[Factors of the hemostasis system as biomarkers of severe course of acute viral infections]. / Faktory sistemy gemostaza kak biomarkery tyazhelogo techeniya ostrykh virusnykh infektsii.

The authors give literature review of hemostasis and immune system factors intraction as main biomarkers of a severe cause of viral infectious diseases. Pro-inflamatory cytokines as the main markers of inflammation, can serve both as biomarkers of the clinical severity of the infectious process and reflect the state of the hemostatic and fibrinolytic systems, since components of these systems are present in various structures of the central nervous system and affect the development of neurons and synaptic plasticity. An inverse correlation has been proven between the concentration of D-dimer and the oxygenation index, and the development of DIC is not associated with the presence of respiratory failure in patients with influenza type A, while the ferritin concentration directly reflects the severity of the disease. One of the markers of endothelial damage may be soluble thrombomodulin, which, however, is rarely used in routine clinical practice. Cytoflavin is a highly effective pathogenetic drug that affects various parts of the hemostasis system, has anti-ischemic, antioxidant, antihypoxic, immunocorrective effect, which is indicated for any generalized infectious disease since its debut.

[Difficulties in diagnosing the chronic course of tick-borne encephalitis in children]. / Trudnosti diagnostiki khronicheskogo techeniya kleshchevogo entsefalita u detei.

Infections transmitted by ixodic ticks in childhood account for about 20%, and tick-borne encephalitis accounts for up to 25% of cases. A feature of the course of tick-borne encephalitis is unpredictability and the possibility of chronization in 1-3% of cases with late diagnosis and inadequate therapy. The article presents a clinical observation of the disease in a child whose chronically progressive course of amyotrophic form was diagnosed 1 year and 8 months after the onset of the disease. The presence of anamnestic data, features of clinical manifestations in the dynamics and typical neurovirualization picture of the disease, even with negative results of serological and molecular genetic studies of blood and cerebrospinal fluid, allowed to make a diagnosis, prescribe etio-pathogenetic therapy and thereby stabilize the patient's condition. The use of complex drugs in the treatment, such as Cytoflavin, allows to optimize the course of the disease.

[FIRES Syndrome in a Preschool Child]. / Sindrom FIRES u doshkol'nika.

Severe epileptic syndromes of childhood are an urgent problem for pediatric neurologists and neuroresuscitators. The article presents a clinical observation of FIRES syndrome in a pediatric patient, which is a form of severe drug-resistant epilepsy in children of preschool and school age, the development of which is caused by hyperthermia, probably associated with herpesvirus (human herpesvirus type 6) infection. The features of the progressive course and the difficulties of diagnostic search are reflected. An empirical approach to etiotropic therapy is described, since the disease manifested itself with respiratory manifestations and fever. The tactic of pathogenetic treatment is described, in which drugs of polyfunctional action, such as Cytoflavin, have a priority, many years of experience in the use of which allows the authors to recommend it as a starting intensive therapy.

[Immunopatological and genetic aspects of pathogenesis of CNS lesions in VZV infection]. / Immunopatologicheskie i geneticheskie aspekty patogeneza porazhenii TsNS pri VZV-infektsii.

The review article provides information about the features of the Varicella-zoster virus (VZV), about the clinical manifestations of CNS damage in acute and chronic VZV infection in children and adults, about the mechanisms of interaction of the pathogen with the immune system during the development of the disease. The question of whether to consider neurological disorders in VZV infection as a complication or manifestation of the disease caused by a defective virus or the presence of subclinical immunodeficiency is discussed, which is confirmed by modern scientific studies. The critical mechanisms of immune defense against VZV, which are the main reason for the penetration of the virus into the CNS and the development of neurological disorders, as well as the relationship between VZV genotypes, the presence of mutations in the gE gene and the nature of the course, the identification of rare variants of the POLR3A, POLR3C, POLR3E and POLR3F genes associated with violation of IFNs induction, and the development of severe VZV infection, in which vasculopathy also occurs, which is the basis for the use of vascular drugs of complex action, such as Cytoflavin, the effectiveness of which has been proven by the authors. A special place is given to the analysis of intrathecal immunopathogenesis, which is likely to be associated with the presence and severity of neurological manifestations, their relapses. The issue of the causes of the development of a severe course of the disease in patients vaccinated against chickenpox, as well as the issue of resistance to specific antiviral drugs, probably associated with the presence of mutations responsible for the resistance of the virus to therapy, is discussed.

