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Vol 14, No 1 (2023)

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Vaccination of children against coronavirus infection caused by SARS-CoV-2

Kharit S.M., Timchenko V. ., Chernova T.M., Bulina O.V.


The novel coronavirus infection (COVID-19) is currently a widespread disease in all countries of the world. The adult population is predominantly involved in the epidemic process. In children, the disease proceeds, as a rule, in asymptomatic, mild and moderate forms. However, severe forms of the disease with the development of adverse outcomes are possible. Severe forms of infection are more likely to develop in children under the age of 1 year and older than 12 years. The risk group for a non-smooth course and adverse outcomes are children with concomitant diseases: genetic, neurological, metabolic disorders, congenital heart defects, obesity, diabetes mellitus, bronchial asthma and other chronic lung diseases, sickle cell anemia, oncopathology, immunodeficiency states. At present, various types of vaccines are used for specific prevention in the world: based on M-RNA technologies, vectorial, inactivated. These vaccines are effective and safe in reducing the burden of disease in eligible adolescents. Despite the emergence of new strains of circulating viruses, vaccines continue to be effective in preventing severe infections, hospitalization and death.

Pediatrician (St. Petersburg). 2023;14(1):5-14
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Original studies

Assessment of hematological parameters in children with COVID-19 in the Republic of Sakha (Yakutia)

Evseeva S.A., Klimova T.M., Bogdashin V.V., Makarova A.M., Sleptsova S.S., Burtseva T.E., Chasnyk V.G.


BACKGROUND: During the coronavirus pandemic, one of the most important areas of scientific research was the study of laboratory parameters, as well as calculated indices that could be used as criteria reflecting the course of the infectious process, and could be used as predictors of severe course and adverse outcome of the disease.

AIM: Assessment of hematological parameters in children with COVID-19 in the Republic of Sakha (Yakutia).

MATERIALS AND METHODS: The article presents data from a retrospective study of 344 cases of a new coronavirus infection caused by the COVID-19 virus (ICD-10 code U07.1) in children hospitalized in the period from 03/23/2020–12/27/2020 in the Children’s Infectious Clinical Hospital of Yakutsk.

RESULTS: The results of the study showed that upon admission to the hospital, the proportion of children with reduced leukocyte levels exceeded the proportion of children with leukocytosis (23 versus 10%), there were reduced hemoglobin levels, changes in the content of platelets, segmented neutrophils, lymphocytes. The rate of erythrocyte sedimentation was increased in 48% of children. Neutrophilia and lymphopenia were associated with the severity of the children’s condition. The values of the ratio of neutrophils to lymphocytes in some age groups were associated with the severity of the condition of children.

CONCLUSIONS: The infectious process in children with a new coronavirus infection is accompanied by a change in the leukocyte formula, an increase in ESR and a change in the platelet content. Neutrophilia and lymphopenia are associated with the severity of the condition of children.

Pediatrician (St. Petersburg). 2023;14(1):15-26
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Features of the course of pneumonia in children with coronavirus infection

Isakova A.Z., Kabaeva D. ., Maimerova G.S., Musurkulova B.A., Bolotbekova A.Z., Boryakin Y.V.


BACKGROUND: The most frequent complication of coronavirus infection (COVID-19) in young children is severe viral pneumonia.

AIM: To reveal the features of the course of coronavirus pneumonia in children.

MATERIALS AND METHODS: A retrospective analysis of 54 case histories of children with coronavirus pneumonia, aged 1 month to 15 years, who received inpatient treatment in the Department of Pulmonology was performed.

RESULTS: The disease was most often registered in children of the first three years of life (66,7%). 49 (90,7%) children turned out to be from family foci of coronavirus infection. The majority of children (44–81.5%) had signs of respiratory failure of I-II degree. Polymerase chain reaction (PCR) for the presence of coronavirus was positive in 37 (68.5%) children. Radiologically, bilateral infiltrates were detected predominantly in the middle and lower parts of the lungs. The multisystem inflammatory syndrome associated with SARS-CoV-2 was characterized by persistent fever, multiple organ damage and clinical and laboratory shifts.

