STATE OF IMMUNITY IN PRESCHOOLERS WITH ACUTE RESPIRATORY VIRAL INFECTIONS ASSOCIATED WITH ADENOID VEGETATIONS

Introduction. Acute respiratory infections are the most common infectious diseases worldwide among children of different age groups. Materials and methods. 59 children between the ages of 3 and 7 participated in the study. The first group included 22 patients with an acute respiratory viral infection, the second one consisted of 23 patients with acute respiratory viral infections associated with adenoid vegetation, and 14 apparently healthy children were included in the control group. Immunology research was conducted during the acute period of the disease. Statistical processing of received data was done with the standard statistical software EZR 1.41. Results. After the research, most of the patients with acute respiratory viral infections were identified an actual increase in CD3+, CD4+, CD8+, CD22+- cells and IgA, IgM in the blood serum. Simultaneously, in patients with acute respiratory viral infections associated with adenoid vegetation during the acute period, the increase in total lymphocytes was identified due to CD4+, CD8+, CD22+ cells and IgG. A comparative analysis of the study results of both groups of patients showed that children from the second group had a significantly higher level of CD3+- cells, while the CD22+- lymphocytes, IgA, IgM and IgG were significantly lower from the similar indicators of the first group. Conclusions. The acute period of the disease in children with acute respiratory viral infections, associated with adenoid vegetation, had an imbalance in both the cell and the immune system's humoral component

Psychosomatic disorders (distress, depression, anxiety, somatization) in young patients who have had COVID-19

AIM: The mission is to assess possible psychosomatic disorders (in particular, stress as a nervous breakdown, an acute temporal phase of a specific disorder, which is manifested primarily by signs of depression and neurosis) in young patients who have had COVID-19, in the course of rehabilitation, to improve medical and psychological support after their discharge from the hospital. MATERIALS AND METHODS: 60 convalescents who have had COVID-19 and had practically been healthy before (men aged 19.87 1.64 years) were examined. The main clinical variants and manifestations of COVID-19 in our study were inapparent infection (II) in 19 cases (31.67%), acute respiratory viral infection (ARVI) in 21 cases (35.0%), pneumonia without respiratory failure (P) in 20 cases (33.33%). These are clinical variants and manifestations of mild-to-moderate of COVID-19 severity. The diagnosis of all clinical variants and manifestations of COVID-19, the patients examination, treatment and discharge from the hospital were carried out in accordance with regulatory documents. The patients were examined 68 month after discharge from the hospital. Psychometric examination of these individuals to separate their clinical manifestations of distress and somatization and manifestations of depression and anxiety was carried out according to the questionnaire The Four-Dimensional Symptom Questionnaire, 4DSQ), developed in 1996 by the Dutch specialists B. Terluin. This questionnaire was translation into Russian and adapted by A.B. Smulevich et al. [2014]. Voluntary informed consent was obtained from each of the patients before their participating the study. RESULTS: Indicators of distress, anxiety, somatization after all the clinical variants and manifestations of COVID-19 have a moderately increased level, which indicates a serious illness that has been suffered, in some cases with an unfavorable outcome. The strongly increased level of depression in our study is probably due to the presence of astheno-neurotic syndrome due to the previous COVID-19 disease. The data on the correlation between the scales of methods indicate the direction of possible psychoprophylactic work with convalescents. CONCLUSIONS: The results of the study showed that young patients without concomitant diseases who have had COVID-19, even with a mild and low-symptom course, may develop psychosomatic consequences such as distress, anxiety, somatization and some others. The reasons, duration, potential risk factors for their development require further study, however, timely developed preventive and therapeutic and diagnostic measures, taking into account the individual characteristics of the patient, can have a positive effect.

THE EFFECTIVENESS OF AGGREGATION OF THE DRUG DERINAT IN THE COMPLEX TREATMENT OF ARVI IN PRESCHOOL CHILDREN IN THE PRACTICE OF THE DISTRICT PEDIATRICIAN

