Regional Children's Clinical Hospital Research Articles

HELMINTHOSES IN CHILDREN OF CHERNIVTSI REGION

According to parasitological monitoring, almost everyone suffers from the parasiticdiseases during the lifetime, and children are the most often suffering.The aim of our study was to estimate the prevalence of ascariasis and enterobiosisamong children of the Chernivtsi region.Material and methods. The statistical laboratory data of the Regional Children's ClinicalHospital in Chernivtsi for the period 2010-2019 were analyzed. A group of children from0 to 18 years old who requested the laboratory to detect helminthoses was identified andstudied.Results. Over a ten-year period of study, among children aged 0-18 years, helminthosesoccurred in 9.38% of people, and in children aged 0-2 years - in 6.71%.In 2015-2019 of all the children, helminthoses were detected 2.6 times more than in 2010-2014, which was due to the greater number of children who sought medical advice in the clinic.Conclusion. Ascariasis was the most common helminthosis in children of Chernivtsiregion. In people aged 0-18 years, ascariasis was detected in 95.74%, and enterobiosis- in 4.26%. In the age group 0-2 years, ascariasis was diagnosed in 92.07% of children,and enterobiosis in 7.93%.

Перинатальні фактори ризику та клінічні особливості гемодинамічно значущої відкритої артеріальної протоки в недоношених новонароджених

The clinical features of the hemodynamically significant patent ductus arteriosus (HSPDA) depend on its diameter, which determines the frequency and severity of early complications of the disease. There are conflicting data on the relationship between perinatal factors and the development of large-diameter HSPDA in premature infants. Purрose — to determine the most significant risk factors in the perinatal history affecting the diameter of the ductus arteriosus and early complications of HSPDA in premature infants. Materials and methods. We examined 40 premature babies (gestational age — 29–36 weeks) with HSPDA, who were admitted for observation in the first day of life in the department of anesthesiology and intensive care of newborns of the MI «Dnipropetrovsk Regional Children's Clinical Hospital» DRC». To analyze the effect of the perinatal history on the diameter of the HSPDA in the first day of life, patients were divided into two groups: Group I (n=19) — children with HSPDA diameter <2 mm, Group II (n=21) — children HSPDA diameter >2 mm. The presence of chronic foci of infection in the mother was determined according to the medical documentation, chorioamnionitis based on the pathological examination of the placenta. Clinical examination and treatment of premature infants was carried out according to the generally accepted methods. Echocardiography with dopplerometry was performed at 5–11 hours of life to determine HSPDA. Results. The risk of developing HSPDA >2 mm in diameter in premature infants whose mothers had early gestosis is 4.72 (CI=1.15–19.41; p<0.03). A high degree of risk of development of a HSPDA diameter >2 mm was also established in premature infants in the presence of chronic foci of infection in the mother (OR=10.56; CI=1.9–58.53; p<0.005), chorioamnionitis (OR=13.5; CI=1.51–120.78, p<0.009). Intrauterine infection in premature infants predetermined an increase in the size of HSPDA >2 mm. On the first day of life, a HSPDA diameter >2 mm in premature infants is a risk factor for such early complications as necrotizing enterocolitis (OR=14.55; CI=1.6–131.96, p<0.007), intraventricular hemorrhage (OR=4,29; CI=1.14–16.18, p<0.03), acute kidney injury on the third (OR=15.94; CI=3.38–75.10, p<0.001) and the fifth day of life (OR=35.63; CI=5.73–221.50, p<0.001). Conclusions. A complicated perinatal anamnesis in premature infants is a risk factor for the development of large-diameter HSPDA, determines the occurrence of early complications of the disease, therefore, prevention of HSPDA should be started during pregnancy. The study was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution specified in the work. Informed consent was obtained from the parents of the children for the research. The authors declare no conflicts of interest. Key words: premature infants, perinatal risk factors, hemodynamically significant patent ductus arteriosus, clinical features.

