Modern Pediatrics. Ukraine

Modern view of allergic rhinitis in children

2024-10-14T22:00:22+03:00

Aim - to conduct analysis of modern data on the prevalence, risk factors, etiopathogenesis, features of the course, approaches to the diagnosis and treatment of allergic rhinitis in children.

Allergic rhinitis is the most common allergic disease in children, the prevalence of which is increasing every year in developed countries around the world. Allergic rhinitis is a chronic inflammatory disease of the nasal mucosa caused by an IgE-mediated type I hypersensitivity reaction. Heredity and environmental factors contribute to the development of allergic rhinitis in children. In turn, allergic rhinitis is a risk factor for the development of asthma and sleep disorders and insomnia and difficulty waking up and daytime sleepiness and morning headaches. Allergic rhinitis leads to the formation of sinusitis and olfactory disorders and acute otitis media and conductive hearing loss and inflammation of the pulp and periodontal disease, which must be taken into account when treating children with allergic rhinitis. In the treatment of allergic rhinitis in children, a graded approach to pharmacological therapy and non-pharmacological methods of treatment are used. Non-pharmacological measures include environmental control and elimination of allergens. According to the course of the disease, new-generation antihistamines and intranasal corticosteroids, and individually selected allergen-specific immunotherapy are prescribed as medications.

Conclusions. Analysis of scientific sources shows that AR is the most common chronic disease in children, which reduces the quality of life. AR is a risk factor for the formation of asthma and the development of complications. Timely diagnosis and rational treatment of allergic rhinitis in children helps to effectively control symptoms and prevent complications and improve the quality of life of patients and their families.

The authors declare no conflict of interest.

Mechanisms of development, diagnosis and conservative therapy of Crohn's disease in pediatric practice

2024-10-14T22:13:43+03:00

In recent years, the incidence of Crohn's disease has significantly increased among both adult and pediatric populations, currently standing at 58 per 100,000 individuals.

This study aims to investigate the primary etiopathogenetic features, diagnostic methods, and conservative treatment options for this condition in children, based on a comprehensive literature review.

It highlights the fundamental differences, including higher disease activity scores, more complicated course of the disease, with the involvement of other organs and systems in the pathological process, difficulty of diagnosis and resistance to treatment, adverse impact on the child's growth and development, presence of protein and energy deficiency manifestations, impaired of psychosocial functions and adaptation capabilities in both physical and social spheres. Among the main etiological and pathogenetic factors of the disease, the genomic theory, infectious theory, intestinal microbiome influence, imbalance of cytokine regulation with an increase in the content of pro-inflammatory cytokines and environmental factors are considered. On the basis of the conducted analysis, it was established that at the current stage, a significant spread of the inflammatory process is determined, which is diagnosed for one meter or more of digestive tract, with the formation of crypt-abscesses and the development of deep ulcers. The main clinical syndromes and complications that characterize the course of this disease and its features in children are described. Modern principles of diagnosis and conservative treatment of pathology are considered, in which the use of mesalazines and antibiotics is highlighted. It is emphasized the need to use enteral therapy and, in the absence of an effect from treatment, the need for a timely transition to the use of immunomodulators, biologics in the treatment regimen.

The authors declare that there is no conflict of interest concerning the publication of this article.

Fat-soluble vitamins, their significance in metabolic processes, growth and development of different age children

2024-10-14T22:30:57+03:00

Vitamins are low-molecular compounds with characteristic high biological activity of various chemical nature, which have a very diverse composition, structure, and physicochemical properties. Unlike macronutrients (proteins, fats and carbohydrates), vitamins are micronutrients, they have high biological activity, although they are not a source of energy or plastic material.

Aim - to increase awareness of the biological and clinical effects of fat-soluble vitamins A, D, E, F, K and their importance in metabolic processes, growth and development of children.

According to vitamins physical and chemical properties, there are classify into fat-soluble and water-soluble. Fat-soluble vitamins are related: A, D, E, F, K. Fat-soluble vitamins have the property of specific biological catalysts (coenzymes) and regulators of various metabolic processes and functions in the child's body, balanced work of all its organs and systems. Fat-soluble vitamins regulate and affect cellular metabolism, stimulate the activity of antioxidant protection systems and ensure the normalization of redox processes, increase the body's resistance to adverse external factors. Vitamins A, D, E, F, K are very important for growth and development, maintaining the health of children and teenagers. Fat-soluble vitamins are necessary to ensure hematopoiesis, regulation of functions of the skin, mucous membranes, sense organs, nervous, endocrine, cardiovascular systems, gastrointestinal tract.

