Pediatrics. Consilium Medicum

Post-covid syndrome (PCS) is a symptom complex that occurs during and after COVID-19 lasting more than 12 weeks, which is not a possible disease. The clinical manifestations of PCS are many-sided, under their mask or manifestations or exacerbations of chronic organic activity, the trigger of which was the virus, are hidden. PCS is a diagnosis of exclusion. The main manifestations of PCS: autonomic dysregulation, cognitive and psycho-emotional disorders, disorders of the respiratory system, cardiovascular, digestive systems. Direct pathogenic factors, the main neurological manifestations are PCS of preservation of brain hypoperfusion, hypoxia and hypoxemia, resulting in energy deficiency of neuronal structures, violation of the probable, as well as virus-induced structural detection of neurons in the cortex and subcortical structures of the brain. The severity and duration of exposure appear to be increasingly dependent on the body's response to SARS-CoV-2. PCS has a different severity of severity in recovered patients and does not always depend on the severity of the acute period. Timely examination with differential diagnosis allows not only to make a diagnosis, but also to recommend therapy with a personalized approach to the correction of PCS.

Aim. Assessment of the state of compensatory resources and the degree of adaptation of the body to environmental conditions in early and full-term infants in comparison with each other and with practically healthy children.

Materials and methods. Under the supervision of 135 infants. 110 were born from mothers with a burdened somatic and obstetric-gynecological history, 41 of them were born at 37–38 weeks (Group 1), 69 at 39–42 weeks (Group 2). The control group (Group 3) consisted of 25 practically healthy children born to practically healthy mothers as a result of physiological pregnancies and childbirth at 38–40 weeks. The children were examined in dynamics at the age of 1 (n=126), 3 (n=116), 6 (n=110), 12 (n=111) months. A comprehensive analysis of the data of anamnesis, physical examination, cardiointervalography was carried out. The following parameters were evaluated initially and in response to the tilt test: mode (М₀), mode amplitude (AM₀), delta x (∆Х), voltage index (IN). Nonparametric methods of statistical analysis were used.

Results. At the age of 2 to 3 days infants born to women with a history of poor health recorded a significant decrease in the median IN₁ value, respectively, in Groups 1, 2, and 3, which indicates a decrease in compensatory reserves, particularly in neonates born at 38–40 weeks. At 1 month of age, Group 1 and 2 had higher median IN₁ values of 804 and 746 versus 550 in Group 3, indicating the development of compensatory resource tension, particularly in children born at 37–38 weeks. At 3 months of age, children in group 1 retained a compensatory tension of IN₁ resources – 521 versus 468 and 460 in groups 2 and 3. At 6 months of age, there is a slight decrease in compensatory IN₁ reservers at 6 months of age in children from women with a history of a history of a history of a history of a disease – 376 and 357 versus 400 in Group 3. At 12 months of age, children in the main groups have even more decreased compensatory resources, especially in group 1 IN₁ – 206, 284 and 380 respectively in groups 1, 2 and 3.

Conclusion. The decrease of functional reserve of adaptation in children of groups 1st and 2nd was facilitated by the influence burdened with somatic and obstetric-gynecological history of mothers, regardless of gestational age and subsequently the health characteristics of children themselves. The statistically significant differences found in the state of compensatory resources and the degree of adaptation of the organism to environmental conditions justify the personalized approach, which justifies a personalized approach when choosing rehabilitation measures.

