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FEATURES OF ADVANCED TRAINING OF PEDIATRIC DOCTORS IN THE CONDITIONS OF THE COVID-19 PANDEMIC IN MOSCOW
I.M. Osmanov, S.N. Borzakova, A.V. Vinokurov, A.V. Miroshina

Summary. The authors assessed the impact of factors caused by the COVID-19 (new coronavirus infection) on the process of improving the qualifications of pediatric doctors in Moscow in 2020, in order to inform the specialized medical community about the features of training on topics related to combating COVID-19 and methodological assistance in the search and selection of advanced training. An analysis of domestic information resources, educational events and programs on this topic, aimed at pediatric doctors, was carried out, information about which is posted on the available Internet resources. Based on the results of processing the obtained data, a thematic catalog of the most informative sources of information in the indicated areas was compiled. The results of the organization and implementation of educational programs and events for pediatric doctors, prepared at the initiative of the Chief Specialists of the DZM, were evaluated. The authors demonstrated that the tasks related to the organization of training during a pandemic were effectively solved thanks to the inclusion of this activity in the main anti-epidemic measures, the involvement of leading scientific and educational medical institutions for the development of educational content and the widespread use of distance learning technologies.
Keywords: COVID-19, coronavirus infection, postgraduate education, pediatric doctors, main non-staff specialists of the MHD, Moscow, distance educational technologies

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MATRIX METALLOPROTEINASES AND DISEASES OF THE HEART IN CHILDREN
L. A. Maksimyak, N. P. Kotlukova

Summary. Heart disease in children of the first year of life is a common problem and can be characterized by a severe clinical course. It is known about the role of the proteolytic system of matrix metalloproteinases (MMPs), their tissue inhibitors (TIMMPs) and inducer (CD147) in the processes of remodeling of the connective tissue of the heart in adults. The aim of this study was to determine the reference values for MMP-1, MMP-2, MMP-3, MMP-9, MMP-13, TIMMP-1, TIMMP-4 and CD147 in children of the first year of life, to identify the relationship between laboratory markers and echocardiographic measurements in children with congenital heart defects (CHD), dilated cardiomyopathies and hypertrophic cardiomyopathies. The study included 73 children aged 1 to 11 months. The patients were divided into 3 groups: CHD (n = 37), dilated cardiomyopathies (n = 8), and hypertrophic cardiomyopathies (n = 8). The comparison group consisted of 20 healthy children. Echocardiography was performed, the concentrations of laboratory markers were determined by enzyme immunoassay. Results. Reference values for MMPs, TIMMPs, and CD147 was determined for the first time in children aged 1-11 months. An age-related decrease in the concentration of MMP-2 was found. MMP-1 in children with CHD correlates with left ventricle end-diastolic diameter, left ventricle end-diastolic volume, and stroke volume. The level of MMP-2 has a negative correlation with the size of the ventricular septal defect. The concentration of TIMMP-1 was increased in heart failure Ross functional class II in relation to Ross functional class III and the comparison group. The results of our study demonstrate the activity of MMPs, TIMPs, CD147 in children with different heart diseases and its relationship with echocardiographic data. Continuing to study these indicators is promising for improving knowledge about the processes of connective tissue remodeling, developing new diagnostic methods and medicines, and predicting the course of diseases.
Keywords: matrix metalloproteinases, tissue inhibitors of matrix metalloproteinases, CD147, congenital heart defects, cardiomyopathy

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THE ROLE AND PLACE OF A GLUTEN-FREE DIET IN CHILDREN'S NUTRITION
Yu.A. Dmitrieva, I.N. Zakharova, E.R. Radchenko, A.S. Vorobyova, E.V. Skorobogatova, Zh.V. Polyakova, T.I. Bocharova, O.V. Shuleshko

Summary. Gluten is an important protein fraction in wheat, rye and barley. The structural features of this protein, its high allergenic and immunogenic potential determine a wide range of pathological conditions, the pathogenesis of which is associated with the use of gluten-containing cereals. The current classification of gluten-associated diseases, based on their pathogenesis, includes celiac disease, wheat allergy, and non-celiac gluten intolerance. The only treatment for these conditions is strict adherence to a gluten-free diet, which ensures control over clinical manifestations and prevention of potential complications. The article discusses the current classification of gluten-associated diseases, identifies approaches to their diagnosis and describes the spectrum of clinical manifestations. The structural features of gluten and current requirements for adherence to a gluten-free diet are discussed.
Keywords: gluten, wheat, children, celiac disease, allergies, gluten sensitivity, autism, schizophrenia, gluten free diet, hidden gluten

