No 2 (2023)
Articles
Results of primary obstructive megaureter treatment using high-pressure balloon dilatation of ureterovesical junction in children
Abstract
Aim. To evaluate the age dependence of efficacy and safety in high-pressure balloon dilatation (HPBD) for primary obstructive megaureter (POM) in children under 2 years.
Materials and methods. From 2020 to 2022, we performed a single-center, unblinded study, with a total of 200 children, treated with HPBD for POM: 117 boys and 83 girls. Study included patients from 1 month to 2 years. The follow-up period was 1 year.
Results. In this series the overall treatment effectiveness was 92.5%. In 15 cases treatment was not effective and these children proceeded with ureteral reimplantation. We didn’t achieve positive treatment results in children older than 15 months and our statistical model was not significant for failed cases. Treatment failure we presumed to be due to hard to dilate severe stenosis and extreme length of the stenotic area.
Conclusion. In our study we found HPBD of uretero-vesical junction to be safe and effective method for treatment of primary obstructive megaureter in young children. The overall success rate was 92.5%. We recommend considering HPBD as the first line treatment for POM in young children. In failure cases we suggest to perform ureteral reimplantation.
188–192
Vitamin D supplementation in children with urinary tract infection
Abstract
Urinary tract infections (UTIs) are one of the most common bacterial infections in the global population. Vitamin D deficiency is also an urgent and common problem, and the high incidence of hypovitaminosis does not depend on age, sex, nationality, and geographical location. Along with the so-called "classical" effects of cholecalciferol, no less significant non-calcemic functions of cholecalciferol have been actively studied over the past two decades, particularly its effect on inflammation and its role in anti-infectious immunity. More and more data on the relationship between UTIs and vitamin D deficiency supports the possible use of cholecalciferol as an adjuvant to basic UTI therapy.
Aim. To analyze the vitamin D status in children with UTI compared to healthy ones.
Materials and methods. The study included 75 children from 1 month to 18 years with UTIs of various localization treated in a healthcare institution in Stavropol. The mean age of the study patients was 6.0±0.3 years. Vitamin D status was based on serum calcidiol [25(OH)D3] level.
Results. The vitamin D level is statistically significantly higher in children of the control group than in patients with UTI: 36.42 ng/mL [24.92–46.37] vs 24.13 ng/mL [13.75–36.42], respectively (p=0.003). There were no patients with severe vitamin deficiency in the control group, while in the UTI group, it occurred in 20.0% of patients. The vitamin D level was less than 20 ng/mL in 31 (41.3%) children with UTI and only 2 (6.6%) in the control group (p=0.001). Normal vitamin status was found in only 38.7% of patients with UTI compared to 66.7% of healthy children (p<0.01). The lowest level was found in patients with acute cystitis – 19.7 ng/mL [9.8–19.7], and the highest in patients with acute pyelonephritis – 31.9 ng/mL [14.3–36.4].
Conclusion. Based on the study results, it can be concluded that vitamin D deficiency may be one of the risk factors for developing UTIs in children. Further studies involving more patients are needed.
193–197
Features of diagnostic search in Churg–Strauss syndrome. Case report
Abstract
Churg–Strauss syndrome is a rare systemic vasculitis affecting small-caliber vessels, which has characteristic clinical manifestations in the forms of allergic rhinosinusitis, bronchial asthma (BA), eosinophilia, and pulmonary infiltrates. The reason for late diagnostics is gradual manifestation of symptoms, that typical of systemic diseases. Improving the knowledge of pediatricians, pulmonologists about the role of diagnostic search in Churg–Strauss syndrome for further routing, monitoring and correction of patient therapy. A 17-year-old boy with BA was admitted to the pulmonology department for clarification, verification of the diagnosis, and selection of therapy. Instrumental and laboratory examination was carried out: on the computer tomography (CT) scan of the thoracic organs "migrating" infiltration of both lungs, based on laboratory data may correspond to eosinophilic zones. On the CT scan of the nasal sinuses polysinusitis, polyposis; external respiration function (spirography) – no pathology; myeloperoxidase-antineutrophil cytoplasmic antibodies (ANCA) – 14 U/ml (normal <5), anti-proteinase 3 anti-neutrophil ANCA – 30 U/ml (normal <5), anti-Saccharomyces cerevisiae antibodies – 6.3–7.2 U/ml, eosinophilia (12%, abs 840 c). The result of the level of antibodies was negative later. Churg–Strauss syndrome was based on the American College of Rheumatology criteria: BA, eosinophilia >10% (abs 840), rhinosinusitis, migrating infiltrations on CT scan. He was discharged for asthma combination therapy with high age doses of inhaled corticosteroids. After treatment his condition improved, there was no need for systemic corticosteroids. The described clinical case clearly demonstrates the difficulty and duration of diagnosing Churg–Strauss syndrome due to the stage-by-stage course of the disease, the frequent (33% of cases) absence of laboratory evidence of vasculitis (ANCA-neg.) significant difficulty of verifying the diagnosis at early stages. The diagnosis provides for a comprehensive and interdisciplinary approach to diagnosis and treatment.
198-204
The role of ultrasound diagnostics in the management of patients with juvenile psoriatic arthritis
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory disease of the peripheral joints, entheses, and spine joints, affecting 10–25% of patients with psoriasis. Early diagnosis of the disease is challenging due to the possible delayed skin and joint symptoms and signs. Before the advent of ultrasound examination, the diagnosis of joint diseases was limited only to the radiological method. The ultrasound diagnosis of joint diseases in children is not established and needs a more comprehensive study.
Materials and methods. The study included 50 PsA patients aged 3 to 17 years. We performed an ultrasound examination of 178 various joints. Knee joints were involved in 46 children, hip joints in 24, ankle joints in 34, and interphalangeal joints in 10. The mean age at onset was 7.8 years (range 1.5 to 14 years). The mean duration of the disease was 4.7 years.
Results. Homogeneous joint effusion was the most common finding in patients with juvenile PsA (JPsA) – 83%. The effusion heterogeneity (17%) was due to hyperechoic inclusions (fibrin) in anechoic content. Diffuse synovium thickening was found in 91% of the joints. In 12.3% of joints, cartilage thinning was observed (in patients with a disease duration of 5 years or more), with fuzzy contours in some cases and normal echostructure in others.
Conclusion. Periarticular structures, most often ligaments and tendons, are also involved in JPsA. The inflammation progresses steadily, with the rate depending on disease activity. Joint ultrasound is a reliable and highly informative method of JPsA diagnosing. It can identify a wide range of joint abnormalities; moreover, the severity of ultrasound abnormalities correlates with the disease severity, enabling using this method for monitoring disease-modifying therapy and as a screening tool for detecting the early signs of arthritis in patients with psoriasis. Joint ultrasound helps to detect early abnormalities.
205–209
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