Children's Clinical Hospital Research Articles

Episodic syndromes associated with migraine (clinical and epidemiological study in pediatric practice)

Migraine in children can manifest itself in non-pain clinical phenotypes, among which several episodic syndromes associated with migraine (ESAM) are identified. A significant association with the later development of migraine was found for infantile colic syndrome, benign torticollis, abdominal migraine (AM), cyclic vomiting syndrome (CVS) and benign paroxysmal vertigo (BPV).Objective: to identify the clinical and epidemiological characteristics of childhood ESAM and its association with migraine.Material and methods. The study was conducted in Tambov Children's Clinical Hospital. A total of 250 children were included in the study: 120 (48%) girls and 130 (52%) boys aged 5 to 18 years (mean age 13±2.9 years, median age 13 [11; 15] years) with headache complaints. The diagnosis of ESAM was made according to the ICHD-3 criteria.Results. ESAM was observed in 95 (38%) patients aged 5–18 years. An analysis of the prevalence of ESAM in the different age groups showed that in children aged 5–10 years CVS (n=12; 4.8%) was more common than AM (n=6; 2.4%) and BPV (n=5; 2%). In the group of 11–14 year-old children, the frequency of AM clearly predominated (n=11; 4.4%), while in the group of 15–18 year-old adolescents, BPV (n=15; 6%) was observed more frequently compared to CVS (n=9; 3.5%) and AM (n=5; 2%).Conclusion. The results of the study indicate a high incidence of ESAM in child and adolescent patients of somatic and neurological hospitals. The data obtained show the importance of timely diagnosis and correct treatment of ESAM.

D-dimer as a Useful Biomarker in Early Diagnosis of Neonatal Sepsis: A Single-Center Study From Romania.

This study evaluates the role of D-dimer in identifying neonatal sepsis and their potential value in clinical decision-making due to challenges in early detection. A case-control study was conducted on 102 neonates at the Children's Clinical Hospital "Louis Turcanu" in Timisoara, Romania, from October 2018 to July 2023. The participants were divided into two groups: those with neonatal sepsis and those without sepsis. The study found that neonates with sepsis were more likely to be delivered by cesarean section and had higher rates of premature ruptured membranes compared to those without sepsis. The D-dimer biomarker's predictive value for sepsis was assessed using a receiver operating characteristic (ROC) curve, with an area under the curve (AUC) exceeding 0.982 and an optimum cutoff value of 342 ng/mL. An increase in neonatal D-dimer significantly increases the likelihood of sepsis by 2.7% per unit increase. A value above 250 ng/mL indicates a 127-fold increased likelihood of sepsis. The D-dimer's ability to predict mortality innewborns with sepsis is unsatisfactory, with an AUC of 0.528. D-dimer, a potential biomarker of neonatal sepsis, warrants further clinical investigation to enhance diagnostic sensitivity and specificity, demonstrating its potential in conjunction with other sepsis markers.

Robot-assisted treatment of simple renal cysts

BACKGROUND: The gold standard in the surgical treatment of simple renal cysts is laparoscopic cyst fenestration. However, laparoscopic procedures have disadvantages which include poor ergonomics of the instruments hindering surgeon's work in children's small abdomen. Robot-assisted surgery has the potential to make surgeon's work easier and to improve surgical outcomes in patients with kidney cysts for the instruments have seven degrees of freedom, hand tremor is filtered. It also promotes comfortable console positioning for the surgeon, and three-dimensional wide-angle imaging of the surgical field. AIM: To present the first experience of applying robot-assisted surgery for fenestration (decortication) of the outer portion of the cyst and argon-plasma coagulation of its inner lining. METHODS: The author's present retrospective data of all patients with simple renal cysts operated on with robot-assisted approach at the Irkutsk State Regional Children's Clinical Hospital. The diagnosis was put after ultrasound examination of kidneys and after computed tomography with intravenous contrast agent. Surgery was performed using a new model of the Versius robotic system manufactured by Cambridge Medical Robotics (UK). RESULTS: Patients' mean age at the time of surgery was (13±5.3) years (median 15 [11; 16] years), mean weight — (46.7±17.2) kg (median 54 [40.5; 56.5] kg), smallest body weight — 27 kg, size of cysts — (1.8±2.4) cm (median 0.4 [0.4; 2.5] cm). Cystic formations in all patients were located on the left: in the upper pole in 2 patients, in the lower pole in 1 patient. During the surgical intervention, there were no complications in the form of bleeding from the kidney parenchyma or damage to neighbouring organs. Histological analysis revealed that the lining of the cyst wall contained transitional epithelium without signs of malignancy. Duration of surgery was (136.7±72.2) min (median 95 [95; 157] min), duration of patients' stay in the intensive care unit — (19.9±2.5) hours (median21.3 [19.1; 21.4] hours), duration of hospital stay — (9.3±2.3) days (median 8 [8; 10] days). Ultrasound examination made in 1, 3 and 6 months after the surgery revealed no signs of disease recurrence in the form of residual accumulation of fluid associated with kidney parenchyma. CONCLUSION: The experience described in the article is encouraging and confirms the reasonability and safety of robot-assisted procedures in pediatric urology.

