Pharmateca

Micronutrients that have proven importance for health and immunity include all vitamins, essential macro- and microelements. Insufficient provision of the body with vitamins and minerals increases the risk of disease, the duration and severity of infection, and the developing infectious process has a negative impact on the micronutrient status of the body. According to actual nutrition data, the consumption of several vitamins at the same time in 30–89% of children does not reach the recommended age norms. In 40-99% of children, low vitamin D blood levels are detected. The widespread prevalence of micronutrient deficiency among the child population requires its compensation, which is achieved by using vitamin- and mineral-fortified foods (mass market and specialized), as well as taking vitamin-mineral supplements by children or mothers of children who are exclusively breastfed, and timely introduction of complementary foods with added micronutrients. Although improving the micronutrient status does not prevent infections, it can help reduce disease symptoms and facilitate recovery.

The article examines the role of scientific schools of the Kazan State Medical Institute in the development of experimental research by Kazan pediatricians, clinical teaching and relevant pediatric practice. The purpose of the work is determined by the need to identify the organizational and substantive forms in which the scientific activity of representatives of the teaching community was carried out, as well as the need to answer the question of how it was related to their pedagogical activity, their everyday life as a university teacher. Using mainly personal and office archival materials, some of which have not previously been introduced into scientific circulation, as well as published scientific works of Kazan pediatricians, the features of scientific research are revealed, due to the unique experience of writing scientific treatises, essays and monographs. Using the retrospective method, as well as the methods of comparative analysis, it is considered how the academic degree and previous work experience in the required field of medical sciences played a role in the decision-making process on granting the right to teach a particular discipline to medical students. The main areas of scientific research are determined, their continuity and the specificity of their evolution in the period under consideration are revealed.

Objective: Evaluation of the dynamics of laboratory blood parameters and the safety of using an IL-4, IL-13 inhibitor (dupilumab) in combination with topical therapy methods in children over 2 years of age with moderate and severe atopic dermatitis in the aspect of 2-year follow-up.

Materials and methods: A 2-year observational study was conducted in 120 children aged 2 to 17 years with atopic dermatitis who received biological therapy with dupilumab in combination with topical therapy methods. Patients were divided into 3 groups by the nature of the therapy. At the 16th, 28th, 52nd, 64th, 104th week of follow-up, all patients underwent laboratory clinical blood and urine tests, a biochemical blood test, and a study of the total IgE level.

Results: The effect of the IL-4, IL-13 inhibitor (dupilumab) in combination with various methods of topical therapy in children with AD during a 2-year follow-up showed that the dynamics of blood biochemical parameters did not undergo statistically significant changes (p>0.05). In all groups, these parameters were within the reference values throughout the follow-up period. Laboratory parameters of the complete blood count showed minor eosinophilia, which decreased to normal values with continued treatment. No statistically significant changes were found in the complete urine analysis either. And when assessing the IgE level, a stable statistically significant (p<0.05) decrease in laboratory parameters was observed from period to period.

Conclusion: Long-term assessment of the dynamics of laboratory parameters in children over 2 years old with moderate and severe AD in the context of 2-year follow-up who received dupilumab in combination with complex methods of topical therapy demonstrated no need for laboratory monitoring and confirmed the safety and efficacy of this therapy and prevention of AD exacerbations, which indicates the advisability of supplementing the complex treatment algorithm.

Background: Obesity in adolescence is accompanied by the development of carbohydrate metabolism disorders, subclinical inflammation and changes in the functional activity of the pancreas. Glucagon-like peptide-1 (GLP-1) receptor agonists, such as liraglutide, are currently widely used to treat obesity in adolescents; however, their effects on biochemical markers of metabolic processes, in particular glucose levels, amylase activity, and inflammatory parameters, remain poorly understood.

Objective: Evaluation of the effect of 24-week liraglutide therapy on fasting glucose levels, amylase activity, C-reactive protein (CRP), and high-sensitivity CRP (hs-CRP) in obese adolescents.

Materials and methods: A single-center, open-label, prospective observational study was conducted at the State Autonomous Healthcare Institution of the Sverdlovsk Region “Children’s City Clinical Hospital No. 11” (Yekaterinburg). The study included 40 adolescents aged 12–15 years with exogenous-constitutional obesity. The main group (n=20) received liraglutide in addition to diet and physical activity, the control group (n=20) received only non-drug treatment. Laboratory parameters were assessed at baseline, after 12 and 24 weeks of therapy. To assess the therapeutic effect, the analysis of covariance (ANCOVA) model was used taking into account the group, gender, baseline glycemia level and stage of puberty.

Results: A statistically significant decrease in SDS of the body mass index was noted in the main group compared with the control group (-0.44±0.19 versus -0.07±0.14; p<0.001). Against the background of 24-week therapy with liraglutide, a statistically significant decrease in fasting glucose level was recorded in the main group compared with the control group: -0.2±0.45 mmol/l versus 0.13±0.38 mmol/l, respectively (p<0.001). Amylase activity significantly decreased in the main group (-2.05±15.19 U/L), while no changes were observed in the control group (9.85±17.46 U/L); however, the difference between the groups in changes in amylase activity was at the border of statistical significance (p=0.037; confidence interval included 0). The concentration of CRP and hs-CRP decreased in both groups, but no statistically significant differences were found between them (p>0.05).