Conclusions. Vitamins A, D, E, F, K are exogenous essential nutritional factors that must be constantly supplied with food in accordance with physiological needs of children. All the vital processes take place in the child's body with the direct participation of fat-soluble vitamins. Fat-soluble vitamins activate various biological reactions, act as bioregulators of various functions in tissues, organs and systems, support protection and adaptation of the child's body, increase resistance to exogenous factors. Timely high-quality diagnosis, prevention of imbalance of fat-soluble vitamins in children, individual selection of vitamin preparations and their correct correction should be priorities in the work of pediatricians. Preventive screening and elimination of deficiency of fat-soluble vitamins in children can not only improve health, but also improve the quality of life.

No conflict of interests was declared by the authors.

Medical and social aspects of health care for adolescents aged 11-14 years by improving physical activity

2024-10-14T22:58:23+03:00

Physical activity plays an important role in the effective health care of adolescents aged 11-14. The peculiarities of the formation of motor skills of adolescents aged 11-14 years do not deny the fundamental principles of the reflexive nature of voluntary exercises. The basic regularities of the reflex theory have not only not lost their significance, but find new confirmation in research on the relationship between the central and executive systems of automated forms of voluntary movements. There is a need to intensify the process of acquiring motor skills of adolescents aged 11-14. Taking into account the individual interests of teenagers, the use of innovative forms and means of forming children’s motor skills will help to more effectively introduce a healthy lifestyle and the formation of motor skills of adolescents 11-14 years old.

The aim of the study is to conduct a systematic analysis of scientific sources regarding the medical and social aspects of health care for adolescents aged 11-14 years by optimizing physical activity.

Research of medical and social aspects of health care by optimizing the mode of motor activity of adolescents aged 11-14 allows us to state the importance and necessity of involving adolescents in physical education and sports. In the conditions of martial law today, the need for the interest of every teenager in motor activity and its use in general secondary education institutions has been identified.

The problem of the health of adolescents aged 11-14 years becomes an important direction in the development of the educational system of a modern school, the purpose of which is physical, mental, and social health. Scientists note that an individual lifestyle is actively formed during adolescence. It is at this stage of growing up that it is important to encourage teenagers to form useful habits, teach them to manage their behavior and, thus, actualize subjectivity in preserving and strengthening health.

The authors declare no conflict of interest.

Determination of the antimicrobial action of "Coldisept nanoSilver nasal spray" and "Coldisept nanoSilver throat spray"

2024-10-13T05:50:17+03:00

Acute respiratory diseases are caused by viruses and bacterial flora. Treatment of acute pharyngitis as the main clinical form of respiratory diseases is mainly local.

The aim is to study the antimicrobial effect of "Coldisept nanoSilver nasal spray" (manufacturer "ARKONA", Poland) and "Coldisept nanoSilver throat spray" (manufacturer "ARKONA", Poland) on clinical isolates of microorganisms Streptococcus pneumoniae, Staphylococcus aureus, Moraxella catarrhalis, Pseudomonas aeruginosa, Haemophilus influenza (hospital strains) and Candida albicans isolated from the nose and oropharynx of patients.

Materials and methods. Antimicrobial activity was evaluated after 5, 10 and 20 minutes of action of one dose of "Coldisept nanoSilver nasal spray" and "Coldisept nanoSilver throat spray" on microorganisms. Bactericidal and fungicidal effect (inhibition of the growth of cells of microorganisms) is expressed as a percentage.

Results. Koldisept nanoSilver nasal spray shows an antimicrobial effect on clinical isolates after 20 minutes: 79.6% - on Streptococcus pneumonia, 77.7% - on Moraxella catarrhalis, 44.0% - on Haemophilus influenza; and fungicidal effect (76.0%) on Candida albicans. Antimicrobial activity of Coldicept nanoSilver nasal spray against the hospital strain of Pseudomonas aeruginosa and Staphylococcus aureus was not detected. Coldisept nanoSilver throat spray shows 100% antimicrobial activity after 5 minutes against clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, 100% antimicrobial activity after 20 minutes against clinical isolates of Streptococcus pyogenes, 75% fungicidal activity against Candida albicans strains through 20 min. A low antimicrobial effect of Coldisept nanoSilver throat spray against the hospital strain of Staphylococcus aureus, which is resistant to most antibiotics, was revealed.

