In the beginning of COVID-19, the proportion of confirmed cases in the pediatric population was relatively small and there was an opinion that children often had a mild or asymptomatic course of infection. Our understanding of the immune response, diagnosis and treatment of COVID-19 is highly oriented towards the adult population. At the same time, despite the fact that COVID-19 in children usually occurs in a mild form, there is an incomplete understanding of the course as an acute infection and its subsequent manifestations such as Long-COVID-19 or Post-COVID-19, PASC in the pediatric population, correlations with comorbidities and immunological changes. In mild COVID-19 in childhood, some authors explain the absence of population decreasing T and B lymphocytes. Regardless of the patient’s condition, they can have the second phase, related to the exacerbation of inflammation in the heart tissue even if the viral infection was completely eliminated—post infectious myocarditis. Mechanism of myocardial dysfunction development in MIS-C are not fully understood. It is known that various immunocompetent cells, including both resident inflammatory cells of peripheral tissues (for example macrophages, dendritic cells, resident memory T-lymphocytes and so on) and also circulating in the peripheral blood immune cells play an important role in the immunopathogenesis of myocarditis. It is expected that hyperproduction of interferons and the enhanced cytokine response of T cells 1 and 2 types contribute to dysfunction of the myocardium. However, the role of Th1 in the pathogenesis of myocarditis remains highly controversial. At the same time, the clinical manifestations and mechanisms of damage, including the heart, both against the background and after COVID-19, in children differ from adults. Further studies are needed to evaluate whether transient or persistent cardiac complications are associated with long-term adverse cardiac events.
The question of COVID-19 and long-COVID-19 course in children remains unsolved. This infection in children, which is associated with COVID-19, can vary from asymptomatic to systemic damage of various systems. Multisystem inflammatory syndrome in children, associated with SARS-CoV-2 (MIS-C), is a serious condition in children and adolescents after experiencing COVID-19. Published data on MIS-C have indicated that the inflammation can be registered in the gastrointestinal tract (60–100%), as well as in cardiovascular (80%), nervous (29–58%), and respiratory (21–65%) systems. However, with the changing characteristics of SARS-CoV-2, the manifestations of COVID-19 and long-COVID-19 in children have also been changing. Currently, there is no clear understanding of the development of severe COVID-19 and MIS-C in children, especially after being exposed to patients with COVID-19. We presented two new clinical courses of multisystem inflammatory syndrome in children with severe multisystem damage after close contact to relatives with COVID-19 or long-COVID-19. Thus, high-risk children, who are positive for SARS-CoV-2 infection after contact with COVID-19 patients, should be clinically managed during the first few months. The identification of the disease complexity requires the involvement of neurologists, cardiologists, and other specialists.
COVID-19 (Coronavirus disease 2019) in children is usually mild. However, multiple organ disorders associated with SARS-CoV-2 (severe acute respiratory syndrome-related coronavirus 2) have been detected with poor respiratory symptoms. Cardiac changes are noted in 17% to 75% of cases, which are associated with diagnostic difficulties in high-risk groups for the development of complications that are associated with myocardial damage by the SARS-CoV-2 virus. The objective of this review is to identify the most significant symptoms of cardiac involvement affected by COVID-19, which require in-depth examination. The authors analyzed publications from December 2019 to the October 2022, which were published in accessible local and international databases. According to the analysis data, the main sign of myocardial involvement was increasing as cardiomarkers in the patient’s blood, in particular troponin I or troponin T. Many authors noted that the increased level of CRP (C-reactive protein) and NT-proBNP, which are accompanied by changes in the ECG (electrocardiogram) and EchoCG (echocardiography), as a rule, were nonspecific. However, the identified cardiac functional dysfunctions affected by SARS-CoV-2, required an cardiac MRI. The lack of timely diagnosis of myocardial involvements, especially in children at high risk for the development of complications associated with SARS-CoV-2 myocardial injury, can lead to death. The direct damage of the structural elements of myocardial blood vessels in patients with severe hypoxic changes resulted from respiratory failure caused by SARS-CoV-2 lung damage, with the development of severe acute diffuse alveolar damage and cell-mediated immune response and myocardial involvement affected by SARS-CoV-2 damage. In this article, the authors introduce a clinical case of a child who dead from inflammatory myocardities with COVID-19 in a background of congenital heart disease and T-cell immunodeficiency.
