Regional Children's Clinical Hospital Research Articles

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.

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.

ОСТРАЯ ПЕРФОРАТИВНАЯ ЯЗВА ТОЩЕЙ КИШКИ У РЕБЕНКА С ЮВЕНИЛЬНЫМ ДЕРМАТОМИОЗИТОМ (СЛУЧАЙ ИЗ ПРАКТИКИ)

Background. Juvenile dermatomyositis (JD) is an inflammatory myopathy in children with predominant involvement of the proximal muscles of the extremities, the development of systemic vasculitis and characteristic skin changes. It is accompanied by progressive muscle weakness, including smooth muscles of the respiratory and digestive organs, as well as striated muscle tissue of the heart. Joint damage and calcification are noted. JD is confirmed by the detection of myositis antibodies in the blood. Corticosteroids and cytostatics are usually prescribed. It should be noted that as of 2023, only 4 patients with this disease were registered in the Republic of Belarus. Objective. To demonstrate a rare case of diagnosis and treatment of perforated jejunal ulcer in a child with JD. Material and methods. Data from the clinical observation of patient Sh., aged 3, treated in the department of emergency surgery of Grodno Regional Children's Clinical Hospital in October 2023. Results. The child was admitted to the children's hospital complaining of abdominal pain, vomiting (3 times), the duration of the disease being 17 hours. The dynamic observation revealed no acute surgical pathology. Acute gastritis was diagnosed, the concomitant pathology being JD (acute course, 2nd degree activity). On the 5th day (on the day of discharge) the child had a sudden bloating. Plain radiography revealed free gas under the diaphragm. The child underwent diagnostic laparoscopy that detected a perforated jejunal ulcer with peritonitis. Laparotomic jejunum resection with anastomosis was performed. Conclusions. We have presented a case, which the surgeons of our hospital have faced for the first time. Having analyzed literature data, we came to the conclusion that the complication was related to the underlying disease and its therapy with corticosteroids. Despite the complexity of the disease, the patient was discharged with an improvement in his condition.

Differentiated choice of therapy regimen for acute poisoning with topical decongestants in children using a medical decision support system

Introduction. Acute poisoning in children is a major public health issue worldwide. Clinical Decision Support System (CDSS) is designed to improve quality of medical care by integrating scientific knowledge and research with information technology.
 Aim. Analyze clinical features of poisoning, identify unintentional differences in drug therapy and create a CDSS for individual choice of therapy for acute poisoning in children.
 Materials and methods. This study includes 178 children hospitalized with acute drug poisoning in Voronezh Regional Children's Clinical Hospital No. 1 from 2016 to 2022. The CDSS for poisoning with topical decongestants includes an algorithm for determination of the case severity depending on the patient's complaints, state of the central nervous system, cardiovascular system, and autonomic nervous system.
 Results. Most frequently poisoning in young children (under 5 years old) was caused by topical decongestants - 31 people (17.1%). After implementation of information technologies there was a significant decrease from 87.5% to 62.5% in the frequency of prescription of laboratory tests and infusion therapy in young children (p0.05). Decrease of glucocorticosteroid therapy in young children from 50% to 12.5% (p0,05).
 Conclusion. Information technologies implemented in the form of CDSS make it possible to carry out diagnosis and take therapeutic measures with consideration to individual features of the patient, reduce frequency of laboratory tests and drug load.

A clinical case of surgical treatment of duodenal diverticulum in a 15-year-old girl

