Regional Children Research Articles

More Complex Investigations Improved Diagnoses of Community-Acquired Pneumonia in Children With Different Vaccination Histories.

Community-acquired pneumonia (CAP) significantly contributes to high infant mortality in Kazakhstan and developing effective treatment methods is critical. The aim of this study was to explore the microbiological and immunological characteristics of CAP in vaccinated and unvaccinated paediatric patients. The study was carried out in the Regional Children's Clinical Hospital and the research centre of Karaganda Medical University, Republic of Kazakhstan. It comprised 85 children aged 2 months to 3 years who had been diagnosed with CAP and had received inpatient treatment from 2017 to 2019. Of these, 45 had complete pneumococcal vaccinations and 40 had not. Their CAP diagnoses were confirmed by microscopic, bacteriological and radiological methods and vaccination status. General clinical examinations were conducted. The study showed the diagnostic and prognostic value of the level of cytokines, depending on the severity of the children's CAP. The level of monocytic chemoattractant protein-1 was 2.1 pg/mL in the vaccinated children with mild CAP and 3.4 pg/mL in those with impaired immunisation. Pneumococcal vaccination affected the aetiological structure of CAP in early childhood. More complex clinical and immunological diagnostic methods increased the efficiency of diagnosing CAP in children with different vaccination histories.

Intestinal monoamine oxidase activity in premature and full-term infants with surgical pathology

Advances in pediatric surgery, intensive care, and anesthesiology have significantly improved the outcomes of surgical treatment of full-term and premature infants with intestinal malformations and necrotizing enterocolitis (NEC). The main challenges in treating children of this complex group today lie in improving diagnostics, choosing treatment tactics, and ensuring the postoperative period. Monoamine oxidase (MAO) is a mitochondrial enzyme that catalyzes oxidative deamination of biogenic and xenobiotic monoamines, including those in intestinal wall cells and tissues. It can be a prognostic and diagnostic marker of the effectiveness and rate of intestinal recovery in the postoperative period, and also serve as a point of application for pharmacological correction. The aim of the study is to determine the activity of intestinal MAO in children of the first year of life with surgical pathology. Material and methods. The study included 24 patients with colon and small intestine pathologies, aged from 1 day to 3 months, who were treated at the Chelyabinsk Regional Children’s Clinical Hospital from October 2022 to May 2024. MAO-A and MAO-B activity was studied by spectrophotometry in intestinal homogenates obtained at the proximal resection margin. Results and discussion. Intestinal samples obtained from patients with diseases accompanied by pronounced inflammatory changes (NEC stage IIIA–IIIB, enterostomy closure after NEC III, intestinal neuronal dysplasia (IND), Hirschsprung’s disease) showed a significant decrease in the activity of the MAO-A isoform. A decrease in MAO-B activity was demonstrated in intestinal wall samples obtained from children with confirmed diagnoses of Hirschsprung’s disease and intestinal neuronal dysplasia, as well as in premature infants with surgical stages of NEC. The highest activity of both enzyme isoforms was found in sigmoid colon samples without pathological changes in patients with anal and rectum atresia.

ЭЛЕКТРИЧЕСКИЕ ОЖОГИ У ДЕТЕЙ: РЕТРОСПЕКТИВНЫЙ АНАЛИЗ ЗА 10-ЛЕТНИЙ ПЕРИОД

Background. A burn injury is a serious damage characterized by a long course and development of severe complications, leading to high mortality and disability. Purpose of the study. To conduct a retrospective analysis of the etiology and epidemiology, concomitant systemic changes, clinical and laboratory parameters, approaches to local treatment and outcomes of electric skin burns in children. Material and methods. During the period from 2014 to 2023, a total of 666 children with burn injuries were hospitalized at the Grodno Regional Children's Clinical Hospital, including 35 children with electrothermal skin burns. Conclusions. Electrothermal burns among pediatric patients occurred in 5.3% of the total number of hospitalized children with burn injuries. Children under 3 years of age (48.6% of cases) were affected most often, boys were 3 times more likely to suffer the injury than girls. The children received this type of injury in the summer, mainly on weekends. The most common cause (97.2%) of electrical injury was contact with household current. The main affected area was the hands (91.4%), in 11.4% of cases surgical intervention was required.