Діагностична та предикторна роль окремих параклінічних маркерів у диференційній діагностиці гострих інфекційно-запальних процесів нижніх дихальних шляхів у дітей

Діагностична та предикторна роль окремих параклінічних маркерів у диференційній діагностиці гострих інфекційно-запальних процесів нижніх дихальних шляхів у дітей

Синдром Пруне–Беллі: випадки з клінічної практики

Objective: to acquaint doctors of various specialties with clinical course, early diagnostics, and treatment strategy for a rare congenital anomaly — Prune Belly syndrome in children. Materials and methods. Inpatient medical records of municipal non-profit enterprise «Ivano-Frankivsk Regional Children's Clinical Hospital» of Ivano-Frankivsk Regional Council. Results. The paper presents the clinical course of a rare congenital anomaly — Prune Belly syndrome in two children. The disease occurs chiefly among boys manifesting itself as multiple congenital malformations including deficiency or aplasia of abdominal muscles, congenital anomalies of the kidneys and urinary tract (hydronephrosis, megaureter, hydroureter, megacystis, vesicoureteral reflux), bilateral cryptorchidism. In addition, Prune Belly syndrome can coexist with urethral pathology, as well as skeletal, cardiovascular, respiratory, gastrointestinal malformations. Conclusion. Modern views on the development, clinical course, and diagnosis of a rare congenital disease with multiple organ malformations — Prune Belly syndrome have been presented for doctors of various specialties. Prenatal diagnosis, detection of potential congenital malformations after birth allows selecting the correct algorithm for monitoring vital organ functions, syndromic treatment and making timely decision on internal organ transplantation. The study was carried out in accordance with the ethical principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of municipal non+profit enterprise «Ivano-Frankivsk Regional Children's Clinical Hospital» of Ivano-Frankivsk Regional Council. The informed consent to participate in the research study was obtained from all the children's parents. Conflict of Interest. The authors declare they have no conflict of interest. Key words: children, Prune Belly syndrome, diagnosis, therapy.

Unsuccessful weaning from mechanical ventilation in children and ways to avoid it

The aim of the work: to determine causes of unsuccessful weaning depending on subglottic edema markers, level of sedation and sedation-agitation, changes in neurological status and bulbar disorders in children with different types of respiratory failure.
 Materials and Methods. We conducted a prospective cohort single-center study at the Department of Anesthesiology and Intensive Care at Lviv Regional Children's Clinical Hospital "OHMATDYT". We included 89 patients aged 1 month – 18 years with acute respiratory failure who was mechanically ventilated for more than 3 days. They were randomly divided into 2 groups. Group I included patients who received lung-protective ventilation strategy and assessment central nervous system function and the percentage of leakage of the gas mixture near the endotracheal tube; group II – patients who received diaphragm-protective in addition to lung-protective ventilation strategy and took into account the results of central nervous system assessment and respiratory gas mixture leakage near endotracheal tube during weaning from mechanical ventilation. The primary endpoint was the frequency of reintubations, the secon­dary endpoint was the frequency of complications (tracheostomy). 82 patients were included in the data analysis. Patients were divided into age subgroups: subgroup 1 – children 1 month – 1 year; subgroup – children 1–3 years; subgroup 3 – children 3–6 years; subgroup 4 – children 6–13 years; subgroup 5 – children 13–18 years.
 Results and Discussion. The frequency of reintubations in patients of the age subgroup 1 was reduced in group II to 5.3 % compared with 22.7 % in group I (p = 0.02), which was accompanied by a higher frequency of elective tracheostomy (before the first attempt of weaning from mechanical ventilation) which was 11 % in comparison with 0 %, p = 0.001). The frequency of reintubations in the age subgroup 2 was reduced to 5.9 % in group II vs 20 % in group I (p = 0.04), and elective tracheostomy was performed in 18 % patients in group II vs 5 % patients in group I (p = 0.05).
 There were no significant differences in the frequency of reintubations among patients in the age subgroup 3 (14.2 % in group I vs 11.1 % in group II, p = 0.31); in the age subgroup 4 (13 % vs 17 %, p = 0.19); the age subgroup 5 (6 % vs 7 %, p = 0.72).

FEATURES OF THE NEONATAL PERIOD IN PREMATURE INFANTS WITH THE BIRTH WEIGHT LESS THAN 1500 G, DEPENDING ON THE PLACENTAL CHANGES

