Modern Pediatrics. Ukraine

On the issue of diagnosing endothelial dysfunction, arterial stiffness and cardiovascular disorders in children with COVID-19 in outpatient settings

2025-01-27T20:54:35+02:00

Aim - to improve the instrumental diagnostic of endothelial dysfunction by determining arterial stiffness for the timely prevention and correction of cardiovascular disorders in children who have had COVID-19 infection in outpatient settings, and to create an algorithm for managing cardiovascular disorders.

Materials and methods. The study group completed by 70 children aged 7-14 years without chronic pathology, who were asymptomatic, mild or moderate in the course of COVID-19 infection with laboratory confirmation of the disease. The comparison group consisted of 30 children with similar age who did not have COVID-19. Structural abnormalities and cardiovascular dysfunction, as well as indicators of arterial stiffness, were investigated by echocardiography. The functional state of the medium-sized vessels’ endothelium was studied by assessing of the blood flow dynamic in the brachial artery and changes in its diameter at rest and during reactive hyperemia. Statistical processing of the obtained data was performed with application package "Statistica 10.0 for Windows" by the method of variation statistics.

Results. In children aged 7-14 years who had COVID-19 infection in an outpatient setting, endothelial dysfunction of hypoergic and paradoxical types with impaired arterial elasticity was detected. Indicators that may be markers of impaired vascular stiffness have been identified. The presence of endothelial dysfunction and arterial stiffness are the causes of a number of cardiovascular disorders, even if the infection is mild or moderate.

Conclusions. Flow-mediated dilatation of the brachial artery is a noninvasive method for assessing endothelial function and endothelium-dependent vasodilator response to increased blood flow-related stress. Endothelial dysfunction is associated with increasing of vascular stiffness, which was proven in the present study. The determination of flow-mediated dilatation of the brachial artery should be supplemented by the studying of arterial stiffness (systolic and diastolic aortic diameters, distensibility, and arterial tension). Based on results of study, an algorithm for the diagnosis and follow-up of children who have suffered COVID-19 infection in outpatient settings aimed at early detection of cardiorespiratory system disorders, has been developed.

The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the child and child's parents was obtained for the research.

No conflict of interest was declared by the authors.

Diagnostic value of functional tests for determining autonomic system balance in children with respiratory pathology

2025-01-27T21:15:59+02:00

Holter monitoring of electrocardiogram (ECG) is a modern method for assessing the balance of the autonomic nervous system (ANS) and its impact on the activity of the cardiovascular system. Heart rate variability (HRV), as a characteristic of heart rate fluctuations of R-R intervals, reflects the balance of the ANS. The diagnostic value of the method increased by cardiovascular reflex tests, such as orthostatic, breath holding, Valsalva maneuver.

Aim - to determine the diagnostic sensitivity and capabilities of functional tests in the process of ECG monitoring to assess the balance of autonomic innervation in children in the model of acute bronchitis.

Materials and methods. The study examined 35 children aged 12-15 years: 15 children with acute bronchitis and 20 clinically healthy individuals. The ANS balance assessed by the data of short-term Holter monitoring of the background ECG and with the following tests: orthostatic and Valsalva. Heart rate variability assessed by heart rate variance dispersion.

Results. The paper analyzes of HRV indicators which have a clear physiological basis, such as the measure of the central tendency of the RR interval, indicators of variance (SDNN), heart rhythm concentration (rMSSD) and the level of parasympathetic effects on the heart rhythm (pNN50). A significant difference between the data obtained in children with bronchitis relative to the clinically healthy persons. The possibility of the assessing autonomic balance in an individual patient according to the data obtained with an orthostatic test and interval analysis with a Poincaré graph is shown.

Conclusions. Assessment of the balance of the ANS using Holter monitoring of ECG with a short recording is a modern method for diagnosing its disorders. In acute bronchitis, the most sensitive indicators are the rMSSD and the pNN50. The use of functional tests during short-term Holter monitoring of ECG recording expands the diagnostic capabilities of the method.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Immunoprevention of contact children from focies of chemoresistant tuberculosis infection with BIVEL immunomodulator (BI-V)

2025-01-27T21:35:18+02:00

Aim - to study the feasibility of using the natural immunomodulator BIVEL (BI-V) as a non-specific immunoprevention of tuberculosis (TB) among contact children from focies of multidrug-resistant tuberculosis infection (FsMDR-TBI) on the basis of clinical and immunological studies.

