ORIGINAL INVESTIGATIONS
Introduction. Inflammation and activation of the immune system are the main cause of secondary injuries in traumatic brain injury (TBI). Given the central role of nitric oxide (NO) in the neuronal Glu cascade with significant changes in the content of ATP in neurons, as well as the presence of GluRc NMDA-type in lymphocytes, it is relevant to determine the effect of NO on the lymphocytes’ adenosine triphosphate (ATP) content.
The aim of the work was to determine the effect of different concentrations of NO-generating compounds (NaNO2 and S-nitrosocysteine) on the content of intra- (hcATP) and extracellular ATP (ecATP) in human lymphocytes and to establish links between NO formed during TBI and the initiation of autoimmune processes in children with TBI of varying severity.
Materials and methods. Blood samples from 36 TBI children were used for analysis. Lymphocytes were isolated in a ficol gradient according to a standard procedure. The ATP concentration in the tris-acetate buffer (pH 7.76) was determined on a Lucy-1 luminometer using luciferin luciferase (Promega). The ATP concentration was expressed in nmol/mg of protein, which was determined by the Bradford method using Fluka kits.
Results. An increase in the level of ATP in lymphocytes immediately after TBI was found to be a positive factor reflecting the activation of lymphocytes. At the same time, a higher level of autontibodies (aAT) to GluRc immediately after severe TBI is a favourable sign for the TBI outcome and coincides with an increase in CGAP in lymphocytes. Prolonged negative trend in ATP content in lymphocytes with similar changes in serum ATP concentrations in severe TBI is an indicator of an unfavourable outcome of severe TBI in children.
Conclusion. A moderate increase in NO in the blood immediately after TBI contributes to an increase in CGAP in lymphocytes and aAT to GluRc, which activates the immune response and protects the brain from hypoxic damage.
Contribution:
Sorokina E.G., Reutov V.P., Semenova Zh.B. — the concept and design of the study;
Sorokina E.G., Karaseva O.V., Semenova Zh.B., Bakaeva Z.V., Pinelis V.G. — collection and processing of the material;
Sorokina E.G., Reutov V.P. — statistical processing and writing the text;
Smirnov I.E. — editing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.
Acknowledgment. The study had no sponsorship.
Conflict of interest. The authors declare no conflict of interest.
Received: May 31, 2024
Accepted: June 11, 2024
Published: July 12, 2024
The effect of carcinogenic factors such as bacterial invasion of Helicobacter pylori on the expression of CK20, CK7 cytokeratins and the distribution of CDX2 protein in the epithelium of the gastric mucosa (CO) and the pathophysiological significance of these processes have not yet been sufficiently studied. Aim: to determine changes in the distribution of CDX2 protein and the expression of cytokeratins CK20, K7 in the gastric mucosa in schoolchildren with Helicobacter pylori-associated gastritis. To evaluate the association between the expression of CDX2 and cytokeratins CK20, CK7 in the epithelium of the gastric mucosa in schoolchildren with gastritis under conditions of bacterial invasion by H. pylori.
Materials and methods. Esophagogastroduodenoscopy was performed with taking biopsies from the gastric mucosa in eighty nine 7–17 years children with gastroenterological complaints. The morphological method confirmed the diagnosis of gastritis and determined the presence of H. pylori infection. Biopsies were examined immunohistochemically to identify the proteins CDX2, CK20, CK7 in the gastric epithelium.
Results. A more pronounced expression of CK7 was noted in the body of the stomach with H. pylori-associated gastritis in 7–11 year schoolchildren, in comparison with those examined without H. pylori (p = 0.003) and with infected 12–17 years schoolchildren (p = 0.017). There were were revealed differences in the expression of CK20 in the antrum, which were absent in uninfected girls and were lower than in girls with bacterial invasion (p = 0.024). Also in girls with H. pylori and in the body of the stomach, CK7 expression was higher (p = 0.045). Among uninfected patients, there was an increase in CK20 expression in the antrum in boys compared to girls, and to greater extent, this concerned the older age group (p = 0.006). While the increased expression of CK7 in schoolchildren of the younger age group primarily affected girls infected with H. pylori in both parts of the stomach. In the body of the stomach, the highest level of CK7 was also observed in H. pylori-associated gastritis 7–11 years old girls (p = 0.004). The association of CDX2 with H. pylori invasion has not been established.
