17th City Children's Clinical Polyclinic

Introduction. The prone position is widely used in modern medicine, ranging from surgical procedures to the management of patients with acute respiratory distress syndrome. The COVID-19 pandemic highlighted its clinical significance, demonstrating improvements in oxygenation and hemodynamics in patients. It is known that the prone position affects the electrical activity of the heart, causing changes in the axis and morphology of the QRS complex, as well as in repolarization parameters. These featuresmay mimic ischemic changes on the electrocardiogram. Contemporary studies also indicate a possible prolongation of the QT interval and its prognostic significance. The aim of the study is to assess the effect of body position (prone position) on heart rate and repolarization parameters according to electrocardiographic data in young healthy men. Materials and methods. A cross-sectional study was conducted at the Research Laboratory “Problems of Hypoxia” of Pitirim Sorokin Syktyvkar State University. The study included 18 young men without chronic or acute diseases. Electrocardiogram recordings were obtained in standard lead II in the supine position and in the prone position using the Poly-Spectrum hardware–software complex. The heart rate, QT interval, corrected QT interval (QTc), Tp–e interval, and the Tp–e/QT and Tp–e/QTc ratios were analyzed.Results. A statistically significant increase in heart rate was observed in the prone position, averaging 21.5% (12.8%; 31.0%). The QT interval duration in the prone position significantly decreased compared with the supine position, whereas QTc significantly increased. QT dispersion, Tp-e, as well as the Tp-e/QT and Tp-e/QTc ratios did not demonstrate significant changes.Discussion and conclusion. The prone position affects the electrophysiological parameters of the heart, leading to an increase in heart rate and the QTc interval while not significantly altering indices of repolarization dispersion, which may be relevant for the interpretation of the electrocardiogram in clinical practice.

INTRODUCTION. The article presents the results of a clinical study of the efficacy and safety of repetitive transcranial magnetic stimulation in children with frequent episodic and chronic tension headache (CTH). AIM. To study the efficacy and safety of repetitive transcranial magnetic stimulation in children and adolescents with frequent episodic and chronic tension-type headache (TTH). MATERIALS AND METHODS. A prospective open cohort clinical study of pediatric patients with a diagnosis of frequent episodic and chronic TTH was conducted at Children’s City Polyclinic No. 39 in Moscow from December 2024 to November 2025. The study included 79 patients aged 8–17 years (mean age 13.36 ± 2.55 years) were included. The method of repetitive magnetic stimulation of the left dorsolateral prefrontal cortex was used with a power of 70–90 % of the individual threshold value of the evoked motor response, a frequency of 10 Hz in intermittent mode (4 sec of stimulation, 11 sec of pausing), with a total procedure duration of 16–19 minutes (2500–3000 pulses in total). Therapy efficacy was evaluated by analyzing the changes in headache diary parameters, diagnostic questionnaires, and instrumental research data. RESULTS. During treatment, there was a significant positive trend in the main criterion of effectiveness — the frequency of episodes and intensity of headache (p 0.001 and p 0.001 respectively), persisting in the delayed period. When assessing the emotional state on the HADS (Hospital Anxiety and Depression Scale) scale after the rTMS course, the proportion of respondents was 50 % in terms of the dynamics of anxiety and depression symptoms (p 0.001, McNemar criterion). There was a significant positive trend on the Spielberger-Khanin scale of situational and personal anxiety (p 0.001 for all parameters) and the CPAQ-R chronic pain acceptance questionnaires (p 0.001) and PedsQL quality of life questionnaire (p 0.001). DISCUSSION. The emotional background in CTH is mainly accompanied by an increase in the level of personal and reactive anxiety. A cumulative analysis of the conducted instrumental physiological tests shows that transcranial neurostimulation techniques can enhance the functionality of the nervous system. However, in order to confirm this observation, a longer delayed assessment period and an increased sample size in each age category are necessary. The effect obtained is directly related to the effect of rTMS and the features of the protocol used. The effect of dorsolateral prefrontal cortex stimulation on the emotional state of patients with anxiety and depressive disorders can be attributed to the neuromodulating effect of repetitive transcranial magnetic stimulation (rTMS). CONCLUSION. Transcranial magnetic stimulation of the left dorsolateral prefrontal cortex significantly reduces both the number of headache episodes and its intensity, while the effect persists or increases after the end of the course of procedures, and reduces symptoms of anxiety and depression in children. The assessment of the safety and tolerability of the procedures revealed isolated cases of adverse events (no more than 5 % of the total sample of patients), which indicates the possibility of using the rTMS protocol with subthreshold intensity in the age range of 8–17 years.