Materials and methods. The object of study: 120 contacted from FsMDR-TBI (75 children and 45 adolescents). The Group 1 - 95 children/adolescents who did not receive BI-V and the Group 2 - 25 patients who received BI-V. The state of phagocytic reactivity of immunity; cellular and humoral immunity; interleukins and specific immunity were determined. Statistical analysis of the obtained results was performed based on a software package Excel.

Results. In infected children/adolescents with FsMDR-TBI, insignificant functional disorders of the cellular response were revealed (decrease by 1.3 times IRI CD3+CD4+/CD3+CD8+), a shift in the balance in the regulatory system towards pro-inflammatory cytokines (increase by 2.0 times TNF-α/IL-10). The existing deviations in the regulatory and cellular response systems disappeared after the completion of the autumn-spring BI-V course. Preventive administration of immunomodulator BI-V to infected children/adolescents with FsMDR-TBI reduced the frequency of acute respiratory viral infections and exacerbations of bronchopulmonary diseases by 2.0 times, the development of latent tuberculosis infection into an active process by 2.6 times. Among children of the Group 2 - 8% of people fell ill with various forms of primary pulmonary TB, among children of the Group 1 - 22.1%. In both groups, the maximum level of TB occurred in the first two years of observation.

Conclusions. The introduction of the algorithm of preventive measures with appointment of BI-V confirmed feasibility of using this immunomodulator for contact children/adolescents with FsMDR-TBI.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethical Committee of the participating institution. The informed consent of patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Features of the course of non-infectious uveitis in children in Ukraine

2025-01-27T22:09:16+02:00

Uveitis that develops in childhood has a potentially severe course and can lead to vision loss.

Аim is to study the manifestations, structure and features of the course of idiopathic uveitis and uveitis in children with rheumatic diseases.

Materials and methods. During 2022-2023 49 children with uveitis were studied, of which 45 patients had a non-infectious (autoimmune) nature of the disease. The results of uveitis activity scales, quality of life in children with autoimmune uveitis and rheumatic diseases were evaluated. Descriptive and correlation analysis were used as analytical and statistical methods.

The results. According to the results of the study, children were observed for idiopathic uveitis, 29 children had inflammation of eye structures associated with juvenile idiopathic arthritis (JIA). The frequency of actual uveitis screening is once every 5.7±1.67 months. In 39.5% of cases, uveitis started asymptomatically. The average age at the time of diagnosis was 10.5±4.1 years. Among patients with non-infectious uveitis, girls predominated, the ratio of boys to girls was 1:2, gender differences were more characteristic of JIA-associated uveitis. Among JIA subtypes, the oligoarticular variant accounted for half of cases with JIA-associated uveitis. Anterior uveitis was unilateral in 60.5% of cases. Eye complications were observed in almost half of the patients. Laboratory markers ANA and HLA B27 were more likely to be detected in patients with JIA-associated uveitis, which made it possible to consider their detection in patients with idiopathic uveitis as a potential risk factor for the development of rheumatic disease. Treatment of children with idiopathic uveitis was significantly less active, which requires further study.

Conclusions. In recent years, the situation with the assessment of the quality of life in medicine has improved, relevant questionnaires are being actively implemented. There remains ambiguity in the results in world medicine regarding the availability of works on determining the relevance of the problem of the quality of life of children with JIA in Ukraine.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Сommittee on bioethics and deontology of these institutions. The informed consent of the children's parents was obtained for the research.

No conflict of interests was declared by the authors.

Changes in physical development in children with cystic fibrosis as a universal mechanism of body adaptation

2025-01-27T22:32:00+02:00

Cystic fibrosis (CF) is the most common monogenic disorder with an autosomal recessive inheritance pattern. The disease leads to damage to the respiratory system, pancreas, intestines, gallbladder and liver. In Ukraine, about 300 children are born with CF each year. As of 2024, there are 16 children with CF living in the Ternopil region.

