Children In Belarus Research Articles

АТИПИЧНЫЙ ГЕМОЛИТИКО-УРЕМИЧЕСКИЙ СИНДРОМ У ДЕТЕЙ В РЕСПУБЛИКЕ БЕЛАРУСЬ: ПЕРВЫЙ ОПЫТ КОМПЛЕМЕНТБЛОКИРУЮЩЕЙ ТЕРАПИИ

Atypical hemolytic uremic syndrome (aHUS) is one of the most complex and severe forms of thrombotic microangiopathy with an unfavorable outcome in its natural course. The purpose of this research was to study the epidemiology, demographics, course and outcomes of aHUS in comparison with patients with typical hemolytic uremic syndrome (tHUS) as well as to conduct a personal analysis of all cases of aHUS and evaluate the response to therapy, including comple-ment-blocking with Eculizumab. Materials and methods used: the study was longitudinal, obser-vational and included all 349 cases of HUS in children in Belarus in 2015-2023. A comparative analysis of demographic and clinical data, laboratory results and outcomes was performed in pa-tients with HUS hospitalized at the Center for Pediatric Nephrology and Renal Replacement Therapy of the Republic of Belarus (Minsk, Belarus). Results: of 349 HUS cases, the proportion of aHUS was 3,7% (13). Children with aHUS were older (4,6 (1,6; 6,7) v. 2,7 (1,7; 4,8) y/o with tHUS) due to the portion of patients older than 5 y/o (46%). In aHUS, severe central nervous system disorders were more often observed (62% v. 14%, p=0,002), the development of critical conditions requiring transfer to mechanical ventilation (39% v. 9%, p=0,006), prolonged anuria with the need for dialysis therapy in 100% of cases and severe adverse outcomes (death or end-stage renal disease) during natural course (66,0% v. 2,7%, p<0,001). The most common trigger for aHUS was acute intestinal infections in 54% of cases. A genetic study was performed in 9 (69%) children with aHUS and in 8 (89%) of them the CFHR3/CFHR1 deletions were detected: in 4 cases (3 hetero- and a single homozygous) and heterozygous pathogenic and probably patho-genic gene mutations, CFHR5 in 2 cases, CFH in a single case and combined CD46 and CFI in a single case as well. Antibodies to complement factor H were detected in 5 patients, 3 of which had a CFHR3/CFHR1 deletion. Therapy with a biosimilar of the original Eculizumab showed its effectiveness in aHUS: in 3 (100%) children it was possible to prevent the return of the disease in the kidney graft, in single patient who did not receive prophylaxis it was able to block the recur-rence of aHUS in the transplanted kidney while preserving its function, in 3 (100%) patients with late administration of treatment the urine output was restored after prolonged anuria (24, 33 and 59 days); in a single child with the antibody variant of aHUS, with early administration of the drug, renal function was preserved. No complications of complement blocking therapy were not-ed. Conclusions: the introduction into clinical practice of a biosimilar of the original Eculizumab in children in Belarus has significantly improved the outcomes and prognosis of the disease.

Hereditary neuromuscular diseases in children of Belarus: Republican Register date

