Introduction. Serum concentrations of collagens I, III, IV types (K-I, K-III, K-IV) and hyaluronic acid (HA) are reported to be informative in terms of noninvasive diagnosis liver fibrosis stages. In pediatrics, there is not enough data on this. Purpose was to assess the diagnostic value of direct biomarkers in predicting the stage of fibrosis in children with chronic liver diseases (CLD).

Materials and methods. A prospective single-center study included 80 children with CLD . All patients underwent marginal resection of liver tissue under laparoscopic control. The serum  K-I, K-IV, and HA concentration were measured by enzyme immunoassay. The authors applied ROC curve analysis to assess quantitative signs’ diagnostic significance in predicting a specific outcome.

Results.The optimal KI value for the diagnosis of cirrhosis was 144.24 ng/ml, with AUROC: 0.758 ± 0.101 with 95% CI: 0.560–0.957, sensitivity and specificity 65.2% and 77.8%, respectively. The optimal K-IV values for the diagnosis of moderate fibrosis and cirrhosis were 11.29 ng/ml and 27.40 ng/ml, respectively, with AUROC 0.807 ± 0.092 with 95% CI: 0.627–0.987, 0.685 ± 0.062 with 95% CI: 0.567–0.810, sensitivity 82.4% and 61.15%, specificity 66.7%, and 64.7%, respectively. The optimal BG values for the diagnosis of weak and moderate fibrosis were 34.9 ng/ml and 36.5 ng/ml, for cirrhosis 38.3 ng/ml, with AUROC 0.912 ± 0.050 with 95% CI: 0.815–1.00; 0.849 ± 0.064 with 95% CI: 0.723–0.974, and 0.825 ± 0.048 with 95% CI: 0.730–0.920, respectively. Sensitivity was 84.6% at all stages, specificity — 77.8%, 61.5% and 70.6%, respectively.

Conclusions. LF biomarkers have diagnostic significance in the detection of the stages of liver fibrosis. LF biomarkers are informative, reproducible noninvasive indices in the diagnosis of liver fibrosis in children.

Contribution:
Kulebina E.A., Surkov A.N., Potapov A.S. — research concept and design;
Kulebina E.A., Surkov A.N. — collection and processing of material;
Kulebina E.A., Surkov A.N. — statistical processing;
Kulebina E.A., Surkov A.N., Alyabeva N.M., Zubkova I.V., Zhuzhula A.A. — text writing;
Fisenko A.P., Potapov A.S. — editing.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Informed consent: a written, voluntary, informed consent to participate in the study was obtained from the parents
of the patients.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: February 18, 2021
Accepted: February 22, 2021
Published: March 10, 2021

 

Timely diagnosis and monitoring of ulcerative colitis (UC) in children is extremely relevant. In recent years, much attention has been paid to improving noninvasive UC diagnosis methods, which are available and convenient in the practice of a doctor. In this regard, we analyzed the significance of changes in noninvasive laboratory parameters of sick children with different clinical and endoscopic UC activity.

Materials and methods. A prospective analysis of data of 80 patients diagnosed with UC at the age of 1 to 18 years with varying degrees of clinical and endoscopic activity of the disease was performed.

Results. Significant changes in the studied laboratory parameters’ levels were revealed depending on the degree of clinical and endoscopic UC activity in children. The changes in fecal calprotectin content, levels of albumin, hemoglobin, and platelets were particularly substantial and informative in the blood of sick children when comparing remission with moderate and high clinical and endoscopic UC activity. A decrease in platelet counts was also found when UC activity increased.

Conclusion. The studied laboratory parameters are informative noninvasive markers of UC activity in children. These indices can be used in the diagnosis of UC activity and monitoring of the course of the disease.

Contribution:
Tsvetkova V.S., Potapov A.S., Semikina E.L. — research concept and design;
Tsvetkova V.S., Anushenko A.O., Lokhmatov M.M., Kopyltsova E.A., Budkina T.N., Akulova S.S. — collection and processing of material;
Tsvetkova V.S., Semikina E.L., Surkov A.N. — statistical processing;
Tsvetkova V.S. — text writing;
Tsvetkova V.S., Fisenko A.P., Potapov A.S. — editing.
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: February 18, 2021
Accepted: February 22, 2021
Published: March 10, 2021

The aim of this work is to determine the causes of chest pain in children with combined pathology and to develop an examination algorithm for chest pain.

Materials and methods. Examined 20 children aged 7-18 years who consulted a pediatrician with pain complaints in the chest. To exclude the cardiac genesis of pain, all patients underwent electrocardiography and echocardiography; the rest of the examinations were prescribed, taking into account the anamnesis and clinical examination data.