Aim - to analyze the parameters of physical development in children with CF to understand the processes of adaptation and maladaptation of the child's body under conditions of chronic hypoxia, which causes dehydration.

Materials and methods. The study was conducted by analyzing the records of hospitalized 15 patients who were receiving inpatient treatment at the Ternopil Regional Clinical Children's Hospital and conducting a literature search of scientific publications from sources such as PubMed, ResearchGate, and Science.

Results. Impairment of physical development, growth and weight gain is one of the most common problems faced by children with CF. The comparison of body mass-to-height ratio (WFLz) and body mass index (BMIz) indicators was carried out as an as assessments of physical development and possible malnutrition in children with CF. Problems with gaining and maintaining weight indicate that the digestive system is not absorbing the nutrients necessary for the child's growth, disrupting adaptation processes.

Conclusions. As a result of the study, no significant impairment of the physical development of children with CF was found, in 10 (66.7%) patients physiological norms were established based on the ratio of body weight to height. As a result of the comparison of BMI indicators, 13 (86.7%) patients were within the physiological deviation range.

No conflict of interests was declared by the authors.

Results of diaphragm agenesis repair

2025-01-28T20:19:07+02:00

Aim: assessment of short-term outcomes in children after diaphragmatic agenesis repair and selection of the optimal method for defect repair.

Materials and methods. This study involved 10 newborns with congenital diaphragmatic hernia (type D) who underwent surgery in one hospital between 2000 and 2023, followed by an assessment of complications, mortality, and the effectiveness of the thoracalization concept of the abdominal cavity.

Results. There were 6 (60%) male patients and 4 (40%) female patients. Right-sided diaphragmatic dome agenesis was diagnosed in 2 (20%) children and left-sided in 8 (80%). Early total mortality in this group was 60%. The surgical approach for treatment was thoracotomy in 80% (n=8) of cases, and in 2 (20%) cases transverse subcostal laparotomy was chosen. All diaphragmatic agenesis repairs were performed using patches (mostly made of polytetrafluoroethylene), with 8 of them applying the principle of thoracalization of the abdominal cavity. Indications for reoperations in our group included hernia recurrence - 2 cases (in one patient at 6 and 15 months) and intestinal obstruction caused by malrotation - 1 case.

Conclusions. Patients with diaphragmatic agenesis have higher mortality compared to the group with small and medium defects. The size of the diaphragmatic defect is an independent prognostic factor and may serve as a marker for the degree of pulmonary hypoplasia and pulmonary hypertension. The optimal method of surgical treatment is diaphragmatic repair using a synthetic polytetrafluoroethylene patch with thoracalization of the abdominal cavity.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethical Committee of these institutions. The informed consent of the children's parents was obtained for the research.

No conflict of interests was declared by the authors.

Physical activity of adolescents in wartime conditions, ways to optimize it

2025-01-28T20:43:59+02:00

The war had a particularly adverse effect on adolescent children, who are going through a period of intensive growth, puberty and personality formation. Physical activity (PA) can reduce the impact of stress, so maintaining it can be considered as a therapeutic anti-stress method.

Aim - to determine the level of PA of adolescents in wartime conditions and the ways to increase it, to evaluate the attitude and motivation of teenagers to physical activity.

Materials and methods. During December 2022 - June 2023 103 adolescents aged 11-17 living in the city of Kharkiv and the Kharkiv region were interviewed about their PA. 88 of them indicated their attitude towards FA and what affects its level. Statistical processing of the results was carried out using the Fisher and Mann-Whitney tests. Differences were considered statistically significant at a probability of 95% or higher (p<0.05).

Results. The PA of teenagers significantly decreased during the war compared to the quarantine period: 70.9% of teenagers had a low level of PA, 16.5% had an average level of PA, and 12.6% had a high level of PA. The main type of activity was walking, most of the children began to exercise in the morning. Adolescents with a high level of PA had a longer duration of outdoor sports games. 77.0% of respondents had a positive attitude towards PA, but motivation to increase exercising was often low. The opinions of adolescents regarding the causes of insufficient physical activity and the consequences of its increase have been analyzed. Own desire has been pointed out as the main factor by 87% of children with low PA and 93% of children with high PA. The steps to ensure a sufficient level of PA for children during a period of social crisis have been determined.