Background. In many countries, problems of rare orphan diseases have recently been discussed, more specifically, hereditary neuromuscular diseases (HNMDs). As for 2020 data, there were about 400 million people worldwide suffering from different types of rare diseases which comprise over 7,000 nosologies. The data from official statistics in many countries do not provide detailed information on the prevalence of HNMDs; it is possible to obtain precise information on morbidity, mortality, analyses of genetic causes, social impact, etc. only in those countries that have registries of patients with HNMDs. Materials and methods. To evaluate the situation with HNMDs in the Republic of Belarus, the pediatric population was examined. The Republican Center for Hereditary Neuromuscular Diseases (RC HNMD) for children was founded, based on which there were formed a computer database and the registry of patients with hereditary neuromuscular diseases. The age of patients was 0 to 18 years old (including 17 years 11 months 29 days). The study was designed as a retrospective, entire, and comparative (by nosologies). Results. As of December 31, 2020, the HNMDs registry for children (0–17 years) demonstrated that the HNMDs prevalence was 2.34 cases per 10,000 age-matched population. The results showed that in type I spinal muscular atrophy the median time before diagnosis verification decreased almost 3-fold: before 2019 it was 7 months, while in 2019–2020, Me = 2.6 months; p < 0.001. Also, there is a significant reduction of the period for verification of the diagnosis of type II spinal muscular atrophy, i.e. from Me = 16 months (before 2019) to Me = 7.5 months (2019–2020), p < 0.05, which demonstrates the importance of establishing a centralized RC HNMD for children in Belarus and substantiates the necessity of developing its structure and cooperation with other community-based and government organizations. Conclusions. Within the structure of HNMDs nosologies, the top ones were taken by Duchenne-Becker muscular dystrophy — 0.8 per 10.000 age-matched population people spinal muscular atrophy — 0.5 per 10,000 of age-matched population, hereditary polyneuropathies — 0.4 by 10,000 of age-matched population. The study results show that the proportion of children born preterm (before 37 weeks of gestation) from the total amount of all children with registered HNMD accounts for 6.4 %, while the highest rate was found for spinal muscular atrophy, which gives the reason to study children born preterm from the standpoint of alertness due to HNMD. The register data in the Republic of Belarus demonstrate the highest specific weight of dystrophynopathies within the structure of HNMDs, which made 40.8 % (178/436) from the total number of HNMDs cases of Registry with the prevalence of 0.95 per 10,000 age-matched population (0–17 years) along with limb-girdle muscular dystrophies, facioscapulohumeral muscular dystrophies.

Major Oncogenic Drivers and Their Clinicopathological Correlations in Sporadic Childhood Papillary Thyroid Carcinoma in Belarus.

Simple SummaryChildhood papillary thyroid carcinomas (PTCs) detected after the Chernobyl accident were genetically characterized by a high prevalence of gene rearrangements and low frequency of point mutations. However, no reports on genetic alterations in sporadic childhood PTCs from the Chernobyl-affected regions are available. This study investigated a series of PTCs from children of Belarus not exposed to radiation, and found that fusion genes were significantly more prevalent than point mutations in these tumors. Clinicopathologically, RET/PTC3 was associated with solid growth pattern and higher tumor aggressiveness, BRAFV600E and RET/PTC1 with classic papillary morphology and mild clinical phenotype, and ETV6ex4/NTRK3 with follicular-patterned PTC and the reduced aggressiveness. The spectrum of driver mutations in sporadic childhood PTC largely parallels that in Chernobyl PTC, although the distribution of oncogene types suggests less aggressive clinical presentation of sporadic PTC, especially than that of early-onset radiation-related PTC.Childhood papillary thyroid carcinoma (PTC) diagnosed after the Chernobyl accident in Belarus displayed a high frequency of gene rearrangements and low frequency of point mutations. Since 2001, only sporadic thyroid cancer occurs in children aged up to 14 years but its molecular characteristics have not been reported. Here, we determine the major oncogenic events in PTC from non-exposed Belarusian children and assess their clinicopathological correlations. Among the 34 tumors, 23 (67.6%) harbored one of the mutually exclusive oncogenes: 5 (14.7%) BRAFV600E, 4 (11.8%) RET/PTC1, 6 (17.6%) RET/PTC3, 2 (5.9%) rare fusion genes, and 6 (17.6%) ETV6ex4/NTRK3. No mutations in codons 12, 13, and 61 of K-, N- and H-RAS, BRAFK601E, or ETV6ex5/NTRK3 or AKAP9/BRAF were detected. Fusion genes were significantly more frequent than BRAFV600E (p = 0.002). Clinicopathologically, RET/PTC3 was associated with solid growth pattern and higher tumor aggressiveness, BRAFV600E and RET/PTC1 with classic papillary morphology and mild clinical phenotype, and ETV6ex4/NTRK3 with follicular-patterned PTC and reduced aggressiveness. The spectrum of driver mutations in sporadic childhood PTC in Belarus largely parallels that in Chernobyl PTC, yet the frequencies of some oncogenes may likely differ from those in the early-onset Chernobyl PTC; clinicopathological features correlate with the oncogene type.