Определить особенности про-и антиоксидантной систем у пациентов с эпилепсией с целью оптимизации проводимой терапии. l 2%0(+; (,%2.$;. Проведено комплексное клинико-биохимическое обследование 58 больных эпилепсией (БЭ). Изучены показатели прооксидантного статуса, спонтанная и форбол-миристатацетат-индуцированная хемилюминесценция крови (ФМА-Л-ХЛ) и малоновый диальдегид плазмы крови (МДА), а также антиоксидантной защиты (АОЗ)-супероксиддисмутаза (СОД) цельной крови и восстановленные тиолы (SH-группы) плазмы крови. Регистрацию спонтанной ХЛ производили на хемилюминометре LКВ-125; для изучения индуцированной ХЛ в качестве активатора использовали ФМА. Определение МДА осуществляли спектрофотометрическим методом с использованием тиобарбитуровой кислоты. Тиоловый статус оценивался по уровню SH-групп в плазме крови. Активность СОД в цельной крови определяли спектрофотометрическим методом, основанном на торможении реакции окисления кверцетина. p%'3+<2 2;. Выявлено статистически значимое снижение активности СОД у БЭ, в среднем на 50 %, по сравнению со здоровыми лицами. Уровень SН-групп у БЭ был достоверно ниже аналогичного параметра у здоровых людей, интенсивность спонтанной ХЛ-в пределах нормы. Получены неоднозначные результаты содержания ФМА-ХЛ, МДА, что свидетельствует о разной чувствительности лейкоцитов к образованию АФК. Патогенетически обосновано использование ферментативных антиоксидантов в качестве аугментирующей терапии, отмечено положительное влияние применения рекомбинантной СОД как на биохимические, так и на клинические показатели у БЭ. g *+>7%-(%. Таким образом, у БЭ наблюдаются процессы свободнорадикального окисления с развитием хронического окислительного стресса на фоне истощения ферментативных компонентов АОЗ, в частности, СОД и тиоловых групп и активация прооксидантных систем. Результаты исследования позволяют рассматривать ферментативные антиоксиданты в качестве патогенетической терапии эпилепсии.
; Иванова Ирина Юрьевна, врач функциональной диагностики лечебно-консультативного отделения; Попов Сергей Валерьевич, врач функциональной диагностики высшей категории лечебно-консультативного отделения; Земсков Иван Александрович, заведующий лечебно-консультативным отделением; Васичкина Елена Сергеевна, доктор мед. наук, профессор, гл. науч. сотр. научно-исследовательского отделения сердечно-сосудистых заболеваний у детей Распространенность синдрома/феномена Вольфа-Паркинсона-Уайта в общей популяции составляет от 1 до 4,5 случая на 1 тыс. человек. В реестре причин внезапной сердечной смерти среди атлетов на долю данного синдрома приходится около 1% всех внезапных сердечных смертей. К факторам высокого риска внезапной сердечной смерти относят: мужской пол, возраст менее 30 лет, наличие эпизодов фибрилляции предсердий в анамнезе, синкопе, семейный анамнез Вольфа-Паркинсона-Уайта и наличие врожденного порока сердца. Приведенные клинические примеры демонстрируют необходимость тщательного обследования спортсменов с идентифицированным феноменом/синдромом Вольфа-Паркинсона-Уайта вне зависимости от наличия симптомов, а также при указании семейного анамнеза. Радиочастотная аблация позволяет уменьшить риск внезапной сердечной смерти у спортсменов с синдромом Вольфа-Паркинсона-Уайта и через короткое время вернуться к занятиям спортом.