Summary. Every year the number of preterm infants in the world and in Ukraine gradually increases - every 10th baby is born prematurely, and premature birth remains the leading cause of 50% neonatal morbidity and mortality. The general condition of this category of infants requires special knowledge and skills, psychological support, patience for both medical staff and parents, and certainly enormous material costs. This is due to the features of the neonatal period of such infants, namely the duration of respiratory support and the need for oxygen therapy, the provision of trophic and complete enteral nutrition, unstable tolerance, and the need for long-term inpatient treatment. However, all these efforts and resources don’t guarantee that the further development of premature babies will be physiological. Placental status provides an important information about explanatory factors that contributed to preterm birth, however, placental features haven’t been properly studied and the correlation between placental changes and neonatal outcomes remains poorly understood. According to the world literature, infection is one of the most important risk factors for premature birth, but the accumulation of evidence based on pathomorphological examination of the placenta and its membranes indicates that the role of specific bacterial and viral infections is not completely convincing and, as a consequence, can be less common cause of premature birth than previously suspected. Different auxiliary activities for preventing premature birth and improving the prognosis for the life and health of premature babies in later childhood’s periods are very important. A better understanding of the underlying mechanisms that regulate uterine-placental blood flow and the impact of other factors on the placenta status can improve diagnostic approaches in early pregnancy and further optimize the principles of preventive activities for both mother and baby.Aim. To establish a connection between pathomorphological changes in the placenta and the effects of premature birth.Materials and methods. A pathomorphological study of the placenta of mothers of 220 premature infants weighing less than 1500 g was performed and based on its results, 5 groups were formed according to the classification of the placental changes. The research was carried out on the basis of the Municipal non-commercial enterprise “Vinnitsa Regional Pathological bureau of Vinnitsa Regional Council” in accordance with the protocol of pathological examination of placenta (form № 013‒1 / o). The investigation was conducted with the support of the director of MNE VRPB Vinnytsia Regional Council Kholod L.P. and the head of the main department of general pathology with histological examinations Hormash P.P. The following research methods were used: macroscopy, slice staining, electronic microscopy and immunohistochemistry, etc. The health of these 220 children in the neonatal period was assessed at the stage of treatment in the Department of Anesthesiology and Neonatal Intensive Care (DANIC), and later - in the Department of Premature Newborns (DPN) of Vinnytsia Regional Children's Clinical Hospital in 2012-2018. Such clinical parameters were analyzed as gestational age, body weight, severity at birth on the Apgar scale for 1 minute, duration of respiratory support and length of hospital stay. Also the frequency of pathological conditions that caused the severity of the neonatal period was taken into account.Results. The study found that pathological changes in the placenta increase the risk of premature birth, the need for respiratory support and oxygen therapy, as well as increase the duration of inpatient treatment. The analysis of clinical indicators of 220 premature infants and pathomorphological studies of the placentas of their mothers showed that the most severe course of the neonatal period was observed in children with inflammatory changes and signs of placental immaturity. Newborns of these groups were diagnosed with a significantly higher frequency of generalized intrauterine infections and neonatal sepsis, severe CNS damage with the development of intraventricular hemorrhage and leukomalacia. The course of the neonatal period in groups of children with signs of premature placental aging and circulatory disorders was characterized by a low incidence of infections, but periventricular leukomalacia, which is an equivalent of adverse effects of preterm birth, was confirmed 5 times more often over the comparison group.Conclusions. All children included in the study had a combination of pathologies that caused the severity of the condition in the neonatal period. The condition of the placenta significantly affected the course of the neonatal period and its inherent pathologies. Thus, newborns with signs of inflammatory changes and immaturity were 10 times more likely to suffer from generalized intrauterine infections and neonatal sepsis. There were more frequent cases of intraventricular hemorrhages, leukomalacia and bronchopulmonary dysplasia in these groups of children.

Physical development and idiopathic nephrotic syndrome in children

INTRODUCTION.Study of physical development (PD) of children with idiopathic nephrotic syndrome (INS) includes mainly assessment of body height and weight during corticosteroid (CS) therapy; specifics of these criteria before and after the treatment are not sufficiently studied. THE AIM: to study PD of children with INS debut during CS therapy and upon its completion.PATIENTS AND METHODS.A retrospective analysis of PD was performed in 89 patients with INS in Voronezh Regional Children's Clinical Hospital No.1 during 1998-2014 using method of Z-score of body height and weight in comparison with regional standards.RESULTS.At the INS debut body height of 38.2% of the children and body weight of 41.2% accordingly were less than those of healthy children, p<0.001. Children with steroid-sensitive nephrotic syndrome (SSNS) had no difference in body height Z-score during CS therapy (0.17±1.06) and upon its completion (0.28±1.22), p=0.794. Body height was less in steroiddependent patients (SDNS) compared to SSNS patients. Z-score body weight values in children with SSNS were higher during maximum doses of CS (0.94±1.59) and returned to previous values after the therapy (-0.24±1.33), р=0,040. Patients with a frequent relapsing SSNS and SDNS had overweight and obesity remained after prednisone treatment (p=0.009).CONCLUSION.Physical development of children with INS has differences associated with CS therapy. Since body height and weight of children with INS were different from the norms before CS therapy, this could be influenced by genetic factors, which to be studied further. The results can be used to prognose CS therapy influence on PD of patients and assess prognosis of INS.