Diseases of the cardiovascular system are one of the main causes of morbidity, disability and mortality. One of the most significant risk factors for their development is atherogenic dyslipidemia. Atherosclerotic vascular damage occurs long before clinical manifestation and often begins to progress as early as childhood. This is why children represent the most important cohort for the prevention of cardiovascular diseases of atherosclerotic genesis. Studies show that taking ω₃-polyunsaturated fatty acids reduces the risk of atherosclerotic vascular disease in adults and children. The effect is achieved by multidirectional effects on risk factors such as insulin resistance, obesity, diabetes mellitus, dyslipidaemia, arterial hypertension, inflammation and endothelial dysfunction. In children with primary dyslipidemia (heterozygous familial hypercholesterolemia) taking ω₃-polyunsaturated fatty acids leads to normalization of serum triglycerides and a moderate decrease in total cholesterol and low-density lipoprotein cholesterol. The most significant therapeutic and prophylactic effects are observed in patients with secondary dyslipidemias caused by obesity and diabetes mellitus, when, besides the decrease in triglycerides and the increase in HDL cholesterol, ω₃-polyunsaturated fatty acids increase the insulin sensitivity of cells and tissue, body weight reduction, increase in muscle mass, stabilization of blood pressure and improvement of liver function are observed. Considering pleiotropic protective effect and good tolerability, ω₃-polyunsaturated fatty acids can be widely used for primary and secondary prevention of atherosclerotic cardiovascular diseases in children and adolescents.

Background. Obesity and vitamin D deficiency in children are widespread in economically developed countries. Among children with obesity and components of the metabolic syndrome, vitamin D deficiency is more common than in children with a normal body mass index (BMI). The growth of metabolic disorders, atherosclerosis, early onset of type 2 diabetes mellitus lead to fatal vascular accidents in young people, and therefore the search for new ways of early diagnosis of these processes is relevant.

Aim. To study of the relationship of endothelial dysfunction with vitamin D deficiency, obesity and associated metabolic disorders among adolescents in Saint Petersburg.

Materials and methods. 5 adolescents aged 14–16 years (15±0.76 years) with primary obesity were examined. Anthropometric parameters were studied: waist circumference, weight, height, calculation of BMI, stage of puberty according to Tanner. Laboratory examination included the following parameters: serum glucose, cholesterol, triglycerides, high density lipoproteins, low density lipoproteins, insulin, 25(OH)D. Atherogenicity index (AI), insulin resistance index (HOMA-IR), vitamin D sufficiency were calculated. Endothelial function was assessed by the value of the reactive hyperemia index (RHI), automatically calculated by the EndoPAT 2000 device (Itamar Medical, Israel).

Results. All examined patients had abdominal obesity (median BMI 33.5 kg/m² [30.9; 34.2]) and reduced vitamin D supply (median 25(OH)D 17.2 ng/ml). Hypercholesterolemia and dyslipidemia due to an increase in low density lipoproteins were diagnosed in 1 (20%) case. Dyslipidemia due to a decrease in high density lipoproteins was detected in 3 (60%) patients. An increase in IA was found in 4 (80%) people. Insulin resistance was present in 60% of the examined, the median value of HOMA-IR was 5.6. The median RHI was 1.74 [1.72; 2.13]. Optimum RHI values were observed in 2 (40%) patients; in most (60%) adolescents, the RHI values corresponded to subnormal values and were close to the lower limit of this zone. A significant inverse correlation of RHI with AI was obtained (R=-0.63, p<0.05).

Conclusion. Taking into account the risk factors previously identified in the examined patients (dyslipidemia, insulin resistance, reduced vitamin D supply), endothelial dysfunction in these patients was regarded as a cardiovascular risk factor. A manageable risk factor is a reduced supply of vitamin D, which can be corrected by an additional donation of cholecalciferol.

Inspite of hemoblastoses rare incidence in common structure of pediatric morbidity, pediatrician of every specialty face with hemoblastoses in his practice. Nowadays it is possible to cure these fatal in the beginning of 1970s diseases. But it could be realized only in team work of pediatric oncologists, hematologists with primary care pediatrics of hole pediatric medical service. Early diagnosis of hemoblastoses different forms, relapse diagnosis timely, early and delayed treatment complications, realization of rehabilitation action, treatment of comorbid diseases, case follow up – sphere of duties, which could be resolved by doctors team.

