Pub Date : 2023-10-13DOI: 10.24110/0031-403x-2023-102-5-26-37
E.S. Petryaykina, N.I. Kolganova, D.Yu. Ovsyannikov, M.I. Ayrapetyan, S.A. Bulynko, Sh.A. Gitinov, V.V. Gorev, D.A. Zhakota, O.I. Zhdanova, M.A. Zhestkova, I.I. Zakirov, I.R. Zinnatullin, T.Yu. Illarionova, M.A. Karpenko, A.K. Konstantinova, S.Kh. Kurbanova, O.G. Malyshev, Ya.V. Marchenkov, N.A. Mitina, B.V. Nguyen, A.D. Ovsyannikov, F.A. Petryaykin, E.E. Petryaykina, A.Yu. Rtishchev, A.I. Safina, Yu.L. Soldatskiy, M.N. Tereshchenko, O.G. Topilin, I.E. Turina, A.G. Tsverava
Organizing pneumonia (OP) is an interstitial lung disease (ILD), which is characterized by the proliferation of granulation tissue in the bronchioles and alveoli, and diagnosed on the basis of clinical history, morphological data, CT changes and response to glucocorticoid (GC) therapy. Information about OP in children is limited due to the insufficient number of cases described and observed. The purpose of this research was to establish the epidemiological characteristics, etiological structure, clinical and CT semiotics of OP in children, to characterize its comorbidity and therapy. Materials and methods used: 20 children aged 4 months to 17 years old with OP were observed in 2009-2023. The diagnosis was set based on the clinical and anamnestic data, the presence of specific CT patterns, positive clinical and radiological dynamics during GC therapy, and (in 2 cases) according to histological examination results. Results: the ratio of boys to girls was 1.8:1, most often OP was diagnosed in infants (40%) and young children (30%) with various comorbid diseases with a frequency of 0.012‰ in the structure of all hospitalized patients of a multidisciplinary hospital in Moscow (Russia) in 2014-2022 The reasons for the acute (80%) and subacute (20%) OP were respiratory infections (40%), aspiration (30%), diffuse connective tissue diseases (DCTD) (10%), in a single case the OP had developed as part of lung injury associated with vaping and electronic cigarettes (EVALI), 15% of patients had an idiopathic version of OP (cryptogenic OP). The clinical picture of OP was characterized by shortness of breath (100%), cough (90%), fever, rales/crepitus (65%), wheezing (45%); the chest CT scan (n=19) showed zones of consolidation (100%), including subpleural localization (84%), trapezoidal shadowing (27%), zones of “ground glass” (68%), reversed halo sign (32%). Therapy included GC (95%), azithromycin (40%), mechanical ventilation (40%), oxygen therapy (60%). Clinical and radiological improvement occurred in 18 (90%) children, and death occurred in 2 (10%) children. Conclusion: OP is a rare variant of ILD whose reasons in children can be respiratory infections, aspiration, DCTD, EVALI. The effectiveness of GC in the presence of characteristic symptoms and CT images confirms the diagnosis.
{"title":"ORGANIZING PNEUMONIA IN CHILDREN: EPIDEMIOLOGY, ETIOLOGICAL STRUCTURE, CLINICAL AND COMPUTED TOMOGRAPHIC SEMIOTICS, COMORBIDITY, THERAPY","authors":"E.S. Petryaykina, N.I. Kolganova, D.Yu. Ovsyannikov, M.I. Ayrapetyan, S.A. Bulynko, Sh.A. Gitinov, V.V. Gorev, D.A. Zhakota, O.I. Zhdanova, M.A. Zhestkova, I.I. Zakirov, I.R. Zinnatullin, T.Yu. Illarionova, M.A. Karpenko, A.K. Konstantinova, S.Kh. Kurbanova, O.G. Malyshev, Ya.V. Marchenkov, N.A. Mitina, B.V. Nguyen, A.D. Ovsyannikov, F.A. Petryaykin, E.E. Petryaykina, A.Yu. Rtishchev, A.I. Safina, Yu.L. Soldatskiy, M.N. Tereshchenko, O.G. Topilin, I.E. Turina, A.G. Tsverava","doi":"10.24110/0031-403x-2023-102-5-26-37","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-5-26-37","url":null,"abstract":"Organizing pneumonia (OP) is an interstitial lung disease (ILD), which is characterized by the proliferation of granulation tissue in the bronchioles and alveoli, and diagnosed on the basis of clinical history, morphological data, CT changes and response to glucocorticoid (GC) therapy. Information about OP in children is limited due to the insufficient number of cases described and observed. The purpose of this research was to establish the epidemiological characteristics, etiological structure, clinical and CT semiotics of OP in children, to characterize its comorbidity and therapy. Materials and methods used: 20 children aged 4 months to 17 years old with OP were observed in 2009-2023. The diagnosis was set based on the clinical and anamnestic data, the presence of specific CT patterns, positive clinical and radiological dynamics during GC therapy, and (in 2 cases) according to histological examination results. Results: the ratio of boys to girls was 1.8:1, most often OP was diagnosed in infants (40%) and young children (30%) with various