Vol 12, No 5 (2021)

This review examines the main aspects of the course of a new coronavirus infection in patients with metabolic syndrome, provides up-to-date statistics on morbidity and mortality. Abdominal obesity, insulin resistance, arterial hypertension and dyslipidemia, which form the metabolic syndrome, are independent factors of a severe course of infection with a high risk of developing SARS, various complications, mainly the development of acute respiratory distress syndrome, extrapulmonary systemic inflammation and, finally, death. During the period of anti-epidemic measures, children turn out to be the most vulnerable in terms of losing the rational, healthy stereotypes of nutrition, regulation of “screen time”, responsible planning of study time and leisure, regular and intense physical activity. It requires increased attention of doctors, teachers and rehabilitation specialists to the problem maintaining the commitment of children and parents to a healthy lifestyle. Based on the formed concept of the presence of common links in the pathogenesis of the development of metabolic disorders and the infectious process, the authors identified the most significant issues of therapy and rehabilitation of this category of patients. Taking into account the need of patients for psychological adaptation of the past illness and increasing their resistance to stressful situations, within the framework of providing a personalized approach to the management of patients, may require timely diagnosis of anxiety-depressive disorders with the appointment of appropriate therapeutic measures.

Background. Purulent meningitis occupies one of the important places in the structure of neuroinfectious diseases in children and is the top ten places among the causes of death. The relevance of their study is due to the severity of the course, high rates of disability and deaths (8–39%). Damage to the vascular bed during neuroinfections, including purulent meningitis, is a mandatory component due to the predominantly hematogenous pathway of pathogens. The penetration of microorganisms through the blood-brain barrier into the cranial cavity and their hematogenous intrathecal circulation cause damage to the cerebral veins and arteries, leading to the development of vasculopathies and vasculitis.

Aim: To determine the features of vascular disorders in purulent meningitis in children.

Materials and methods. 100 children with purulent meningitis were examined, aged from 1 to 17 years 11 months, for the period since 2007 to 2020. All patients underwent neurological monitoring, etiological verification of diagnoses, determination of markers of endothelial dysfunction in the blood (D-dimer and desquamated endothelial cells), as well as MRI of the brain and MRI angiography.

Results. A complex lesion of the vascular system in purulent meningitis in children was proved, associated with both structural and functional properties of the vascular wall, as well as damage to the vasomotor function of the endothelium.

Conclusions. With purulent meningitis, there is damage to the vascular bed in the form of systemic vasculitis, including cerebral vessels, as evidenced by the presence of both markers of endothelial damage (desquamated endothelial cells and D-dimer) and changes in MRI and MRI angiography.

Background. A variety of products made from different materials (natural latex, silicone, silicone-coated latex, polyvinyl chloride, polyurethane and other) are used as gastrostomy tubes. They have different resistance to damaging factors, different microbial landscape and timing of infection. The aim of investigation is to compare the resistance of various gastrostomy tubes materials to the effects of damaging factors in an in vitro model experiment.

Materials and methods. The experiment was performed with 2 latex urinary N 34 Pezzer catheters, 2 latex silicone-coated urinary 26 Fr Foley catheters, 2 polyurethane 18 Fr nasogastric tubes, 2 silicone 24 Fr branded gastrostomy tubes for percutaneous endoscopic bumper-type installation. All the tubes were cut on to 5 sections 50 mm long, weighed, marked at the ends and placed in a sealed vessels with 40 ml of water for 14 days at a temperature of 36°C. After that, the tube fragments were wiped with filter paper, re-weighed and measured. Similar pieces of tubes 50 mm long were weighed and placed in a 0.1 M hydrochloric acid solution for 14 days at a temperature of 36°C, followed by repeated measurements. After the experiment, the samples were washed with distilled water and dried at 70°C for a day, followed by measurement.

Results. The change in the mass and linear dimensions of the polyurethane and silicone tubes were negligible (0.1–0.5%) after the influence of water and a solution of hydrochloric acid. Changes in latex and latex with silicone coating tubes were significant, the mass changed by 2–12% due to water absorption, the length – by 1–3.5%. For latex materials, a decrease of 1% in mass was noted after drying. Decrease in linear dimensions of polyurethane materials was a result of exposure to elevated temperatures.

