Errors in prescribing pharmacological drugs remain common in pediatric practice. A certain role belongs to the inadequate quality of medical care and medical errors. Typical errors that are considered in judicial practice: polypharmacy, errors in dosage, use of medicines outside the instructions (off-label), etc. Cases of irrational use of medicines are considered. Until now, in outpatient settings, up to 50% of cases, prescribing antibiotics to children is recognized as unjustified. Aggressive promotion of medicines in the pharmaceutical market exacerbates the problems of irrational use of medicines. When changing doctors, there is often no continuity in the treatment of a sick child, as a result, errors in the technique of prescribing medicines may occur. For the treatment of many diseases of childhood, especially in neonatology, there are no special pediatric drugs and specific pediatric forms, which forces medical professionals to take risks by prescribing drugs with unknown safety and questionable efficacy. The problems of drug supply in pediatrics and the use of off-label drugs have not been completely resolved. Fueling the problem is the lack of drugs that have official approval for use in pediatric including gastroenterological, practice.

25(OH)D sufficiency was studied among 103 patients with oncohematological diseases living in the Moscow regions. A high frequency of severe deficiency was shown in 41,7% of children, deficiency in 31,1% of cases, insufficiency in 22,3% of cases, 4.9% of children have a normal content of 25(OH)D. As the age increases, 25(OH)D deficiency becomes more pronounced. Impaired supply of 25(OH)D in patients with oncohematological diseases is observed throughout the year and is aggravated in the winter-spring period.

The aim of the work was to study the clinical significance of the genetic polymorphism of the adhesion factor - the genetic locus rs602662 FUT2 in Helicobacter pylori-associated diseases. Methods: The study included 91 patients. The study for the presence of the polymorphic locus rs602662 of the FUT2 gene was carried out by the standard TaqMan PCR method on a “Real-Time CFX96 Touch” amplifier. The duration of the study was 6 months. Results: When assessing the contribution of the genotype of the rs602662 locus of the FUT2 gene as a risk factor for the occurrence of clinical manifestations in H. pylori infection, it was found that the A allele has a protective effect on the occurrence of clinical symptoms of dyspepsia. The odds ratio (OR) for allele “A” carriers (genotypes A/A and G/A versus G/G) to have clinical symptoms with a positive H. pylori status was 0.175 (CI=[0.049-0.625] chi2=7.79 p=0.0053). Conclusion. As a result of the study, it was revealed that the carriage of the “A” allele has a significant associative relationship with the absence of clinical symptoms in patients with H. pylori infection 0.175 (C.I.= [0.049-0.625] chi2=7.79 p=0.0053).

The aim of the work is to establish the regularities of changes in the cellular composition of the fundal and pyloric glands in chronic gastritis in children. Material and methods. 213 patients aged 7-17 years with chronic Hp-associated gastritis were examined. The cellular composition of the fundal and pyloric glands was determined in gastrobioptates. Immunohistochemical analysis was used to determine cells containing gastrin, somatostatin, pepsinogens I and II, acidic and neutral mucins. The results were expressed in‰ per 1000 epithelial cells. Results. As inflammation increases in the fundal glands, the number of main and cells containing pepsinogens I and II decreases, the number of lining, additional and endocrine cells increases. In the pyloric glands, the pool of endocrinocytes increases, the number of lining cells and cells immunopositive to pepsinogen II significantly decreases. Parallel to the severity of the process, there is a sharp increase in D- and G-cells and an increase in the number of epithelial cells containing acidic and neutral mucins. Conclusion. Chronic inflammation of the gastric mucosa is accompanied by a significant restructuring of the cellular composition of its glands.