Introduction. Duodenal diverticula account for about 10% of all diverticula in the gastrointestinal tract and occupy the second place in the incidence structure after colon diverticula. They are characterized by the asymptomatic course, as a result of which they are often detected by chance. Clinical manifestations of duodenal diverticula inflammation are not typical, and this diagnosis is a diagnosis of exclusion. Most often, they are revealed after developed complications: first place - strictures of the diverticulum with intestinal obstruction as a result of chronic inflammation, then - bleeding associated with the possible ectopia of pancreatic tissue and peritonitis in case of diverticulum perforation.Material and methods. Since 1972, 19 patients have been treated for duodenal diverticula at Rostov State Medical University (Rostov-on-Don) and Regional Children's Clinical Hospital (Rostov-on-Don). The main clinical manifestation, almost in all cases, was bleeding. X-ray with contrast examination of the gastrointestinal tract was made almost to all patients. If the contrast leakage into the duodenum was seen at the examination, plus clinical manifestations, it was an indication for surgical management. A clinical case of girl I. ,15 y.o., is given as an example.Conclusion. Duodenal diverticulum is extremely rare in childhood. So as to verify the diagnosis, it is necessary to follow the examination algorithm, which promotes the choice and tactics of treatment. To the authors' opinion, the key role in the diagnostics of the discussed pathology belongs to fibrogastroduodenoscopy. An indication for surgical treatment is the combination of instrumental diagnostic findings and clinical manifestations. During the duodenal diverticulum resection, surgeons must have a clear visualization of large duodenal papilla localization relative to its mouth.

ОБ ОПЫТЕ ОРГАНИЗАЦИИ ИММУНОПРОФИЛАКТИКИ ПАЛИВИЗУМАБОМ РЕСПИРАТОРНО-СИНЦИТИАЛЬНОЙ ВИРУСНОЙ ИНФЕКЦИИ У НЕДОНОШЕННЫХ ДЕТЕЙ

The article presents the regional experience of organizing immunoprophylaxis of respiratory 
 syncytial viral infection in premature infants, including those with bronchopulmonary dysplasia, with palivi zumab is presented on the basis of Regional Children's Clinical Hospital named after. N.N. Silischeva. In the 
 follow-up of children who received this drug for the observation period from 2019 to 2021, the following were 
 noted: the absence of side effects and undesirable effects of the drug, high adherence of parents to treatment 
 with palivizumab, the advantages of a centralized approach to organizing the prevention of RSV infection in 
 premature infants from the high-risk group in the Astrakhan region.

КЛИНИКО-ЭПИДЕМИОЛОГИЧЕСКАЯ ХАРАКТЕРИСТИКА ГЕНЕРАЛИЗОВАННЫХ ФОРМ МЕНИНГОКОККОВОЙ ИНФЕКЦИИ В ГРОДНЕНСКОЙ ОБЛАСТИ ЗА ПЕРИОД 2018-2022 гг.

The article presents an analysis of the epidemiological situation of meningococcal infection in the Grodno region over the past five years. Aim. Analysis of the dynamics of morbidity and factors affecting the frequency of meningococcal infection in the Grodno region. Material and methods. A retrospective comparative analysis of the morbidity of the population of the Grodno region was carried out using statistical reporting forms of the database of the Grodno Regional Center for Hygiene, Epidemiology and Public Health, as well as an analysis of the medical histories of the Grodno Regional Infectious Clinical Hospital and the Grodno Regional Children's Clinical Hospital. Results. An analysis of the epidemiological situation in the Grodno region over the past five years has revealed fluctuations in morbidity rates, the replacement of leading strains of meningococci, concomitant diseases in patients, the "maturation" of meningococcal infection: children account for about 61.5% of cases of generalized forms of meningococcal infection which is less than the usual 75-80%. Conclusions: Over the past five years, there has been a decrease in the incidence of meningococcal infection in the Grodno region. The epidemic situation in general for meningococcal infection in the Grodno region for the period 2018–2022 is characterized by signs of an interepidemic period, i.e. sporadic morbidity persists. The leading serotypes in patients are meningococci of serogroup B and C. In the structure of patients with generalized forms of meningococcal infection, a group of homeschooled children prevails. Concomitant chronic diseases were registered in most patients.