[Modern concepts on the pathogenesis of neuroborreliosis]. / Sovremennye predstavleniya o patogeneze neiroborrelioza.

The analysis of publications on the websites PubMed, ClinicalKey, devoted to the pathogenesis of neuroborreliosis (NB), using keywords for search: «pathogenesis of neuroborreliosis¼, «neuroborreliosis in children¼, «pathogenesis of Lyme disease¼, as well as an analysis of the results of the published research results of the staff of the Research Institute of Pediatric Infections, St-Petersburg, Russia is presented. Syndromes of early and late NB are more often observed among the forms without migrating erythema, and their development can be caused by all representatives of the species B. burgdorferi s.l. (B.b.), but more often - B. garinii, since it most effectively suppresses the factors of innate and adaptive immune response, reducing interferon production, phagocytosis and complement synthesis. The cause of immunosuppression with the development of NB may be simultaneous infection with several genovids and borrelia species or pathogens of other infections transmitted by Ixodes ticks, for example, infection with B.b. and tick-borne encephalitis virus. The ability to move along peripheral nerves, the change of surface antigens of the VlsE protein, as well as the formation of atypical cysts and granular forms allows B.b. to affect different structures of the peripheral and central nervous system, avoid an immune response and persist for a long time, causing chronic neuroinfection. Both the B.b. themselves, capable of being outside and inside glial cells and neurons, and inflammatory reactions developing in response to their introduction and associated with the synthesis of cytokines and chemokines and mimicry, cause damage to the vascular endothelium, vasculitis and impaired blood supply to the brain, demyelination, autoimmune inflammation and degeneration, leading to the development of NB syndromes, the spectrum of which varies depending on the duration of neuroinfection. In the development of NB and its outcomes, the following are also important: early initiation of treatment, the effectiveness of antibacterial drugs, the use of immunotropic agents that optimize the patient's immune response to the fight against neuroinfection, as well as the timely use of pathogenetic drugs, such as Cytoflavin, which have a complex effect on the vascular endothelium.

[Structural epilepsy or herpes simplex encephalitis relapse: diagnostic problems]. / Strukturnaya epilepsiya ili retsidiv gerpeticheskogo entsefalita: diagnosticheskie trudnosti.

The article gives the clinical case of herpes simplex encephalitis relapse with the resistant seizures in a child. What we describe is a clinical approach towards the differential diagnostic of the seizures in structural epilepsy, which are resistant to anticonvulsants, or late herpes simplex encephalitis relapse. Good clinical perspective may be the indication of the intratecal synthesis of the IgG-specific antibodies to the herpes simplex type 1 and 2. Conducting etiotropic treatment with the appointment of acyclovir and pathogenetic therapy with the use of Cytoflavin contributed to the rapid and stable remission of epileptic seizures and regression of neurological deficit.

Quantitative Electroencephalography Indicators in Children with Acute Purulent Meningitis.

