Vol 11, No 2 (2020)

According to the World Health Organization (WHO), viral diseases form serious public health problem. WHO announced that the disease caused by the new virus named “coronavirus disease 2019” or “Coronavirus disease 2019” (COVID-19), and the virus causing the infection was named SARS-Cov-2 by the International Committee on Taxonomy of Viruses. Children usually have asymptomatic or mild forms. However, children with comorbidity are in risk of developing severe forms of COVID-19. The review presents modern ideas about the amount of laboratory tests in cases of suspected presence of the SARS-CoV-2 virus, methods of radio diagnostic (computer tomography, x-ray, thorax ultrasound), features of the clinical course of infection in children depending on the severity of the of infection and indicated detailed criteria for severe forms of coronavirus infection. Special attention is focused on the clinical monitoring of children in a non-core hospital: the detection of leukopenia and lymphopenia, CRP level control, monitoring of coagulation disorders, providing tests on other respiratory viruses. Specific recommendations, comprehensive to date, on the use of drugs for the treatment of children with COVID-19 upon admission to a non-core hospital are given. The organisational issues of treatment children infected with COVID-19 in a non-core hospital are described in details. Special attention is focused on the compliance of strict safety rules by staff working with infected patients entering and leaving the “Red” zone. Thus, the proper organisation of the units for the treatment of children infected with COVID-19 in a non-core hospital, taking into account the features of their disease, will make it possible to provide complete and high-quality treatment of infection during the pandemic.

Objective. Assessing the relationship between health indicators in infants born with intrauterine growth retardation (JGR) of hypoplastic type of mild severity among themselves, compared with infants born without IGR, and with practically healthy infants from practically healthy mothers.

Materials and methods. Under the supervision were 109 infants. From mothers with a burdened somatic and obstetric-gynecological history, 84 children were born: 15 (gr. 1) – with mild of hypo-plastic type IGR, 69 (gr. 2) – without IGR. The control group (gr. 3) consisted of 25 healthy children born to healthy mothers. All observed babies were born full-term. They were examined in dynamics at the age of 1 (n = 104), 3 (n = 98), 6 (n = 92), 12 (n = 94) months. Outcome recording methods were a comprehensive case history analysis, physical examination, assessment of electrocar-diography and cardiointervalography. Distribution-free statistical analysis methods.

Results. A correlation was found at 2–3 days between weight and body length (r = 0.63), body weight and stress index (r = –0.56), sympathetic activity and stress index (r = 0.84), intraatrial and atrioventricular conductivity (r = 0.64); at 1 month between sympathetic activity and stress index (r = 0.62); at 3 months between weight and body length (r = 0.79), sympathetic activity and stress index (r = 0.87), sympathetic activity and intraventricular conduction (r = 0.67), intraatrial and atrioventricular conduction (r = 0.71); at 6 months between weight and body length (r = 0.81), body weight and intraatrial conduction (r = 0.65), body weight and electric systole (r = –0.58), sympathetic activity and stress index (r = 0.92); at 12 months between body length and intraatrial (r = 0.74), body length and atrioventricular conduction (r = 0.76), sympathetic activity and stress index (r = 0.94), sympathetic activity and electrical systole (r = –0.71), stress index and intraventricular conduction (r = 0.68), stress index and electric systole (r = –0.69), intraatrial and stress index (r = 0.9), atrioventricular conduction and electric systole (r = 0.63).

Conclusions. The revealed correlation communications between of some studied parameters allow doctors to allocate groups of dispensary observation, to diagnose changes at early stages of the pathological process, conduct correctional actions with assessment of their efficiency.

Nowadays there are no decicive descriptions of constitutional features and body mass deviations in a narrow group taking into consideration their sex, age, habitation region, and a concrete type of body mass deficit or excess. The present study focuses at comparative assessment of number and frequency of pronounced deficit, deficit, nominally normal body mass, preobesity and obesity in junior schoolchildren and adolescents with lepto-, meso- and hypersomal somatotype. All in all 274 persons took part in the study, 130 of junior schoolchildren aged 7 to 9 years (64 boys and 66 girls) as well as 142 adolescents 14–17 years old (65 boys and 77 girls). Somatotype was determined in all children with the help of I.I. Salivon and V.A. Melnik’s method, as well as body mass index was calculated. Comparing the number of children with various deviations of body mass in case of lepto- meso- and hypersomal somatotype was accomplished with the help of precise Fisher’s criterion for conjugated features tables 3 × 5. In boys and girls of junior school age with leptosomal (boys – 62%, girls – 81%) somatotype body mass deficit was predominant, while in adolescents with leptosomal somatotype body mass deficit was found in 37% boys and 15% of girls. Hypersomal boys form obesity and excessive body mass when they enter adolescence. On the other hand 40% girls of junior school age with hypersomal somatotype are already obese and 100% of them preserve obesity till puberty. The results of the study may be useful for specifying individual recommendations for children with metabolic pathology at pre-hospital stage for correction of both excess and deficit of body mass should be made prior to entering puberty.

The problem of vitamin D deficiency is one of the most actual today. According to numerous clinical studies, its insufficiency of this micronutrient is registered in half of the world’s population.

Aim of the study. To study the provision of vitamin D in infants, suffering from food allergy and living in the Donbass in a military conflict.

