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Влияние микробиоты кишечника и обеспеченности витаминами A и D на здоровье ребенка
Захарова И.Н., Дедикова О.В., Кучина А.Е., Сгибнева А.И. Влияние микробиоты кишечника и обеспеченности витаминами A и D на здоровье ребенка. Педиатрия. Consilium Medicum. 2021; 1: 25–29. DOI: 10.26442/26586630.2021.1.200824
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Zakharova IN, Dedikova OV, Kuchina AE, Sgibneva AI. Impact of gut microbiota and vitamin A and D supplementation on child health. Pediatrics. Consilium Medicum. 2021; 1: 25–29. DOI: 10.26442/26586630.2021.1.200824
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Аннотация
В настоящее время обсуждается влияние нутриентов на развитие и состояние здоровья ребенка начиная с внутриутробного развития и на протяжении всей дальнейшей жизни. Особое внимание уделяется питанию матери, наличию грудного вскармливания, приему таких добавок, как витамин D и пробиотики. Известно, что на состав микробиоты кишечника новорожденного ребенка негативное влияние оказывает прием антибиотиков матерью во время беременности или в раннем неонатальном периоде, что сказывается на развитии иммунной системы младенца, способствует развитию атопических заболеваний, включая атопический дерматит и бронхиальную астму, повышает риск развития ожирения и метаболического синдрома, болезни Крона, сахарного диабета 1-го типа и т.д. Различия в микробиоте особенно значимы после антибактериальной терапии по поводу экстренного кесарева сечения. Исследования показали возможность нормализации микробиоты в течение 1-го года жизни у младенцев, вскармливаемых исключительно грудью. В научной литературе обсуждается синергизм пробиотических штаммов кишечной микробиоты и витамина D.
Ключевые слова: кишечник, микробиота, пробиотики, витамин D, физическое развитие, концепция пищевого программирования, ось кишечник–легкие, иммунная система, инфекции дыхательных путей, кесарево сечение, штаммоспецифичность, дети
Ключевые слова: кишечник, микробиота, пробиотики, витамин D, физическое развитие, концепция пищевого программирования, ось кишечник–легкие, иммунная система, инфекции дыхательных путей, кесарево сечение, штаммоспецифичность, дети
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The influence of nutrients on the development and health of a child from its prenatal development and throughout its life is discussed now. Particular attention is paid to maternal nutrition, the presence of breastfeeding, the intake of supplements such as vitamin D and probiotics. It is known that the composition of the intestinal microbiota of the newborn child is negatively affected by the mother's taking antibiotics during pregnancy or in the early neonatal period, which affects the development of the infant's immune system, contributes to atopic diseases, including atopic dermatitis and bronchial asthma, increases the risk of obesity and metabolic syndrome, Crohn's disease, type 1 diabetes, etc. Differences in the microbiota are particularly significant after antibiotic therapy for emergency caesarean section. Studies have shown that it is possible to normalise the microbiota during the 1st year of life in exclusively breastfed infants. The synergism of probiotic strains of gut microbiota and vitamin D is discussed in the scientific literature.
Keywords: gut, microbiota, probiotics, vitamin D, physical development, concept of nutritional programming, gut-lung axis, immune system, respiratory tract infections, caesarean section, strain specificity, children
Полный текст
Список литературы
1. Berti C, Agostoni C, Davanzo R, et al. Early-life nutritional exposures and lifelong health: immediate and long-lasting impacts of probiotics, vitamin D, and breastfeeding. Nutr Rev 2017; 75 (2): 83–97. DOI: 10.1093/nutrit/nuw056
2. Tamblyn JA, Hewison M, Wagner CL, et al. Immunological role of vitamin D at the maternal–fetal interface. J Endocrinol 2015; 224: R107–R121.
3. Cetin I, Berti C, Calabrese S. Role of micronutrients in the periconceptional period. Hum Reprod Update 2010; 16: 80–95.
4. Palmer DJ, Huang R-C, Craig JM, et al. Nutritional influences on epigenetic programming: asthma, allergy, and obesity. Immunol Allergy Clin North Am 2014; 34: 825–37.
