Cavity Of Children Research Articles

Obliteration of the middle ear cavity in children: the current state of the problem and our first experience

In the period from May 2018 to November 2020, on the basis of the Federal State Autonomous Institution «National Medical Research Center of Children's Health» of the Ministry of Health of Russia, 28 children aged from 6 to 17-year-old with chronic otitis media and cholesteatoma were operated using osteoplastic obliteration, who had previously sanitizing operation on the middle ear. All children on admission to the hospital and 6-12 months after the operation underwent a complex examination. The condition of each patient was assessed using the OMO-22 quality of life questionnaire, to which the parents answered the questions twice - before and 1 year after surgery. During the postoperative period none of the patients had clinical signs of recurrence of cholesteatoma, which was confirmed by CT scan. When assessing the quality of life of children using a questionnaire, the average score before the operation was 130.2±27.7, after the operation - 61.5±21.1. The indicator of the bone-air interval before surgery in patients averaged 29.8±9.7 dB, 1 year after surgery - 13.0±10.9 dB (p>0.05). The first experience of using osteoplastic materials for obliterating the paratympanic spaces in children has shown high efficiency, ease of use and safety.

Specific features of the adhesion process of the abdominal cavity in children with different degrees of connective tissue dysplasia

Aim. To assess adhesions of the abdominal cavity in children with varying degrees of connective tissue dysplasia (CTD) severity.
 Methods. A total of 91 children with average age of 10.6 1.4 years were observed from 2005 to 2019. Composed of 53 boys (58.2%) and 38 girls (41.8%). Patients were divided into two groups: group 1 (69 children without CTD) and group 2 (22 children with CTD). Clinical data and screening cards were used to diagnose DST. All patients underwent an assessment for the clinical course, a macroscopic visual assessment adhesive process severity in the abdominal cavity according to three different scales (Nair, F. Coccolini, N.I. Ayushinova). Immunohistochemistry was performed against collagen I, III, IV type, Laminin 1, angiogenesis factors, transforming growth factor beta (TGF-), and Fibroblast Growth Factor Receptor 1 (FGFR1). A semi-quantitative counting method was used to record the relative number of immunopositive structures. Statistical analysis was carried out by methods of variation statistics using the Chi-square test and MannWhitney U-tests, as well as the Spearman rank correlation method for the reliability of differences between groups.
 Results. In the adhesive process visualization, the N.I. Ayushinov scale was revealed to be the most informative, showing the average score of 7 0.8 points in group 2 and 14 1.2 in group 1 (rs 0.35; p 0.05). In group 2, the adhesive material showed no (56%) or chaotic fragments (44%) of type I collagen, and the ratio of type I to type III collagen is 2.7: 5.1. In group 1, the ratio of type I to type III collagen is 5.9:1.8. The ratio of collagen IV to type I is 6.5: 2.9. Both groups have a moderate (++) amount of TGF-. TGF- is positive with macrophages. FGFR1 was found in the control group (++++). A positive response was seen in fibroblasts and macrophages (U = 79.00; p = 0.006). Statistically significant analyzes of vascular endothelial growth factor in compared groups (rs = 0.632, p 0.001) had a positive correlation..
 Conclusion. Thus, the study showed features of clinical course and morphological changes during the development of adhesions in the abdominal cavity in children with varying degrees of severity of CTD. Data obtained dictate the need for an individual approach in predicting adhesive disease, as well as targeted preventive care.

External Tube drainage Versus Omentoplasty In the Management of Residual Hepatic Hydatid Peri-cyst Cavity in Children.

External Tube drainage Versus Omentoplasty In the Management of Residual Hepatic Hydatid Peri-cyst Cavity in Children.