Conclusions. During the war in Ukraine, the number of sedentary children increased significantly and the number of children with high motor activity decreased significantly. A sufficient level of PA in wartime conditions can be ensured by a combination of daily walks (40-60 minutes) with morning exercise and maintenance of physical education activities. Adding games and sports activities at least three times a week will allow to achieve a high level of activity. Increasing the motivation of teenagers to increase PA is an important task for parents, teachers, doctors, psychologists, and the public.

No conflict of interests was declared by the authors.

Features of the neurological status of newborns from mothers with parvovirus B19 infection

2025-01-28T21:06:30+02:00

To date, the issue of parvovirus B19 (B19V) infection in pregnant women and its impact on the fetus remains quite relevant. B19V is one of the causes of perinatal pathology, particularly non-immune fetal hydrops (NIFH), which can lead to intrauterine anemia, heart failure, and fetal death.

Aim - to investigate the neurological status of newborns who underwent intrauterine treatment for NIFH caused by B19V infection.

Materials and methods. A retrospective analysis of the medical histories of 32 pregnancies complicated by NIFH due to parvovirus B19 was conducted over the period 2022-2024 at the Perinatal Center in Kyiv. Intrauterine erythrocyte transfusions were performed on 11 fetuses with severe anemia. Neurological status was assessed using the HINE scale at 3 and 6 months of age.

Results. Survival after treatment reached 72.7%, while mortality without treatment was 100%. A favorable prognosis for future neurological disorders was noted in 62.5% of the children, while 37.5% showed a risk of impairments.

Conclusions. Intrauterine erythrocyte transfusions are effective in treating fetal anemia caused by B19V infection. However, neurological disorders remain possible, requiring continued follow-up of children after treatment.

The authors declare no conflict of interest.

Dynamics of the psychological state of internally displaced school-age children and adolescents

2025-01-28T21:20:41+02:00

Internally displaced persons (IDPs) are one of the most disadvantaged population groups in countries affected by hostilities, man-made disasters or other social conflicts and violence.

Aim - to identify gender peculiarities of the emotional state of school-age children and adolescents in war conditions in order to develop effective strategies for psychological support in a timely manner.

Materials and methods. In May 2022, 1017 IDPs adolescents and 4144 adolescents from Lviv and Lviv region (LR) were surveyed anonymously, and a year later, 1173 adolescents in Lviv region, including 139 IDPs.

Results. An analysis of responses about feelings, impressions and emotional state of school-age children and adolescents shows that fear for the lives of their relatives and their fate was the most significant feeling for both IDPs and local residents. Fear for home, housing, and family property remained the second most important fear. A constant feeling of anxiety, helplessness and despair was reported by one-third of IDPs children and adolescents at the beginning of hostilities and evacuation, but during the year this figure decreased to the level of LR. These feelings were more often experienced by girls, regardless of their city of residence. Almost half of all respondents, regardless of their city of residence and gender, reported anger at the situation. Most adolescents expressed confidence that everything will be fine. By almost all indicators, girls from the IDPs group were more emotionally stressed.

Conclusions. The problem of the health status of school-age children and adolescents of IDPs and the organization of medical and psychological assistance to them requires careful study and solution. The traumatic events of the war in Ukraine and the internal migration of school-age children and adolescents have had a significant impact on the mental state of not only them, but also local residents, especially girls. This group of children should be considered as a risk group. Determining their emotional state is of great importance for the prevention of reducing the prevalence of psychopathology, psychosocial dysfunction, timely diagnosis and treatment.

No conflict of interest was declared by the authors.

Etiological therapy of respiratory-synchitic viral infection in the present and future

2025-01-28T21:58:23+02:00

For several decades, acute respiratory infections caused by respiratory syncytial virus (RSV) have been a leading cause of respiratory tract pathology in young children.