COVID-19 IN NEWBORNS: OWN EXPERIENCE ON THE EXAMPLE OF CLINICAL CASES

Introduction. Currently, there is controversial information regarding the epidemiologic characteristics and severity of COVID-19 in pregnant women and newborns. Most researchers report the same severity of disease in pregnant and non-pregnant women, and a milder course of disease in the neonatal period, with the possibility of critical illness in some infants. Ideas about the possibility of transmission of SARS-CoV-2 to a newborn have changed. Since intrauterine transmission of the novel coronavirus is currently considered rare, COVID-19 in newborns is usually associated with postnatal transmission of the virus.The aim of the work was to analyze the epidemiologic and clinical features of the COVID-19 in newborns based on the analysis of clinical cases.Material and methods. On 2020, at the beginning of the COVID-19 pandemic, 11 newborns were admitted to the infectious diseases departments of Chernivtsi Regional Children's Clinical Hospital, 9 children were referred from home by a family physician, and 2 children were transferred from maternity care facilities. Diagnosis was confirmed by PCR-RT detection of SARS-CoV-2 RNA in nasal/oropharyngeal swabs.The research was conducted in accordance with the principles of bioethics, the conclusion of the Commission on Biomedical Ethics of the Bukovinian State Medical University on the observance of moral and legal rules for conducting medical-scientific research, Protocol No. 6 dated March 16, 2023.The research was carried out within the framework of scientific and research activity of the Department of Pediatrics and Infectious Diseases of Children of the Bukovinian State Medical University "Modern epidemiological, clinical-paraclinical and diagnostic features of the most common inflammatory infectious and non-infectious diseases in children", state registration number: 0122U002208.Results. The analysis of the epidemiologic data allowed to identify an intrafamilial source of infection in all identified cases (in one case the source of infection could not be identified), in most cases it was the mother, in one case the source of infection was the father and the grandmother. In most families there are older siblings who could serve as a potential additional source of infection, but respiratory symptoms in siblings were identified in one third of the families.In the late neonatal period, cases of horizontal virus transmission were characterized by mild symptoms of upper respiratory tract infection as acute nasopharyngitis, one case - as a mixture with secretory diarrhea. COVID-19 in another child was accompanied by acute gastroenteritis and moderate dehydration. The clinical picture of coronavirus infection in the remaining third of cases was characterized by lower respiratory tract infection as acute tracheobronchitis, acute obstructive bronchitis and bronchiolitis.Two infants were transferred from the maternity hospital after delivery because of COVID-19 maternal symptoms and SARS-CoV-2 RNA detection in the infants' nasal/oropharyngeal swabs on the first day of life. These children were asymptomatic with no clinical or laboratory evidence of an infectious-inflammatory process during observation.Conclusions. The presence of an exclusively family source of infection can be considered an epidemiological feature of COVID-19 in the neonatal period. In the case of horizontal transmission of the SARS-CoV-2 virus in newborns, the disease COVID-19 in most cases proceeds as mild upper respiratory tract infection, less often – as lower respiratory tract infection and/or secretory diarrhea. In the case of maternal COVID-19 disease before childbirth the vertical and/or antenatal infection mode and the subsequent asymptomatic neonatal COVID-19 cannot be denied.

Thrombosis in Multisystem Inflammatory Syndrome Associated with COVID-19 in Children: Retrospective Cohort Study Analysis and Review of the Literature.

