RATIONALE: Continuous subcutaneous insulin infusion (CSII) is an effective method for optimizing glycemic control in children with type 1 diabetes mellitus (DM1). However, the use of CSII does not always result in adequate glycemic control. Telehealth can be applied as one of the methods to improve the effectiveness of treatment.AIMS: To evaluate the use of remote medical support of children and adolescents with DM1 and its influence on glycemic control, quality of life, and incidence of acute complications of DM1.MATERIALS AND METHODS: We conducted a 24-week multi-institutional prospective open-label controlled clinical trial. 180 children and adolescents were included in this study and divided into the following categories: 1) age 8–18 years; 2) DM1 at least 1 year; 3) pump insulin therapy Medtronic Paradigm (Medtronic MiniMed, USA) at least 6 months; 4) self-monitoring of glycemia at least 4 times a day and replacement of the insulin pump infusion system at least once every 3 days; 5) inadequate glycemic control of DM1: the level of glycated hemoglobin (HbA1c) 7.5% or higher. Patients were assigned to a remote consultation group (RC; n=100) or a traditional control group (TC; n=80). All patients were trained on the basic principles of DM1 and CSII, and we measured initial HbA1c, then after 12 and 24 weeks, also registered and analyzed glycemic indicators and daily doses of insulin, evaluated and corrected the treatment. Patients or their parents in the RC group sent pump data via the Internet to the pump insulin therapy center at least once every 2 weeks at home and received treatment recommendations in response.RESULTS: The total number of patients included in the study in all institutions was 180 children at 8–18 years. Patients in both groups did not differ in age, gender, duration of DM1 and CSII, and HbA1c level. The total amount of remote consultations for all institutions was 949. The decrease in the level of HbA1c by the end of the study against the initial one was statistically significantly greater in the RC group: 1.17% compared to 0.59% in the TC group (p<0.05). The proportion of patients who reached the target level of HbA1c (<7.5%) was significantly higher in the RC group (32%) compared to the TC group (12.5%, p<0.05). During the study, the incidence of DKA and severe hypoglycemia in the RC group was statistically significantly lower.CONCLUSIONS: Remote monitoring in children with DM1 resulted in significant improvements in glycemic control (HbA1c, glycemic variability, and hypoglycemic frequency). The accumulation of evidence on the effectiveness and safety of telehealth in DM should contribute to implementing this approach in practical health care.

The purpose of this bibliographical review is to provide an exceptional and up-to-date overview of COVID-19 infection in children describing its epidemiology, pathogenesis, clinical features and outcomes. The article provides a comprehensive analysis of publications by foreign and Russian authors on a new coronavirus infection (COVID-19) caused by SARS-CoV-2 in children. A complete clinical description of the course of COVID-19 in pediatric population is given: from asymptomatic virus carrying till the development of acute pneumonia, multi-inflammatory syndrome, multiple organ failure and death. Among the clinical manifestations there are described as follows: respiratory syndrome, gastrointestinal tract injury, manifestations in the central nervous system, lesions of the skin and mucous membranes and a complete characteristic of multi-inflammatory syndrome. The studied methods of development of COVID-19 are examined in pathogenesis. The issues of anti-tuberculosis vaccination, the impact of serum cholecalciferol level on the severity and outcomes of COVID-19 disease are highlighted. The latest publications on intrauterine infection of the fetus and the breast milk research for the presence of SARS-CoV-2 were analyzed.

Data on the decrease in the overall performance of the MoCA-test (in particular, on assignments to memory and attention domains), atrophic changes in the cerebral cortex and violations of the content of the main metabolites of brain cells in patients with DM type 1 in comparison with the control group were obtained. A number of positive and negative correlations between these disorders and coefficients of glycemic variability were found in patients with DM type 1. The results suggest a significant negative effect of high levels of glycaemia variability on cognitive functions in patients with DM type 1.