Association Between 131I Exposure After the Chernobyl Accident and Thyroid Volume in Children in Belarus

Thyroid enlargement can cause problems with swallowing or breathing and a decrease in accuracy of screening for thyroid cancer. Exposure to radioactive iodines after the 1986 Chernobyl accident is known to increase risk of thyroid cancer in those exposed at a young age, but little is known about its effects on thyroid volume, which could have important clinical implications. The objective of this study is to characterize the dose-response association between iodine-131 (131I) exposure and thyroid volume using data from a Belarusian-American cohort study of residents of Belarus exposed during childhood. Persons exposed to Chernobyl fallout in Belarus at the age of 18 years or younger had individual 131I doses to the thyroid gland estimated from direct thyroid activity measurements, radioecological and biokinetic models, and interview data on whereabouts and dietary habits collected during baseline screening in 1996-2001 (N=11,970; median age 21 years). Thyroid volume was estimated from thyroid ultrasound measurements during screening. Individuals with diagnoses of benign or malignant tumors of thyroid gland, any thyroid surgery or aplasia, and missing thyroid volume measurements were excluded (n=1,104). Dose and thyroid volume were log-transformed due to right-skewed distributions. We used a multivariable linear regression to estimate the dose-response association between 131I dose to the thyroid and thyroid volume accounting for confounding effects of sex, age at screening, and place of residence at the time of screening, a proxy for endemic iodine deficiency. To examine nonlinear effects, we added a quadratic term for the log-transformed dose. Among 10,866 participants, dose to thyroid ranged from 0.0005 to 39 gray (Gy) (median=0.3 Gy). In a linear regression model adjusted for confounders, log thyroid volume was best described by a linear-quadratic function of log dose (p<0.001 for log dose and log dose-squared coefficients). The largest effect was observed for doses 0.3-0.6 Gy (14%), then gradually decreased. Subjects with thyroid dose of 1 Gy had an average thyroid volume 13.6% (95% CI 8-19.2%) higher compared to those with dose 1 mGy. Thyroid volume increased with age and was significantly higher for males compared to females and for those from Minsk city and area compared to other regions (both p<0.001). The adjusted R2-value was 30%, suggesting unaccounted factors that might better explain this association. This is the first study to assess the dose-response association between exposure to 131I and thyroid volume. Although statistically significant, the observed increase in thyroid volume with dose was small. Availability of measurements of iodine deficiency and dietary habits around the time of an accident in the future studies of nuclear accidents will be essential for understanding the mechanism of association between radiation dose and thyroid volume in young people.

ROLE OF IRF5 GENE POLYMORPHISM IN PREDISPOSITION TO JUVENILE-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS IN THE BELARUSIAN POPULATION

The IRF5 (interferon regulatory factor 5) gene encoding a transcription factor is involved in the regulation of interferon synthesis and other proinflammatory cytokines. It is assumed that the IRF5 gene is associated with juvenileonset systemic lupus erythematosus (jSLE), a chronic autoimmune disease that develops in childhood and differs from the adult subtype of SLE in a number of its manifestations. The aim of the presented work was to conduct a pilot study of IRF5 rs2004640 polymorphism in the population of children in Belarus and its association with the development of jSLE. Genotyping of DNA samples was performed using real-time PCR in a group of patients diagnosed with&#x0D; jSLE (38 people) and in the clinical control group without autoimmune and inflammatory diseases (378 people). The frequency of the IRF5 rs2004640 minor T allele was determined in the Belarusian population of children (under the age of 17). It was found that the rs2004640 TT genotype is associated with the risk of the jSLE development (OR = 2.27; 95% CI 1.08–4.76; p = 0.035) that after further investigations may improve an early diagnosis of jSLE.

Comparative Characteristics of the Somatometric Parameters of City School Children of Belarus aged 8-16 Examined in the Period from 1925 to 2010-2012

Objective: to study the changes of the somatometric parameters of city school children of Belarus aged 8-16 over time in the period from 1925 to 2010-2012.Material and methods. To study the somatometric parameters, over 2010-2012 the city school children (1423 boys and 1438 girls) aged 8-16 were examined by the method of V. V. Bunak. The following somatometric parameters were measured in the examined schoolchildren: body length and body weight, chest circumference. To assess the changes in the dynamics of the somatometric parameters of the city school children of Belarus over time, the obtained data were compared to the corresponding data obtained by Р. М. Моnоszоn-Luibina in 1925, by S. A. Lialikov and S. D. Orehovy over 1989-1997.Results. It has been found that the city school children of Belarus examined over 2010-2012 are characterized by higher indices of the somatometric parameters (body length and body weight, chest circumference) (p &lt; 0.05-0.001) as compared to their peers examined in 1925, and 1989-1997.Conclusion. The comparative analysis of the obtained data has made it possible to establish the presence of the process of acceleration in the city school children of Belarus aged 8-16 at the beginning of the 21st century.