Background: The causative agent of the new coronavirus infection SARS-CoV-2 has unique properties causing hyperinflammatory syndrome and cytokine storm, as well as widespread endotheliitis and thrombotic microangiopathy, initially detected in the lungs of adult patients who died from a severe form of the disease. Venous and arterial thrombosis in adults were identified as common causes of severe complications and deaths in new coronavirus infections. There are very few reports of thrombotic events in children with COVID-19 in the literature. Methods: We conducted a retrospective analysis of the histories of 60 patients in the Irkutsk Regional Children's Clinical Hospital from November 2020 to November 2022 with a MIS-C diagnosis established according to WHO criteria, of which 8 (13.3%) were diagnosed with venous and/or arterial thrombosis, confirmed by laboratory and ultrasound and/or X-ray methods. Results: The average age of children with thrombosis (Me) was 7.5 years (min 4 months, max 17 years), with a M:F ratio of 3.0. Venous thrombosis was detected in six of the eight patients, including in the deep veins of the lower extremities in four. Pulmonary embolism occurred in two (one of them was fatal), and cerebral venous sinus thrombosis and thrombosis of the branches of the upper and lower vena cava were found in one patient. Extensive bilateral stroke due to thrombosis of the large cerebral arteries occurred in two patients, including one in combination with distal gangrene. Secondary thrombotic renal microangiopathy took place in three of the eight patients. Among these three, atypical HUS was diagnosed in one case. Multiple thrombosis involving the venous and arterial bed was detected in four of the eight patients. High levels of D-dimer, thrombocytopenia, increased NT-proBNP, cerebral coma, and aseptic meningitis were the events most often associated with thrombosis. All patients received immunomodulatory therapy (immunoglobulin, dexamethasone/methylprednisolone), pathogenetic therapy for multiorgan failure, anticoagulant therapy with heparin/LMWH, and acetylsalicylic acid. Biologics were used in two patients. Conclusions: The main predictors of thrombosis in children with MIS-C were increased D-dimer, thrombocytopenia, hospitalization in the ICU, and noncardiogenic pulmonary edema. Thrombosis of the deep veins of the lower extremities, large cerebral arteries, and secondary thrombotic microangiopathy was common. There was a single death (12.5% of the eight patients), associated with PE.

EMPIRIC ANTIBIOTIC THERAPY OF ACUTE INFLAMMATORY PROCESSES OF THE FACE AND NECK IN CHILDREN AT THE OUTPATIENT STAGE, BASED ON THE RESULTS OF BACTERIOLOGICAL MONITORING OF THE DEPARTMENT OF MAXILLOFACIAL SURGERY.

Based on the analysis of bacteriological cultures of the wound discharge according to archival data of the case histories of patients with acute inflammatory processes of the face and neck on the basis of the Department of Maxillofacial Surgery of the Voronezh Regional Children's Clinical Hospital No. 2, data were obtained on microbiological pathogens and their sensitivity to various antibacterial drugs. Monitoring was carried out and the pathogen was classified in the main inflammatory processes of the face and neck in children from 1 to 15 years old. Based on the results obtained, we have developed and proposed schemes for empirical antibiotic therapy for use by pediatric dentists and pediatricians on an outpatient basis. The most relevant for outpatient applications are oral antibiotics with high bioavailability and efficacy against etiological pathogens.

РАСПРОСТРАНЕННОСТЬ ХРОНИЧЕСКОГО ГАСТРОДУОДЕНИТА СРЕДИ ДЕТЕЙ, ПРОЖИВАЮЩИХ В ГОРОДЕ ЯРОСЛАВЛЕ

Chronic gastroduodenitis (CGD) is one of the most common diseases in children. Current data on the prevalence and incidence of CGD in children vary greatly from different sources, and therefore it is difficult to form strategies aimed at preventing CGD at an early age, which leads to an increase in the number of patients with late diagnoses, as well as a decrease in the quality of life of patients and their families, and has significant socio-economic consequences. The aim of the study was to assess the prevalence of CGD among children living in the large administrative center of the Central Federal District, the city of Yaroslavl. A retrospective analysis of the clinical, endoscopic and morphological status of the upper digestive tract in children with chronic digestive diseases examined in the conditions of the consultative and diagnostic center (CDC) of the Regional Children's Clinical Hospital (RCCH) for the period 2017-2021 was carried out. Based on the data obtained, the following statistical indicators were calculated: gender-age composition of patients with CGD, morbidity, prevalence for specific annual indicators and age groups. At the time of the retrospective analysis, 2,416 children were diagnosed with CGD. In 2021, the incidence was 4.92 per 1,000 children, and the prevalence was 20.61 per 1,000 children, these indicators change every year in waves. Our data on the prevalence of CGD in the city of Yaroslavl are underestimated and have a wide spread in different age categories. The problem raised in our study requires in-depth study on additional samples of children in this region.