comorbid diseases with a frequency of 0.012‰ in the structure of all hospitalized patients of a multidisciplinary hospital in Moscow (Russia) in 2014-2022 The reasons for the acute (80%) and subacute (20%) OP were respiratory infections (40%), aspiration (30%), diffuse connective tissue diseases (DCTD) (10%), in a single case the OP had developed as part of lung injury associated with vaping and electronic cigarettes (EVALI), 15% of patients had an idiopathic version of OP (cryptogenic OP). The clinical picture of OP was characterized by shortness of breath (100%), cough (90%), fever, rales/crepitus (65%), wheezing (45%); the chest CT scan (n=19) showed zones of consolidation (100%), including subpleural localization (84%), trapezoidal shadowing (27%), zones of “ground glass” (68%), reversed halo sign (32%). Therapy included GC (95%), azithromycin (40%), mechanical ventilation (40%), oxygen therapy (60%). Clinical and radiological improvement occurred in 18 (90%) children, and death occurred in 2 (10%) children. Conclusion: OP is a rare variant of ILD whose reasons in children can be respiratory infections, aspiration, DCTD, EVALI. The effectiveness of GC in the presence of characteristic symptoms and CT images confirms the diagnosis.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135804896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-13DOI: 10.24110/0031-403x-2023-102-5-156-167
A.N. Lazareva, A.Yu. Rtishchev, I.G. Vorontsova, I.G. Rybkina, E.E. Petryaykina
COVID-19 pandemic has affected the healthcare systems Worldwide causing not only a redistribution of healthcare resources aimed at combating the pandemic and helping patients who required emergency treatment for COVID-19, but also, to a certain extent, restricting access to consultative and outpatient centers. In addition, due to the fear of contracting an infection, patients delayed seeking qualified and timely medical care, did not go to specialized medical institutions or engaged in self-diagnosis and self-medication, which in its turn has worsened the course of certain diseases or even led to the development of life-threatening conditions. The cancellation of medical appointments, elective procedures and prescriptions as well as concerns about contracting COVID-19 when seeking medical care during the pandemic have all led to delays in diagnosis and timely provision of necessary medical care to pediatric patients. Increase in online consultations has led to a decrease in face-to-face contacts with physicians, which may have contributed to underestimation of the severity of the disease. During any infectious pandemic the social isolation undoubtedly effectively reduces the spread of infectious diseases by reducing social contacts in spite of negative consequences that affect both the healthcare system and public health: a decrease in the quality of medical services due to the redistribution of resources, refusal from seeking medical advice due to patients’ fear of contracting an infection when visiting medical institutions as well as delayed diagnosis of diseases and untimely identification of life-threatening conditions. One of such conditions is diabetic ketoacidosis (DKA). This complication is very common, has the most severe course and has greater risk for future disability and mortality during the manifestation of newly diagnosed type 1 diabetes mellitus (T1D).
{"title":"SOCIAL AND MEDICAL ASPECTS OF THE COVID-19 PANDEMIC. MANIFESTATION PARTICULARITIES OF THE NEWLY DIAGNOSED TYPE 1 DIABETES MELLITUS IN CHILDREN AND ADOLESCENTS DURING THE COVID-19 PANDEMIC","authors":"A.N. Lazareva, A.Yu. Rtishchev, I.G. Vorontsova, I.G. Rybkina, E.E. Petryaykina","doi":"10.24110/0031-403x-2023-102-5-156-167","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-5-156-167","url":null,"abstract":"COVID-19 pandemic has affected the healthcare systems Worldwide causing not only a redistribution of healthcare resources aimed at combating the pandemic and helping patients who required emergency treatment for COVID-19, but also, to a certain extent, restricting access to consultative and outpatient centers. In addition, due to the fear of contracting an infection, patients delayed seeking qualified and timely medical care, did not go to specialized medical institutions or engaged in self-diagnosis and self-medication, which in its turn has worsened the course of certain diseases or even led to the development of life-threatening conditions. The cancellation of medical appointments, elective procedures and prescriptions as well as concerns about contracting COVID-19 when seeking medical care during the pandemic have all led to delays in