The article presents data on the prevalence, clinical, diagnostic and treatment characteristics of acute hyperlipidemic pancreatitis in children, based on a literature review and a clinical case presentation. The aim of this work is to define the nature of hyperlipidemic pancreatitis in children based on the literature review, and the clinical case presentation. Material and methods. The analysis of the literature data of the last 10 years through the Google Scholar and PubMed databases was performed. The clinical course, blood tests assessing protein and lipid indicators, abdominal ultrasound findings typical for acute hyperlipidemic pancreatitis were examined in a patient O. S., born in 2007. Results. The disease was diagnosis based on the study of anamnestic, clinical, laboratory and ultrasound findings. Lipid profile test revealed an increase in the level of cholesterol and triglycerides, and a decrease in the level of high-density lipoproteins. Abdominal ultrasound showed changes in the pancreatic tissues: the pancreas was significantly enlarged with a heterogeneous structure of the parenchyma, the echogenicity was significantly increased due to edema, and there was a small amount of effusion. Laparoscopic drainage of the omentum and abdominal cavity was recommended and performed. The key to the successful treatment was repeated long-term use of detoxification and hypolipidemic therapy in combination with dietary corrections (a low-fat diet). Conclusions. As of today, acute hyperlipidemic pancreatitis continues to be one of the least studied and rare pathologies among the pediatric population. This necessitates the search for and implementation of both diagnostic and treatment algorithms into clinical practice to timely correct and prevent complications.
An analysis of domestic and foreign literature on the prevalence, causes and mechanisms of pneumonia in children. This article highlights the prevalence and features of the clinic and diagnosis of pneumonia in children based on a review of the literature. Out-of-hospital pneumonia today remains a pressing medical and social problem, often leading to complications and often causing the death of children, both in Ukraine and around the world, so it needs more in-depth diagnosis. It is known that the severity of this disease depends on age, etiology, comorbidity and timely hospitalization. The incidence and prevalence of respiratory diseases is one of the main indicators of health among children in the world. Therefore, the purpose of this research is to analyze foreign and domestic literature sources on the prevalence and search for the most informative diagnostic criteria for pneumonia in young children. More recent meta-analyzes of etiological data indicate a change in the profile of the pathogen, which increases the recognition that community-acquired pneumonia is caused by sequential or simultaneous interaction of more than one microorganism. Given the epidemiology of community-acquired pneumonia and long-term hospital stays, the study and synthesis of data on the diagnostic criteria for community-acquired pneumonia remains relevant. It is currently not possible to identify a single marker or clinical sign that can be used to distinguish bacterial from viral pneumonia. It is important to evaluate all indicators of objective, instrumental and laboratory examination. Based on literature data, cytokine status indicators can be used to prevent the development of complications from pneumonia, prescribe adequate therapy and determine the duration of treatment. There are many other biomarkers that have been linked to the severity of pneumonia in children. According to statistics, a study of children with COVID-19 showed that the blood of patients, especially those with severe disease, has high levels of proinflammatory cytokines, especially IL-6, which during infection may be a key cytokine that causes serious inflammation and acute damage to many organs and systems. In particular, such a biomarker is IL-6 - the only serum cytokine, the presence of which probably correlates with the severity of pneumonia. The relationship between serum IL-6 and IL-10 levels is an important diagnostic criterion for determining the severity of pneumonia in children on admission, which allows screening for the risk of complications and assessing the possibility of rapid recovery. The use of immune and inflammatory markers in children with pneumonia can potentially lead to the development of innovative methods for predicting complications of community-acquired pneumonia and determining the severity. In addition, it has been shown that serum IL-6 levels are significantly reduced in patients with pneumonia during the recovery period, which allows to evaluate the effectiveness of treatment. Procalcitonin is also an important indicator of the inflammatory process. There are conflicting data on the ability of procalcitonin to distinguish between bacterial and viral infections. Given these data, procalcitonin can be used as a diagnostic criterion for the presence of bacterial infection and the appropriateness of antibiotic therapy. Analysis of available scientific works on prevalence features of the clinic and diagnosis of pneumonia in children, showed that the issue of timely diagnosis and differential diagnosis of pneumonia in children is still relevant and requires further research.
Chronic acid-dependent diseases and, in particular, gastroesophageal reflux disease (GERD), are urgent problems in pediatric gastroenterology. However, the clinical features and functional state of the pancreas in adolescents with reflux disease remain not fully understood. Purpose - to investigate the main parameters of quality of life, clinical features, and functional state of the pancreas in adolescents with GERD. Materials and methods. We examined 100 inpatients aged 13-17 years who were hospitalised in the period between 2016 and 2022. The diagnosis was verified according to modern protocols of diagnosis and treatment, and the results were statistically processed using the Statistica for Microsoft 7.0 software package. Results. Of the children we examined, 80.0% had endoscopically positive (non-erosive form) GERD, with 50.0% having concomitant functional pancreatic disorders. The most significant changes in blood amylase were noted in patients with comorbidity (120.5±0.1 g/(hr×L) and 33±0.3 g/(hr×L), p<0.05) and in patients with the erosive form of GERD (98.1±0.2 g/(hr×L) and 25±0.1 g/(hr×L), p<0.05). Serum lipase levels were also more pronounced in patients with comorbid GERD (70±0.1 U/L and 35±0.2 U/L, χ2=32, p<0.0001). In these teenagers, there was a violation of the quality of life according to the main parameters: heartburn, regurgitation, sleep disorders (the sum of points on three scales was 14.95±0.36 (95% confidence interval: 14.85-15.05) in combination with the appearance of pathology. 11.25±0.65 (95% confidence interval: 11.02-11.48) points - in patients with an isolated course of the disease, erosive form (р˂0.001). Conclusions. The clinical features of GERD in combination with functional pancreatic disorders include severe abdominal pain localized in the pyloric duodenal zone and left hypochondrium. In adolescents with comorbid GERD, the levels of organ-specific enzymes were more often increased compared to the control group. Quality of life was significantly changed in them too. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.
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