The aim is to highlight modern concepts of pathogenesis and the main directions of medicamentous treatment of respiratory syncytial virus infection.

Two antigenic subtypes of RSV have been identified: A and B, and at least 37 genotypes of RSV type B and 13 genotypes of RSV type A. Respiratory syncytial virus infection (RSVI) in young children is characterized by a high probability of unfavorable life-threatening course, which requires hospitalization. Despite significant advances in virology and molecular biology that reveal the details of RSV interaction with the macrophage and the functioning of RSV replication mechanisms, treatment recommendations for patients with RSVI are limited mainly to pathogenetic and symptomatic therapy. Ribavirin, a nucleoside analog, is the only FDA-licensed antiviral agent for the treatment of RSVI that moderately inhibits viral replication. Instead, scientists are focusing on the development of new drugs that inhibit the activity of various viral proteins and surface receptor molecules of respiratory tract epithelial cells. The most promising drugs in this group are chemical compounds that inhibit RSV protein F, in particular, ziresovir, which is in phase III clinical trials. Currently, the possibility of using receptor tyrosine kinase inhibitors, such as erlotinib and vandetanib, in the treatment of RSVI is being investigated. Non-nucleoside inhibitors of RSV L-protein RNA polymerase, in particular the small molecule PC786, have great prospects for effective use in RSVI. It is also believed that the CX3CR1 receptor is the most promising target for drugs that will be developed to control the level of expression during the prevention and treatment of RSVI.

The authors declare no conflict of interest.

Management tactics of patients with acute stenosing laryngotracheitis (a review of the guidelines of medical communities)

2025-01-28T22:16:51+02:00

Acute stenosing laryngotracheitis (croup) is a clinical syndrome manifested by a barking cough, inspiratory stridor, hoarseness of voice and is accompanied by difficulty breathing. After establishing the diagnosis, it is necessary to carefully determine the degree of its severity in order to prescribe optimal therapy.

The aim of this article is to generalize and analyze the management tactics of patients with acute stenotic laryngotracheitis (croup).

Modern publications, clinical guidelines, national and international protocols were analyzed. Literature was searched in scientific databases: PubMed, Scopus, Web of Science, and Google Scholar. The main approach to the medical treatment of croup is the use of agents that effectively reduce swelling of the mucous membrane of the subligamentous space and increase the lumen of the respiratory tract. To achieve this goal, systemic corticosteroids, inhaled corticosteroids, and racemic epinephrine are prescribed. In the treatment of croup, systemic corticosteroids can be used in different forms: orally, intramuscularly, intravenously, or rectally. Oral administration is the preferred method of systemic corticosteroid administration, especially in the age group of 6 months to 3 years. According to the guidelines, budesonide, which is used through a nebulizer, is an effective method of treating croup in children, especially in cases where oral administration of drugs is not possible due to repeated episodes of vomiting. The use of racemic epinephrine or epinephrine by nebulizer is the recommended first step in the treatment of a child with persistent inspiratory stridor at rest and marked chest wall retraction.

Conclusions. The main aspects of the tactics of managing patients with croup in the ward are timely diagnosis and adequate medical intervention in order to prevent complications. Effective treatment of croup requires a comprehensive approach that includes the integration of systemic and inhaled corticosteroids along with epinephrine for immediate relief of symptoms. Scientific studies point to the need for continuous improvement of clinical protocols in order to optimize the treatment of this serious medical problem related to croup.

No conflict of interests was declared by the authors.

Water and fat soluble vitamins, their significance in metabolism, growth and development of children

2025-01-28T22:30:11+02:00

Vitamins are organic molecules that are necessary for the child's body in small quantities to maintain proper metabolic function.

Aim - to increase awareness of the biological and clinical effects of vitamins, their importance in metabolism, growth and development of children of various ages.