РОБОТ-АССИСТИРОВАННЫЕ ОПЕРАЦИИ В ДЕТСКОЙ АБДОМИНАЛЬНОЙ ХИРУРГИИ: ПЕРВОНАЧАЛЬНЫЙ ОПЫТ

Purpose of this research was to apply the possibilities of robot-assisted surgery technology in children with abdominal pathology in terms of assessing feasibility and evaluating postoperative results. Material and methods used: the scientific study was carried out at the Irkutsk Oblast Regional Children's Clinical Hospital (Irkutsk, Russia) in Dec. 2022-June 2023. During this period, 11 robot-assisted procedures were performed on the abdominal organs. The study was conducted within the framework of the Clinical Trials Program for Medical Products approved by the Federal Service for Surveillance in Healthcare of the Russian Federation. All surgical procedures were implemented according to the same principles and patterns that the Authors have gathered previously with the Versius Surgical Robot. In all cases, the three robotic ports were used: a single 12-mm trocar for optics (intervened at the umbilicus) and two 5-mm trocars for robotic arms. Additionally, another 5-mm laparoport was installed for the assistant surgeon to work during the robotic intervention. During the study, patients' perioperative parameters related to data charts, surgical details and both early and long-term outcomes were recorded. Results: the total number of patients involved in robotic interventions on the abdominal organs was 11, 4 (36,4%) boys/7 (63,6%) girls. The mean age at the time of surgery was 10,9±5.1 y/o (Me 12.0 [7.0; 15.0] y/o), mean weight at the time of surgery was 39.7±18.0 kg (Me 43.0 [24.0; 53.8] kg). The distribution of reasons for surgical interventions was as follows: 3 (27,3%) patients with Nissen fundoplication, 3 (27,3%) patients with cholecystectomy, 2 (18,2%) patients with Heller esophagomyotomy with Dor fundoplication, 2 (18,2%) patients with splenic cyst fenestration and a single (9%) patient with enucleation of ovarian teratoma. The mean duration was 100±52.4 min (Me 70.0 [65.0; 122.5] min). None of the operations were accompanied by any intraoperative complications. There were also no conversions into laparoscopic and/or open surgeries. In the long-term period after the operations, the number of significant complications in the form of recurrence of symptoms of the initial disease did not increase, patients showed no digestive problems during the entire follow-up period as well. Conclusion: Russia’s initial experience with robotic-assisted abdominal surgery confirmed that robotics can be safely and effectively used in children. Fundoplication, esophagomyotomy and cholecystectomy are by far the most commonly performed basic interventions in pediatric surgery. Obviously, this is the first stage in the development of robotic abdominal surgery in children hence it would further involve a more complex procedure.

Клинический случай идиопатической формы синдрома Свита

Background. Sweet’s syndrome (acute febrile neutrophilic dermatosis) is an extremely rare disease of the group of neutrophilic dermatoses with undulating courses of illness, which is an inflammatory non-infectious skin reaction characterized histopathologically by the presence of dense diffuse neutrophil infiltrate in the dermis without signs of leukocytoclastic vasculitis, edema and fragmentation of neutrophil nuclei. The mechanism of development of this disease is presumably associated with a cytokine-mediated hypersensitivity reaction followed by neutrophil infiltration of the dermis, however, the etiology of the development of this pathogenesis is not known. Sweet syndrome is a current problem, since complications can occur in the form of damage to the organs of the central nervous system, eyes, lungs, skin breakdown, as well as changes in the immune system in the form of immunodeficiency. Aim. To evaluate, describe, study the courses and complications of the idiopathic form of Sweet’s syndrome. Materials and methods. Study of examination data of a (3-year-old girld) who was being treated at the department of pulmonology of Kursk Regional Children's Clinical Hospital. Study and analysis of scientific literature on the problem of Sweet's syndrome. Conclusion. As a result of studying this Clinical case, we came to the conclusion that despite the fact that Sweet’s syndrome is an extremely rare disease and more often debuts at the age of 60, it can also be observed in children, which must be taken into account in the presence of a skin rash without a known etiology and pathogenesis. Since complications may occur, it is necessary to identify and treat exacerbations of this disease in a timely manner. The prognosis of the disease is relatively favorable, since complications of Sweet’s syndrome can lead to a decrease in the quality of life of patients.