Results. According to the examination results, most patients were found to have gastrointestinal tract pathology: gastroesophageal reflux disease, chronic gastritis, biliary tract dysfunction. Against the background of adherence to a diet and taking medications prescribed by a gastroenterologist, their pain syndrome subsided, which confirmed the noncardial genesis of thoracalgia. A clinical analysis of cases of combined (cardiac and non-cardiac) pathology was carried out, an algorithm for examining children with chest pain was presented.

Discussion. The causes of chest pain in children and the tactics of managing these patients are discussed, the clinical significance of the history and clinical examination data in drawing up a plan for the examination of such patients is determined.

Contribution:
Berezneva N.A., Stenina O.I. — concept and design of the study;
Berezneva N.A., Stenina O.I. — collection and processing of material;
Berezneva N.A. — text writing;
Uglitsky A.K. — editing.
All co-authors — approval of the final version of the article, responsibility for the integrity of all its parts.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: February 04, 2021
Accepted: February 22, 2021
Published: March 10, 2021

 

Aim of the study was assess both the effectiveness and safety of anesthetic management and optimizing postoperative anesthesia under conditions of multimodal anesthesia and analgesia during abdominal operations in children.

Patients and methods. The authors examined 58 children aged 1 to 17 years with abdominal operations (malformations, diseases, and abdominal organ injuries). To ensure anesthetic protection, patients underwent combined general anesthesia with propofol and fentanil (induction) with inhalation of sevoflurane + propofol intra venous (maintenance) in combination with epidural blockade with bupivacaine.

Results. According to surgical intervention, the arrangement of perioperative analgesic protection provided a favorable correction of the hemodynamic status of patients, a decrease in inhalation anesthetic, promoted a smooth course of the postoperative period, a long painless period, an excellent psychoemotional background, and rapid postoperative recovery.

Contribution.
Satvaldieva E.A., Fayziev O.Ya. — concept and design of the study;
Fayziev O.Ya., Yusupov A.S. — collection and processing of material;
Fayziev O.Ya. — text writing;
Satvaldieva E.A., Uglitsky A.K. — editing
All co-authors — approval of the final version of the article, responsibility for the integrity of all its parts.

Conflict of interest. The authors declare no conflict of interest.

Acknowledgment. The study had no sponsorship.

Received: February 10, 2021
Accepted: February 22, 2021
Published: March 10, 2021  

The aim of the study is to demonstrate a differentiated approach to recurrent cryptorchidism treatment.

Materials and methods. Over the past five years (since 2015), the staff of the Department of Pediatric Surgery of A.I. Evdokimov Moscow State University of Medicine and Dentistry, performed surgical treatment of 20 children aged 2–17 years with recurrent cryptorchidism (22 testicles). Relapse of cryptorchidism on one side was diagnosed in 18 patients. Two patients had a bilateral cryptorchidism recurrence, these children had a combined pathology in the form of Prader–Willi syndrome. In 3 children, surgical treatment at their place of residence was performed two or more times. As a preoperative preparation to increase the elasticity of blood vessels and to lengthen them, a course of human chorionic gonadotropin (hCG) hormone therapy was carried out according to the scheme. The exception was children over the age of 6–7 as administration of hCG at this age can provoke an earlier onset of puberty. Intraoperatively, in 15 children, the testicle was fixed in the scrotum according to the method of Shemaker, Herzen, and others. In 5 children with abdominal cryptorchidism, the testicle was not descended into the scrotum and was fixed in the inguinal canal due to a deficiency in the length of the spermatic cord (SC).

On examination, a testicle in the middle or lower third of the inguinal canal was found in 10 patients, at the root of the scrotum — in 7. In 5 patients, the testicle was not detected. The average period between the first and repeated surgery was 3 years (from 4 months to 8 years). Upon admission, all patients underwent a clinical examination, ultrasound examination of the inguinal canals, and a study of the hormonal profile if indicated.

Results. After revision of the inguinal canal, 17 testicles were successfully re-descended using the Shemaker technique. Of these, 16 testicles were fixed in the scrotum, 1 testicle — at the root of the scrotum. During the second operation, the vaginal process of the peritoneum was found in 7 children. Laparoscopically-assisted orchipexy was performed in 3 patients. Orchiectomy was performed in 5 cases due to testicular atrophy.

The duration of the surgery was 55–120 minutes. There was no intraoperative blood loss. In the long-term postoperative period (after a year or more), postoperative testicular atrophy was not detected.

