No 2 (2024)

Infant diarrhea may be caused by infectious, allergic, or surgical diseases. A distinct group comprises congenital enteropathies, a heterogeneous group of genetically determined diseases, including defects in the absorption and transport of nutrients and electrolytes, impaired differentiation of enterocytes and enteroendocrine cells, and defects in the modulation of the intestinal immune response. The final diagnosis of enteropathies is based on the results of molecular genetic tests; however, a detailed assessment of clinical and medical history data and the results of laboratory and instrumental studies enables quick diagnostic search direction and choice of the correct therapeutic tactics. The article considers the algorithm for the differential diagnosis of congenital diarrhea, presents a clinical case of congenital osmotic diarrhea due to disaccharidase insufficiency, and considers the difficulties of the diagnostic search and approaches to diet therapy. The prospective of using a fructose-based formula, Galactomin-19, in the diet therapy of glucose-galactose malabsorption, is presented.

Background. The method of choice for surgical correction of scoliosis is the technology of three-dimensional polysegmental fixation according to Cotrel–Dubousset. Its use is associated with inherent difficulties and risks, often associated with malposition of supporting elements, as well as the risk of complications. The incidence of neurological complications during surgical correction of scoliosis can reach 7%. High risks, including irreversible complications, of surgical correction of scoliosis dictate the need to introduce modern safety methods, including O-arm navigation and intraoperative neuromonitoring (IONM).

Aim. Increasing the effectiveness and safety of surgical correction of scoliosis in children using O-arm navigation and IONM.

Materials and methods. 136 patients operated on for scoliosis were observed. The patients were divided into 2 groups: group 1 included patients operated on using the “free-hand” technology (a total of 609 screws were analyzed in 30 patients); group 2 included patients operated on using O-arm navigation and IONM (524 screws in 25 patients). The average Cobb angle of deformation was 66.9±28.1° in group I and 82.4±25.8° in group 2. Malpositions were assessed using the classification of G. Rao et al. (2002), and an analysis of neurological complications was also carried out in 69 patients in group 1, and in 67 patients in group 2.

Results. In group 1, the overall incidence of malpositions was 27.3% (166 out of 609 screws). In group 2, it was 10.5% (55 out of 524 screws). In group 1, the frequency of grade 1 malpositions was 3.9% (24 out of 609), grade 2 – 11.8% (72 out of 609), grade 3 – 11.5% (70 out of 609). In 2: grade 1 occurred in 4.2% of cases (22 out of 524), grade 2 – 3.4% (18 out of 524), and grade 3 – 2.9% (15 out of 524). The frequency of medial malpositions in the first group was 7.6% (46 out of 609), in the second group – 2.7% (14 out of 524). Lateral malpositions in the group 1 were 11.7% (71 out of 609), in the group 2 – 4.4% (24 out of 524). Anterior malpositions in group 1 – 8.05% (49 out of 609), in group 2 – 3.2% (17 out of 524). In group 1 there were 3 cases of neurological complications – 4.3%, in group 2 – in 1 case – 1.4%.

Conclusion. O-arm navigation and IONM made it possible to reduce the frequency of malpositions, and there was also a tendency to reduce the number of neurological complications in the group of patients where IONM and O-arm navigation were used.

Goat milk (GM) has been a valuable food product for children and adults all over the world for thousands of years and has been used as an important element of healthy nutrition and healing. The article provides information confirming the importance of GM, which is described in the studies of ancient greek and roman scientists (Hippocrates, Galen), in traditional chinese and arabic medicine (the works of Li Shizheng and Avicenna). The works of domestic and foreign scientists also show the possibility of using GM not only as an alternative to breast milk, but also as a highly effective means for strengthening health. The functional composition of GM makes it possible to create mixtures as close as possible to breast milk, which can be used as a source of nutrition for children in the absence of breastfeeding.

Eosinophilic esophagitis (EoE) is a chronic, slowly progressive immune-mediated disease considered a separate clinical and morphological syndrome. The incidence of EoE is currently tending to increase in children. Endoscopy with biopsy is essential for diagnosing EoE in children and adults. The article presents modern endoscopic capabilities in pediatric practice. Attention is drawn to the need to use the available modern endoscopic protocols for the diagnosis of eosinophilic lesions of the esophagus in children; the role of correct and high-quality endoscopic and pathomorphological interpretation of the data obtained for the verification of the diagnosis in EoE is emphasized.

The new coronavirus infection (COVID-19) that emerged in 2019 is a infection caused by the SARS-CoV-2 virus. Although SARS-CoV-2 predominantly affects the respiratory system, numerous studies suggest significant gastrointestinal involvement in COVID-19, particularly in children.

Aim. To evaluate the effect of the synbiotic Maxilac® in children with COVID-19 after antibacterial therapy (ABT).

Materials and methods. A clinical post-approval open-label observational prospective single-center study with minimal intervention was conducted. The microbiome of children with COVID-19 was studied. Twelve children with COVID-19 complicated by a bacterial infection (pneumonia, sinusitis, otitis) were included, receiving ABT and then taking the synbiotic Maxilac® for 4 weeks. Patient data were collected: symptoms, medical history, clinical status, study of intestinal microbiota (IM) by 16S sequencing, stool test for zonulin, and review of drug therapy. The material was sampled in patients with COVID-19 at 3 time points: at the time of acute COVID-19 disease, at the time of recovery from COVID-19, and 4 weeks after starting the synbiotic therapy.