Острые респираторные вирусные инфекции (ОРВИ) представляют собой серьезную проблему для общественного здравоохранения во всем мире, вызывая значительную заболеваемость и смертность среди людей всех возрастных групп. Дети заражаются в среднем в два-три раза чаще, чем взрослые. Целью исследования является оценка эффективности препарата Деринат в комплексном лечении острых респираторных вирусных инфекций у детей дошкольного возраста в условиях амбулаторно-поликлинического приема. В исследование были включены дети в возрасте от 3 до 7 лет (включительно) не являющиеся школьниками, с клиническим диагнозом острая респираторная вирусная инфекция (ОРВИ), с симптомами, проявляющимися не длительнее 48 часов, не подвергавшихся противовирусной и иммуномодулирующей терапией в течение 30 дней до текущего посещения врача. В результате проведенного исследования установлено, что комплексное лечение ОРВИ у детей дошкольного возраста с применением препарата Деринат с первого дня терапии позволяет устранить отдельные симптомы ОРВИ значительно быстрее и эффективнее, чем при стандартных схемах терапии: ринорея и заложенность носа купируется на 2 день терапии, а гиперемия ротоглотки и отечность миндалин - на 3 день. Назначение изучаемого препарата в комплексном лечении ОРВИ в 2,4 раза повышает «Индекс здоровья» у дошкольников по сравнению с показателем при стандартных схемах лечения Acute respiratory viral infections are a serious public health problem worldwide, causing significant morbidity and mortality among people of all age groups. Children are infected on average two to three times more often than adults. The aim of the study is to evaluate the effectiveness of the drug Derinat in the complex treatment of acute respiratory viral infections in preschool children in outpatient settings. The study included children aged 3 to 7 years (inclusive) who are not schoolchildren, with a clinical diagnosis of acute respiratory viral infection, with symptoms that manifest no longer than 48 hours, who were not subjected to antiviral and immunomodulatory therapy for 30 days before the current doctor's visit. As a result of the study, it was found that the complex treatment of acute respiratory viral infections in preschool children with the use of the drug Derinat from the first day of therapy can eliminate individual symptoms of ARVI much faster and more effectively than with standard therapy regimens: rhinorrhea and nasal congestion are stopped on day 2 of therapy, and oropharyngeal hyperemia and tonsillar edema - on day 3. The administration of the studied drug in the complex treatment of acute respiratory viral infections increases the "Health Index" in preschool children by 2.4 times compared to the indicator for standard treatment regimens

MEDICAL AND SOCIAL MONITORING OF INCIDENCE RATE OF ACUTE BRONCHITIS AND PNEUMONIA IN CHILDERN (BASED ON DATA FROM MICROBIOLOGICAL LABORATORY OF THE CITY OF HLUKHIV, SUMY REGION)

The article emphasizes on medical and social monitoring of the incidence of acute bronchitis and pneumonia in children and elucidates the peculiarities of the course of these diseases during the Covid-19 pandemic. It has been established that the main cause of acute respiratory viral infection (ARVI), including pneumonia and bronchitis, and other respiratory diseases, is an impairment of the mechanisms of specific and non-specific protection. In terms of prevalence, bronchitis and pneumonia occupy the first place among broncho-pulmonary diseases in children. Recurrent bronchitis occurs in children of different ages, but most often in the childhood period from 4 to 7 years. The highest number of hospitalized children with acute bronchitis and pneumonia was observed in the city of Hlukhiv and the Hlukhiv district, Sumy region, in 2019; the number of boys significantly exceeded the number of girls. The main cause for the decrease in the incidence and pathogenicity of SARS-CoV-2 infection in children is still remaining unclear. Although this decrease in incidence was attributed to reduced exposure and risk factors during the initial phase of a pandemic, it is now understood that biological factors that interfere with the pathogenesis of infection and the immune response may play a protective role in children compared to the more aggressive clinical manifestations seen in adults. The data obtained demonstrate the patients with acute bronchitis have different numbers of erythrocyte sedimentation rate (ESR). Some patients, 43 out of 64, have normal ESR values, within 4-12 mm / h (p <0.05). With an exacerbation of the process, an increase in ESR is noted in the range of 12-14 mm / h in 21 patients. We have found out acute pneumonia in children is associated with complex changes in blood parameters, and, in particularly, with neutrophilic leukocytosis, increased hemoglobin up to 170 ± 1.4 g / l, an accelerated ESR, a significant increase in platelets. The positive effect of physiotherapy exercises and massage can also improve the parameters of the peripheral blood in the children. Thus, these supportive measures maintain the general mechanisms of homeostasis.

