Alexander O. Izyumov

Background . The prevalence of chronic tonsil diseases is constantly increasing among children of different ages. To date, the treatment of pediatric patients with chronic diseases of the upper respiratory tract remains controversial and requires new therapeutic approaches. Aim . To study the clinical and anamnestic characteristics of chronic adenoiditis in children aged 3-6 years and to evaluate the effectiveness of including a probiotic drug in postoperative rehabilitation. Methods. A total of 100 children aged 3–6 years with chronic inflammatory processes of the nasopharynx were examined. The patients were divided into 2 comparable groups, depending on the treatment and rehabilitation measures received. A parent survey was conducted to assess the severity of clinical symptoms before treatment and 30 days after adenotomy. Results. The frequency and duration of viral infections in children with chronic adenoiditis were assessed. Before surgery, 62 % of children had acute respiratory infections (ARIs) once every 2 months or more, and 62 % had ARI episodes lasting more than 7 days. According to the survey results, after treatment there was a statistically significant decrease in the frequency of the following symptoms in children in both study groups: difficulty in nasal breathing, snoring, cough, and bad breath. In the main group, there was a marked decrease in the intensity of nasal breathing difficulty (by 84 %) and in the frequency of sleep disorders (by 58 %) after probiotic treatment. Conclusion . The post-treatment survey data demonstrate regression of clinical symptoms in both groups. However, with respect to symptoms such as decreased intensity of nasal breathing and reduced frequency of sleep disorders, higher therapeutic efficacy was observed when a probiotic was used as an adjunct to adenotomy.

Among the main pathologies of childhood, respiratory tract lesions dominate, with a significant proportion of this category of diseases being chronic inflammatory processes localized mainly in the pharyngeal tonsil (adenoids) and palatine tonsils. Due to the prevalence of these pathologies, it is necessary to develop new approaches to the treatment and rehabilitation of patients. The aim of the study was to conduct a study of the microbiome of the upper respiratory tract and gastrointestinal tract in paediatric patients with chronic adenoiditis for a comparative analysis of the clinical effectiveness of various treatment approaches. Material and methods . We checked out 150 kids aged 3-6 years with chronic inflammation in their nasopharynx. We split the patients into 3 comparable groups based on the treatment and rehabilitation measures carried out. Group 1 included patients who underwent surgery under general anesthesia. Children in groups 2 and 3 received nasopharyngeal irrigation with a probiotic solution for 30 days after surgery or without surgery, respectively. All children underwent bacteriological testing of the oral and nasopharyngeal microbiome, as well as qualitative and quantitative analysis of the luminal intestinal microflora. Results and discussion . In groups 2 and 3, after treatment, the number of cultures positive for Streptococcus salivarius (by 20 and 28 %, respectively), S. mitis (by 14 and 18 %, respectively) in washings from the mouth and nasopharynx statistically significantly increased, in group 3 − cultures containing Neisseria spp. and S. oralis (by 38 and 20 %, respectively). In groups 2 and 3, a decrease in the number of transient and accessory microflora, including Staphylococcus aureus and S. pyogenes , was detected. The composition of the intestinal microbiome significantly improved: in groups 2 and 3 normal microflora was determined in 94.0 % of patients in group 2 (before treatment – only in 8 %) and in 96.0 % of children in group 3 (before treatment – in 16 %). Conclusions. The data obtained indicate the significant effectiveness of probiotic therapy in the postoperative period, as well as in combination with conventional conservative treatment methods for the correction of the microflora of the upper respiratory tract and intestinal biocenosis in children with chronic infectious and inflammatory processes of the nasopharynx.