diagnosis and timely provision of necessary medical care to pediatric patients. Increase in online consultations has led to a decrease in face-to-face contacts with physicians, which may have contributed to underestimation of the severity of the disease. During any infectious pandemic the social isolation undoubtedly effectively reduces the spread of infectious diseases by reducing social contacts in spite of negative consequences that affect both the healthcare system and public health: a decrease in the quality of medical services due to the redistribution of resources, refusal from seeking medical advice due to patients’ fear of contracting an infection when visiting medical institutions as well as delayed diagnosis of diseases and untimely identification of life-threatening conditions. One of such conditions is diabetic ketoacidosis (DKA). This complication is very common, has the most severe course and has greater risk for future disability and mortality during the manifestation of newly diagnosed type 1 diabetes mellitus (T1D).","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135804899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose of the research was to assess the metabolic profiles of the intestinal microbiome of children and adolescents with normal body weight and obesity taking into consideration the feeding type. Materials and methods used: a single-center, single-stage study of 188 children aged 10 to 18 years old (13.0 [11.0; 15.0] y/o), 103 (54.8%) boys/85 (45.2%) girls, who were divided into 2 groups: G1 (n=96) of healthy children and adolescents without obesity (19 (19.8%) on natural feeding/36 (37.5%) on artificial feeding/41 (42.7%) on mixed feeding); and G2 (n=92) of children and adolescents who were diagnosed with obesity (28 (30.4%)/13 (14.1%) and 51 (55.4%), accordingly). Bacterial DNA was isolated from fecal samples followed by sequencing of the variable region v3-v4 of 16S rRNA. PICRUSt2 was used to determine the metabolic profiles of the gut microbiota. Results and discussion: 358 metabolic pathways were reconstructed in the intestinal microbiome of children and adolescents. In obese children and adolescents, 47 metabolic pathways (12.13%) were decreased and only 3 (0.84%) were increased. There was a statistically significant decrease (p<0.05) in the anabolic processes of carbohydrate metabolism, amino acid and nucleotide metabolism in the intestinal microbiome of obese children. Metabolic pathways, whose content was statistically significantly increased in obesity, are of particular interest: thus, there was an increase in the pathways of glycogen II degradation (p=0.006), degradation of biogenic amines (p˂0.001), biosynthesis of UDP-N-acetyl-D-glucosamine I (p=0.045). The microbiota of obese children and adolescents was characterized by a statistically significantly lower potential for the synthesis of essential amino acids - arginine, histidine and lysine, the synthesis of terpenes and terpene-like vitamins K and E, as well as vitamins B1 and folic acid. The study revealed that in healthy children and adolescents, the feeding type during the first year of life affects the content of 20 pathways in the metabolic profiles of the intestinal microbiome. Conclusion: the metabolic profiles of the intestinal microbiota change in children with obesity. It was also revealed that the feeding type represents the effect of programming of the metabolic capabilities of the intestinal microbiome in subsequent periods of ontogenesis.
本研究的目的是评估正常体重和肥胖儿童和青少年肠道微生物群的代谢特征，并考虑喂养类型。采用的材料和方法:对188名10至18岁儿童进行单中心、单阶段研究(13.0 [11.0;15.0] y/o)，男孩103例(54.8%)/女孩85例(45.2%)，分为2组:健康无肥胖儿童青少年G1组(n=96)(自然喂养19例(19.8%)/人工喂养36例(37.5%)/混合喂养41例(42.7%));诊断为肥胖的儿童和青少年分别为28(30.4%)/13(14.1%)和51 (55.4%)，G2 (n=92)。从粪便样品中分离细菌DNA，对16S rRNA可变区v3-v4进行测序。PICRUSt2用于确定肠道微生物群的代谢谱。结果与讨论:在儿童和青少年肠道微生物群中重建了358条代谢途径。肥胖儿童和青少年有47条代谢途径减少(12.13%)，仅有3条代谢途径增加(0.84%)。肥胖儿童肠道菌群中碳水化合物代谢、氨基酸和核苷酸代谢的合成代谢过程降低，差异有统计学意义(p < 0.05)。代谢途径，其含量在肥胖中有统计学意义上的显著增加，特别令人感兴趣:因此，糖原II降解途径增加(p=0.006)，生物胺降解(p小于0.001)，udp - n -乙酰基- d -氨基葡萄糖I的生物合成(p=0.045)。肥胖儿童和青少年的微生物群在合成必需氨基酸——精氨酸、组氨酸和赖氨酸，合成萜烯和类萜烯维生素K和E，以及维生素B1和叶酸方面具有统计学上显著的低潜力。该研究表明，在健康儿童和青少年中，生命第一年的喂养方式会影响肠道微生物群代谢谱中20种途径的含量。结论:肥胖儿童肠道菌群代谢谱发生变化。研究还表明，饲喂类型代表了在个体发育的后续阶段肠道微生物群代谢能力编程的影响。