Risk factors for allergic rhinitis in children residing in five different regions of the Central Federal District: Observational study

Aim. To detect known risk factors for allergic rhinitis and determine the associated risks in five regions of the Central Federal District of the Russian Federation for 20172021 in different age groups.
 Materials and methods. The study was conducted at the Odintsovo Regional Hospital (Odintsovo), the Regional Children's Clinical Hospital (Yaroslavl), the City Children's Clinical Hospital (Tver), the Regional Children's Clinical Hospital (Vladimir), and the Vologda Children's City Polyclinic (Vologda). The homogeneity of the studied populations for the time criterion was assessed; the risk factors for allergic rhinitis (AR) recorded by the pediatrician in patients with an established diagnosis with ICD-10 codes J30.1, J30.2, J30.3, and J30.4 were analyzed. The total children population was 361,281 in the fourth quarter of 2021, and the number of children diagnosed with AR was 6,757. The study included children aged from 0 to 17 years. When assessing the evidence base, the data analysis and synthesis for each study site in each time range was performed in 100% of patients with AR.
 Results. The analysis results showed that in 20172021, in all studied regions, there was a steady increase in the total children's population and an increase in AR patients from birth to 17 years, and in some regions, such as Odintsovo and Tver, the prevalence of AR is growing exponentially. All risk factors were divided into three groups according to the feasibility of controlling their effect: uncontrollable (6 factors), partially controlled (10 factors) and controlled (12 factors). Most controlled risk factors were socio-biological and medical, and partially controlled ones were medical and socio-economic.
 Conclusion. The breakdown of risk factors into groups according to control feasibility will enable the reformatting of therapeutic and preventive measures aimed at reducing the prevalence of AR, which is a predictor of bronchial asthma occurrence.

The effects of correction of vitamin D deficiency in children undergoing hematopoietic stem cell transplantation

Literature data suggest that vitamin D (VD) deficiency may adversely affect many systems of the body, not only skeletal system, as believed earlier, but also central nervous system, cardiovascular system, urinary system, and immune system, which is particularly important for patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Two consecutive studies of VD deficiency after allogeneic HSCT in pediatric patients showed that VD deficiency was associated with decreased overall survival. The correction of VD deficiency was also reported to be a challenge, and in some cases higher doses of VD were needed (200 IU/kg/day or more), but even with this more aggressive approach VD deficiency could persist. In this article, we present a literature review on this topic as well as our data on the management of VD deficiency and monitoring of serum 25-hydroxycholecalciferol (25-HVD) levels in 18 children undergoing allogeneic HSCT at our hospital. This study was approved by the Independent Ethics Committee of the Regional Children's Clinical Hospital (Yekaterinburg). Unfortunately, because of the small size of the patient group we were not able to obtain reliable scientific data. However, here we present our approach to the clinical management of VD deficiency, personalized dosing of VD, and safe therapeutic ranges of VD metabolites in blood. The majority of HSCT recipients in our study achieved therapeutic levels of 25-hydroxycholecalciferol. Treatment of VD deficiency in children undergoing allogeneic HSCT is a promising way to improve overall survival, but further studies are needed to develop optimal clinical strategies.

Research in machine learning methods for solving problems of the medical profile

The work is devoted to the study of machine learning methods for solving medical problems. The aim of the work is to analyze machine learning methods to improve the accuracy and reduce the time for diagnosing diseases of the genitourinary system in children. The object of research is machine learning methods. The subject of the study is a classifier of diseases of the genitourinary system of patients of the Dnipropetrovsk Re-gional Children's Clinical Hospital "Dnepropetrovsk Regional Council". As a result of the study, the following tasks were solved: an analysis of the literature on the applica-tion of machine learning methods to diseases of the genitourinary system was made; a program was developed to extract the necessary information on statements in a semi-automatic mode; Python libraries and part of machine learning methods were analyzed; primary analysis and processing of data was carried out; applied methods of classifica-tion, feature selection and filling in missing values; the obtained results were analyzed and the substantiation of the research results in the subject area was made.