Erratum in "Point-of-Care Blood Glucose Testing: Post-Market Performance Assessment of the Accu-Chek Inform II Hospital-Use Glucose Meter" (DOI: 10.26442/00403660.2023.12.202522)

In the article "Point-of-care blood glucose testing: post-market performance assessment of the Accu-Chek Inform II hospital-use glucose meter," published in the Terapevticheskii Arkhiv journal, Vol. 95, No.12, 2023 (DOI: 10.26442/00403660.2023.12.202522), errors were made: the term "measurements at the place of treatment" was changed, as well as the section "Conflict of interest." At the request of the authors' team, errors in the conflict of interest and the wording of the term have been corrected, and the section "Information about the authors" has been updated. The publisher replaced the original version of the published article with the corrected one; the information on the website was also corrected. Correct text of the section "Conflict of interest": Conflict of interest. All authors are not employees or consultants of Roche Diagnostics and have not received any compensation from Roche Diagnostics. Correct wording of the term in Russian: "измерения по месту лечения". Changes were made to the title of the article in Russian: "Измерения глюкозы по месту лечения: пострегистрационное испытание госпитального глюкометра Акку-Чек Информ II", the text of the abstract, keywords, citation, in the text of the article, and abbreviations. Information of the place of work has been updated: Center for Laboratory Diagnostics of the Russian Children Clinical Hospital, a Branch of the Pirogov Russian National Research Medical University. The publisher apologizes to readers and authors for the errors and is confident that the correction of errors will ensure the correct perception and interpretation of the results of the study described in the text.

Study of the spectrum and antibiotic sensitivity of the respiratory tract microbiota of newborns with infectious complications during long-term mechanical lung ventilation

determining the structure of leading microbial colonizers of the respiratory tract as potential causative agents of ventilator-associated pneumonia and their sensitivity to antibacterial drugs plays an important role in choosing effective tactics for etiotropic therapy of newborns. According to the data of scientific publications, the etiological structure of infectious complications associated with long-term respiratory support in newborns is known to have certain features. The spectrum of nosocomial microbial pathogens and their sensitivity to antimicrobial drugs are among them. The patients of early age are characterized by a number of peculiarities of anatomical and physiological characteristics and the qualitative and quantitative composition of the microbiota of the respiratory tract. In order to form ideas about the determining causative agents of VAP in newborns, it was advisable to conduct a microbiological study of the species composition of microorganisms associated with this infectious complication, as well as to determine their sensitivity to antibiotics recommended by the management protocols of the corresponding pathology. To study and solve this problem, it is necessary to study the spectrum and antibiotic sensitivity of the causative agents of VAP. A prospective study was conducted in 69 newborns with VAP (2020 - 2023), who were treated in the Neonatal Intensive Care Unit (NICU) of the Vinnytsia Regional Children's Clinical Hospital (VRCCH) and consisted in studying the composition of the microbiota and antibiotic sensitivity. We took into account opportunistic microorganisms that are not characteristic of this biotope of the respiratory tract of newborns who were diagnosed with VAP during long-term mechanical ventilation. As a result of the prospective analysis of the microbiological study of the microbiota of 69 newborns, 82 microorganisms - etiologically significant pathogens of VAP - were isolated and identified. Thus, according to the data of our bacteriological studies, 17 Gram-positive and 65 Gram-negative pathogens of VAP were isolated and identified in NICU VRCCH for 2020-2023. As a result of the study of antibiotic sensitivity of VAP pathogens in newborns, the following trends were observed. Low sensitivity of Acinetobacter baumannii to ceftazidime, aztreonam, imipinem, meropenem, amoxicillin, piperacillin, levofloxacin, ciprofloxacin was established. And sensitive to amikacin, gentamicin and cefoperazone-sulbactam. High rates of resistance of Pseudomonas aeruginosa to ceftazidime, doxycycline, imipinem, meropenem, gentamicin, piperacillin, levofloxacin, ciprofloxacin, ofloxacin were established. The best indicators of sensitivity of P. aeruginosa to amikacin, cefoperazone-sulbactam and tobramycin were found. According to the results of the sensitivity of K. pneumoniae to antibiotics, resistance to all antibiotics was established. The development of resistance of Staphylococcus aureus to azithromycin, norfloxacin, cefotaxime, benzylpenicillin has been established. The indicators of S. aureus sensitivity to amikacin, tetracycline and vancomycin turned out to be the best. We took into account opportunistic microorganisms that are not typical for this biotype of the airways of newborns who were diagnosed with VAP during long-term mechanical ventilation. The results of the study indicate the need to take into account the data of a microbiological study with the mandatory identification of isolated pathogens, their microbial load at the site of infection, determining their antibiotic sensitivity is of crucial importance in the selection of etiotropic treatment tactics for newborns with VAP.