Necrotic Enterocolitis: Clinical and Anamnestic Parallels in Premature Infants.

Necrotic enterocolitis (NEC) in neonatal practice remains one of the major causes of morbidity and mortality in premature infants due to the combined effect of various pathogenic factors: infectious, metabolic, circulatory on the relatively immature bowel. Most often the onset of the disease occurs at the gestational age of the baby 29-32 weeks at the age of 2-3 weeks of life.Objective of study: evaluation of anamnestic, clinical and paraclinical data and course of NEC in premature infants who were hospitalized in the neonatal unit of Regional Children's Clinical Hospital (RCCH) of Chernivtsi.Materials and methods. A retrospective analysis of the diseases of 28 premature infants who were hospitalized in the neonatal intensive care unit (NICU) of RCCH was performed. While in the hospital, all children underwent general clinical, biochemical, instrumental methods of investigation and determination of immunological parameters of the infectious-inflammatory process in the blood serum, namely the level of C-reactive protein and pressepsin was made.Results. Among the examined, the proportion of deeply premature infants (up to 32 weeks of gestation) was 50%, including extremely low weight 17.8%. About 80% of children were born with signs of asphyxia of varying severity. It was shown that the development of NEC in premature children is associated with a burdened infectious history in mothers amid anemia (r = + 0.79), a short gestation period (r = + 0.44), and a low Apgar score in the fifth minute (r = + 0.45), the severity of the condition at admission to the hospital (r = + 0.74), the need for long-term mechanical ventilation (r = + 0.67), hemodynamic support with the vasoactive drugs (r = + 0.39), apnea development (r = + 0.83), feeding intolerance (r = + 0.45) and thrombocytopenia (r = +0.68). It was established that the determination of serum presepsin content makes it possible to verify the genesis of the development of NEC.Conclusion. The formation of NEC in premature infants is associated with the development of multiple organ failure in the anamnesis due to asphyxia, and its chances are increased due to the presence of a generalized infectious inflammatory process.

Зміни рівня пулу вісцеральних білків у дітей з різними формами дихальної недостатності

Malnutrition has substantial clinical and socioeconomic significance. Early nutritional disturbances may adversely affect the course of existing lung diseases in early childhood and increase the risk of lung disease in adults. Early diagnosis with combination of clinical examination, anthropometric and laboratory methods in children with acute respiratory failure help to improve results of treatment, and laboratory markers which quickly respond to changes in nutrition will provide optimal monitoring for patients and conditions for immediate correction of these disorders by physicians. The aim of the study was to determine the features of visceral proteins pool (albumin and transthyretin) in children with different types of respiratory failure and duration of their stay in the intensive care unit depending on the plan of nutritional disorders monitoring and correction. Material and Methods. We conducted a prospective cohort single-center study at the Department of Anesthesiology and Intensive Care at Lviv Regional Children's Clinical Hospital "OHMATDYT". We included 237 patients aged from 1 month to 18 years and distributed them into a control group, Group I, and Group II. In Groups I and II patients with acute respiratory failure were included who were mechanically ventilated for more than 2 days. Group I included patients who received lung-protective ventilation strategy and assessment of nutritional status; Group II included patients who received diaphragm-protective in addition to lung-protective ventilation strategy; the results of nutritional status assessment were taken into account as well. The atients were divided into age subgroups: 1st subgroup - children from1 month to 1 year of age; 2nd subgroup - children of 1 - 3 years; 3rd subgroup - children of 3 - 6 years; 4th subgroup - children of 6 - 13 years; 5th subgroup - children of 13 - 18 years. The stages of the study were the following: 1st day (d1), 3rd day (d3), 5th day (d5), 7th day (d7), 9th day (d9), 14th day (d14), 28th day (d28). The primary endpoint was the duration of stay in the intensive care department. The additional assessment criteria included serum albumin and transthyretin levels, the frequency of transfusions of albumin solution, and the frequency of changes in nutritional therapy procedure. The statistical analysis of the study results was performed using MS Excel 2017 with the calculation of the median [IQR - interquartile range], and p-values calculations. Results and Discussion. As a result of the analysis of data on the visceral pool of proteins, it should be noted that the most common disorders were found in patients of the 1st, 2nd and 5th age subgroups: in 1st age subgroup there were disorders related to albumin and transthyretin level; in 2nd age subgroup -to transthyretin level, in 5th age subgroup -to albumin. This might be explained in terms of malnutrition impact on development of body weight deficit and lower body mass index in children of 1st and 2nd age subgroups. On the other hand, in 5th age subgroup nutritional deficiency might be the basis for the emergence of serious diseases that are directly related to nutritional status (severe bacterial infections) and lead to their severe course. The analysis of the frequency of transfusions of albumin solution found that it was performed: in the 1st age subgroup - in 50% of patients of Group I and 0% patients of Group II; in the 2nd age subgroup there were no patient received albumin solution; in the 3rd age subgroup - in 30% of patients of I group and in 0% of patients of II group; in the 4th group - in 20% of patients in Group I and in 0% patients in Group II; in 5th age subgroup - in 0% patients of Group I and in 50% of patients in Group II. The change in the procedure of the nutritional therapy was carried out: in 1st age subgroup - 18% in Group I, 0% in Group II; in 2nd age subgroup - 0% patients in Group I and 30% patients of Group II; in 3rd age subgroup - 0% patients in Group I and 33% patients of Group II; in 4th age subgroup - 40% in Group I and 50% in GroupII; in 5th age subgroup - 0% in Group I and 43% in Group II. Conclusions. It was found that the duration of stay in the intensive care unit depends on principles of monitoring and correction of nutritional disorders in children with respiratory failure. A reliable twofold decrease of the time spent in the intensive care unit was achieved in Group II in comparison with Group I and in the 2nd age subgroup; the time of ICU stay also decreased 2.3 times in 5th age subgroup (p<0.05). Keywords: visceral proteins, children, acute respiratory failure