Clinical features of gingivostomatitis due to primary infection of herpes simplex virus in children

BackgroundPrimary herpetic gingivostomatitis (PHGS) in children, though usually self-limited, might mimic bacterial and enteroviral pharyngitis clinically. We conducted a study to define the clinical features of PHGS in children.MethodsBetween January 2012 and December 2016, 282 inpatients aged less than 19 years with cell culture-confirmed herpes simplex virus (HSV) infection in a medical center were identified from the virologic laboratory logbook. Clinical data were retrospectively collected.ResultsAmong the 282 inpatients, 185 cases were considered as PHGS and were included for analysis. Fever was present in 99.5%. The mean duration of fever was 5.11 days (±2.24) with the longest being 17 days. Common oral manifestations included oral ulcers (84.3%), which equally resided in the anterior and posterior part of the oral cavity (65.4% vs. 63.2%), gum swelling and/or bleeding (67.6%), and exudate coated tonsils (16.8%). Leukocytosis (WBC count > 15,000/uL3) was noted in 52 patients (28.1%) and a serum C-reactive protein level > 40 mg/L in 55 patients (29.7%). Fixty-five patients (35%) were diagnosed with PHGS on admission and were significantly more likely to have ulcers over the anterior oral cavity (76.1% vs. 26.7%) and gum swelling/bleeding (76.2% vs. 7.5%, p-value all < 0.001) on admission and were significantly less likely to receive antibiotic treatment (16.9 vs. 36.7%, p-value < 0.01) than others. Forty-six patients (25%) undiagnosed as PHGS on discharge were significantly more likely to have exudate coated on the tonsils, to receive antibiotic treatment and significantly less likely to have gum swelling/bleeding and oral ulcers (all p-values < 0.01).ConclusionsMeticulously identifying specific oral manifestations of gum swelling/bleeding and ulcers over the anterior oral cavity in children can help making the diagnosis of PHGS earlier and subsequently reduce unnecessary prescription of antibiotics.

Age-related description of the posterior structures of the nasal cavity in children

The aim of the study was to describe morphometric characteristics of the posterior parts of the nasal cavity in different periods of childhood and to specify the age-related norm for improving surgical treatment options of choanal atresia and providing an optimal access to the anterior part of the skull base. Material and methods. The study included 87 children aged 1-21 who were exposed to craniometry of the nasal cavity structures. Results. The age-related variability of the linear dimensions and shape of the choanae, their relationship with the dimensions of the pyriform aperture and the height of the nasal cavity in the posterior part were defined in the study. The increase in the height of the choanae and the height of the nasal cavity at the back starts from 2– 3 years of age, and the width – from 8–12 years of age. The height and width of the pyriform aperture are equal to the age of 8–12; these parameters increase in older children's groups with a predominance of the height over the width. The height of the nasal cavity at the back increases in all age periods. The growth of the studied structures of the nasal cavity is completed by adolescence. In infancy, the height of the choanae is less than the height of the nasal cavity at the back by 45%, and less than the height of the pyriform aperture by 20%; in adolescence, these ratios are 42% and 23%, respectively. In infancy the choanal width is less than the width of the pyriform aperture by 49%, and in adolescence – by 40%. In infancy and early childhood, the choanae are typically small in height and width. Their shape is round in 25% of cases, however, ovoid shape is also found. The height and width of the pyriform-shaped aperture at these age periods are similar and do not exceed 17–18 mm; the height of the nasal cavity at the back is 25–27 mm. Conclusion. The authors have described age-related morphometric features of the posterior structures of the nasal cavity. These features should be taken into account by otorhinolaryngologists and neurosurgeons when planning endoscopic intranasal surgical access in children. The younger the child is, the more difficult it is to perform a surgery due to the significant restriction of the access resulted from the small size of the piriform opening and the nasal cavity, and the obstinacy of the nasal septum. When performing choanotomy for atresia, it is necessary to form the choana comparing it in shape and size with the age-related norm