The aim of the present work was to assess the state of brain bioelectrical activity in children during the acute period of bacterial purulent meningitis, with quantitative mathematical analysis of the changes found. The studies included 31 children on days 1 and 6 from onset of illness: 16 children (8.9 ± 2.4 years) admitted to the Pediatric Scientific Clinical Center for Infectious Diseases with laboratory confirmation of diagnoses of purulent meningitis (due to Neisseria meningitidis) (n = 11) or Streptomyces pneumoniae (n = 2) or unidentified pathogen (n = 3)), along with 15 healthy children. Electroencephalogram (EEG) traces were recorded from all these children in the state of calm waking using a Neuron-Spectrum 4/VP 16-channel electroencephalograph. Clinical assessment of the EEG included analysis of background rhythms, zonal differences, and detection of pathological types of activity. Quantitative analysis consisted of the mean power (µV2) and amplitude (µV) of the α, θ, and δ rhythms, along with mean power ratios - α/θ and α/δ. Visual analysis of the EEG in 100% of children in the acute period of purulent meningitis showed diffuse slowing with detection of δ and θ waves. Focal changes in the form of sharp waves were seen in 18.8% of cases (three patients). No cases displayed periodic activity. Meningitis patients showed significant reductions in the α/δ (p = 0.001) and α/θ (p = 0.048) spectral ratios. ROC analysis showed that the α/θ value was <0.18 and the α/δ value was <0.02 (sensitivity 100% and specificity 80%, AUROC 0.9), which may be evidence of the likely development of cerebral edema. Thus, pediatric patients with acute purulent meningitis showed significant impairments to the normal α/θ and α/δ rhythm power ratios on the EEG, which is presumptively explained by suppression of the functional activity of the thalamus and thalamocortical pathways, as well as the reticular formation of the brain.

[Herpesviruses and biomarkers in disseminated encephalomyelitis and multiple sclerosis in children (part II)]. / Gerpesvirusy i biomarkery pri disseminirovannom entsefalomielite i rasseyannom skleroze u detei (chast' II).

Recently, the problem of demyelinating diseases in children is still very acute. This occurs, on the one hand, by high access and specificity of diagnostic methods and, on the other hand - by high morbidity of children different neuroinfectious diseases which can lead to demyelinating diseases. This literature review presents the currently available information on the autoantibodies and neurospecific protein role in the development of multiple sclerosis and acute disseminative encephalitis in children. The authors also describe their experience of complex etiopatogenic therapy and cytoflavin use that helps to reduce frequency and expression of demyelinating process and endothelium dysfunction in case of active herpesvirus infection.

[Herpesviruses and biomarkers in disseminated encephalomyelitis and multiple sclerosis in children]. / Gerpesvirusy i biomarkery pri disseminirovannom entsefalomielite i rasseyannom skleroze u detei.

The relevance of the study of demyelinating diseases is due to their increasing frequency in children, clarification of the role of infectious agents in their genesis, as well as the possibility of transformation of disseminated encephalomyelitis into multiple sclerosis. The literature review presents the currently available information on the causes of the development of demyelinating diseases, biomarkers of disseminated encephalomyelitis and multiple sclerosis, the causes of an unfavorable course and possible laboratory parameters indicating the transition from one disease to another, which can be used as prognostic factors. The authors also noted the experience of the authors on the importance of adequate etiopathogenetic therapy in changing the nature of the course of the disease, in particular, when confirming the relationship between the frequency of exacerbations of ADEM and MS with the activation of herpesvirus infections, courses of specific antiviral therapy are effective, as well as pathogenetic therapy aimed at correcting endothelial dysfunction using the drug cytoflavin.

[Clinical-etiological and MRI parallels of encephalitis in children]. / Kliniko-etiologicheskie i MRT paralleli entsefalitov u detei.

