Visualization of osteochondral fragments in the cavity of the knee joint in case of patellar dislocation in children

The objective was to assess the capabilities of MRI and CT in visualizing free bone and cartilage fragments in the knee cavity after lateral dislocation of the patella. Materials and methods. CT and MRI were performed in 220 patients, including 127 girls and 93 boys aged 12 to 18 years (mean age 14.5 years), with acute lateral patellar dislocation. Results. Lateral dislocation of the patella in 25% of cases led to the appearance of osteochondral fragments. CT scan revealed and confirmed osteochondral fragments surgery in 55 people (100%), MRI scan - in 50 people (90%). The sites of the detachment of the osteochondral fragments were: a medial facet of the patella in 22 (38.8%), the outer edge of femur lateral condyle in 33 (58.2%), t patella and lateral condyle of the femur in 2 patients (3%). Free cartilage fragments not detected by CT were detected by MRI in 2 patients. Conclusion. Patellar dislocation is an injury that is likely to require surgery. The volume of osteochondral and soft tissue lesions can be established with the maximum degree of probability by MRI while detecting small osteochondral fragments is most reliable with CT. Combining these two observation methods provides the complete possible information about the extent of damage, which allows timely resolution of treatment tactics.

Vulvar Lichen Sclerosus et Atrophicus in girls

The review is devoted to diagnosing and treating lichen sclerosus (LS), a chronic inflammatory dermatosis with a predisposition to lesions of the anogenital region in girls. An essential role in the aetiology of this form of pathology is attributed to genetic mutations, injuries, infections and autoimmune diseases, and hormonal and local factors. The peak incidence is observed in 4-6 year girls, accounting for 7-15% of all cases of vulvar LS. The main goal of pharmacotherapy for vulvar LS is to relieve clinical symptoms and prevent scarring and adhesions. The authors analyzed international and domestic publications from 2017 to 2021. PubMed and Google Academy databases were used for the search, keywords: lichen sclerosus, girls. The retrospective and prospective cohort, randomized clinical trials, case series and literature reviews, and clinical guidelines were considered. Our review presents modern data on the diagnosis and treatment of SL in girls, which will be useful for both pediatric gynecologists and doctors of related specialties. The first symptoms of LS are usually nonspecific and are misdiagnosed by non-profile specialists. Some symptoms of LS may disappear spontaneously after menarche, and the course of the disease may be latent. This is why it is generally accepted that the epidemiology of LS is underestimated. Despite this, it can be assumed that the etiology and pathogenesis of LS is probably multifactorial. This review describes several leading etiological factors regarding the potential etiopathogenesis of vulvar LS in girls.

Clinical and functional features of the small circle of blood circulation in children with a new form of bronchopulmonary dysplasia

The aim of the work is to analyze the data of Echo-CG examination of premature infants who have formed and have not formed bronchopulmonary dysplasia (BPD) to determine the frequency of the formation of pulmonary hypertension (PH). Materials and methods. A total of 199 preterm infants treated in the Department of Pathology of Newborns were examined. The first group included moderate and severe BPD children (n = 117; 59%). The second group consisted of children without BPD within clearly decreed terms (n = 82; 41%). In each group, patients were divided into four subgroups by the gestational age at birth and the timing of the Echo-CG. Results. Only two (1.1%) patients out of 117 BPD children of the first group were diagnosed with pulmonary hypertension (PH). In 3 (2.5%) of 117 infants of the same group, enlargement of the right heart without PH was revealed. Out of 82 children without BPD, two patients had signs of right heart enlargement. PH was not diagnosed in any of the patients in this group. Discussion. To aggravate the efficiency of PH diagnosis, a number of indices of screening echocardiography seem to be increased by additional analysis of changes in the systolic eccentricity index (EI), as a reliable marker of PH in BPD children. Systolic IE should be integrated into screening in preterm infants for the diagnosis of PH. The use of Echo-CG data along with analysis of blood BNP or NT-proBNP blood content be also expanded. Optimizing the diagnosis of PH at the early stages of BPD is necessary to increase the efficacy of targeted therapy and reduce the risk of severe complications of BPD.

