Children's City Clinical Research Articles

Selective screening for celiac disease in patients with gastrointestinal symptoms: a retrospective study

Background. Currently, the effectiveness of various screening programs for celiac disease remains a matter of debate. According to most researchers, selective screening among patients with characteristic symptoms or at-risk groups is most effective. Aim. To evaluate the effectiveness of selective screening for celiac disease in patients with gastrointestinal symptoms. Materials and methods. In an open retrospective clinical study, the rate of celiac disease among 1,482 children who were examined in the Bashlyaeva Children's City Clinical Hospital and the most significant symptoms of the disease depending on age were identified. Results. The mean rate of celiac disease was 8.26%: from 6 months to 3 years 7.25%, from 4 to 7 years 10.28%, from 8 to 14 years 9.33%, and in adolescents from 15 years and older 4.05%. The most significant symptoms of the disease in young children were abdominal distension/flatulence, asthenia, and weight loss; preschool children had stool disorders (constipation, diarrhea), abdominal distension/flatulence, and anemia. At the age of 8–14 years, only nausea was statistically significantly associated with celiac disease. We have not identified any significant symptoms in the older age group. Conclusion. Our study has shown the high effectiveness of selective screening for celiac disease. The selective screening program is most effective in children of early and preschool age, which defines this age category as a target for introducing screening programs in medical check-ups before enrollment to preschool institutions and schools.

РАСШИРЕННЫЙ НЕОНАТАЛЬНЫЙ СКРИНИНГ ДЛЯ ВЫЯВЛЕНИЯ ВРОЖДЕННЫХ ДЕФЕКТОВ ИММУННОЙ СИСТЕМЫ: ОПЫТ МОСКОВСКОГО ЦЕНТРА НЕОНАТАЛЬНОГО СКРИНИНГА

Starting Jan., 2023 the extended neonatal screening (ENS) has been carried out in Russia that includes the determination of TREC/KREС markers, which in its turn allow suspecting severe combined immunodeficiency (SCID), phenotypical T-cell immunodeficiencies and X-linked agammaglobulinemia (XLA) prior to possible development of severe infectious complications. The purpose of the research was to evaluate the results of ENS for congenital immunodeficiency disorders (CIDs) in newborns in Moscow and to subsequently identify the most problematic issues in organizing of its implementation. Materials and methods used: the study was conducted in the Morozov Children's City Clinical Hospital (Moscow, Russia) among the 116,584 children born in Moscow in Jan. 01-Dec. 31, 2023 (this was the first year since the ENS introduction in Moscow) with a decrease in TREC/KREC below 100 copies per 105. Results: a total of 14 patients with CIDs were identified, of which 4 patients had a genetically confirmed form of SCID; 2 patients with immunophenotype of SCID; 3 patients with XLA; 2 patients with DiGeorge syndrome; single patient with a syndrome associated with a mutation in the PI4KA gene; and 2 patients with syndromic pathology without genetic confirmation. Thus, the frequency of detection of patients with the immunophenotype of SCID was a single case per 19,430 children, the frequency of patients with XLA was 1:38,861. 5 of 14 had already received hematopoietic stem cell transplantation, single patient was preparing for it at the time of the manuscript finalization. All of the patients receive regular immunoglobulin replacement therapy. Conclusion: the experience of an integrated approach to the provision of medical care based on neonatal screening in a municipal children's multidisciplinary hospital is presented; the results of the study helped identifying organizational shortcomings and determined the vector for its further development in order to improving of medical care provision to children with CIDs.

Chest wall reconstruction with a non-rigid synthetic rib prosthesis: a multicenter study