{"title":"INFLUENCE OF THE FEEDING TYPE DURING THE FIRST YEAR OF LIFE ON THE METABOLIC PROFILES OF THE INTESTINAL MICROBIAL COMMUNITY OF OBESE AND NORMAL-WEIGHT CHILDREN AND ADOLESCENTS RESIDING IN THE ROSTOV OBLAST OF RUSSIA","authors":"A.V. Shestopalov, I.M. Kolesnikova, D.V. Savchuk, A.M. Gaponov, E.D. Teplyakova, T.V. Grigoryeva, I.Y. Vasiliev, A.G. Rumyantsev, O.V. Borisenko, S.A. Rumyantsev","doi":"10.24110/0031-403x-2023-102-5-90-102","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-5-90-102","url":null,"abstract":"Purpose of the research was to assess the metabolic profiles of the intestinal microbiome of children and adolescents with normal body weight and obesity taking into consideration the feeding type. Materials and methods used: a single-center, single-stage study of 188 children aged 10 to 18 years old (13.0 [11.0; 15.0] y/o), 103 (54.8%) boys/85 (45.2%) girls, who were divided into 2 groups: G1 (n=96) of healthy children and adolescents without obesity (19 (19.8%) on natural feeding/36 (37.5%) on artificial feeding/41 (42.7%) on mixed feeding); and G2 (n=92) of children and adolescents who were diagnosed with obesity (28 (30.4%)/13 (14.1%) and 51 (55.4%), accordingly). Bacterial DNA was isolated from fecal samples followed by sequencing of the variable region v3-v4 of 16S rRNA. PICRUSt2 was used to determine the metabolic profiles of the gut microbiota. Results and discussion: 358 metabolic pathways were reconstructed in the intestinal microbiome of children and adolescents. In obese children and adolescents, 47 metabolic pathways (12.13%) were decreased and only 3 (0.84%) were increased. There was a statistically significant decrease (p<0.05) in the anabolic processes of carbohydrate metabolism, amino acid and nucleotide metabolism in the intestinal microbiome of obese children. Metabolic pathways, whose content was statistically significantly increased in obesity, are of particular interest: thus, there was an increase in the pathways of glycogen II degradation (p=0.006), degradation of biogenic amines (p˂0.001), biosynthesis of UDP-N-acetyl-D-glucosamine I (p=0.045). The microbiota of obese children and adolescents was characterized by a statistically significantly lower potential for the synthesis of essential amino acids - arginine, histidine and lysine, the synthesis of terpenes and terpene-like vitamins K and E, as well as vitamins B1 and folic acid. The study revealed that in healthy children and adolescents, the feeding type during the first year of life affects the content of 20 pathways in the metabolic profiles of the intestinal microbiome. Conclusion: the metabolic profiles of the intestinal microbiota change in children with obesity. It was also revealed that the feeding type represents the effect of programming of the metabolic capabilities of the intestinal microbiome in subsequent periods of ontogenesis.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135805448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiac manifestations in the acute phase and complications of COVID-19 in children, especially newborns, have not been sufficiently studied as yet. The purpose of this research was to determine the nature of damage to the cardiovascular system (CVS) in newborns from mothers who had a new coronavirus infection at different stages of pregnancy and who were infected after birth. Materials and methods used: a single-center observational comparative study with elements of retrospective analysis. The 3 groups of full-term newborns of 37 each were formed as follows: the main group 1 (A) of newborns from mothers who had a laboratory-confirmed new coronavirus infection in the 1st to 2nd trimesters of pregnancy; the comparison group 2 (B) of newborns with a laboratory-confirmed new coronavirus infection from mothers who had COVID-19 in the peripartum period; and the control group 3 (C) of practically healthy newborns. The frequency of various types of CVS lesions (myocarditis, rhythm and conduction disorders, perinatal CVS lesions) as well as the frequency of occurrence of signs of electrophysiological myocardial instability, hemodynamic disorders and increased levels of cardiac-specific enzymes were assessed. Results: newborns from mothers who suffered a new coronavirus infection during pregnancy are more likely than newborns from physiologically healthy pregnancy and childbirth to develop cardiac problems (heart failure (p=0.025), cardiac arrhythmias (p<0.001), specified congenital anomalies of the cardiac septum (p1-3<0.001), other specified congenital heart anomalies (p1-3=0.032) and other cardiovascular disorders that arose in the perinatal period (p<0.001)), in particular, maladaptive disorders of the cardiovascular system with signs of electrical instability of the myocardium, dilation of the heart cavities and increased levels of cardiac-specific enzymes, which required the exclusion of myocarditis. Conclusion: the identified changes in the cardiovascular system dictate the need for monitoring of newborns from mothers with COVID-19 with dynamic CVS assessment.