OBJECTIVE: Improving the diagnosis of encephalitis (EF) in children by establishing clinical, etiological and MRI parallels. MATERIAL AND METHODS: 364 children aged from 1 month to 17 years with EF were examined. MRI of the brain and spinal cord, blood and CSF examination for herpes viruses type 1-6 (HHV), enteroviruses (EV), tick-borne encephalitis viruses (TBEV), Borrelia burgdorferi (BB), varicella zoster (VVZ), herpes simplex (HSV1) and Epstein-Barr (EBV) were performed. RESULTS: The etiological structure was dominated by HHV types 1-6, tick-borne infections (19%), EV (14.6%), and other agents (6%). Clinical and topical variants of EF: leukoencephalitis (leukoePH) - 68.4%, polyoencephalitis (polioePH) - 22.8% and panencephalitis (panePH) - 8.8%. LEUKOEPH was more often caused by VVZ, EBV and BB, foci in the white matter of the large hemispheres, sensitive, cerebellar and pyramidal symptoms, acute course followed by complete recovery (65.8%), the risk of exacerbations and progression with the development of multiple sclerosis in 6% were observed in 80.7%. POLIO in 71.1% were caused by TBEV or EV, lesions were located in the thalamus, basal ganglia, cortex, manifested by deep depression of consciousness, epilepsy, central paralysis and speech disorders, in 83.1% there was a chronic course with the development of brain atrophy. PanEF was caused by cytomegalovirus in more than 1/2 of cases, with subtotal-total white matter damage, in 1/3 of cases - with the involvement of other structures, there was a chronic course with polymorphism of neurological symptoms, rare complete recovery (15.6%). The cerebellar form of EF in 88.7% was associated with VZV, subcortical and stem - with TBEV and EV, cortical and limbic - with HSV-1 and 2 and HHV-6. The outcomes of EF depend both on the timeliness of etiological and neuroimaging diagnostics, and on the adequacy of early therapy already with EF, including the use of acyclovir in combination with recombinant interferons alpha-2-ß with antioxidants, and the immediate appointment of Cytoflavin infusions upon admission to the hospital. CONCLUSIONS: Clinical and topical variants and forms of EF in children are associated with etiology, have different rates of complications, the nature of the course and outcomes, the knowledge of which makes it possible to optimize the diagnostic process.

[Developmental disorders of academic skills in children: the efficacy and safety of Tenoten for children in the multicenter double-blind placebo-controlled randomized study]. / Narusheniya razvitiya uchebnykh navykov u detei: effektivnost' i bezopasnost' Tenotena detskogo po dannym mnogotsentrovogo dvoinogo slepogo platsebo-kontroliruemogo randomizirovannogo issledovaniya.

OBJECTIVE: To evaluate the efficacy and safety of tenoten for children in the treatment of specific developmental disorders of academic skills in children of 1-3 grades. MATERIAL AND METHODS: Two hundred and forty children, aged 7-9 years, (Total set, Safety population) with verified specific reading disorder (F81.0), specific spelling disorder (F81.1), specific disorder of arithmetical skills (F81.2), mixed disorder of scholastic skills (F81.3; F81.2+F81.0, or F81.2+F81.1, or F81.2+F81.0+F81.1), diagnosed with the use of logopedic or psychological testing (15-35 scores in Fotekova T.A. and Akhutina T.V. reading and writing tests; 5-15 scores in arithmetical subscale of the Wechsler Intelligence Scale for Children) were enrolled in the study. CT was conducted in 10 clinical centers in Russian Federation in 2015- 2019. Patients were randomized into two groups. The first one (n=122) received tenoten for children in a dose of 1 tablet 3 times a day, the second one (n=118) was administered placebo in the same dosage regimen. The clinical data on 237 children (121 of the tenoten group and 116 of the placebo group) were used for Intention-to-treat efficacy analysis. Data on 220 children (115 of the tenoten group and 105 of the placebo group) were included in Per-protocol analysis. The duration of study was 12 weeks. The mean total academic skills (reading, spelling, and counting) score in groups after 12 weeks of treatment was set as the primary efficacy endpoint. RESULTS: The mean total academic skills score increased by 18.55±15.87 points. The significant total difference between the median changes in the total score in the tenoten and placebo groups was 5 points. There was a trend towards positive changes in reading and spelling mean scores in tests that didn't reach statistical significance due to lack of normal distribution of points in samples. There were 73 adverse events (AEs) in 42 patients of the tenoten group and 95 AEs in 31 children of the placebo group. No serious or severe AEs were registered in the tenoten group. No AEs definitely related to the study treatment were registered. No negative drug interactions were observed in the tenoten group. CONCLUSIONS: Tenoten for children is an effective and safe treatment for specific developmental disorders of academic skills in primary school children. Tenoten for children is well tolerated. The treatment is characterized by a high level of adherence of children and their parents to therapy.