Conclusion. Thus, in schoolchildren with gastritis, there was detected an expression of CK20, CK7 and CDX2 in the epithelium of the gastric mucosa, with features of its severity and a close association with the gender and age characteristics of the child.
Contribution:
Vshivkov V.A., Polivanova T.V. — concept and design of the study, data collection and processing, editing the text;
Vshivkov V.A. — statistical processing of the data;
Polivanova T.V. — writing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.
Acknowledgment. The study had no sponsorship.
Conflict of interest. The authors declare no conflict of interest.
Received: May 06, 2024
Accepted: June 11, 2024
Published: July 12, 2024
Introduction. Hydronephrosis is a common form of kidney pathology in children. Despite the early diagnosis and optimistic results of surgical treatment of the obstruction of the pyelourethral segment, which reach 98% in children, a group of patients with recurrent hydronephrosis is forming, which requires the development of optimal tactics for its surgical treatment.
Aim: to determine the effectiveness of various methods of surgical treatment of recurrent hydronephrosis in children.
Materials and methods. Seventy one patient with recurrent hydronephrosis was observed in the Department of pediatric urology-andrology. The age of the patients ranged from 6 months to 17 years. In 36 patients of the main group, the treatment of recurrent hydronephrosis was carried out according to the author’s algorithm. In 35 patients of the comparison group, treatment was carried out using traditional methods before the introduction of the algorithm into practice.
Results. Recurrence of hydronephrosis in children was diagnosed within 1 to 28 months after initial surgical treatment for obstruction of the pyelourethral segment. The cause of recurrent hydronephrosis in 47 patients was stricture of the pelvic ureteral segment, an aberrant vessel was detected in 5 patients, and in 9 patients a pronounced bend of the ureter in the pyelourethral segment was determined due to compression by the lower pole of the kidney. A combination of several causes of recurrent hydronephrosis was noted in 10 patients. In patients with recurrent hydronephrosis, whose treatment was carried out according to the author’s algorithm, a less pronounced scarring process and a shorter length of ureteral stricture were revealed, as well as a shorter period of hospital stay than in patients treated without taking into account the developed algorithm. In patients treated according to the author’s algorithm, a positive result was achieved in 93%, and in patients of the comparison group — in 88% of cases.
Conclusion. To increase the effectiveness of surgical treatment of children with recurrent hydronephrosis, an integrated approach is needed, choosing the optimal tactics of surgical treatment.
Contribution:
Sharkov S.M., Lobach A.Yu. — concept and design of the study;
Lobach A.Yu., Surov R.V., Lazishvili M.N., Morozov K.D., Kovachich A.S., Kondratieva T.A. — collection and processing of the material;
Lobach A.Yu., Sharkov S.M. — writing the text;
Shmyrov O.S., Kulaev A.V. — editing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.
Acknowledgment. The study had no sponsorship.
Conflict of interest. The authors declare no conflict of interest.
Received: May 17, 2024
Accepted: June 11, 2024
Published: July 12, 2024
PUBLIC HEALTH, MANAGEMENT AND SOCIOLOGY OF HEALTH CARE, MEDICAL AND SOCIAL EXAMINATION
Introduction. In modern conditions, it is necessary to support breastfeeding and develop a set of measures for personalized optimization of a woman’s nutrition at all stages: from conception planning and pregnancy to the postpartum period and the entire period of breastfeeding.
The purpose of the work is to determine the effectiveness of using a set of measures aimed at promoting breastfeeding in the model of the updated form of the Federal project “Open Maternity Hospital”.
Materials and methods. In 2018, the Expert and Educational Center “Parents’ Choice” developed the Federal project “Open Maternity Hospital”, which included a set of managerial and methodological measures aimed at optimizing the nutrition of nursing women and the implementation of the Program for breastfeeding have been developed, tested and approved by specialists, both for consultants and for parents. In 2023, the Federal project “Open Maternity Hospital” has been significantly modified, expanded and updated its information base. By May 2024, 14 regions and one hundred thirty five maternity hospitals had joined the project. The updated version of the project included developed recommendations on the nutrition in lactating women and the promotion of breastfeeding.
