Vol 28, No 1 (2021)

To date, the results of one incompleted clinical trial evaluating the efficacy and safety of riamilovir for patients with COVID-19, as well as the results of a generalized experience of use the drug without a control group and randomization of patients have been published. This trial did not reveal the benefits of using the drug. The study of the use of riamilovir in the treatment of hospitalized patients with laboratory-confirmed mild to moderate COVID-19 is ongoing.

Inhalation therapy for respiratory diseases with high prevalence is an important method of therapeutic care for children in modern settings. The advantages of such a treatment method relate to the ability to deliver drugs directly to the target organ, which makes the use of low doses of drugs effective by creating a high concentration of drugs directly in the respiratory tract. The effectiveness of inhalation therapy largely depends not only on the type and dosage of the drug, but also on the characteristics of inhalation devices that are very diverse. Recent decades have been marked by the discovery of new and improved systems for delivering drugs to the respiratory system. Nebulizer therapy is most widely used in pediatric practice, allowing the use of all standard inhalation solutions and their permissible combinations in children of any age, as well as in severe patients.

The article provides an overview of the foreign and domestic literature on the development of telemedicine in the world. R. Mark was the first to use the term “telemedicine" in his work “The Telemedicine System: The Missing Connection Between Home and Hospital" in 1974. However, the provision of medical care at a distance existed long before that time. Also, individual telemedicine tools have been used for more than 100 years since the introduction into practice of such types of telecommunications as telegraph, radio, telephone, television, computer networks, and the Internet. The researchers note that there are difficulties with the availability of medical care to the population in various countries, especially in remote rural areas. In this regard, telemedicine consultations are an actual alternative.

The article highlights the problem of modern approaches to the diagnosis and treatment of acute otitis media in children. Data on the effectiveness of topical preparations in the complex therapy of this disease are presented. Local anti-inflammatory therapy of middle ear diseases can significantly increase the effectiveness of treatment without the risk of complications. At the present stage, antibiotics are considered drugs of choice. Based on clinical guidelines, indications for systemic antibacterial therapy and tympanocentesis are listed.

Center for Children’s Health, which required intensive treatment, but in some cases the course of this infection did not require a specific approach in the presence of significant changes in the lungs. Based on updated world data and our own experience, the Clinic has made changes to the treatment protocols for children with moderate to severe COVID-19, including a short course of systemic glucocorticosteroids, as well as low molecular weight heparin. The success of this approach was the starting point for its inclusion in the new, second version of the guidelines for the treatment of COVID-19 in children dated 07/03/2020.

Background. Campylobacter is the leading hemorrhagic colitis and one of the most common bacterial infections in all regions of the world. In the extensive practice of practical medicine, the appointment of antibacterial drugs for campylobacteriosis is considered. This is of particular importance in the growing amount of data on the increased resistance of campylobacter to antimicrobial effects and the rapid spread of resistant strains in food and the environment. Objective. Evaluation of the antibiotic resistance level of Campylobacter spp. Methods. 50 patients with manifest forms of campylobacteriosis were examined. The phenotypic profiles of antibiotic resistance of 54 strains of Campylobacter jejuni and Campylobacter coli isolated from patients with manifest forms of the disease were studied. The sensitivity of the isolated strains to 10 antimicrobial drugs of 8 pharmacological groups (erythromycin, ciprofloxacin, nalidixic acid, gentamicin, amikacin, tetracycline, doxycycline, ampicillin, chloramphenicol, and cefotaxime) was determined by the disc diffusion method. Results. Most of the tested Campylobacter spp. strains were resistant to nalidixic acid and tetracycline. The frequency of isolation of strains resistant to macrolides and fluoroquinolones was 11.1 and 16.7%, respectively; 14.8% of isolates were multiresistant to 4 or more antibiotics. The obtained data indicate a high prevalence of antibiotic-resistant strains among campylobacteria isolated from patients with manifest forms of the disease. According to the study, risk factors for infection with resistant strains of Campylobacter spp. Included overseas travel to the Asian region and eradication therapy. Conclusion. The results of the study confirm the need for further evaluation of the formation of antibiotic resistance of Campylobacter spp. based on the determination of genetic profiles and intracellular mechanisms of expression of other pathogenic factors.