Conclusions. The results obtained in the study of the antimicrobial action of the Coldisept nanoSilver nasal spray and the Coldisept nanoSilver throat spray on clinical isolates of microorganisms will contribute to a more rational prescription of these drugs in clinical practice.

The authors declare no conflict of interest.

Extrahepatic portal vein obstruction in children. The diagnosis is established - what is next?

2024-10-13T06:11:45+03:00

Extrahepatic portal vein obstruction (EHPVO) is the most common cause of portal hypertension in children, the most life-threatening manifestation of which is variceal bleeding, with a mortality rate of 4-19%.

The aim of the study is to determine the treatment tactics for children with symptomatic portal hypertension from the moment of diagnosis of EHPVO, indications for the endoscopic prevention and surgical procedures; to study the risk factors that influence the esophageal variceal bleeding to become the first sign of EHPVO.

Materials and methods. The data of patients, which was collected retrospectively from 245 case histories between January 2011 and January 2022, revealed 55 (22.4%) children with EHPVO, who had not undergone surgical procedures. The median follow-up period was 25 (95% CI 20-35) months. Statistical analysis was performed using IBM SPSS for Windows version 24.0 and EZR(R-statistics). A P-value˂0.05 was considered statistically significant. Scheffe’s method, Kruskal-Wallis and Dunn’s tests were used to compare the follow-up results. Chi-square test was used to assess varices grade dynamics.

Results. The mean age of patients in the group was 5.1±0.54 years, 34 (61.8%) patients were males. 36 (65.5%) patients had complicated delivery with subsequent umbilical catheter insertion. 27 (47.1%) patients manifested bleeding episodes. Endoscopic ligation showed good results in improving varices grade (p<0.001). The logistic regression model identified factors connected to the bleeding risks: “way of delivery” (p=0.027) and “hemoglobin level” (p=0.0015). Indications for surgical intervention were failure to decrease the esophageal varices grade (n=4; 7.2%) and an increase in the volume of the spleen with thrombocytopenia progression (n=6; 10,9%).

Conclusion. The most careful medical attention to babies of the risk group is required. Endoscopic ligation has shown good results in variceal grade decrease. Indications for surgical treatment are failure to decrease the grade of esophageal varices, an increase in the volume of the spleen with thrombocytopenia progression.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research 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.

An interdisciplinary approach to improving the diagnosis of vision disorders in children as a priority vector of preventive intervention

2024-10-13T06:23:55+03:00

The relevance of the study is due to the need to preserve the health of the children's population in the difficult conditions of conducting hostilities on the territory of our country. The modern experience of the developed countries of the world shows the growing spread of ophthalmic pathology, which is recognized as an important problem of modern times.

Aim - to substantiate the feasibility of strengthening preventive intervention using an interdisciplinary approach in improving the diagnosis of vision disorders in children of various ages.

Materials and methods. The materials for the study were the results of a sociological study of the readiness of educators of secondary educational institutions from all regions of Ukraine (teachers, teachers of schools and lyceums) (a total of 6,215 questionnaires were subject to analysis) and doctors who provide medical and preventive care to children in outpatient polyclinic conditions (of the total analysis 504 questionnaires were submitted). Research methods were: sociological survey, analytical-synthetic, content analysis, system approach and system analysis, medical-statistical. In particular, the latter was used to calculate the representativeness and reliability of the results of planned and conducted sociological research.

The results of the study prove the importance of using an interdisciplinary systemic approach in the implementation of modern medical and preventive technologies to improve the diagnosis of vision disorders in children. The development of this direction is a priority, as it allows timely prevention of the influence of controlled risk factors for the formation of visual functions in childhood, which allows increasing the effectiveness of preventive intervention, including due to early diagnosis and correction of detected diseases of the eye and its accessory apparatus in children. A high willingness of secondary school teachers to participate in preventive measures was revealed in combination with an increase in the level of activity of preventive work of medical personnel. The vast majority of respondents expressed the feasibility of introducing regular systematic supervision of vision functions in school-age children (99.40±0.10%) and supporting the implementation of state preventive programs to preserve vision from childhood in Ukraine (97.38±0.20%).

