State Pediatric Medical University Research Articles

Report on the first All-Russian Student Olympiad on Endoscopy

Purpose: To demonstrate the results of the first All-Russian Student Olympiad on Endoscopy. Materials and methods: The team of authors prepared and conducted the first All-Russian Student Olympiad on Endoscopy within the framework of the conference «Topical Issues of Endoscopy». The Olympiad was held in two stages, which allowed evaluating the theoretical knowledge and practical skills of the participants. The topic of the first All-Russian Student Olympiad was upper GI tract endoscopy. The first stage consisted of testing and a quiz. The test was devoted to general issues of endoscopy, and the quiz was devoted to bleeding from the upper GI tract and methods of endoscopic hemostasis. The second stage consisted of a practical part and answers to the judges’ questions. The practical part involved performance of video endoscopy on a biopreparation (porcine esophagus and stomach), identification of a conditional ulcer complicated by bleeding and performance of endoscopic hemostasis by clipping. When performing the task, the team spoke through all their actions. After the manipulation, each team answered 2 questions from the judges. Results: The results of the All-Russian Student Olympiad revealed three winners. 1st place: the team of the N. I. Pirogov Russian National Research Medical University (A. A. Klimenko, 3rd year student; K. A. Kuznetsova, 5th year student; A. I. Khizhnyak, 5th year student); 2nd place: the team of the St. Petersburg State Pediatric Medical University (D. K. Skalinsky, 3rd year student; A. D. Komarova, 3rd year student; I. A. Cherepakhina, 5th year student); 3rd place: the team of the V. A. Almazov National Medical Research Center FSBI of the Ministry of Health of Russia (A. D. Shelimanova, 4th year student; Yu. M. Bogdanov, 5th year student; M. V. Chukin, 4th year student). Conclusion: The event enabled the students to show curiosity, determine the attitude to the future profession, demonstrate their knowledge and manual skills in the field of endoscopy, as well as gain experience in teamwork. Evaluating the work of the novice endoscopists, the leading specialists in the field of surgery and endoscopy identify promising students, which has a positive impact on attracting young promising specialists to the profession.

Parameters of physical development of term newborns with Intrauterine Growth Retardation, born in a 3B Level Perinatal Centre of St. Petersburg State Pediatric Medical University in 2022

BACKGROUND: Intrauterine growth retardation of a newborn child is an current problem in neonatology, obstetrics and pediatrics. Due to intrauterine development disorders, these newborns have increased morbidity and mortality rates. In the presence of Intrauterine growth retardation, the likelihood of developing complications in the early neonatal period increases (birth asphyxia, meconium aspiration, hypoglycemia, polycythemia, etc.), and the risk of developing infections and neurological disorders) is increased. AIM: The aim of this study is to study the parameters of physical development of term newborns born in the Perinatal Centre 3B level of the St. Petersburg State Pediatric Medical University in 2022 year, to determine the frequency and structure of disorders associated with Intrauterine growth retardation and malnutrition depending on the gestational age of term newborns for a differential approach in the management of children with Intrauterine growth retardation by neonatologists and paediatricians. MATERIALS AND METHODS: There were analyzed 1000 hospital neonatal records of newborns children born at the Perinatal Centre of Level 3B of St. Petersburg State Pediatric Medical University in 2022 year. Of these, 55 term babies were born with Intrauterine growth retardation. The study examined the physical development of term newborns, determined the frequency and structure of disorders associated with intrauterine growth retardation and malnutrition, depending on the gestational age of term newborns. RESULTS: Retardation of intrauterine growth and development in newborn children born in level 3B centres are represented by low body weight in relation to gestational age in 63.6% of cases, trophic disorders with normal body weight and reduced weight/length ratio in 34.6% of cases, and low height index with normal body weight in 1.8% of cases. Severe physical developmental disorders were found only in children with low body weight: in 13% of cases of low birth weight for gestational age, and in 55% of cases of small fetal size for gestational age. CONCLUSIONS: the distribution of physical development disorders (ICD code P05.2) in term infants, depending on the degree of maturity has a linear trend and occurs with maximum frequency (50%) in late term newborns, which is associated with the onset of aging of the placenta and the intensification of existing, even compensated, placental insufficiency.