Short-term association between ambient air pollution and childhood non-allergic rhinitis: A time-series study at a National Children's Regional Medical Center, in Hefei, China, from 2015 to 2021.

The relationship between air pollution exposure and non-allergic rhinitis (NAR) risk in children is underexplored and uncertain. Therefore, the impact of numerous air pollutants on the incidence of NAR in a Chinese pediatric population were investigated. Data on daily outpatient visits for NAR among children aged 0-18 years from 2015 to 2021 were obtained from Anhui Provincial Children's Hospital. A quasi-Poisson generalized linear regression model combined with a distributed lag nonlinear model was applied to evaluate the association between air pollution and outpatient visits for childhood NAR. A total of 38233 NAR outpatients were included and a positive association and cumulative effects between air pollution and childhood NAR were observed. The relative risks (RRs) and 95 % confidence intervals (95 % CIs) for childhood NAR at the 75th percentile of NO2, SO2, PM10, PM2.5, O3, and CO against their minimum concentrations were 1.157 (95 % CI: 1.089, 1.23), 1.078 (1.005, 1.157), 1.168 (1.089, 1.252), 1.076 (1.02, 1.136), 1.033 (0.961, 1.11) and 1.07 (1.01, 1.134), respectively. The cumulative effects of the air pollutants were pronounced, which was much higher than each single effects. Furthermore, the risk estimates for childhood NAR during the cold season were higher than those in the warm season. Lastly, boys and school children were found to be more vulnerable to air pollutants than girls and preschool children. All these findings suggest that air pollutants have adverse effects on childhood NAR, even at levels below those recommended by the air quality guidelines. Our study results highlight the significance of paying attention to the effects of air pollutants to prevent NAR occurrence, particularly in boys and school children and during the cold season. Therefore, stronger control measures to mitigate air pollution must be implemented to decrease NAR incidence in the pediatric population.

Сравнение робот-ассистированной и лапароскопической пиелопластики в лечении обструкции пиелоуретерального сегмента у детей

Purpose of this research was to evaluate the perioperative and functional outcomes of robot-assisted and laparoscopic pyeloplasty performed in a specialized pediatric surgical center with the use of the Versius modular & portable surgical robot by “CMR Surgical,” Ltd. (Cambridge, Cambridgeshire, United Kingdom). Material and methods used: Authors present retrospective data on all patients (34) with pyeloureteral junction obstruction who had undergone the Anderson-Hynes pyeloplasty using either robot-assisted or laparoscopic techniques at the Irkutsk Oblast Regional Children's Clinical Hospital (Irkutsk, Russia) in Jan. 2020-May 2023. Robotic surgical interventions were performed using the Versius modular & portable surgical robot. All surgical procedures were performed in the manner of the Anderson-Hynes procedure. The study recorded patients' perioperative parameters related to demographics, surgical details and both early and long-term outcomes. Results: all surgical interventions were considered successful based on the fact that the desired result was achieved: a decrease in the size of the pelvis after the surgery. Robot-assisted procedures were performed in 10 and a laparoscopic method was used in 24. The mean age of patients was significantly lower in the laparoscopy group (4.0 [1,9;6,8] y/o v. 11,0 [7,0;15,0] y/o; p=0.001) as was the mean patients’ weight (17. 0 [11.5; 26.8] kg v. 54.6 [29.1; 63.0] kg; p=0.003). The gender composition in both groups was comparable (p=0.252) and demonstrated the dominance of male patients. The indicator of the total duration of surgical interventions was higher in the robot-assisted surgery group (157,5 [128,8; 196,3] minutes v. 117,5 [95.0; 161.3] minutes in the laparoscopy group; p=0,037). The average duration of the installation of the robotic system (i.e. the “docking time”) was 15,0 [10,0; 20,0] minutes. During the study, no statistical difference was found between the length of stay of patients in the intensive care unit (19,0 [16,9; 19,6] minutes v. 19,0 [17.0; 19.0] minutes). There was a significant difference in hospital stay in favor of a reduction in the robot-assisted surgery group (p<0,001), with a median hospital stay after robot-assisted surgery of 7,0 [6.0; 7.0] days, while patients who underwent laparoscopy were discharged only after 14 [13.0; 14.0] days. Authors did register neither early nor late postoperative complications of any kind in both groups. Conclusion: the robotic pyeloplasty is a safe and effective technique for the treatment of pyeloureteral junction obstruction. The robotic approach in the treatment of hydronephrosis in children is accompanied by the benefits of earlier recovery of patients after the surgery which in its turn is confirmed by a shorter time spent both in the intensive care unit and in the hospital.