Conclusions. The important medico-social significance of disorders of visual functions in children of various ages has an impact on the formation of the health of future generations. The results of the study open the perspective of cross-sectoral interaction with the involvement of educators and doctors in the planning and implementation of comprehensive programs to prevent the development of ophthalmic pathology among children of different ages.

The authors declare no conflict of interest.

Psychological testing in children with elevated blood lead level: the effect of spirulina

2024-10-13T06:44:20+03:00

The search for effective and safe remedies to reduce the negative effects of lead on a child’s cognitive sphere is an urgent problem.

Aim - to analyze changes in psychological testing indicators in children with elevated blood lead level and the effect of spirulina on them.

Materials and methods. A total of 33 children aged 7 to 15 years were examined. The children were divided into 2 groups depending on the lead level in their blood: up to and including 49 μg/l (control group) and from 50 μg/l or more (main group). Statistical processing of the results was carried out by the method of variation series using the Student's t-test, and analysis of variance was carried out using the F-criterion.

Results. In children with elevated blood lead level, there was a significant increase in cognitive impairment (memory and attention) compared to control scores. According to WHO recommendations, nutritional intervention was selected to correct the identified changes. For this purpose, children of the main group received a course of spirulina according to the following scheme: 0.5 g twice a day for 10 days, then 1 g twice a day for 20 days. As a result, the level of lead in the blood of children in this group decreased: (62.64±5.73) μg/l, compared to the initial value (75.55±1.99) μg/l. Cognitive indicators also improved: the number of correctly reproduced images significantly increased and the time to switch attention decreased, compared to the indicators before taking microalgal drugs.

Conclusions. Spirulina has a neuroprotective effect in children with chronic lead intoxication. The analysis of variance confirmed this conclusion: the score on the number of correctly reproduced images according to criterion F was 4.58. The effect on the time of switching attention according to criterion F was 8.58.

No conflict of interests was declared by the authors.

Peculiarities of Kawasaki disease in pre-COVID-19 period

2024-10-13T07:04:13+03:00

Kawasaki disease (KD) is one of the most common causes of fevers of unknown origin and acquired heart defects in children under five years of age. Currently, there are no specific laboratory tests for the diagnosis of KD, so it is established on the basis of clinical data.

Aim - to determine the clinical, laboratory and instrumental features of KD in the pre-modern period in order to optimize treatment.

Materials and methods. Retrospective review of medical histories of 8 children with KD aged 6 months to 5 years (boys - 4, girls - 4). The diagnosis was verified according to the criteria of the American Heart Association, which were approved by the EULAR/PreS Consensus in 2017. Objective and laboratory parameters were examined.

Results. According to the results of the main clinical criteria of KD, febrile fever for more than 5 days, bilateral conjunctival injection without exudation and oropharyngeal changes were observed in all the examined (100%). According to the results of laboratory tests, 100% of the examined had thrombocytosis, 87.5% - anemia, 75.0% - neutrophilic leukocytosis and increased in the erythrocyte sedimentation rate. According to the echocardiological examination of the heart, 100% of the children had signs of dilatation of the heart cavities. Aneurysm of coronary arteries was diagnosed in 37.5% of the examined.

Conclusions. The time of diagnosis of KD determines the therapy and prognosis of the disease. The peculiarities of the course of KD are the cyclic nature and symptoms inherent in many other diseases, which complicates timely diagnosis, leads to the delay of therapy, prolonged hospitalization of patients and worsening of the prognosis.

The study was carried out according to the principles of the Declaration of Helsinki. The study protocol was accepted by the Local Ethical Committee of these institutions. The informed consent of the children's parents was obtained for the research.

The authors declare no conflict of interest.

The role of adenosine monophosphate-activated protein kinase and serum amyloid A proteins in the early diagnosis of neonatal sepsis

2024-10-13T07:24:43+03:00

Neonatal sepsis is a leading cause of mortality among newborns globally, with an incidence of 1 per 1,000 live births. Current diagnostic markers such as C-reactive protein (CRP) and procalcitonin (PCT) lack specificity and sensitivity for early diagnosis, highlighting the need for more reliable biomarkers.

