STRUCTURE OF THE REASONS OF THE COMPLICATED COURSE OF APPENDICULAR PERITONITIS AT CHILDREN

Appendicular peritonitis is one of the most complicated purulent-inflammatory diseases in children. More than 60% emergency operations children performed at non-specialized general surgical departments. Staff are not sufficiently familiar with the peculiarities of pediatric surgery. This is the main cause of treatment-tactical and technical errors. Analysis of the data errors and determining factors of their controllability are the main reserves in terms of optimization of medical care for children with appendicular peritonitis

Differentiated disorders of the immune system in acute hematogenic and acute posttraumatic osteomyelitis in children

Osteomyelitis is an inflammation of bone and bone marrow caused by the spread of S. aureus from a local focus by the hematogenous route or from an open traumatic fracture; it is difficult to treat and remains a serious problem. The condition for spreading of the infectious process into bone is the effect of S. aureus and its impaired elimination due to immune system (IS) dysfunction. Controversial information on the immunopathogenetic mechanisms of acute osteomyelitis needs study, which would allow the development of sound immunotherapy. Purpose of the study: to specify the variants of antibacterial immune protection disorders in children with acute hematogenous and acute posttraumatic osteomyelitis. Materials and methods. Children 8-15 years old (n = 22) were studied: Study Group 1 (SG1, n = 12) – with acute hematogenous osteomyelitis (AHO); Study Group 2 (SG2, n = 10) – with acute post-traumatic osteomyelitis (APTO). The comparison group (CG) – 13 healthy children. Tested: Tlymphocytes (CD3+CD19- , CD3+CD4+, CD3+CD8+), B lymphocytes (CD3- CD19+), NK (CD3- CD16+CD56+) and TNK (CD3+CD16+CD56+) lymphocytes, neutrophil granulocytes (NG, CD16, CD32, CD64) (FC-500 Beckman Coulter, USA); the level of serum IgA, IgM, IgG (ELISA). Phagocytic function of NGs in relation to S. aureus was assessed: the number of actively phagocytizing NGs (%PhAN), capture processes (PhN, PhI) and killing activity (%D, DI). Results. In both groups was revealed a decrease of T lymphocytes, T helpers, TCTL and NK quantity (p1-4 < 0.05). In AHO, the levels of IgA, IgM, IgG did not differ from that in GS, while in APTO the levels of IgA and IgG increased (p1, 2 < 0.05). The density of CD64, CD16, CD32 receptor expression on NG in the studied groups has been a different equipping, predetermining an incompetence of the phagocytic function: in AHO associated with abnormalities in the function capture and killing, in APTO only with the S. aureus digestion. Conclusion. The revealed combined defects of IS functioning necessitate the development of new approaches in the treatment of AHO and APTO in children, pathogenetically substantiating the use of immunotherapy in the complex etiopathogenetic treatment. This approach will contribute to the restoration of mechanisms of anti-infective immunity, timely elimination of pathogens, improve the clinical course of the diseases, prevent the chronic inflammatory process

In vitro phenotypic re-orientation of functionally important neutrophil subpopulations and their microbicidal activity in the children with purulent inflammatory diseases influenced by glucosaminil muramildipeptide