{"title":"CARDIOVASCULAR SYSTEM IN NEWBORNS BORN TO MOTHERS WHO HAD A NEW CORONAVIRUS INFECTION DURING PREGNANCY","authors":"D.O. Vladimirov, L.A. Balykova, M.V. Shirmankina, A.V. Kudashova, I.S. Nazarova, N.R. Belkina, O.M. Soldatov","doi":"10.24110/0031-403x-2023-102-5-78-89","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-5-78-89","url":null,"abstract":"Cardiac manifestations in the acute phase and complications of COVID-19 in children, especially newborns, have not been sufficiently studied as yet. The purpose of this research was to determine the nature of damage to the cardiovascular system (CVS) in newborns from mothers who had a new coronavirus infection at different stages of pregnancy and who were infected after birth. Materials and methods used: a single-center observational comparative study with elements of retrospective analysis. The 3 groups of full-term newborns of 37 each were formed as follows: the main group 1 (A) of newborns from mothers who had a laboratory-confirmed new coronavirus infection in the 1st to 2nd trimesters of pregnancy; the comparison group 2 (B) of newborns with a laboratory-confirmed new coronavirus infection from mothers who had COVID-19 in the peripartum period; and the control group 3 (C) of practically healthy newborns. The frequency of various types of CVS lesions (myocarditis, rhythm and conduction disorders, perinatal CVS lesions) as well as the frequency of occurrence of signs of electrophysiological myocardial instability, hemodynamic disorders and increased levels of cardiac-specific enzymes were assessed. Results: newborns from mothers who suffered a new coronavirus infection during pregnancy are more likely than newborns from physiologically healthy pregnancy and childbirth to develop cardiac problems (heart failure (p=0.025), cardiac arrhythmias (p<0.001), specified congenital anomalies of the cardiac septum (p1-3<0.001), other specified congenital heart anomalies (p1-3=0.032) and other cardiovascular disorders that arose in the perinatal period (p<0.001)), in particular, maladaptive disorders of the cardiovascular system with signs of electrical instability of the myocardium, dilation of the heart cavities and increased levels of cardiac-specific enzymes, which required the exclusion of myocarditis. Conclusion: the identified changes in the cardiovascular system dictate the need for monitoring of newborns from mothers with COVID-19 with dynamic CVS assessment.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135804898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Absence of pathognomonic signs of tuberculosis (TB) of the respiratory system and the diversity of its clinical manifestations reduce the alertness of primary health care (PHC) physicians to this problem, which in its turn leads to belated TB diagnosis. Most often initial diagnosis is “community-acquired pneumonia” at the onset of the disease. An algorithm for interdisciplinary interaction between pediatricians and TB specialists in cases of suspected TB of the respiratory system is proposed. The reasons for untimely detection of TB and diagnostic errors in PHC units are presented using the clinical cases. Absence of suspicion of TB in the presence of its predictors (contact with a TB patient, results of skin immunological tests); development of pulmonary disease outside the season of viral infections in patients who are not included in the risk group according to their frequency and in patients from socially problematic living conditions; incorrect interpretation of the clinical and radiological picture and the course of the disease at its onset are the main reasons for late diagnosis. Conclusion: identifying TB in children and adolescents when seeking medical help is the final part of the diagnostic journey of patients, since opportunities to diagnose the disease at earlier stages of its development were missed. The results of the presented observations indicate the need for interdisciplinary interaction between pediatric physicians and TB specialists for timely diagnosis of TB.
{"title":"RESPIRATORY TUBERCULOSIS IN ADOLESCENTS MASKED AS COMMUNITY-ACQUIRED PNEUMONIA: CLINICAL OBSERVATIONS","authors":"E.S. Ovsyankina, L.V. Panova, I.Yu. Petrakova, O.A. Piskunova","doi":"10.24110/0031-403x-2023-102-5-208-215","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-5-208-215","url":null,"abstract":"Absence of pathognomonic signs of tuberculosis (TB) of the respiratory system and the diversity of its clinical manifestations reduce the alertness of primary health care (PHC) physicians to this problem, which in its turn leads to belated TB diagnosis. Most often initial diagnosis is “community-acquired pneumonia” at the onset of the disease. An algorithm for interdisciplinary interaction between pediatricians and TB specialists in cases of suspected TB of the respiratory system is proposed. The reasons for untimely detection of TB and diagnostic errors in PHC units are presented using the clinical cases. Absence of suspicion of TB in the presence of its predictors (contact with a TB patient, results of skin immunological tests); development of pulmonary disease outside the season of viral infections in patients who are not included in the risk group according to their frequency and in patients from socially problematic living conditions; incorrect interpretation of the clinical and radiological picture and the course of the disease at its onset are the main reasons for late diagnosis. Conclusion: identifying TB in children and adolescents when seeking medical help is the final part of the diagnostic journey of patients, since opportunities to diagnose the disease at earlier stages of its development were missed. The results of the presented observations indicate the need for interdisciplinary interaction between pediatric physicians and TB specialists for timely diagnosis of TB.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135805197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite the fact that remote shock wave lithotripsy is a non-invasive method of surgical treatment of urolithiasis, the issue of diagnosis and possible reduction of the degree of acute kidney injury, the outcome of which is to varying degrees each session, remains relevant. The article represents a bibliographical sources analysis covering an extensive range of modern biomarkers detected in blood and urine tests used to assess the acute kidney injury of various etiologies, including shock wave lithotripsy. The statistical significance, advantages and disadvantages of the described new indicators are analyzed as well as the possibility of their complex application aiming to rather objective assessment of the degree of damage.