Conclusions. According to the results of the model experiment, silicone and polyurethane tubes showed the least absorption of liquids, changes in weight and length, which indicates their resistance to damaging factors in the experiment and allows us to recommend products made from these materials for gastrostomy. Latex catheters have demonstrated maximum fluid accumulation, weight and length changes, which makes their use in clinical practice impractical.

Disorders of control mechanisms caused by glucocorticoid hormones of adrenal cortex have a significant role in the pathogenesis of infectious diseases, first of all, due to cortisol, one of the key hormones with anti-inflammatory activity. Currently the conception about the mechanisms of cortisol influence, its functional abilities, connection with immune and nerve cells, involvement in cytokine regulation, features of free-radical oxidation has been extended. There has been identified the dependence of cortisol influence upon the isoform, amount and affinity of its receptors on target cells. The present review describes the study results concerning cortisol level in case of the most often occurring infectious diseases in children – acute respiratory and intestinal infections, infectious diseases of the central nervous system. There has been noticed a considerable data variability about cortisol level in normal state and in pathological one, however, the majority of articles have detected its connection with clinical manifestations and outcomes of the diseases. The study of cortisol level in cerebrospinal fluid is of a special interest in case of neuroinfections, specifying its direct connection with the disease severity and aetiology that gives new possibilities to develop effective diagnostic criteria. In general, the literature data specifies the advanced study of disorders of hypothalamus-hypophysial-adrenal gland functioning, receptor apparatus of target cells, as well as interrelations of cortisol with immune system in case of infectious diseases to reveal new criteria for diagnostics, course prediction and disease outcome, therapy correction.

Tularemia is an acute zoonotic natural focal disease caused by Francisella tularensis, with a variety of pathogen transmission mechanisms. A person becomes infected in various ways, mainly through insect bites (mosquitoes, ticks), through direct contact with infected animals, and also by inhalation. The disease is characterized by high fever, intoxication, inflammatory changes in the area of the entrance gate, regional lymphadenitis. It is often difficult to suspect tularemia in the early stages due to the lack of specificity of clinical manifestations (fever, intoxication, regional lymphadenitis). Even in endemic regions, in most cases, acute respiratory viral infection, lymphadenitis, fever of unknown origin are diagnosed, which leads to a late start of etiotropic treatment. There is a clinical case of tularemia in a 13-year-old child who was misdiagnosed in the early stages of the disease. And only a careful collection of an epidemiological history (stay in an endemic area, a mosquito bite), as well as a competent assessment of clinical and laboratory data, allowed tularemia to be included in the differential diagnosis on the 18^th day of the disease and confirmed by the detection of the highest titers of anti-tularemia antibodies in blood serum. Thus, against the background of low morbidity, especially in childhood, there is no alertness among doctors of all specialties, which leads to late diagnosis and, as a consequence, late started specific treatment. All children with prolonged fever in the presence of lymphadenitis of unknown genesis, who have been in a territory unfavorable for tularemia, need to undergo a specific examination to identify mild and erased forms of the disease.

Numerous studies in language acquisition have been revealed that oral discourse plays a crucial role in cognitive development and communicative development and has an impact on the so-called narrative mind, social intelligence, autobiographic memory, and personal identity. The paper is devoted to the main patterns and mechanisms of the acquisition of oral personal discourse along with the early and preschool age. The paper includes the following sub-topics: conversation acquisition, personal narrative and fictional story acquisition, relations between different genres of personal discourse, and cognitive prerequisites for the acquisition of personal discourse. The paper is based on the meta-analysis of numerous studies covering various fields of science (psychology, psycholinguistics, sociolinguistics, and linguistics) and decades of scientific investigations in child development. The main issues discussed in the paper are acquisition and development of interaction structure (the skills necessary to initiate and to close a conversation); acquisition and development of conversation structure (the skills necessary for turn-taking and topic continuation); acquisition and development of some metadiscursive skills necessary for successful communication (e.g. to acknowledge communication breakdowns in a proper way); acquisition and development of some pragmatic skills necessary for successful communication (e.g. to modify speech characteristics according to the social role and status of the interlocutor and the context of the communication, to produce relevant speech acts); acquisition and development of narrative structure (story structure, episode completeness, internal state terms); and acquisition and development of narrative cohesion and coherence. The given issues are discussed from the perspective of the biological age and linguistic, communicative, and cognitive development.