Myocarditis in Children: Clinical Overview, Diagnosis and Treatment

The lecture presents modern views on the problem of myocarditis in pediatrics. Current ideas about the definition, prevalence, etiology and pathogenesis of inflammatory myocardial lesions in children are presented. Features of clinical manifestations of the disease in patients of different age groups, difficulties of diagnosis and treatment of myocarditis and its complications are disclosed in accordance with federal clinical recommendations. Special attention is paid to diagnostic approaches adjusted with the European society of cardiologists, including first and second level techniques, determination of indications for their implementation and diagnostic capabilities, as well as differential diagnosis of myocarditis with other cardiological diseases. Issues of heart failure treatment in myocarditis and indications for heart transplantation for patients under 18 years of age were also discussed. The lecture has illustrated clinical examples that clearly demonstrate the diversity of the clinical picture and the ambiguity of myocarditis prognosis in children and teenagers

PROBLEM OF METABOLIC DISORDERS IN CHILDREN WITH JUVENILE ARTHRITIS LIVING IN THE REPUBLIC OF MORDOVIA

It is assumed that juvenile idiopathic arthritis (JIA), as many other rheumatic diseases, is in close pathogenic connection with metabolic disorders and early atherosclerosis. However, the prevalence of metabolic syndrome and its components both in healthy Finno-Ugrian children and teens and JIA patients is unknown.Objective of the present work was to study the prevalence of metabolic disorders in children with JIA, living in the Republic of Mordovia.Subjects and methods. Authors have examined 82 children (among them 44 girls) with JIA aged 10–18 years. Results. Full complex of metabolic syndrome symptoms was revealed in 36.6% of patients, most of which had arthritis. Dyslipidaemia, obesity and arterial hypertension were recorded most frequently and correlated with activity of the disease and the dose of systemic glucocorticoids.Conclusion. JIA is associated with high prevalence of metabolic disorders which only partially (arterial hypertension and carbohydrate metabolism disorders) are connected with glucocorticoid therapy and mainly determined by the high inflammatory activity of the disease

Миокардиты у детей: клиническая картина, диагностика и лечение

The lecture presents modern views on the problem of myocarditis in pediatrics. Current ideas about the definition, prevalence, etiology and pathogenesis of inflammatory myocardial lesions in children are presented. Features of clinical manifestations of the disease in patients of different age groups, difficulties of diagnosis and treatment of myocarditis and its complications are disclosed in accordance with federal clinical recommendations. Special attention is paid to diagnostic approaches adjusted with the European society of cardiologists, including first and second level techniques, determination of indications for their implementation and diagnostic capabilities, as well as differential diagnosis of myocarditis with other cardiological diseases. Issues of heart failure treatment in myocarditis and indications for heart transplantation for patients under 18 years of age were also discussed. The lecture has illustrated clinical examples that clearly demonstrate the diversity of the clinical picture and the ambiguity of myocarditis prognosis in children and teenagers.В лекции представлены современные взгляды на проблему миокардитов в детском возрасте. Приведены актуальные сведения о распространенности, этиологии и патогенезе воспалительных поражений миокарда у детей. В соответствии с федеральными клиническими рекомендациями раскрыты особенности проявления симптомов заболевания у пациентов разных возрастных групп, трудности диагностики и лечения миокардита и его осложнений. Особое внимание уделено согласованным Европейским обществом кардиологов диагностическим подходам, в том числе методикам первого и второго уровня, определению показаний к их проведению и диагностическим возможностям, а также дифференциальному диагнозу миокардитов с другими кардиологическими заболеваниями. Обсуждаются вопросы лечения сердечной недостаточности при миокардитах и показания к проведению трансплантации сердца лицам в возрасте до 18 лет. Лекция проиллюстрирована результатами собственных наблюдений, наглядно демонстрирующими разнообразие клинической картины и неоднозначность прогноза миокардита у детей и подростков

The correlation of blood pressure changes and cardiac morpho- functional restructuring in young athletes

A steady increase in the number of young sportsmen predetermines the relevance of studying the nature and severity of cardiovascular system remodeling in young athletes, including the development of arterial hypertension (AH) and left ventricular myocardial hypertrophy (LVHM).Objective. To study the prevalence and nature of arterial hypertension (AH) and its associations with signs of cardiovascular remodeling in young athletes taking into account pathogenetic relationship and genetic determination.Characteristics of children and methods. The study included 80 young athletes (including 42 boys, average age 14,5±1,54 years), divided into 4 groups depending on the kind of sports (1 – cyclic, 2 – game, 3 – complex coordination, 4 – power). We used the following research methods: “office” (i.e. during visit to the doctor) measurement of blood pressure, electrocardiography, echocardiography, color Doppler scanning of the neck vessels, daily monitoring of blood pressure, bicycle ergometry, genetic testing using the original panel with 448 markers.Results. An increase in blood pressure at rest was detected in 2,5% of children engaged in power sports, an insufficient decrease at night – in 16,3% of children, and an excessive reaction of blood pressure to dosed physical activity – in 25% of children. These changes correlated with signs of sports remodeling, in particular with the formation of left ventricular myocardial hypertrophy, which was diagnosed in 7–12,5% of athletes. According to the results of genetic testing, pronounced polymorphism in the NO synthase gene at three loci (rs10918594, rs12143842, rs16847548) was associated with a reorganization of the cardiovascular system in 45% of athletes.Conclusion. Violation of the circadian profile of blood pressure and excessive reaction to physical activity demonstrate 7,5–25% of young athletes, especially those involved in complex coordination and power sports. These changes were associated with the severity of sports remodeling and determined by a genetic predisposition

Frontiers of chaotic advection

This work reviews the present position of and surveys future perspectives in the physics of chaotic advection: the field that emerged three decades ago at the intersection of fluid mechanics and nonlinear dynamics, which encompasses a range of applications with length scales ranging from micrometers to hundreds of kilometers, including systems as diverse as mixing and thermal processing of viscous fluids, microfluidics, biological flows, and oceanographic and atmospheric flows