{"title":"BIOMARKERS OF ACUTE KIDNEY INJURY IN REMOTE SHOCK WAVE LITHOTRIPSY IN CHILDREN","authors":"O.D. Nikulin, S.N. Zorkin, E.L. Semikina, M.A. Snovskaya, D.S. Shakhnovsky, A.A. Zhuzhula","doi":"10.24110/0031-403x-2023-102-5-181-190","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-5-181-190","url":null,"abstract":"Despite the fact that remote shock wave lithotripsy is a non-invasive method of surgical treatment of urolithiasis, the issue of diagnosis and possible reduction of the degree of acute kidney injury, the outcome of which is to varying degrees each session, remains relevant. The article represents a bibliographical sources analysis covering an extensive range of modern biomarkers detected in blood and urine tests used to assess the acute kidney injury of various etiologies, including shock wave lithotripsy. The statistical significance, advantages and disadvantages of the described new indicators are analyzed as well as the possibility of their complex application aiming to rather objective assessment of the degree of damage.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135805198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Authors, based on bibliographical research and their own data, provide up-to-date information on interstitial lung diseases (ILD) in children. The classification of ILD in children that is used in the registry of pediatric patients with ILD in the European Union (2022) with a critical analysis is given, and the need for its practical use is substantiated. The algorithm for diagnosing childhood ILD is described in detail starting with the diagnostic criteria for childhood ILD syndrome and possible complications. The algorithm includes step-by-step, sequential steps to diagnose these rare diseases. Taking into account the latest advances in genetics and molecular biology, the main proteins and their encoding genes associated with ILD, types of inheritance and phenotypes are listed as well. Indications and findings during lung biopsy, general approaches to the treatment of ILD in children, including oxygen therapy, drug therapy and other therapy, taking into account the existing consensus of experts, are characterized.
{"title":"INTERSTITIAL LUNG DISEASES IN CHILDREN: MODERN CLASSIFICATION, DIAGNOSTIC ALGORITHM, COMMON THERAPEUTIC APPROACHES","authors":"M.A. Zhestkova, D.Yu. Ovsyannikov, V.A. Strelnikova, E.S. Petryaykina, Sh.A. Gitinov, E.V. Boytsova, A.A. Pushkov, K.V. Savostyanov","doi":"10.24110/0031-403x-2023-102-5-103-115","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-5-103-115","url":null,"abstract":"Authors, based on bibliographical research and their own data, provide up-to-date information on interstitial lung diseases (ILD) in children. The classification of ILD in children that is used in the registry of pediatric patients with ILD in the European Union (2022) with a critical analysis is given, and the need for its practical use is substantiated. The algorithm for diagnosing childhood ILD is described in detail starting with the diagnostic criteria for childhood ILD syndrome and possible complications. The algorithm includes step-by-step, sequential steps to diagnose these rare diseases. Taking into account the latest advances in genetics and molecular biology, the main proteins and their encoding genes associated with ILD, types of inheritance and phenotypes are listed as well. Indications and findings during lung biopsy, general approaches to the treatment of ILD in children, including oxygen therapy, drug therapy and other therapy, taking into account the existing consensus of experts, are characterized.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135804897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renovascular arterial hypertension (AH) is one of the most common and prognostically most serious secondary hypertensions in children, however, descriptions of renal artery stenosis as part of middle aortic syndrome are quite rarely described Worldwide, and the etiology of this syndrome remains unclear in more than half of all the cases. Treatment approaches include a combination of complex conservative and surgical endovascular techniques that require constant monitoring of effectiveness. A clinical case observation and treatment tactics for refractory hypertension in an adolescent patient with hypoplasia of the abdominal aorta, stenosis of both renal arteries, a progressive decline in the function and volume of the left kidney (a picture of shrinkage of the left kidney on scintigraphy, an increase in hyperazotemia) and left ventricular (LV) hypertrophy is presented. Due to the ineffectiveness of drug antihypertensive therapy, the patient subsequently underwent aortoaortic bypass surgery of the abdominal aorta with prosthetics and implantation of the left renal artery into the shunt, balloon vasodilation with the installation of stents in the lower pole artery of the left kidney and the right renal artery. Over time, there was an improvement in the velocity parameters of the vessels of both kidneys, a decrease in blood pressure to values close to normal and regression of LV hypertrophy. Conclusion: the treatment tactics for a patient with renovascular hypertension and hypoplasia of the abdominal aorta, including drug methods in combination with two-stage surgical correction - the application of an aortoaortic shunt and endovascular treatment - turned out to be the most effective in terms of controlled hypertension.