This retrospective multicenter study included 22 patients who underwent chest wall tumor resection with subsequent Codubix rib endoprosthesis reconstruction from 2019 to 2023. Four medical institutions participated in the study: P.A. Herzen Moscow Cancer Research Institute, Sverdlovsk Regional Oncology Hospital, Morozov Children's City Clinical Hospital and Kaluga Regional Oncology Hospital. Inclusion criteria were the presence of chest wall tumors, both primary and secondary, removal of more than 2 ribs, resection of the rib arch and the sternum. The median age was 60 years (48-66), 11 (50%) patients were females and 11 (50%) males. Operations for chest wall sarcoma, metastatic lesions, and lung cancer were performed in 9 (40.9%), 4 (18.2%), and 3 (13.6%) patients, respectively. The median number of removed ribs was 3 (2-4), with a maximum of 7. Sternotomy was performed in 9 (40.9%) patients, and subtotal resection of the body or handle of the sternum was carried out in 77.7%. Combined resections were performed in 14 (63.6%) patients. Radical tumor removal (R0) was achieved in 21 (95.5%) patients. Complications were observed in 9 (40.9%) patients, with intermuscular seroma being the most common in three (33.3%), followed by hydrothorax in 2 (22.2%), bilateral pneumonia, acute respiratory failure, and postoperative delirium in 1 (11.1%) patient each. One patient had the Codubix plate removed due to postoperative wound infection. The median overall and recurrence-free survival was not reached, and the 1-year recurrence-free survival was 63.9%, with an overall survival of 86.8%. Reconstruction with Codubix material allows for satisfactory functional and cosmetic results, characterized by a low complication rate and good adaptive properties.

Optimized interdisciplinary approach in the treatment of maxillary sinus upper wall fractures in children

To study the effectiveness and safety of the functional method of treating fractures of the upper wall of the maxillary sinus using endoscopic sinus surgery and a sinus balloon catheter. The study included 106 children aged 5 to 17 years with fractures of the upper wall of the maxillary sinus who underwent surgical treatment at the Morozovskaya Children's City Clinical Hospital from 2018 to 2023. Treatment was administered to children with pronounced bone defects, combined injuries, and ophthalmological symptoms. As a result of the treatment, all 106 children showed no hernial protrusions in the lumen of the maxillary sinus on control tomograms. There were no cases of decreased visual acuity or impaired eye movement function during follow-up by an ophthalmologist. Complete consolidation of bone fragments with restoration of the integrity of the sinus wall was achieved in 91.5% of patients; in the remaining 8.5% of cases, a bone defect in the upper wall of the maxillary sinus up to 1-2 mm in diameter was preserved according to CT data, which clinically did not manifest itself. The proposed technique using a sinus balloon catheter is preferable for children with fractures of the upper wall of the maxillary sinus. Due to the functionality of access, absence of the need for endoprosthetics of the bone walls of the sinus and orbit, minimization of disruptions to the growth zones of the facial skeleton, and achieving good functional and cosmetic results.

Сравнительная характеристика тестикулярной и уретральной микробиоты у пациентов с различными видами азооспермии и сопутствующим варикоцеле.

Introduction. Everywhere, about 15% of couples of reproductive age have the problem of infertility, with the male factor being the main cause in 50% of cases. The lack of effective treatment for male infertility is largely due to the multifactorial etiology of this disease. One of these factors is infections of the urogenital tract, the diagnostic search for which requires the development of new methods. Today, next generation sequencing (NGS), using the nucleotide sequence in the 16S rRNA region of the bacterial genome, is the most modern and highly sensitive method for determining the microbiome. Aim: to study and compare the structure of the testicular and urethral microbiota in patients with various types of azoospermia and concomitant varicocele. Materials and methods. The study included 107 infertile patients with various types of azoospermia, in some cases, with concomitant varicocele, who applied to the Center for Reproductive and Cellular Medicine of the State Budgetary Healthcare Institution of the Children's City Clinical Hospital in Krasnodar, Ministry of Health of the Republic of Krasnodar region. As a result of sample preparation, 31 samples did not meet the quality criteria and were excluded from the study. In all cases, patients underwent micro-TESE (multifocal testicular biopsy), as well as collection of biological material from the urethra. When studying the structure of the microbiome of testicular tissue, amplicons of the bacterial 16S rRNA gene were analyzed using high-throughput next-generation sequencing (NGS). Data were processed using the QIIME program (version 1.9.1). Results. Comparative characteristics of the structure of the microbiota of the urethra and testicles were carried out using average values in groups, at the level of phyla and families. When comparing the urethral microbiota, a similarity in the species composition of the microbiota was revealed in patients with nonobstructive azoospermia (NOA) and obstructive azoospermia (ОА), while the species composition of the testicular microbiota in patients with ОА is similar to that in patients with varicocele. As a result of data analysis, 6 phyla and 12 families of bacteria were identified that are common to both testicular and urethral tissue. When comparing the frequency of occurrence of these bacteria, differences were identified in the comparison groups. Conclusions. The microbiota of the urethra in men has a wide taxonomic composition, which has characteristics in infertile patients, caused, in our opinion, by disruption of the GTB, in particular, in patients with varicocele. The structure of the microbiota of testicular tissue has a decrease in species diversity in patients with non-obstructive azoospermia with the dominant Enterobacteriaceae_A family, in contrast to patients with obstructive azoospermia and patients with NOA and concomitant varicocele. The current situation and the discrepancy in scientific publications and expert opinions require further expansion of the range of scientific interdisciplinary research.