Results. The analysis of data on the implementation of the updated project form showed the Federal project “Open Maternity Hospital” to open up new opportunities for the protection of maternal and infant health in various regions of the country as it creates conditions that favourably affect the increase in fertility in the region and provides personalized information work to identify the quality of medical care for women with disabilities. It is an additional means of formation a positive image of the medical institutions and the regional health authority; improves the conditions for the prevention of postpartum depression and other disorders in women after childbirth and during the first year of the infant life; improves the effectiveness of measures to optimize breastfeeding; improves parents’ awareness of safe and high-quality nutrition in infants; expands the possibilities of using the target audience of the project for operational sociological surveys.
Conclusion. The model of the updated form of the Federal project “Open Maternity Hospital”, developed on the initiative and with the direct participation of the author, is an accessible method in the regions for the active introduction into healthcare of a set of measures aimed at promoting breastfeeding, raising awareness of medical workers and nursing women to optimize breastfeeding and nutrition of women during breastfeeding. It serves as a modern means of expanding the communicative conditions for medical personnel, this is important for improving the quality of medical care to the population.
Acknowledgment. The study had no sponsorship.
Conflict of interest. The author declares no conflict of interest.
Received: May 22, 2024
Accepted: June 11, 2024
Published: July 12, 2024
Introduction. The infant mortality rates largely depend on the regional characteristics of medical care for infants over the first year of life. In various regions of the Russian Federation, the infant mortality rate and its trend are determined by the influence of social, climatic, geographical, ethnic, historical, cultural factors, as well as differences in infrastructure and quality of medical care for women of reproductive age and newborns.
The purpose of the work is to determine the possibilities of reducing the infant mortality in the Republic of Ingushetia.
Materials and methods. There were interviewed one hundred fifty two 23–67 years pediatricians with an average work experience of 16.5 ± 12.2 years, providing medical care to infants during the first year of life at various stages. The survey of doctors was conducted on the basis of medical institutions of the Republic of Ingushetia. The survey was conducted among doctors of the following specialties: 59.3% of pediatricians, 23.6% of obstetricians and gynecologists, 10.8% of neonatologists. 60.2% of the respondents worked in inpatient, 37.3% in outpatient clinics, and 2.5% in other medical institutions.
Results. The quality of medical care and activities has been established to prevent infant mortality owing to the improvement of medical, managerial and behavioural factors on the part of parents and medical institutions.
Conclusion. To effectively prevent infant mortality, investments are necessary at the stage of prevention of risk factors for sudden infant death, injuries, poisoning, and infectious diseases; at the stage of timely diagnosis — for injuries and poisoning, neoplasms, diseases of the endocrine system and blood pathology.
Contribution:
Fisenko A.P., Balaev M.Kh. — concept and design of the study;
Balaev M.Kh., Aprosimova S.I. — data acquisition and analysis, statistical processing;
Balaev M.Kh. – writing the text; Fisenko A.P. — editing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.
Acknowledgment. The study had no sponsorship.
Conflict of interest. The authors declare no conflict of interest.
Received: May 20, 2024
Accepted: June 11, 2024
Published: July 12, 2024
Introduction. From an early age, patients with cerebral palsy (CP) require long-term, individual rehabilitation assistance to maintain impaired functions, develop self-service, social activity, and improve the quality of life (QOL). Changes in the QOL indices make it possible to adequately and timely determine the effectiveness of the ongoing medical rehabilitation in CP patients. Aim: to determine the effectiveness of short-term and long-term rehabilitation programs for CP patients.
Materials and methods. One hundred nine 5 to 18 years CP patients were examined. Of these, the 1st group consisted of 34 children who were rehabilitated under a long-term comprehensive program within the framework of the First Step project. The 2nd group consisted of 75 CP patients underwent a single rehabilitation course for 28 days. The comparison group consisted of 115 conditionally healthy children of the same age. The leading criterion for evaluating the effectiveness of rehabilitation programs was the quality of life in patients, determined by questioning the legal representatives of patients using the Russian version of the Health Utilities Index (HUI) questionnaire for children from 5 to 12 years old, as well as the Proxy version for over 12 years children by self-assessment (HUI23S2RU.15Q, Self-version).