Justification of Intensive care management of children with severe COVID19 (а case study)

the unprecedented COVID-19 pandemic that spread across the world and lasted for more than 3 years had significant medical and social consequences. Despite the fact that in the children's population the coronavirus infection has a milder course and a much lower risk of mortality, there are individual cases with pre-existing comorbidities that cause severe acute respiratory distress syndrome. Thus, in most cases, severe COVID-19 developed in children with pre-existing conditions, including: immunodeficiency, diabetes mellitus, bronchial asthma, etc. Therefore, comorbidities disposed children to progress to severe Covid-19 which requires treatments with more aggressive therapeutic tactics and personalised management. The article presents a clinical case of severe acute respiratory distress syndrome caused by the SARS-CoV-2 virus in an early age child. The patient was observed in the Anesthesiology and Intensive Therapy Department of the Chernivtsi Regional Children's Clinical Hospital. Due to acute respiratory infection, the child has been developing signs of respiratory failure. The available instrumental findings confirmed right lung pneumonia, complicated by pneumothorax. Laboratory tests confirmed leukocytosis, thrombocytopenia, hypertransfusion, increased procalcitonin, increased level of C-reactive protein, D-dimer and interleukin-6 as well as circulating immune complexes. The treatment regimen included respiratory protection (oxygen therapy), support of hemodynamics (infusion of glucose-saline solutions), administration of intravenous normal human immunoglobulin, a short course of parenteral glucocorticosteroids, the use of step-by-step combined antibacterial therapy and a direct-acting antiviral drug (remdesivir), and thromboembolism prophylaxis (low-molecular-weight heparin). Following intensive treatment, the child's condition was characterised by a slow positive dynamics, leading to full recovery. This case demonstrates the need for timely detection of life-threatening conditions caused by COVID-19 and requires an aggressive management of child's condition using a complex intensive therapy.

Retrospective Indicators of Foreign Body Aspiration in Children of the Surgery Department of the Osh Interregional Children's Clinical Hospital

The article provides the results of a retrospective analysis of medical documentation (medical history form No. 003/Y) in 245 children with foreign bodies of the respiratory tract who were hospitalized at the Osh Interregional Clinical Children’s Hospital from 2012 to 2016. According to localization, foreign bodies in the respiratory tract were mostly in 56 (22.85%) patients — in the right main bronchus, 32 (13.1%) children — in the left main bronchus.

Coagulation Tests and Volume of Blood Loss in Patients with Premature Placental Abruption

Introduction. Placental abruption continues to be one of the leading causes of bleeding during pregnancy and delivery, posing a direct threat to the health and life of both mother and fetus, making a significant contribution to the structure of maternal and neonatal morbidity and mortality. The study of predictors and prediction of the severity of the consequences of this complication is one of the areas of scientific research.The purpose of the study is to expand the possibilities of predicting massive bleeding, which is a consequence of premature placental abruption, based on the analysis of prenatal laboratory parameters of the hemostasis system as a universal tool for optimizing the choice of treatment tactics.Material and methods. A retrospective assessment of the relationship between the volume of bleeding and prenatal laboratory parameters of the hemostasis system was carried out in 46 patients with premature detachment of the placenta delivered by caesarean section in Sverdlovsk Regional Children Clinical Hospital, Ekaterinburg in 2020 using the methods of statistical analysis of quantitative indicators.Results and discussion. When comparing the volume of blood loss with prenatal indicators of hemostasis, prognostic significance was revealed and paired linear regression equations were constructed for the following parameters: platelet level, plateletcrit, prothrombin time, Quick prothrombin time, activated partial thromboplastin time. And no relationship was found between the volume of blood loss and MPV (p = 0.231), PDW (p = 0.121), P-LCR (p = 0.205), thrombin time (p = 0.79), fibrinogen value (p = 0.07).Conclusion. The results of the study can be used in building a decision-making algorithm and medical tactics of a multidisciplinary team during care for a patient with premature placental abruption, however, further research is required in this direction to build a universal formula for predicting bleeding volume in placental abruption.