BACKGROUND: The problem of the pathogenesis of the multisystem inflammatory syndrome (MIS-C), associated with SARS-CoV-2, remains relevant, but is still far from being resolved. In this regard. AIM: The aim our research was to study and evaluate the levels of autoantibodies to native and denatured DNA in the blood serum of children who underwent MIS-C, associated with SARS-CoV-2, in comparison with the initial period of the pathological process. MATERIALS AND METHODS: 101 children aged 2 to 17 years old were examined, 77 of them was with a confirmed diagnosis of MIS-C associated with SARS-CoV-2. We have formed 3 groups: group 1 — children with MIS-C upon admission to the hospital; group 2 — children who underwent MIS-C after a course of rehabilitation; group 3 — comparison group. All children underwent determination of the concentrations of IgG-autoantibodies to native and denatured DNA in blood serum, which was performed by EIA ELISA using commercial test systems of Vector-Best LLC (Russia) according to the manufacturer’s instructions. Statistical processing of the obtained results was carried out using the Statistica v. 10.0 application package. Statistical processing used the Newman–Keuls multiple comparison test. RESULTS: It was noted that both in the initial period of MIS-C and after rehabilitation, an increased content of autoantibodies to nDNA and dDNA was determined compared to the control group. At the same time, there was a significant excess of the levels of indicators in the post-rehabilitation period compared with the initial period of MIS-C. During a clinical examination of children who underwent MIS-C, most of them noted the appearance of pain in the joints. The results obtained indicate the persistence of inflammatory reactions with the development of an autoreactive component. This requires both the search for risk markers for the development of MIS-C and further monitoring of children who have undergone MIS-C to prevent autoimmune complications, including arthritis, damage to the vascular endothelium with the possible formation of thrombotic complications. CONCLUSIONS: In the acute period of MIS-C and after rehabilitation, increased levels of the average content of autoantibodies to nDNA and dDNA were noted compared to the control. Individual values of autoantibodies to nDNA and dDNA exceeded normative levels of the indicator were found in a significantly larger number of children in the post-rehabilitation period after MIS-C, and this excess was more pronounced compared to the acute period of the process. When assessing the clinical condition of children after MIS-C, most of them showed pain in the joints during exercise, abdominal and neurological disorders, and decreased tolerance to physical activity, which indicates persistent inflammatory reactions.

Содержание цитокинов в сыворотке крови детей, перенесших мультисистемный воспалительный синдром, связанный с SARS-CoV-2

The relevance of research on a novel coronavirus infection is associated with an increase in the incidence among children since 2021, which may be due to the accumulation of mutations in the virus genome and its evolution towards increased contagiousness, replicative ability, and evasion of immune protection. While there are many studies in adults, data analyzing the clinical course of the disease in pediatric patients infected with SARS-CoV-2 are limited, particularly regarding adolescents. Objective. To study the clinical and laboratory features of the course of a novel coronavirus infection in hospitalized adolescents in Novosibirsk during the first, second and third waves of the pandemic. Мaterials and methods. A retrospective analysis of case histories of 125 children treated at Novosibirsk Children's Clinical Hospital No 6 with a confirmed diagnosis of coronavirus infection during three pandemic waves was carried out (June–August 2020, October–December 2020, June–August 2021). Based on these time intervals, three groups of adolescents admitted to the hospital during the first, second, and third waves of coronavirus infection were formed. SARS-CoV-2 RNA in nasopharyngeal and oropharyngeal scrapings was determined using the PCR-RT method. Biochemical and general clinical studies were performed in accordance with the guidelines of the Ministry of Health of the Russian Federation. Statistical processing was carried out using the Satistika 7.0 software package (StatSoft, USA). Differences between the groups were assessed using the Z-test and the Mann–Whitney U test. Differences between the compared series were considered statistically significant with a probability level of 95%. Results. It was shown that during three pandemic waves (June 2020 – August 2021), more than half of the hospitalized children were adolescents. At the same time, regardless of the pandemic wave, intoxication, catarrhal and intestinal syndromes predominated in hospitalized adolescents. CNS injury symptoms were significantly less frequent in the first wave, as were skin rashes. Cough in the third wave was observed in 100% of hospitalized adolescents. The average values of the parameters of complete blood count, as well as CRP, D-dimer and ferritin had no statistically significant differences in different pandemic waves, but there was a significant variation in individual values within the groups in each wave. Key words: adolescents, coronavirus infection, COVID-19, clinical manifestations, laboratory parameters