The aim of the study is to evaluate the role of adenosine monophosphate-activated protein kinase (AMPK) and serum amyloid A (SAA) proteins as potential biomarkers for the early diagnosis of sepsis in neonates suspected of having the condition.

Materials and methods. A cohort study was conducted involving 143 newborns suspected of sepsis, admitted to the intensive care units within the first 24 hours of life. Clinical evaluations included respiratory distress assessment, chest and abdominal imaging, and brain ultrasound. Blood samples were analyzed for CRP, PCT, AMPK, and SAA levels using enzyme-linked immunosorbent assay (ELISA) kits. Statistical analysis involved Mann-Whitney and independent samples t-tests, as well as receiver operating characteristic (ROC) analysis to determine diagnostic cutoff levels. The nonparametric Spearman rank correlation test (r - the Spearman rank-order correlation coefficient) was used. Differences at p˂0.05 were considered reliable.

Results. Inflammatory markers CRP and PCT were used to confirm sepsis diagnosis in conjunction with clinical assessment. However, 12.8% of infants with PCT >2 ng/mL and 17.5% with CRP >5 mg/mL did not have confirmed sepsis. Conversely, sepsis was confirmed in 63.6% of infants with PCT <2 ng/mL and 53.7% with CRP <5 mg/mL. A significant correlation between AMPK and SAA was observed in 111 infants (r=0.192, p=0.044). The ROC analysis indicated that AMPK and SAA levels below specific thresholds were significant for excluding sepsis.

Conclusion. AMPK and AA levels are promising diagnostic markers for neonatal sepsis, warranting further investigation in larger studies. These biomarkers can improve early diagnosis and reduce unnecessary antibiotic usage, thus improving neonatal outcomes.

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

No conflict of interests was declared by the authors.

Vitamin D status in children with idiopathic stunting

2024-10-13T07:42:42+03:00

Short stature is considered idiopathic in the absence of systemic, endocrine, nutritional, or genetic abnormalities and is defined as growth below two standard deviations of the mean for age, sex, and population.

Aim - analysis of laboratory and auxological indicators and levels of vitamin D in children with idiopathic short stature (ISS) depending on gender to improve the diagnosis of this pathology.

Materials and methods. Thirty-five children with ISS were examined. The following were taken into account: the patient's gender and age, anthropometric data, the blood level of vitamin D, bone age, the level of growth hormone (GH) after stimulation tests (clonidine, insulin), levels of insulin-like growth factor 1 (IGF-1), serum level of total and ionized calcium.

Results. In boys with ISS with an existing vitamin D deficiency basal level of GH was low and 1.7 times lower than in girls with the corresponding deficiency. In the insulin-test, an increase in GH levels was observed in both sexes to normal levels, but in girls, the GH level was 1.6 times higher compared to boys. Showed that regardless of the vitamin D, this indicator was within the normal range. In children with vitamin D deficiency its levels were slightly higher in boys than in girls, but not significantly. In conditions of vitamin D deficiency, a lower level of vitamin D was lower in girls than in boys.

Conclusions. Boys were found to have a low level of vitamin D in blood serum (85.7%), while its deficiency occurred in 46.4% and insufficiency in 39.3%. Girls have a low level of vitamin D occurred in 100% of them, mostly vitamin D deficiency was observed (57.1%), vitamin D deficiency was present in 42.9% of girls with ISS. In children with ISS and hypovitaminosis D, no abnormalities were found in a number of biochemical indicators - creatinine, urea, cholesterol, calcium (total and ionized) and phosphorus in the blood.

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. It was found that most of the studied patients had a low level of vit. D, which may be a prerequisite for a standard recommendation to determine this vitamin in children with ISS.

No conflict of interests was declared by the author.

Necrotizing enterocolitis in premature infants: the importance of risk factors in its development

2024-10-13T07:51:22+03:00

Aim: to investigate the relationship between different risk factors and the neonatal development of necrotizing enterocolitis (NEC).

Material and methods. A prospective retrospective case-control study of premature infants with suspected of NEC in 2020-2021 was conducted. A total of 88 cases of preterm neonates with suspected NEC and 30 preterm neonates in the control group were identified and analyzed. NEC diagnosis was performed in 29 (32.5%) infants. The collected variables included pregnancy- and maternal-related risk factors, physical developmental indicators of infants, Apgar score, mechanical ventilation, mode and type of delivery, sex of infants. Statistical processing of indicators was carried out in the Windows SPSS20 system. Differences at p˂0.05 were considered reliable.