Retrospective evaluation of the effect of long-term use of inhalation glucocorticosteroids on physical development of children and adolescents with bronchial asthma

The aim of research was to evaluate retrospectively the dose-depended effect of the use of inhaled steroids on the anthropometrical indices of children and adolescents with bronchial asthma.Material and methods. Based on the pulmonological department of the Regional children clinical hospital in Chernivtsi city there has been conducted the evaluation of the physical development of 50 asthma patients who were under long-term use of inhaled glucocorticosteroids (IGCS). All patients underwent anthropometric study: weight and height measurements with calculation of body mass index (BMI). The assessment of physical development of patients has been performed by a centile method, taking into account the age of patients (using percentile tables "anthropometric indices to age").Results. Analysis of the data has showed that a patients' height was, on average, 50±4.4 percentile, which was corresponding to the average age-related normative values. At the same time height below (10-25 percentiles) average regarding to the age was recorded in 12 % of all examined patients, but an low (5-10 percentile) or very low (<5 percentiles) height were noted in only 4 patients (6 % and 2 % respectively among all patients). Meanwhile, it has been found that the average BMI in the examined patients was 20.4±0.5 kg/m2, which was corresponding to the normostenic structure. Simultaneously, only 5 of examined patients (10 %) were overweight (BMI> 25 kg/m2), and only one person out them (2 %) had clinically significant (BMI> 30 kg/m2) obesity.Conclusion. From the perspective of evidence-based medicine, negative impact of the long-term use of IGCS, in medium-high or high doses as well, on growth and body weight of the asthmatic children and adolescents had not been confirmed. At that, statistically significant data on the association of obesity and short stature with prolonged use of medium-high or high doses of IGCS had not been found: the attributive risk of excessive (body mass index> 25 kg/m2) body weight was 24 %, the odd ratio=3.2 (95 % confidence interval: 0.33-30.94), but at the same time the attributive risk of short stature (height <10 percentiles): was 18 % and the odds ratio=2.3 (95 % confidence interval: 0.22-23.88)

Мodern methods of diagnostic and surgery of dentigerous cysts of the jaws in children