Introduction. The intestinal microbiome has attracted much attention from scientists worldwide due to its complex interaction with many diseases, including obesity, metabolic disorders, and cardiovascular diseases. Objective: to study the state of the small intestinal microbiome in adolescents with constitutional-exogenous obesity and lipid metabolism disorders. Materials and methods. A one-time case-control study was conducted on 50 adolescents aged 12-17 years with constitutional-exogenous obesity of grades 2-4 living in St. Petersburg. Complaints, life history data and disease, objective clinical examination, and laboratory and instrumental research results were assessed. In particular, special attention was paid to the analysis of the lipidogram. The state of the parietal microbiota of the small intestine was studied by the method of blood gas chromatography-mass spectrometry (MSMM) (according to the author’s method of Osipov G.A.). Statistical data processing was carried out using the IBM SPSS Statistics 27.0 program (USA). Results and discussion. Analysis of the quantitative composition of the small intestine microbiome showed that there was a redistribution of phylotypes. It was characterized by a general decrease in the number of all identified bacteria and the predominance of Firmicutes microorganisms. Moreover, with hypercholesterolemia, an increase in clostridium propionicum, lactobacillus spp and lactococcus spp was noted, and with hypertriglyceridemia, a decrease in micromycete spp (sitosterol). Our data were comparable with the results of work conducted by scientists from China. However, a number of foreign studies have shown that lactobacilli contribute to a decrease in the level of total cholesterol, LDL. This problem requires further study. Conclusion. In adolescents with obesity and dyslipidemia, the microbiome of the small intestine was found to have a decreased diversity and a predominance of Firmicutes microorganisms, a decreased amount of micromycete spp (sitosterol).

Oat grass (Avena sativa L.) harvested at the milk ripeness stage is a valuable source of bioactive compounds, including polysaccharides, phenolics, alkaloids, and cardiac glycosides with diverse health-promoting properties. This study introduces a novel extraction approach that combines natural fermentation with a brief hot water treatment to maximize the yield of a broad spectrum of bioactive compounds while maintaining extract quality. The optimized protocol (12 h cold water fermentation followed by 1 min boiling) was systematically compared with two widely applied techniques: ultrasound-assisted aqueous extraction and ultrasound-assisted extraction with deep eutectic solvents (DES). The fermentation-based method resulted in the highest polysaccharide recovery (4.93 ± 0.15 mg g-1), superior phenolic compound content, and enhanced antioxidant activity, as demonstrated by high DPPH radical scavenging capacity (66.3 ± 2.6%) and ferric reducing power (4.52 ± 0.18 mg TE g-1). In contrast, ultrasound extraction in water or DES achieved lower polysaccharide yields and showed reduced functional activity, while DES-based extraction produced higher amounts of alkaloids and glycosides, highlighting the importance of safety profiling and indicating a need for careful consideration regarding extract safety and downstream purification for food applications. The aqueous fermentation approach offered the advantages of simplicity, and avoided issues related to solvent recovery inherent to DES systems. These findings highlight fermentation-assisted hot water extraction as a scalable and sustainable method for producing oat-derived polysaccharide-rich extracts with potential applications in functional foods and nutraceuticals.

Medicinal plants are a valuable source of biologically active substances used to prevent and treat diverse diseases. The major classes of these compounds—alkaloids, glycosides, flavonoids, essential oils, tannins, polyphenols, and polysaccharides—exhibit broad pharmacological activities, including antimicrobial, anti-inflammatory, antiseptic, and antioxidant effects. Phytochemical screening of plant extracts plays a crucial role in identifying these compounds and supporting the development of new therapeutic agents. In this study, a spectrophotometric phytochemical screening was performed to evaluate alkaloids, tannins, flavonoids, phenolic compounds, steroid cardiac glycosides, and polysaccharides and the antioxidant activity of extracts from three medicinal plants from different families, milk-ripened oats (Avena sativa L.), madder root (Rubia tinctorum L.), and Scotch heather (Calluna vulgaris L.), was assessed. High-performance liquid chromatography was used to achieve a more detailed chemical profile. Both conventional solvents (methanol, ethanol, water-alcohol mixtures, water, acetonitrile) and a new class of solvents, deep eutectic solvents, were used as extractants. Ultrasound-assisted extraction proceeded at 40–80°C for 10–60 min. The optimal extraction conditions were found for the major compound groups: 80°C for 60 min with conventional solvents, 50°C for 30 min for Calluna vulgaris L. with deep eutectic solvents, and 60°C for 30 min for madder root and oats with deep eutectic solvents. The results demonstrate that deep eutectic solvents effectively extract the target bioactive substances under milder conditions, underscoring their potential as environmentally sustainable extractants in phytochemical research.

