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Hemophagocytic syndrome is a key point in the pathogenesis of severe forms of multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C). The factors associated with hemophagocytosis in patients with MIS-C were assessed in the present study of 94 boys and 64 girls ranging in age from 4 months to 17 years, each of whose HScore was calculated. In accordance with a previous analysis, patients with HScore ≤ 91 ( n = 79) and HScore > 91 ( n = 79) were compared. Patients with HScore > 91 had a higher frequency of symptoms such as cervical lymphadenopathy, dry cracked lips, bright mucous, erythema/swelling of hands and feet, peeling of fingers, edematous syndrome, hepatomegaly, splenomegaly, and hypotension/shock. They also had a higher erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and D-dimer levels, and a tendency to anemia, thrombocytopenia, and hypofibrinogenemia. They more often needed acetylsalicylic acid and biological treatment and were admitted to ICU in 70.9% of cases. Conclusion: The following signs of severe MIS-C were associated with HScore > 91: myocardial involvement, pericarditis, hypotension/shock, and ICU admission.

Multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) is a life-threatening condition that often requires intensive care unit (ICU) admission. The aim of this study was to determine risk factors for severe/life-threatening course of MIS-C. The study included 166 patients (99 boys, 67 girls) aged 4 months-17 years (median 8.2 years). The criterion of severity was the fact of ICU admission. To conduct a comparative analysis, MIS-C patients were divided into two groups: patients hospitalized in the ICU ( n = 84, 50.6%) and those who did not need ICU admission ( n = 82, 49.4%). Patients with a more severe course of MIS-C were significantly older. They had a higher frequency of signs such as rash, swelling, hepatomegaly, splenomegaly, and neurological and respiratory symptoms. Hypotension/shock and myocardial involvement were much more common in patients with severe MIS-C. These patients had a more significant increase in CRP, creatinine, troponin, and D-dimer levels. Additionally, the presence of macrophage activation syndrome was higher in patients admitted to the ICU. Conclusion: Nineteen predictors of severe course of MIS-C were found, out of which hepatomegaly, splenomegaly, D-dimer > 2568 ng/mL, troponin > 10 pg/mL were mainly associated with the probability of being classified as early predictors of severe MIS-C requiring ICU admission.

Objective: To study burnout of Russian physicians in the conditions of COVID-19 pandemic and how their work with coronavirus-infected patients influenced it. According to a three-factor model of burnout developed by Maslach and Jackson, this syndrome includes emotional exhaustion, depersonalization, and reduction of personal accomplishment. Design: A cross-sectional survey study. Setting: Large medical practice. Participants: Physicians of different specialties. Methods: Data collection was conducted from June 23 to July 12, 2020. We developed a Google form including a questionnaire and psychological inventories and placed it in a medical portal. Maslach Burnout Inventory - Human Services Survey for Medical Personnel was used to study burnout; the Hospital Anxiety and Depression Scale was used to determine anxiety and depression. Results: Of all the physicians who took part in the study (N = 599), 31.2 % worked with coronavirus-infected patients. Of the medical personnel who treated COVID-19 patients, 63.6% noted increased workload during the pandemic. Compared to other physicians, they more often had a high degree of emotional exhaustion (43.3 % vs 33.0 %, φ* = 2.404, P ≤ 0.01) and depersonalization (41.7 % vs 34, 0%, φ* = 1.803, P ≤ 0.05). An overwhelming majority of physicians, without any dependence on work with infected patients, had an absence of anxiety and depression. The identified interrelations between the symptoms of burnout, anxiety, depression; age and career stage in medical personnel were identical, except for weak correlations between age and emotional exhaustion (rs = -0.097, P ≤ 0.05), as well as career stage and personal accomplishment (rs = 0.102, P ≤ 0.05) in those physicians who worked with COVID-19 patients. The structure of burnout was identical in all physicians and did not depend on interaction with the infected patients. Conclusion: Public health authorities should reduce the workload on physicians involved in treating infected patients against the backdrop of the pandemic. Psychotherapeutic measures focused on preventing burnout should reduce its number among physicians interacting with patients infected with the coronavirus., (© 2022 Marshfield Clinic Health System.)