Economic Burden of Invasive Meningococcal Infection in Children in the Republic of Belarus

Relevance Invasive meningococcal infection (IMI) is a significant clinical problem and is associated with a high probability of severe complications and death. Vaccination programs against meningococcus can achieve significant clinical effectiveness and require significant financial costs. This makes it relevant to study the economic burden of meningococcal infection in the conditions of modern healthcare in order to obtain basic data for subsequent research in the field of evaluation of medical technologies.Aims. To assess the economic burden of IMI in children in the conditions of healthcare in the Republic of BelarusMaterial and methods: a retrospective study using the "cost of illness" method was conducted for 22 children hospitalized in the city children's infectious clinical diseases hospital in 2018-2019. All values are presented in belarusian rubles. The average ± standard deviation, minimum – maximum values, median [Q1, Q3], cost shares (%) are calculated for the cost values. The minimum– maximum values and median [Q1, Q3] were calculated for the age of the patients.Results: taking into account the costs of treatment in healthcare organizations of all patients studied, the share of direct costs of hospitalization was 29.0%, the share of direct costs of diagnosis – 7.2%, the share of direct costs of pharmacotherapy - 8.3%. A significant part of the costs accounted for observations after discharge and amounted to 55.4%.Conclusion: a retrospective study of the economic burden of MI in the Republic of Belarus using the "cost of illness" method in patients hospitalized in a public health organization demonstrates a significant economic burden of this disease, which in the long term is primarily due to the presence of complications in the patient, as well as the impact of the patient's death on the value of total costs. The data obtained can be used in conducting national research on the evaluation of medical technologies.

ВЛИЯНИЕ ПРИМЕНЕНИЯ МЕТОТРЕКСАТА НА СОСТОЯНИЕ МИЕЛОПОЭЗА И ТРОМБОЦИТОПОЭЗА У ДЕТЕЙ С ИДИОПАТИЧЕСКИМ АРТРИТОМ

Methotrexate is the mainstay drug in the treatment of juvenile idiopathic arthritis (JIA). The effect of methotrexate on the hematopoietic system manifests itself in the form of its inhibition, contributing to the development of aplastic anemia, leukopenia, neutropenia and thrombocytopenia. The purpose of the study was to study the effect of methotrexate on the state of the leukocyte and megakaryocyte pool of cells in patients with JIA. Material and methods. The study was carried out on the basis of the 2nd City Children's Clinical Hospital in Minsk. A study of the state of hematopoiesis was carried out in 82 children with JIA who received only methotrexate. The comparison group consisted of 40 patients who were diagnosed with JIA and had a complete blood count performed before starting methotrexate therapy. Results. Statistically significant differences were identified in both the megakaryocyte and leukocyte series. Against the background of an increase in the number of platelets before the start of basic therapy, there was a decrease in the average volume of platelets (p<0.01) and, accordingly, the distribution of platelets by volume (p<0.001). Changes in the white blood cell count (WBC) were manifested in a gradual decrease in the number of leukocytes during long-term use of methotrexate (p < 0.001). Conclusion. The use of methotrexate in patients with JIA contributes to a significant decrease in the content of platelets, leukocytes, neutrophils, lymphocytes, and monocytes, which is due to the relief of the inflammatory process. The duration of methotrexate administration did not affect the content of lymphocytes and basophils.