The vast majority of cases involved transmission from adult patients. The disease most often developed in children under 3 years of age. The course of the disease is accompanied by the development of grade I–II respiratory failure and intoxication. PCR for the presence of coronavirus may be negative due to late admission of patients to the hospital. Radiological changes were characterized by extensive bilateral lesions mainly in the lower and middle lobes of the lungs. Persistent fever, multiorgan lesions, clinical and laboratory shifts in coronavirus pneumonia in children indicate the development of multisystem inflammatory syndrome associated with SARS-CoV-2.

CONCLUSIONS: Pneumonia in most cases proceeded with the development of respiratory failure, symptoms of gastrointestinal tract damage, a pronounced intoxication syndrome. At the same time, there was revealed inconsistency of radiologically extensive lung lesions with more scanty auscultatory data.

Pediatrician (St. Petersburg). 2023;14(1):27-33
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Hemostasis in children with COVID-19-RELATED illness

Dondurey E.A., Pshenichnaya K.I., Ivanova I.A.


BACKGROUND: During the COVID-19 pandemic, the problem of coronavirus-associated coagulopathy was one of the most difficult and poorly studied. The detected hemostasis disorders in adults are extrapolated to children and adolescents without sufficient representation in the literature. Because of COVID-19 is generally told as a mild disease in children a detailed laboratory examination not required. As a result, thrombotic and hemorrhagic complications, as well as the children’s multisystem inflammatory syndrome (MIS-C) are unexpected. At the same time, the hemostasis assessment in children with COVID-19 is necessary for the coronavirus-associated coagulopathy timely diagnosis, adequate anticoagulant therapy prescribing, various convalescence thrombotic complications prevention, as well as determining the necessary period of dynamic monitoring of patients.

AIM: To assess the hemostasis in children with COVID-19-related illness in the acute disease period and convalescence.

MATERIALS AND METHODS: The results of the examination of 460 patients from 2 days to 18 years old hospitalized with confirmed SARS-CoV-2 infection and 110 outpatient children from 3 months to 17 years old at different periods of COVID-19 convalescence are presented. The study included platelet count measured using automated hematocytometers, the main coagulation laboratory parameters and D-dimer level.

RESULTS: The observational study indicate that children hospitalized with acute COVID-19-related illness have adult like coagulation changes, which significantly depend on the disease severity, presents of pneumonia and in the intensive care need cases, and the most sensitive indicator was the D-dimer level. However, there were opposite changes: both hyper- and hypocoagulation, a high frequency of normal or elevated platelet counts, as well as the presence of coagulopathy in 1/5 of cases even with a mild COVID-19 and the absence in 1/4 of severe cases. During the convalescence, coagulation laboratory parameters were normal, with the exception of an increased D-dimer level in every sixth patient within 1 month after recovery.

CONCLUSIONS: Hemostasis changes in children with COVID-19-related illness differ from the adults by opposite, duration and risk factors. The anticoagulant therapy selection and duration requires an individual approach with the hematologist assistance. Further studies are needed to clarify the causes and consequences of hemostasis changes in children with mild forms of novel coronavirus SARS-CoV-2 infection, to establish additional coronavirus-associated coagulopathy factors in children with moderate and severe COVID-19, to develop recommendations for anticoagulant therapy in childhood.

Pediatrician (St. Petersburg). 2023;14(1):35-43
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The predictors of severe course of multisystem inflammatory syndrome associated with the new coronavirus infection COVID-19 in children: results of a retrospective-prospective multicenter study

Avrusin I.S., Abramova N.N., Belozerov K.E., Efremova O.S., Bregel L.V., Kondratiev G.V., Dondurey E.A., Vilnitz A.A., Konstantinova Y.E., Burtseva T.E., Vinnikova E.I., Isupova E.A., Kornishina T.L., Masalova V.V., Redkina M.V., Solodkova I.V., Kalashnikova O.V., Chasnyk V.G., Alexandrovich Y.S., Kostik M.M.


BACKGROUND: Multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) is a rare but severe disease in which various organs and systems are affected, including heart, lungs, kidneys, brain, skin, eyes and organs of the gastrointestinal tract. MIS-C is rather difficult to diagnose, since it has much in common with the infectious process, and Kawasaki disease. However, MIS-C course is more severe and therefore patients need hospitalization in the intensive care unit in half of the cases.

AIM: To determine the factors associated with severe course of MIS-C, requiring hospitalization of patients in the intensive care unit.