5. Collado MC, Cernada M, B€auerl C, et al. Microbial ecology and host-microbiota interactions during early life stages. Gut Microbes 2012; 3: 352–65.
6. Berti C, Cetin I, Agostoni C, et al. Pregnancy and infants’ outcome: nutritional andmetabolic implications. Crit Rev Food Sci Nutr 2016; 56: 82–91.
7. Kerr CA, Grice DM, Tran CD, et al. Early life events influence whole-of-life metabolic health via gut microflora and gut permeability. Crit Rev Microbiol 2015; 41: 326–40.
8. Broe A, Pottegard A, Lamont R, et al. Increasing use of antibiotics in pregnancy during the period 2000–2010: prevalence, timing, category, and demographics. BJOG 2014; 121 (8): 988–96.
9. Walker RW, Clemente JC, Peter I, et al. The prenatal gut microbiome: are we colonized with bacteria in utero? Pediatr Obes 2017; 12 (Suppl. 1): 3–17.
10. Mueller NT, Bakacs E, Combellick J, et al. The infant microbiome development: mom matters. Trends Mol Med 2015; 21 (2): 109–17.
11. Vidal AC, Murphy SK, Murtha AP, et al. Associations between antibiotic exposure during pregnancy, birth weight and aberrant methylation at imprinted genes among offspring. Int J Obes (Lond) 2013; 37 (7): 907–13.
12. Azad MB, Konya T, Persaud RR, et al. Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: a prospective cohort study. BJOG 2016; 123 (6): 983–93.
13. Bager P, Wohlfahrt J, Westergaard T. Caesarean delivery and risk of atopy and allergic disease: meta-analyses. Clin Exp Allergy 2008; 38: 634–42.
14. Thavagnanam S, Fleming J, Bromley A, et al. A meta-analysis of the association between Caesarean section and childhood asthma. Clin Exp Allergy 2008; 38: 629–33.
15. Decker E, Engelmann G, Findeisen A, et al. Cesarean delivery is associated with celiac disease but not inflammatory bowel disease in children. Pediatrics 2010; 125: e1433–e1440.
16. Pei Z, Heinrich J, Fuertes E, et al. Cesarean delivery and risk of childhood obesity. J Pediatr 2014; 164: 1068–1073.e1062.
17. Sevelsted A, Stokholm J, Bonnelykke K, Bisgaard H. Cesarean section and chronic immune disorders. Obstet Gynecol Surv 2015; 70: 303–5. DOI: 10.1097/01.ogx.0000466336.81671.9f
18. Huh SY, Rifas-Shiman SL, Zera CA, et al. Delivery by caesarean section and risk of obesity in preschool age children: a prospective cohort study. Arch Dis Child 2012; 97: 610–6. DOI: 10.1136/archdischild-2011-301141
19. Elovitz MA, Gajer P, Riis V, et al. Cervicovaginal microbiota and local immune response modulate the risk of spontaneous preterm delivery. Nat Commun 2019; 10 (1): 1305. DOI: 10.1038/s41467-019-09285-9
20. Anand S, Mande SS. Diet, Microbiota and Gut-Lung Connection. Front Microbiol 2018; 9: 2147. DOI: 10.3389/fmicb.2018.02147
21. Man WH, van Houten MA, Mérelle ME, et al. Bacterial and viral respiratory tract microbiota and host characteristics in children with lower respiratory tract infections: a matched case-control study. Lancet Respir Med 2019; 7: 417–26.
22. Jayawardena R, Sooriyaarachchi P, Chourdakis M, et al. Enhancing immunity in viral infections, with special emphasis on COVID-19: A review. Diabetes Metab Syndr 2020; 14 (4): 367–82.
23. Hardy H, Harris J, Lyon E, et al. Probiotics, Prebiotics and Immunomodulation of Gut Mucosal Defences: Homeostasis and Immunopathology. Nutrients 2013; 5 (6): 1869–912. Published online 2013 May 29. DOI: 10.3390/nu5061869
24. Preidis GA, Saulnier DM, Blutt SE, et al. Probiotics stimulate enterocyte migration and microbial diversity in the neonatal mouse intestine. FASEB J 2012; 26: 1960–9.