Право на паліативну допомогу: досвід реалізації проєктів

The key elements of medical and social care for palliative care patients should be the educational component such as information campaigns and cultural projects, which explain that palliative care is not waiting for death, but a dignified and organized life of the patient and his relatives. Ivano-Frankivsk National Medical University has joined to different projects to support vulnerable groups. In particular, with the financial support of the Public Health program initiative of the International Renaissance Foundation, the university has been implementing measures aimed at social support of children treated in the oncohematology department of Ivano-Frankivsk Regional Children's Clinical Hospital and their families for four years. These children receive high-dose chemotherapy, the procedure of which is long, they do not leave the department for many months, and therefore in addition to treatment they desperately need communication, interesting games, smiles, sincere prayer. At the same time, members of their families need to be able to take a «social break» to watch a movie, visit a theater or swimming pool, feel psychological and legal support, learn to relieve stress and anxiety, counteract stress, not be confined to problems. The quality of life of such people can be greatly improved when they try to see something positive in each day. No conflict of interests was declared by the authors.

ТЕЧЕНИЕ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ COVID-19 У РЕБЕНКА С РЕДКИМ СИНДРОМОМ СМИТА–ЛЕМЛИ–ОПИЦА: КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

Severe forms of COVID-19 are more likely to develop in children of the first year of life with genetic disorders and congenital malformations. Only a few lethal outcomes of the disease in children have been registered ongoing Worldwide over the entire period of the COVID-19 pandemic. This Article represents a clinical case of COVID-19 in a child with a rare Smith-Lemli-Opitz syndrome. On the 2nd day after the reported contact with a family member with COVID-19 the patient aged 3 years and 2 months old was hospitalized in the infectious diseases department with the diagnoses of “Severe coronavirus infection (PCR-confirmed); cardiopulmonary insufficiency; and congenital heart disease.” Since the age of 1.5 months old the patient repeatedly underwent inpatient examination and treatment with the Psycho-Neurological Department of the Belgorod Oblast Regional Children's Clinical Hospital (located in Belgorod, Russia). Furthermore, at the age of 1.5 y/o, according to the results of the medical genetic counseling, the diagnosis of Smith-Lemli-Opitz syndrome was established. Due to the COVID-19, the patient's condition deteriorated rapidly, and on the 5th day after the hospitalization the patient has died due to acute heart failure, cardiogenic pulmonary edema and pulmonary hemorrhage.

A CASE OF ORPHAN HYALINE FIBROMATOSIS SYNDROME IN UKRAINE

Background. Hyaline fibromatosis syndrome is a rare, highly dramatic, autosomal recessive multisystem disorder. The basis of the disease is the abnormal diffuse deposition of hyaline material in the connective tissue and internal organs. Mutations in the CMG2 gene (also known as the ANTXR2 gene) cause the disease. CMG2 encodes a transmembrane protein involved in endothelial development. Hyaline fibromatosis syndrome involves two allelic diseases that have the same phenotype. These are infantile systemic hyalinosis and juvenile hyaline fibromatosis. Common signs of these diseases are pain, joint contractures, skin lesions (thickening of the skin with areas of hyperpigmentation, pearl-sized nodules or papules), subcutaneous nodules on the head, neck, and extremities, gingival hypertrophy, osteopenia, protein-losing enteropathy, increased susceptibility to infectious diseases. Diseases differ in the time of the first clinical signs onset, the severity of the course, and the life expectancy of patients. In the case of infantile systemic hyalinosis, the prognosis is fatal. Hyaline fibromatosis syndrome is an orphan disease that is very difficult to diagnose. There is no pathogenetic treatment for the disease today. Clinical case. We described a case of hyaline fibromatosis syndrome in a boy who was observed and treated at the Municipal Non-Profit Enterprise of Sumy Regional Council "Regional Children's Clinical Hospital" (Ukraine). The diagnosis was made based on medical and genetic analysis. The early manifestation of symptoms and the severe course of the disease forced us to think about infantile systemic hyalinosis in the child. Along with characteristic external phenotypic signs, severe enteropathy with protein loss and persistent infections were observed in the child. As far as we know, this is the first case of the disease diagnosed in Ukraine. This publication aims to draw medical professionals' attention to the diversity of the course of genetic diseases in children. Comprehensive care, timely and symptomatic treatment make it possible to prolong the life of patients.