КЛИНИКО-ДИАГНОСТИЧЕСКОЕ ЗНАЧЕНИЕ ГЕПСИДИНА В РЕГУЛЯЦИИ ОБМЕНА ЖЕЛЕЗА У ПАЦИЕНТОВ С ЮВЕНИЛЬНЫМ ИДИОПАТИЧЕСКИМ АРТРИТОМ

Introduction. Anemia in juvenile idiopathic arthritis (JIA), as a rule, has a multifactorial genesis, which is based on an immune-mediated mechanism: cytokines during inflammation cause changes in iron metabolism, which leads to changes in the production of red blood cells and their precursors, reticulocytes; An increase in hepcidin content causes disturbances in iron metabolism. The purpose of the study was to study hepcidin levels in patients with JIA and determine its prognostic value for the development of anemia. Material and methods. A total of 65 patients with JIA who were undergoing inpatient treatment at the 2nd State Children's Clinical Hospital in Minsk were examined. All patients underwent a general blood test using a hematological analyzer “Sysmex XS-800i” (Japan) with determination of erythrocyte, reticulocyte, and platelet parameters. A biochemical blood test included determination of iron metabolism indicators. The enzyme immunoassay method was used to study the content of cytokines: interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), interleukin-4 (IL-4), interleukin-1β (IL-1β) and γ-interferon (γ-IFN). Results. All patients were divided into two groups according to the median hepcidin value. The first group, in which the values were less than 4760.0 pg/ml, included 31 patients, the second group, in which the values were more than 4760.0 pg/ml, included 34 patients. An increase in hepcidin content was accompanied by an increase in the incidence of anemia (χ² = 4.55; p = 0.03). Based on the results of the Pearson correlation analysis (r), a number of statistically significant relationships between the concentration of hepcidin and the level of IL-6 were identified (r = 0.27; p < 0.05); hemoglobin (r= - 0.28; p<0.05); hemoglobin content in the erythrocyte (r = - 0.29; p < 0.05 and erythropoietin (r = 0.32; p < 0.05). Conclusions. In children with juvenile idiopathic arthritis, increased levels of hepcidin in the blood are accompanied by an increased risk of developing anemia. The earliest markers of the development of this anemia are a decrease in the hemoglobin content in the erythrocyte, a decrease in the average volume of the erythrocyte, and an increase in the synthesis of immature forms of reticulocytes. Hepcidin acts as a marker of both the activity of the inflammatory process in children with JIA and affects the distribution of iron between its storage and the functionally active pool.

Modern aspects of diagnosis and treatment of chronic inflammatory demyelinating polyneuropathy in children

Analysis of demographic, clinical, laboratory, electrophysiological and neuroimaging data and pathogenetic therapy of pediatric patients with chronic inflammatory demyelinating polyneuropathy (CIDP). Patients (n=30) were observed in a separate structural unit of the Russian Children's Clinical Hospital of the Russian National Research Medical University named after. N.I. Pirogova Ministry of Health of the Russian Federation in the period from 2006 to 2023. The examination was carried out in accordance with the recommendations of the Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society on the Management of CIDP (2021). All patients received immunotherapy, including intravenous immunoglobulin (IVIG) (n=1), IVIG and glucocorticosteroids (GCS) (n=17, 56.7%), IVIG+GCS+plasmapheresis (n=12, 40.0%). Alternative therapy included cyclophosphamide (n=1), cyclophosphamide followed by mycophenolate mofetil (n=1), rituximab (n=2, 6.6%), azathioprine (n=3), mycophenolate mofetil (n=2, 6.6%). In all patients, there was a significant difference between scores on the MRCss and INCAT functional scales before and after treatment. At the moment, 11/30 (36.6%) patients are in clinical remission and are not receiving pathogenetic therapy. The median duration of remission is 48 months (30-84). The longest remission (84 months) was observed in a patient with the onset of CIDP at the age of 1 year 7 months. Early diagnosis of CIDP is important, since the disease is potentially curable; early administration of pathogenetic therapy provides a long-term favorable prognosis.