Syndromic Diagnostics of Respiratory Infections in Children As One of Antibiotic Management Tools in a Hospital

An observational, ambispective, non-interventional study was conducted to compare the effectiveness of introducing syndromic diagnostic according to the RP-2021 protocol on the basis of the pediatric departments of the Morozov Children's City Clinical Hospital. The study was carried out in two phases. The prospective phase (February–June 2022) was conducted using multiplex PCR tests (mPCR) – BioFire FilmArray respiratory panel – and routine diagnostic tests according to accepted standards for patient examination. The second phase of the study was a retrospective analysis of the comparison group’s (historical control group) primary medical records for standard test results from the same time frame, February to June 2021. Data on 40 patients on the historical control group were taken from the CIS EMIAS system.
 The mPCR results of the prospective group were available to the doctor several hours later, at the very beginning of the diagnostic algorithm. The length of the hospital stay in the prospective period following the introduction of mPCR testing was reduced by one day compared to the period before the introduction of this technology.
 The study showed that express methods of syndromic diagnostic testing allow to quickly establish the etiology of a respiratory infection for preterm infants, as well as children with bronchopulmonary dysplasia, bronchiolitis, comorbid patients, patients in the ICU with suspected influenza, whooping cough, and atypical pathogens, which in turn optimizes antibiotics prescription and hospitalization time. This study highlights the importance of rapid diagnosis of respiratory pathogens in pediatric patients under the age of five in order to optimize patient management when admitting them to the emergency department with a suspected acute respiratory infection. 
 In the prospective observation group after the introduction of mPCR testing, patients were significantly less likely to receive antibiotics — 47.5% (n=19) compared to the historical control group of 72.5% (n=29). The study presents the advantages of the syndromic approach to the diagnosis of respiratory infections in children as one of the most effective tools for increasing the rationality of antibiotic use in a children's hospital.

2020–2021 rhinovirus genetic diversity in Saint Petersburg

Introduction. Rhinoviruses represent one of the most common respiratory viruses and belong to the Picornoviridae family, genus Enterovirus, being divided into three types: A, B, C, which account for 169 types. Rhinoviruses predominate in autumn and spring periods, although they circulate throughout almost entire epidemic season. The rhinovirus genome is represented by a single-stranded 7.2 thousand base-long +RNA. According to the publications, the most common rhinovirus species is rhinovirus A (HRV-A), followed by rhinoviruses C (HRV-C) and finally rhinovirus B (HRV-B). The aim of our study was to define rhinovirus genetic diversity in Saint Petersburg . Materials and methods. The study was conducted at the Laboratory of Molecular Virology, Smorodintsev Research Institute of Influenza. Samples (smears from the nasopharynx and oropharynx) were delivered from the S.P. Botkin Clinical Infectious Diseases Hospital, St. Olga’s Children's City Hospital, N.F. Filatov Children's City Clinical Hospital No. 5. Outpatient samples were used as well. Samples received from December 2020 to October 2021 were analyzed. Detection of rhinoviruses was carried out by real-time PCR, typing — by Sanger sequencing, with primers developed by da Costa Souza L. et al. (2021). Results. According to total specimen testing, rhinoviruses comprise 3.2% total number of specimens tested. Of these, 71 rhinoviruses were typed, representing 17.03% total number of rhinovirus-positive specimens. The most common was HRV-A (55%), among which 21 types were found (the most common HRV-A46 is 13%, n = 5). HRV-B and HRV-C were found in equal numbers — 23% (n = 16) of each species out of total number of typed rhinoviruses. Among HRV-B, 8 types were found; the most common HRV-B06 comprised 33% (n = 5). Among HRV-C, 7 types were found (the most common types are HRV-C42, HRV-C32 and HRV-C15 — 19% each, n = 3). HRV-A was detected mainly in patients aged 18 to 65 years (57.5%, n = 23). HRV-B was detected only in adult patients (100%, n = 16). HRV-C was detected in children under 2 years of age (43.75%, n = 7) and adults aged 18–65 years (31.25%, n = 5). In some cases, HRV-A and HRV-C were associated with various respiratory tract syndromes such as acute nasopharyngitis, laryngotracheitis, obstructive bronchitis, and pneumonia. HRV-B was related to clinical manifestations of pneumonia in seven cases. Conclusion. Rhinovirus type A prevails in Saint Petersburg . Rhinoviruses can be associated with diverse respiratory tract syndromes.