Introduction . Follicular cysts of the jaws is one of the most common types of odontogenic cysts associated with the crown of an impacted tooth. Purpose of the study. To analyze modern methods of diagnosis and surgical treatment of follicular cysts of the jaws in children. Materials and methods . On the basis of the Department of maxillofacial surgery of the Nizhny Novgorod regional children's clinical hospital for the period from 2003 to 2018, 240 patients were treated with a diagnosis of «follicular jaw cyst». The age of children varied from 4 to 17 years (10,5 ± 0,2 years), including 131 boys and 109 girls. The diagnosis of «follicular cyst» was established on the basis of complaints, anamnesis, objective examination, x-ray examination. Preoperative preparation included antibacterial treatment. Subsequently, the children underwent surgery under General anesthesia (cystotomy, cystectomy, plastic cystectomy, cystectomy with sinusitis). Results and discussion. From 183 (76,3%) of patients with follicular cysts were impressed with the lower jaw, situated mainly in the area of premolars (69%). In the case of follicular cysts on the upper jaw, the vast majority of formations developed from the rudiments of fangs and premolars (16%). For an earlier diagnosis of the pathology, an algorithm has been developed, the use of which allows to detect the cyst before the symptoms appear. According to the studies, the leading signs of pathology were identified: the delay in the eruption of the tooth (or teeth) with its (their) presence on the other side and the detection of an increase in the follicle of a permanent tooth more than 2.5 mm on the radiograph. Conclusion . The use of diagnostic algorithm in the treatment of follicular cysts of the jaws in children, followed by the use of cystectomy, reduces the duration of hospitalization, retains the germ of a permanent tooth and contributes to the early recovery of patients.

EXPERIENCE OF THE OPERATION OF CATHAMNESTIC OBSERVATION CENTER IN VINNYTSIA REGION

Long-term consequences and a decrease in the quality of life of children born prematurely determine the chronic pathology that develops in this category of children as a result of diseases that have been transmitted in the first months of life. The system of medical and social support is a guarantee of optimal health and development of prematurely born children, as well as provides an opportunity to evaluate further health indicators of newborns of high perinatal risk children in the medical, social and economic aspects. The article presents the formation, development and experience of the catamnestic service of the Vinnytsia Regional Children's Clinical Hospital, the main indicators of the work of the cathamnesis office in recent years are presented. Measures have been taken to reorganize the catamencing service, in particular, to expand the area, carry out repairs, to upgrade the equipment, and also to separate the cathartic surveillance from the clinic, which made it possible to bring the medical service closer to the patient, to reduce the probability of crossings of infants of the perinatal risk group and older children. The increase in the effectiveness of catamnestic observation is realized through the introduction of practices and clinical trials with high level of evidence, in particular early intervention techniques that provide timely detection of the adverse effects of premature birth and their correction in accordance with modern standards.

Clinical CHARACTERISTICS of children with neurocirculatory dystonia ON hypertonic type

Objective: to study clinical characteristics of children with neurocirculatory dystonia (NCD) on hypertonic type. Material and methods . The study included 30 children aged 7-16 with NCD on hypertensive type who were undergoing a check-up or treatment at the Cardiologic Ward of Gomel Regional Children's Clinical Hospital. Results. According to the data of the clinical examination of the children with NCD on hypertensive type, it was found that the majority of the patients had neurological and cardiac complaints; intensive physical development, clinically non-significant arrhythmias, hypersympathicotonic vegetative reactivity, moderate exercise tolerance and labile arterial hypertension according to the data of 24-hour blood pressure monitoring were predominant. Conclusion . The described clinical characteristics of the children with NCD on hypertonic type testify to the presence of functional shifts in the vegetative regulation in the patients of this group, which makes it possible to select a pathogenetically grounded therapy and to control its effectiveness.

CLINICAL AND DIAGNOSTIC VALUE OF DETERMINATION OF NEOPTERIN IN ATOPIC DERMATITIS IN CHILDREN

Aim. To improve the diagnosis of allergic skin diseases in childrenMaterials and methods. 135 children aged from 2 to 6 with atopic dermatitis were examined during exacerbation. They were on inpatient treatment in the skin and venereologic department of the Regional skin and venereologic dispensary and the Department of Allergology of the Regional children's clinical hospital. At the same time, 103 people (the main group) had uncomplicated course of the disease, 32 patients had complications of atopic dermatitis in the form of secondary infection. The control group consisted of 29 children aged 2 to 6. Neopterin in serum was determined by enzyme-linked immunosorbent analysis using test kits "Neopterin ELISA" (Germany). Statistical reliability of the obtained data was evaluated using The Student's test.Results. Atopic dermatitis in children, regardless of clinical manifestations, is accompanied by an increase in the content of neopterin in serum. The nature of the increase in the level of neopterin is determined by the duration of the disease, while its highest values are characteristic of the prolonged course of the process (over 4 years).Conclusion. The determination of neopterin in children with atopic dermatitis is a promising laboratory method for assessing the severity of dermatosis, monitoring and forecasting the further course of the process, as well as evaluating the effectiveness of therapeutic measures.

