ОПЫТ ДИАГНОСТИКИ И ЛЕЧЕНИЯ ИНВАГИНАЦИИ КИШЕЧНИКА У ДЕТЕЙ

Experience of diagnostics and treatment of 263 children with the acquired intestinal impassability – intestines invagination is presented. The assessment is given to radiological and ultrasonic methods of diagnostics of an invagination. Advantage of ultrasonic research to a choice of medicaltactics thatled to extension of indications to conservative treatmentis proved.Представлен опыт диагностики и лечения 263 детей с приобретенной кишечной непроходимостью – инвагинацией кишечника. Дана оценка рентгенологическому и ультразвуковому методам диагностики инвагинации. Доказано преимущество ультразвукового исследования для выбора лечебной тактики, что привело к расширению показаний к консервативному лечению.

Клинико-эпидемиологические особенности течения новой коронавирусной инфекции COVID-19 у детей в периоды подъема заболеваемости в городе Москве в 2020—2021 гг.

Purpose: to identify the features of COVID-19 infection in children at different periods of the epidemiological rise in the incidence in the city of Moscow.Results. The article presents the observation of 1561 children hospitalized in the State Medical Institution «Children's City Clinical Hospital named after Z. A. Bash-lyaeva DZM» with a diagnosis of a new coronavirus infection COVID-19 during the periods of epidemiological rises in morbidity («2nd and 3rd waves of COVID-19»). An increase in the number of hospitalized children during the «3rd wave of COVID-19», early admission dates from the onset of the disease, due to the lack of treatment effect in outpatient settings, the predominance of school-age children and adolescents, the predominant course of infection with the development of viral pneumonia CT2-3, less often CT3-4, a 10-fold reduction in the number of children with MIS-syndrome, an elongation of the period of viral release in patients.Цель: выявить особенности течения инфекции COVID-19 у детей в разные периоды эпидемиологического подъема заболеваемости в городе Москве в 2020—2021 гг.Результаты: В статье представлено наблюдение за 1561 ребенком, госпитализированным в ГБУЗ «Детская городская клиническая больница имени З.А. Башляевой ДЗМ» с диагнозом новая коронавирусная инфекция COVID-19 в периоды эпидемиологического подъема заболеваемости («2-й и 3-й волн COVID-19»). Показано увеличение числа госпитализированных детей во время «3-й волны COVID-19», ранние сроки поступления от начала заболевания, в связи с отсутствием эффекта лечения в амбулаторных условиях, преобладание детей школьного возраста и подростков, преимущественное течение инфекции с развитием вирусной пневмонии КТ2-3, реже КТ3-4, сокращение числа детей с MIS-синдром в 10 раз, удлинение периода вирусовыделения у пациентов

EXPERIENCE OF DIAGNOSTICS AND TREATMENT OF INTESTINE INVAGINATION AT CHILDREN

Experience of diagnostics and treatment of 263 children with the acquired intestinal impassability – intestines invagination is presented. The assessment is given to radiological and ultrasonic methods of diagnostics of an invagination. Advantage of ultrasonic research to a choice of medicaltactics thatled to extension of indications to conservative treatmentis proved

In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study

Background: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation. Methods: EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic—from March 1 to Sept 13, 2020—at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing. Findings: Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46–60]) were included in the study. Median ECMO duration was 15 days (IQR 8–27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms. Interpretation: Patient's age, timing of cannulation (<4 days vs ≥4 days from intubation), and use of inotropes and vasopressors are essential factors to consider when analysing the outcomes of patients receiving ECMO for COVID-19. Despite post-discharge survival being favourable, persisting long-term symptoms suggest that dedicated post-ECMO follow-up programmes are required. Funding: None