25. Huang Z, Liu Y, Qi G, et al. Role of vitamin A in the immune system. J Clin Med 2018; 7 (9): 258.
26. Siddiqui FQ, Ahmad MM, Kakar F, et al. The role of vitamin A in enhancing humoral immunity produced by antirabies vaccine. East Mediterr Health J 2001; 7 (4e5): 799e804.
27. Valeur N, Engel P, Carbajal N, et al. Colonization and immunomodulation by Lactobacillus reuteri ATCC 55730 in the human gastrointestinal tract. Appl Environ Microbiol 2004; 70: 1176–81.
28. Preidis GA, Saulnier DM, Blutt SE, et al. Host Response to Probiotics Determined by Nutritional Status of Rotavirus-infected Neonatal Mice. J Pediatr Gastroenterol Nutr 2012; 55 (3): 299–307. doi: 10.1097/MPG.0b013e31824d2548
29. Wacker M, Holick MF. Vitamin D – effects on skeletal and extraskeletal health and the need for supplementation. Nutrients 2013; 5: 111–48.
30. Wu S, Yoon S, Zhang Y-G, et al. Vitamin D receptor pathway is required for probiotic protection in colitis. Am J Physiol Gastrointest Liver Physiol 2015; 309 (5): G341–349.
31. Luthold RV, Fernandes GR, Franco-de-Moraes AC, et al. Gut microbiota interactions with the immunomodulatory role of vitamin D in normal individuals. Metabolism 2017; 69: 76–86.
32. Su D, Nie Y, Zhu A, et al. Vitamin D signaling through induction of Paneth cell defensins maintains gut microbiota and improves metabolic disorders and hepatic steatosis in animal models. Front Physiol 2016; 7: 498.
33. Milliken S, Allen RM, Lamont RF. The role of antimicrobial treatment during pregnancy on the neonatal gut microbiome and the development of atopy, asthma, allergy and obesity in childhood. Expert Opin Drug Saf 2019. DOI:10.1080/14740338.2019.1579795
34. Cardwell CR, Stene LC, Joner G, et al. Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia 2008; 51: 726–35.
2. Tamblyn JA, Hewison M, Wagner CL, et al. Immunological role of vitamin D at the maternal–fetal interface. J Endocrinol 2015; 224: R107–R121.
3. Cetin I, Berti C, Calabrese S. Role of micronutrients in the periconceptional period. Hum Reprod Update 2010; 16: 80–95.
4. Palmer DJ, Huang R-C, Craig JM, et al. Nutritional influences on epigenetic programming: asthma, allergy, and obesity. Immunol Allergy Clin North Am 2014; 34: 825–37.
5. Collado MC, Cernada M, B€auerl C, et al. Microbial ecology and host-microbiota interactions during early life stages. Gut Microbes 2012; 3: 352–65.
6. Berti C, Cetin I, Agostoni C, et al. Pregnancy and infants’ outcome: nutritional andmetabolic implications. Crit Rev Food Sci Nutr 2016; 56: 82–91.
7. Kerr CA, Grice DM, Tran CD, et al. Early life events influence whole-of-life metabolic health via gut microflora and gut permeability. Crit Rev Microbiol 2015; 41: 326–40.
8. Broe A, Pottegard A, Lamont R, et al. Increasing use of antibiotics in pregnancy during the period 2000–2010: prevalence, timing, category, and demographics. BJOG 2014; 121 (8): 988–96.
9. Walker RW, Clemente JC, Peter I, et al. The prenatal gut microbiome: are we colonized with bacteria in utero? Pediatr Obes 2017; 12 (Suppl. 1): 3–17.
10. Mueller NT, Bakacs E, Combellick J, et al. The infant microbiome development: mom matters. Trends Mol Med 2015; 21 (2): 109–17.
11. Vidal AC, Murphy SK, Murtha AP, et al. Associations between antibiotic exposure during pregnancy, birth weight and aberrant methylation at imprinted genes among offspring. Int J Obes (Lond) 2013; 37 (7): 907–13.
12. Azad MB, Konya T, Persaud RR, et al. Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: a prospective cohort study. BJOG 2016; 123 (6): 983–93.