Collagens of placenta composition in obese puerperant women who gave birth to сhildren at St. Petersburg State Pediatric Medical University in 2018–2021

BACKGROUND: The relevance of the problem of obesity is associated with the high frequency and steady growth of this pathology in the population. The epigenetic influence of maternal obesity on the course of pregnancy and childbirth, as well as on the condition of the fetus and newborn, is currently being studied. This article analyzes changes in the composition of the connective tissue of the placenta against the background of obesity in pregnant and puerperas. AIM: The aim of this study is to identify the pathomorphological features of the placenta and the composition of placental collagens in women who were obese before pregnancy and at the time of delivery at the Perinatal Center of St. Petersburg State Medical University from 2018 to 2021 to assess potential fetal risks and to predict possible complications during pregnancy and in the postnatal period for the mother. MATERIALS AND METHODS: A histological examination of the placentas of obese women (18 patients) and the ones with a normal body mass index (18 patients) who gave birth to mature newborns at the Perinatal Center of St. Petersburg State Medical University from 2018 to 2021 was performed followed by immunohistochemical examination. Staining of placenta specimens was carried out in accordance with the standard immunohistochemical protocol, using primary antibodies to type I–IV collagen. RESULTS: Microscopic examination of chorionic villi revealed no significant differences in the presence of chronic inflammation and angiogenesis disorders between the groups. When studying collagen expression levels, the following differences have been found: in the group of pregnant obese patients, the optical luminescence density and distribution area for type I–III collagen in the placenta were significantly higher, while for type IV collagen they were significantly lower compared with the control group. CONCLUSIONS: The following features of the formation of connective tissue in the placenta in obese mothers have been revealed: an increase in type I–III collagen production and a decrease in type IV collagen production. The obtained findings indicate an earlier functional and morphological change in the placenta than those detected by standard histological methods.

READINESS OF PEDIATRICIANS TO FORM A VALUE ATTITUDE OF PATIENTS TO THEIR HEALTH

Background. At present, the Russian state, medical and educational communities are concerned about the health of the younger generation. In this regard, at the stage of training pediatricians in residency, there is a very acute issue related to the search for approaches, means and methods of training that contribute to the formation of the readiness of such specialists to carry out psychological and pedagogical activities and solve pedagogical problems, in the process of professional medical activity, one of which is the education of the value attitude of children to their own health. From 2022 to 2023 academic year, an experimental study was conducted at the Faculty of Retraining and Continuing Professional Education at the St. Petersburg State Pediatric Medical University, aimed at to studying evaluate the pediatrician's level of psychological and pedagogical knowledge formation and pedagogical skills which are related to their readiness to the psychological and pedagogical type of activity and the solution of pedagogical problems in medical practice. Purpose. To identify changes in the state of psychological and pedagogical knowledge and the motivational orientation of pediatricians to the formation of the value attitude of patients to health during the experimental work, conditioned by the contextual approach to the study of the discipline "Pedagogy". Materials and methods. The study involved 300 first-year pediatricians with an average age of 25.48±2.03 years, including 233 women and 67 men. All respondents were divided into two groups (150 people each) – the main group and the control group – according to the criterion of participation in the experimental work, which involved the use of a contextual approach in the process of studying the discipline of the Pedagogy curriculum. Residents agreed to conduct research procedures. In advance, the authors of the article received permission from the Local Ethics Committee of the St. Petersburg State Pediatric Medical University to organize an experimental study. The methodology of the study consisted of adapted questionnaires and questionnaires. The followingstatistical methods were used: Wilcoxon T-test (for related samples); the analysis of correlations between the studied parameters was carried out using the C. Spearman criterion. The calculation of the results was carried out using the application package of the program "IBM SPSS Statistics 27". Results. Experimental research work has revealed changes in the level of formation of psychological and pedagogical knowledge and pedagogical skills that ensure the readiness of pediatricians to carry out psychological and pedagogical activities in the process of medical practice and to solve the pedagogical problem aimed at educating the value attitude of patients to their own health. Conclusions. The results of the experimental study indicate the need to use a contextual approach in the process of training pediatricians for psychological and pedagogical activities, and as a didactic means of teaching - medical and pedagogical situations recreated or modeled by specialists.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ РАННЕГО И ПОЗДНЕГО НАЗНАЧЕНИЯ БИОАНАЛОГА РИТУКСИМАБА BCD020 ПРИ СИСТЕМНОЙ КРАСНОЙ ВОЛЧАНКЕ У ДЕТЕЙ: РЕЗУЛЬТАТЫ ОДНОЦЕНТРОВОГО РЕТРОСПЕКТИВНОГО КОГОРТНОГО ИССЛЕДОВАНИЯ