Results. A relationship between the number of pregnancies and NEC in preterm infants was found. The birth of a newborn from the 3rd-4th pregnancy increased the risk of NEC development (p=0.001). In babies whose diagnosis of NEC is not confirmed, the height was 38.9±0.5 sm (min 30, max 47); with a confirmed diagnosis of NEC, it was 41.2±0.7 cm (min 34, max 48) (p=0.019).

Conclusions. The factors recognized by this case-control study that increased the risk of neonatal NEC contained heterogeneity. There were no significant differences in terms of other maternal, pregnancy and neonatal risk factors in the development of NEC.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Ethics Committee of Azerbaijan Medical University. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Macrophage activation syndrome in a patient with systemic juvenile idiopathic arthritis and down syndrome

2024-10-14T23:20:26+03:00

Down syndrome is a genetic mutation characterized by a trisomy of chromosome 21. In most cases, the syndrome is combined with other congenital defects of organs and systems, in this category of patients there is an increased risk of developing autoimmune disorders. Macrophage activation syndrome (MАS) is a potentially fatal disease caused by overactivation of macrophages and T- lymphocytes, leading to a systemic inflammatory response. A trigger for the development of MАS can be any infection, prescription of medication or drug replacement. The main clinical symptoms of this syndrome are fever, hepatosplenomegaly, lymphadenopathy, marked cytopenia, and coagulopathy. Clinical manifestations can be signs of the main disease and the onset of MАS. Diagnosis of MАS is difficult due to the lack of clear classical diagnostic criteria, especially in patients with systemic diseases. Additional laboratory findings in MАS include elevated serum triglycerides, lactate dehydrogenase, and ferritin. Timely diagnosis and early therapeutic intervention are the key to preventing the activation of the syndrome.

Aim - to present a clinical case of a patient with Down syndrome in whom the treatment of systemic idiopathic arthritis was the development of MАS, which caused difficulties in diagnosis in the early stages of the syndrome's manifestation and its atypical course.

Clinical case. An 8-year-old girl with Down syndrome and systemic idiopathic arthritis periodically fevered to febrile numbers, had a rash on the body and limbs, blood tests showed thrombocytopenia, increased levels of ferritin and aspartate aminotransferase, which indicated the development of MАS against the background of immunosuppressive therapy.

Conclusions. The article describes a case of a child with Down syndrome and systemic idiopathic arthritis, the treatment of the latter was complicated by the development of MАS, which had atypical clinical manifestations and laboratory parameters. The clinical case described above is an example of a long-term diagnostic search that delayed the appointment of treatment.

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.

A clinical case of a complicated form of pneumonia in a child after COVID-19

2024-10-14T23:43:53+03:00

Aim - on the basis of the clinical evaluation of the main symptoms of the clinical case, present the diagnostic features of a complicated form of pneumonia in an older child after COVID-19.

Clinical case. A clinical case of a complicated form of pneumonia in a child after COVID-19 is described. It is known that a 10-year-old boy became acutely ill due to the appearance of pain in the chest and abdomen. He was hospitalized in severe condition. The pain syndrome in the chest was strongly expressed and paroxysmal in nature, mainly localized in the region of 3, 4, 5 ribs. At the same time, the boy was in a forced position - on the right side with bent legs. The pain was so intense that the child became pale and the skin of the forehead was covered with sweat.

Conclusions. Organs of the respiratory system are most often affected in patients with COVID-19, wich is characterized by persistent respiratory symptoms after an acute illness of COVID-19. It should be noted that the list of clinical signs and symptoms is not specific for the diagnosis of community-acquired pneumonia, which complicates the primary diagnosis and requires the inclusion of additional diagnostic methods in the list of the methods of examination. The detection of acute phase parameters should be considered as an addition to the blood count, especially for patients as a subject to hospitalization. These parameters are a useful tool for making a diagnosis, and also can be useful for controlling the course of the disease and treatment. Chest radiography is considered a routine method for diagnosing diseases of the respiratory system, but ultrasound examination of the lungs is a more sensitive and save imaging method, especially for the examination of the pediatric patients with parapneumonic pleural effusion to determine the presents and characteristics of the fluid in the pleural cavity, and further monitoring of the child's condition. The assessment of the probability of COVID-19 according to the CO-RADS classification is carried out based on the results of computer tomography in the case when the patient has an indication for carrying out this method of examination, but it is not used for the primary diagnosis of respiratory system diseases.