Diagnosis of early forms of dental caries in а primary school children

Relevance. At present the question of finding and applying effective methods and approaches for diagnosing early manifestations of dental caries in the form of foci of demineralization during eruption of permanent teeth in children remains an important and relevant issue. Timely diagnosis at the age of 6-7 years prevents the transition of the initial forms of caries into carious defects and further excludes the use of invasive methods of surgical recovery treatment. The aim is improving the approach of caries diagnostics approach by identifying foci of demineralization and hidden carious cavities in children during teething of permanent teeth.Materials and methods. An epidemiological examination of 380 children in Moscow aged 6-7 years was carried out. Of the total number of children examined by the method of randomization 150 people were selected, which are divided into 3 groups depending on the intensity of caries. Children of each group were diagnosed with caries using various diagnostic methods – visual inspection, vital staining, hardware method (Estus-LED-Alladin Multicolor (Geosoft, Russia).Results. In children 6-7 years of age in Moscow, the average prevalence and intensity of caries was established. However, the epidemiological examination does not take into account the number of foci of demineralization and hidden carious cavities, which can subsequently be transformed into destructive forms and cause an increase in caries. This indicates the need to improve the diagnostic approach using different methods for identifying early forms of caries. When using the hardware method, a greater number of foci of demineralization and hidden carious cavities were revealed on all surfaces of permanent teeth. There was a tendency to an increase in the number of foci of demineralization and hidden carious cavities depending on the intensity of caries.Conclusions. The effectiveness of the hardware method in the group of children DMF = 0 was 40,9% in comparison with the visual method and 36,4% in comparison with vital staining; with DMF = 1-2 – 35,4% in comparison with other methods, with DMF ≥ 3 – 43.3% in comparison with the visual and 40% in comparison with the vital. Diagnosis of early forms of caries made it possible to prescribe treatment and preventive measures in a timely manner and further reduce the growth of caries.

The use of decongestants for the treatment of runny nose symptom in children: the clinical and pharmaceutical analysis of the pharmaceutical market of Ukraine

The rational treatment of acute rhinosinusitis of infectious or allergic origin is an urgent task of both therapeutic and pediatric practice. This problem is of particular importance in connection with its prevalence in children, with a large list of drugs for the symptomatic treatment, the presence of significant side effects in active pharmaceutical ingredients, the peculiarities of the use of dosage forms, as well as a wide range of OTC drugs, including those approved for use in children.Aim. To develop recommendations for introducing changes or additions to the peculiarities of using decongestants for topical use in diseases of the nasal cavity (sympathomimetics, corticosteroids, antihistamines, etc.) in children (under 15 years of age) in the Protocol of the Pharmacist “Symptomatic treatment of rhinitis”.Materials and methods. To achieve the goal, the clinical and pharmaceutical analysis of decongestants for local use in diseases of the nasal cavity (sympathomimetics, corticosteroids, antihistamines, etc.), registered and marketed inUkraine was performed.Results. As a result of the study it has been found that in February 2020 there are 146 decongestants for local use in diseases of the nasal cavity registered at the Ukrainian market. 87.7 % of the drugs are OTC and can be used by patients/patient representatives independently. 12.3 % of the drugs (18 items, mainly from the group of corticosteroids) are dispensed by prescription. The analysis of the composition of decongestants has been performed; it has been found that agents based on oxymetazoline (21.2 %) and xylometazoline and its combinations (39 %) prevail. When studying the prescribing information it has been found that 136 of 146 trade names can be used in the case of a cold in children under the age of15. In addition, depending on the age, the ranking of their active pharmaceutical ingredients (APIs) can be presented by the following sequence: sodium chloride (0.65 %), phenylephrine hydrochloride (0.125 %), oxymetazoline hydrochloride (0.01 %). Clinical and pharmacological evaluation of undesirable effects of APIs and the ways of their prevention have been performed.Conclusions. The range and presence of undesirable effects of APIs of modern decongestants requires a cautious approach to responsible self-medication and a careful selection of the drug for the symptomatic treatment of acute rhinosinusitis in children. It is recommended to clarify the Protocol of the Pharmacist “Symptomatic treatment of rhinitis” on the possibility of using decongestants for topical use in diseases of the nasal cavity in children of different ages.