Does the birth weight have any influence on the persistence of bronchial asthma during childhood period of life?

Objective. To study the clinical-anamnestic features of the bronchial asthma course in schoolchildren who were born with low birth weight (LBW). Material and methods. To achieve the goal of the research a cohort of school-age children (61 patients) with persistent bronchial asthma (BA) who were receiving in-patient treatment at the Regional Children's Clinical Hospital in Chernivtsi was formed by a simple random sample. Depending on the patients' birth body weight two groups of clinical observation were formed. The first (I) clinical group included 35 children with low birth weight (≤ 2500 g), and the second (II) control group consisted of 26 patients with birth body weight > 2500 g. The main clinical characteristics (age, gestational age, and residency) of the comparison groups were comparable. These survey results were analyzed by the methods of parametric (Pt, Students’ criteria) and nonparametric (Pφ, Fisher's angular transformation) methods of calculation. The research was conducted in compliance with the rules of ethical principles of carrying out scientific medical research with the participation of a humans, approved by the Helsinki Declaration (1964-2013) and corresponding orders of the Health Ministry of Ukraine. Results. The analysis of the data has showed the prevalence of the females in the group of patients who were born with LBW (60% of patients in the I clinical group of observation and 34.6% of cases in the II group of comparison (P 0,05). In children with low birth weight the debut of BA in the preschool age (3-6 years) occurred much more frequently (37.1% of observations) than in patients of the II group of comparison (3.8% of cases) (Pφ 0.05). An allergic anamnesis burden on maternal pedigree was noted three times more frequently (34.3% of cases) in patients born with LBW comparing to the II clinical group (16% of observations; Рφ 0.05). Conclusions. Thus, bronchial asthma in children born with LBW was characterized by: prevalence of female patients; the onset of the disease in preschool age (at 3-6 years); a deficiency of patients' body mass during an actual examination that was associated with the social status of this cohort of patients (31.6% of children were orphans or half- orphans) and mother's tobacco use; accommodation of patients in zones of high technological pollution of the environment; the burden of an allergic anamnesis according to the maternal pedigree; the predominance of the triggering role of specific provocative factors (inhalation and food allergens, pharmaceutical drugs) in the asthma exacerbation.

ТОТАЛЬНЫЙ И ПАРЦИАЛЬНЫЙ ДЕФИЦИТ IGA В СЫВОРОТКЕ КРОВИ У ДЕТЕЙ. КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

We conducted a 13-year observation of 9 patients with total and partial IgA deficiency. The age of children in primary treatment was 3.0 ± 0.2 years on average. The observation was carried out on the basis of the outpatient service of Irkutsk State Regional Children's Clinical Hospital. The examination included immunological, clinical-allergic and functional methods of research. To assess the humoral link of the immune system, serum Ig concentrations of classes A, M, G (mg/dl) were determined in the first 3 years annually, and then every 2-3 years. As a result, it was found that among the patients with IgA immunodeficiency, boys predominate over girls in a ratio of 3.5:1. With a partial IgA deficiency detected at an early age, the majority of patients have normalization of their IgA level, but sometimes there is a transformation into a selective IgA deficiency with an increase in the number of clinical markers of this condition. With a selective deficiency of IgA detected at an early age, half of the patients have normalization of the IgA level by the age of adolescence, but another half still maintain a significant decrease in serum IgA. Clinical manifestations in the majority of observed children with selective IgA deficiency included atopic respiratory diseases - bronchial asthma and allergic rhinitis, in one case - diabetes mellitus. In some children, the selective deficiency of IgA was asymptomatic.

Clinical and electroencephalographic characteristics of chronic tic disorders in children and adolescents