Background: The identification of risk factors for the development of perioperative complications is one of the most important problems of pediatric anesthesiology., Purpose: To identify risk factors for the development of perioperative complications in children undergoing ambulatory surgical interventions on ENT organs., Methods: Total of 141 patients were examined at the age from 7 to 17 years. Depending on the presence of complications all patients were divided into three groups: «No complications» ( n = 64), «One complication» ( n = 55) and «Two or more complications» ( n = 22). The study was carried out in the following areas: Preoperative clinical status, intraoperative and postoperative complications. The severity of nasal breathing disorders was determined rhinomanometrically. 31 children underwent somnography. In the study of heart rate variability was evaluated. Intraoperative complications included: Cardiac arrhythmias, arterial hypertension and desaturation less than 90%. Postoperative complications included: Cardiorespiratory complications, pain, delirium, postoperative nausea and vomiting., Results: The most significant complication in the intraoperative period is desaturation below 90%, in the postoperative period they are pain, nausea and vomiting. Risk factors for the development of complications in the perioperative period are a decrease in the thyromental distance, hyperplasia of the tonsils of the third degree, Malampati score ≥ to 2 points, parents' bad habits, combined neurological and respiratory pathologies in a child, an assessment of the class «allergology» of the ASPOND scale is not less than 180 points and the prevalence of vagal influences., Conclusions: The obtained results indicate that the presence of risk factors for perioperative complications during operations on ENT organs in children are associated with the initial autonomic status and the predominance of the parasympathetic nervous system as well as with clinical markers., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Saudi Journal of Anesthesia.)

We report a case of cerebral salt-wasting syndrome in a 12-year-old boy with severe traumatic brain injury. The child developed refractory intracranial hypertension at the time of injury, which required decompressive craniectomy on the 7th day after injury. Infusion of hypertonic sodium chloride solutions performed at the intensive care unit resulted in hypernatremia on the 5th day and polyuria and hypovolemia on the 11th day, which was regarded as manifestations of central diabetes insipidus. Persistent hyponatremia developed on the 17th day after injury; on the next day, the therapy was supplemented with Fludrocortisone at a dose of 100 µg/day, followed by an increase in the dose to 150 µg/day, which had no significant effect. Fludrocortisone was discontinued on the 30th day of therapy, but it was re-used at a dose of 400 µg/day from the 54th day. During this treatment, polyuria gradually decreased to 4 to 5 l/day, and the plasma sodium concentration remained within the reference values. The dose of Fludrocortisone was increased to 600 µg/day since the 66th day. The child was transferred to a specialized department on the 67th day after injury. At the Department of Neurosurgery, the dose of Cortineff was gradually reduced starting with the 94th day and completely discontinued on the 122nd day after injury. On day 132th of the post-traumatic period, the patient was transferred to another hospital for rehabilitation therapy.

The Protocol isn't seen as directive. The goal of the Protocol is to define theframes ofdiagnostic criteria and therapeutic action, within which a doctor working in an intensive therapy children have freedom of choice. The Protocol takes into account that the critical and postagressive states are characterized by the features of malnutrition, particularly manifested in the period of intensive growth (first life year). The Protocol submitted by: contraindications to artificial nutricion in any form; indications for parenteral nutrition; components ofparenteral nutrition; calculation of water and energy needs; calculation of substrate requirements; the system of "two in one" and "three in one "; monitoring the effectiveness ofparenteral nutrition; the use of adjuvants and active additives to artificial nutrition, indications for early enteral nutrition, time of the beginning of enteral nutricion and tolerance to it: trial feeding; trophic nutricion; the technique ofprobe feeding; selection offormulas for enteral nutrition; monitoring the effectiveness of enteral nutrition. The Protocol does not discuss the issues of planned nutritional preparation for surgery, nutritional support in chronic malabsorption, sipping.

The article describes some characteristics of temperature homeostasis regulation while intraoperative period and its correction methods by infusions of balanced crystalloid solutions on the basis amino acids and the Krebs cycle substrates., Materials and Methods: 107 children of different ages were included into the study. All of them underwent surgery on thoracic or abdominal organs. The average age was 13 (7-16) years. All the operations were performed with total intravenous anesthesia and artificial lung ventilation. 0,9% sodium chloride solution, "Mafusol" "Infezol-40" and "Reamberin" were used in order to correct perioperative hypothermia. Results of the study. It was found that solutions based onfumarate (mafusol) and succinate (reamberin) have a significant positive effect on the temperature homeostasis. This fact means they can be recommendfor a broad usage in clinical practice for the purpose ofprevention and elimination of intraoperative hypothermia.

