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

The Effect of Levocarnitine on Dynamics of the Brain Bioelectrical Activity Formation in Term Infants Delivered by Cesarean Section: Open Randomized Study Results

The brain activity of a newborn affects postnatal adaptation, the disorder of which can cause dysfunction of organs and systems of the immature organism and the development of diseases in more distant periods of maturation.Objective: Our aim was to study the effect of levocarnitine on dynamics of the brain bioelectrical activity formation in term infants delivered by cesarean section.Methods. The study included term infants (gestation period 38–40 weeks) delivered by cesarean section, with perinatal hypoxic lesion of the central nervous system (cerebral ischemia). Children were randomized into groups of standard (recommended) treatment and standard treatment enhanced with levocarnitine (plus levocarnitine) — 30% oral solution at a dose of 100 mg/kg per day for 3 weeks starting from the 7th day of life. The brain bioelectrical activity was assessed with electroencephalography (EEG) of the natural sleep period on the 3rd–6th day and then at 3, 6, and 12 months.Results. 45 children were randomized into groups of standard treatment and standard treatment plus levocarnitine, of which 44 and 40 children completed the study, respectively. Initially, the delayed formation of age-related brain activity was detected in 16/40 (40%) children receiving levocarnitine and in 19/44 (43%) in the experimental group (p = 0.767), disturbances in the EEG sleep pattern with generation of background anomalies — in 17 (43%) and 16 (36%) (p = 0.565), pathological graph elements — in 1 (3%) and 2 (5%) children (p = 0.536), respectively. According to the dynamic EEG control results, it was found that after 1 year the cerebral dysfunction was registered less frequently in children receiving levocarnitine — in 32 (80%) vs. 42 (96%) children in the group of standard treatment (p = 0.028).Conclusion. Adminisration of levocarnitine in the neonatal period reduces the risk of developing cerebral dysfunction by the end of the first year of life

New Mechanisms of Perinatal Hypoxia and Perspectives of Pathogenesis-oriented Treatment

New Mechanisms of Perinatal Hypoxia and Perspectives of Pathogenesis-oriented Treatmen

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

New Mechanisms of Perinatal Hypoxia and Perspectives of Pathogenesis-oriented Treatment

New Mechanisms of Perinatal Hypoxia and Perspectives of Pathogenesis-oriented Treatmen

Heart Transplantation as a Treatment Method for Refractory Heart Failure due to Post-myocarditis Dilated Cardiomyopathy: a Clinical Case

Background. Implementation of mechanical circulatory support and heart transplantation technologies in paediatric clinical practice is changing approaches of diagnostics and treatment of heart failure (HF) in children. The experience of carrying out such operations in Russian Federation is extremely limited until recently due to absence of legal mechanisms of people declaration of intention recording about postmortal use of organs for transplantation.Clinical Case Description. The rare clinical case of drug-refractory (cardiotonic agents and cardioverter defibrillator implantation) chronic cardiac failure caused by post-myocarditis dilated cardiomyopathy (DCM) which demanded heart transplantation. Postoperative course, specific and non-specific complications, diagnostics and correction approaches are described.Conclusion. In the absence of proper analysis of non-specific slight symptoms myocarditis can progress to DCM and be complicated by development of refractory HF. The only method of sustaining child’s life in such case is heart transplantation which is connected with high risk of numerous and life-threatening complications

Study of the Structure, Oxygen-Transporting Functions, and Ionic Composition of Erythrocytes at Vascular Diseases

The present paper explores the role of erythrocytes in the pathogenesis of vascular diseases. The state of erythrocytes, their ionic composition and structure, and properties of erythrocytes hemoglobin were studied by using laser interference microscopy, Raman scattering spectroscopy, and capillary electrophoresis. In patients suffering from vascular disorders we identified statistically significant changes in the shape of erythrocytes, their ionic composition, and redistribution of hemoglobin throughout cells

Amylase-Sensitive Polymeric Nanoparticles Based on Dextran Sulfate and Doxorubicin with Anticoagulant Activity

This study looked into the synthesis and study of Dextrane Sulfate−Doxorubicin Nanoparticles (DS−Dox NP) that are sensitive to amylase and show anticoagulant properties. The particles were obtained by the method of solvent replacement. They had a size of 305 ± 58 nm, with a mass ratio of DS:Dox = 3.3:1. On heating to 37 °C, the release of Dox from the particles was equal to 24.2% of the drug contained. In the presence of amylase, this ratio had increased to 42.1%. The study of the biological activity of the particles included an assessment of the cytotoxicity and the effect on hemostasis and antitumor activity. In a study of cytotoxicity on the L929 cell culture, it was found that the synthesized particles had less toxicity, compared to free doxorubicin. However, in the presence of amylase, their cytotoxicity was higher than the traditional forms of the drug. In a study of the effect of DS−Dox NP on hemostasis, it was found that the particles had a heparin-like anticoagulant effect. Antitumor activity was studied on the model of ascitic Zaidel hepatoma in rats. The frequency of complete cure in animals treated with the DS−Dox nanoparticles was higher, compared to animals receiving the traditional form of the drug

Amino acid formulas in patients with food allergy

The article presents modern approaches to the use of balanced formulas for nutrition and diet correction in children with various forms of food allergies. The guidelines are based on all available up to date evidence on the efficacy, safety and utility of using such innovative medical technology as specialized amino acid formulas. This formula is the targeted medical intervention for food allergies and confirmed cow's milk protein allergy, and particularly for patients with reduced physical growth and development (growth rates included). The material is based on methodological guidelines on the amino acid formulas usage previously developed by specialist experts of the Union of pediatricians of Russia in 2020

Amino Acid Formulas in Patients with Gastrointestinal Diseases

Modern approaches for the management of children with gastrointestinal pathologies include optimal nutritional support that makes it possible to replete energy failure and restore essential nutrients balance. The article presents key information on gastrointestinal diseases in which modern amino acid formulas can be used to regulate nutritional status. The authors have conducted the extensive analysis of all available for now evidence on the efficacy, safety and utility of using such innovative medical technology as special elemental formula in gastrointestinal tract pathological conditions. This material is the basis for guidlines on the use of amino acid formulas developed by expert specialists of the Union of Pediatricians of Russia in 2020