Vitamins are essential nutrients that practically cannot be synthesized in the child's body in sufficient quantities for normal functioning, and therefore they must be obtained and regularly consumed with food. Vitamins are found in small amounts in animal and plant foods. The deficiency of each of the vitamins causes specific metabolic disorders in children. Vitamins have high biological activity in small doses, they show the properties of specific biological catalysts of metabolic processes, growth and development, affect various vital functions of the child's body. The need for vitamins increases markedly in children under conditions of intensive growth and development, with excessive physical exertion, stress and neuropsychological stress, following various elimination diets with food restrictions, after suffering acute infectious diseases, against the background of accompanying chronic somatic diseases, as a result taking certain medicines, living in unfavorable climatic or environmental conditions. It is important to monitor the content of each of the vitamins in the daily diet of children. The following types of vitamin metabolism disorders are known: avitaminosis, monohypovitaminosis, polyhypovitaminosis. hypo-, hyper- and dysvitaminosis.

Conclusions. Vitamins as biological coenzymes activate a large number of physiological reactions, thus regulating growth and development, functions of various tissues, organs and systems. Vitamins improve adaptation and increase the resistance of the child's body to various adverse exogenous factors. It is very important that the child's body is not able to synthesize in sufficient quantity and store all vitamins for a long time, so a full set of vitamins should be received regularly in accordance with physiological needs. Timely screening and correction of vitamin deficiency in children can not only improve health, but also increase the quality of life.

No conflict of interests was declared by the authors.

A repeated case of neonatal sepsis in one family: coincidence or unfortunate pattern?

2025-01-28T23:01:54+02:00

Neonatal sepsis still remains an extremely relevant problem for newborns and a challenge for neonatologists and continues to take one of the prominent places of neonatal morbidity and mortality worldwide. The causes of neonatal sepsis are multifactorial and may have both maternal and other, unexplained causes. In recent years, numerous studies have been focused at studying the relationship between genetic variations and the frequency and causes of neonatal sepsis. Research are still continuous for study the role of genes associated with the formation of the inflammatory response in newborns. Research the role of genes associated with the formation of an inflammatory response in newborn children continues.

Aim - to provide substantiated information on the problem of the features of the clinical course of neonatal sepsis with an analysis of literature data on possible genetic determinants of the occurrence of this disease in newborns using the example of a specific clinical case.

The article presents a clinical case of fulminant sepsis in a newborn baby with a fatal outcome, which occurred repeatedly in the same family over two years with a similar clinical features and outcome. The authors tried to analyze the peculiarities of the neonatal sepsis, diagnostic procedures, treatment methods, causes of death and to link clinical and diagnostic findings with possible genetic disorders. The presented clinical case suggests the need for more in-depth studies involving geneticists and other specialists to predict the health of married couples and their future children.

Conclusions. Identification of variations in genes involved in the bacterial-induced cellular response, as well as in the pathogenesis of sepsis, may allow the development of new diagnostic tools, improve the classification of sepsis, and more accurately predict the results of treatment in patients. Considering the mother's history, the course of the disease in the newborn, and the available clinical and laboratory examination data, a comprehensive in-depth genetic study of this married couple is mandatory.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The informed consent of the children's parents was obtained for the research.

No conflict of interests was declared by the authors.

Osteochondrodysplasia: punctate chondrodysplasia (а literature reference and own clinical case)

2025-01-28T23:17:59+02:00

Osteochondrodystrophies belong to the group of perixsomal diseases. Punctate chondrodysplasia is a genetic disorder of connective tissue, accompanied by the formation of punctate calcifications in the epiphyses, areas of the bone growth plate and in periarticular tissues, followed by shortening of the limbs, the development of flexion contractures and deformities of the feet and curvature of the spinal column. Foci of calcifications can be visualized using fetal ultrasound and radiography during the neonatal and infancy period. The clinical symptoms of this pathology are different, depending on the number of organs and systems involved in the pathological process. The diagnosis is based on the study of genealogical history, clinical manifestations, data from laboratory and instrumental research methods, DNA diagnostics. Treatment of the above pathology is syndromic. Osteochondrodysplasia is an example of a severe hereditary pathology, the prevalence of which tends to increase. Genetic heterogeneity and polymorphism of clinical symptoms indicate the need for an in-depth and detailed study of such diseases, the features of their metabolic disorders and their consequences in patients.