BACKGROUND: Muscular dystrophies are a broad and heterogeneous group of hereditary neuromuscular disorders, most commonly manifesting with primary symmetric involvement of proximal skeletal muscles in the upper and lower limbs. Patients with these disorders are at increased risk of muscle fiber damage if exercises and their intensity are inappropriately selected during physical therapy. At present, no neuroimaging markers are available to assess the safety of physical exercise in patients with inherited myopathies. Quantitative MRI criteria for detecting clinically significant changes in skeletal muscles have also not been developed. AIM: This study aimed to evaluate the safety of physical therapy exercises in pediatric patients with muscular dystrophies using neuroimaging, clinical, and laboratory methods. METHODS: The study included 86 patients with genetically confirmed Duchenne muscular dystrophy (mean age 7.5 ± 2.4 years) and 42 patients with limb-girdle muscular dystrophies (mean age 11.8 ± 3.3 years). All patients underwent a 4-month rehabilitation program consisting of aerobic physical therapy exercises, stretching, and cycle ergometer training. Safety was assessed using clinical, laboratory, and neuroimaging measures. RESULTS: According to MRI findings, no statistically significant increase in T2 water signal intensity was observed after aerobic exercises without load in the major muscle groups of the pelvic and shoulder girdles, thighs, and calves in either group, indicating no progression of nonspecific inflammation or edema. All reported adverse events were mild and short-term, did not affect the rehabilitation, or require additional pharmacological or non-pharmacological treatment. Eight cases of skeletal muscle injury were observed, attributable to concentric or eccentric exercises. In the Duchenne muscular dystrophy group, the mean skeletal muscle signal intensity before exercise was 34.9 ± 1.0 ms and increased to 44.1 ± 3.7 ms during follow-up (p 0.01). In the limb-girdle muscular dystrophies group, signal intensity was 33.6 ± 2.3 ms and 44.3 ± 4.1 ms, respectively (p 0.01). CONCLUSION: Thus, the developed rehabilitation program, which includes aerobic exercises without load, does not result in skeletal muscle damage in patients with various forms of muscular dystrophy, as confirmed by neuroimaging, clinical, and laboratory assessments. In patients with Duchenne muscular dystrophy, skeletal muscle MR signal intensity from water increased on average by 20.4 ± 5.8%, whereas in patients with limb-girdle muscular dystrophies it increased by 23.8 ± 6.3%. This increase is clinically significant and indicates skeletal muscle injury accompanied by corresponding symptoms.

Introduction. Iridodialysis refers to a localized detachment occurring at the attachment site of the iris to the ciliary body. This condition is often the most severe consequence of ocular trauma, leading to discomfort, decreased visual quality, and diplopia. Conventional corrective approaches typically induce astigmatism, thereby compromising the functional results of the operation.Purpose: to assess the effectiveness of an innovative surgical approach for traumatic iridodialysis that incorporates the one-time implantation of a toric intraocular lens in patients with prior unsuccessful cataract surgeries.Case description. A patient reported significant cosmetic and visual disturbances including reduced visual acuity, photophobia, and visual discomfort in the right eye, following an earlier complicated cataract surgery that did not involve an intraocular lens implant. Our treatment strategy utilized a minimally invasive technique for the simultaneous implantation of the intraocular lens and closed iridoplasty.Conclusions. The surgical approach provided rapid and complete rehabilitation, yielding high clinical and functional outcomes, including the restoration of visual acuity and the resolution of the patient’s cosmetic concerns.