13. Bager P, Wohlfahrt J, Westergaard T. Caesarean delivery and risk of atopy and allergic disease: meta-analyses. Clin Exp Allergy 2008; 38: 634–42.
14. Thavagnanam S, Fleming J, Bromley A, et al. A meta-analysis of the association between Caesarean section and childhood asthma. Clin Exp Allergy 2008; 38: 629–33.
15. Decker E, Engelmann G, Findeisen A, et al. Cesarean delivery is associated with celiac disease but not inflammatory bowel disease in children. Pediatrics 2010; 125: e1433–e1440.
16. Pei Z, Heinrich J, Fuertes E, et al. Cesarean delivery and risk of childhood obesity. J Pediatr 2014; 164: 1068–1073.e1062.
17. Sevelsted A, Stokholm J, Bonnelykke K, Bisgaard H. Cesarean section and chronic immune disorders. Obstet Gynecol Surv 2015; 70: 303–5. DOI: 10.1097/01.ogx.0000466336.81671.9f
18. Huh SY, Rifas-Shiman SL, Zera CA, et al. Delivery by caesarean section and risk of obesity in preschool age children: a prospective cohort study. Arch Dis Child 2012; 97: 610–6. DOI: 10.1136/archdischild-2011-301141
19. Elovitz MA, Gajer P, Riis V, et al. Cervicovaginal microbiota and local immune response modulate the risk of spontaneous preterm delivery. Nat Commun 2019; 10 (1): 1305. DOI: 10.1038/s41467-019-09285-9
20. Anand S, Mande SS. Diet, Microbiota and Gut-Lung Connection. Front Microbiol 2018; 9: 2147. DOI: 10.3389/fmicb.2018.02147
21. Man WH, van Houten MA, Mérelle ME, et al. Bacterial and viral respiratory tract microbiota and host characteristics in children with lower respiratory tract infections: a matched case-control study. Lancet Respir Med 2019; 7: 417–26.
22. Jayawardena R, Sooriyaarachchi P, Chourdakis M, et al. Enhancing immunity in viral infections, with special emphasis on COVID-19: A review. Diabetes Metab Syndr 2020; 14 (4): 367–82.
23. Hardy H, Harris J, Lyon E, et al. Probiotics, Prebiotics and Immunomodulation of Gut Mucosal Defences: Homeostasis and Immunopathology. Nutrients 2013; 5 (6): 1869–912. Published online 2013 May 29. DOI: 10.3390/nu5061869
24. Preidis GA, Saulnier DM, Blutt SE, et al. Probiotics stimulate enterocyte migration and microbial diversity in the neonatal mouse intestine. FASEB J 2012; 26: 1960–9.
25. Huang Z, Liu Y, Qi G, et al. Role of vitamin A in the immune system. J Clin Med 2018; 7 (9): 258.
26. Siddiqui FQ, Ahmad MM, Kakar F, et al. The role of vitamin A in enhancing humoral immunity produced by antirabies vaccine. East Mediterr Health J 2001; 7 (4e5): 799e804.
27. Valeur N, Engel P, Carbajal N, et al. Colonization and immunomodulation by Lactobacillus reuteri ATCC 55730 in the human gastrointestinal tract. Appl Environ Microbiol 2004; 70: 1176–81.
28. Preidis GA, Saulnier DM, Blutt SE, et al. Host Response to Probiotics Determined by Nutritional Status of Rotavirus-infected Neonatal Mice. J Pediatr Gastroenterol Nutr 2012; 55 (3): 299–307. doi: 10.1097/MPG.0b013e31824d2548
29. Wacker M, Holick MF. Vitamin D – effects on skeletal and extraskeletal health and the need for supplementation. Nutrients 2013; 5: 111–48.
30. Wu S, Yoon S, Zhang Y-G, et al. Vitamin D receptor pathway is required for probiotic protection in colitis. Am J Physiol Gastrointest Liver Physiol 2015; 309 (5): G341–349.
31. Luthold RV, Fernandes GR, Franco-de-Moraes AC, et al. Gut microbiota interactions with the immunomodulatory role of vitamin D in normal individuals. Metabolism 2017; 69: 76–86.