Results. The total quality of life in CP patients was found to be low compared with conditionally healthy children in such aspects as speech, the ability to move, fine motor skills, and cognitive development. When analyzing the trend in multi-attribute utilitarian indices (HUI3) of QOL in CP patients in the 1st and 2nd groups after 12 months. from the beginning of the first rehabilitation, significant positive changes in overall quality of life were determined in patients with cerebral palsy of the 1st group who received comprehensive rehabilitation compared with the level in patients of the 2nd group who underwent rehabilitation once. In CP patients from the 1st group, there was revealed a significant improvement in quality of life in the aspects of “Ability to move”, “Cognitive development” and “Pain”. The analysis of the cost-benefit data showed that the cost per 1 QALY in CP patients of the 2nd group rehabilitated under the short-term program is less. However, in patients with cerebral palsy from the 1st group, a higher usefulness (effectiveness) of a long-term rehabilitation program has been established.
Conclusion. A long-term comprehensive rehabilitation program for patients with cerebral palsy is effective and significantly improves the quality of life of sick children and their families.
Contribution:
Vinyarskaya I.V. — concept and design of the study, editing the text;
Golovina O.N. — collection and processing of material, writing the text;
Chernikov V.V. — statistical processing of the material.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.
Acknowledgment. The study had no sponsorship.
Conflict of interest. The authors declare no conflict of interest.
Received: May 15, 2024
Accepted: June 11, 2024
Published: July 12, 2024
REVIEWS
Introduction. Endometriosis is an estrogen–dependent disease characterized by the spread of endometrial-like tissue outside the uterine cavity. Symptoms of the disease appear after menarche, in adolescence. The symptoms of endometriosis often go unnoticed and underestimated in early age, which leads to a delay in the beginning of therapy and the progression of the disease. The difficulty of diagnosing of endometriosis in adolescents is determined not only by the specificity of the clinical picture, but also by the lack of generally accepted markers for detecting the disease, as well as the difficulty of identifying initial forms using imaging techniques such as ultrasound, MRI.
The purpose of this review is to identify the age-related features of endometriosis, especially in children and adolescents, to provide early diagnosis of the disease and timely initiation of the treatmen. Endometrial foci in adolescents look different from adults. As a rule, merging vesicular or papular, transparent, red and white lesions are more characteristic than black or blue ones for this age group. While in adult women, the foci of endometriosis are black with pronounced fibrosis. Histological examination after laparoscopic surgery remains the gold standard for confirming the diagnosis, although the results of these studies may not always correspond to each other. Microscopic examination reveals areas of fibrous, fatty, muscular tissue, hemorrhages, vessels, areas of calcification and infiltration by multinucleated leukocytes, as well as a combination of endosalpingiosis and endometriod-like tissues. Moreover, it is important to carry out differential diagnosis with chronic pelvic pain, as well as with abnormalities in development, pathologies of the gastrointestinal tract, adenomyosis.
Conclusion. Thus, endometriosis is an estrogen-dependent disease affecting more than 10% of women of reproductive age. However, often the symptoms of the disease go unnoticed in adolescence, which leads to the progression of the disease in the future in women. Timely diagnosis of endometriosis plays an important role in preventing the development of complications and eliminating infertility in the future.
Contribution:
Sibirskaya E.V., Adamyan L.V., Sharkov S.M. — the concept and design of the study;
Nakhapetyan E.D., Platonova E.V., Kurbatova K.S. — preparation of the material, writing the text;
Pivazyan L.G. — editing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.
Acknowledgment. The study had no sponsorship.
Conflict of interest. The authors declare no conflict of interest.
Received: April 30, 2024
Accepted: June 11, 2024
Published: July 12, 2024
Children with chronic neurological pathology are at risk for the development of severe infectious diseases, but despite this, there is a poor coverage of preventive vaccinations in this category of children worldwide. For modern vaccine preparations, the presence of severe neurological conditions is not a contraindication to administration. There are only two reasons why vaccination should be postponed or the vaccine drug should be replaced. These are contraindications for the administration of live vaccines to children receiving immunosuppressive therapy, and contraindications for whole-cell pertussis vaccines to children with progressive neurological disease and convulsive syndrome. Studies conducted in different countries of the world prove the good tolerability and safety of vaccination in children with severe neurological pathology. But the use of certain drugs in the treatment of the underlying disease may affect the immunogenicity and effectiveness of vaccination. Currently, there is no generally accepted tactic for vaccinating children with various severe neurological conditions. This fact, as well as outdated attitudes in doctors and parents about the connection of vaccination with the onset of diseases of the nervous system, further increases the number of unvaccinated children. Issues related to the optimal vaccination time for children with severe neurological pathology, the frequency and strategy of vaccine administration still need to be addressed. There is a need to create widely recognized vaccination guidelines for children with severe neurological diseases, considering the nature of the disease, its course, and the therapy received.