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RISKS OF USING TOPICAL DECONGESTANTS AND POSSIBLE ALTERNATIVE
E.S. Kovrigina, D.D. Pankov, A.A. Pukhov

Summary. Topical decongestants traditionally have been used to treat acute rhinosinusitis. Despite the high efficiency, the use of topical decongestants is associated with a number of side effects and undesirable phenomena: cyto- and ciliotoxic effects, systemic sympathomimetic effects, rebound syndrome, rhinitis medicamentosa. Decongestant poisoning accounts for an average of 20-25% of all drug intoxication, almost all poisoning is recorded among children of early and primary school age. One of the alternative options for symptomatic treatment of acute rhinitis is inhalation of essential oils. The pharmacological and therapeutic effects of essential oils, safety issues and advantages of using essential oils by inhalation are considered. The review presents the results of clinical studies of a complex of essential oils in the composition of the path inhalation "Dyshi" in the treatment and prevention of acute infectious rhinitis / rhinopharyngitis, ARI of the upper respiratory tract in children. The safety and synergistic activity of the components of the complex is noted, which makes its use more effective in clinical practice. The rehabilitation potential of the combination of essential oils is considered.
Keywords: decongestants, rhinitis, children, essential oils, Dyshi inhalation patch

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FEBRILE SEIZURES: DIALOGUE BETWEEN A PEDIATRICIAN AND AN EPILEPTOLOGIST
A.M. Pivovarova, E.I. Shabelnikova, Z.K. Gorchkhanova

Summary. The article provides answers to the main questions about febrile seizures: how often they occur, what factors predispose to their development, whether the risk of their transformation into epilepsy is high and what its level depends on, what measures should be taken by parents in the event of febrile seizures, what is the prognosis and the risk of relapse, how necessary is treatment for this condition, etc.
Keywords: febrile seizures, epileptic seizures, epilepsy, fever

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VITAMIN AND MINERAL COMPLEXES: A COMPONENT OF A HEALTHY LIFESTYLE AND A BASE FOR THE FORMATION OF GOOD PHYSICAL SHAPE IN CHILDREN-ATHLETES
The article is based on materials provided by the Biotec Group of Companies

Summary. Children, who do sports, spend much more energy than their peers. Adequate nutrition support is not only the key for proper growth and development of young sportsmen, but also a resource for improving sports results. Using of specialized food products, that have the specified parameters of nutritional and energy value, helps to fulfill the deficit in macro- and microelements.
Keywords: children-athletes, nutritional support, deficiency replenishment, vitamin and mineral complexes, hydration, improvement of sports results

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TELEMEDICINE: DEFINITION, FEATURES OF LEGAL REGULATION, PROBLEMS AND PROSPECTS
M.I. Sirotkina

Summary. The article discusses the concept of telemedicine, the history of its legal regulation in the Russian Federation and abroad, possible actions of a doctor and a patient in the provision of services using telemedicine technologies, the advantages of telemedicine and the problems of its actual application.
Keywords: telemedicine, legal acts, laws, remote monitoring, remote interaction

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MODERN SYSTEMIC PHARMACOTHERAPY OF INFANT HEMANGIOMAS
N.P. Kotlukova, N.K. Konstantinova, I.I. Trunina, N.D. Telezhnikova, E.V. Poletaeva

Summary. This publication continues to highlight the problem of modern management tactics for patients with infant hemangiomas. This problem was discussed in an article published in the journal «Practice of Pediatrics» No. 4, 2020. «Modern strategy and tactics of management of children with infant hemangiomas». In this article, the same team of authors introduces readers to the first experience of modern systemic pharmacotherapy of infant hemangiomas with Hemangiol® (Pierre Fabre Medicament, France). Hemangiol® (propranolol for oral use) is the first and only officially registered drug, including in Russia, created for the treatment of children with this pathology. Since December 2019, 55 patients with infantile hemangiomas have been treated with Hemangiol® in the Department of Cardiology of the Bashlyaeva State Clinical Hospital in Moscow. The article presents data on the results of the use of Hemangiol® in this cohort of patients.
Keywords: infantile hemangioma, propranolol, treatment, β-blocker, Hemangiol®