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 interests was declared by the authors.

Late onset of familial haemophagocytic lymphohistiocytosis 2 associated with heterozygous PRF1 mutation: challenges in diagnosis and treatment

2024-10-14T23:59:14+03:00

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition caused by immune overactivation. Familial HLH (f-HLH), such as f-HLH 2, is associated with mutations in the PRF1 gene, essential for ruling out secondary HLH.

Aim - to describe a clinical case of late onset f-HLH 2 associated with a heterozygous mutation in the PRF1 gene in a 13-year-old boy.

Case report. A 13-year-old boy presented with fever, nausea, vomiting, abdominal pain, and jaundice. Examination revealed hepatosplenomegaly, elevated liver enzymes, hyperbilirubinemia, hypertriglyceridemia, hypofibrinogenemia, hyperferritinemia, and reduced NK-cells and T-lymphocytes. Cytomegalovirus (CMV) was detected by polymerase chain reaction. Pancytopenia soon developed. Bone marrow biopsy confirmed hemophagocytosis, leading to a diagnosis of secondary HLH associated with CMV. Treatment included intravenous immunoglobulin, HLH 2004 protocol (without etoposide), and ganciclovir, with initial improvement. However, cytopenia recurred after dexamethasone was stopped. Ruxolitinib was introduced alongside cyclosporine (CsA), leading to normalisation of liver function, spleen size, lymphocyte subpopulations, and haemogram. Cytopenia returned after ruxolitinib cessation. Whole-exome sequencing revealed a heterozygous PRF1 gene mutation, confirming the diagnosis of f-HLH 2.

Conclusions. Timely laboratory diagnostics, bone marrow biopsy, genetic testing, and appropriate treatment are critical in preventing complications and improving outcomes in HLH. Early intervention with specific therapies, such as immunosuppressants and genetic evaluation, is essential in managing f-HLH 2.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The informed consent of the child's parents was obtained for the study.

The authors declare no conflict of interest.

Subungual exostosis of fingers in pediatric practice: clinic, diagnosis, treatment

2024-10-15T00:30:22+03:00

Subungual exostosis is a fairly rare benign cartilaginous tumor with bone-cartilaginous proliferation affecting the distal phalanges of the toes (more often the first toe (80%) or the hand, which is characterized by long growth. The presence of subungual exostosis significantly worsens the quality of life of patients due to a serious impact on wearing footwear, walking, and daily behavior The etiology and pathogenesis of subungual exostosis are not clearly defined, but the risk factors for the occurrence of pathology traditionally include traumatic injuries (reactive metaplasia), chronic infections, tumors, hereditary abnormalities, and cartilage cyst activation.

The aim is to highlight the peculiarities of the methods of diagnosis and treatment of the pathology of exostoses of the fingers in pediatric practice based on literature sources and own experience.

The described clinical case with exostosis of the first toe demonstratesa typical clinical picture of an exostosis with a typical histological structure. Radical solution to the problem of bone volume formation, which provoked a pain syndrome, with the imposition of separate nodal sutures on the wound, in our opinion, significantly shortens the wound healing period and creates a good cosmetic effect.

Conclusions. In contrast to clinical complaints, X-ray signs of subungual exostosis have inconspicuous data due to the presence of a distinct X-ray contrast layer in the form of a peculiar "cap". In order to detail the pathological formation, computer tomography scan or magnetic resonance imaging is sometimes recommended. Differential diagnosis of subungual exostosis is carried out with pyogenic granuloma, subungual viral wart, ingrown toenail, glomus tumor, Kenen's tumor (angiofibroma), keratoacanthoma, nail bed cancer, amelanotic tumor, melanoma, osteochondroma, which is covered with hyaline cartilage in contrast to subungual exostosis, for which inherent fibrocartilaginous coating, hemangiolymphangioma and glomus angioma (Barre-Masson tumor), Nora's disease, etc. Conservative treatment is ineffective. Surgical excision of subungual exostosis is today considered the method of choice and may be accompanied by reconstruction of the nail bed. The success rate of surgical resection is more than 95%, with a 5% recurrence rate.

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 interests was declared by the authors.