Contribution:
Galitskaya M.G., Makarova S.G. — concept and design of the study;
Galitskaya M.G., Abdullayeva L.M. — collection and processing of the material, writing the text;
Fisenko A.P., Makarova S.G. — editing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.
Acknowledgment. The study had no sponsorship.
Conflict of interest. The authors declare no conflict of interest.
Received: May 24, 2024
Accepted: June 11, 2024
Published: July 12, 2024
Functional gastrointestinal diseases, accompanied by prolonged abdominal pain, significantly affect on the patients’ quality of life, regardless of their age and gender. So far, the diagnosis of such disorders remains challenging. Currently there is no consensus on the type and number of tests to be performed, or on the age at which children should be examined. Chronic abdominal pain may mask functional gastrointestinal disorders as well as organic diseases of various organs and systems. The analysis of modern ideas about functional diseases of the digestive system, accompanied by abdominal pain, is carried out.
Contribution:
Zokirov N.Z., Alieva E.I., Krasnov A.V., Sytkov V.V. — concept and design of the study;
Krasnov A.V., Sytkov V.V., Potapova N.A. — collection and processing of the material;
Krasnov A.V., Sytkov V.V. — writing the text;
Zokirov N.Z., Sytkov V.V. — editing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.
Acknowledgment. The study had no sponsorship.
Conflict of interest. The authors declare no conflict of interest.
Received: May 20, 2024
Accepted: June 11, 2024
Published: July 12, 2024
CLINICAL CASE
Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease characterized by esophageal dysfunction due to prolonged eosinophilic infiltration of tissues. In recent years, there has been a tendency to increase the prevalence of EoE, which may lead to an increase in the detection of esophageal strictures in children.
Aim: to determine the clinical features of the phenotype of eosinophilic esophagitis with an outcome in stenosis in children.
Materials and methods. Seventy children diagnosed with EoE were examined, 9 (12.86%) of them had esophageal stenosis. The average age of the disease manifestation was 6.17 years. The analysis of a series of EoE cases with esophageal stenosis was carried out to describe the phenotype of the disease. At the same time, clinical characteristics of patients with EoE, data from laboratory and instrumental examination methods, including esophagogastroduodenoscopy with biopsy, were used.
Results. In the examined patients, the delay in the diagnosis of EoE averaged 3 years after the appearance of the first symptoms. Early manifestations of EOE in children are discomfort when swallowing and the need to grind food. The most common concomitant gastroenterological disease was gastroesophageal reflux (GER). All patients had food allergies, of which 55 (77.8%) were allergic to cow’s milk proteins (ACMP). Esophageal stenosis was more often local, in the lower or middle third. Inflammatory changes in the mucous membrane (MM) of the esophagus were detected in all patients; ring-type disorders were noted in 47 (66.7%) patients. The median of the maximum number of eosinophils in MM is 30 per 0.3 mm2. Subepithelial fibrosis was observed in 16 (22.2%) children. In 62 (88.9%) patients, esophageal stenosis was stopped against the background of conservative treatment.
Conclusion. Increasing awareness of EoE in children is necessary to reduce the time for diagnosis, timely treatment and reduce the risk of complications in the form of esophageal stenosis.
Contribution:
Makarova S.G., Lokhmatov M.M., Vyazankina S.S., Budkina T.N., Fisenko A.P., Alkhasov A.B., Potapov A.S. — concept and design studies;
Vyazankina S.S., Budkina T.N., Kulikov K.A., Ilansskaya M.V., Movsisyan G.B., Anushenko A.O., Oldakovsky V.I., Tupylenko A.V., Korolev G.A., Galimova A.A. — collection and processing of material;
Vyazankina S.S., Budkina T.N. — statistical processing of the material, writing the text;
Makarova S.G., Lokhmatov M.M., Ereshko O.A., Gordeeva I.G. — editing the text.
All co-authors have final approval of the article and are responsible for the integrity of all parts of the article.
Acknowledgment. The study had no sponsorship.
Conflict of interest. The authors declare no conflict of interest.
Received: June 04, 2024
Accepted: June 11, 2024
Published: July 12, 2024
IN MEMORY OF COLLEAGUE
ISSN 2413-2918 (Online)
