Vol 1, No 4 (2021)

Osteoporosis in children differs from that in adults in causes, mechanisms, diagnosis, monitoring and treatment options. Unlike adult patients, children have intensive growth accompanied by close interaction between osteoblasts and osteoclasts, which, being the main bone remodeling units, constantly renew and restore bone tissue.

Disturbance of fine regulation of intercellular interaction between osteoblasts and osteoclasts can lead to osteoporosis in children. The pediatrician in his practical work should take into account the fact that some diseases or therapy aimed at the correction of disorders in these diseases can cause a decrease in mineralization of skeletal bones and contribute to the violation of bone integrity under minor loads. Some fractures, such as vertebral fractures, may be asymptomatic, causing certain diagnostic difficulties. According to the modern classification, primary and secondary osteoporosis are distinguished in children. Primary osteoporosis includes, first of all, osteogenesis imperfecta, which is diagnosed using genetic tests. And the degree of osteogenesis imperfecta is based on a comparison of genotypic and phenotypic changes. The causes of secondary osteoporosis are diverse. It can result from muscle hypofunction, delayed puberty, is detected in thalassemia and often has iatrogenic causes, such as prolonged steroid use in chronic inflammation.

Prevention and treatment of pediatric osteoporosis can, on the one hand, improve the quality of life of patients and, on the other hand, reduce the risk of complications of the underlying disease. The quality organization of preventive measures should be based on scientific evidence about the causes and risks of the disease.

Increased awareness of pediatricians about the mechanisms of primary and secondary osteoporosis in children, targeted screening and timely referral of young patients to subspecialists for appropriate treatment can contribute to early detection of osteoporosis, timely treatment of asymptomatic fractures and prevention of further bone destruction.

From the position of modern knowledge breast cancer (BC) is considered as a systemic polygenic disease, the emergence and development of which is the result of sequential genetic changes with the emergence of properties of uncontrolled cell proliferation, immortalization and malignant transformation, as well as the loss of a number of physiological functions. The course, prognosis, and treatment options of pre-tumor pathology and breast cancer directly depend on their molecular-biological properties of the tumor. In this connection, in recent years in domestic and foreign literature special attention is paid to immuno-histochemical and molecular-genetic characteristics of breast cancer, and special importance is given to such factors as determination of receptors to estrogen, progesterone, HER-2/neu-status, proliferative activity of Ki-67 and others. - The so-called receptor status of the tumor, which makes it possible to identify molecular genetic subtypes of breast cancer, and therefore plays a crucial role in the assessment of per- spective and choice of treatment tactics. However, there is a lack of data on the receptor status and the role of genes of cell division, control of proliferation activity (Ki-67, CYCLIN D1, B1, MYC, etc.), differentiation (H1, B1, MYC, etc.). ), differentiation (HER- 2/neu), apoptosis (p53) in benign breast pathologies (cystic fibrosis, intraductal papilloma, fibroadenomas), which could have a resource for determining the potential malignancy of ongoing processes in breast tissues with the possibility of wide clinical application. Determination of the potential for malignant transformation of pre-tumor dysplastic and proliferative processes requires an adequate treatment strategy (surgical intervention or conservative treatment). The aim of this work was to consider the importance of understanding the molecular processes and genetic events of carcinogenesis by which breast cancer develops from previous stepwise changes, as well as the need to identify molecular biological markers of pre-tumor, benign and malignant breast changes in the practice of the clinician, which could potentially guide clinical and therapeutic decisions for patients with dysplastic and hyperproliferative diseases who are at increased risk of developing invasive breast carcinoma.

