The article presents a rare clinical case of trichobezoar. The article describes the difficulties of diagnostic search when a child was treated for anemia by a hematologist for 4 years. The diagnosis was made already against the background of the developed complication.
Проведен анализ 121 истории болезни детей с ожирением в возрасте от 5 до 17 лет. Ведущими осложнениями и сопутствующими заболеваниями являются: гастропатология (96 %), кардиальные нарушения (50 %), метаболические нарушения (47 %), гипоталамический синдром (46 %), ускоренное или акселеративное физическое развитие (85 %), задержка полового развития у мальчиков (25 %), ускоренное половое созревание (60 %) и гиперандрогения у девочек (5 %). Установлено, что метаболический синдром в 1,5 раза чаще встречался у детей с 1-2-й степенью ожирения, чем у детей с 3-й степенью ожирения. Выявлена высокая заболеваемость детей с ожирением, что отражает сниженную иммунологическую реактивность организма.
Dehydration is one of the most common disorders of water and electrolyte metabolism in young children. The reasons leading to the lack of water in the child’s body are very diverse. In clinical practice, a correct assessment of the pathophysiological mechanisms in various types of dehydration is necessary, which will allow timely identification of changes in various organ systems and conduct rational rehydration therapy. Water losses in children occur in a certain sequence. First of all, the intravascular subsector of the extracellular sector is subjected to water losses (clinical manifestations of dehydration in the child in this case are absent). If the pathological process continues, the intercellular subsector of the extracellular sector loses water, and then the patient first presents clinical symptoms: loss of body weight, dryness and brightness of the mucous membranes, reduction of subcutaneous fiber turgor, shrinkage of the mole in children of the first year of life, reduction of diuresis. Last of all, the intracellular sector loses its volume. Depending on the osmolarity of the extracellular fluid, isotonic, hypertonic and hypotonic dehydration are isolated. The most difficult in children is hypotonic dehydration, which is accompanied by a low osmolarity of the extracellular sector with predominant losses of sodium from the body. A retrospective analysis of a clinical case illustrates water-electrolyte disturbances in hypotonic dehydration. The child developed extracellular hypotonic dehydration because of sodium and water loss through the gastrointestinal tract. Hypotonic dehydration is characterized by an extreme degree of dissonance of the water-electrolyte balance, that is, the patient has severe extracellular dehydration and intracellular hyperhydration (edema, cell swelling). In this clinical case, violations of the waterelectrolyte balance led to the development of cerebral edema against the background of the existing cerebral deficiency, and death.
We have to state that «adult» diseases are increasingly common in children. In the article, the team of authors describes the clinical cases of thrombosis in children: the difficulties of verifying the diagnosis, justifying the therapy, and the tacticsof the doctor's action.
Introduction. In recent years, there has been an increase in the number of schoolchildren with chronic diseases. Employees of the Astrakhan State Medical University, together with colleagues from Children’s City Polyclinic №4, worked to study the impact of nutrition on the growth of disease cases in educational institutions.Aim. Study of the impact of nutrition in educational institutions on the state of health of modern schoolchildren in the city of Astrakhan, as well as the understanding of children and their parents of the principles of healthy nutrition of children.Materials and methods. The health status of 9063 schoolchildren was monitored in general education institutions located in the service area of Children’s City Polyclinic No. 4. Data from preventive examinations 2018–2020 were used. Schoolchildren (579 people) in grades 8–11 and parents (591 people) were surveyed for the state of the child’s health and attitude to healthy nutrition in schools.Results. According to the results of monitoring by the Office of Rospotrebnadzor in the Astrakhan region in the region, no educational institution has a balanced diet. Preventive examinations of schoolchildren showed that only 7% of children with health group I entered the first grades. In a significant part of schoolchildren, various functional violations were noted (57%). In the structure of such disorders, the first place is diseases of the musculoskeletal system, the second place is the pathology of the digestive organs, and the third place is the violation of neuropsychiatric health. There was a high level of allergopathology, eye diseases. 3% of children showed hearing loss. When examining the cardiovascular system (ECG screening), only 63% of schoolchildren had no significant abnormalities.Conclusion. Unsustainable nutrition of schoolchildren is one of the reasons for the high level of incidence of schoolchildren, the prevalence of chronic diseases, and physical disorders. It is necessary to introduce healthy-saving technologies in schools and control the organization of nutrition for schoolchildren.
During last decade the percent of complications of 1 type Diabetes mellitus in children decreased by 12 %, the structure of complications changed, but delay in growth and sexual development as well as fatty liver hepatosis occur in 25 % of cases. Decompensation of diabetes occurs more often in children between the ages of 11 to 16. The higher the level of HbA1c, the more complications occur. In patients with diabetes lasting 5 years or more the dose of insulin is more than 1 units/kg/day.
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