Цель исследования -установить вклад клинико-лабораторных и метаболических факторов риска развития кардиоваскулярных нарушений в формировании персонифицированного подхода диагностики при ожирении у детей и подростков. Определение состава кишечной микробиоты производилось по методу Осипова, гормональные исследования осуществлялись методом ИФА. По результатам работы у детей с ожирением выявлено увеличение концентрации инсулина, триацилглицеролов и лептина, снижение концентрации ТМАО, инкретинов, глюкагона и резистина, в тонком кишечнике увеличена общая бактериальная и вирусная нагрузка, снижено видовое разнообразие, в микробиоте толстого кишечника отмечено снижение количества резидентной микрофлоры.Ключевые слова: ожирение, кишечная микробиота, триметиламиноксид, глюкагоноподобный пептид. Clinical, laboratory and biochemical aspects of the diagnosis of cardiovascular complications in obese children and adolescents

Background. Variability of glycemia is an important problem in the control of diabetes mellitus. It can be assumed that cognitive impairment associated with this disease is due to the fact that variability of glycemia affects not only the structure, but also metabolism of the brain. Objective — the study was aimed at assessing the values of glycemia variability, as well as their relationship with neuropsychological testing and magnetic resonance imaging data in patients with type 1 diabetes mellitus (DM1). Material and methods. We carried out a one-stage observational study of sex and age matched patients with DM1 and individuals without diabetes. All participants underwent neuropsychological testing, magnetic resonance imaging (MRI), and proton magnetic resonance spectroscopy (PMRS) of the brain; fasting plasma glucose and glycated hemoglobin (HbA1c) levels were assessed. The results of continuous monitoring of glycemia were analyzed in DM1 patients followed by calculation of glycemic variability coefficients. Results. DM1 58 patients demonstrated decrease in neuropsychological testing scores (p<0.05), decrease in the gray matter volume (p=0.004), and increase in the white matter volume (p=0.001), as well as impaired metabolism of the brain (p<0.05). Correlations between the total result of the MoCa test and LI (r=–0.34; p=0.008), MODD (r=–0.36; p=0.005), and ADRR (r=–0.28; p=0.032) were found. Negative relationship between the CONGA index and the volume of the left hippocampus (r=–0.27; p=0.044) was found. There were also some correlations between the glycemic variability indexes and the content of the main metabolites in different areas of the brain (p<0.05). Conclusion. MD1 patients with cognitive dysfunction demonstrated anatomical and metabolic brain disorders associated with glycemic variability.

РЕЗЮМЕСахарный диабет (СД) связан с изменениями в структуре головного мозга и ухудшением когнитивных функций от легкой до умеренной степени по данным нейропсихологического тестирования. В условиях растущей эпидемии СД и увеличения числа людей, доживающих до старости, когнитивная дисфункция, ассоциированная с СД, может иметь серьезные последствия для будущего общественного и практического здравоохранения. Хроническая гипергликемия, тяжелые эпизоды гипогликемии и микрососудистые осложнения являются важными факторами риска, общими для СД 1-го и 2-го типа. Также СД связан со структурными и функциональными изменениями в головном мозге, которые возможно диагностировать посредством различных вариантов магнитно-резонансной томографии (МРТ) головного мозга. В представленном обзоре рассмотрены исследования, проведенные за последние два десятилетия, чтобы улучшить понимание того, как СД влияет на функцию и структуру головного мозга. Также описаны изменения, характерные для СД 1-го и 2-го типа при проведении стандартной, функциональной МРТ и протонной магнитно-резонансной спектроскопии, и их особенности.Ключевые слова: сахарный диабет, когнитивные нарушения, нейровизуализационные методики.Конфликт интересов. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи.Источник финансирования. Авторы заявляют об отсутствии финансирования при проведении исследования.

This review summarizes the results from national and international studies regarding the quantitative and qualitative composition of intestinal microbiota in health and the dominance of certain bacteria in the intestinal microbiota of obese children. Moreover, we discuss the relationships between the development of obesity and the changes in the composition and metabolic activity of intestinal microbiota in children. These analyses are of scientific interest from the perspective of finding new targets and approaches to conservative management aimed at preventing and treating obesity through the restoration of intestinal microflora.

The present review encompasses the data from the Russian-language and foreign publications. Diabetes mellitus (DM) is currently considered to be a global socio-medical, psychological, and economic problem due to the high frequency of vascular complications resulting in early invalidization of the patients. Encephalopathy (EP) is one of the most severe complications of DM leading to the substantial deterioration of the quality of life. Both the markers and the diagnostic criteria of EP remain to be determined. Certain neurospecific proteins are believed to be predictors of this pathology.