Campylobacteriosis is one of the most common bacterial intestinal infections with high risks of severe and prolonged infection in childhood. The growing incidence of campylobacteriosis, the variety of clinical forms of the disease, the difficulties of timely diagnosis of the infection against the background of a high level of resistance of the microorganism to a number of antibacterial drugs determine the need to optimize the rational tactics of treating this infectious disease. One of the possible ways to overcome these difficulties is to further expand the use of probiotics and autoprobiotics. Aim: to reveal the features of the influence of autoprobiotic and probiotic E. faecium strains on clinical and laboratory parameters in children with non-smooth forms of campylobacteriosis .. Materials and methods: In the period from 2018 to 2020. In DNCIB FMBA, a comprehensive single-center prospective dynamic open observational study of 34 children with an uneven course of campylobacteriosis was carried out. For therapeutic purposes, patients were prescribed an autoprobiotic (group A; n = 15) or a probiotic strain E. faecium (group P; n = 19). Clinical and laboratory parameters and indicators of the intestinal microbiocenosis composition were assessed by real-time PCR. Results: Studies of the effect of two different approaches to prescribing probiotic strains of enterococcus to children with a protracted course of campylobacteriosis - a conditionally “reference” industrial strain E. faecium L3 and autoprobiotic strains with a comparable frequency (88.9% and 93.3% of cases, respectively) revealed their significant positive impact on the course of protracted forms of campylobacteriosis, which was expressed by the disappearance of abdominal pain syndrome, normalization of the frequency and consistency of stools, relief of hemocolitis in the absence of undesirable side effects. Analysis of the dynamics of coprograms before and after taking autoprobiotics and probiotic E. faecium L3 also did not reveal significant differences: there was an equivalent positive dynamics in the form of improvement in most of the macroscopic and microscopic characteristics of the stool. The study of the composition of the intestinal microbiota showed that after the course of administration of autoprobiotic strains of E. faecium, there was a significant increase in the content of butyrate-producing indigenous representative - F. prausnitzii, which promotes the repair of the intestinal mucosa. The studies also showed that the course use of autoprobiotic strains of enterococcus contributed to a decrease in the frequency of convalescent release of campylobacter, which suggests a sanitizing effect of autoprobiotics and does not exclude a similar effect in relation to other bacterial pathogens of intestinal infections in children.

A study of intrahepatic hemodynamics was conducted in 150 children aged 11 to 14 years, of which 33 were practically healthy children, 117 were patients with biliary dyskinesia (85 with type 1 diabetes, 32 without type 1 diabetes). In patients with biliary dyskinesia, a decrease in the speed of blood flow in the hepatic artery with an increase in indices (resistance, pulsation, systolic-diastolic), as well as an increase in the speed of blood flow in the hepatic vein with a decrease in these indices was revealed. The inhibition of hepatic hemodynamics may be due to the deterioration of bile secretion, as a result of a violation of the normal innervation of the bile system, associated with the development of diabetic neuropathy in children with type 1 diabetes. It is suggested that angiopathy of hepatic arteries and veins plays a certain role in the Genesis of intrahepatic blood flow disorders.

Aim. To study the level of oxidative stress and the state of antioxidant protection of blood in children with inflammatory bowel diseases before and after a course of hyperbaric oxygenation Materials and methods. Markers of oxidative stress (malondialdehyde of blood plasma and erythrocytes, ischemia-modified blood plasma albumin) and indicators of antioxidant blood defense (catalase and reduced erythrocyte glutathione) were studied in 16 patients with Crohn’s disease and 11 patients with ulcerative colitis aged 6 to 17 years, thiol groups of blood plasma). Similar indicators were studied after a course of hyperbaric oxygenation, carried out in a single-seat air-oxygen pressure chamber “BaroOx 1.0”. The course consisted of 5-8 daily sessions in the 1.3-1.4 ata regimen for 40 minutes. Results. In pediatric patients with Crohn’s disease and ulcerative colitis, a significant development of oxidative stress (an increase in the level of malondialdehyde in blood plasma and erythrocytes, ischemia-modified blood plasma albumin) and changes in antioxidant protection indicators were revealed. After a course of hyperbaric oxygenation, a significant decrease in the concentration of markers of oxidative stress and an increase in the antioxidant defense of the blood were noted. Conclusion. The use of hyperbaric oxygenation in children with inflammatory bowel diseases significantly reduces the manifestations of oxidative stress and intensifies the antioxidant defense of the blood.

The aim of the study is to identification of risk factors and features of the course of respiratory failure accompanied by gastrointestinal insufficiency in “early” full-term newborns s Methods. The study design is retrospective, controlled, non - randomized, single-center.. Inclusion criteria are newborns with a gestation period of 37 weeks. Exclusion criteria congenital malformations that require emergency surgical correction. 279 patients met the inclusion and exclusion criteria. 3 (1.1%) children were killed. 36 (12.9%) children developed severe respiratory failure. Statistical processing was carried out on the basis of the “BioStat”program. Results. Respiratory problems were realized mainly in newborns extracted by emergency caesarean section (OR = 1,2, χ2 = 5,12, p=0,04). The duration and severity of enteral insufficiency was associated with the degree of respiratory disorders Moreover, prevention with corticosteroids contributed to the use of less aggressive and respiratory support methods in these children. Conclusions. The most significant risk factor for the development of severe respiratory failure in “early” full-term patients is performing a caesarean section for emergency indications. Antenatal steroid prevention of respiratory failure in “early” full-term infants may help reduce the frequency of aggressive methods of artificial respiratory support. The severity of respiratory failure is also associated with gastrointestinal insufficiency.