MATERIALS AND METHODS: The retrospective study included 166 patients (99 boys, 67 girls), aged 4 months to 17 years (median 8.2 years), with a diagnosis of “multisystem inflammatory syndrome associated with COVID-19 in children”. To conduct a comparative analysis, patients with MIS-C were divided into two groups: group 1 — patients hospitalized in the intensive care unit (n = 84, 50.6%), and group 2 — patients who did not need hospitalization in the intensive care unit (n = 82, 49.4%).

RESULTS: Patients with a more severe course of MIS-C were significantly older. They had a higher frequency of signs such as rash, swelling, hepatomegaly, splenomegaly, neurological and respiratory symptoms. Hypotension/shock and myocardial involvement were much more common in patients with severe MIS-C. These patients had a more significant increase in CRP, creatinine, troponin and D-dimer levels. Also, in patients hospitalized in the intensive care unit, signs of hemophagocytic syndrome were more often observed.

CONCLUSIONS: The main factors determining the severity of MIS-C are damage to the cardiovascular system, the central nervous system, the presence of respiratory and hemodynamic disorders, especially hemophagocytosis.

Pediatrician (St. Petersburg). 2023;14(1):45-59
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The relationship between liver lipase gene polymorphism and the development of endothelial dysfunction in military personnel in extreme climatic conditions

Lemeshchenko A.V., Lysikov M. .


BACKGROUND: The analysis of the association of polymorphism of hepatic lipase gene with vascular wall stiffness in extreme climatic conditions, the development of criteria for the selection and effectiveness of military service in the Arctic zone, depending on the characteristics of the genotype is one of the main tasks of military medicine.

AIM: The aim is to evaluate the relationship of the polymorphism of the LIPC rs2043085 and rs1532085 genes with vascular wall stiffness in military personnel in extreme climatic conditions.

MATERIALS AND METHODS: 295 contract servicemen undergoing military service in various climatic and geographical conditions were examined. Participants are divided into three groups: 1st group — 100 people serving in the Arctic climate zone; 2nd group — 100 people serving in the temperate climate zone; 3rd group — 95 people serving in the conditions of the mid—mountain subtropical zone. The average age of military personnel in all groups was approximately 34 years. All the examined patients were examined, blood pressure and heart rate were measured, regional blood circulation was assessed using the AngioScan-01P device based on the study of the shape of the volumetric pulse wave by a photoplethysmographic sensor, and a molecular genetic study was performed. Genotyping of single-nucleotide variants of the LIPC rs2043085 and rs1532085 genes was performed using a polymerase chain reaction in real time on an amplifier (RT-PCR) DT-Prime (GC “DNA Technology”, Russia) using a set of reagents manufactured by the company “Syntol” (Moscow).

RESULTS: In servicemen undergoing military service in the Arctic zone, a significant increase in systolic blood pressure, increased vascular stiffness, arterial wall stiffness, and average arterial wall stiffness were revealed. In military personnel undergoing military service in the conditions of the mid-mountain subtropical zone, a significant increase in the stiffness of the artery wall was revealed. On the contrary, high elasticity of the arterial wall has been established in servicemen undergoing military service in a temperate zone. Statistically significant differences in the frequency of occurrence of the LIPS gene (rs2043085) were found in servicemen undergoing military service in various climatic and geographical zones: in the Arctic zone — mainly persons with the T/T genotype (up to 53%), in the temperate zone the T/C genotype prevails (up to 43%), in the subtropical zone — genotype C/C (up to 40%). The association of the T/T genotype of the LIPS gene (rs2043085) with the stiffness of the vascular wall was established, which corresponds to an excess of the average passport age of the subjects by 6–7 years, and in the same genotype, according to the type of pulse wave, there is a tendency to increase the stiffness of the artery wall in servicemen aged 34 years with an average military service of 13 years, serving in the Arctic zone for more than 10 years.

CONCLUSIONS: In the conditions of the Arctic belt, with prolonged exposure (more than 10 years) to adverse environmental factors, the cardiovascular system is depleted, physiological functions are involuted and the body prematurely ages in the form of hypertonic vascular reactions with the progression of excessive vascular stiffness, especially in individuals with the LIPS gene genotype T/T (rs2043085).