Results. The administration of the synbiotic Maxilac® to patients who received ABT for bacterial complications of COVID-19 relieves clinical gastroenterological symptoms, prevents the development of dysbiosis, and normalizes intestinal permeability. The results indicated significant changes in IM after ABT in complicated COVID-19 and the normalizing effect of synbiotic Maxilac® on IM during administration for 30 days. The synbiotic Maxilac® in the group of children with COVID-19 who received ABT had no side effects and was safe.

Conclusion. Children with COVID-19, complicated by a bacterial infection, treated with ABT are recommended to receive the synbiotic Maxilac® for at least 30 days after recovery.

Every organ in the human body has its own microbiota, and the eye, a complex multi-component organ, is no exception. Due to the limitations of traditional methods, detailed study of the ocular microbiome began only in 2010 as part of the Eye Microbiome Project, when advances in research methods made it possible to obtain detailed data, although there had been debate previously about whether microorganisms were even able to attach to the ocular surface due to the layers of the tear film, which have antibacterial properties. The cornea, conjunctiva, lacrimal glands and tear film, meibomian glands and microbiome form the microenvironment of the ocular surface, interacting together and resisting irritants, allergens and pathogens. Homeostasis of the ocular microbiota is critical for maintaining the health of the visual organ. Most microorganisms are found on the cornea and conjunctiva, and modern research methods, including 16S rRNA sequencing, have allowed us to establish the "core" of the ocular surface microbiota, identifying the most common types: Staphylococcus, Corynebacterium, Propionibacterium, and Streptococcus, although the exact composition of the “core” remains debatable. Many factors can influence the composition of the microbiome, including age, contact lens wear, ophthalmic medications, and antibiotics. Like the microbiome of many other organs, the ocular surface microbiome is influenced by the gut microbiome: this relationship has been called the "microbiota – gut – eye" axis. Within the "gut – eye" axis, healthy gut microbiota produce short-chain fatty acids, indoles, polyamines, and other substances that have a beneficial effect on the immune system and retinal health. The state of dysbiosis leads to disruption of homeostasis, and the increasing inflammatory reaction can contribute to damage to the optic nerve and progression of eye disease. Some ophthalmologic diseases, such as diabetic retinopathy, age-related macular degradation, choroidal neovascularization, uveitis, primary open-angle glaucoma, Sjogren's syndrome, dry eye syndrome are associated with dysbiosis of the intestinal microbial composition. Correction of intestinal dysbiosis using various methods can lead to a decrease in the risk of eye diseases, although additional research is needed to discover new methods for treating ophthalmologic pathologies along the "microbiota – gut – eye" axis.

Background. Chronic pancreatitis (CP) in children is a relatively rare polyetiological disease of the pancreas, accompanied by progressive inflammation of the parenchyma with gradual loss of its function and/or the occurrence of specific complications. Indications for a particular treatment method for a specific patient with a specific etiology and stage of CP are not clearly defined and largely depend on the experience and technical capabilities of a specific clinic. In recent years, individual centers have accumulated experience in using endoscopic methods for the treatment of CP in children, which seems very promising.

Aim. To analyze the results of our experience in endoscopic treatment of CP in children.

Materials and methods. From 2018 to June 2023, endoscopic treatment methods were used in 31 children with CP. Indications for endoscopic treatment were frequent episodes of exacerbation of pancreatitis in combination with signs of ductal hypertension with or without Wirsungolithiasis. According to etiology, patients were divided into groups: pancreatic duct anomalies, abnormal pancreaticobiliary junction (APBJ), hereditary CP, acquired duct strictures and idiopathic pancreatitis. The results were assessed by the frequency of episodes of exacerbation of pancreatitis.

Results. Endoscopic treatment failed in two patients due to: impossibility of cannulation of the main pancreatic duct in a child operated on for annular pancreas and impossibility of recanalization of posttraumatic duct stricture in the isthmus area. Early complications included post-manipulation pancreatitis (n=2; 6.4%), asymptomatic hyperenzymemia (n=5; 16.1%), stent loss (n=2; 6.4%), stent obstruction with pancreatic precipitates (n=2; 6.4%). The average follow-up period was 2.31±1.32 years. In all groups except APBJ, there was a significant decrease in exacerbation episodes with their complete absence in most patients. Ineffectiveness of endoscopic treatment was noted in one case of a combination of the complete type of divided pancreas and a pathogenic mutation of the gene SPINK1. Thus, endoscopic treatment was effective in 28 (90.3%) children in the early period and in 22 (71%) in the late period due to the return of symptoms in the APBJ group.

Conclusion. Endoscopic treatment of chronic pancreatitis in children is effective and can be recommended as first-line therapy. Endoscopic treatment of symptomatic APBJ has a temporary clinical effect.

In the two recent decades a decrease in tuberculosis (TB) incidence has been observed worldwide, according to the World Health Organization, while the incidence of extrapulmonary TB, including TB of the intestine, is growing. Generally, diagnosis of TB in children and adolescents is difficult due to its subclinical course in a significant part of patients. A special diagnostic challenge is extrapulmonary TB, including abdominal TB. Abdominal TB has entered the top five most frequent manifestations of extrapulmonary TB along with TB of the peripheral lymph nodes, urogenital TB, bone and joint TB, and TB of the central nervous system. Lack of specific clinical signs of the disease results in late diagnosis of abdominal TB. We described a case of generalized TB with intestinal lesion in an adolescent. We detected mistakes in the follow-up of the female patient with double exposure to household TB, which resulted in late diagnosis of the disease. We demonstrated the challenges in diagnosing intestinal TB under the guise of appendicitis, which led to the development of complications – spilled peritonitis and abdominal abscess. The tactics of management of the female patient at high risk for developing bowel obstruction was represented. Interdisciplinary interactions with extrapulmonary TB specialists were accented for cases of generalized TB.