Chronic tic disorders (CTDs) are one of the relevant problems of pediatric neurology, the higher prevalence of which is associated with undifferentiated therapy without considering comorbidity. Objective: to enhance the efficiency of diagnosis and therapy of tic disorders in children and adolescents in terms of video-electroencephalography (EEG) monitoring data. Patients and methods. The investigation enrolled 116 patients, including 83 (71.6%) boys and 33 (28.4%) girls at the age of 3 to 15 years (mean age, 9.0±3.0 years), diagnosed with CTD who had been examined at the Specialized Neurology Department, Voronezh Regional Children's Clinical Hospital One, in the period 2010–2014. The investigation consisted of two steps: 1) clinical, laboratory, and neurophysiologic examination; 2) differentiated therapy. The Yaele Global Tic Severity Scale (YGTSS) was used. The diagnosis was established in accordance with the draft classification of epileptic seizures and epilepsy syndromes by the Intern ational League Against Epilepsy. Video-EEG monitoring was carried out in an awake state and during daytime and/or nighttime sleep. Results and discussion. EEC epileptiform activity was recorded in 46.6% of the patients; a concurrence of CTDs and epilepsy was ascertained in 16.4% of cases. The risk factors of epilepsy in children with CTDs and EEG epileptiform activity are isolated motor tics in the facial region (p=0.0023), MRI epileptogenic changes (p = 0.01), a remitting course (p=0.02), and an early age at the full-scaled picture of tic disorder (p=0.02). CTD therapy with antiepileptic drugs (extended-release valproic acid) was effective and safe in both epileptic seizures (remission in 85.7% of cases) and tics with an improvement in 81.5% of cases with retention in therapy during 2–3 years. Therapy with dopamine transmissionlowering drugs was effective against tics; however, their intake for more than 6 months increased a risk for added epileptic seizures in patients with EEG epileptiform activity (the secondary bilateral synchronization phenomenon and epileptic seizures were recorded in 42.9 and 14.3% of the patients, respectively).

URINARY SYSTEM PATHOLOGY IN CHILDREN POPULATION OF KHARKIV REGION: MORBIDITY AND SOME RISK FACTORS

Urinary system pathology in children now is one of the most important problems of medical science.
 The aim of this study – to analyze the morbidity and reveal the risk factors for development of urinary system diseases in children of Kharkiv region.
 Materials and methods. The material of the study was the information (gender, age, weight and body length at birth, gestational age, clinical diagnosis), obtained during hospitalization of 663 patients aged from 3 months to 17 years in the nephrological center of Kharkiv regional children clinical hospital during the period from 2012 to 2013 years.
 Results. The authors found that in children population of Kharkiv region among all diseases of urinary system a significant number of cases occur in congenital malformations, dismetabolic nephropathy, urolithiasis.
 Conclusions. Regional risk factors for development of urinary system pathology in children are female and living in the village. Decreased weight and body length at birth are risk factors for development in children urinary system congenital malformations.

Contribution of congenital malformations of the digestive system in the structure of mortality of newborns

The analysis of frequency of gastricduodenal congenital malformations in lethality structure was carried out among newborns which were cured last 5 years in regional children clinical hospital. This pathology occurres in every third lethality case among newborns with congenital malformation's with frequency q = 0,60 in boys from rural region. The availability of probable risk factors in pregnant women who gave birth children with gastric-duodenal congenital malformations was found out.

The Clinical and Neurophysiological Features of Epileptic Syndromes Associated with Benign Focal Epileptiform Discharges of Childhood

Benign focal epileptiform discharge of childhood (BFEDC) is an age-dependent pattern determined in electroencephalograms (EEGs), which is associated with idiopathic benign focal epilepsy (BFE). Studies of BFE revealed symptomatic phenocopies in patients with cerebral struc- tural abnormalities in such conditions as infantile cerebral palsy and malformations. Some arguments against the «benign» nature of BFEDC are presented, since BFEDC may impair various cognitive functions and behavior (e.g., cause epileptic encephalophathies). Objective. To determine the clinical and neurophysiological features of epileptic syndromes associated with prolonged epileptiform activity during sleep in children and adolescents, as well as approaches to rational therapy. Patients and Methods . A total of 1862 children aged 2–18 admitted to the specialized Department of Psychoneurology of the Voronezh Regional Children Clinical Hospital No 1 in 2004–2007, who had epileptic seizures and non-epileptic neurological disorders, were exam- ined. The children underwent assessment of the neurological status, neuropsychological assessment, and video-EEG monitoring. The spike- wave index (SWI) was calculated and magnetic resonance imaging (MRI) of the brain was performed to register the epileptiform activity during sleep. Results and Discussion. It was demonstrated that when ISW of BFEDC patterns is >30%, evolution into epileptic encephalopathy was observed in 66% of patients (including epilepsy with electrical status epilepticus in sleep in 49% of patients and cognitive epileptiform disinte- gration in 17% of patients). The results prove the justification of prescribing antiepileptic drugs to patients with SWI ≥30% even if they have no epileptic seizures. Duo-therapy with valproate and ethosuximide or levetiracetam is most the effective therapy. Further prospective studies for children with BFEDC will give new insight into this area.