Results of treatment for the posttraumatic neuropathies of peripheral nerves of the upper limb in children

BACKGROUND: Peripheral nerve injuries are severe types of injury with potential life-long impairment, which is crucial in the pediatric population. Considering the lack of literature on pediatric nerve lesions, we analyzed the results of treatment for children with injuries of the peripheral nerves of the upper extremities in the Department of Microsurgery of the N.F. Filatov Children's City Clinical Hospital.
 AIM: This study aimed to evaluate the results of treatment for children with injuries of the peripheral nerves of the upper limb and to establish the relationship between the recovery of the function of the upper limb and the time elapsed from the moment of injury to surgery.
 MATERIALS AND METHODS: From 2017 to 2021, 114 patients with injuries of the peripheral nerves of the upper limb were treated in the Department of Microsurgery. The following data were extracted from the case histories and at the follow-up appointment: age, gender, level of damage, type of surgical intervention, period from the moment of injury to surgical intervention, and postoperative recovery of peripheral nerve functions. For the assessment of the sensory function of the nerves, a discriminatory two-point sensitivity test (Weber Test) and the Grigorovich scale were used. Electromyographic and ultrasound studies were also performed. Subjective feelings were assessed using the QuickDash questionnaire. The digital data were subjected to statistical processing.
 RESULTS: Analysis of the results of treatment for children with different periods from the moment of injury to surgery found no differences among the groups up to 14 days and more than 14 days (p 0.05). For further data analysis, the patients were divided into four groups depending on the period from the moment of injury to surgery: 1) up to 3 months, 2) from 3 to 6 months, 3) from 6 to 12 months, and 4) more than 12 months. No differences were found in the results (p 0.05). According to the evaluation of the effect of age on the recovery of peripheral nerve function, better recovery of sensitivity was observed at the age of up to 11 years compared with at the age of more than 11 years (p 0.05).
 CONCLUSIONS: Considering the lack of statistically significant differences in the results of treatment for children at various times from the moment of injury to surgery, we can conclude that a period of more than 12 months from the moment of injury to surgery does not influence the achievement of satisfactory results of reconstructive surgical interventions for peripheral nerves in children.

Differential approach to the diagnosis and treatment of appendicular peritonitis in children

The incidence of appendicular peritonitis (AP) is 3-4 % among all acute surgical diseases in children, and the structure of acute appendicitis in recent decades fluctuates within 10-15 %. Timeliness and informativeness of acute abdomen diagnostics remain important tasks of clinical practice. The use of laparoscopy with its possibility of diapeutic approach allows to diagnose and eliminate the cause of the disease. On the basis of the surgical department of the Children's City Clinical Hospital No. 1 in Nizhny Novgorod. In the period from 2018 to 2022, 126 (11.2%) patients with various types of AP were treated in Nizhny Novgorod. All children were examined with assessment of general and local status, laboratory tests were performed using unified methods developed for practical healthcare. In complicated or doubtful cases, ultrasound of the abdominal cavity organs was performed (Vivid-7 of expert class using high-frequency transducers: convex (frequency up to 5 MHz) and linear (frequency up to 10 MHz). Local forms of AP prevailed – 90 %, of which appendicular abscess was found in 35 % of observations. Data of anamnesis, examination of patients, assessment of purulent-inflammatory markers in complicated and controversial situations were resolved by ultrasound of abdominal cavity organs. Instrumental diagnostics allowed them to detect anechogenic contents (effusion), delimited areas of absceding between the intestinal loops, perforation defect of the appendix wall, periappendicular abscess forming. Within the framework of surgical correction the priority was given to laparoscopy (59.5 %), a modern therapeutic and diagnostic method with a diapeutic approach. Open interventions were used in 51 (49.5%) patients, of which: Sprengel's access was performed in 31 (61%) patients, Volkovich-Dyakonov was used in 19 (37%) cases, midline laparotomy was performed in 1 child. Analysis of the results of bacteriological studies allowed us to identify the leading pathological pathogens belonging to Gram-negative or Gram-positive flora. In the postoperative period, therapy corresponding to the treatment of patients with peritonitis was prescribed. Evaluation of bacteriological examination revealed that Enterobacteriaceae (87%), non-fermenting bacteria (72%) were susceptible to all antibiotics. However, the highest susceptibility (73 %) was noted to cephalosporins. All children were discharged home in satisfactory condition, with an average bed-day of 12.32 ± 2.4.

