COVID-19 AND CHILDREN: COMPLICATIONS AND LATE OUTCOMES.

Since December 2019, Covid-19 has become a challenge for doctors around the world, including pediatricians. In most infected children, the disease manifests itself in a mild or is char- acterized by a subclinical course. At the same time, in some cases, a severe clinical picture of the so-called late Covid disease may develop, in the form of a multisystem syndrome and other complications. In 2020-2021 at the Academic Pediatric Clinic named after G. Zhvania of Tbilisi State Medical University, we observed 60 children with post-Covid complications and late Covid syn- drome. More than half (32 children - 53.3%) were under 5 years of age, with a predominance of boys (33 children - 55%) who had a Covid-19 infection 1.5-2 months before contacting us with a positive antibody reaction. Most of them (51 children - 85%) were healthy before the disease. Vasculopathy, immune thrombocytopenia, thalassemia minor, primary diabetes, iron deficiency anemia, coagulopathy, pneumonia-atelectasis, exacerbation of the underlying disease - arthralgia, arthritis and abnormal manifestations of sleep disturbance, general weakness and dizziness were noted. Separately, it is necessary to highlight the multisystem inflammatory syndrome in chirdren - MIS-C (8 children - 13%) proceeding with clinical signs of Kawasaki disease (mucocutaneous-lymphatic syndrome) with hectic temperature, polyserositis, hepatosplenomegaly, high rates of inflammation markers, a tendency to hypercoagulability. One patient had a coronary artery aneurysm. In 3 cases, the ANA and ANF titer was increased (up to 1:640) and also with nucleic, cytoplasmic and linear fibrils fluorescence, which indicates immune reactions in Covid infection, which can explain the positive effect of corticosteroid therapy in the treatment of these patients. Only 22 (36%) patients were hospitalized, the rest were observed on an outpatient basis. Based on the aforementioned, it can be concluded that even with the asymptomatic course of Covidinfection in children, complications can be observed and the syndrome of the so-called late Covid, which dictates the need for a thorough examination of these patients and observation in dynamics.

RESOLUTION OF NATIONAL ADVISORY BOARD.

On October 2, 2020, by Novo Nordisk initiative, an expert council was held in Tbilisi, Georgia, dedicated to the problems of introducing innovative insulin therapy on the example of insulin degludek into the clinical practice. The council chaired by prof. R. Kurashvili included seven leading endocrinology experts in Georgia and a specialist in the field of pharmaco-economics from Russian Federation Prof. A. Kulikov. During the expert council, important scientific, clinical and economic emphases were made on the benefits of using insulin degludec associated with its unique structure and mechanism of action. Special emphasis was placed on the difficulty in managing children and adolescents with type 1 diabetes. The meeting provided compelling evidence that insulin degludec reduces the incidence of hypoglycemia and diabetic ketoacidosis, thereby contributing to overall health and the prevention of vascular complications in children and adolescents with diabetes. The members of the council resolved to petition the Georgian Ministry of Health to include insulin degludek in the state program for children and adolescents with diabetes.

Hallermann-Streiff syndrome: a case report from Georgia.

We report a 9 years and 6 month old boy with the Hallermann-Streiff syndrome (HSS). The patient was referred by a pediatrician. The diagnosis was established by endocrinologist based on the presence of specific facial gestalt (bird-like face) and bilateral congenital cataracts. The patient was not short, but had mild mental retardation; hypotrichosis was represented by Sign of Hertoghe (Queen Anne's sign) only. Thyroid function was normal. X-ray study yielded valuable data. The night apnoea (secondary to the dyscephalic narrowing of the upper airways) constituted the major concern. We also discuss diagnostic criteria for the HSS along with significance of various clinical signs. Combination of specific facial gestalt and ocular abnormalities should be particularly alarming. Endocrine aspects of the HSS are reviewed. X-ray study is recommended as an inexpensive and readily available but informative tool.

[Faun tail--isolated sacrolumbar hypertrichosis in pediatric endocrinology].

3 girls with Faun tail are presented. Local hairiness in the sacrolumbar area was associated with spinal dysraphism, tethered cord, intradural lipoma, meningomyelocele and dyastematomyelia, all confirmed by MRI. Moderate neurological findings were present in one case only. In all the cases the primary diagnosis of the principal spinal pathology was established by endocrinologist (two patients were referred by dermatologists, one by ortopaedist). This indicates that a physician of any specialty may have to establish the primary neurological diagnosis. Hence, the awareness of the possible connection between the neurological pathology and the cutaneous symptoms, including local hypertrichosis, is of major significance.

[Diagnostic value of definition of lactate dehydrogenase in mixed saliva in children with periodontitis at diabetes mellitus, type I].

The problem of treatment of periodontitis remains one of the hot topics in practical stomatology. It has been established that modern adaptogenic infection is rather aggressive to whole organism of a human being. All these demands accurate approach while choosing of a conservative method of treatment for such forms as acute and chronic periodontitis. There were 27 children under observation with diabetes mellitus of type 1 (I group). Mean age was 10.5+/-0.75 years. 15 were girls and 13 boys. All patients from the I group were examined for the pathologies of oral cavity. In 100% dryness in a mouth and in 67% bleeding from the gum had been revealed. The mild form of chronic catarrhal gingivitis was revealed in 12 patients, moderate in 5, chronic hypertrophic gingivitis in 8 respectively. Studying of pH of saliva and lactate dehydrogenase (LDH) activity in children with periodontitis developed on the background of recently diagnosed type 1 diabetes mellitus has shown, that pH of saliva was equal to 5.3+/-0.18. In control group (healthy children) pH of saliva was 6.8+/-0.06. In the conclusion it should be emphasized, that we have tried to explain some aspects of multiple character of development of periodontitis at recently discovered insulin-depended diabetes mellitus. Character of changes of some properties of saliva pH and of enzyme activity of LDG promotes to carrying out medical and preventive actions, influencing the main blocks of pathogenesis of this pathological process. Besides, we consider possibility of inclusion the studied parameters of mixed saliva in the algorithm of investigation of periodontitis in children with recently diagnosed type 1 diabetes mellitus.

[Clinico-diagnostic characteristics of autoimmune thyroiditis in children]. / Kliniko-diagnosticheskie osobennosti autoimmunnogo tireodita u detei.

As many as 174 children (152 with autoimmune thyroiditis, 12 with thyroid diseases of non-autoimmune genesis and 10 with diffuse toxic goiter) underwent clinical and laboratory examinations with a purpose of delineating the clinical course and comparative assessments of the methods applied in the diagnosis of autoimmune thyroiditis. High risk for the disease in the pre- and pubertal age, the lack of a specific appearance, gradual disease development, uneventful course in many cases with a progressive development of hypothyrosis, and rare development of the grave patterns of hypothyrosis have been established. In clinically euthyroid conditions, the thyroliberin test revealed the predominance of latent or evident hypothyrosis in the majority of patients. Aspiration puncture of the thyroid accompanied by a cytological study of the punctate and detection of circulating immune complexes (increase of the content of medium-size circulating immune complexes) turned out to be of high diagnostic value. The measurement of the titer of antithyroid antibodies is of importance provided their level is high. Nevertheless the lack of antibodies does not allow one to exclude autoimmune thyroiditis. The scanning of the thyroid is of additional diagnostic significance, particularly in cases that require differentiation with nodular patterns of goiter and neoplasms.