Longitudinal study of the primary prevention effect on dental caries

Assessment of the dental caries prevalence among 12-year-old children in Belarus and Russia and evaluation a possible effect of the primary prevention programs on oral health in adult population. Meta-analysis of the world dental literature and study of the descriptive epidemiology data on the prevalence of dental caries among key age groups of children, adolescents and adults using earlier study data carried in Minsk and Moscow and within the intercountry scientific project using the EGOHID system in 2013-2017 yrs. Analysis of the epidemiology data on the DMFT of 12-year-old children in the last 40-50 years suggested a trend of the reduction of dental caries prevalence in Belarus and Russia by 10-15%. An effect of the long-term preventive programs on dental caries in adults and elderlies was dubious. The evident success in primary prevention of dental caries in children might improve oral health in adolescents and adult people, however, it had no, or minimal effects on the oral health of elderlies.

IgM nephropathy in children: clinical, immunological, pathomorphological features

BACKGROUND. Studies on the problem of IgM nephropathy in children in the world literature are few. Data on the disease in adults and children In Belarus have not previously been presented.THE AIM: to analyze the clinical, immunological, morphological characteristics, treatment regimen and prognostic factors of IgM nephropathy in children.PATIENTS AND METHODS. The study included 153 patients during the 6 years observed in the Republican Center for Pediatric Nephrology, among whom 21 were diagnosed with IgM nephropathy.RESULTS. Analysis of clinical, morphological features, the participation of markers of activation of T- and B-lymphocytes, pro-inflammatory and profibrotic molecules was performed.CONCLUSIONS. In most cases, IgM nephropathy is characterized by steroid dependence or resistance, or frequent relapses, which dictates the need to join cytostatic agent. In childhood is characterized by a benign course with no signs of progression.

Заместительная почечная терапия (ЗПТ) у детей в Республике Беларусь 2007-2016 гг. Анализ антропометрических данных пациентов на диализе и после трансплантации почки (Отчет по данным национального детского регистра ЗПТ)

Заместительная почечная терапия (ЗПТ) у детей в Республике Беларусь 2007-2016 гг. Анализ антропометрических данных пациентов на диализе и после трансплантации почки (Отчет по данным национального детского регистра ЗПТ)

Underweight, overweight and obesity in children and adolescents from Minsk, Belarus in the period 2001-2008.

Objective: The aim of the study is to consider the prevalence of all deviations from the body weight standard (underweight, overweight and obesity) among 4-18 years old children, adolescents and youths of Minsk, Belarus examined in the period 2001-2008. Subjects and methods: The measurements of 2969 children, teenagers and young adults carried out in the period 2001-2008 were used. Children were classified as underweight, normal weight, overweight and obese using Body Mass Index (BMI) cutoff points proposed by IOTF. Results: Underweight was recorded more often in girls (10.7%) than in boys (7.5%), differences are significant (p < 0.05). More frequent occurrence of underweight was typical for girls and boys of older age periods (11-18 years) - 11.6-14.2% and 8.9-9.6%, respectively. Overweight was found in boys and girls with the same frequency (10.9 and 10.7%, respectively). Obesity was more often observed in boys than in girls (2.3 and 1.8%). An increase in the proportion of overweight children (especially intensive in boys) was observed before the pubertal growth spurt. Conclusion: Our analysis showed a fairly low percentage of deviations from the standard body weight. The considerable variability of the data on the prevalence of overweight and obesity in children of Belarus obtained by different authors can be related both to differences in levels of living in different regions of the country and fairly rapid changes in this area due to socio-economic changes in society.