Viral intestinal infections in young children in Baku

Viral pathogens are a common cause of acute intestinal infections, especially in young children. The purpose of the work is to assess the role of acute intestinal infection of viral etiology in children in Baku, depending on age. Materials and methods . 117 patients under the age of 3 years who were admitted to the Children's City Clinical Hospitals No. 1 and No. 7 of Baku with a diagnosis of «Acute intestinal infection» in 2019 were under observation. Etiological diagnosis of viral gastroenteritis of various etiologies (rotavirus, adenovirus and astrovirus) was carried out using enzyme immunoassay and immunochromatography. Results . Of the 117 samples examined, 58.9% of cases detected viral pathogens, namely group A rotavirus (RV) — 27.4 ± 4.1%, adenovirus 40/41 serotypes (AdV) — 18.8 ± 3.6%, and human astrovirus (HAstV) — 12.8 ± 3.1%. With rotavirus infection, the frequency of detection of pathogens increased from 26.7 ± 11.4% in children of the first year of life to 33.8 ± 5.4% in children in the age group of 1—3 years. The largest number of mono-adenoviral intestinal infections (40/41 serotypes) was detected in children aged 7—12 months - 33.3 ± 12.2%. It was found that human astroviruses were also detected most often in children aged 7— 12 months — 20.0 ± 10.3%. It was found that among mixed viral intestinal infections in young children, the association RV + AstV was more common (6.8 ± 2.3%). Among mixed cultures, the association frequency of RV + C. albicans prevailed and amounted to 7.7 ± 2.5% with predominant detection in the age group of 7— 12 months. — 20.0 ± 10.3%.

Эпидемиология ожирения у детей и подростков Новосибирской области в 2018–2022 гг.

Aim. To analyze the obesity prevalence in children and adolescents of the Novosibirsk region for the period 2018–2022, to assess the state of lipid and carbohydrate metabolism in children with primary obesity of 1–2 degrees without arterial hypertension. Design. An observational, descriptive, cross-sectional study. Materials and methods. The analysis of statistical indicators according to the annual reporting forms of federal statistical observation No. 12 in children and adolescents of the Novosibirsk Region and the patient database of the City Center for Endocrine and Metabolic Disorders in the Children's City Clinical Hospital No. 1 of the Novosibirsk Region for 2018–2022 was carried out. We also examined 154 children aged 6–17 years with primary obesity of 1–2 degrees, without arterial hypertension in medical history and at the time of examination; their standard lipid profile, fasting blood glucose, insulin, oral glucose tolerance test, Homeostasis Model Assessment (HOMA) and Triglyceride-Glucose Index (TyG) were examined. Results. According to the data of report form No. 12 in the Novosibirsk Region for 2018–2022, obesity is the leader among the endocrine system diseases in children and adolescents. The maximum number of cases of obesity among children and adolescents was registered in 2019 (9030 people; 1560.7 cases per 100 thousand population), the minimum — in 2021 (7289 people; 1235.6 cases per 100 thousand population). Among the examined children with primary obesity of 1–2 degrees, impaired glucose tolerance was detected in 5.2%, changes in the standard lipid profile — in 33.8%. The group of children with insulin resistance estimated by the HOMA index above 3.16 was 46 people (29.9%), according to the TyG index — above 7.98 — 78 children (50.6%). Conclusions. According to statistical reporting, the maximum number of cases of obesity among children and adolescents was registered in 2019, the minimum — in 2021, the incidence rate is lower than the prevalence of pathology in Russia. The highest prevalence of obesity was noted in the age group of 15–17 years. The revealed high comorbidity for the main components of the metabolic syndrome in patients with 1–2 degrees of obesity indicates the need for early examination, correction and monitoring of key cardiometabolic risk factors in this patients group. Keywords: obesity, prevalence of obesity, children, lipid and carbohydrate metabolism, dyslipidemia