{"title":"TREATMENT TACTICS FOR SEVERE REFRACTORY ARTERIAL HYPERTENSION IN AN ADOLESCENT WITH ABDOMINAL AORTIC HYPOPLASIA AND RENAL ARTERY STENOSIS. A CLINICAL CASE","authors":"A.E. Matyunova, S.A. Sakhovsky, L.V. Bregel, B.L. Mironkov, I.A. Miloserdov, Yu.A. Kozlov, I.A. Kovalev, T.S. Korinets, A.O. Barakin","doi":"10.24110/0031-403x-2023-102-5-237-245","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-5-237-245","url":null,"abstract":"Renovascular arterial hypertension (AH) is one of the most common and prognostically most serious secondary hypertensions in children, however, descriptions of renal artery stenosis as part of middle aortic syndrome are quite rarely described Worldwide, and the etiology of this syndrome remains unclear in more than half of all the cases. Treatment approaches include a combination of complex conservative and surgical endovascular techniques that require constant monitoring of effectiveness. A clinical case observation and treatment tactics for refractory hypertension in an adolescent patient with hypoplasia of the abdominal aorta, stenosis of both renal arteries, a progressive decline in the function and volume of the left kidney (a picture of shrinkage of the left kidney on scintigraphy, an increase in hyperazotemia) and left ventricular (LV) hypertrophy is presented. Due to the ineffectiveness of drug antihypertensive therapy, the patient subsequently underwent aortoaortic bypass surgery of the abdominal aorta with prosthetics and implantation of the left renal artery into the shunt, balloon vasodilation with the installation of stents in the lower pole artery of the left kidney and the right renal artery. Over time, there was an improvement in the velocity parameters of the vessels of both kidneys, a decrease in blood pressure to values close to normal and regression of LV hypertrophy. Conclusion: the treatment tactics for a patient with renovascular hypertension and hypoplasia of the abdominal aorta, including drug methods in combination with two-stage surgical correction - the application of an aortoaortic shunt and endovascular treatment - turned out to be the most effective in terms of controlled hypertension.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135805054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) in children are both accompanied by copious amounts of infected sputum. Kinesitherapy (KT) eliminates mucostasis by providing bronchial drainage. KT methods are being constantly improved. The purpose of this research was to determine the effectiveness and safety of the new vest airway clearance system (ACS) chest vibration therapy machine model YK800 by Zhengzhou Yangkun Medical Instrument Co., Ltd. (Zhengzhou, China) in children with CF and PCD. The ACS consists of a compressor and a vest and creates high-frequency oscillation of the chest promoting drainage of problematic parts of the respiratory tract, small- and medium-caliber bronchi. Materials and methods used: in a study based on the National Medical Research Center for Children’s Health (Moscow, Russia) the KT included 5 sessions with the Yangkun YK800 in 15 patients aged 5 to 17 y/o: 8 with CF and 7 with PCD. Objective criteria: measurement of external respiratory function (ERF) and saturation, monitoring of chest excursion, and the 6-minute walk test. Subjective criteria: complaints, well-being, comfort. Results: objective criteria - improved ERF indicators in % (FVC p=0.004; r=0.829; FEV1 p=0.023; r=0.973; FEF25% p=0.018; r=0.840; FEF50% p=0.016; r=0.827; FEF75% p=0.015; r=0.867), especially high-speed indicators (FEF25%, FEF50%, FEF75%) that indicate the cleansing of mucus in the medium and small respiratory tracts; saturation improved (p=0.020; r=0.548); chest excursion increased (p=0.002; r=0.779). According to the 6-minute walk test, there was a significant increase in the distance traveled (p=0.000; r=0.535), 13 (86.6%) patients at the end of the course rated it as easier. Subjective criteria - 80% of patients noted sen-sations of productive coughing, easier expectoration of sputum: improvement in general condi-tion - 15, reduction in fatigue - 12, increased physical activity - 12, easier expectoration of phlegm - 13, reduction in episodes of paroxysmal cough - 13. Comfort in the use of the vest was rated at 4.4 points, noting mild vibration. Conclusion: the Yangkun YK800 vest airway clearance system as part of the KT has shown its effectiveness and safety in children with CF and PCD.
{"title":"NEW VEST AIRWAY CLEARANCE SYSTEM CHEST VIBRATION THERAPY MACHINE MODEL YK800 BY ZHENGZHOU YANGKUN MEDICAL INSTRUMENT CO., LTD. (ZHENGZHOU, CHINA) IN KINESITHERAPY FOR CHILDREN WITH CHRONIC LUNG DISEASES","authors":"V.A. Tsezarik, O.I. Simonova, Y.V. Gorinova, G.S. Lupandina-Bolotova, O.M. Konova","doi":"10.24110/0031-403x-2023-102-5-37-44","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-5-37-44","url":null,"abstract":"Cystic fibrosis (CF) and primary ciliary dyskinesia (PCD) in children are both accompanied by copious amounts of infected sputum. Kinesitherapy (KT) eliminates mucostasis by providing bronchial drainage. KT methods are being constantly improved. The purpose of this research was to determine the effectiveness and safety of the new vest airway clearance system (ACS) chest vibration therapy machine model YK800 by Zhengzhou Yangkun Medical Instrument Co., Ltd. (Zhengzhou, China) in children with CF and PCD. The ACS consists of a compressor and a vest and creates high-frequency oscillation of the chest promoting drainage of problematic parts of the respiratory tract, small- and medium-caliber bronchi. Materials and methods used: in a study based