Materials and methods. 105 infants living in the Donetsk People’s Republic suffering from food allergy were examined. The level of vitamin D in serum in these patients was studied by determining serum levels of 25(OH)D.

Results and discussion. Insufficient vitamin D levels were found in 57.1 ± 4.8% infants with food allergy, which was significantly higher (р < 0.05) compared to healthy children (12.5 ± 5.2%). At the same time, children with food allergies, long-term living near the region of active hostilities, statistically significant (р < 0.001) often had a reduced level of vitamin D. It was found that in the group of patients with low level of vitamin D polyvalent food allergy was determined statistically significantly more common compared to the group of patients with normal level of vitamin D.

Conclusion. Infants, suffering from food allergy and living in the Donetsk People’s Republic in a long-term military conflict are characterized by a decrease in vitamin D level, which may play a role in the formation of the immune response, the development of clinical symptoms of pathology and disrupt the development of tolerance to the food allergens.

Hiatal hernia is the most common type of visceral anatomy disorder, observed in people under 30 years of age in 10%, older than 50 years – in 60%. Four types of hiatal hernias (I–IV) are distinguished by the variant of the disturbances in the relationship between the esophagus, stomach, and diaphragm. Indications for surgical treatment of hiatal hernias are gastroesophageal reflux or anatomical disorders, which have a risk of developing life-threatening conditions (obstruction or necrosis of the stomach). An unresolved problem in this part of surgery is the high rate of disease recurrence, reaching 10–15 – 40–60%. The subjective reasons for the unsatisfactory results of surgical treatment of this pathology include technical errors in performing interventions (insufficient mobilization of the esophagus, stomach, legs of the diaphragm, incomplete excision of the hernial sac) and flaws in perioperative support (insufficient analgesia, vomiting, cough). The objective factors of the repeated displacement of the abdominal organs into the chest are the large size of the hiatal opening (more than 5 cm in maximum dimension), the insufficient mechanical strength of the legs of the diaphragm (hypotrophy, fibrosis) and the shortening of the esophagus (reduction of the abdominal part length less than 5 cm). Each of the noted factors plays a own role, together determining the success or failure of the surgical intervention. Understanding the basic principles and unresolved issues in this field of surgery is a prerequisite for its further development.

Aspirated lipoid pneumonia is a rare lung disease, in which interstitial lesion with chronic respiratory failure is predominantly expressed. In the available literature, this pathology is described in the form of separate observations with an empirical selection of therapeutic measures. The appearance of lipophages in a bronchial aspirate is recognized as a pathognomonic sign of lipoid pneumonia. There is no etiological treatment of the disease. The effectiveness of intensive therapy, according to available sources, depends on the severity of respiratory failure and on the timing of the start of complex bronchodrainage therapy, and theoretically the most attractive is kinesitherapy. Only one observation describes the use of bronchial lavage with sequential separate intubation of the main bronchi. Hormone therapy is considered effective, but the physiological basis for its use is not presented. The published observation is characterized by a late start of treatment due to a long diagnostic search. The applied therapeutic measures are given and described in detail with an assessment of the expected and achieved practical benefits. It was shown that beneficial effects were due to the use of bronchodrainage therapy techniques, including the jet high-frequency artificial ventilation of the lungs. There are doubts about the appropriateness of the use of corticosteroids in this pathology.

Acute poisoning in children is one of the most frequent reasons for seeking medical care and hospitalization in intensive care units, but it is extremely rare in children of the first year of life. On the example of the clinical case, the peculiarities of the course of acute severe methadone poisoning in a two-month-old child against the background of natural feeding are considered. The main data of history and clinical-laboratory examination are reflected, which allowed to suspect acute poisoning in a timely manner and to carry out reasonable intensive therapy, against the background of which the maximum rapid improvement of the child ‘s condition is achieved. The algorithm of differential diagnosis of comatose state in children is presented, which can be used in all cases of sudden suppression of consciousness of unclear genesis. Special attention is paid to the need for maximum early recognition of exogenous poisoning and targeted pathogenetic treatment aimed at elimination of toxicant metabolites. A distinctive feature of this case was the severe course of acute methadone poisoning in the infant with the development of coma and respiratory distress, which regressed against the background of the treatment carried out with the full recovery of the patient.

Training and education of children with physical and mental health problems makes a number of requirements for teachers working in various correctional medical institutions. These specialists must have a high level of adaptive characteristics allowing combining up-to-date pedagogical methodology with individual approach, taking into account the current state of the child. As a result of applying complex experimental psychological techniques we managed to identify specific features of correctional teachers’ adaptive characteristics (when comparing with public school teachers), namely: low level of activity and optimism, insufficient adaptive strategy to cope with stress characterizing maladaptive personality types. There were also a lot of negative organizational factors affecting the process and result of professional activity: a lot of work, unauthorized persons at the lessons, interaction problems with parents, insufficiency of pupils’ independent work, need for individual explanation, lack of real results in teacher’s activity. Teachers working in correctional schools and having an average level of social and psychological adaptation give a lower evaluation of various aspects in professional activity. They have a pronounced value of psychological and physiological professional maladjustment shown in somatic, emotional and social spheres as well as motivation decrease in their professional activity. Correctional school teachers have a high degree of professional burnout and their emotional exhaustion and depersonalization are more pronounced.