Contribution:
Poddubny I.V., Fayzulin A.K., Fedorova E.V. — concept;
Fedorova E.V., Sytkov V.V., Khanov M.M. — collection and processing of material;
Fedorova E.V., Tolstov K.N., Sytkov V.V. — writing the text;
Poddubny I.V. Faizulin A.K., Kalinchenko N.Yu. — editing.
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: February 6, 2021
Accepted: February 22, 2021
Published: March 10, 2021

Prevention aims to create optimal conditions for the formation of children’s health, ensuring the protection of the child’s body from diseases. The goal is to identify priority problems in preventive work with preschool children in outpatient and polyclinic conditions. Materials and methods. Authors studied information from medical documents of 3-6 year children from the children’s polyclinics in Moscow, questionnaires of parents of children observed during 2017-2020. Preventive examinations cover 97.0% of children; a third of children have a chronic pathology. 68.1% of children passed dispensary examinations. 82.1% of children got vaccinated by age. The «Mother’s School» improves the medical literacy of parents. Conclusions. It is necessary to select a specific time for specialists during preventive examinations to intensify healthy lifestyle promotion among parents.

The article deals with bioethics’ problems in medical students’ training through the prism of the philosophy of education, which was formed in the middle of the XX century when the humanitarian-anthropological turn in philosophy was formed. The term “bioethics “was first used in 1970 by W.R. Potter, who proposed the concept of “bioethics” to refer to a complex interdisciplinary knowledge, the goal of which is the survival of humankind. As an independent discipline, bioethics is taught in the first years of the medical university. It is this course of bioethics in medical universities that can be called “propaedeutics of bioethics.” This is due to the fact theoretical bioethics to be studied in the context of philosophy, when the student is given the opportunity to adequately interpret philosophical abstractions in bioethics, and applied, often very acute and complex problems of bioethics are studied in the senior courses of the university and in the system of postgraduate education, when future doctors master medical bioethics in the courses of resuscitation, transplantology, medical genetics, psychiatry, etc. The professional knowledge and culture of the doctor were shown to be not identical to his humanism. In this regard, the need for the integration of humanitarian and clinical disciplines in Russian higher medical schools is emphasized. At the same time, numerous concepts and principles of bioethics serve as universal mechanisms for “fitting” modern man and his life world into the totality of life, which allows us to speak of bioethics as universal ethics.

The review examines the issues of dispensary observation, which is the most critical stage in care for patients with urinary tract infection (UTI). It includes periodic examination and preventive treatment of children after acute, recurrent and chronic UTI. The purpose of dispensary observation is the timely detection and/or prevention of complications and exacerbations of diseases, their prevention, effective rehabilitation of the urinary system after a previous infection at the outpatient stage. The schemes of antibacterial prophylaxis from the standpoint of Russian and foreign clinical guidelines are presented. The issues of primary and secondary prevention of UTI are discussed. The article considers the practical issues of dispensary observation of children with a previous UTI at the outpatient stage. The schemes of antibacterial prophylaxis from the standpoint of Russian and foreign clinical recommendations are presented. The issues of primary and secondary prevention of UTI are discussed.

Herlin-Werner-Vanderlich syndrome refers to the Müllerian duct anomalies, including uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. At the first stage of treatment, a reasonable intervention is opening the hemivaginal septum by extra-vaginal access under visual control or using vaginoscopy. We identified a rare variant of the defect identified, since the longitudinal septum of the hemivagina did not prolapse through the introinus, which required a complex diagnosis and surgical aid in the newborn. A significant volume of hydrometrocolpos was associated with the accumulation of urine from the right hypoplasmic kidney with an abnormal flow of the ectopic ureter into the cavity of the atresized vagina. It determined the need for surgical treatment for urgent indications. In this regard, a biochemical analysis of the fluid obtained after drainage of the hydrometrocolpos with the detection of the concentration of urea, creatinine, total protein, and cellular composition is mandatory.

Tubulopathy is accompanied by electrolyte imbalance due to impaired excretion of hydrogen ions (type I), impaired reabsorption of bicarbonates (type II), abnormal aldosterone production, or interaction with it (IV). The course can be asymptomatic or with manifestations of electrolyte disorders: weakness, nausea, bone deformities. Diagnosis of renal acidemia is based on measurements of urine pH and electrolytes, data from genetic tests. A clinical case of renal tubular acidosis (type III) in an infant. The article presents the clinical picture of renal tubular acidosis, its classification, and diagnostics in children. Authors consider the importance of applying modern research methods to conduct timely treatment and improve the patients’ lives.

In a brief outline of the activities of the outstanding domestic pediatrician A.A. Kisel, his unique contribution to medical education and the development of pediatrics is described. His connection with contemporary scientists is determined, the significance of scientific research publications is analyzed. There are discussed views of A.A. Kisel on general issues of pathology and therapy, his unique contribution to pediatric phthisiology and rheumatology.