Juvenile systemic lupus erythematosus (jSLE) is a severe life-threatening disease with an immunoinflammatory pathogenesis and possible involvement of several organs or organ systems, both sequentially and simultaneously. Early initiation of biological therapy may improve disease outcomes. The purpose of this research was to evaluate the benefits of early initiation of genetically engineered biological therapy for jSLE with the Rituximab biosimilar BCD020. Materials and methods used: a single-center retrospective cohort study performed at the Saint Petersburg State Pediatric Medical University (Saint Petersburg, Russia) in 2012-2022 that included information on 36 patients with early Rituximab prescription (ERP; within less than 6 months from the jSLE diagnosis) and late Rituximab prescription (LRP; after over one year). The main characteristics of the disease were compared at the onset, at the time of initiation of Rituximab therapy and at 12 months after that. Results: the main baseline differences between the groups were statistically significantly higher disease activity according to the SLEDAI scale (p=0.003) and a higher incidence of macrophage activation syndrome (p=0.096), a higher average daily dose of glucocorticosteroids (GCS) in the ERP group (p=0.027). At the end of the study there were no statistically significant differences in the main outcomes of SLE between the compared groups. The main advantages of ERP were a statistically significantly shorter time to achieve a low daily dose of GCS (<0.2 mg/kg) - 1.2 (0.9; 1.4) years compared to 2.8 (2.3; 4 .0) years (p<0.001) and a higher likelihood of achieving a low dose of corticosteroids (RR=57.8 [95% CI: 7.2; 463.2], p<0.001) and achieving remission (SLEDAI=0); RR=37.6 [95% CI: 4.45; 333.3], p<0.001). During the research there were no statistically significant differences in the incidence of adverse events, including severe adverse events, between the compared groups of patients. Conclusion: ERP makes it possible to improve the control over the activity of jSLE and minimize the volume of GCS drugs with similar treatment outcomes and safety profile. Further research is required in order to determine the indications for biological therapy for jSLE.

55 years of devoted service to medicine, morphology and pedagogy (on the 80th anniversary of the birth of Professor N.R. Karelina)

A long and long way of professional development has been done so that in 2023 we would congratulate Natalia Rafailovna Karelina, Doctor of Medical Sciences, Professor, member of the Board of the Scientific Medical Society of Anatomists, Histologists and Embryologists of Russia on the 80th anniversary. For more than 21 years, she has been the head of the Department of Human Anatomy at St. Petersburg State Pediatric Medical University and inspires the younger generation to scientific achievements. The staff of the Department of Human Anatomy of St. Petersburg State Medical University, friends and colleagues, as well as numerous students cordially congratulate Natalia Rafailovna and wish her long life, good health, professional longevity and enthusiasm for the benefit of her beloved medical science and pedagogy

Diagnosis and X-ray endovascular methods of treatment of arterial priapism in children

Diagnosis and X-ray endovascular methods of treatment of arterial priapism in children

BCD020 rituximab bioanalog compared to standard treatment in juvenile systemic lupus erythematosus: The data of 12 months case-control study.