Testicular inguinal ectopia following hernia repair in children

Introduction. Inguinal ectopic testis is a rare complication after inguinal hernia repair. In modern literature, there are few articles devoted to this problem.Objective. To study the testicular elevation mechanisms after inguinal hernia surgery in children and methods to treat this complication.Materials & methods. A cross-sectional retrospective analysis of medical records of male children who underwent inguinal plasty between January 2018 and December 2023 was performed at the Chelyabinsk Regional Children's Clinical Hospital. Those who underwent subsequent orchopexy for ipsilateral cryptorchidism were identified. Cryptorchidisms that were misdiagnosed were excluded.Results. A total of 1140 boys with inguinal hernias were treated, of which 978 (86%) were operated on laparoscopically using the PIRS technique, and 162 (14%) underwent open hernia repair. In nine (0.7%) children, an ectopic testicle in the groin was detected after surgery. During orchiopexy, extensive adhesions and scars in the inguinal canal were found only in two cases after open plastic surgery. The processus vaginalis remained intact after laparoscopic repair and partially after open hernia repair.Conclusion. Ectopic testicles in patients undergoing inguinal hernia repair can be successfully treated with orchiopexy performed through the inguinal approach.

Efficacy and Safety of Ruxolitinib Cream by Anatomic Region in Children Aged 2 to 11 Years With Atopic Dermatitis: Results From TRuE-AD3

Atopic dermatitis (AD) is a chronic, pruritic inflammatory skin disease. Ruxolitinib (Janus kinase [JAK]1/JAK2 inhibitor) cream has demonstrated efficacy and safety in patients aged ≥2 years with AD. In adolescents (aged ≥12 y) and adults with AD, application of ruxolitinib cream resulted in significant improvements across all anatomic regions vs vehicle. The objective of this analysis was to evaluate the efficacy and safety of ruxolitinib cream by anatomic region in the randomized, double-blind, phase 3 TRuE-AD3 study (NCT04921969). Children aged 2–11 years with AD for ≥3 months and an Investigator’s Global Assessment score of 2/3 were randomized 2:2:1 to apply 0.75% or 1.5% ruxolitinib cream twice daily (BID) or vehicle BID for 8 weeks. Efficacy was evaluated using the Eczema Area and Severity Index (EASI) subscores for head/neck, trunk, upper limbs, and lower limbs. Of 330 patients in TRuE-AD3, the mean (SD) age was 6.5 (2.9) years, and 179 patients (54.2%) were female; the mean (SD) EASI score was 8.6 (5.4). Improvements in EASI score were demonstrated with 0.75% and 1.5% ruxolitinib cream vs vehicle at first observation (Week 2), with statistically significant differences (at 0.05 alpha level and all P values below are nominal) at Week 8 in the head and neck (−0.63 [P=0.0108] and −0.70 [P=0.0011] vs −0.41), trunk (−0.98 [P=0.0310] and −1.18 [P=0.0003] vs −0.70), upper limbs (−1.81 [P<0.0001] and −2.06 [P<0.0001] vs −1.18), and lower limbs (−2.91 [P<0.0001] and −3.23 [P<0.0001] vs −1.43). Improvements in induration/papulation/edema, erythema, excoriation, and lichenification were observed for both strengths of ruxolitinib cream vs vehicle in all regions at Week 2, with statistical significance (at 0.05 alpha level) in nearly all AD signs and regions at Week 8. Ruxolitinib cream was well tolerated in both treatment groups (n=264), with 4.5% of patients experiencing application site reactions, which was similar to the frequency of application site reactions (4.3%) among patients with head/neck involvement (n=161) . In conclusion, ruxolitinib cream demonstrated significant improvements in AD vs vehicle in children with AD across anatomic regions, including on the head/neck, and was well tolerated. (Funding, Incyte Corporation)