Characteristics of measles in children during the rise in incidence in 2019

In Moscow, as in Russia, in 2019 there was an increase in the incidence of measles in recent years.Purpose: to analyze the course of measles in children hospitalized in 2019 during the period of rising incidence.Materials and methods: a retrospective analysis and statistical processing of 30 case histories of children hospitalized with measles in the infectious diseases department of the Children's City Clinical Hospital № 9 named after G.N. Speransky in 2019.Results: More than half of the patients were under the age of 3 years (53%). In 90% of cases, the sick were not vaccinated, in 73% – due to the refusal of their parents. Only 23% of patients had measles contact, mostly familial. Measles in hospitalized children proceeds typically, in 83.3% of cases in a moderate form, with characteristic pathognomonic symptoms: in 83.3% of patients, Belsky-Filatov-Koplik spots are detected, on average, on the 4.4 ± 0.8 day of illness, spotted – papular rash on the face with staged distribution and subsequent staged pigmentation in all patients. Complications develop in 66.7% of cases, more often pneumonia (36.7%) and obstructive bronchitis (20%), which in 16.7% of cases cause the severity of the course and lead to the development of emergency syndromes and conditions (respiratory failure, obstructive syndrome).Conclusions. Failure to vaccinate against measles contributes to morbidity with possible complications.

Внебольничные пневмонии у детей

The article shows a quantitative and structural analysis of community-acquired pneumonia in inpatients of the Children's City Clinical Hospital named after. V. M. Istomin for 2021. The intra-annual dynamics of morbidity was determined, the distribution of the disease among different age groups of patients was shown, the leading symptoms, morphological forms, and the localization of the pathological process were established. The average terms of the course of the disease associated with certain periods of the year are given. The territory with the largest number of children who fell ill with community-acquired pneumonia assigned to this medical institution was identified

New devices to control fever in children with COVID-19 and other acute respiratory infections

Introduction. When performing thermometry, different measuring instruments can be used: from contact individual to remote. Doubts about the accuracy of the measurements obtained arise in the course of severe infections, impaired general well-being, a feeling of fever, headache.The aim of the study was to evaluate the effectiveness of daily monitoring of body temperature in children with COVID-19 coronavirus infection and other acute respiratory viral infections using a medical thermograph designed to graphically display the dynamics of changes in the child's body temperature during the day to monitor its variability, compared to a halystone thermometer.Materials and methods. The clinical study was performed at two clinical sites of the Academician G.N. Speransky Department of Pediatrics, Russian Medical Academy of Continuing Professional Education: the Khimki Regional Hospital and the Z.A. Bashlyaeva Children's City Clinical Hospital. The study included 120 children aged from 3 months to 3 years, divided into 4 groups. Group 1 and 2 were children with ARI, Group 3 and 4 were children with COVID-19. Body temperature in the 1st and 3rd groups was measured only by a halistane thermometer; in the 2nd and 4th groups - by a new generation intellectual thermograph with halistane thermometer control in the specified time intervals.Results. The study obtained high reliability of indicators of the new thermograph, designed to graphically display the dynamics of changes in body temperature during the day, compared with the halistane thermometer, commonly used in hospitals.Conclusions. The thermograph registers the child's body temperature with high reliability, which makes it possible to react to its changes in time. The use of thermograph makes it possible to set the critical value of body temperature at its rise for each user individually depending on his premorbid background, which is especially important in the group of children with a high risk of febrile convulsions and microcirculatory disorders in terms of prevention of the possible development of adverse events.

Treatment of children with polyfractures of the pelvis

Moscow Institute of Pediatrics and Pediatric Surgery, Central Institute of Traumatology and Orthopedics named after V.I. II.II. Priorova, Russian State Medical University, Children's City Clinical Hospital No. 9, MoscowAn analysis of the results of clinical and radiological examination and treatment of 43 children with pelvic polyfracures in the acute and long-term periods of trauma, as well as sectional and experimental studies is presented. Established a high incidence of diagnostic errors and unsatisfactory outcomes in the treatment of children with pelvic polyfractures. The main reasons for the development of complications, depending on the localization and nature of pelvic injuries, were revealed, and the ways of their prevention were substantiated. A technique has been developed for the use of external fixation rod devices in the treatment of children with pelvic polyfractures. The effectiveness of the proposed therapeutic tactics is confirmed by the results of treatment of 12 children.