A RETROSPECTIVE STUDY OF JAUNDICE IN INFANTS IN KYIV FROM 2017 TO 2021

Study objectives. The aim of the study was to evaluate the effectiveness of inpatient medical care in Kyiv (diagnostic capabilities and prescription of phototherapy) for newborns with various clinical forms of jaundice during 2017–2021. Methods. We performed a retrospective analysis of 616 infant jaundice cases of various clinical forms at the Department of Neonatal Pathology at Children's Clinical Hospital No. 6 in Kyiv (2017–2021), diagnosed as ICD P59 neonatal jaundice (NJ) and prolonged jaundice (PJN) and P55 hemolytic disease of the newborn (HDN) based on the relevant criteria. For statistical analysis, MedStat (v2.6.2) and EZR (v1.61) were used. The analysis showed that hospitalization with various forms of jaundice decreased in 2021 by about 2.1 times vs. 2018 and by 1.5 times vs. 2017 (p < 0.001). PJN was more common (55.0%) than NJ (39.8%) and HDN (5.2%), p < 0.001. A logistic regression model (AUC = 0.785) showed that the manifestation of PJN might be influenced by a history of cesarean section. At the time of hospitalization, there was no significant difference between the bilirubin levels measured by two methods: total serum bilirubin (TSBa) and transcutaneous bilirubin (TcBa), p = 0.380. Children with HDN (84.4%) were more likely to require phototherapy for more than 5 days than children with NJ (63.7%) and PJN (62.2%), p < 0.05. Conclusion. The study showed a decrease in the number of hospitalizations for jaundice in infants from 2017 to 2021. The prevalence of PJN was higher than NJ. A history of cesarean section was associated with PJN. Median bilirubin levels showed no significant difference between the two methods. Children with HDN more often required prolonged phototherapy, which was probably due to a less effective daily decline in bilirubin levels.

АНАЛИЗ ДЕТСКОГО ТРАВМАТИЗМА С ГОСПИТАЛИЗАЦИЕЙ В АРХАНГЕЛЬСКОЙ ОБЛАСТИ ЗА 2020-2022 ГГ.

Relevance. At the moment, the problem of child injuries is being discussed all over the world. Childhood trauma is one of the main causes of hospitalization and mortality. In this regard, a detailed analysis of the causes of childhood injuries and their consequences is necessary for the development and implementation of preventive work. The aim is to estimate the situation related to child injuries in the Arkhangelsk region with the proposal of some organizational measures to reduce the frequency of injuries and their consequences. Materials and methods. The analysis was carried out on the basis of information statistical materials obtained from the Arkhangelsk Regional Children's Clinical Hospital named after P.G. Vyzhletsov. The annual changes in the number of injuries among children of the Arkhangelsk region from 2020 to 2022 were studied. The age characteristics, the nature/localization of injuries, as well as the type (place) where the injury was received were determined. The results of the study. Throughout the study period, the number of injuries among children of the Arkhangelsk region decreased by almost 20%. Annual changes in the number of injured children in different age ranges showed a decrease in the studied indicator in the infant and preschool, as well as high school groups. At the same time, in the categories of primary and secondary school age, this indicator has been constantly increasing for three years, eventually increasing by almost 10% . The conclusion was made about the need for further development of a program for prevention, injury prevention, and its implementation should be entrusted to the educational direction in the family and in educational organizations.

Point-of-Care Blood Glucose Testing: Post-Market Performance Assessment of the Accu-Chek Inform II Hospital-Use Glucose Meter

A point-of-care glucose testing (POCT) is an essential component of care in patients with hyperglycemia and hypoglycemia in inpatient and outpatient settings. In Russian medical facilities (MFs), conventional glucose meters designed for self-monitoring by patients with diabetes are commonly used for POCT. These home-use meters have two serious disadvantages: the first is large measurement bias and the second - they can't be integrated into laboratory information systems, so measurement data have to be recorded into patient charts manually. Both factors may lead to medical errors. It is reasonable to use in the MFs specialized POCT glucose meters, as they are superior to conventional ones in accuracy and may be easily connected to laboratory information systems. With this in mind, physicians at the Russian Children's Clinical Hospital decided to substitute conventional meters with the Accu-Chek Inform II POCT meter, however, after preliminary performance assessment of the model. To test the Accu-Chek Inform II performance characteristics: accuracy, linearity, repeatability, and mean absolute relative difference (MARD). Performance of the Accu-Chek Inform II was tested by comparing the results of parallel CGL measurements with the meter and reference laboratory analyzer in capillary blood samples. Overall, 99 parallel CGL measurements were made in 45 samples. Accuracy was evaluated according to the ISO 15197-2013 and POCT12-A3 criteria. The Accu-Chek Inform II meter met the requirements of ISO 15197-2013 and POCT12-A3 and demonstrated high linearity (correlation coefficient, r=1,0), good repeatability (mean coefficient of variation, CV=1,38%) and acceptable MARD (4,9%). The Accu-Chek Inform II POCT glucose meter may be efficiently and safely used in inpatient and outpatient MFs and particularly in pediatric clinics.