Systemic lupus erythematosus (SLE) is the most frequent and serious systemic connective tissue disease. Nowadays there is no clear guidance on its treatment in childhood. There are a lot of negative effects of standard-of-care treatment (SOCT), including steroid toxicity. Rituximab (RTX) is the biological B-lymphocyte-depleting agent suggested as a basic therapy in pediatric SLE. To compare the benefits of RTX above SOCT. The data from case histories of 79 children from the Saint-Petersburg State Pediatric Medical University from 2012 to 2022 years, were analyzed. The diagnosis of SLE was established with SLICC criteria. We compared the outcomes of treatment of SLE in children treated with and without RTX. Laboratory data, doses of glucocorticosteroids, disease activity measured with SELENA-SLEDAI, and organ damage were assessed at the time of initiation of therapy and one year later. Patients, treated with RTX initially had a higher degree of disease activity with prevalence of central nervous system and kidney involvement, compared to patients with SOCT. One year later the disease characteristics became similar between groups with a more marked reduction of disease activity (SELENA-SLEDAI activity index) in the children who received RTX [-19 points (17; 23) since baseline] compared to children with SOCT [-10 (5; 15.5) points since baseline, P = 0.001], the number of patients with active lupus nephritis, and daily proteinuria. During RTX therapy, infectious diseases had three patients; one patient developed a bi-cytopenia. RTX can be considered as the option in the treatment of severe forms of SLE, due to its ability to arrest disease activity compared to SOCT.

Features of severe forms of new coronavirus infection (COVID-19) in children

BACKGROUND: The problem of the complicated course of COVID-19 and deaths in children with severe comorbid pathology is relevant. Severe forms of the disease are often the cause of critical conditions and deaths, including decompensated respiratory failure, acute respiratory distress syndrome, septic shock, cardiac, hepatic, renal insufficiency, coagulation disorders, damage to the central nervous system.
 AIM: The aim is to analyze the features of the course of COVID-19 in children who require mandatory hospitalization in specialized hospitals for background pathology, to identify predictors of the development of severe forms of COVID-19 in order to choose the optimal ways of treating this pathology.
 MATERIALS AND METHODS: Under the supervision of the St. Petersburg State Pediatric Medical University in the department for children with new coronavirus infection COVID-19 with intensive care and intensive care wards in the period 2020–2022 with a confirmed diagnosis of “new coronavirus infection” there were 791 patients aged 0 to 17 years. The diagnosis was made on the basis of clinical and epidemiological data, the results of a comprehensive laboratory and instrumental study. The severity of the disease was determined in accordance with the methodological recommendations of the Ministry of Health of the Russian Federation.
 RESULTS: The severe form of COVID-19 was diagnosed in 34 patients out of 791 (4.3%). Adverse outcomes were 1.4%. In 27 out of 34 children (79.4%), new coronavirus infection occurred against the background of severe comorbid pathology. Pneumonia was diagnosed in 91.2% of cases. 88.2% of patients needed oxygen therapy.
 CONCLUSIONS: Severe forms of COVID-19 in children are characterized by high fever with severe intoxication, respiratory tract damage with a significant volume of lung damage (CT-3 and CT-4) with the development of multiple organ failure. Predictors that require mandatory hospitalization in specialized hospitals for background pathology in severe forms of COVID-19 are: primary immunodeficiency conditions, oncohematological pathology with postcytostatic aplasia of hematopoiesis, severe organic lesions of the central nervous system, epilepsy, protein-energy deficiency of 3–4 degrees, bronchopulmonary dysplasia, atypical emolytic uremic syndrome with acute kidney damage. Comprehensive treatment of such patients should be carried out by a multidisciplinary team in a specialized department with extensive diagnostic and therapeutic capabilities.