Condition and perspective of renal replacement therapy (RRT) in children in the Republic of Belarus

Objective: to assess the incidence, prevalence and outcomes of end-stage renal disease (ESRD) in children in Belarus, age and gender of patients, etiology of renal diseases leading to ESRD. The study included 121 children, who received RRT as of January 01, 2007 and all subsequent new patients, who started this therapy before December 31, 2016. Results. The incidence of ESRD in children in Belarus aged 0–14 years for the period 2007–2016 was 7 (6; 8) cases per year (4.8 (4.2; 5.2) per million age related population (pmarp)) and at the age of 0–17 years for the period 2009–2016 – 11 (9; 12) cases per year (5.6 (4.8; 6.8) pmarp). The prevalence of ESRD during the period from 2007 to 2016 increased by 31.7% in the group of 0–14 years [from 26 patients (18.3 pmarp) to 38 (24.1 pmarp) patients], and by 46.7% aged 0–17 [from 37 (21 pmarp) to 57 (30.8 pmarp)]. The main cause of ESRD was congenital abnormality of kidneys and urinary tract (44.6% of cases). As of December 31, 2016, 75.4% of children were transplanted, 15.8% received peritoneal dialysis and 8.8% – hemodialysis. 5 year RRT mortality rate was 17.9 deaths per 1000 patient-years and main course of death was infection complications (50%). Conclusions. The incidence of ESRD in children in Belarus corresponds to the average of ESPN/ERA–EDTA Register, the prevalence islower, but with a constant growth. The low mortality rate of patients on RRT and high transplantation activity with insufficient number of preemptive transplantations is maintained.

Роль та місце гендеру у системі освіти Pеспубліки Білорусь

The article highlights the legal framework for introducing a gender approach in the education system of the Republic of Belarus, analyzed documents related to the implementation of the gender component in the activities of educational institutions, namely the national action plans for gender equality, the document «Main Directions of the State Family Policy», the National Action Plans The National Program for Demographic Security, the Presidential Program «Children of Belarus», the State Employment Program, the Concept of Continuous Education of Children and Students in the Republic of Belarus. The article highlights the importance of gender issues for the development of society as a whole and of the individual in particular. The definition of the concept of «gender education» is given and emphasis is placed on the process of socialization as a leading factor in the development of gender identity and progressive views on gender issues. Stressed that should clearly distinguish between two levels of implementation of gender policy in the educational system of the Republic of Belarus – declarative and implementation. In declarative level made a significant number of regulations that ensure the development of gender education. In impelentatsiynomu level there are a number of problems are overcome only possible to achieve full.

Childhood asthma prevalence and risk factors in three Eastern European countries--the Belarus, Ukraine, Poland Asthma Study (BUPAS): an international prevalence study.

BackgroundThe prevalence of asthma and other allergic diseases among children living in Eastern is not well described. Our objective was to estimate and compare the prevalence of asthma, respiratory symptoms and allergic diseases in children in Belarus, Ukraine, and Poland as well as to identify risk factors for these conditions. We also sought to profile and compare children with asthma between locations.MethodsData were collected as a part of an international, multicenter, cross-sectional study of childhood asthma: The Belarus Ukraine Poland Asthma Study (BUPAS). Subjects were children aged 7–13 years attending primary and secondary schools in the urban and surrounding rural area of Grodno (Belarus), Ternopil (Ukraine) and Silesia Region (Poland). Physician-diagnosed respiratory diseases and symptoms as well as allergic diseases were ascertained using the ISAAC questionnaire completed by the parents.ResultsIn total there were 4019 children from Belarus (rural: 2018, urban: 2001), 4493 from Ukraine (1972; 2521), and 4036 from Poland (2002, 2034). The overall response rate was 76.7 %. Groups were similar in case of gender and age (p > 0.05). Almost all analyzed respiratory and allergic conditions differed significantly between countries including asthma [Poland (rural, urban): 3.5 %, 4.1 %; Ukraine: 1.4 %, 2.1 %; Belarus: 1.4 %, 1.5 %], spastic bronchitis (Poland: 2.7 %, 3.2 %; Ukraine: 7.5 %, 6.5 %; Belarus: 6.4 %, 7.9 %), and chest wheeze in the last year (Poland: 4.8 %, 5.2 %; Ukraine: 11.5 %, 13.0 %; Belarus: 10.7 %, 10.0 %). These differences remained after adjustment for potential confounders. Risk factor associations were generally similar between outcomes. Symptom characteristics of children with asthma between countries were not consistent. The ratio of current wheeze:diagnosis of asthma differed by country: (Rural areas: Belarus: 10.9:1, Ukraine: 17.3:1, Poland: 2.4:1; Urban areas: Belarus: 8.1:1, Ukraine: 7.3:1 Poland: 1.9:1).ConclusionsThe findings show large between-country differences and relatively low prevalence of asthma and allergic diseases in children of Western Belarus and Ukraine. There is evidence for underdiagnosis of asthma in these regions.