Introduction. The article is devoted to the experience of treating children with pancreatic tumors who underwent pancreatoduodenal resection (PDR) at the Department of Pediatric Surgery, Faculty of Pediatrics, N. I. Pirogov Russian National Research Medical University and at the Center for the Treatment of Developmental Anomalies and Diseases of the Hepatopancreatobiliary System in Children on the basis of the N. F. Filatov Children’s City Clinical Hospital. This type of operation was performed in children with tumors of the head of the pancreas, with the spread of fibroinflammatory changes to nearby organs in chronic pancreatitis and with complicated forms of chronic duodenal obstruction. Materials and methods. For the period from 2010 to 2021 9 PDEs were performed in patients aged 1 to 16 years. The results of treatment in this category of patients were assessed as satisfactory. It is noted that the postoperative period has a number of features: prolonged restoration of gastric motility and passage through the gastrointestinal tract (100% of patients), exacerbation of chronic pancreatitis (100% of patients). Against the background of conservative therapy in all children (100% of patients), the symptoms of pancreatitis were stopped in the period from 26 to 41 postoperative days, the evacuation function of the stomach was fully restored within 2-4 weeks after the operation. Discussion and conclusions. Among the postoperative complications, there were: stenosis of biliary and pancreatic-digestive anastomoses (22% and 11% of those studied, respectively), adhesive intestinal obstruction (11% of cases), intra-abdominal bleeding (11% of patients). One patient had a lethal outcome after repeated surgical interventions for pancreatic head limphangioma complicated by intra-abdominal bleeding and biliary peritonitis. The prognosis in this category of patients is favorable - in the follow-up after surgical treatment in all children (100% of patients), the passage through the gastrointestinal tract is not disturbed, the endo- and exocrine function of the pancreas is preserved (100% of patients), there were no indications for prescribing enzyme therapy and insulin preparations …

The aim of this work: to evaluate the effectiveness of the developed methods of intestinal decompression in the treatment of spilled appendicular peritonitis in children. Materials and methods. The study was conducted on the basis of the 2nd SamMI clinic in the period from 1990 to 2014. Long-term decompression of the small intestine was carried out through appendicostomy or cecostomy, the technique of which was significantly different in the main group (79 patients) and the comparison group (34 patients). Results. The methods we developed for decompression of the small intestine in children with common appendicular peritonitis (WAP) contributed to an earlier restoration of intestinal motility and the appearance of the first independent stool (on day 4), normalization of body temperature by 4-5 days, and a reduction in the duration of the gastric tube (up to 3 days) and early activation of patients (2-3 days).

Introduction. Despite the good long-term results of duodenal atresia correction in the long term, about 10% of patients have severe upper gastrointestinal motility disorders: GERD, gastroduodenitis, and megaduodenum, which requires re-reconstruction of the duodenal anastomosis. Materials and methods. For the period from 2010 to 2021 in the clinic of the FGBUZ DGKB them. N. F. Filatov DZM Moscow 7 patients was treated with megaduodenum, operated on for duodenal atresia. The average age of the patients was 5.4 ± 3.9, boys predominated (6/7). All children underwent a standardized examination: ultrasound, barium fluoroscopy, FGEDS and laboratory research methods. MRCP and abdominal CT were performed as indicated (3/7). All patients were operated on, depending on the cause of obstruction and the degree of its compensation. Reconstruction of the previously applied anastomosis (4/7) or resection of the duodenum (3/7) was performed. Results. Main patient complaints: abdominal pain 7/7 (100%), vomiting 7/7 (100%), abdominal distention 4/7 (57.1%), poor weight loss 3/7 (42.8%), constipation 3/7 (42.8%). 5 out of 7 had multiple congenital malformations (MCDs). Mechanical causes of chronic renal failure were detected in 4 out of 7 children: stenosis of the duodeno-duodenoanastomosis (2), “blind loop” syndrome (infringement of the Roux loop in the form of a “double-barrel” in the window of the mesentery of the transverse colon) (1), stenosis of the duodeno-duodenoanastomosis in in combination with fibrosis of the head of the pancreas (1). In the remaining 3 cases a secondary megaduodenum was detected with good obstruction of the previously imposed anastomosis. Hiowever, it was noted that the diameter of the anastomosis was definitely less than the diameter of the duodenum above its level. In 6 out of 7 patients chronic renal failure was complicated by secondary gastroesophageal reflux disease (GERD), which required surgical correction in only one patient after 6 months. In other cases, the dynamics of reflux spontaneously decreased to 1 degree and was intermittent, the patients had no complaints. All children were examined in follow-up after 1, 3, 6 and 12 months. All of them showed positive dynamics in the form of weight gain, absence of complaints and signs of protein-energy insufficiency. Conclusion. Children operated on for duodenal atresia need long-term careful dispensary observation. Since in the presence of pronounced motor-evacuation disorders of the duodenum, repeated interventions are necessary. Surgical tactics should be strictly differentiated. Resection of the duodenum improves passage through the upper gastrointestinal tract and is well tolerated by patients.