Teacher, scientist, practitioner – Valeriy P. Ivashchenko

The article is dedicated to the 80th anniversary of Valery P. Ivashchenko, a labor veteran, honored figure in the field of physical education and sports, an experienced teacher, scientist, practitioner, associate professor of the department of physical education. His career is traced from a person passionate about sports to the head of a teaching staff. The important role of V.P. Ivashchenko’s scientific activities for the development of the department, his participation in all-Russian and international conferences, writing articles, developing educational programs and manuals are emphasized. The stages of the biography are presented: studying at the Leningrad Institute of Physical Culture named after P.F. Lesgaft, coaching, refereeing, postgraduate studies, defending a candidate’s thesis, teaching at the Institute of Physical Culture, heading the department of physical education at the St. Petersburg State Pediatric Medical University. The article briefly highlights the main points of the methodological, practical and pedagogical activities of V.P. Ivashchenko, namely, conducting educational classes, opening sports sections, preparing university teams for participation in competitions at various levels. The authors of the article mentioned Valery Pavlovich’s well-deserved awards for many years of conscientious work in the field of physical culture and sports, as well as the conferment of honorary titles. His high level of professionalism, creative attitude to work, desire for an active lifestyle and remarkable human qualities were noted. Biographical information in the article is presented by V.P. Ivashchenko.

Assessment of effective doses for fluoroscopy-guided balloon dilatation of benign esophageal strictures in pediatric medicine

Interventional examinations are associated with high levels of patient exposure per examination, which makes it particularly important to monitor individual patient doses and to assess radiation risks. The aim of this study was the assessment of effective doses for fluoroscopy-guided balloon dilatation of benign esophageal strictures, whichwasperformedonpediatricpatientsaged 1 to 2 yearsatthe Departmentof Radiosurgical Methodsof Diagnosis and Treatment of St. Petersburg State Pediatric Medical University. Patient exposure patterns were basedonourowndatacollection. Thecalculationofeffectiveandorgandosesofpatientsnormalizedbythevalue of the dose area product measured during the study was carried out using PCXMC 2.0 software. The conversion coefficients from the dose area product to the effective dose were calculated using tissue weighting coefficients from the ICRP Publications 60 and 103 their values were 10.7 and 11.7 µSv/cGy cm2, respectively. The results of verification of the method indicated that the use of inappropriate conversion coefficients leads to an almost double underestimation of children’s effective doses. Differences in the values of conversion coefficients are significant and are explained by differences in voltage, source to image distance, and irradiation field size. A simplified model of patient exposure was proposed, which is described by a single irradiation field. The assessment of effective doses using multi-field and single-field irradiation model shows comparable results, which allows using the differentiated approach to the assessment of radiation doses of patients.

Кровоизлияния в сетчатку у новорожденных. Клинические особенности и факторы риска

Material and methods. The study included newborns born at the Perinatal Center of St. Petersburg State Pediatric Medical University in the period from July 2021 to October 2022. Anamnestic and other risk factors for the development of retinal hemorrhages were assessed in newborns with and without retinal hemorrhages (RH). Depending on the severity of RH (according to the results of the examination on the RetCam retinal camera), the newborns were divided into groups in which the bilaterality of the RH was assessed, localization in the layers and area of the retina, with an emphasis on the macular region and the optic disk. Results. Of the 75 newborns, 16 had birth-related RH (23.1%). Normal spontaneous vaginal delivery showed the highest association with RH (odds ratio, 5.515; 95% confidence interval, 1.15–26.46, p<0.001). Hemorrhages were more often bilateral (68.8%), intraretinal (87.5%) and localized in the central zone of the retina (81.3%). At the same time, severe RH were more often located in zones I and II, in each newborn they affected the optic nerve or macula, in 6.3% of cases they spread to the vitreous body, and in 25% they were accompanied by Roth’s spots. Conclusion. RH occur in 21.3% of full-term newborns and are largely associated with normal delivery. The main characteristics of hemorrhages in newborns differ notably depending on their severity. Severe retinal hemorrhages in newborns may have negative consequences for the development of visual functions at an older age, which requires further long-term studies. This study confirmed that the digital wide-angle retinal camera is an effective method for examining a large number of newborns with RH. Key words: newborn, retinal hemorrhages, vitreous hemorrhages, Roth’s spots

Cicatricial complications of respiratory papillomatosis surgical treatment at the department of Saint Petersburg State Pediatric Medical University clinical hospital in 2019–2021