Outpatient Management of Acute Respiratory Infections in Children

Background. Antimicrobial resistance is one of the most crucial problems in human health care worldwide. The main cause of this crisis is the excessive and misuse of antibacterial drugs (ADs). The highest rate of improper antibiotics' prescriptions in pediatric practice is observed at treatment of respiratory tract infections in outpatient clinics. Objective. The aim of the study is to analyze the clinical practice of management of patients with acute respiratory infections (ARI) and the use of ADs in children's outpatient clinics across the regions of Russian Federation. Methods. Multicenter retrospective study was conducted. All ARI cases documented in 969 medical records (form 112/y) of children born in 2015–2017 yy. in 16 regions of Russian Federation (selected randomly) were analyzed. Results. Acute viral infection was diagnosed in 79.6% cases of referencing to doctor with ARI symptoms. Systemic ADs were prescribed in 23% cases of ARI. Antibacterial therapy was received by 14% of children diagnosed with acute respiratory viral infection, 35% with acute laryngotracheitis, 80% with acute bronchitis, 76% with acute rhinosinusitis, 94% with ARI associated with otitis media, 52% with tonsillopharyngitis, and 100% with community-acquired pneumonia. Amoxicillin (35%), amoxicillin/clavulanic acid (24%), azithromycin (20.2%) were prescribed most often. Parenteral administration of ADs was prescribed in 3.9% of cases, mostly for children with community-acquired pneumonia. Prescribed antibacterial therapy was unreasonable in 84% of analyzed cases. Polypragmasy occurred in 50.5% of cases. Clinical protocols violations were mostly common for management of patients with laryngotracheitis and tonsillopharyngitis. Conclusion. There is favorable trend towards the decrease in ADs prescribing frequency in outpatient clinics for children with ARI. Thus, polypragmasy and irrational choice of antibacterial therapy frequency remains quite high.

Prospects for the drug use based on common ivy for bronchopulmonary pathology in childhood

Respiratory diseases persistently lead in the structure of general morbidity in both children and adolescents. Acute respiratory infections are the most common among them. Interest of pediatricians to phytotherapy is not accidental and is due to the fact that it has a mild therapeutic effect, enhances the effectiveness of complex therapy, has few side effects. Of particular interest are herbal remedies containing ivy extract (Hedera helix), the active ingredients are mainly found in ivy leaves, they are biologically active substances: Triterpene saponins, glycosides, also contain carbohydrates, essential oils, steroids, phenolcarboxylic acids, coumarins, flavonoids, carotenoids, tocopherols (vitamin E), B and C vitamins, tannins, phytoncides. Ivy preparations are prescribed as an expectorant in the treatment of infectious and inflammatory diseases of the upper and lower respiratory tract due to their proven multidirectional effects: secretolytic, mucolytic, bronchospasmolytic. They also have anti-inflammatory, reparative, antioxidant effects.This article presents a clinical example of an officinal ivy-based preparation used in the treatment of a 3.5 year old patient diagnosed with acute respiratory viral infection. Temperature increased to 38 °C, runny nose; on the second day of illness the temperature remained subfebrile and a dry cough appeared. Nasal vasoconstrictor drops and oral acetylcysteine were prescribed, but there was no relief. On the third day of the illness, against the background of subfebrile temperature, the cough persisted, single dry rales were heard in the lungs, wheezing appeared during physical exertion. Acetylcysteine was withdrawn and replaced by ivy-based drops (16 drops 3 times a day orally after meals in a small amount of water). After 2 days the cough was moist, the sputum was easily expectorated, the wheezing in the lungs was almost gone, there was no more wheezing and the temperature was normal. By the sixth day of treatment the cough was gone and the girl had almost recovered. Nevertheless, Gedelix was continued for another 4 days. Prospective results and detailed study of the effects of herbal preparations on the basis of ivy extracts served as the basis for their recommendation as a complex therapy of cough in children.

The Role of Otoscopy in the Diagnosis of Rare Diseases in Pediatrics. Congenital Middle Ear Cholesteatoma in the Child: Clinical Case

The clinical recommendations “Acute respiratory viral infection (ARVI) in children" indicate that otoscopy should be a part of routine pediatric examination of each patient along with auscultation, percussion, etc. Nowadays, there are no legal regulations on which specialists can perform otoscopy. Thus, there is significant pediatricians’ interest in otoscopy, especially in diagnosis of acute otitis media (AOM) during primary examination for timely antibacterial management. Moreover, pediatricians could reveal such rare and very aggressive middle ear disease as cholesteatoma, its early diagnosis can prevent the development of any complications and determines the range and quality of rehabilitation actions.

Dietary Management of the Coronavirus Disease (COVID-19)

The article considers a vital problem, i. e. the role of nutrition in coronavirus disease (COVID-19). The author compares the diet therapy of acute respiratory viral infection and the flu as well as COVID-19. Special attention is drawn to dietary management of COVID-19, namely, the impact of the diet therapy on the risks of contracting and morbidity of coronavirus disease; the role of macro- and micronutrients in shaping the immune status of a person; the relationship between the nutritional status, body composition and possible outcomes of COVID-19. The paper accentuates a special part of balanced nutrition and dieting as prevention of COVID-19.