CLINICAL CASE OF FAMILIAL HYPOPHOSPHATEMIC RICKETS IN A CHILD

X-linked hypophosphatemic rickets is an inherited disorder caused by mutations in the PHEX gene (phosphate- regulating proteinwith homology to endopeptidases on the X chromosome). Chronic hypophosphatemia leads to impaired bone mineralization, resulting ingrowth retardation, rickets, and damage to other organs and systems, including maxillofacial abnormalities. Clinically, these manifestationsbecome signifi cant when the child begins to walk.The purpose of the study is to describe a clinical case of congenital hypophosphatemic rickets in a child.Material and methods of the study. clinical, biochemical, genetic and imaging examination of the child Results of the study. The article presents a clinical case of a 9-year-old boy, who was adopted after being removed from an unfavorable psychosocial environment and admitted to the Odesa Regional Children’s Clinical Hospital to clarify the diagnosis and treatment tactics.On admission, the mother reported complaints of delayed psychophysical development, memory impairment, psychosocial dysfunction, deformities of the bones of the upper and lower extremities, chest and skull. The examination revealed a decrease in the level of phosphorus in the blood, increased levels of parathyroid hormone and alkaline phosphatase, and signs of osteomalacia in the x-ray. The diff erential diagnosis included vitamin D-dependent rickets, mucopolysaccharidosis, nanism, hyperparathyroidism, and metaphyseal chondrodystrophy. Based on the data obtained, the fi nal diagnosis was made and appropriate treatment was prescribed.Conclusions. The expanded diff erential diagnosis of rickets with rickets-like diseases contributed to the correct clinical diagnosis. Timely pathogenetic treatment reduces renal tubular phosphorus loss, improves mineral metabolism and quality of life. Prescription of growth hormone will reduce the manifestations of nanism.

TRANCE STEREOTYPIES IN HUMAN AND PRIMATE PANTOMIMICRY

The authors reviewed and analysed Russian and foreign experimental studies on pantomimic stereotypes. Initially, stereotypical behaviuor was negatively evaluated. Modern research considers adaptive functions and possibilities of self-stimulation as a way to harmonise emotional and mental state. A comparative analysis of circular, pendulum and diagonal movements in children and Old World monkeys was conducted using an ethological approach to the study of behavioural patterns. Human observations were conducted in the psychoneurological department of Silischeva Astrakhan Regional Children’s Clinical Hospital, 40 preschool children with mental dysontogenesis participated. Five laboratory macaques and a family of hamadryas baboons kept in an aviary with homologous kinesics were observed in Sukhumi nursery. According to the authors’ team, walking (running) in a circle and diagonally, swinging the body “right-to-leftˮ in the pantomimic production of children and monkeys are associated with self-stimulation of an altered state of consciousness. Trance stereotypes divert attention from external stressors and stimuli and harmonise mental homeostasis. The study may be of interest to anthropologists, primatologists, specialists in the study of the psyche and pathological behaviour of animals and Homo sapiens.

Геморагічний васкуліт у підлітка, індукований вірусом COVID-19

Hemorrhagic vasculitis (Henoch-Schönlein purpura) Vasculitis is a common disease that is often preceded by a bacterial or viral infection of the upper respiratory tract. Aim - to investigate the specifics of the course and treatment of hemorrhagic vasculitis in a child after suffering from COVID-19 on the example of a clinical case. Clinical case. A case of acute hemorrhagic vasculitis in a 14-year-old boy is presented. A boy was admitted to Ternopil Regional Children's Clinical Hospital with complaints of a rise in body temperature to high numbers, the appearance of rashes on the lower limbs, buttocks, pain and swelling in the knee joints. From the anamnesis of life, it is known that 2 weeks before the appearance of this hemorrhagic syndrome, he suffered from COVID-19. The disease began acutely with an increase in temperature of 40.1°C. Specific disorders associated with vasculitis/capillaritis are considered in detail: clinical syndromes are identified during objective examination: intoxication, hemorrhagic, articular. Examinations were carried out: general blood test, general urine test, biochemical tests. Maintenance therapy with sufficient hydration, restoration and maintenance of electrolyte balance. In order to control pain, simple analgesics (paracetamol 15 mg/kg every 6 hours orally) were prescribed. A differential diagnosis was made with meningococcal infection, idiopathic arthritis, and thrombocytopenia. The algorithm for the diagnosis of hemorrhagic vasculitis is presented. The need to be vigilant about the development of hemorrhagic vasculitis in children who have suffered from COVID-19 is justified. The research was carried out in accordance with the Declaration of Helsinki. Informed consent of the child's parents was obtained for the research. No conflict of interests was declared by the authors.