Pediatrician (St. Petersburg). 2023;14(1):73-80
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The influence of the term of military service and extreme climatic conditions on the parameters of cardiovascular system

Semenov A.A., Lemeshchenko A.V., Krishtop V.V.


BACKGROUND: The state of the cardiovascular system is one of the central links in the adaptation of servicemen and persons involved in priority sectors of the economy to the extreme climatic conditions of the Arctic and Subtropical zones.

AIM: To evaluate the indicators of the cardiovascular system in military personnel, depending on the length of military service in extreme climatic conditions.

MATERIALS AND METHODS: A single-stage randomized cross-sectional study included 313 male contract servicemen, 28–40 years old. The subjects were grouped into three groups: those serving in the Arctic zone, in the Middle Zone and a group serving in the conditions of the mid-mountain Subtropical zone. An alternative way of dividing the sample was the distribution of military personnel according to the length of stay in the current climatic and geographical conditions. Pulse oximetry and assessment of regional blood circulation were performed.

RESULTS: In military personnel serving in the Arctic and Subtropical zones, in contrast to service in the Middle climatic zone, a set of changes was revealed, including: an increase in the proportion of military personnel with arterial hypoxemia and an increase in vascular stiffness associated with an increase in the proportion of military personnel with pulse wave type A, corresponding to a rigid artery wall, and a decrease in the proportion of persons with pulse wave type waves with, corresponding to the high elasticity of the arterial wall. In military personnel serving in the conditions of the mid-mountain Subtropical zone, the increase in vascular stiffness was less pronounced, but covered a larger percentage of military personnel. As the service life increases, vascular stiffness gradually increases from –16,7 ± 14,2 conl. units, in the first 5 years, to –8,0 ± 14,3 conl. units in 5–10 years, and to 0,5 ± 16,0 conventional units in military personnel with a service life of more than 10 years.

CONCLUSIONS: With an increase in the duration of stay in unfavorable climatic conditions of the Arctic and mid-mountain Subtropical zones, the cardiovascular system is depleted in the form of a decrease in saturation and an increase in arterial hypoxemia with a restructuring of vascular reactions according to hypertension with an experience of more than 10 years.

Pediatrician (St. Petersburg). 2023;14(1):81-88
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Expression of the hypoxia-inducible factor as a predictor of the resistance of the organism of laboratory animals to hypoxia

Kim A.E., Shustov E.B., Kashuro V.A., Ganapolsky V.P., Katkova E.B.


BACKGROUND: One of the key transcriptional regulators that determine the body’s resistance to hypoxia is the hypoxia-inducible factor HIF-1α, the study of the role of which in the body’s resistance to extreme influences can justify new directions in medical technologies for its increase.

AIM: To evaluate the quantitative contribution of the level of expression of the hypoxia-inducible factor HIF-1α in various tissues of laboratory animals to the increase in the resistance of animals to the effects of hypoxic hypoxia.

MATERIALS AND METHODS: The study was carried out on outbred white laboratory rats obtained from the Rappolovo nursery weighing 180–220 g. To conduct the study, animals were previously tested for an individual level of resistance to hypoxia, which made it possible to form experimental groups from highly resistant and low resistant animals. Biological material was taken from all animals (whole blood, plasma, tissues of the heart, liver, kidneys, brain), in which the expression of the HIF-1α and TSPO genes (housekeeping gene) was determined by the Real-Time-PCR method. Total RNA was isolated from the test material by affinity sorption,synthesis of the first strand of cDNA, amplification, followed by determination of the expression level of the HIF-1α gene in rats was carried out according to the instructions and the manufacturer’s protocol by PCR with detection of the accumulation of reaction products in real time (Real-Time PCR) using a CFX-96 detecting amplifier (Bio-Rad, USA) and specific primers and probes for the HIF-1α gene in rats (DNK-Sintez, Russia). Statistical processing of the obtained data was carried out using the ANOVA analysis of variance.

RESULTS: It has been established that the level of resistance of animals to hypoxia is largely determined by their genetic characteristics. Even under normoxic conditions, the expression of the TSPO housekeeping gene in animals with a high level of resistance to hypoxia differed with a high degree of reliability from low-resistance animals (in the kidneys, liver, and brain, on average, by 40–60%; in the heart, by 25%). The values of the expression of this gene, determined in whole blood or plasma, make it possible to differentiate groups of animals according to the level of resistance to hypoxia. A similar ratio between animals with high and low resistance is also observed in tissues obtained immediately after hypoxic exposure. An analysis of the reaction of the genomic regulation system to extreme exposure showed that it increased the expression of the TSPO gene by 1.6–2 times equally in all tissues, regardless of the level of animal resistance. For the HIF-1α gene, similar patterns were found, but the severity of their manifestations is more and significant.