Candidal Species Seen in Oral Cavity of Children with Type I Diabetes Mellitus

Candidal Species Seen in Oral Cavity of Children with Type I Diabetes Mellitus

Formative and Pilot Study for an Effectiveness-Implementation Hybrid Cluster Randomized Trial to Incorporate Oral Health Activities into Pediatric Well-Child Visits.

Background: Dental caries in pediatric patients are noted to have broad impacts on systemic health and well-being. Thus, utilizing an effectiveness-implementation hybrid I design, the Pediatric Providers Against Cavities in Children’s Teeth (PACT) trial is investigating multi-level interventions at the practice (incorporation of oral health in electronic medical record [EMR]) and provider levels (theory-based didactic and skills training to communicate oral health facts to parent/caregiver, give a prescription to see a dentist and a list of area dentists) to increase dental utilization among 3 to 6 year old Medicaid-enrolled children attending well-child visits (WCV). The formative and pilot work for the larger main trial are presented. Methods: Formative work—Focus groups with 26 participants (Community leaders, providers, parent/caregivers); and key informant interviews with practice leadership (n = 4). Topics discussed were: core oral health (OH) information to communicate at WCVs and study logistics. Transcripts were coded and analyzed using Atlas.ti; Pilot study was refined using the formative findings and was conducted at two pediatric practices to test the implementation of: the provider didactic and skills training curriculum; EMR incorporation of four OH questions; logistics of incorporating OH activities at a WCV; and parent/caregiver recruitment. Results: Formative work showed that providers and parent/caregivers required knowledge of dental caries, and a list of area Medicaid-accepting dentists. Providers and practice leadership advised on the logistics of incorporating oral health into WCVs. All groups suggested asking parent/caregivers their preferred method of contact and emphasizing importance of OH to motivate participation. Utilizing these findings, the curriculum and protocol was revised. The pilot study in two practices successfully implemented the protocol as follows: all seven providers were trained in two 45 min didactic education and skills session; incorporation of OH questions into practices EMR; recruited 86 child-parent dyads (95% participation) at the WCV; providers delivered the OH intervention to parent/caregivers in <2 min and 90% completed EMR documentation of OH questions. These findings were instrumental in finalizing the main PACT trial in 18 practices. The RE-AIM framework is used in the main trial to collect effectiveness and implementation measures at baseline and follow-up visits. Conclusions: The formative and pilot findings were instrumental in refining the OH intervention and protocol which has resulted in successful implementation of the main trial. Trial Registration: Clinical trials.gov, Registered 9 November 2017, NCT03385629.

Dynamics of findings of non-specific resistance in the mouth cavity in children with lesions of the mucous membrane epithelium of the mouth cavity against acute lymphoblastic leukemia in the treatment process.

There was con­ducted study of dynamics of findings of non-specific resistance in the mouth cavity in children with lesions of the mucous membrane epithelium of the mouth cavity against acute lymphoblastic leukemia in the treatment process by authors-developed methods. It is known that in children with leukemia immunodeficiency states develop immunological disorders resulted from treatment with cytotoxic drugs. Moreover, not only general, but also the local immunity of the mouth cavity suffers, which is accompanied by development of infectious processes in the tissues that perform the barrier function, which include mucous membrane epithelium of the mouth cavity. A key role in the system of antimicrobial protection of the mouth cavity is performed by mucolytic enzyme lisocyme and α-defensins (HNP 1-3). 76 children with acute lymphoblastic leukemia aged from 2 to 18 years suffering from such dental diseases as generalized chronic catarrhal gingivitis, erosive-ulcerative and candidal stomatitis took part in the clinical study. All children under clinical study were divided into 2 groups - the main and comparison. Standard protocol treatment was used in the comparison group. Developed treatment-and-prophylactic complex was used in the main group. The children of the main group were prescribed developed treatment-and-prophylactic complex depending on the period of the disease: the first version of local treatment was used in the acute period and the relapse of the disease, the second - in the period of remission. The results of research have shown a stimulating effect of therapeutic and prophylactic measures on the natural antimicrobial system of mouth cavity protection, both in children of the main groups under study and in the comparison groups. Such a phenomenon should be considered as a positive process that contributes to the increase of resistance in periodontal tissues and mucous membrane epithelium of the mouth cavity.

