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Pediatriya - Zhurnal im G.N ; Speranskogo. 101(5):50-62, 2022.
Article in Russian | EMBASE | ID: covidwho-2081376


The pathogenetic basis for Pediatric Multisystem Inflammatory Syndrome (PMIS) associated with SARS-CoV-2 is systemic vasculitis resulting from hyperproduction of pro-inflammatory cytokines associated with dysregulation of the immune response. Clinical manifestations of PMIS include fever with features of Kawasaki Syndrome (KS) and multi-organ dysfunction coupled with frequent unusual heart involvement, ranging from mild with minimal ECG changes or elevated troponin to fulminant myocarditis or Takotsubo syndrome (TTS). The purpose of the research was to study the characteristics of cardiovascular disorders in Kawasaki-like multisystem inflammatory syndrome associated with COVID-19 in children observed in the East Siberian area of Russia. A single-center retrospective cohort study was carried out on the basis of the Irkutsk Oblast Regional Children's Clinical Hospital (Irkutsk, Russia): 36 patients with PMIS associated with COVID-19 in Nov. 18, 2020 - Dec. 31, 2021, including 21 boys (M/F ratio 1.4:1) at the average age of 7.5 years old (1.5 months to 17 years old). The diagnostic signs of KS were observed in 34 (94%) children, including the complete set of diagnostic signs in 21 (58%). Refractory fever and a sharp increase in inflammatory biomarkers were detected in all 36 (100%) children;multiorgan dysfunction in 31 (86%);thrombocytopenia in 24 (67%);gastrointestinal syndrome in 25 (69%);cerebral dysfunction in 24 (66)%;various cardiovascular disorders in 30 (83%), including: dilatation of the left ventricle (LV) and a decrease in myocardial contractility in 3 (8%);moderate coronary dilatation in 5 (14%);thickening of the posterior LV walls in diastole in 5 (13%);thickening of the interventricular septum in diastole in 6 (16%). According to the MRI results performed in 15 children the signs of myocardial damage were found in 6 (40%). LV dilatation and decreased myocardial contractility were noted in 3 (8%) children, clinically apparent thrombotic complications in 3 (8%) children as well, and severe neurological deficit in one patient (3%). An increase in the level of D-dimer was observed in 26 (72%) patients, thrombocytopenia in 24 (67%), a statistically significant correlation between thrombocytopenia and myocardial damage was found (R=-0.506, p=0.001). The treatment measures were given as follows: inotropic support (dobutrex/dobutamine) was received by 8 (22%), artificial lung ventilation - by 8 (22%), intravenous human immunoglobulin 1.5-2.0 g/kg/course - by 28 (77%), dexamethasone - by 24 (67%), tocilizumab - by 2 (5%) patients. All 36 (100%) patients have survived. Conclusion(s): the Kawasaki-like multisystem inflammatory syndrome associated with COVID-19 was accompanied by the cardiovascular disorders (pericarditis, arrhythmias, abnormal ECG changes, elevated troponin and/or natriuretic peptide, LV thickening on echocardiography, coronary dilatation) in most patients, although LV dilatation and decreased myocardial contractility were observed in a few cases only. A negative correlation between thrombocytopenia and myocardial damage was found, which may indicate the involvement of thrombotic microvascular inflammation in the genesis of myocardial disorders. Copyright © 2022, Pediatria Ltd. All rights reserved.

Endoskopicheskaya khirurgiya ; 26(2):34-38, 2020.
Article | Web of Science | ID: covidwho-789997


Disseminating knowledge and sharing ideas about the rapidly spreading COVID-19 infection caused by the SARS-CoV-2 is critical to the work of surgeons worldwide. Recommendations for working with patients infected with SARS-CoV-2 should be published quickly and updated by the relevant scientific societies often to protect surgeons. In this context, the number of endosurgical procedures in pediatric surgery during the current pandemic is strongly recommended. At the same time, laparoscopy can be used with maximum precautions in those few cases where the benefits of endosurgery outweigh the risks. We must increase the awareness of medical staff and provide protection against the risk of occupational exposure to viral infection in both laparoscopic and open surgery. There is an urgent need to create a strict protocol for the rational use of carboxyperitoneum during laparoscopy. It is necessary to prevent the danger of aerosol diffusion for surgeons during endosurgical treatment, including the mandatory filtering devices using. Распространение знаний и обмен идеями о быстро распространяющейся инфекции COVID-19, вызванной коронавирусом SARS-CoV-2, имеют решающее значение для работы хирургов во всем мире. Рекомендации по работе с пациентами, инфицированными SARS-CoV-2, должны публиковаться быстро и часто обновляться соответствующими научными обществами, чтобы обезопасить хирургов. В этом контексте настоятельно рекомендуется сократить число эндохирургических процедур в детской хирургии во время нынешней пандемии. В то же время лапароскопия может применяться с максимальными мерами предосторожности в тех немногих случаях, когда преимущества эндохирургии перевешивают риски выполнения эндоскопической хирургии. Мы должны повысить уровень осведомленности медперсонала и обеспечить меры защиты от риска профессионального воздействия вирусной инфекции как в лапароскопической, так и в традиционной открытой хирургии. Существует острая необходимость в создании строгого протокола для рационального применения карбоксиперитонеума во время лапароскопии и предупреждения опасности диффузии аэрозоля для хирургов во время проведения эндохирургических операций, включая обязательное использование фильтрующих устройств.