At the present stage one of the unresolved issues of domestic cardiology is high mortality of the population due to diseases of cardiovascular system. Moreover, according to epidemiologic studies in Russia, there is a tendency to the growth of sudden cardiac death, including among young people of working age. The leading mechanism of development of sudden cardiac death in young people is recognized to be heart rhythm and conduction disorders, mainly ventricular tachyarrhythmias causing acute interruption of effective cardiac activity. The most tragic are the cases of the first and only manifestation of sudden cardiac death in children and young people without structural heart pathology. In connection with the above-mentioned, the aim of this review was to analyze the genetic causes of life-threatening cardiac rhythm and conduction disorders in young people and the possibility of their early identification within the framework of personalized diagnostic approach. The review reflects modern ideas about the genetic basis of fatal arrhythmias, analyzes the data of domestic and foreign clinical recommendations, scientific articles, and expert opinions. The possibilities of molecular genetic diagnostics in prolonged QT interval syndrome, shortened QT interval syndrome, Brugada syndrome, catecholami- nergic polymorphic ventricular tachycardia, idiopathic ventricular tachycardia, arrhythmogenic right ventricular dysplasia and a number of other cardiac rhythm and conduction disorders with high risk of adverse cardiovascular events are described in detail. Thus, this review highlights the current knowledge on the role of genetic factors in the development of life-threatening arrhythmias accompanied by a high risk of sudden cardiac death, as well as the importance of genetic diagnosis in this pathology. Early and qualitative personalized diagnostics of sudden cardiac death will make it possible to detect predisposition to the development of a fatal event long before its occurrence, which will contribute to the timely implementation of preventive measures, preserve the ability to work, creative and social activity of young patients, and improve the quality of life.

This paper is a review of domestic and foreign literature, as well as journal articles and scientific publications investigating the nature of cystic fibrosis and its relationship with the risk of breast cancer. The relevance of the topic is confirmed by real figures. Statistics, based on the analysis of appeals to specialists, shows that cystic diseases are one of the most common pathologies of the mammary glands. Cystic fibrosis can be safely called the most common of their forms, while the question of its influence on the risk of cancer is becoming an increasingly discussed topic in medicine.

The review compiles and summarizes information from a variety of sources prepared by different authors in recent years, which gives an opportunity to see the actual picture of the seriousness of the situation and, at the same time, to get acquainted with the real statistics.

The purpose of this review is to analyze the results of recent studies on the topic, to highlight the most important and priority areas of research, and to formulate conclusions based on the results obtained.

In addition to the causes of cystic fibrosis, the reviewed studies actively raise questions about the mechanisms leading to its transformation into life-threatening forms of oncology, risk factors of neoplasms, the relationship between the increase in the probability of breast cancer and age and quality of life of women, and modern methods of prevention and treatment of this disease. The main problems arising on the way of effective treatment and possibilities of early detection of cancer, the background for the development of which is FBC, as well as methods of their solution by means of additional examination, use of other technologies, methods and alternative classifications of patients falling into risk groups are considered.

The conclusions presented in the final part of the paper summarize all the current results of research and studies on the subject conducted over the last five years. In conclusion, the need for further in-depth study of cystic fibrosis, search for methods of breast cancer prognosis and its early detection for more productive and effective treatment is expressed.

This paper considers the relevance of virtual autopsy (postmortem MSCT) in determining the causes of mortality due to brain and lung pathology in pediatric practice. Virtopsy (virtual autopsy) is a virtual alternative to the traditional autopsy, conducted with the use of body scanning and visualization technologies. The information obtained allows the body of the deceased to be examined without a traditional autopsy, revealing morphological signs of various traumas and diseases in the form of hemorrhages, fluid and free gas accumulation in cavities, organs and tissues. In addition, in traditional autopsy there are technical difficulties associated with the peculiarities of the study of certain areas of the body, namely, the face, neck, and the distal parts of the upper extremities. This method allows visualization of internal organs and soft tissues with assessment of their topography, size and detection of pathological changes. The number of refusals to autopsy is increasing worldwide, particularly for religious and ethical reasons. Virtual autopsy allows to avoid questions concerning the necessity of consent of the deceased, relatives or heirs of the deceased, or legal representatives to conduct such research within the framework of pathological and forensic examination of the corpse, as well as this method allows to avoid refusal of autopsy, including for religious and other reasons. Virtopsy is characterized by high speed and cost-effectiveness of postmortem MSCT examination, high accuracy, allowing to measure the size, volume of internal organs and pathological formations, to calculate their weight, as well as to examine internal organs in very thin slices and to detect the smallest pathological changes with targeted autopsy, which is unavailable in classical autopsy. The aim of this paper is to highlight and reflect the potential application of postmortem computed tomography to analyze the lungs and brain in stillborn and deceased children at preschool age. A literature search for relevant studies was conducted in PubMed, EMBASE, Web of Science, and Google Scholar using the following keywords: virtual autopsy, child mortality, stillborn, computed tomography, brain, lung, pediatrics, children, forensic medicine, contrast-enhanced postmortem CT.