Conclusion: Liraglutide therapy in obese adolescents for 24 weeks led to an improvement in carbohydrate metabolism parameters, expressed in a decrease in fasting glucose levels, and affected amylase activity, while changes in inflammatory markers require further study. The obtained results indicate that liraglutide can have a complex metabolic effect that goes beyond weight loss: improvement of carbohydrate metabolism, possible reduction of the metabolic load on the pancreas and modification of the inflammatory status. This emphasizes the prospects of using liraglutide as a tool for multilevel correction of metabolic disorders in adolescents with obesity.

Background: Despite the implementation of control and supervisory measures, there are problems with the balance of nutrition in preschool institutions and its completeness in terms of basic food components and energy value.

Objective: Evaluation of the macro- and micronutrient provision, caloric content of daily rations of children in preschool organizations, assessment of the nutrition balance.

Materials and methods: Mathematical and statistical calculations and comparative analysis of relative and absolute values were carried out using tabular methods, built-in statistical functions of Microsoft Excel, and an online calculator.

Results: The actual energy value of the diet for children in the nursery group is lower than the standard by 2.6%, and for the preschool group - by 4.9%, which is an acceptable deviation. In children under 3 years old, there is a moderate excess of protein consumption (by 11.9%), fats (by 6.4%), as well as a lack of carbohydrates (by 8%). In the diet of children from 3 to 7 years old, with a balance in fats, there is an excess of protein consumption (by 7%), a lack of carbohydrates (by 12%) compared to the norm. Significant deviations were found in micronutrients: calcium and iodine deficiencies are pronounced. The iodine supply of children is 50-57% of the norm. An imbalance in calcium and phosphorus was established: with a calcium deficiency (62%), there is an excess of phosphorus (26.4% in the younger group and 13.3% in the older group).

Conclusion: The study revealed an imbalance in children’s nutrition in terms of macro- and micronutrients, a moderate discrepancy in the provision of proteins, fats, carbohydrates and calories with the recommended standards, a significant imbalance of microelements: iodine and calcium deficiency, excess of phosphorus.

Findings: It is necessary to adjust the diet according to the 15-day menu to achieve balance and optimize the organized nutrition of children in a preschool institution.

Modern science has the latest theoretical data on the function and structure of the tonsillar apparatus, which are able to detail the issues of the occurrence and development of chronic tonsillitis (CT) taking into account the rich and diverse material accumulated by modern clinics. CT caused by BHSA-infection has the most unfavorable course, accompanied by frequent relapses of acute tonsillitis and the development of severe complications (peritonsillar abscess, purulent lymphadenitis, etc.) from the first days, as well as diseases associated with CT (glomerulonephritis, rheumatic fever, etc.). An important role in the occurrence of CT belongs to the interaction of microorganisms located in the crypts of the palatine tonsils with the macroorganism. Given the increased activity of the tonsils in childhood and their impact on the normal development of the immune system, approaches to surgical treatment should be very thoughtful and balanced. One of the urgent problems of otolaryngology remains the search for pathogenetically substantiated, effective and safe methods of treating CT. The emergence of new strains of antibiotic-resistant microorganisms is a serious clinical problem that is associated with a more severe course of diseases. Exacerbation of CT and sore throat remains a common reason for the unjustified prescription of systemic antibacterial therapy. In most cases, with the exception of streptococcal tonsillitis, antibiotics can be considered excessive treatment, since they are a completely inappropriate solution for the treatment of viral infections. In conservative therapy, agents that can, on the one hand, restrain the inflammatory reaction, and on the other, are able to modulate the immune response are of great interest. The article highlights the possibilities of modern herbal medicine in the conservative treatment of CT, promoting a balanced and scientifically substantiated personalized approach in the interests of the patient. The presented herbal remedies are included in clinical guidelines, their use is pathogenetically substantiated.

Mycoplasmal infection is a widespread disease, including in the pediatric population. Epidemiological studies of recent years demonstrate that the share of pneumonia caused by Mycoplasma pneumoniae in children and adolescents is from 18 to 44%, reaching 50% in older children. Since the effectiveness of treatment of atypical pneumonia directly depends on the timeliness of diagnosis with early prescription and rational choice of initial antibiotic therapy, it is important to pay attention to the features of the clinical course of mycoplasmal infection with lung damage, such as acute onset of the disease, relatively mild course with febrile fever, significant respiratory manifestations often with broncho-obstruction, unilateral focal nature of lung damage, absence of specific changes in the general blood test. This article presents a clinical observation of a teenage girl with late diagnosis of mycoplasmal pneumonia.

Congenital bone, joint, and muscle defects may be a manifestation of genetic syndromes, in which congenital defects extend not only to bones, joints, and muscles, but also to other organs and systems. Brooke syndrome is an autosomal recessive disorder with multiple joint contractures and bone fragility. The disease is associated with pathogenic mutations in the FKBP10 and PLOD2 genes, mapped to chromosomes 17 and 3, respectively. The PLOD2 and FKBP10 genes act during the maturation of type 1 procollagen and contribute to the molecular stability of bone tissue. Mutations in the PLOD2 and FKBP10 genes lead to abnormal bone matrix assembly and abnormal post-translational modifications of type 1 collagen, which determines the pathogenesis of brittle bone disease. The article presents a case of a rare disease with increased bone fragility, multiple congenital contractures and congenital heart defect, genetically identified as Brooke syndrome type 1.