on the National Medical Research Center for Children’s Health (Moscow, Russia) the KT included 5 sessions with the Yangkun YK800 in 15 patients aged 5 to 17 y/o: 8 with CF and 7 with PCD. Objective criteria: measurement of external respiratory function (ERF) and saturation, monitoring of chest excursion, and the 6-minute walk test. Subjective criteria: complaints, well-being, comfort. Results: objective criteria - improved ERF indicators in % (FVC p=0.004; r=0.829; FEV1 p=0.023; r=0.973; FEF25% p=0.018; r=0.840; FEF50% p=0.016; r=0.827; FEF75% p=0.015; r=0.867), especially high-speed indicators (FEF25%, FEF50%, FEF75%) that indicate the cleansing of mucus in the medium and small respiratory tracts; saturation improved (p=0.020; r=0.548); chest excursion increased (p=0.002; r=0.779). According to the 6-minute walk test, there was a significant increase in the distance traveled (p=0.000; r=0.535), 13 (86.6%) patients at the end of the course rated it as easier. Subjective criteria - 80% of patients noted sen-sations of productive coughing, easier expectoration of sputum: improvement in general condi-tion - 15, reduction in fatigue - 12, increased physical activity - 12, easier expectoration of phlegm - 13, reduction in episodes of paroxysmal cough - 13. Comfort in the use of the vest was rated at 4.4 points, noting mild vibration. Conclusion: the Yangkun YK800 vest airway clearance system as part of the KT has shown its effectiveness and safety in children with CF and PCD.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135805056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose of the research was to study the relationship between the serum bilirubin level and the spirometric parameters in adolescents with bronchial asthma (BA). Materials and methods used: 213 patients (73,7% boys) with atopic BA aged 10 to 17 y/o were examined. All patients underwent determination of serum bilirubin level, spirometry indicators and general clinical examination. All patients were divided into three groups: G1 of 84 with reduced bilirubin level (less than 10 mсmol/l); G2 of 77 with normal bilirubin level (10 to 17,0 mсmol/l); and G3 of children with slightly elevated bilirubin level (17,1 to 45 mсmol/l). Results: elevated serum bilirubin level in this study occurred in 24.4% (52/213) of patients with BA. As the level of serum bilirubin increased in the general group of patients, a statistically significant increase in the z-criterion of the forced expiratory volume per 1 second (FEV1)/forced vital capacity (FVC) (p=0,005) and the z-criterion of the mean forced expiratory flow during the 25-75% of FVC (p=0,032) was observed, which was confirmed by the revealed positive correlations between the level of bilirubin and these spirometric indicators. The increase in z-criterion FEV1/FVC with an increase in bilirubin levels was statically significant in boys (p=0,046), in girls there was only a tendency to increase this indicator (p=0,07). Conclusion: bronchial patency in patients with slightly elevated bilirubin levels is higher than in patients with reduced serum bilirubin level in the blood. The best characteristics of bronchial patency in patients with “slightly elevated” bilirubin level suggest its protective effect in children with BA.
{"title":"RELATIONSHIP BETWEEN THE SERUM BILIRUBIN LEVEL AND THE SPIROMETRIC PARAMETERS IN ADOLESCENTS WITH BRONCHIAL ASTHMA. A PILOT STUDY","authors":"O.S. Boriskina, T.I. Eliseeva, E.V. Tush, R.N. Khramova, S.K. Soodaeva, D.Yu. Ovsyannikov, E.V. Pavlova, A.N. Isharina, N.I. Kubysheva, O.V. Khaletskaya, D.V. Novikov, V.V. Novikov","doi":"10.24110/0031-403x-2023-102-5-13-17","DOIUrl":"https://doi.org/10.24110/0031-403x-2023-102-5-13-17","url":null,"abstract":"Purpose of the research was to study the relationship between the serum bilirubin level and the spirometric parameters in adolescents with bronchial asthma (BA). Materials and methods used: 213 patients (73,7% boys) with atopic BA aged 10 to 17 y/o were examined. All patients underwent determination of serum bilirubin level, spirometry indicators and general clinical examination. All patients were divided into three groups: G1 of 84 with reduced bilirubin level (less than 10 mсmol/l); G2 of 77 with normal bilirubin level (10 to 17,0 mсmol/l); and G3 of children with slightly elevated bilirubin level (17,1 to 45 mсmol/l). Results: elevated serum bilirubin level in this study occurred in 24.4% (52/213) of patients with BA. As the level of serum bilirubin increased in the general group of patients, a statistically significant increase in the z-criterion of the forced expiratory volume per 1 second (FEV1)/forced vital capacity (FVC) (p=0,005) and the z-criterion of the mean forced expiratory flow during the 25-75% of FVC (p=0,032) was observed, which was confirmed by the revealed positive correlations between the level of bilirubin and these spirometric indicators. The increase in z-criterion FEV1/FVC with an increase in bilirubin levels was statically significant in boys (p=0,046), in girls there was only a tendency to increase this indicator (p=0,07). Conclusion: bronchial patency in patients with slightly elevated bilirubin levels is higher than in patients with reduced serum bilirubin level in the blood. The best characteristics of bronchial patency in patients with “slightly elevated” bilirubin level suggest its protective effect in children with BA.","PeriodicalId":39654,"journal":{"name":"Pediatriya - Zhurnal im G.N. Speranskogo","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135805449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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