Original software package for psychophysiological and cognitive functions analysis of children

Psychometry plays an important role when determining the state of psychophysiological and cognitive functions in children of different ages. Goal. To deliver an original software package for a psychophysiological computer complex (PCC) “Psychomat” for implementing an online analysis of psychophysiological and cognitive functions in children of different ages. Materials and methods. One hundred eighty-four conditionally healthy school children aged 6 to 17 years were examined using a set of psychophysiological tests and original methods for evaluating higher mental functions (24 tests, 66 parameters). Results. An original software package as the computer psychophysiological complex “Psychomat” was elaborated. The norm base was determined. Also, the testing mechanism and scoring system in points for psychophysiological functions assessment were developed. Thus, it became possible to establish the patterns of cognitive and psychophysiological functions development at different ages. Conclusion. This newly created software package can be used as a test system for mass examination of children of different ages.

Diagnostic capabilities of magnetic susceptibility-weighted images in traumatic brain injury in children

Introduction. In MRI, the difference in sensitivity between tissues is used to obtain images weighted by the inhomogeneity of the magnetic field termed susceptibility-weighted imaging (SWI) and a high-resolution 3D radiofrequency gradient echo scan with full speed compensation is applied. The aim was to determine the features of lesions caused by traumatic brain injury in children using the SWI sequence. Materials and methods. 535 TBI children aged two months up to 18 years old (average age 9.58 ± 1.5) were studied. There were 325 boys (60.7%), 210 girls (39.3%). MRI was performed without and with intravenous contrast on a Phillips Achieva 3 T scanner with T1- and T2WI, 2D and 3D images, FLAIR, magnetic resonance angiography (TOF MRA), SWI, and DW/DTI, MRS and fMRI, SWI were used for visualization of DAI. Results. Patients included children with severe TBI - 178 (33.3%), moderate TBI - 172 (32.1%) and mild TBI - 185 (34.6%). Of the 535 injured children, 129 (24.1%) had MRI performed within the first 24 hours from the moment of injury, up to 48 hours - at 91 (17.0%), up to 72 hours - in 78 (14.6%) and up to 13 days - in 237 (44.3%). DAI foci at all degrees of TBI were detected in 422 (78.9%) children out of 535 children. Conclusion. SWI is a sensitive method for diagnosing brain lesions in TBI and significantly contributes to predicting outcomes in the early stages after trauma. The amount of brain lesions diagnosed by SWI correlates with the degree of injury according to the Glasgo Coma Scale. The study of the brain functional connections can inform about possible relationships between the localization of the SWI lesion and cognitive deficits, potentially providing an opportunity to use SWI in the hyperacute phase.

Nutritional factors in the pathogenesis and treatment of psoriasis in children

In the pathogenesis of the psoriatic disease, genetic and environmental factors play a significant role, and one of the most critical ecological influences is nutrition. At the same time, the influence of nutrition on the pathogenetic links of psoriasis is currently underestimated. The clinical guidelines for managing children and adults with psoriasis do not mention the need to consult a nutritionist and any dietary recommendations. The purpose of this literature review was to analyze current data on the role of various nutritional factors in the development of psoriatic disease, the pathogenesis of its complicated course, as well as the effectiveness of dietary interventions in the treatment of this category of patients. The analysis of sixty eight sources of literature has shown that dietary changes and the use of biologically active food supplements can have a specific effect on the complex therapy of the disease. The possibilities of diet therapy in patients with psoriasis and metabolic syndrome are also discussed. At the same time, it is evident that further research is needed to improve the evidence base for the effectiveness of nutritional methods in managing this category of patients, especially in paediatric-age patients.

Medical professional consultation for adolescents with deviations in health state as a professional trajectory into adulthood

The issues of adaptation and vocational guidance of children with disabilities during the transition from school to vocational training and employment are undoubtedly crucial for the socialization of children with various forms of chronic pathology. The aim of this work is to determine the possibilities of professional medical consultation (PMC) in the rehabilitation of adolescents with disabilities. Materials and methods. The issues of the history of the development of vocational guidance of children are considered. The personal experience of the medical professional consulting of 940 adolescents with various deviations in health conditions is presented. Results. The structure of diseases in adolescents who received professional advice was analyzed. Clinical examples of PMC of adolescents with various forms of pathology of the central nervous system, arterial hypertension and peptic ulcer disease are presented. The unfavourable factors of the working environment and the professions recommended for adolescents have been determined. The importance of the cooperating work of a doctor and a psychologist in the development of a professional trajectory for adolescents with various health deviations from risk groups is shown. Conclusion. The PMC of adolescents with deviations in health is one of the stages of medical, social and labour rehabilitation. It allows choosing a worthy profession and determining its successful implementation in adult life. The military-industrial complex for children is one of the critical areas of social paediatrics.