Aspectos clínicos da cavidade oral de pacientes com a síndrome congênita do zika: revisão da literatura

RESUMO: O vírus Zika pertence a família Flaviviridae, gênero Flavivírus e foi descoberto em 1947 nos macacos rhésus, na floresta Zika em Uganda na África, daí a origem do nome Zika. Inicialmente apresentava os mesmos sintomas febris da dengue. Teve seu primeiro relato em humanos em 1960 ainda na África. Na década de 1970 o vírus se espalhou e chegou a Indonésia, India, Paquistão e Malásia. Seu principal vetor no Brasil é o mosquito Aedes aegypti. Entre o final de 2014 e início de 2015, surgiu um surto de uma doença exantemática clinicamente diferente da dengue. A confirmação da presença do vírus Zika no Brasil ocorreu em março de 2015. Coincidentemente em agosto do mesmo ano começaram a nascer crianças com microcefalia neonatal no estado de Pernambuco e em outros estados do Nordeste brasileiro. Diante desse surto desconhecido de microcefalia, o Ministério da Saúde declarou emergência nacional. Logo após, foi estabelecida uma relação causal entre o vírus Zika e a série de alterações congênitas que posteriormente foi denominada Síndrome Congênita do Zika. Em aproximadamente 90% dos casos, a microcefalia está associada a alterações neurológicas. O presente estudo teve como ênfase a seguinte questão norteadora: Existem alterações clínicas orais em pacientes acometido pela Síndrome Congênita do Zika? Tendo como objetivo relatar os aspectos clínicos da cavidade oral em pacientes com a Síndrome Congênita do Zika, através de um levantamento bibliográfico. Trata-se de uma revisão da literatura, realizada em publicações feitas a partir de 2014, utilizando as plataformas de pesquisa PubMed, Lilacs, Scielo, BVS e Google Acadêmico. Esses resultados apontam que podem existir alterações na cavidade oral em crianças com Síndrome Congênita do Zika, demonstrando que os efeitos causados pelo vírus Zika estão além dos danos neurológicos. Por se tratar de uma Síndrome recém-descoberta, os dados referentes aos achados clínicos orais em crianças com Síndrome Congênita do Zika são poucos e ainda precisam ser mais pesquisados. Sugerimos que sejam feitos estudos com exames complementares pra reforçar e até aumentar os achados clínicos das crianças com Síndrome Congênita do Zika.&#x0D; PALAVRAS-CHAVE: Microcefalia, Zika Vírus, Saúde Bucal.

Патогенетическое обоснование применения иммунотерапии в лечении рекуррентных ко-инфекций верхних дыхательных путей у детей с врожденными расщелинами губы и нёба

The synergism of the action of co-infecting microorganisms contributes to their overcoming the epithelial barrier, modification of the function of cells of the immune system (IS) and evading the immune response. In children with congenital cleft lip and palate (CCLP), despite elimination of the anatomical defect at an earlier age, the frequency of infectious and inflammatory diseases of the respiratory tract and oral cavity involving pathogen associations increases as they get older, at the same time defects in the functioning of IS are preserved. Objective. To develop immunotherapy program for children with CCLP, suffering from recurrent co-infections of the upper respiratory tract and oral cavity, based on the study of the dynamics of the microbial landscape transformation, IS dysfunction, clinical manifestations of infectious and inflammatory diseases of the upper respiratory tract and oral cavity in children with CCLP at different ages. Patients and methods. The study included 120 children from 1 to 12 years of age with CCLP at different stages of surgical treatment. The study was carried out: T and B lymphocytes, natural killer cells (FC500 "Beckman Coulter", USA), phagocytic and microbicidal functions of neutrophilic granulocytes (NG), serum IgA, IgM, IgG and sIgA levels in the oral fluid (ELISA), detection of microbial pathogens (microbiological analysis, ELISA) and viral (PCR). Results. Comprehensive examination of children with CCLP at different age periods, including characteristics of the clinical manifestations of infectious and inflammatory diseases, assessment of the microbial landscape of the oral cavity and upper respiratory tract with the identification of co-infection features, clarification of the variants of IS dysfunction, made it possible to reveal children with the most severe clinical manifestations of recurrent co-infections and to optimize treatment. Conclusion. The developed program of combined local interferon and systemic immunotherapy for immunocompromised children with CCLP contributes to the restoration of IS functions, anti-infective resistance and achievement of positive clinical effects in the form of regression of clinical signs of immunocompromise in patients with recurrent co-infections, which allows to obtain a protective effect and provide timely surgical care, to avoid complications in the postoperative period and at the stage of recovery, and by improving anti-infective immunity to enhance the quality of life of children with CCLP. Key words: children, congenital cleft lip and palate, co-infection, systemic immunity, microbiocenosis, immunotherapy

