Pediatrics. Consilium Medicum

A literature review based on the analysis of data published in the open press or available in electronic form on the official websites of international and national professional medical communities, as well as government regulatory bodies, is devoted to the issues of influenza immunization in the context of the COVID-19 pandemic and the start of vaccination against coronavirus infection caused by the SARS-CoV-2 virus. It is emphasized that influenza vaccinations significantly reduce the incidence and frequency of severe forms of influenza infection, which is accompanied by a decrease in the burden on the healthcare system and the preservation of reserves to combat the COVID-19 pandemic. Preliminary data are presented on the positive impact of influenza immunization on the incidence, severity and outcome of COVID-19, especially in people over the age of 65. Changes were noted in the National Immunization Schedule aimed at increasing coverage with influenza vaccinations, as well as at the start of vaccination against coronavirus infection caused by the SARS-CoV-2 virus, with the allocation of priority populations for priority immunization.

The current epidemic season is characterized by a high incidence of acute respiratory viral infections and a new coronavirus infection among children. A significant part of children suffer from respiratory infections in mild and moderately severe forms, and only need symptomatic therapy, which includes antipyretic therapy. Both with a banal respiratory infection, and with COVID-19, ibuprofen and paracetamol can be used.

Relevance. Topical antimicrobial agents (TAAs) have been used for many years to treat infections of various organs and systems, acting directly at the site of inflammation and providing a high local concentration in the absence of side/undesirable effects often associated with the use of systemic antibacterial agents. TAAs are included in the clinical guidelines of professional medical communities not only in combination with systemic antibacterial agents, but also as an alternative method of treatment (especially in otorhinolaryngology).

Aim. To evaluate the clinical efficacy of a solution for intranasal use based on framycetin of Russian (Tramicent^®) and foreign (Isofra^®) production in the complex therapy of patients with rhinopharyngitis and rhinosinusitis.

Materials and methods. The study included children aged 3 to 9 years who applied for an outpatient appointment with an otorhinolaryngologist for nasal congestion and/or discharge and did not require hospitalization for the underlying disease. All patients were prescribed treatment: sea water solutions for irrigation of the nasal mucosa in combination with intranasal TAA framycetin: Russian-made framycetin was used in children of group 1 (Tramicent^®), in children of group 2 – foreign production (Isofra^®). 7 days after the initial examination, the state of nasal breathing, rhinoscopic picture, dynamics of disease symptoms and satisfaction with the treatment of parents/legal representatives were assessed.

Results. The study included 61 patients aged 3 to 9 years (31 boys and 30 girls) with diagnoses of rhinopharyngitis (68%) and rhinosinusitis (32%). Comparison of the evaluated symptoms in patients on day 0 and day 7 showed that both drugs had a positive therapeutic effect: a statistically significant difference was noted in both groups for all studied symptoms on day 0 versus day 7 (p<0.05). Patients and/or their parents/legal representatives subjectively assessed the effectiveness of treatment with both drugs as “satisfied” and “very (very) satisfied”, no statistically significant difference was found (p=0.1987).

Discussion. The use of a Russian drug based on framycetin, in comparison with its foreign analogue, showed comparable clinical efficacy for all indicators evaluated in this study, with the exception of the symptom «nasal cavity edema». Subjective assessment of the treatment performed by parents/legal representatives of children also did not reveal a statistically significant difference in the use of framycetin produced in Russia and abroad (p=0.1987).

Conclusion. A Russian-made drug based on framycetin is not inferior in clinical efficacy to a foreign analogue, it is safe and can be used in treatment regimens for infectious and inflammatory pathologies of the nasal cavity and nasopharynx in children aged 3 to 9 years.

We analyzed the changes in LVMI depending on the BMI and the body composition of the body in children 10–17 years of age.

Materials and methods. 112 children were examined: 60 obese children, 26 with overweight and 26 patients in the control group. All the children underwent anthropometry with the calculation of BMI, evaluation of the body composition of the body according to bioimpedance analysis, echocardiography with calculation of LVM and LVMI and detection of arterial hypertension according to the data of daily monitoring of arterial pressure.

