Aim. To establish the etiological structure and to present clinical and laboratory and instrumental characteristics of bronchiectasis (BE) not associated with cystic fibrosis (CF) in children. Materials and methods. Sixty-seven hospitalised patients with BЕ not related to CF were followed up between 2017 and 2022. Examination methods: clinical-anamnestic method, general clinical laboratory investigations, investigation of allergological and immune status, phagocytosis system, determination of concentration of specific IgE and IgG to fungi of genus Aspergillus, sweat test, radiological examination and computed tomography (CT) of chest organs, bronchoscopy, Bacteriological examination of sputum and/or tracheobronchial aspirates, nasal and/or bronchial ciliary motility, esophagogastroduodenoscopy, 24-hour pH-metry, intra-esophageal combined impedance-pH-metry, genetic study, lung biopsy. Results. Etiologic factors of BЕ not associated with CF in children were severe pneumonia (22%), primary ciliary dyskinesia (22%), bronchial asthma (13%), Williams-Campbell syndrome (7%), bronchial foreign bodies (7%), gastroesophageal reflux disease (6%), Bronchopulmonary dysplasia (6%), postinfectious bronchiolitis obliterans (5%), allergic bronchopulmonary aspergillosis (3%), chronic granulomatous disease (3%), AIDS (1%), prolonged bacterial bronchitis (1%), brain-lung-thyroid syndrome (1%). The clinical picture is characterized by cough (91%), shortness of breath (67%), fever during exacerbation (48%), chest pain (24%), exercise intolerance (55%), drumstick symptom (9%), moist (76%) and dry wheezing (37%). CT-semiotics of BЕ not associated with CF is characterized by localization in one (58%) or several (42%) lobes; traction (42%), non-traction (49%) B and their combination (9%); increased broncho-arterial ratio 0.9; thickening of bronchial wall; "mosaic perfusion"/"air-trap" symptom (9%); more frequent involvement of lower lungs (64%). The main infectious agents in BЕ not associated with CF were Haemophilus influenzae, Pseudomonas aeruginosa, Staphylococcus aureus. Conclusion. On the basis of a multicentre study, the etiological structure, clinical and laboratory and CT-characteristics of non-CF ВE in children were established.

The purpose of the study was to determine the predictors of severe bronchiectasis (BE) not associated with cystic fibrosis (CF) in children and to evaluate the effectiveness of a stepwise complex conservative therapy. Materials and methods of the study: study design - multicenter cohort prospective pilot study. 67 hospitalized pediatric patients aged from 11 months up to 17 years old (52% boys and 48% girls) with BE caused by previous pneumonia (22%), primary ciliary dyskinesia (22%), bronchial asthma (13%), Williams-Campbell syndrome (7%), bronchial foreign bodies (7%), gastroesophageal reflux disease (6%), bronchopulmonary dysplasia (6%), postinfectious bronchiolitis obliterans (5%), allergic bronchopulmonary aspergillosis (3%), chronic granulomatous disease (3%), AIDS (1%), protracted bacterial bronchitis (1%), and brain-lung-thyroid syndrome (1%) were observed. Predictors of severe BE were determined based on a comparison of groups of patients with mild (up to 4 exacerbations of BE per year) and moderate (from 4 to 6 exacerbations) course of BE (n=31) and patients with severe course of BE (>6 exacerbations per year, n=36). At the second stage of the study, in patients with changes in the severity of the course of BE, who were followed in dynamics (n=42), the frequency of exacerbations was assessed during the year after the appointment of a stepwise complex conservative therapy, which included, depending on the severity, daily drainage massage, exercise therapy, auxiliary devices for the respiratory tract clearance, long-term anti-inflammatory azithromycin, inhaled/intravenous antibiotics, and/or respiratory support. Results: the clinical picture of severe BE occurring with >6 exacerbations per year compared with mild/moderate course of the disease (≤6 exacerbations per year) is characterized by a statistically significantly more frequent registration of dyspnea (86% and 45%, p<0.001), exercise intolerance (69% and 39%, p=0.012), wet rales (89% and 61%, p=0.011), finger clubbing (17% and 0%, p=0.027). The prognostic model for determining the likelihood of severe BE not associated with CF in children includes the age of manifestation, a positive result of bacteriological examination of sputum/aspirates from the respiratory tract, localization of BE in the middle lobe of the right lung and/or lingual segments, and dyspnea. The appointment of gradual conservative therapy for BE, depending on the severity/frequency of exacerbations, makes it possible to statistically significantly reduce the severity of BE (p<0.001) and the median of exacerbations during the year from 9.00 [3.25-12.00] before treatment to 2.00 [1.00-3.00] after treatment (p<0.001). Conclusion: BEs are heterogeneous in severity, which determines the choice of therapy. Conservative therapy of BE not associated with CF in children has a stepwise principle depending on the severity of the course. Its appointment could therefore reduce the frequency of exacerbations.

In order to improve the clinical use of antibiotics in surgical departments of Morozovskaya Children City Clinical Hospital of Moscow Healthcare Department authors prepared, discussed and agreed upon a protocol for perioperative and post-exposure antimicrobial prophylaxis. The choice of antibiotics for systemic use was made according to the Antimicrobial Stewardship Program (ASP) stratification both for patients of type I (community-acquired infection without risk for shedding of polyresistant infectious agents) and type II (community-acquired infections with risk factors for shedding of polyresistant infectious agents). Study determined indications for post-exposure antimicrobial prophylaxis within the approved protocol. Following that the Chief Physician issued an Order On Division of Responsibility of all Members of the Operating Team and On Approval of the Protocol for Conducting Perioperative and Post-Exposure Antimicrobial Prophylaxis. As a result of the implementation of the protocol, by the end of 2020 clinical use of antibiotics in surgical departments has improved.

Fig 1 The facies of twin I (a) and twin II (b) showing characteristic triangular facies, open mouth and broad root of nose. They also had flat occiput and intermittent protruding tongue which is not evident in this picture. Sleep electroencephalographic 10s epoch (Neonatal montage; sensitivity: 10 μV/mm; sweep: 30 mm/s) showing chaotic background with runs of high amplitude (400-1000 μV) slow-waves resembling hypsarrhythmia (c).

A case-report of the treatment of a 13-year-old child with Meckel's gangrenous-perforative diverticulitis complicated by diffuse peritonitis is presented. The perforation localized at the base of Meckel's diverticulum, therefore ileal resection was performed. The presence of peritonitis required a difficult choice of further surgical management - the stoma formation or performing a primary intestinal anastomosis. Nowadays, it is considered an enterostomy to be the most reliable and rational surgical option after bowel resection in peritonitis conditions. However, this issue has become increasingly controversial. There are many publications which testify to the success of primary intestinal anastomosis, regardless of the peritonitis severity and the degree of contamination of the abdominal cavity, even noting the advantages of radical treatment and prevention of various stoma-related complications. In the presented clinical observation the child underwent primary intestinal anastomosis, despite the presence of an exudative inflammatory process in the abdominal cavity. This option was chosen because of the stable general condition of the child, satisfactory central and peripheral hemodynamics, and the absence of significant hydrobalance disorders. There were no complications in the postoperative period. The child was discharged on the seventh postoperative day. We aimed to evaluate our experience with the primary anastomosis approach in peritonitis condition.