Introduction. The question of selecting the optimal diameter of gastrostomic tubes for enteric feeding remains unresolved. The aim of the study is to justify the choice of tube diameter for enteric feeding by studying deposits on the inner wall. Materials and Methods. A model for the introduction of specialized enteric and blender food through a tube at a temperature ranging from 36° to 40 °C has been developed. Polyvinylchloride probes with a length of 110 cm and an outer diameter ranging from 10 to 30 Fr with a step of 2 Fr are used as nutrient tubes. An imitation is performed nourishment 5 times a day for 300 ml for 30 days. After simulation, the probe’s internal clearance will wash 150 ml of water with a temperature of 37 °C, dried. At the beginning and end of the experiment, weighing and measuring the length of the probe was carried out. The results and their discussion. The specialized feed caused a blockage of 10 and 12 Fr probes, which were removed by washing 150 ml of water. There was no significant change in the mass of probes after the enteric feeding, indicating minimal sediments on the inner surface. The blending caused a blockage of probes 10, 12 and 14 Fr in diameter. Probes 10 and 12 Fr in diameter could not be recovered from washing with water. The power deposition on the inner walls of the probes was visually determined. No significant changes in the length of the probes were observed during the experiment. However, the change in the mass of probes after the blender feed is statistically larger than after the specialized one (p<0.001, Mann-Whitney criterion). Conclusion. It is advisable to use gastrostomic tubes with a diameter of 14-18 Fr to feed specialized mixtures. 18-24 Fr diameter tubes should be used when using a blender supply.

The article summarizes clinical guidelines for endoscopic examinations (esophagogastroduodenoscopy, ileocolonoscopy, video capsule endoscopy) in children with ulcerative colitis (UC). Such issues of endoscopic examinations and monitoring of UC as indications for primary and repeated examinations, technical aspects of examinations, biopsy, endoscopic activity indices and endoscopic semiotics of UC, the role of video capsule endoscopy are considered.

Aims. Study of clinical-diagnostic features of the course of chronic gastroduodenitis in children taking into account types of constitution (somatotypes). As well as the impact of these features on the course of the disease. Materials and methods. 167 patients diagnosed with “Chronic gastroduodenitis” aged from 4 to 17 years were examined, having morphological changes in the mucosa of the stomach and duodenum, meeting the criteria of gastroduodenitis. An estimate was made of the age, gender composition, types of constitution according to the classification of M. V. Chernorutsky (based on the Pinje Index). Clinical-anamnestic and laboratory-instrumental features of the course of chronic gastroduodenitis in a certain somatotype are noted. The effect of the patient’s constitutional specificity on the course of the disease was analyzed and evaluated. Results and conclusion. It has been revealed that the presence of the asthenic somatotype leads to the frequent development of chronic gastroduodenitis in children, but a lighter course, unlike the normosthenics, and the presence of the hypersthenic somatotype as a whole is a protective factor in the development and course of the disease.

Pregnancy occurring against the background of diabetes mellitus is often complicated by fetoplacental insufficiency, intrauterine hypoxia, which affects, first of all, the nervous system of the fetus. Literature data indicate a close relationship between disorders of the nervous and immune systems. The question of the effect of autoantibodies to insulin and its receptors on the course of pregnancy and the condition of the fetus remains poorly understood. Autoantibodies to nerve tissue proteins (S100, GFCP, OBM, and FRN) also affect the child’s nervous system, which is accompanied by immunological changes (increased activity) of the α1-proteinase inhibitor. Their level can serve as a marker of CNS damage. Deviations in immunological parameters and neurological disorders can persist up to 18 years.