The feasibility of descriptive epidemiology in assessments of dental caries disease in children in Russia and Belarus.

this study aims to estimate significance of the descriptive dental epidemiology in evaluation of the long-term effect of the Community program for prevention of dental caries. The descriptive dental epidemiology data of DMFT 12-year-old children in Belarus and Russia were analyzed since 1961 to 2014. Meta-analysis of publications indicated that prevalence of dental caries has dropped from average 3.7-3.8 DMFT at baseline to 2.2-2.6 DMFT after 20 years of the programs implementation in Belarus and Russia accordingly. However, during last 5-6 years a negative trend was assumed. Based on long-term DMFT monitoring, the community programs in Belarus and Russia were effective in reducing dental caries by 30-40% for about 30-years period. However, the observed trend was not stable perhaps due to insufficient scientific support of programs.

Clinical and Pathologic Features of “Sporadic” Papillary Thyroid Carcinoma Registered in the Years 2005 to 2008 in Children and Adolescents of Belarus

A systematic analysis of the clinical and pathologic patterns of childhood "sporadic" thyroid carcinoma in Belarus, in the absence of the "Chernobyl radioactive iodine factor," has never been performed. The aim of this study was to establish the essential features of "sporadic" papillary thyroid carcinoma (PTC) in Belarusian children and adolescents, and the relationship of tumor pathology to extrathyroidal extension (ETE) and lymph node metastases. This was a retrospective population-based study with assessment of histological samples of 119 cases of thyroid cancer in Belarusian children and adolescents of 0-18 years old registered during 2005-2008 years. Sporadic PTC was noted in 94 children who were not exposed to the Chernobyl radiation release. None of the 119 cases of thyroid were follicular thyroid cancer. The incidence rate of PTC was 1.13 per 100,000 persons. The median age at diagnosis was 15.1 years with fourfold predominance of diagnosis in female patients. Relapse was detected in 2% of cases with median follow-up of 4.2 years. Median tumor size was 12 mm. Three percent of the cases of PTC had multifocal growth. The classical variant of PTC was registered in 46% of the patients with thyroid cancer, the follicular variant of PTC was noted in 20% of the cases. The percent of rare types of PTC (tall cell and diffuse sclerosing) were equal to that for solid PTCs (13%, 12%, and 10%, respectively). Adolescents had a pure papillary carcinoma more often compared to children who represented tumors with mixed papillary/follicular patterns more frequently (p<0.05). Two-thirds of the patients with PTC had regional lymph node metastases. ETE was established in 39 of 74 patients in whom ETE could be assessed by morphology. Multivariate analysis showed that lymphatic invasion was the strongest independent factor associated with both ETE (p<0.0001) and lymph node metastases (p<0.0001). In 2005-2008, sporadic thyroid cancer in children of Belarus was represented by high prevalence of PTC and absence of follicular thyroid cancer. Sporadic cases of PTC in Belarus were characterized by smaller tumor size, a small number of cases with multifocal growth, an equal number of rare types and solid PTCs, a relatively high prevalence of pure papillary variant of PTC in adolescents, and a low frequency of early relapses. A high frequency of ETE and lymph node metastases was detected. The strongest morphologic factor associated with both of them was lymphatic invasion.

Application of the M technique to two severely disabled children in Belarus

Following the early-morning explosion of reactor four at the Chernobyl nuclear plant on 26 April 1986, radioactive fallout fell over 80% of Belarus. More than 2.2 million people were affected, including thousands of children. As a result, there are now over 50,000 children in 600 orphanages in Belarus. Many of the orphanages are without basic amenities and are operating in dire circumstances. This article outlines two case studies of orphaned children with profound disabilities in one of these orphanages. The first author, a nurse volunteer from Ireland, used a method of touch called the 'M technique' to calm and soothe the children. The M technique is a gentle repetitive method of touch that can be learnt in a few hours. The results suggest that even when the situation appears very challenging, simple touch can have a beneficial effect.