Allergic rhinitis in children: from diagnosis to therapy

Allergic rhinitis, according to modern data, affects up to a quarter of the population of developed countries. The disease affects not only the nasal mucosa, but also affects the receptors and mediators of inflammation in the bone marrow. A significant decrease in the quality of life of patients against the background of exacerbation of allergic rhinitis makes us look for new approaches to both the treatment of attacks and their prevention. Correction, including surgical, of concomitant pathology of the nasal cavity and paranasal sinuses significantly improves the quality of life of patients with allergic rhinitis. For a long time, surgical treatment of concomitant pathology of the nasal cavity in children was extremely limited due to the risk of damage to the growth zones and, as a consequence, a high probability of recurrence of deformation of the structures of the nose and paranasal sinuses. With the development of endoscopic methods of surgical treatment of the nasal cavity and paranasal sinuses, operations with minimal invasiveness and, as a consequence, safe at any age were introduced into practice. Surgical intervention on the structures of the lymphoid pharyngeal ring in children with allergic rhinitis is causing heated debate in the pediatric community to date. The article considers modern approaches to the diagnosis and treatment of allergic rhinitis in children. Topical problems of conservative and surgical treatment are discussed. Special attention is paid to the safety of various treatment regimens. The discussed practical issues of tactics of treatment of allergic rhinitis are relevant for both pediatric allergists and ENT pediatricians.

The Influence of Diffuse Nontoxic Goiter on the State of Protective Mechanisms of the Oral Cavity in Children.

Immunopathogenesis of inflammatory and dystrophic diseases of the tissues of the oral cavity is characterized by cellular and humoral factors of specific and nonspecific resistance, the functioning of which is determined by the overall somatic state.This study aimed to study the features of protective mechanisms of the oral cavity due to orthodontic pathology, pathology of periodontal tissues, and odontogenic inflammatory process in children with diffuse nontoxic goiter.Eighty children with diffuse nontoxic goiter aged 12-15 years with different dental status were examined. Evaluation of local immunity of the oral cavity was carried out by determining the content of sIgA, IgA, IgG, lysozyme activity, and levels of IL-1β, IL-4 by enzyme immunoassay.Immunological studies have shown that in children with diffuse nontoxic goiter, the activity of lysozyme in the oral fluid is decreased. The level of sIgА is also reduced by about 20%. Besides, there is an increase in the content of IgG and a growing trend in the level of IgА. The content of IL-1β and IL-4 in such children fluctuates more compared to somatically healthy children.In conclusion, a violation of the local protective mechanisms of the oral cavity is observed in children with diffuse nontoxic goiter. Also, the increase in the severity of dental pathology leads to increased tension of local protective and compensatory reactions.