The diagnostic value of cytokines in chronic glomerulonephritis in children

In modern clinical practice of pediatricians, the problem of timely adequate treatment of chronic glomerulonephritis (CGN) in children is of particular relevance, due to both the high prevalence of the disease and the severity of its course, the complexity of therapy and the ambiguity of the prognosis. Lesions of the urinary system in children are not only common, but also tend to grow, and often at an early age. Deterioration of the environmental background, toxic and allergic effects of drugs lead to damage primarily to the kidneys, which are the eliminating organ. The aim of the study was to study urocytokines to assess the immune response in children with HCG, depending on the association with cytomegalovirus infection. The study included 100 children aged 4-7 years, permanently residing in the Bukhara region of the Republic of Uzbekistan. At the time of the study, the patients were undergoing routine treatment in the Department of Pediatric Nephrology of the Bukhara Regional Children’s Multidisciplinary Medical Center. All children underwent general clinical (general blood test with leukoformula, general urine analysis, biochemical blood test with determination of urea, creatinine and cystatin C, immunological (TNFα, IL-18, MCP-1, IgM and IgG antibodies to cytomegalovirus infection (CMVI) in blood serum, IL-1β and IL-17A in urine) examination methods. Thus, it was found that the concentration of cystatin C in the blood serum was inversely proportional to the glomerular filtration rate in the kidneys – with a decrease in kidney function in sick children, a twofold increase was noted, that is, the accumulation of cystatin C in the blood. An increase in the concentration of IL-18 in serum and IL-1β in urine relative to the control group in CGN was an indicator of the severity of an autoimmune reaction, and a relatively low concentration of cytokines in both blood and urine in CGN with CMVI indicated suppression of the specific antiviral immunity of CMVI. It was found that an increase in serum MCP-1 by 1.4 times in group 1 and 2.9 times in group 2 of CGN with CMVI is an indicator of viral kidney damage. A significantly high concentration of IL-17A in urine in CGN with CMVI indicated local cytokine production in the kidneys and acted as an indicator of the prognosis of the outcome of CGN.

Assessment of metabolic indicators of the cardiovascular system in children with nephrotic syndrome

Objective: to evaluate the metabolic parameters of the cardiovascular system in nephrotic syndrome in children Material and methods: 110 children hospitalized with nephrotic syndrome in the nephrology department of the Samarkand Regional Children’s Multidisciplinary Medical Center were examined. Results: Renocardial syndrome with nephrotic syndrome develops in 64.8% of cases, the majority of patients are children 3-6 years of age (44.1%), with a predominance of boys (58.8%). In a cardiometric study in patients with nephrotic syndrome, renocardial syndrome is manifested by significant changes in metabolic and adaptation parameters: oxygen and lactate content - by 1.5 times, creatine phosphate - by 20%, tension index - by 4.8 times and vascular stiffness index - by 5.2 times. Conclusion: Deviation of cardiometry indicators in different age groups indicates a decrease in the intensity of blood circulation in organs and systems, indicating a significant load on the cardiovascular system in nephrotic syndrome.