Aim - to present a clinical case of a patient with punctate osteochondrodysplasia, as an example of the need for constant palliative care.

Clinical case. Multiple malformations in a child are diagnosed prenatally, confirmed after birth. The boy's condition from birth is hard, the boy has no spontaneous breathing since birth, attempts at non-invasive artificial lung ventilation were unsuccessful. The child underwent a lower tracheostomy for further long-term invasive ventilation to sustain life. Throughout his life, the patient will need multidisciplinary supervision by doctors, long-term antibiotic therapy for the prevention of secondary bacterial infection, periodic sanitation of the tracheobronchial tree.

Conclusions. Patients with osteochondrodysplasia almost always have a serious condition. Children with osteochondrodysplasia need specialized lifelong care, taking into account the individual manifestations of the disease and the needs of the child.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interest was declared by the authors.

Congenital epidermolysis bullosa: practical aspects of comprehensive treatment

2025-01-28T23:43:31+02:00

Epidermolysis bullosa is a chronic illness with early manifestations. Disease currently does not have specific treatment and is characteristic of high disability rate outcomes which implies significant impact on life quality.

Aim - considered clinical case discusses early prophylaxis of unfavorable outcomes with disability and rationale for multidisciplinary approach to care and management BE patients.

Discussed clinical case evaluates using combustiology based approaches and techniques to treatment of early stages of illness, discusses pain intensity estimation and management, indications for antibacterial therapy, nutritional demands and skin care aspects from multidisciplinary standpoints.

Conclusions. Using combustiology based approaches for estimation of severity and area skin injuries and plastic surgery techniques for severe types of EB in newborn period may prevent early development of disability. Multidisciplinary approach since birth gives opportunity to provide comprehensive treatment, define follow-up strategy and family support.

The study was carried out in accordance with the main provisions of the Declaration of Helsinki. The consent of the child's parents was obtained for the study.

The authors declare no conflict of interest.

Posterior urethral polyp in the development of secondary vesicoureteral reflux

2025-01-29T22:11:37+02:00

Vesicoureteral reflux is a common defect, the essence of which is retrograde throwing of urine from the bladder into the upper urinary tract.

Aim - to demonstrate the experience of diagnosis and treatment of posterior urethral polyps on the basis of a clinical case.

In the pediatric population, vesicoureteral reflux occurs in 1-2% of children. Cystographic studies conducted in children for various indications revealed the presence of vesicoureteral reflux in 30 % of patients with urinary tract infection and in 17% of children without urinary tract infection. Up to 70% of patients in the first year of life with a history of urinary tract infection have vesicoureteral reflux. It is important that with secondary vesicoureteral reflux, the valves of the ureter may initially be anatomically and functionally capable, but the overloading of the valve mechanism by prolonged (permanent) increased intra-vesical pressure associated with the obstruction leads to distortion of the ureteric-vesicular connection. unity Congenital polyps of the urethra in the pediatric population are a rare, irregular pathology of mesenchymal origin, the exact frequency of which is unknown, they occur more often in the form of benign neoplasms of the posterior urethra among male patients, and usually have a course with the phenomena of obstruction of the lower urinary tract. Until 2004, 181 cases of urethral polyps were registered, and after that period only a few cases of pathology were described in the medical literature. J. Hunter is credited with the first documented case of urethral polyps in a bull (1763), and Thompson was the first to report this pathology in humans in 1855. In 1899, Neuberger first diagnosed a urethral polyp using an endoscope. In the clinical case, the experience of treating a rare pathology - a polyp of the back of the urethra with the help of cystoscopy, which caused secondary vesicoureteral reflux - is given.

Conclusions. Polyp of the posterior urethra in pedagogical practice refers to a rare pathology that leads to the development of secondary vesicoureteral reflux. In the treatment of vesicoureteral reflux of the small foot in the presence of a polyp of the posterior urethra, its resection is usually sufficient. In the treatment of vesicoureteral reflux, any STING-type procedure without prior resection of the posterior urethral polyp is not effective.

The study was carried out in accordance with the main provisions of the Declaration of Helsinki. The consent of the child's parents was obtained for the study.

The authors declare no conflict of interest.