Background: Patent ductus arteriosus (PDA) is one of the most common pathological conditions within the neonatal period Functioning of hemodynamically significant patent ductus arteriosus can cause a development ofvarious complications. This is why the earliest possible drug therapy or surgery is required in order to eliminate this fetal communication., The Aim: to study the efficacy and safety of acetaminophen administering to infants with low birth weight for medical obliteration of hemodynamically significant ductus arteriosus., Materials and Methods: The study included 16 infants with gestational age up to 29 weeks and birth weight less than 1200 g, the average birth weight was 980±230 g and gestation was 26,4±1,4 weeks. The average age of the observable patients at the moment of the beginning of the acetaminophen therapy was 56±6 h. Ductus arteriosus diameter was 3,75±1,25 mm. All the children underwent drug obliteration of the PDA through the intravenous acetaminophen administering. 15 mg / kg of the drug was given every 6 hours for three days. The full treatment course included 12 injections., Results: The expected effect (closing of the ductus arteriosus) was achieved in 14 (87.5%) children undergoing the drug therapy. Two children with the birth weight of 1000 g and 1200 g remained with the ductus arteriosus open, but the signs of the left heart volume overload decreased significantly. To achieve a clinical benefit, it took 11 injections of the drug, on average. The children with the ongoing therapy were receiving enteral nutrition with the standard dosages corresponding to their age. No complications of the urinary tract, gastrointestinal tract or haemostatic system were registered., Conclusion: Using acetaminophenfor medical obliteration of the ductus arteriosus is a highly effective and safe method of treatment that has to be used in routine clinical practice. Dosing of the drug is easy to control and change, hence it is possible to cancel the drug administering as soon as the required result is achieved so as to minimize any complications.

Background: Fluid and transfusion therapy is proved to be a required component of treating children with severe major trauma significantly influencing the case outcome., Objective: To analyze efficiency of fluid and transfusion therapy in children with severe major trauma and assess its correspondence with current recommendations., Materials and Methods: 150 children aged from 0 to 18 years getting treatment in intensive care units of children's city hospitals of Saint Petersburg, Archangelsk, Ufa, Samara, and Leningrad region were included in the research. The main course of severe major trauma were car injury and catatrauma. The coefficient according to Pediatric trauma score (PTS) was 6.4 points. The mean duration of hospitalization in emergencies units was 3 (2-7) days, the duration of artificial lung ventilation was 48 ± 99.9 hours, the duration of hospitalization in the department ward was 24 (15-32) days. Favorable outcome (transferring from emergencies units to department wards) was reported in 147 (98%) children, death cases were registered in 4 (2.6%) children., Results: There was determined that the basic crystalloid solutions used for infusion therapy in children were the following: Ringer solution, Plasma-lit solution and 10% glucose solution. "Gelofisin" and "Voluven" had more frequent administration rate among colloidal solutions. Transfusion of blood was performed in 26% patients. The infusion therapy in the first three days did not exceed the necessary physiological requirements that provided stabilization of the patient's condition and did not produce a negative influence on the status of hemodynamics and gas exchange., Conclusion: Administration of current well-balanced crystalloid and colloidal solutions to children with severe combined trauma in an amount within the limits of required physiological indicators does not produce a negative influence on the status of gas exchange and the case outcome.

Unlabelled: Respiratory distress-syndrome (RDS) in newborns is a one of the most frequent critical conditions of neonatal period requires the use of invasive methods of respiratory support., Purpose of the Study: To define an efficiency of complex application of exogenous surfactant and recruitment maneuver in newborns with RDS., Materials and Methods: 30 newborns with RDS and progressive hypoxemia were included in the study. Average mass of body was 1575 grams. In 11 newborns RDS was accompanied severe hypoxemia and required the application of recruitment maneuver and exogenous surfactant administration., Results: Application of recruitment maneuver with exogenous surfactant administration allow to improve gas exchange and blood oxygenation in newborns with RDS (PaO2 54 vs 39 mmHg; SpO2 95 vs 90% and blood pH 7.34 vs 7.28). Application of recruitment maneuver with exogenous surfactant administration decrease number of complications and improve outcomes.