This literature review is devoted to the issue of COVID-19 influence on the state of the eye. The group of viruses of the Coronaviridae family has long been known to mankind. Many of them can cause acute infectious diseases.

Strains dangerous for humans belong to the genus Betacoronavirus. They cause symptoms typical of seasonal influenza. SARS-CoV-2, a new type of coronavirus, became known in December 2019. Its pathogenic properties are related to the tropicity of the viros to angiotensin-converting enzyme type II receptors. The new strain leads to cytokine storm syndrome as well as activation of the clotting system. SARS-CoV-2 virus affects all systems and organs. The main ophthalmologic pathologies are: dry eye syndrome, blepharitis, conjunctivitis, keratitis, uveitis, vascular disorders and optic neuritis. Decreased tear fluid production plays a major role in the basis of post-coronovirus dry eye syndrome. A new coronovirus infection causes inflammatory eyelid hyperemia, meibomian gland dysfunction, corneal opacity, decreased visual acuity, lacrimation, itching, and pain. Neurotoxic effects are produced by the virus when it passes through the blood-brain barrier or by the deposition of immune complexes. The effects of coronovirus are not well understood at this time. What is known is that the SARS-CoV-2 virus results in an enhanced immune response to the stimulus in patients, which contributes to the growth of intrasystemic damage. Ophthalmologists should be attentive to the group of patients who have a new coronavirus infection. Visual organ disorders should be detected and prevented as early as possible to prevent more severe consequences associated with exposure to SARS-CoV-2 virus.

Relevance. For the second year mankind is fighting the COVID-19 pandemic, new information about postcovicular syndrome is accumulating. In the post-vision period patients often face visual organ damage, pathologic changes have various manifestations.

Necrotizing enterocolitis is one of the leading causes of mortality among newborns. As a rule, the diagnosis of necrotizing enterocolitis at the early stage is difficult, because the symptoms are nonspecific and vary widely, which is the reason for late diagnosis and untimely start of therapy. The main purpose of this literature review is to systematize the data on the effectiveness of selected biomarkers in the early diagnosis of necrotizing enterocolitis in newborn infants. It was previously thought that inflammatory mediators and factors involved in the immune response could be early markers, but they also lacked specificity. Currently, the search for new predictors of necrotizing en- terocolitis is actively conducted, the effectiveness of which will be proved by high sensitivity and specificity in relation to this condition. In this work we analyzed the materials of both original articles and meta-analyses of domestic and foreign authors. The results of scientific studies are quite contradictory regarding the effectiveness of fecal calprotectin, claudin, intestinal fatty acid-binding protein, serum protein amyloid A. However, the use of citrulline, zonulin, endocan, fecal microRNA, lactate, interleukin-33, Trefoil factor 3 as predictors of necrotizing enterocolitis development has been confirmed by many studies and is promising. In view of the ambiguity of the literature data, further study of the relationship between the indices of some biomarkers and the severity of necrotizing enterocolitis course is required.