Cicatricial complications of respiratory papillomatosis surgical treatment at the department of Saint Petersburg State Pediatric Medical University clinical hospital in 2019–2021

Acute EBV mononucleosis in children of various ages hospitalized in the infectious hospital of the St. Petersburg State Pediatric Medical University in 2017–2020

Acute EBV mononucleosis in children of various ages hospitalized in the infectious hospital of the St. Petersburg State Pediatric Medical University in 2017–2020

The influence of Epstein–Barr-associated infection upon pituitary-thyroid system in children at different periods of the disease

BACKGROUND: The interest in infectious mononucleosis caused by the EpsteinBarr virus (EBV) is currently apparent. EpsteinBarr virus reaches tropism for reticular and lymphoid tissues, does not eliminate from the body and causes an immunopathological process in which the endocrine system develops. Thyroxine (T4), triiodothyronine (T3), and thyroid-stimulating hormone determinations are the most widely used diagnostic tests to assess thyroid function.
 AIM: To study changes in T3, T4, thyroid-stimulating hormone in children of older sex and age at the height and convalescence of infectious mononucleosis, the period of EpsteinBarr virus.
 MATERIALS AND METHODS: Under the supervision of the child were 94 aged from 1 to 17 years, among them from 1 to 5 years 22%, from 5 to 10 years 39%, from 10 to 15 years 27%, from 15 to 17 years 12% , diagnosed with EpsteinBarr virus mononucleosis, moderate severity. The diagnosis was made on the basis of clinical, anamnestic and laboratory data. The studies leading to the diagnosis were carried out in the laboratory of the Saint Petersburg State Pediatric Medical University. In addition to routine settings (clinical minimum), detection of M- and G- antibodies to EpsteinBarr virus, detection of the genome in the blood by PCR, determination of the levels of T3, T4, thyroid-stimulating hormone by enzyme-linked immunosorbent assay in blood serum.
 RESULTS: Regular changes in T3 concentrations were registered in both girls and boys of all three age groups: the concentration of T3, T4 in the period of the peak of the disease was reduced compared to the period of convalescence. Significant changes in thyroid-stimulating hormone were registered in girls and boys of all three age groups: the concentration of thyroid-stimulating hormone during the peak of the disease slightly decreased compared to the period of convalescence in boys and increased compared to the period of convalescence in girls.
 CONCLUSIONS: The changes in the levels of T3, T4, thyroid-stimulating hormone in children during the peak of infectious mononucleosis depends on the severity of the disease, the presence and nature of complications.

Molecular genetic diagnosis and treatment of congenital hyperinsulinism: results of observation of patients with variants in the genes <i>ABCC8</i> and <i>KCNJ11</i>

Congenital hyperinsulinism is a rare hereditary disease characterized by inadequate hypersecretion of insulin by pancreatic -cells, clinically manifested by persistent hypoglycemia, which poses a great threat to patient survival and a high risk of developing severe neurological complications.
 The article presents the results of clinical, hormonal and molecular genetic examination and treatment of 10 patients with congenital hyperinsulinism caused by mutations in the genes of ATP-dependent potassium channels (KCNJ11, ABCC8), hospitalized in Saint Petersburg State Pediatric Medical University clinic in 20102023. In all the studied patients, the disease manifested from the 1st to the 3rd day of life, and the median age of diagnosis of congenital hyperinsulinism in the study group was 1 month (min 14 days; max 3 years 9 months). In 8 out of 10 patients, a severe course of hypoglycemic syndrome was noted at the onset of the disease. According to the molecular genetic investigation results, 8 different mutations were identified: in the KCNJ11 (2/8) and ABCC8 (6/8) genes. Identical variants were found in two pairs of related patients. In children with mutations in the ABCC8 gene (n = 8), 2 variants with unknown clinical significance were identified, which were not previously described in allelic databases and scientific literature. According to the analysis of anamnestic and clinical and laboratory data, 80.0% of children, including patients with new, previously not described in the scientific literature, variants in the ABCC8 gene have a severe progressive course of congenital hyperinsulinism, requiring the appointment of insulinostatic therapy.