РезюмеЦель исследования -оценить вклад психоэмоционального фактора в аритмогенез у пациентов с иди-опатическими желудочковыми аритмиями (ЖА) на основании анализа результатов различных менталь-ных проб (МП).Материал и методы. После тщательного обследования в исследование было включено 66 пациентов без структурной патологии сердца с патологическим количеством ЖА и тревожными невротическими расстройствами (ТНР). Всем пациентам проводились МП согласно протоколу обследования.Результаты. Данные статистического анализа показали, что исходные уровни гемодинамических по-казателей до проведения четырех МП статистически не различались. Таким образом, последователь-ность пробы не влияет на ее результат. Сравнительный анализ изменений гемодинамических параметров и ЖА при выполнении МП выявил статистически значимые отличия лишь по изменению гемодинамиче-ских параметров. Сравнительный анализ между мужчинами и женщинами по изменению как гемодина-мических показателей, так и ЖА во время проведения МП не выявил гендерных отличий в реакции при выполнении ментальных стресс-тестов.Заключение. Использование ментальных стресс-тестов позволяет оценить вклад психоэмоциональ-ного фактора в генез ЖА у пациентов с идиопатическими нарушениями ритма и коморбидными ТНР. МП необходимо включать в алгоритм обследования пациентов с ЖА ввиду различного влияния психоэмоци-онального и физического стресса, как триггера, на желудочковый эктопический очаг.Ключевые слова: ментальные пробы, желудочковые аритмии, психоэмоциональный фактор, стресс. AbstractThe aim of the study was to evaluate the contribution of psychoemotional factor in arrhythmogenesis in patients with idiopathic ventricular arrhythmias (VA) on the basis of analysis of the results of various mental stress-tests (MT).Material and methods. 66 patients with idiopathic VA and anxiety neurotic disorders (AND) were included in the study after careful examination. MT were performed all patients according to the study protocol.Results. According the data of statistical analysis there were not stasistically significant differences in the baseline levels of hemodynamic parameters in the perid of rest between MT. Thus, the sequence of the test does not affect its result. According comparative analysis there were statistically significant differences between MT only in the hemodynamic parameters changes and not in the change of VA. Comparative analysis between men and women in the changes of hemodynamic parameters and VA during the MT did not reveal gender differences.The conclusion. Use of MT allows to evaluate the contribution of psyhoemotional factor in the genesis of VA in patients with idiopathic arrhythmia and AND. MT should be included in the algorithm for examining patients with VA because of the different effects of psychoemotional and physical stress, like a trigger, on the ventricular ectopic focus.
Arrhythmogenic cardiomyopathy (ACM) is a genetically determined disease with a high risk of sudden cardiac death (SCD). The spectrum of genetic causes of this disease is quite wide and includes mutations in both desmosomal and non-desmosomal genes. A positive result of a genetic examination is used as a diagnostic tool in patients with ACM, so its correct interpretation is one of the key factors in a personalized approach to managing a patient with this pathology. The review presents generalized modern ideas about the genetic nature of ACM.
Background. The problem of managing children with hypertrophic cardiomyopathy (HCM) remains relevant due to the high risk of sudden cardiac death (SCD). Registers of patients with HCM contribute to a better understanding of the course of the disease and its outcomes.Objective. To study the structure of CMP with a hypertrophic phenotype, as well as to identify clinical, molecular and genetic features of the course of HCM and outcome in children based on anamnestic, clinical and instrumental data from an electronic database.Design and method/ Currently, the database includes complete information on 80 children from 0 to 18 years of age inclusive with a hypertrophic phenotype of CMP. The study was performed on the basis of the Department of Pediatric Cardiology and Medical Rehabilitation of the V.A. Almazov” of the Ministry of Health of Russia. The database contains the history of the disease and family history, the results of clinical and laboratory-instrumental examination, the results of molecular genetic research. The register is dynamically updated.Results. The mean age of onset of HCM was 1.75 [0.02; 10.00] years. There were more boys than girls — 54 (67.5 %). The main complaints were decreased exercise tolerance in 35 (43.8 %) children and shortness of breath in 30 (37.5%) children. All children had signs of heart failure (HF): 53 (66.3 %) had signs of functional class 2 HF, 26 (32.5 %) — functional class 1 and 1 (1.2 %) — functional class 3. Ventricular arrhythmias were recorded in 23 (29 %) children, unstable ventricular tachycardia in 2 (2.5 %) children. Myocardial fibrosis of the left ventricle according to the results of MRI of the heart was found in 60.7 %. A lethal outcome was registered in 5 % (n = 4) of cases on average at 241 ± 117 days of life. All the deceased had phenocopies of HCM.Conclusion. Maintaining an electronic database of patients with HCM will allow a better understanding of the influence of factors, including genetic ones, on the course, outcomes, and prognosis of the disease in the pediatric population.
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