In the spring of 2020, publications with a series of observations about children who had a new coronavirus infection caused by SARS-CoV-2 with a symptom complex resembling the manifestations of Kawasaki disease, but with a higher frequency of vasogenic shock are beginning to appear from various countries of the world. From the list of suggested names for this syndrome, the medical community has chosen "COVID-19-related pediatric multisystem inflammatory syndrome", which has been entered into ICD-10 under U10 and U10.9. According to the statistics cited, there is a risk of an increase in the number of patients with severe forms of this disease in the future. The purpose of this literature review is to provide up-to-date information on the disease and to sensitize specialists from different disciplines to join efforts in the study of this pathology. In general, research findings suggest that pediatric multisystem inflammatory syndrome (PMIS) is a post-infectious immune-mediated inflammatory disease. However, more research is needed on the pathogenesis of this syndrome, as understanding the mechanism of development allows for more rational therapeutic strategies. We present diagnostic criteria for DMVS proposed by the US Centers for Disease Control and Prevention, the World Health Organization, and the UK Consensus of Specialists. We also present the criteria of DMVS by frequency of occurrence, which can serve as a guide in the diagnosis. The problem of DMVS is multidisciplinary, as the initial manifestations of DMVS are similar to the initial manifestations of other infectious diseases, so children are hospitalized in infectious diseases departments of hospitals with suspicion of intestinal infection, neuroinfection, surgical departments of hospitals. Therapy of the disease is selected individually and depends on the clinical manifestations and severity of the condition. International and domestic recommendations suggest the inclusion of antibiotics, intravenous immunoglobulins, anticoagulants, antiaggregants, corticosteroids, recombinant interleukin-1 repeat antagonist (anakinra), interleukin-6 inhibitor (tocilizumab), monoclonal antibodies to TNF-α (infliximab). To date, there are no clear criteria determining the indications for the use of a particular therapy regimen in the treatment of patients with DMVS. Similar to Kawasaki disease, DMVS associated with a new coronavirus infection is likely to lead to the development of severe cardiovascular complications in long-term outcomes. This case study illustrates the complexity of the differential diagnosis and treatment of a patient with DMVS. Awareness about the risk of pediatric multisystem inflammatory syndrome after coronavirus infection, about the proposed diagnostic criteria and treatment methods is a necessity dictated by the current situation in the world.

The purpose of this literature review is to raise awareness of doctors about modern methods of diagnostics and treatment of juvenile epiphyseolysis of the femoral head as it is one of the most common pathologies of the hip joint in children. It is necessary to clarify the etiologic factors causing the disease, to understand the modern methods of diagnosis and treatment of femoral head dislocation. There is an opinion that only obese children are susceptible to the pathology, but according to the preliminary data we have found, there are other predisposing factors that sometimes contribute to a more unstable course, which is significant, such as the so-called "lean" juvenile epiphysio- lysis, when BMI is within the age norm or even reduced. This fact additionally complicates early diagnosis. The most important problem remains the late diagnosis of the disease due to the low symptomatology of the disease at early stages, including radiographic data. There is still no consensus on the need for preventive treatment of the femoral epiphysis on the contralateral side to prevent bilateral development of the disease. Some authors are in favor of mandatory fixation of the second joint; others are against it because of the unnecessary impact on the joint, which may never develop epiphysis, because it may lead to unnecessary complications. We set out to find out whether the risk of postoperative complications exceeds the harm that can be caused to children when bilateral epiphysiolysis develops. Also, what method of surgical treatment is preferable at the present stage, what method causes fewer complications, what is the correlation between the course and severity of the disease and the choice of tactics for further management of such patients. Having studied the literature, we concluded that there is a lack of information in Russian. Therefore, for the most part, the material for this review was searched in the foreign bibliographic database of medical publications Medline. Materials in Russian were selected from the Russian scientific electronic library eLibrary.

In the human body all processes are interconnected, any deviation from the norm can lead to serious diseases. This applies to all organ systems, but, in this case, we would like to pay attention to diseases affecting the human oral cavity. As it is known, the oral cavity contains a biological liquid - mixed saliva, the study of which allows predicting the development of both organ and systemic disorders. It is important to realize that the composition of mixed saliva is variable in each person, so the course of a particular disease will be different, so the approach to treatment will be individualized. The literature review will provide an opportunity to analyze the effectiveness of different methods of oral fluid testing and will help in clinical dentistry to correctly identify risk factors in patients with high levels of dental caries intensity and inflammatory periodontal diseases. This has a significant potential for treatment and prevention planning, including the organization of dynamic follow-up of such patients.

This article shows the development of the doctrine of neurosyphilis as an independent nosologic form, starting from the stage of random sectional findings to the methods of lifetime diagnosis. The main direction in the diagnosis of neurosyphilis is the study of liquor, which includes both the determination of nonspecific indicators (color, density, protein, cytosis) and the use of special diagnostic methods (methods of direct detection of the pathogen, nonspecific and specific serological tests). Neuroimaging methods provide mainly topical diagnosis of CNS lesions, and are also of little use in skin and venereal dispensaries. None of the methods currently in use can be labeled as a "gold standard". Thus, the prospects of neurosyphilis diagnostics are connected with the search for additional laboratory criteria, which would allow not only to increase the objectivity of CNS lesion detection in syphilis, but also to determine the degree of neural tissue damage.