SARS-CoV-2 infection in children in Moscow in 2020: clinical features and impact on circulation of other respiratory viruses: SARS-CoV-2 infection in children in Moscow in 2020

ObjectivesThis study aimed to estimate the impact of the COVID-19 pandemic on the circulation of non-SARS-CoV-2 respiratory viruses and the clinical characteristics of COVID-19 in hospitalized children. MethodsA total of 226 and 864 children admitted to the Children's City Clinical Hospital with acute respiratory infection in September to November of 2018 and 2020 in Moscow were tested for respiratory viruses using multiplex polymerase chain reaction (PCR) and Mycoplasma pneumoniae/Chlamydia pneumoniae using enzyme-linked immunosorbent assay. ResultsThe detection rate of non-SARS-CoV-2 viruses in 2020 was lower than in 2018, 16.9% versus 37.6%. An increase in the median age of children with respiratory viruses was observed during the pandemic (3 years vs 1 year). There was no significant difference in the frequency of intensive care unit (ICU) admission in children with SARS-CoV-2 and other respiratory virus infections (2.7% vs 2.9%). SARS-CoV-2 and human rhinoviruses, human metapneumoviruses, and human adenoviruses showed significantly lower than expected co-detection rates during co-circulation. An increase in body mass index (BMI) or bacterial coinfection leads to an increased risk of ICU admission and a longer duration of COVID-19 in children. ConclusionsThe COVID-19 pandemic led to significant changes in the epidemiological characteristics of non-SARS-CoV-2 respiratory viruses during the autumn peak of the 2020 pandemic, compared with the same period in 2018.

Peculiarities of preparing a patient with a cochlear implant for a magnetic resonance imaging

To develop an algorithm of actions aimed at preparing a patient with a cochlear implant for magnetic resonance imaging (MRI). A deaf patient after bilateral cochlear implantation (CI) came to St. Vladimir Children's City Clinical Hospital (Moscow) with symptoms of the demyelinating disease for MRI of the brain and spinal cord. Magnet were removed for MRI, then new magnets were installed. The temporary removing magnet for MRI of the brain and spinal cord allows to significantly reduce artifacts of MRI images.

Анафилаксия среди детей, госпитализированных с острыми аллергическими реакциями: пятилетний ретроспективный анализ

Objective. To determine the frequency, range of triggers, features of clinical symptoms and treatment of anaphylaxis in children hospitalized with severe systemic allergic reactions in the pediatric department in Moscow. Patients and methods. We conducted a retrospective analysis of 1197 medical records of children admitted to the Z.A.Bashlyaeva Children's City Clinical Hospital with severe allergic reactions over the period from 2016 to 2020 to determine the clinical criteria for anaphylaxis. The diagnosis of anaphylaxis was made retrospectively in 86 patients based on corresponding reports of 2 independent allergy specialists. Results. The incidence of anaphylaxis among children hospitalized with severe allergic reactions was 7.18%. The use of the new WAOAG (2020) anaphylaxis criteria, compared with the previously adopted NIAID/FAAN (2006), slightly increased the coverage of patients diagnosed with anaphylaxis (7.18% vs 7.01%, respectively). Food allergens were the predominant cause of anaphylaxis in children (78%); the second most important trigger were medications (5%), and 7% of patients had idiopathic anaphylaxis. The main causes of food anaphylaxis were tree nuts (31%), cow's milk (19%), fish/seafood (16%), and chicken egg (9%); the frequency of anaphylactic reactions to peanuts did not exceed 4%. The incidence of anaphylaxis to cow's milk and chicken egg was higher in the group of children younger than 3 years (p = 0.003, p = 0.01, respectively), and the incidence of anaphylaxis to fruits was lower (p = 0.05) compared with patients aged 3-18 years. The proportion of anaphylaxis to tree nuts in children was highest and irrespective of patient age. In the development of anaphylaxis, skin/mucosal (98%) and respiratory (71%) symptoms were the most frequent, followed by gastrointestinal symptoms (29%) and laryngeal symptoms (26%). In hospital, anaphylaxis was diagnosed in 10 (12%) patients, and only 21% of children received epinephrine for the treatment of anaphylaxis. At discharge, epinephrine was recommended for 13% of patients. Conclusion. The diagnosis of anaphylaxis is to be excluded in patients with severe allergic reactions, since its incidence in this group of patients reaches 7.18%. Food allergens are the main trigger of anaphylaxis in children in the Russian Federation. The age-dependent spectrum of food anaphylaxis triggers in Russia suggests the use of diagnostic allergy panels in infants that include not only cow's milk, chicken egg, fish, but also tree nuts. Less than 1/4 of children receive epinephrine in the treatment of anaphylactic reactions; the rate of verification of the diagnosis of anaphylaxis and prescription of epinephrine is extremely low and does not exceed 13%. Key words: anaphylaxis, anaphylactic reaction, trigger, allergen, children, food allergy, infants