Numerous studies over last decade have shown that functional capacity of neutrophil granulocytes (NG) determines the course and outcome of many diseases. Identification of phenotypic variants of functionally significant NG subpopulations is a new approach allows us to assess the adequacy or deficiency of NG involvement into infectious inflammation processes at molecular level. An opportunity of reorienting a deficient NG subpopulational phenotype in purulent inflammatory diseases due to the rearrangement of the receptor set induced by various immunotropic substances may serve as a key to recovery of normal NG functioning.Our aim was to study the effect of glucosaminylmuramyldipeptide (GMDP) under in vitro conditions upon the phenotypic profile of four functionally significant subpopulations, i.e., CD62L+CD63-NG, CD62L+CD63+NG and CD64-CD32+CD16+CD11b+NG, CD64+CD32+CD16+CD11b+NG, along with assessment of expression density of appropriate membrane molecules and NG microbicidal activity in the children with purulent inflammatory diseases. 90 samples of peripheral blood (PC) were taken from children 2 to 4 years old, including 12 children with minor purulent infection (MPI), and 7 children were studied as conditionally healthy controls. Their peripheral blood was incubated for 60 minutes at 37 °C with GMP (10-6 g/l). Using flow cytometry technique, the relative numbers of some NG subpopulations, i.e., CD64-CD16+CD32+CD11b+NG, CD64+CD16+CD32+CD11b+NG, CD62L+CD63-NG, CD62L+CD63+NG were evaluated, and the phenotype features of each subpopulation were investigated according to the density of appropriate membrane molecule expression (MFI). In parallel, phagocytic and microbicidal activity of NG was tested in these study groups. The obtained data indicate for presence of for distinct NG subpopulations, both in healthy children and in children with MPI. We have revealed phenotypic transformation of the four studied NG subpopulations from MPI patients including disturbed phagocytic and microbicidal functions of the cells. Using of this in vitro system, we have shown that the transformed phenotype of the four functionally significant NG subpopulations of MPI patients was re-arranged under GMDP treatment. At the same time, the number of CD62L+CD63+NG and CD64-CD32+CD16+CD11b+NG subpopulations was increased, along with decreased amounts of CD64+CD32+CD16+CD11b+NG and CD62L+CD63-NG subpopulations, being accompanied by restoration of microbicidal activity of NGs.The obtained data allow us to accomplish current understanding of immunotropic effects of GMDP, and to extend the potential scope of its experimental and clinical application. The new data on GMDP effects revealed by in vitro system, i.e. phenotype rearrangement of functionally significant NG subpopulations CD64-CD16+CD32+CD11b+, CD64+CD16+CD32+CD11b+, CD62L+CD63-, CD62L+CD63+ in atypical purulent inflammatory diseases in children, may be used in the future in order to develop innovative strategies of immunotherapy aiming for correction of NG dysfunction in children with MPI

Clinical and immunological efficacy of immunotherapeutic program after surgical treatment of children with various forms of acute peritonitis

Acute peritonitis (AP) is among the most frequent and severe conditions in pediatric abdominal surgery. Due to development of antibiotic resistance and increasing number of atypical infectious and inflammatory diseases (IIDs), a lot of specialists suggest combined treatments for these patients which should include not only surgical and etiotropic approaches, as well as therapy aimed at correction of functional defects of immunity. Neutrophilic granulocytes (NGs) reepresent a unique population of cells of primary anti-infectious immune response. Functional NG defects in pediatric AP play a leading role in development, prevalence, severity of peritoneal inflammation, and response to the therapy. Special role is given to functionally significant NG subsets responsible for triggering and implementation of phagocytosis and microbicidal properties of NG in purulent lesions and inflammatory process in children. There is an urgent need for development of new approaches to targeted immunomodulatory therapy in order to correct the NG dysfunction. The aim of the present study was to arrange the programs of immunomodulatory therapy after surgical treatment of immunocompromised children with various forms of acute peritonitis followed by subsequent evaluation of its clinical and immunological efficacy. The study included 12 immunocompromised children aged 5-12 years with different clinical course of acute peritonitis. The study group 1 included patients with local nonrestricted AP; study group 2 involved children with diffuse AP. The comparison groups consisted of 6 children who received standard therapy, i.e., clinical comparison groups 1 and 2, matched for sex, age and diagnosis. A control group consisted of 18 conditionally healthy children at similar age. Clinical examination included collection of the patient’s history, complaints, objective examination and clinical course assessment of the underlying disease. Immunological study included determination of receptor, phagocytic and microbicidal activity of NCs; assessment of NC subpopulations by their numbers and phenotype using flow cytometry, i.e., the cells co-expressing CD64, CD16, CD32, CD11b, with testing density of these membrane receptors by the MFI approach. Targeted immunomodulatory therapy programs were applied for treatment of children with unrestricted local and diffuse AP, taking into account clinical features of AP, as well as changes in number and phenotype of NC subpopulations, and impairment of their effector function. The standards of postsurgical treatment in the children with various forms of AP included different courses of treatment with Imunofan (Hexapeptide – arginyl-alpha-aspartyl-lysyl-valyl-tyrosyl-arginine; HP) using different schedules and duration. We have shown high clinical and immunological efficiency of these therapeutic programs. Thus, reversal of adequate NG functioning was observed, including positive rearrangements of negatively transformed functional NG subpopulations. In this respect, a positive clinical effect was noted in children with atypical AP with various clinical courses, i.e., absence of postsurgical complications, rapid regression of intoxication signs, normalization of body temperature, reduced volume of antibiotic therapy and shorter hospitalization terms