Clinical and pathologic features of ‘sporadic’ papillary thyroid carcinoma registered in 2005-2008 years in children and adolescents of Belarus

Abstract Background: A systematic analysis of clinical and pathologic patterns of childhood 'sporadic' thyroid carcinoma in Belarus in the absence of the Chernobyl radioiodine has never been performed before. The aim of this study was to establish the main 'sporadic' PTC essentials in Belarusian children and adolescents, and relationship of tumor pathology with extrathyroid extension and lymph node metastases. Methods: This was a retrospective population-based study with assessment of histological samples of 119 cases of thyroid cancer in Belarusian children and adolescents of 0-18 years old registered during 2005-2008 years. Sporadic papillary thyroid carcinoma was established in 94 unexposed children, none had a follicular thyroid cancer. Results: The incidence rate of PTC was 1.13 per 100 000, median age at diagnosis was 15.1 years with 4-fold predominance of females. Relapse was detected in 2% of cases with median follow-up 4.2 years. Median tumor size was 12 mm, total number of PTC cases with multifocal growth was 3%. Classical variant of PTC was registered in 46%, follicular in 20%, tall cell in 12% of cases. Percentages of rare types of PTC (tall cell and diffuse sclerosing) were equal to solid PTC (13%, 12% and 10%, respectively). Adolescents had a pure papillary carcinoma more often comparing to children who represented tumors with mixed papillary/follicular patterns more frequently (p<0.05). Two of third PTC cases had regional lymph nodes metastases. Extrathyroid extension (ETE) was established in 39 of 74 patients in whom ETE could be assessed by morphology. Multivariate analysis showed that lymphatic invasion was the strongest independent factor associated with both extrathyroid extension (p<0.0001) and lymph nodes metastases (p<0.0001). Conclusion: In 2005-2008, sporadic thyroid cancer in children of Belarus was represented by high prevalence of PTC and absence of follicular thyroid cancer. Sporadic PTC in Belarus displayed lower tumor size, small number of cases with multifocal growth, equal number of rare types and solid PTC, prevalence of pure papillary variant in adolescents, and a low frequency of early relapses. High frequency of ETE and lymph nodes metastases was detected, and the strongest morphology factor associated with both of them was lymphatic invasion.

Lobectomy versus total thyroidectomy in children with post-Chernobyl thyroid cancer: a 15 year follow-up

In 1994, 21 Belarus children presenting papillary thyroid cancer (PTC) diagnosed after the Chernobyl disaster, and already submitted to subtotal surgery, underwent thyroid re-operation and post-operative radioiodine (131(I)) therapy. All were re-evaluated after a 15-year follow-up, to evaluate the results of partial versus total thyroidectomy. Nineteen out of 21 children (mean age 9.2years) had previously undergone a lobectomy. All cases underwent re-operation in 1994. Histology revealed a PTC in the residual lobe in three cases, three had lymph node metastases. After surgery, 20 patients underwent 131(I) therapy. The post-131(I) whole body scan was negative in seven cases, showed neck node metastases in five, lung metastases in three, multiple associated metastases in six. The follow-up was performed with rhTSH-stimulated serum thyroglobulin (Tg) evaluation and ultrasonography. Twenty patients showed Tg <1ng/ml and negative ultrasonography; the patient who refused 131(I) therapy showed a thyroid remnant and a Tg of 32ng/ml. Chi-square analysis showed significantly higher prevalences of residual cancer in the neck or lung, lymph node metastases, and re-operations (before completion) in patients who had undergone lobectomy than in those who had undergone completion thyroidectomy and 131(I) therapy. The surgical complications after lobectomy were similar to those after completion thyroidectomy. A less-than-total thyroidectomy should not be indicated in patients with radiation-induced PTC, due to the high risk of residual cancer in the thyroid left in situ. The results of this study favor total thyroidectomy as the initial treatment for thyroid cancer in children exposed to fallout radiation.

Ionizing radiation and leukemia in relation to the incidence in children of Belarus after the Chernobyl accident

The article contains the scientific facts regarding the radiogenic leukemia risks in children after the exposure of low doses ionizing radiation, as well as the results of the main completed epidemiological childhood leukemia studies in Belarus after the Chernobyl accident, and a discussion of the necessity of further researches taking into account the recommendations of the Chernobyl Forum and World Health Organization.

Thinking aloud about palliative care

The author offers some thoughts from the practice of hospice care for children in Belarus, where conditions are different from those in the majority of European countries. There is a brief sketch of the work of the Belarusian Children’s Hospice.