Symptoms Do Not Predict White Matter Injury in the Watershed Regions in Children with Moyamoya

ObjectiveTo assess if white matter injuries differ in symptomatic versus asymptomatic moyamoya-affected hemispheres using diffusion magnetic resonance imaging (dMRI) since there is controversy on when or if to revascularize children with asymptomatic moyamoya. Study designWe conducted a cross-sectional study of children with moyamoya who underwent dMRI prior to revascularization surgery as well as controls without moyamoya. We measured the fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) of white matter tracts in the watershed regions. Moyamoya-affected hemispheres were included if they did not have any visible stroke or infarct. Moyamoya-affected hemispheres were labeled “symptomatic” if transient ischemic attack (TIA), seizure, or movement disorder were localizable to that hemisphere, or if the child had headaches. Moyamoya-affected hemispheres were “asymptomatic” if the child did not have symptoms attributable to that hemisphere. Asymptomatic and symptomatic hemispheres were compared with each other and control children using ANOVA. ResultsWe included 17 children with moyamoya with 26 moyamoya-affected hemispheres and 27 control children. Compared with controls MD, RD, and AD were higher in both symptomatic and asymptomatic moyamoya-affected hemispheres but were not significantly different from each other. ConclusionChildren with moyamoya without stroke or silent infarct have unrecognized white matter injury that is similar in both symptomatic and asymptomatic moyamoya-affected hemispheres, suggesting that symptoms do not accurately reflect moyamoya severity.

카오스, 죽음, 재탄생으로 나타난 모래놀이상담 사례

This study is a case study of sand play counseling that appeared as chaos, death, and rebirth. The subjects of this study are two elementary school children living in Jeollabuk-do. Child A is a third-grade boy at Y Elementary School in City I, and Child B is a fourth-grade girl at B Regional Children's Center in County Y. The results of the study showed that in the chaos stage of Children A and B, they displayed disorderly characters, unrelated tasks, and threatening or confusing play, and showed confusion and conflict about maternal nature. In the death stage, the conflict between uncertainty and certainty began, a strong desire for attachment was shown, and fear and anxiety about reality appeared. In the rebirth stage, a new self appeared, adaptation to daily life was shown, and the play of death and rebirth was in progress, and new thoughts were reborn through death, and they appeared in the order of integration, order, and organization. This shows that sandplay counseling is a process of adaptation that shows inner strength, communication with the world, and harmonious integration to children who have experienced emotional conflict, maladjustment, and confusion during the growing up process.

Профілактика патологічних змін евентерованих органів при гастрошизисі у плодів і новонароджених дітей

The primary cause of unsatisfactory outcomes in the treatment of gastroschisis (GS) is the pathological changes in eviscerated organs and their consequences. One preventive method against these pathological changes is the premature delivery of pregnant women with fetal GS, either by physiological means or cesarean section. Aim - to analyze and develop preventive measures for pathological changes in eviscerated organs in GS by optimizing the delivery timing and method in pregnant women, to improve outcomes in fetuses and neonates. Materials and methods. The study examined the impact of delivery timing and method on the condition of eviscerated organs in 118 neonates with isolated (uncomplicated) GS. Depending on the delivery method, patients were divided into two groups: Group I included 72 neonates born at the SI “Institute of Pediatrics, Obstetrics, and Gynecology named after Acad. O.M. Lukyanova of the NAMS of Ukraine” between 2006 and 2023 via cesarean section, with 80% of cases being premature (at 35-37 weeks gestation); Group II included 46 neonates delivered vaginally between 1987 and 2005, who were treated either at the Institute (n=23) or at the Mykolaiv Regional Children’s Clinical Hospital (n=23). Neonates with complicated GS forms were excluded from the study. According to the degree of pathological changes in the eviscerated organs, cases were classified as unchanged, moderately changed, or markedly changed. Results. The implementation of planned premature cesarean delivery for pregnant women with fetal GS effectively reduced the occurrence of marked changes of eviscerated organs by 49.1%. At the same time, there was a significant increase (49.2%) in cases with unchanged and moderately changed organ conditions. Conclusions. One of the preventive measures to reduce the frequency and degree of pathological changes in eviscerated organs in GS is planned premature cesarean delivery at 37 weeks gestation. This approach positively influences the condition of eviscerated organs in fetuses with GS, preventing marked pathological changes in two-thirds of cases and significantly increasing (by 49.2%) the occurrence of unchanged or moderately changed organs. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the institution's Local Ethics Committee, and informed consent was obtained from the patients. Authors declare no conflict of interest.