The study of the prevalence of anomalies of the dentition in the bukhara region, their early diagnosis and treatment

The study of the prevalence of dentoalveolar anomalies and deformations, and the effectiveness of their treatment is an urgent problem, since it allows you to determine the need of the population for therapeutic and preventive orthodontic measures, calculate the necessary amount of orthodontic care, and determine the effectiveness of therapeutic and preventive measures (Sablina G.I, Kovtonyuk P.A., 2004). The exclusion of orthodontic care from dental care for children and adolescents and its transfer to the category of paid medical services has led to a sharp reduction in orthodontists working in children's dental institutions, and preventive work is not carried out among the children's team to prevent dentition. Over the past decades, many new methods and treatment tools have appeared in domestic orthodontics, allowing the orthodontist to carry out the necessary medical and preventive measures at the early stages of the formation of pathology. An algorithm will be developed for the treatment of patients with occlusion anomalies during the period of constant occlusion with the use of anthropometric measurements and an articulator at the final stage, which will increase the effectiveness of the treatment and achieve stable long-term results. A standardized examination of children with anomalies of the dentition will be carried out using the example of the Bukhara region. A comparison will be made of indicators of soft tissues of the oral cavity in children with abnormalities of the dentofacial system and a negative effect of occlusion pathology on the condition of the oral mucosa will be established.

Role of Caudal Epidural Block in enhanced recovery after pediatric oncologic surgery. Article

Introduction. Enhanced recovery after surgery and the early initiation of chemotherapy is a significant advantage of laparoscopic surgeries for malignant tumors of abdominal cavity in children. Despite the extensive experience in using caudal block in pediatric patients, it has not yet been determined whether the use of ultrasound navigation provides any clinical advantage in post-operative recovery after laparoscopic surgeries in pediatric oncology. Materials and methods. The study included 40 patients of Pediatric Oncology and Hematology, Federal Blokhin National Medical Research Center, ASA II–III, who underwent laparoscopic surgeries for malignant tumors of the abdominal cavity during 2017–2019. Patients were divided randomly into 2 groups. The CB (caudal blockade) group included 23 children. In CB group caudal epidural block as a regional component of combined anesthesia was used (CB group n = 23). GA (general anesthesia) group included 17 children who underwent general anesthesia (GA group, n = 17). Results. The median of the total dose of fentanyl in the CB group was 7.29 (6; 9.25) μg/kg, in the GA group — 10.7 (7.6; 12.5) μg/kg (р ≤ 0.012). In the postoperative period, patients in CB group didn’t require additional analgesia for 24 hours after caudal-epidural administration of morphine. After caudal-epidural administration of trimeperidin, 12 hours later. Enteral nutrition in children in the CB group was started in 4.7 ± 0.5 hours. In the GA group, enteral nutrition in 10 (59 %) patients was started in 20 hours after the end of the surgery. 5 children developed Conclusions. This study demonstrates that caudal epidural block for laparoscopic surgeries performed under ultrasound navigation provides effective analgesia in both perioperative and postoperative periods, promotes early start of enteral nutrition, minimizing the frequency of postoperative nausea and vomiting. Ultrasound navigation increases the likelihood of success and safety of the caudal epidural block.

A modified open technique using the Veress needle through facial defect for port insertion in pediatric laparoscopy

Laparoscopic procedures are being performed in infants and children much more frequently. Nevertheless, there is anxiety about complications resulting from port insertion due to the smaller abdominal cavity in children. Most complications are related to the entry of the first port. In this study, we present our patients who underwent laparoscopy using our modified Veress needle technique. The hospital records of the patients who underwent laparoscopy between 2010 and 2015 were evaluated retrospectively regarding intraoperative and postoperative complications. In all patients, the first port was inserted using our modified Veress needle technique. Laparoscopic procedures were performed on 139 patients. There were no major intraoperative or postoperative complications such as visceral or vascular injury in our patients. Only 5 (3.5%) minor complications were determined intraoperatively. Minor intraoperative complications included port dislocation (n = 2), intra-abdominal gas leakage (n = 1), subcutaneous emphysema (n = 1), and abdominal wall bleeding (n = 1). There were no minor complications postoperatively. In our technique, the umbilicus is pulled upwards strongly, reducing the risk of intra-abdominal injury.