Background. Today, bronchopulmonary dysplasia (BPD) is an important problem in modern pediatrics. Severe chronic lung pathology is often formed in children after BPD. It is known that the main predictors of BPD severity are gestational age, respiratory distress syndrome, duration of mechanical ventilation (MV) modes, and comorbidities. At the same time, various variants of the course and outcomes of BPD are diagnosed in a number of premature infants, despite identical nursing conditions and respiratory support modes, which dictates the need for further evaluation of pathogenetic mechanisms. Objective. Identification of the main factors determining the outcomes of BPD in children. Methods. The study involved 146 patients (main group) with a previously established BPD diagnosis at the age from 2 years 11 months to 4 years 1 month (3.35±0.13 years). The gestational age in children of the main group ranged from 25 to 37 weeks (30.9±2.3 weeks), weight at birth - from 562 to 2500 g (1458±458 g). Depending on the variant of the transformation of the diagnosis, the patients were divided into 2 subgroups: the first was formed by 88 children (3.7±0.43 years), in whom the restoration of morphofunctional structures with implementation in the form of recovery or recurrent bronchitis was observed; the second subgroup consisted of 58 patients (3.2±0.66 years) with unfavorable outcomes of the disease in the form of chronic bronchitis or obliterating broncholitis. Results. The results of this study indicate that chronic lung diseases are significantly more likely to develop in patients with severe BPD, while favorable outcomes of the disease were more often observed in patients with moderate BPD. Statistical analysis showed that in children born at a gestational age of less than 31 weeks, the outcome in the form of chronic bronchitis and obliterating bronchiolitis was significantly more frequent. Analysis of the duration and modes of ventilation support showed that mechanical ventilation with strict parameters immediately after childbirth and the duration of respiratory support more than 3 weeks were among the main risk factors for the formation of BPD outcomes in the form of chronic lung diseases. The study revealed that concomitant laryngostenosis was a predisposing factor for the formation of BPD outcomes in the form of chronic lung diseases. According to our data, early (age up to one year) starts and a high frequency of respiratory viral infections in children with BPD are a predisposing factor for an unfavorable outcome of BPD in the form of chronic bronchitis, obliterating bronchiolitis, and pneumofibrosis. Conclusion. Thus, it can be argued that the formation of chronic lung diseases as option of the BPD outcome is associated with a variant of the course of the disease, gestational age, duration and parameters of mechanical ventilation, the presence of concomitant pathology, high frequency and early start of ARVI.

Background. Currently, it is important to study the immunopathological mechanisms underlying the development of bronchopulmonary dysplasia, which, as is commonly known, are accompanied by active inflammation, leading to structural changes in the tissues of the lungs and bronchi. At the same time, despite the leading etiopathogenetic significance of matrix metalloproteinase-9 (MMP-9), there are isolated articles in the literature highlighting the dynamics of enzyme levels in the context of clinical course and disease outcomes. The data obtained will be useful for understanding the intimate mechanisms of the development of pathology, including bronchopulmonary dysplasia (BPD) in children and be the basis of personalized therapy. Objective. Determination of the MMP-9 levels depending on the severity, phase of the disease and BPD outcomes in children. Methods. According to the study design, 146 children with BPD were examined at the stage of revision of the diagnosis due to age-related transformation. The complex of examination included general clinical and instrumental research methods in accordance with the standard of medical care. The severity and form of BPD in patients were determined according to the working classification of clinical forms of bronchopulmonary diseases in children [2]. The determination of MMP-9 in blood serum was carried out by the method of enzyme-linked immunosorbent assay using the ELISA Kit for MMP-9 (Cloud-Clone Corp., USA). With a normal distribution of the variables, statistical analysis of the results was carried out using the methods of parametric statistics. Results. Follow-up of children over 3 years of age did not reveal statistically significant differences in the studied enzyme levels compared to the children in the control group, despite the traced trend of an increase in average level with increasing severity. At the same time, during the period of exacerbation, a significant increase in the MMP-9 level was observed, which indicates the activation of inflammation with the involvement of the main gelatinase B producer cells. Summing up the data reflecting the structure of indicators depending on the outcomes of BPD, there was no significant increase in the MMP-9 level in patients with chronic bronchopulmonary pathology and recovered children relative to each other and the control group. Conclusion. According to the study, by the time the diagnosis was revised, children with a new form of BPD had reference serum MMP-9 values, which may be associated with the completion of the processes of fibrosis of the lung tissue on the one hand and the favorable effect of surfactant administration in the neonatal period, on the other.

The global increase in antimicrobial resistance requires the search for alternative treatments for infectious diseases that reduce the frequency of antibiotic use. One way to solve this problem is the use of phytopreparations created by modern standards and well studied in experimental and clinical studies. This review examines the effect of combined herbal drugs produced by phytoneering technology (Tonsilgon® N, Sinupret®, Bronchipret®) on antibiotic prescribing rates in children with acute respiratory tract infections (ARTI). The results of clinical studies show that the use of these phytopreparations in children with ARTI leads to a decrease in the frequency of prescribing antibacterial therapy.

Bacterial and fungal skin infections, secondarily infected dermatoses remain a pressing issue in dermatology. The traditional, well-studied combination of the antibiotic neomycin, the antimycotic natamycin and topical hydrocortisone has for many years maintained its position in the topical therapy of intertrigo, skin candidiasis, diaper dermatitis, chronic inflammatory skin diseases complicated by secondary infection and other skin conditions. This combination (hydrocortisone+natamycin+neomycin) is rather popular among dermatologists and doctors of related specialties. In recent years, extensive experience has been gained in the clinical use of this drug in domestic dermatological practice.