COVID-19 и коморбидная патология у детей

Objective. To analyze clinical and laboratory characteristics of COVID-19 in children with comorbidities admitted to the intensive care unit (ICU). Patients and methods. This study included 155 infants/children aged 1 month to 18 years with confirmed COVID-19 who were admitted to the ICU No. 2 of Z.A. Bashlyaeva Children's City Clinical Hospital, Moscow Healthcare Department between March 2020 and June 2021. The diagnosis was confirmed by epidemiological, clinical, and laboratory data. Results. Thirty-six out of 155 patients admitted to the ICU (23.2 ± 3.4%) had no comorbidities. Comorbidities were detected in 119 children (76.8±3.4%) with severe COVID-19, which manifested as multisystem inflammatory syndrome in children (MIS-C) (n = 16; 13.4 ± 2.7%), CT 1-2 pneumonia (n = 25; 21 ± 3.3%), CT 2-3 pneumonia (n = 7; 5.9 ± 1.9%), and CT 3-4 pneumonia (n = 19; 16 ± 3.0%). Viral pneumonia with MIS-C was observed in 10 children (8.4 ± 2.2%). Six patients (3.9 ± 1.6%) were diagnosed with generalized bacterial infection, which aggravated the course of COVID-19. Conclusion. A total of 76.8% of children in our study were found to have some comorbidities, which is a risk factor for severe COVID-19. The most common comorbidities included nervous system diseases, metabolic disorders (such as obesity), concomitant infectious diseases, etc. So far, the information on the effects of different comorbidities on the course of COVID-19 in children is limited, which necessitated the analysis of COVID-19 course in this cohort of patients. Key words: children, new coronavirus infection, SARS-CoV-2, COVID-19, pneumonia, multisystem inflammatory syndrome, comorbidity

Hemorrhagic colitis syndrome in children: the etiological structure in the infectious diseases clinic

The range of differential diagnostic search in the development of hemorrhagic colitis (hemocolitis) is wide enough and includes infectious and non-infectious factors. Purpose: clinical, laboratory and etiological analysis of bacterial diarrhea occurring with hemorrhagic colitis in the infectious diseases department.Materials and methods: a retrospective study of 141 case histories of those hospitalized in the infectious diseases department of the2 Children's City Clinical Hospital No. 9 named after G.N. Speransky of Moscow in 2019—2021 patients with clinical picture of hemocolitis. Hemocolitis was determined on the basis of macroscopic and microscopic signs (in scatology — mucus, leukocytes, erythrocytes) signs. All patients underwent routine laboratory examinations. The etiology was verified using modern methods of laboratory diagnostics (bacteriological analysis of feces, Latex test, ICA, ELISA, PCR, IHR).Results. There were 137 patients with infectious hemocolitis. Inflammatory bowel disease was diagnosed in 3 children, anus fissure — in 1 child. Young children under 3 years of age prevailed (77%). The etiology of infectious hemocolitis was deciphered in 47 patients (34%). Salmonellosis (36%) and shigellosis (36%) prevailed. Campylobacteriosis, clostridiosis-dificile and klebsiellosis accounted for 11%, 9% and 6% of cases, respectively. Yersiniosis was detected in 1 child at the age of 5 months. The severe form was found in 5.8% of cases, in most cases with shigellosis. Symptoms of intoxication and febrile fever were expressed in all patients, vomiting — in 28.5%, abdominal pain — in 94%, mesenteric adenitis on ultrasound — in 15%, diarrhea with a frequency of more than 5 times a day — in 84%, dehydration — in 64%, intercurrent diseases (ARVI, pneumonia) — in 41.3% of cases. Inflammatory changes in infectious hemocolitis were manifested by an increase in C-reactive protein in 71% (23.91 ± 24.17 mg/l), leukocytosis — in 69% (11.58 ± 3.52 х103 / μl), thrombocytosis — in 26%, an increase in the relative number of stab neutrophils in the general blood test in 78% of cases (10.95 ± 0.4%).Conclusions. Differential diagnostic search in the development of hemocolitis should include modern diagnostic methods, if necessary, additional instrumental studies and specialist consultations to exclude inflammatory bowel diseases.