The role of dental education of 7–8 year’s children in the complex of preventive measures

The article is devoted to the study of the intensity, prevalence of dental caries and oral hygiene indices among younger schoolchildren, against the background of a complex of preventive measures and dental education, which was carried out on an individual and group level in the conditions of a school dental office, and health lessons in classes. The dental study involved 106 primary schoolchildren, including 54 boys (51%) and 52 girls (49%) aged 7–8 years, who were examined on the basis of the dental office of the school №176 of Nizhny Novgorod. The children were divided into 2 groups: 1 – prevention group and 2 – control group. In 1 group of children every three months during the year we carried out professional oral hygiene, then treatment of all teeth with a deep fluoridation and training in the standard method of brushing teeth on models in a dental office. In addition, for children of group 1, we organized health lessons with training in the standard method of brushing teeth in the classroom, the use of additional hygiene products for the oral cavity in children of this age and the demonstration of a cartoon about dental caries. In the control group a set of preventive measures was also carried out in the form of professional oral hygiene and application of all teeth with the drug Gluftored, training in the standard method of brushing teeth on models every three months during the year, but dental education in the form of health lessons in the classroom was not. According to the clinical examination of 7–8 year’s children, it was revealed that during regular preventive measures and dental education among younger schoolchildren, the development of caries for permanent teeth is not observed, oral hygiene is improved, and dental health is rising.

CORRELATION RELATIONS OF CARISES AND SOCIO-HYGIENIC FACTORS

There is a demand in statistical processing of questionnaire data and objective screening of children with the usage of correlation analysis as well as interview with parents in order to increase their awareness about caries prevention and lifestyle. The emergence of caries in children 7-12 years of age is influenced by socio-hygienic factors. During the interview with parents, the effect of a combination of factors was found (i.e. avoiding referring to a dentist for the purpose of prevention or professional hygiene, neglecting the additional hygienic tools and methods and low awareness about them, regularity and balance of nutrition, lack of awareness concerning etiology of caries appearance, referring to a dentist only in case of toothache, anxiety during a visit to a dentist. Interview with children showed the impact of a combination of factors on the occurrence of caries. Among them are evasion of referring to a dentist for the purpose of prevention, lack of awareness concerning etiology of caries appearance, referring to a dentist only in case of toothache, anxiety during a visit to a dentist, low awareness concerning additional hygienic tools and methods. The combined effect of parental awareness and habits on the development of caries in children is much higher than the effect of the respective peculiarities of children. Thus, the analysis of caries appearance factors in children aged 7-12 years reveals the existence of close relationships between the alimentary, behavioral habits of parents and the appropriate habits of children and the development of pathological changes in the oral cavity of children which leads to the propagation of carious lesions. This requires improvement of preventive work with parents aimed at formation of healthy lifestyle habits and oral health care in order to prevent pathology of oral cavity and masticatory apparatus.

MALNUTRITION IN CHILDREN WITH UNREPAIRED OROFACIAL CLEFT: A SYSTEMATIC REVIEW

Background: The anatomical defect of the oral cavity in children with orofacial clefts presents them with feeding challenges which increase their risk of becoming malnourished. The objective of this review was to investigate the extent of malnutrition among children under 5 years with unrepaired cleft of the lip and/ or palate. Materials and Methods: A systematic literature search of published articles that assessed malnutrition in children with unrepaired cleft lip and/or palate was conducted. Pubmed Central, Cochrane library, Pubmed (MEDLINE) and Google Scholar databases were searched. Result: A total of 4,489 papers were found of which 8 were included in the review after meeting the inclusion criteria. Malnutrition was found to be higher in isolated cleft palate and cleft lip and palate infants than in isolated cleft lip infants who had nutritional status close to that of non-cleft infants. Syndromic cleft infants were highly malnourished compared to non-syndromic infants. Weight-for-age was the most assessed anthropometric indicator of nutritional status. Average prevalence of underweight (low weight-for-age) was 21.5%. Conclusion: Malnutrition is high especially within the first year of life in infants with unrepaired cleft lip and/or palate. Keywords: Cleft lip and palate, malnutrition, growth impairment, failure to thrive