CONCLUSIONS: The main organ that provides a high level of resistance to hypoxia associated with the basic (under normoxic conditions) expression of HIF-1α is the brain. The expression of the hypoxia-inducible factor in it is more than 300 times higher than the expression of the “housekeeping” genes. The second most important organ is the liver, in which HIF-1α expression activity is more than 15 times higher than the expression of “housekeeping” genes. Under conditions of moderate hypoxia, a compensatory-adaptive reaction is noted, associated with the activation of hypoxic defense mechanisms in blood and liver cells, and in low-resistant animals, also in the brain tissue. In the myocardium, such a compensatory-adaptive reaction is activated only in the group of highly resistant animals. A high level of basal expression of the HIF-1α transcription factor under daily (normoxic) conditions may be a predictor of a high level of resistance to hypoxia in a given animal.

Pediatrician (St. Petersburg). 2023;14(1):61-71
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What is the current status of the covid pandemic? What can/should we do at this point?

Rennebohm R.M.


As a direct result of the mass vaccination campaign against COVID (in all age groups), humanity is likely to face a threatening situation that could potentially become catastrophic. The mass vaccination campaign has caused multiple increasingly contagious dominant variants of the SARS-CoV-2 virus.

The reason is the phenomenon of “immune escape”, neutralizing antibodies induced by the vaccine quickly cease their function, and vaccine non-neutralizing antibodies can make the virus more contagious — a form of antibody-mediated or “antibody dependent amplification” of the infection.

Thus, anti-COVID vaccines do not teach the innate immune system to fight the virus, but instead non-neutralizing vaccine antibodies neutralize the innate immune system of those who are vaccinated. Vaccines against COVID do not contribute to the formation of collective immunity, but, on the contrary, make the virus more contagious. The mass vaccination campaign predisposes to “depletion of immunity” in vaccinated people. Vaccinated people (of all ages) are currently repeatedly re-infected with SARS-CoV-2. The depletion of immunity decreases a vaccinated person’s ability to cope not only with SARS-CoV-2 but with other infections, including EBV, CMV, herpes virus and even tuberculosis. To solve the problem, it is necessary to put an end to simplistic and incorrect directives, to create conditions for a constructive dialogue between scientists and doctors who were responsible for the prevailing narrative about COVID and the policy of combating it, and those scientists and doctors who challenged the prevailing narrative and its policies. We must also encourage such dialogue among citizens — dialogue and demystifying education that will improve understanding of the COVID situation, create consensus, and unite people in positive, constructive efforts to save lives and end this pandemic.

Pediatrician (St. Petersburg). 2023;14(1):89-98
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The role of the renin-angiotensin-aldosterone system in the development of cardiovascular complications in COVID-19

Zabezhinsky M.M., Semenova A.A.


During the pandemic caused by SARS-CoV-2, cardiovascular disease has been found to be an important risk factor for COVID-19. At the same time, it turned out that patients who did not suffer from cardiovascular pathology before infection with SARS-CoV-2 often had cardiovascular complications in the form of myocarditis, arrhythmias, and heart failure. It is extremely important to elucidate the pathogenetic mechanisms that determine the relationship between COVID-19 and cardiovascular pathology. Analysis of the data of the scientific literature suggests that an imbalance in the renin-angiotensin-aldosterone system (RAAS), expressed in the hyperproduction of angiotensin II and the deficiency of angiotensin 1-7, is an important factor in the pathogenetic link that causes comorbidity of COVID-19 and cardiovascular pathology. According to modern concepts, the RAAS is a complex, multicomponent, multi-level, two-axis system that has, both cardio- and vasoprotective (ACE2/Ang1-7/MasR axis) and damaging effects on the heart and blood vessels (ACE/Ang II/AT1R axis). Patients with cardiovascular diseases, as a rule, already have an imbalance of the RAAS, characterized by hyperproduction of “cardiotoxic” angiotensin II. Coronavirus, interacting with ACE2 — an important component of the cardioprotective axis of RAAS, and reducing its quantity and activity, increases this imbalance, which aggravates the damage to the cardiovascular system. In addition, an imbalance of RAAS can lead to an imbalance in the kallikrein-kinin system with the accumulation of vascular permeability-increasing des-Arg9-bradykinin, potentiate inflammation, create prerequisites for the development of COVID-19 associated coagulopathy and acute respiratory distress syndrome. In the pathogenetic therapy of coronavirus infection, complicated by lesions of the cardiovascular system, it may be advisable to use drugs that correct changes in the renin-angiotensin-aldosterone system.