СLINICAL CHARACTERISTICS OF CHILDREN AND ADOLESCENTS WITH METABOLIC SYNDROME IN KYIV

This study aimed to clinically evaluate children and adolescents with metabolic syndrome (MetS) in order to identify and diagnose the condition at an early stage and prevent possible complications.
 Materials and Methods. A comprehensive examination of 105 children aged 10 to 17 years with MetS was conducted at the Rheumatology and Cardiology Department of Children's Clinical Hospital No. 6 in Kyiv. The International Diabetes Federation (IDF) criteria were used to establish MetS. Anthropometric assessments included calculation of body mass index, evaluation of waist circumference using age-specific percentile charts, determination of waist-to-height ratio (WHtR), and measurement of neck circumference in lying and standing positions. Ambulatory blood pressure monitoring was performed using the ABM-04 device (Meditech, Hungary), and laboratory investigations (glucose, insulin, lipid profile) were conducted using the Cobas 6000 analyzer and test system (Roche Diagnostics). The EZR version 1.61 (November 11, 2022) package was used for statistical analysis of the obtained data.
 Results and Discussion. In terms of heredity analysis, the presence of hypertension in the father of children, maternal grandmother, and mother was the most common, indicating the importance of genetic influence on the development of this condition. Among the most common complaints were elevated blood pressure, headaches, anxiety, and palpitations. The logistic regression model demonstrated that daytime sleepiness was associated with symptoms such as sweating, morning hoarseness, tinnitus, weather sensitivity, and fatigue. There was no statistically significant difference between the manifestations of acanthosis nigricans and purple stretch marks in girls and boys, but a higher tendency was observed in males.
 Conclusions. Metabolic syndrome in children and adolescents is associated with a high risk of complications, as most of them have a high WHtR value. Cardiovascular diseases showed the highest hereditary dependency in close relatives of children with MetS. Cardiovascular symptoms are the most common among children with MetS, but girls had significantly higher frequencies of emotional and psychological symptoms.

НОВООБРАЗОВАНИЯ У ДЕТЕЙ С СИНДРОМОМ КОСТЕЛЛО: ОПЫТ РОССИЙСКОЙ ДЕТСКОЙ КЛИНИЧЕСКОЙ БОЛЬНИЦЫ

Costello Syndrome is an extremely rare genetic disorder caused by a mutation in the HRAS gene that encodes for a highly active protein that in its turn affects the cell growth and division. Patients have a unique phenotype and multiple developmental abnormalities that suggest the anomaly from the first days of life. The important feature of the disease is a predisposition to the development of neoplasms, both benign and malignant. This fact must obligatory be taken into consideration by physicians who are treating children with Costello Syndrome. Authors present the three clinical cases of children with Costello Syndrome coupled with neoplasms who underwent treatment at the Department of Surgical Treatment Methods of Oncology with the Russian Children's Clinical Hospital with the Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia (Moscow, Russia). The Authors’ experience in treating these patients, including a risk-adapted approach to therapy and early removal of detected formations, can be considered successful as yet. The descriptions of these clinical cases are of scientific and practical interest not only for pediatric oncologists but also for pediatricians, neurologists, cardiologists and other specialists due to the rarity of Costello Syndrome as they contribute to the formation of oncological vigilance.

Features of Immunological Status in Children with Pulmonary Echinococcosis in the Southern Regions of the Kyrgyz Republic

The article presents an analysis of the results of a survey of 105 children with pulmonary echinococcosis aged 4 to 16 years who received inpatient treatment in the thoracic surgical department of the Osh Interregional Children's Clinical Hospital. The aim of the study was to study the immune status of patients suffering from lung echinococcosis. The research method was a complex immunogram, which determines the state of humoral immunity. It was revealed that the organism of a child reacts to the invasion of the parasite in the form of chronic intoxication, which manifests itself in the form of a lack of body weight, lag in physical development, adynamia, hypochromic anemia, dysproteinemia, etc. In addition, in children with combined echinococcosis, the level of total IgE is more than 4 times higher than in patients with other forms of echinococcosis of the lungs, but at the same time, without changing the number of poorly differentiated forms of T cells and their precursors. This is explained by the fact that in the body of children suffering from a combined form of echinococcosis, the immune system undergoes tremendous changes and requires special attention by the attending physician through an in-depth examination in the pre- and postoperative periods and the study of long-term results.