Purpose – to investigate the diagnostic morphofunctional capabilities of the cardiopulmonary complex for electrocardiographic evaluation of the health school (HS) classes for phthisiopulmonological male patients MDR XDR MBT effectiveness. Materials and methods. 74 male patients of the Rostov Regional Clinical Center for Phthisiopulmonology took part in the study after signing a voluntary informed consent. The age of the patients ranged from 26 to 67 years. The study was conducted in 2018. 40 patients (the main group) took part in the HS and attended from 1 to 6 classes out of 10. The interval between classes was 7 days. 34 patients did not participate in the work of the HS and made up the control group. The medical effectiveness of HS was assessed by the difference in the angles of the alpha electrical axes of the atria, ventricles and the heart as a whole before classes (on admission to the hospital) and after classes (before discharge). Results and discussion. Significant correlations (p<0.05) were established between the frequency of visits to HS by patients with MDR XDR MBT and the following indicators: "Angle alpha deviation of the electrical axis of the ventricles (in degrees)" = -0.461; "Angle alpha deviation of the electrical axis of the heart (in degrees)" = -0.408. Conclusion. The positive dynamics of electrocardiographic vectors allows us to consider the cardiopulmonary complex as a universal indicator system that reflects morphofunctional and clinical changes in the state of phthisiopulmonological patients as a result of informational and cognitive influences.

Objective. To analyze the work of the emergency medical care department (EMCD) of the largest children's polyclinic of the city in 2020-2022 and to evaluate the organization of the EMC for the attached children during the Covid-19 pandemic. Materials and methods. Mathematical and statistical analysis of quantitative and qualitative indicators of EMCD activity based on a continuous sample of primary accounting and reporting medical documentation. Results. A significant increase in the number of EMCD visits was demonstrated. In 2022, the growth was 40,96 % and 28,12 % compared to 2020 and 2021. It was found out that in 97,4–98,0 % of all cases provided with EMC, were the children with respiratory diseases. Their number in 2022 increased 1,3 times compared to 2021, and 1,43 times compared to 2020. In this group of patients, the number of children with pneumonia increased by 63.5 % in 2021 compared to 2020. Conclusions. The proper organization of the work of the EMCD made it possible to provide children with available, timely and rapid primary medical social and emergency medical care during an increased workload in the context of the COVID-19 pandemic.

Background. Alport syndrome is a systemic, hereditary, progressive disease characterized by ultrastructural changes in the glomerular basement membrane caused by pathogenic variants of type IV collagen genes. The use of angiotensin-converting enzyme inhibitors (ACEI) for nephroprotection is effective at the microhematuria and/or albuminuria stage. Treatment tactics in case of nephrotic syndrome development in such patients remains the subject of discussion. Clinical case description. The patient was diagnosed with proteinuria at the neonatal period and hematuria at the age of one month. The hereditary nephritis was diagnosed at the age of 6 years; the ACEI was administered, however, the proteinuria continued to increase. The diagnosis was confirmed at the age of 8.5 years via the puncture nephrobiopsy: collagenopathy, type IV, focal segmental glomerular sclerosis. Moreover, chronic bilateral sensorineural hearing loss and bilateral myopic astigmatism were diagnosed. Ciclosporin A (125 mg/day) was additionally prescribed. The increase in the cystatin C, urea, uric acid, cholesterol levels in blood was mentioned after 14 months of treatment. These parameters decreased after reducing cyclosporine A dose to 100 mg/day, however, proteinuria has increased. Angiotensin II receptor blocker (candesartan 8 mg/day) was prescribed to enhance nephroprotective therapy at the age of 10 years 2 months. Another increase of the immunodepressant dose was performed at the age of 11, it led to decrease in the estimated glomerular filtration rate and increase of creatinine, cystatin C, urea, cholesterol, uric acid, and potassium levels in the blood. These changes were considered as cyclosporine-dependent. The dose of cyclosporine A was reduced to 125 mg/day, and to 100 mg/day from the age of 14. There was no progression of chronic kidney disease at the follow-up at the age of 15.5 years. Conclusion. Nephroprotective treatment of a child with Alport syndrome initiated after the development of nephrotic syndrome did not stop the chronic kidney disease progression. Whereas relatively high doses of ciclosporin A have reduced proteinuria but led to nephrotoxicity and cyclosporin dependence.