Risk factors for delayed speech development in children of early and preschool age

Speech is the most critical component of the neuropsychic development of a child. Over the past decade, an increase in the prevalence of delayed speech development (DSD) in children has been recorded worldwide. Timely diagnosis and correction of DSD at the early stages can lead to good results and minor violations of speech development in the future. Objective. To execute a comparative analysis of risk factors and the leading causes of the DSD development in children of early and preschool age in the Belgorod region from 2019 to 2021. Materials and methods. The analysis of 165 medical records of children examined and treated at the Belgorod Medical Center for the period from 2019 to 2021 was carried out. Results. DSD was found to be more common in children aged 1.5 to 3 years (79.5%), much less common in children over the age of 4 years (6.6%).DSD in boys (69.7%) occurs more than two times more common than girls (30.9%). The average age of mothers of DSD children ranged from 30 to 35 years. More than 50% of all DSD children are premature babies. All mothers of the examined patients had a complicated pregnancy and delivery in their history. Children living in the city (62.5%) had a 25% higher probability of DSD occurrence than children from rural areas (37.5%). According to the results of the study, lesions of the visual organs, residual and perinatal lesions of the central nervous system were the most common forms of pathology in DSD children. Conclusion. It is necessary to improve the early diagnosis and prevention of the DSD in children. Early detection of deviations in the child’s speech development will allow timely drug therapy and comprehensive systematic corrective work.

Vaccination against pneumococcal infections in children with chronic heart failure

In current conditions, the most effective method of preventing pneumococcal infections (PI) is vaccination, which can significantly reduce the incidence and mortality from pneumococcus and reduce the level of antibiotic resistance. The use of pneumococcal conjugate vaccines has reduced the incidence of invasive PIs in vaccinated children and unvaccinated populations. This is especially true for children with severe somatic pathology, including those with various forms of heart failure (HF). The data show that vaccination of sick HF children can be a clinically effective intervention to improve the treatment results of circulatory failure and improve patients’ quality of life. However, questions regarding the optimal timing of vaccination of sick children with heart failure, dose, frequency and strategies of vaccine introduction still need to be resolved. Data on the pathophysiology of cardioprotection provision during effective vaccination against PI, influenza and COVID-19 in cardiac pathology are summarized. The authors recommend providing conditions for effective vaccine prevention of PI in children with heart failure.

Dynamics of acute poisoning with narcotic and psychotropic drugs in children

Introduction. Acute poisoning of chemical aetiology in children and adolescents is a significant medical and social problem. The average overall assessment of the state of the drug situation in St. Petersburg by all criteria is: in 2018 - 3.6 (pre-crisis condition), in 2019 - 3.5 (pre-crisis), in 2020 - 3.3 (severe). The aim of this work is to analyze the structure of acute poisoning with narcotic and psychodysleptic drugs in children of St. Petersburg. Materials and methods. An analysis was carried out of 4256 cases of acute chemical poisoning in children (form No. 64) admitted to the acute poisoning department of N.F. Filatov St. Petersburg State Children Hospital from 2016 to 2018. Results. The total number of chemical aetiology poisonings was 1441 cases in 2016, 1,527 in 2017 and 1,288 in 2018. Poisoning with narcotic and psychodysleptic drugs was (of the total number of poisonings) in 2016 - 3.1%, in 2017 - 5.8% and 2018 - 4.9%. The top place among poisonings with toxic substances of this group are opiates, methadone, LSD, hashish. The maximum poisoning with psychotropic drugs is psychostimulants such as methamphetamine - 2.6%, amphetamine - 1.4%, ecstasy - 1.2%. There was a significant increase in acute poisoning with unspecified psychotropic drugs from 0.7% (2016) to 4.6% (2018). Conclusions. The obtained results of the study revealed a decrease in the total number of acute chemical poisoning by 18.9%. On the background of a reduction in the total number of poisonings, there is an increase in the frequency of poisoning with neurodestructive substances (methadone, hashish, LSD, benzodiazepine, amphetamine, methamphetamine and ecstasy). The most frequent cause of acute chemical intoxication in children is poisoning with psychotropic drugs.