Newborn asphyxia: features of the course of pregnancy and delivery and the structure of the placenta

BACKGROUND: The main cause of early neonatal death is neonatal asphyxia. Asphyxia transferred during childbirth can lead to damage of the brain, respiratory disorders, hemodynamic disorders, and impaired renal function.
 AIM: The aim of the study is to determine the factors predisposing to the birth of a child in a state of asphyxia.
 MATERIALS AND METHODS: A retrospective study was conducted, which included the analysis of medical records of 11,662 women who gave birth at the Perinatal Center of the Saint Petersburg State Pediatric Medical University (level IIIB obstetric institution), whose pregnancy ended in urgent delivery. The main group included patients who gave birth to full-term babies in a state of moderate and severe asphyxia (n = 70), the control group included patients who gave birth to children without asphyxia (n = 11,592).
 RESULTS: Factors predisposing to the birth of a full-term baby in a state of moderate and severe asphyxia were identified, which can be used to develop a system for predicting the birth of a child in a state of asphyxia and a set of preventive measures.
 CONCLUSIONS: More frequent ascending infection of stage II and III makes it necessary to timely identify and treat a bacterial infection in all full-term pregnant women. A prognostic model for the birth of a full-term baby in a state of asphyxia has been constructed. Women at risk should undergo an additional examination at 37 weeks of pregnancy: sowing from the cervical canal for flora and sensitivity to antibacterial drugs to identify pathogenic and opportunistic microflora, childbirth should be carried out under mandatory constant monitoring control.

E10 Temporo-mandibular joint involvement risk factors in juvenile idiopathic arthritis

Abstract Introduction Recent recommendations suppose temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) is a risk factor of poor outcomes and severe disease course. Objectives To compare the clinical characteristics of patients with juvenile idiopathic arthritis with and without TMJ involvement. Methods We analyzed the data of 753 patients with juvenile idiopathic arthritis aged 2–17 years, depending on TMJ arthritis (n = 43; 5.7%) or no TMJ arthritis (n = 710; 94.3%). Clinical, laboratory characteristics and treatment regimens were compared. Odds ratio (OR) analysis of sensitivity (Se) and specificity (Sp) was performed to obtained the predictors of TMJ involvement. Results Despite the similar age of onset, TMJ arthritis was associated with longer course of the disease, polyarticular JIA category, use of systemic corticosteroids and longer achievement of remission with similar rate of biologic administration. TMJ arthritis was associated with involvement of cervical spine, hip and shoulder arthritis. The main risk factors, associated with TMJ involvement in JIA were active joints > 8 (OR = 14.9 (5.8; 38.3), P = 0.0000001), delayed remission > 7 years (OR = 3.1 (1.6; 5.8), P = 0.0004), delayed hip involvement (OR = 4.6 (0.9; 22.6), P = 0.041), hip osteoarthritis (OR = 4.0 (1.2; 13.0), P = 0.014), and avascular necrosis of the hip. Cervical spine arthritis (OR = 10.3 (5.4; 19.8), P = 0.000001), and corticosteroid treatment (OR = 2.3 (1.2; 4.4), P = 0.0007) were associated with TMJ arthritis. Patients with TMJ arthritis required more biologics (OR-3.2 (1.6; 6.2), P = 0.0006). Oligoarticular JIA category and uveitis were protective against TMJ involvement. Data are in the table. Conclusion TMJ involvement is marker of poor disease prognosis. Early initiation of biologics and avoidance of corticosteroids might improve the risk of TMJ involvement. Ethics Written consent was obtained according to the declaration of Helsinki. This retrospective study's protocol was approved by the local Ethical Committee of Saint Petersburg State Pediatric Medical University (protocol number 11/10 from 23.11.2020).