Clinical structure and features of the course of pain and non-specific somatoform disorders in adolescent children

Annotation. The research is devoted to the study of clinical signs of painful and nonspecific somatoform disorders in children of early and late adolescence, depending on sex, place of residence, and study. The study examined 56 adolescent children with pain and non-specific syndromes who were treated in the MNP “Khmelnytskyi Regional Children's Hospital” of the Khmelnytskyi Regional Council and in the MP “Khmelnytskyi City Children’s Hospital” of the Khmelnytsky City Council. The average age of the children was 14,0±4,53 years. Among them, children of early adolescence (10-14 years) accounted for 57.2%, and late adolescence (15 years 11 months 28 days) – 42.8%. The clinical signs of pain and nonspecific somatoform disorders in the children we examined were as follows: headache, thermoregulation disorder, fibromyalgia and arthralgia syndrome, nonspecific back pain, asthenic syndrome with decreased work capacity, increased meteorological sensitivity, and impaired concentration. Nonspecific persistent pain syndrome occurred in 56 children, in particular, cephalic pain – in 77.4 %, polyarthralgia – in 8.9%, fibromyalgia syndrome – in 8.5%, nonspecific back pain – in 13.4% of children; thermoregulatory disorders were identified in 42.7%, asthenic syndrome – in 35.3% of children. It shows that among pain somatoform disorders, headache, in particular, tension headache and migraine, occupies the first rank in children. Stress, tension, and sleep disturbances were predominant among the triggering factors. Therefore, among adolescent children with painful and non-specific somatoform disorders, cephalalgia, with a predominance of tension headaches, and long daytime low fevers are most often diagnosed, as a manifestation of autonomic somatoform dysfunctions with impaired thermoregulation. At the same time, migraine, episodic symptoms associated with migraine, as well as trigeminal variants of headache and long-term pain of other localization were found in isolated cases. The age dependence of primary headache has been revealed: tension headaches occur more often in children of early adolescence, and migraines in children of older adolescence, which is important to consider in the differential diagnosis of headaches, since the treatment and prevention of attacks of these forms of headache are completely different.

NASOPHARYNGEAL MICROBIOTA IN CHILDREN WITH CHRONIC ADENOIDITIS

Background: Adenoiditis is a common condition in children that can lead to significant respiratory complications and may affect overall health and quality of life. Specific Background: This study was conducted at the LOR-Department and polyclinic of the Bukhara Regional Children's Multidisciplinary Medical Center, along with the "BUKHARA LOR MED CENTRE," focusing on the bacteriological profiles of pediatric patients diagnosed with adenoiditis. Knowledge Gap: Despite the prevalence of adenoiditis, there is limited understanding of the microbial agents involved, particularly in the pediatric population, which hinders effective treatment strategies. Aims: The objective of this study was to perform a bacteriological examination of children aged 3 to 18 diagnosed with adenoiditis to identify common pathogens and their distribution by gender. Results: A total of 154 children were examined, of whom 67.5% were boys and 32.5% were girls. The bacteriological analysis revealed a diverse range of microbial agents, providing insights into the predominant pathogens associated with adenoiditis in this demographic. Novelty: This research contributes to the limited existing literature by detailing the microbial landscape of adenoiditis in a significant pediatric cohort, specifically in the Bukhara region. Implications: The findings underscore the importance of targeted bacteriological assessments in the management of adenoiditis, which may inform more effective therapeutic approaches and improve clinical outcomes for affected children. Further studies are warranted to explore the clinical significance of the identified pathogens and their potential impact on treatment protocols.

