealed. The child was treated with IL-1 beta inhibitor (canakinumab) with positive effect.

Conclusion. Diagnostics of cryopyrin-associated periodic syndrome in children is the serious challenge. Timely decision with help of molecular genetic methods is crucial for successful target therapy.

The challenge with selection of probiotic is still very topical due to the huge amount of different kinds of probiotics on pharmaceutical market and due to the lack of major studies about their effects in children. In this regard the administration of such specimens in children should be performed with special selectivity. The efficiency of the most studied probiotic bacterial strains used in prevention and treatment were analysed in this article. Requirements for probiotic microorganisms (included those used in pediatrics) were described. It is noted that probiotics are often considered as food supplement. However they are implemented in prevention and treatment of functional disorders and diseases of the gastrointestinal tract.

The atopic dermatitis (AD) is common skin disease and has significant impact on patients and their families quality of life. In recent years the term “sensitive skin" has been used more frequently. It is separate syndrome with subjective perception (such as burning, itching, tingling, etc.) along with thickening and dryness of the skin in response to environmental factors (biotic, abiotic and anthropogenic) which normally do not cause such symptoms. This syndrome is often associated with AD. The AD and sensitive skin syndrome pathogenesis and their management are presented in the article. Efficiency and safety parameters of pimecrolimus 1% cream in children (including its appliance on sensitive skin areas) are analysed.

Some medication instructions have records about the need of caution in case of management in pregnant women or during lactation period. Moreover the instructions do not have direct prohibition against drug administration during gestation and lactation periods. In this regard the legitimacy of such medications prescription to pregnant women or women during lactation period is questionable (even when physician thinks that there are indications for such therapy). Another question is legal responsibility of the physician in case of any adverse effects development. The evidence favouring legitimacy of physician actions on prescribing such medication are considered as well as the probability of physician prosecution to civil and criminal liability are analyzed in this article. Special attention should be given to the issue of recognition of physician actions as reasonable risk. The guidelines based on performed analysis have been developed. The implementation of this guidelines can significantly reduce the risks of physician legal exposure.

American Academy of Pediatrics (AAP) has described the epidemiological situation with seasonal influenza in USA as well as possible prevention and treatment. AAP has provided guidelines on implementation of influenza vaccines and antiviral drugs in children (risk groups included). The primary goal of this document is to increase vaccination coverage of the child population, pregnant women and medical workers. Answers to several frequent anti-vaxxers questions are presented.