OA03 Are there any differences in the outcomes of treatment of a 12-month course of rituximab BCD020 biosimilar in systemic lupus erythematosus in children with early and late administration of the drug

Abstract Background Juvenile systemic lupus erythematosus (JSLE) is a severe life-threatening disease. The place of rituximab in JSLE management is still undefined. The early biologic intervention might improve disease’s outcomes. Aim of study To assess the advantages of early rituximab administration compared with late. Material and methods In the retrospective cohort study the information about 36 JSLE patients, whom rituximab biosimilar BCD020 was initiated were included. All patients were divided in two groups: early start of rituximab (less than six months from onset) and late start (more than one year). We compared initial disease characteristics at onset, on the baseline (BL)—start of rituximab and end of the study—(EOS) - 12 months, and treatment characteristics. Results The time gap between early and late rituximab administration was 19 months. There were no differences in disease profile at onset, except higher SLEDAI and MAS frequency in early rituximab group. Baseline differences were: lower C3, C4, higher SLEDAI and oral daily corticosteroids dosage. At the end of the study, patient whom rituximab was prescribed early had more impressive changes in SLEDAI, e.g. 100% of patients decreased SLEDAI, compared with 79% in late rituximab group. The detailed information about disease activity and treatment outcomes in both groups are in the table. There were no differences in adverse events between groups, except more impressive signs of corticosteroid toxicity in group of late rituximab administration. Conclusion Early administration of rituximab biosimilar made it possible to control the JSLE activity faster and reduce the dose of corticosteroids effectively. There were no differences in adverse events, except signs of corticosteroid toxicity in group of late rituximab initiation. This work was financially supported by the Ministry of Science and Higher Education of the Russian Federation (Agreement No. 075–15-2022–301). Ethics The study was approved by the Ethical Committee of the Saint-Petersburg State Pediatric Medical University (Protocol No1/3 from 11/Jan/2021). There were no violations of patient's rights according to the Declaration of Helsinki.

Cortisol concentration as a marker of adaptation processes in children with infectious mononucleosis at different periods of the disease

BACKGROUND: Infectious mononucleosis is an acute infectious disease caused by EpsteinBarr virus. This virus replicates in B-lymphocytes but may be as well found in the epithelial cells of pharynx and parotid ducts. Its typical symptoms include fever, lymphadenopathy and herpetic angina, the endocrine system may also be involved in the pathologic process.
 AIM: The aim of the study is the change in cortisol levels in children of different sex and age during the peak and convalescence of infectious mononucleosis caused by the EpsteinBarr virus.
 MATERIALS AND METHODS: Under observation were 94 children aged 1 to 17 years, among them from 1 to 5 years 22%, from 5 to 10 years 39%, from 10 to 15 years 27%, from 15 to 17 years 12%, with a diagnosis of EpsteinBarr virus mononucleosis moderate severity. The diagnosis was made on the basis of clinical, anamnestic and laboratory data. Studies confirming the diagnosis were carried out in the laboratory of St. Petersburg State Pediatric Medical University. In addition to routine examinations (clinical minimum), determination of M- and G- antibody titers to the EpsteinBarr virus, detection of the EpsteinBarr virus genome in the blood by PCR, and determination of cortisol levels by enzyme-linked immunosorbent assay in blood serum.
 RESULTS: In all age groups, the cortisol concentration during the peak period was higher than during the convalescence period. At the same time, in girls in groups from 6 to 10 years old and from 11 to 16 years old, this difference was significant (1045.19 111.10 versus 740.97 120.68 nM/l and 977.31 81.40 versus 735.48 113.04 nM/l respectively). In boys of all age groups, the differences were significant and amounted to 1211.30 128.36 versus 864.63 126.90 nM/l in the group from 1 to 5 years old, and 1066.76 39.01 versus 817,90 101,52 nM/l in the age group from 6 to 10 years old, in the age group from 11 to 16 years 950.14 101.54 versus 779.61 125.68 nM/l.
 CONCLUSIONS: Changes in cortisol levels in children during the peak of infectious mononucleosis depend on the severity of the disease, the presence and nature of complications. The level of cortisol determines various options for adaptation to infectious mononucleosis.