CLINICAL AND ANAMNESTIC FEATURES OF THE NEWBORNS WITH PERINATAL HIV EXPOSURE

Introduction. Maternal HIV infection has many adverse effects, including low birth weight, which is the primary cause of neonatal, infant, and under-five mortality. In the literature, the issue of intrauterine growth restriction (IUGR) in children who were born to HIV-positive mothers is being discussed, and the causes that may be the result of the direct effect of the virus, immunosuppression, or concomitant diseases are being studied. The association between maternal HIV infection and low birth weight (LBW) was not adequately explored and the available studies suggested inconsistent findings. Objective: to analyze the clinical and anamnestic data of the newborns with perinatal HIV exposure and to assess their physical development according to the gestational age and HIV stage of the mother. Material and methods. In order to achieve this goal, 34 medical histories of the patients who had been treated in the neonatal center of Vinnytsya Regional Children's Clinical Hospital from 2015 to 2022 with a diagnosis of perinatal HIV exposure were retrospectively analyzed. Results. According to the results of the study, a third of the children were born prematurely (12 (35 ± 8) %, 95%CI: 27–43 %). Сhildren born to mothers with stage IV of HIV infection had the lowest mean gestational age. When assessing the physical development of newborns according to gestational age, it was established that 9 children ((26 ± 8) %, 95%CI: 18–34 %) were small for gestational age, and 3 children ((9 ± 5) %, 95%CI: 4–14 %) were small-for-date. The lowest body weight values were observed in children born to mothers with stage IV of HIV infection – (1561.42 ± 0.21) g, which significantly differs from the weight of newborns whose mothers had HIV infection of stage I (2550.10 ± 1.51) g and stage II (2646.36 ± 1.69) g, p < 0.05. Conclusions. Among children with perinatal HIV exposure, there is a risk of premature birth with IUGR. Children born to mothers with stage IV HIV infection had significantly lower gestational age and body weight values.

КЛИНИЧЕСКОЕ ЗНАЧЕНИЕ ПОЛИМОРФНОЯДЕРНЫХ НЕЙТРОФИЛОВ В СТРАТИФИКАЦИИ ДЕТЕЙ С ОСТРОЙ БОЛЬЮ В ЖИВОТЕ

Background. Acute abdominal pain in children is defined as acute pain of non-traumatic genesis lasting up to 5-7 days, and presents a serious diagnostic and tactical problem. Many aspects of diagnosis and treatment remain controversial. Aim. To determine the clinical significance of polymorphonuclear neutrophil count in the stratification of children with acute abdominal pain. Material and Methods. A prospective randomized blind clinical trial was performed. The results of examination and treatment of 633 children admitted to Grodno Regional Children's Clinical Hospital with acute abdominal pain were analyzed. The number of polymorphonuclear neutrophils was analyzed in relative (PNRV) and absolute (PNAV) values. Statistics included evidence-based criteria, ROC and precision-recall curve analysis, Kullback's measure of informativeness (Jxi), Bayes' theorem. Results. Separation points were determined for the PNRV and PNAV tests. It was 65% for the PNRV test and 8.952×109/L for the PNAV test. For PNRV values less than 65%, the probability of acute appendicitis (AA) as a cause of acute abdominal pain was 1.8% (CI 0.2 to 3.4); the overall informative value was 2.94. With PNAV test values less than 6.5×109/L, the probability of AA was 1.2% (CI 0.03 to 2.4%); the overall informative value was 5.24. It was demonstrated that an increase in test values above the indicated values did not significantly increase the probability of AA as a cause of acute abdominal pain in children. Conclusion. The tests studied are highly informative and can be used to stratify patients with acute abdominal pain. It is necessary to validate the results obtained taking into account the specific capabilities of a given medical institution and the type of equipment used.