Treatment of cryptorchidism in pediatric surgical practice: a multicenter study

Introduction. Cryptorchidism is a common disease in pediatric urological and andrological practice since the issues of tactical approaches and its optimal treatment remain extremely relevant. Cryptorchidism makes a significant contribution to the structure of male infertility.Objective. To conduct a retrospective analysis of treatment results in children and adolescents with cryptorchidism.Materials & methods. This study summarises the treatment results of 8308 patients with cryptorchidism aged from 6 months to 17 years who underwent inpatient treatment in the Russian Federation and the Republic of Uzbekistan.Results. It was revealed that from 2015 to 2019, patients were admitted for surgical treatment evenly over the years. The ratio of right-sided / left-sided / bilateral cryptorchidism was 4.6 : 4.4 : 1 The inguinal form prevailed more than 6 times over the abdominal location. At the same time, 26.1% of the patients underwent surgery at the optimal time, and 9.8% were older than 10 years. More often, children are operated from an open inguinal access (95.0%), much less often — laparoscopically and percutaneously. Stage-by-stage treatment was carried out in 6.0% of patients.Conclusion. Thus, the approach presented in the study in the surgical treatment of cryptorchidism provided good treatment results. The number of disease relapses was 1.9% (mainly among children over 7 years old). Most surgeons are very reserved about primary orchidectomies (only 3.8% were performed)

ON THE SELECTION OF SURGICAL TECHNIGUES IN THE TREATMENT OF PULMONARY – PLEURAL FORM OF ACUTE NECROTIZING PNEUMONIA IN CHILDREN

Summary: suppurative lung and pleura are one of the urgent problems of pediatric surgery. Implementation in practice of VATS treatment proved an advantage of this method over traditional. However, issues of local influence on inflammatory processes in all these methods of surgical treatment to date remain unsolved

Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey

BACKGROUND: Many people with schizophrenia experience stigma caused by other people's knowledge, attitudes, and behaviour; this can lead to impoverishment, social marginalisation, and low quality of life. We aimed to describe the nature, direction, and severity of anticipated and experienced discrimination reported by people with schizophrenia. METHODS: We did a cross-sectional survey in 27 countries, in centres affiliated to the INDIGO Research Network, by use of face-to-face interviews with 732 participants with schizophrenia. Discrimination was measured with the newly validated discrimination and stigma scale (DISC), which produces three subscores: positive experienced discrimination; negative experienced discrimination; and anticipated discrimination. FINDINGS: Negative discrimination was experienced by 344 (47%) of 729 participants in making or keeping friends, by 315 (43%) of 728 from family members, by 209 (29%) of 724 in finding a job, 215 (29%) of 730 in keeping a job, and by 196 (27%) of 724 in intimate or sexual relationships. Positive experienced discrimination was rare. Anticipated discrimination affected 469 (64%) in applying for work, training, or education and 402 (55%) looking for a close relationship; 526 (72%) felt the need to conceal their diagnosis. Over a third of participants anticipated discrimination for job seeking and close personal relationships when no discrimination was experienced. INTERPRETATION: Rates of both anticipated and experienced discrimination are consistently high across countries among people with mental illness. Measures such as disability discrimination laws might, therefore, not be effective without interventions to improve self-esteem of people with mental illness