Results. Children with obesity had large sizes of LV, LVM and LVMI. Arterial hypertension was noted in 60.2% of cases among patients with excess body weight, but significant differences in LVMI in children with and without arterial hypertension were not received. In children with increasing body weight there is an increase in all body components, especially fat mass. With an increase in body weight, the increase in LVM occurs to a greater extent than the increase in active cell mass (reflects the development of LV hypertrophy in obesity). When analyzing the proportions between the LVM and the body components, it is seen that with the development of obesity, LVM in relation to the active cell mass, extracellular and intracellular water sectors increases, but in relation to fat mass significantly decreases.

Conclusion. The outstripping growth of LVM in relation to the active cell mass and intra- and extracellular water sectors and the «deficit» of LVM in relation to the fat mass were revealed. In children with obesity, there is no evidence of water retention and the development of left ventricular hypertrophy is not associated with an increase in volume loading, but is apparently due to non-hemodynamic factors.

Materials and methods. The data of 4 groups with patients from 4 to 14 years old were studied. Group 1: 22 patients (34 knees), with angular deformities about the knee. Group 2: 38 patients (38 knees) with leg length discrepancies. Group 3: 15 patients (27 knees) with knee flexion contracture and cerebral palsy. Patients of 1–3 groups were operated by guided growth. The reference group (40 patients, 60 knees) was formed to determine the normal knee extension values in children according to X-ray and goniometry data.

Results. The mean angle of deformity before and after surgical treatment in group 1 were: 15.3 and 1.6º; in group 3: 160 and 4º recurrence, respectively, (p<0.05). The mean leg length discrepancy before and after surgery in group 2 were: 30 and 8 mm (p<0.05). The mean correction rate in group 1 was 0.6º per month, in group 2 – 0.9 mm per month, in group 3 – 2.9º per month. The mean score on the Gillette FAQ in group 3 increased after surgical treatment from 3.63 to 4.13. In reference group the mean angle of passive extension was 5º recurrence with goniometry lying on back, and 15º recurrence on X-ray. The mean active extension in a standing position was 4º recurrence. Smaller values of the tibiofemoral angle with goniometry in the standing position and passive extension with X-ray and goniometry can serve as clinical and radiological criteria for knee flexion contracture.

Conclusion. Guided growth is an effective technique for correcting leg length discrepancy and angular deformities about the knee in children. Close outpatient observation allows to not only timely identify orthopedic pathology, but also to effectively correct it without major reconstructive operation.

Aim. To carry out a comparative analysis of approaches to the surgical correction of equinoplonal valgus deformity of the feet in children with infantile cerebral palsy.

Materials and methods. A retrospective clinical and radiological analysis of the results of surgical treatment of 109 patients (194 feet) with equinoplovalgus deformity of the feet was performed. The patients are divided into four groups according to the method of surgical correction and age periods. Tendon-muscle plastics: in study group 1a, 21 children 4–7 years old and 23 children 8–11 years old in group 1b. Osteoplastic surgery: 28 children 4–7 years old in study group 2a and 34 children in group 2b. The average age of the patients was 8.2±2.8 years. According to the neurological status, patients of I – III levels of motor development (according to the Gross Motor Function Classification System – GMFCS) with hemiparesis, diplegia and tetraparesis were examined. Comparative analysis was carried out with a reference group consisting of 40 children (71 feet) with exostotic chondrodysplasia or injury to the ligamentous apparatus of one foot at the age of 4–11 years without neurological pathology and foot deformities.

Results. A significant improvement in clinical and radiological parameters was determined in all study groups 14±2 months after surgical treatment in comparison with preoperative parameters. Most of the values approached the established reference intervals. Assessment 34±3 months after surgical treatment in study groups 1a and 1b showed a decrease in the studied clinical and radiological parameters. The results after 34±3 months in study groups 2a and 2b with performed osteoplastic interventions did not reveal significant differences from the parameters after 14±2 months. Such results indicate the preservation of early results of surgical treatment when using osteoplastic methods for correcting foot deformities in children 4–11 years old. The results obtained with the use of soft tissue surgical techniques in children 8–11 years old indicate a high recurrence rate in the long term.

Conclusion. The study of functional status parameters according to the Gillette Functional Assessment Questionnaire 22±4 months after surgery revealed an increase in functional status in 42.85% of children in group 1a and 71.43% in group 2a. In group 1b, an increase in functional status was noted in 30.45% of children, in group 2b – in 67.65% of children. In 4.33% of children of the primary school group, tendon-muscle plastic showed negative dynamics in the functional status. The data obtained in general indicate that there are great prospects for long-term correction of foot deformity by means of osteoplastic operations in comparison with surgery of soft tissue structures.