COMPLEX TREATMENT OF CHRONIC ADENOIDITIS IN CHILDREN

Background: Chronic adenoiditis in children is a prevalent condition that often leads to significant respiratory issues, including tubar dysfunction and snoring. Specific Background: The Bukhara Regional Children's Multidisciplinary Medical Center provides specialized ENT care, highlighting the need for effective treatment modalities in varying age groups. Knowledge Gap: Traditional therapeutic approaches exhibit limitations in their efficacy, particularly in rapidly alleviating symptoms and restoring normal respiratory function. Aims: This study aims to evaluate the effectiveness of photodynamic therapy (PDT) in comparison to conventional treatments for chronic adenoiditis among children aged 7 months to 11 years. Results: Analysis of 70 pediatric patients revealed that photodynamic therapy significantly improved nasal breathing, reducing snoring and tubar dysfunction five times faster than traditional methods. Additionally, it enhanced anterior active rhinomanometry outcomes, yielding a fourfold increase in total volume flow and a twentyfold reduction in total resistance. Novelty: This investigation is among the first to quantitatively assess the benefits of PDT in pediatric chronic adenoiditis, demonstrating its superior therapeutic efficacy. Implications: The findings suggest that incorporating photodynamic therapy into treatment protocols could offer significant advantages in managing chronic adenoiditis, warranting further exploration and potential integration into clinical practice to improve pediatric respiratory health outcomes.

Kidney diseases in adolescents classified according to nomenclature for kidney function and disease (KDIGO 2019): a cross-sectional study of the regional register 2013-2022 years

Aim. To determine the structure of kidney diseases in 17-year-old adolescents before their transition to the adult healthcare system using the 2019 KDIGO.Methods. This single-center, cross-sectional descriptive study analysed a 10-year regional register of 893 adolescents hospitalized in the V.P. Sitnikova nephrology department at Voronezh Regional Children’s Clinical Hospital between 2013 and 2022. Kidney functions assessed using the CKiDbed (2009) and CKDEPI (2009) equations. Statistical significance was defined as a p<0.05.Results. Over 70% of all hospitalizations were related attributed renal tubulo-interstitial diseases (N10- N16), congenital malformations of the urinary system (Q60-Q64), and glomerular diseases (N00-N08). The distribution of kidney conditions included CKD (36.6%), AKD without AKI (14.9%), AKD combined with CKD (8.5%), AKI (0.4%), AKI combined with CKD (1.3%), and no kidney disease. CKD was more prevalent in males (69.5%, vs 45.3% in females, p<0.001), while AKD was more common in females (38.0% vs 15.1% in males). GFR calculation discrepancies between CKiDbed and CKD-EPI equations led to changes in GFR categories and CKD/AKD stages 55.8% of adolescents, with the largest median discrepancy in males (37 ml/min/1.73 m2).Conclusions. the study classified kidney diseases in 17-year-old, revealing gender differences and highlighting the impact of varying GFR calculation methods of disease staging. The findings emphasized the need for consistent GFR assessment approaches across pediatric and young adult healthcare.

Multiple recurrences of adnexal torsion in a 9-year-old girl: a case report

Most girls with abdominal pain syndrome caused by gynecological pathology are admitted to pediatric surgery departments. When adnexal torsion is detected, detorsion is performed. There is no single protocol for ovariopexy. A 9-year-old girl was admitted to the surgical hospital of the Regional Children’s Clinical Hospital No. 2 in Voronezh for the first time because of nagging pain in the lower abdomen. Vomiting was noted at the height of the pain syndrome. Ultrasound of the pelvic organs revealed torsion of the right uterine appendages. Laparoscopy showed that the right ovary was purple and enlarged in size and torsion of the uterine appendages by 720°. Detorsion of the right adnexal torsion was conducted, and blood supply was restored after 10 minutes. The child was discharged on hospitalization day 9. Five months later, the patient was admitted with repeated right adnexal torsion. Laparoscopic detorsion was performed: blood flow was restored, and the ovary was found to be viable. The patient was recommended to be hospitalized at the Federal Medical Center in Moscow for laparoscopic ovariopexy; however, her patients refused further treatment. The girl was discharged from the hospital on postoperative day 9. After 11 days, recurrent torsion of the right uterine appendages by 720° occurred, and laparoscopic detorsion was performed. Ten days after consulting a gynecologist, laparoscopic fixation of the right uterine appendages was planned. Ovariopexy was performed by suturing the ovary to the broad ligament of the uterus with an interrupted suture. The patient was discharged from the hospital in a satisfactory condition. Four months following ovariopexy, the child had no complaints, and ultrasound showed no pathological changes in the ovaries.