Nowadays the patient more often has a comorbid pathology. The combinations of two or more chronic diseases, which are either pathologically interlaced or exist simultaneously, may worsen the case of each individual disease. Kidney diseases are often associated with gastrointestinal disorders, cardiovascular and endocrine diseases, because of the same immunological features of etiology and pathogenesis. Chronic kidney disease (CKD) requires correction of lifestyle and implementation of control over the physical development in children from the first stages of the disease. CKD C4-C5 leads to unbalance in homeostasis and to increased level of toxic substances in blood, that is why doctors can see changes in different organs and systems especially in gastrointestinal tract. The urinary system and the gastrointestinal tract have a common plan of structure, functioning and regulation. It determines the general mechanisms of etiology and pathogenesis. There is a direct correlation between the stage of CKD and the damage level of the gastrointestinal system. This article covers the pathophysiological mechanisms of digestive system damage in advanced stages of CKD. Special attention is paid to changes in microbiota of the gastrointestinal tract. In turn, it affects to systemic inflammation, which is an aggravating factor in course of the CKD and its progression. The emphasis is made on involvement of the gastrointestinal tract in varying degrees in children with CKD C4-C5.

Oral allergic syndrome is a manifestation of an acute allergic reaction from the mucous membrane of the oropharynx in the form, itching and tingling on the oral mucosa, dysphonia, itching in the auricles, some patients may experience classic manifestations of hay fever in the form of rhinoconjunctival syndrome. Diagnostics of this disease includes collection of allergic anamnesis, allergy examination. The only pathogenetic method of therapy is carrying out specific immunotherapy with causally significant allergens.

A review article is devoted to diagnostical etiopathogenetic criteria of hepatoblastoma in pediatric patients. There is a distinguished cytogenetic analysis that detects only a limited amount of structural and numerical anomalies in hepatoblastomas; histopathological assessment of liver bioptats which facilitates treatment tactics. Distinctive laboratory findings in pediatric hepatoblastoma are microcytic anaemia, reactive thrombocytosis, and elevated alpha-fetoprotein. The immunohistochemical analysis allows the assessment of the nuclear expression of INI1 (SMARCB1) and the exclusion of malignant rhabdoid liver tumours. There is recommended hepatic doppler ultrasonography, as well as a three-dimensional assessment of primary tumour sizes and tumour volume to reveal the extent of hepatoblastoma according to the PRETEXT system. Radiography and computed tomography of the chest organs are advised to determine hepatoblastoma’s metastases.

The aim is to draw attention to the frequency of occurrence, the clinical course of intrauterine peritonitis, as well as the possibilities of prenatal diagnosis, the most significant predictors determining the need for postnatal operative intervention of intrauterine peritonitis by the example of the analysis of the authors ‘ clinical observation. Materials and methods: clinical material on the management of a patient with clinical symptoms of intrauterine peritonitis from the moment of birth to the stage of closure of the ileostomy is presented. Results: the article provides brief information about the disease, its clinical forms, the main intrauterine ultrasound signs of the disease, its clinical picture after birth and treatment methods. The analysis of the analyzed clinical case confirms the multi-disciplinary nature of the problem and the importance of the readiness of not only neonatologists and pediatric surgeons, but also other specialists engaged in intrauterine ultrasound diagnostics.

Objective: To demonstrate the appendicitis-like onset of Crohn’s disease and the detection of granulomas as findings. Materials and Methods: the medical history of a girl with an appedicite-like onset of Crohn’s disease was analyzed. A complete clinical and laboratory, instrumental examination, histological, histomorphometric analysis of the surgical material and biopsy specimens of the mucous membrane of the colon and ileum were carried out. Results: morphological markers of Crohn’s disease were revealed in a girl against the background of complete health with appendicitis-like onset of Crohn’s disease. Conclusion: Crohn’s disease can be disguised as a variety of diseases. It is very important to have the attitude of surgeons to exclude this disease, conduct an intestinal revision and a complete morphological examination of the operating material in case of suspicion.

Relevance: Hirschsprung’s disease (HD) is a congenital disease characterized by the absence of ganglion cells in the submucosal nerve plexus of Meissner, as well as the muscular-intestinal nerve plexus of Auerbach. This disease is one of the variants of neurocrystopathies and leads to disorders of intestinal peristalsis, which most often manifest themselves in the form of colon obstruction. About 80% of cases are caused by genetic mutations that are autosomal dominant with incomplete penetrance. The first symptoms of the disease usually appear immediately after birth, with a difficult discharge of meconium, in the future the disease is masked under chronic constipation, with which such patients most often come to see pediatricians. Aim: to present a clinical case of Hirschsprung’s disease, under the guise of chronic constipation Material and methods: The medical history of a boy aged 3 years 9 months with Hirschsprung’s disease, rectosigmoid form, subcompensation stage is presented.