Abnormal findings in urinalysis are one of the most common symptoms kidneys and urinary tract diseases. Authors discuss assessment of changes in urinalysis from the position of general pediatrician. The normal values of protein, erythrocytes, leukocytes, cylinders, crystals, glucose in urine are considered, as evidenced by changes in these parameters, as well as changes of urinary color and specific gravity. The algorithm of the pediatrician's tactics after detection of different degrees of proteinuria, erythrocyturia and leukocyturia is presented. It is shown that with a high degree of severity of changes in urine, especially in combination with arterial hypertension, edema, fever, and other clinical symptoms, needs in emergent specialized impatient medical aid. In other cases, outpatient examination and treatment are recommended. The issues of urinary tract infection (UTI), diagnosed by the presence of piuria and bacteriuria, are discussed. Routine method of UTIs treatment is antibiotic therapy, but the existence of uropathogens in the form of biofilms contributes to their drug resistance, which dictates actuality of alternative therapeutic methods search. In cases without anatomical obstacles to urinary flow, including patients with functional disorders of urination, the application of the phytodrug Canephron® N, which contains three medicinal plants (centaury herb, lovage root and rosemary leaves), can be effective. The drug is prescribed after antibacterial therapy or simultaneously with it, is effective as an anti-relapse therapy, helps to reduce crystalluria and normalize the passage of urine. In vitro experiments show its ability to inhibit the formation of microbial biofilms. The drug in the form of a solution can be prescribed to children aged 1 year and older.

The appearance of new high-tech microbiological research methods has significantly changed the understanding of the human microbiome. The purpose of the meeting of the Council of Experts “Dysbiosis. The immediate and long-term consequences of microbiome disorders and options for their correction with probiotics” was the definition of modern positions about possible methods of studying the intestinal microbiome, the possibilities of correcting dysbiosis, the use of Saccharomyces boulardii CNCM I-745 to correct microbiome disorders in various clinical situations. The criteria of the microbiological “norm” for the intestinal microbiome have not been definitively established. To study the microbiome, a set of methods is used that combine cultural and molecular genetic methods that complement each other. Currently, there are no clinical markers of dysbiosis, and laboratory markers of dysbiosis require modification.

Probiotics can provide restoration of the intestinal microbiota. The effectiveness and safety of the use of Saccharomyces boulardii CNCM I-745 for this purpose has been proven. In the case of acute intestinal infection, antibiotic-associated diarrhea, and the consequences of HP infection eradication, studies have a high level of evidence.

This article is a reprint. Primary Publication: Gorelov AV, Zakharova IN, Khavkin AI, Kafarskaya LI, Usenko DV, Belmer SV, Kornienko EA, Privorotsky VF, Krasnov VV, Kondyurina EG, Panfilova VN, Tkhakushinova NKh, Plaksina AN, Rychkova OA, Pechkurov DV, Nizhevich AA, Fayzullina RA, Yablokova EA. Resolution of the Council of Experts “Dysbiosis. Immediate and long-term consequences of microbiome disorders and options for their correction with probiotics”. Vopr. prakt. pediatr. (Clinical Practice in Pediatrics). 2022;17(1):213–221 (in Russian). DOI: 10.20953/1817-7646-2022-1-213-221. With the permission of the copyright holder. Published with reductions.

Introduction. Laryngeal stenosis is a congenital or acquired narrowing of the larynx that causes airway obstruction. Approximately 90% of cases of acquired subglottic stenosis in infants and children are due to endotracheal intubation. Laryngotracheoplasty with T-tube placement is a method for treating laryngotracheal stenosis.

Aim. To demonstrate our experience of treating children with stenosis of the subglottic space using laryngoplasty with T-tube placement.

Materials and methods. 53 patients with postintubation laryngeal stenosis are treating in the surgical thoracic department of the National Medical Research Center for Children's Health for the period from 2019 until now. All children were examined. 33 patients underwent laryngoplasty with T-tube stenting.

Results. Nowadays, 18 children have been decannulated after laryngoplasty with T-tube stenting, the rest of the patients continue their treatment.

Conclusion. According to our materials, T-tube stenting is safe and can be an alternative method for treating children with severe acquired laryngeal stenosis.