Pediatrician (St. Petersburg). 2023;14(1):98-118
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A template for exempting and protecting children from COVID vaccination

Rennebohm R.M.


In the era of the COVID-19 pandemic, medical professionals and broader community are being heavily pushed to vaccinate against COVID. In many cases, vaccination was mandatory, usually without proper informed consent. Many citizens questioned reasonableness of the mass vaccination campaign, especially vaccination of children, and, accordingly, asked to be exempted from the compulsory vaccination.

This document is aimed to exempt and protect children from vaccination against COVID, and is intended to inform everyone involved in making vaccination decisions. Not a single child should be given any of the COVID vaccines. Naturally acquired immunity against COVID significantly exceeds the immunity induced by vaccines. The interaction between the immune system and viruses is multidimensional and involves complex and delicate adjustments in both the virus and the immune system at the individual and population level. COVID vaccines use a simplified, one-dimensional, exclusionary approach that can disrupt important components and functions of the immune system. The mass vaccination campaign against COVID causes serious damage to the immune ecosystem, it is responsible for generation of a long series of new dominant variants that become more contagious and resistant to vaccines (due to the phenomenon of “immune escape”) and will inevitably become more virulent. This is based on the fundamental laws of natural selection and was predictable. The organizers of the mass vaccination campaign failed to assess the complexity and sensitivity of the immune ecosystem and, thus, prolonged the COVID-19 pandemic and made it catastrophically dangerous. COVID vaccines have proven unable to prevent infection or transmission of the virus. The virus, as expected, quickly became resistant to vaccine neutralizing antibodies.

For the above-mentioned scientific reasons, the mass vaccination campaign against COVID must be stopped — for the whole of humanity and especially for children.

Pediatrician (St. Petersburg). 2023;14(1):119-126
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Clinical observation

Observation of severe pediatric inflammatory multisystem syndrome associated with COVID-19

Efremova O.S., Bregel L.V., Rudenko N.Y., Kniazeva N.A., Kostik M.M.


One of the rare manifestations of COVID-19 is pediatric inflammatory multisystem syndrome, most often in publications it is found out how pediatric inflammatory multisystem syndrome in children (РIMS). The progression of the inflammatory response in РIMS may be a consequence of the development of secondary hemophagocytic syndrome, a significant part of which is refractory fever, an increase in ferritin, AST and ALT, cytopenia, an increase in interleukin 6, severe hepatic and neurological dysfunction. The case with this group of representatives of other multiple organ failure manifestations in the detection of acute distress syndrome and acute heart failure, in the detection of the development of myocarditis.

A feature of the described clinical detection is the dynamic observation of a severe pediatric multisystem inflammatory syndrome associated with COVID-19, complicated by myocarditis with acute heart failure, left ventricular dysfunction and secondary hemophagocytic syndrome, in an 11-year-old girl with underlying obesity. The child is taking triple therapy with glucocorticosteroids in combination with intravenous immunoglobulin and cyclosporine A, with an expected effect on the ongoing treatment. Possible features of observation are noted: 1) a very early start of РIMS during the acute phase of СOVID-19; 2) transient dyslipidemia at the onset of РIMS with an increase in cholesterol, mainly due to the low-density lipoprotein fraction, and spontaneous regression without lipid-lowering drugs; 3) MRI signs of myocarditis in a month after the onset of the disease, despite the normalization of echocardiography and pro-BNP.

Pediatrician (St. Petersburg). 2023;14(1):127-134
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In Memory of Professor Nikolay Pavlovich Shabalov

Pediatrician (St. Petersburg). 2023;14(1):135-136
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