32. Su D, Nie Y, Zhu A, et al. Vitamin D signaling through induction of Paneth cell defensins maintains gut microbiota and improves metabolic disorders and hepatic steatosis in animal models. Front Physiol 2016; 7: 498.
33. Milliken S, Allen RM, Lamont RF. The role of antimicrobial treatment during pregnancy on the neonatal gut microbiome and the development of atopy, asthma, allergy and obesity in childhood. Expert Opin Drug Saf 2019. DOI:10.1080/14740338.2019.1579795
34. Cardwell CR, Stene LC, Joner G, et al. Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia 2008; 51: 726–35.
________________________________________________
1. Berti C, Agostoni C, Davanzo R, et al. Early-life nutritional exposures and lifelong health: immediate and long-lasting impacts of probiotics, vitamin D, and breastfeeding. Nutr Rev 2017; 75 (2): 83–97. DOI: 10.1093/nutrit/nuw056
2. Tamblyn JA, Hewison M, Wagner CL, et al. Immunological role of vitamin D at the maternal–fetal interface. J Endocrinol 2015; 224: R107–R121.
3. Cetin I, Berti C, Calabrese S. Role of micronutrients in the periconceptional period. Hum Reprod Update 2010; 16: 80–95.
4. Palmer DJ, Huang R-C, Craig JM, et al. Nutritional influences on epigenetic programming: asthma, allergy, and obesity. Immunol Allergy Clin North Am 2014; 34: 825–37.
5. Collado MC, Cernada M, B€auerl C, et al. Microbial ecology and host-microbiota interactions during early life stages. Gut Microbes 2012; 3: 352–65.
6. Berti C, Cetin I, Agostoni C, et al. Pregnancy and infants’ outcome: nutritional andmetabolic implications. Crit Rev Food Sci Nutr 2016; 56: 82–91.
7. Kerr CA, Grice DM, Tran CD, et al. Early life events influence whole-of-life metabolic health via gut microflora and gut permeability. Crit Rev Microbiol 2015; 41: 326–40.
8. Broe A, Pottegard A, Lamont R, et al. Increasing use of antibiotics in pregnancy during the period 2000–2010: prevalence, timing, category, and demographics. BJOG 2014; 121 (8): 988–96.
9. Walker RW, Clemente JC, Peter I, et al. The prenatal gut microbiome: are we colonized with bacteria in utero? Pediatr Obes 2017; 12 (Suppl. 1): 3–17.
10. Mueller NT, Bakacs E, Combellick J, et al. The infant microbiome development: mom matters. Trends Mol Med 2015; 21 (2): 109–17.
11. Vidal AC, Murphy SK, Murtha AP, et al. Associations between antibiotic exposure during pregnancy, birth weight and aberrant methylation at imprinted genes among offspring. Int J Obes (Lond) 2013; 37 (7): 907–13.
12. Azad MB, Konya T, Persaud RR, et al. Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: a prospective cohort study. BJOG 2016; 123 (6): 983–93.
13. Bager P, Wohlfahrt J, Westergaard T. Caesarean delivery and risk of atopy and allergic disease: meta-analyses. Clin Exp Allergy 2008; 38: 634–42.
14. Thavagnanam S, Fleming J, Bromley A, et al. A meta-analysis of the association between Caesarean section and childhood asthma. Clin Exp Allergy 2008; 38: 629–33.
15. Decker E, Engelmann G, Findeisen A, et al. Cesarean delivery is associated with celiac disease but not inflammatory bowel disease in children. Pediatrics 2010; 125: e1433–e1440.
16. Pei Z, Heinrich J, Fuertes E, et al. Cesarean delivery and risk of childhood obesity. J Pediatr 2014; 164: 1068–1073.e1062.
17. Sevelsted A, Stokholm J, Bonnelykke K, Bisgaard H. Cesarean section and chronic immune disorders. Obstet Gynecol Surv 2015; 70: 303–5. DOI: 10.1097/01.ogx.0000466336.81671.9f
18. Huh SY, Rifas-Shiman SL, Zera CA, et al. Delivery by caesarean section and risk of obesity in preschool age children: a prospective cohort study. Arch Dis Child 2012; 97: 610–6. DOI: 10.1136/archdischild-2011-301141
19. Elovitz MA, Gajer P, Riis V, et al. Cervicovaginal microbiota and local immune response modulate the risk of spontaneous preterm delivery. Nat Commun 2019; 10 (1): 1305. DOI: 10.1038/s41467-019-09285-9
20. Anand S, Mande SS. Diet, Microbiota and Gut-Lung Connection. Front Microbiol 2018; 9: 2147. DOI: 10.3389/fmicb.2018.02147
21. Man WH, van Houten MA, Mérelle ME, et al. Bacterial and viral respiratory tract microbiota and host characteristics in children with lower respiratory tract infections: a matched case-control study. Lancet Respir Med 2019; 7: 417–26.
22. Jayawardena R, Sooriyaarachchi P, Chourdakis M, et al. Enhancing immunity in viral infections, with special emphasis on COVID-19: A review. Diabetes Metab Syndr 2020; 14 (4): 367–82.
23. Hardy H, Harris J, Lyon E, et al. Probiotics, Prebiotics and Immunomodulation of Gut Mucosal Defences: Homeostasis and Immunopathology. Nutrients 2013; 5 (6): 1869–912. Published online 2013 May 29. DOI: 10.3390/nu5061869
24. Preidis GA, Saulnier DM, Blutt SE, et al. Probiotics stimulate enterocyte migration and microbial diversity in the neonatal mouse intestine. FASEB J 2012; 26: 1960–9.
25. Huang Z, Liu Y, Qi G, et al. Role of vitamin A in the immune system. J Clin Med 2018; 7 (9): 258.
26. Siddiqui FQ, Ahmad MM, Kakar F, et al. The role of vitamin A in enhancing humoral immunity produced by antirabies vaccine. East Mediterr Health J 2001; 7 (4e5): 799e804.
27. Valeur N, Engel P, Carbajal N, et al. Colonization and immunomodulation by Lactobacillus reuteri ATCC 55730 in the human gastrointestinal tract. Appl Environ Microbiol 2004; 70: 1176–81.
28. Preidis GA, Saulnier DM, Blutt SE, et al. Host Response to Probiotics Determined by Nutritional Status of Rotavirus-infected Neonatal Mice. J Pediatr Gastroenterol Nutr 2012; 55 (3): 299–307. doi: 10.1097/MPG.0b013e31824d2548
29. Wacker M, Holick MF. Vitamin D – effects on skeletal and extraskeletal health and the need for supplementation. Nutrients 2013; 5: 111–48.
30. Wu S, Yoon S, Zhang Y-G, et al. Vitamin D receptor pathway is required for probiotic protection in colitis. Am J Physiol Gastrointest Liver Physiol 2015; 309 (5): G341–349.
31. Luthold RV, Fernandes GR, Franco-de-Moraes AC, et al. Gut microbiota interactions with the immunomodulatory role of vitamin D in normal individuals. Metabolism 2017; 69: 76–86.
32. Su D, Nie Y, Zhu A, et al. Vitamin D signaling through induction of Paneth cell defensins maintains gut microbiota and improves metabolic disorders and hepatic steatosis in animal models. Front Physiol 2016; 7: 498.
33. Milliken S, Allen RM, Lamont RF. The role of antimicrobial treatment during pregnancy on the neonatal gut microbiome and the development of atopy, asthma, allergy and obesity in childhood. Expert Opin Drug Saf 2019. DOI:10.1080/14740338.2019.1579795
34. Cardwell CR, Stene LC, Joner G, et al. Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia 2008; 51: 726–35.
Авторы
И.Н. Захарова*1, О.В. Дедикова1, А.Е. Кучина1, А.И. Сгибнева2
1 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
2 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*zakharova-rmapo@yandex.ru
1 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
2 ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*zakharova-rmapo@yandex.ru
________________________________________________
Irina N. Zakharova1, Olga V. Dedikova1, Anastasiia E. Kuchina1, Aleksandra I. Sgibneva2
1 Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
2 Pirogov Russian National Research Medical University, Moscow, Russia
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.