[Problems of differential diagnosis of acute symptomatic infectious seizures and epilepsy in children]. / Problemy differentsial'noi diagnostiki simptomaticheskikh pristupov pri ostroi infektsii i epilepsii u detei.

Viral encephalitis, its complications and the newly diagnosed epilepsy in children require a complex approach to the differential diagnosis using laboratory and instrumental examinations. Possibilities of MRI in the differential diagnosis of seizures in children and in detection of ischemic-hypoxic and metabolic disorders in the suspected epileptic focus are demonstrated in the clinical observation.

[Virus-induced opsoclonus-myoclonus syndrome during pregnancy]. / Virus-indutsirovannyi sindrom opsoklonusa-mioklonusa pri beremennosti.

Opsoclonus-myoclonus syndrome (OMS) is a very rare condition with various etiologies (paraneoplastic, parainfectious, toxic, idiopathic, etc.) with an autoimmune pathogenetic mechanism of development. The authors describe the case of OMS in a 41-year-old woman at 37 weeks of gestation, who developed opsoclonus, myoclonus, severe trunk ataxia, tremor and bilateral pyramidal symptoms, inability to sit, stand and walk without support. Differential diagnosis was conducted between virus-induced OMS, rotavirus encephalitis, paraneoplastic syndrome, and demyelinating diseases of the central nervous system. Routine laboratory tests of blood and urine, serological tests of blood and cerebrospinal fluid (CSF) revealed no pathology. Only small lymphocytic pleocytosis and a slight increase in protein were observed in CSF. No pathology was detected during magnetic resonance imaging. On the 40th week of pregnancy (20th day of illness), the patient gave birth to a healthy full-term baby through the birth canal. In view of the most likely autoimmune process triggered by rotavirus infection, intravenous immunosuppressive therapy with methylprednisolone (1000 mg/day №3) was performed, followed by switching to prednisolone per os (60 mg/kg/day), as well as neuroprotective and neurometabolic therapy with cytoflavin. On day 42 of the illness (and on day 20 of the immunosuppressive therapy), a significant positive trend was noted. The patient was discharged on day 56 with light residual elements of opsoclonus and ataxia, and could walk independently without support. Thus, in case of suspected OMS, it is necessary to conduct a mandatory full diagnostic search, especially aimed at exclusion of the paraneoplastic process. And also, given the possibility of recurrence, further outpatient monitoring of these patients should be carried out.

[Age dynamic of the motor evoked potential from the tongue in healthy persons.]

Our aim was to determine parameters of motor evoked potential (MEP), elicited by the transcranial magnetic stimulation (TMS) from the tongue in healthy persons of different age. 62 neurologically healthy individuals without any speech problems (age range from 2 years old to 75 years, 34 females & 28 males) were enrolled. All underwent diagnostic TMS, single-pulse protocol, 90-sm round coil, Neiro-MS-D device. Coil was placed on Fz point, registration was performed by the surface electrode on the middle line of the tongue. Results. MEPs were of different appearance, but were registered in all cases, its average latency was 7,14±0,63 ms, average amplitude - 1,79±1,09 mV. There were no gender differences. Significant age difference (p<0,001) was registered between children (age 2-17 years) and two older groups (18-55 and 56-75 years) both on latency and on amplitude. MEPs latency was in three age groups, respectively, 6,21±0,45; 7,05±0,76, and 7,27±0,64 ms. MEPs amplitudes were 0,81±0,61; 1,88±1,01 and 1,69±0,92 mV, respectively. In healthy people aged 2-75 years MEP from the tongue may be registered in 100% of the cases; its average latency is 7,14±0,63 ms, average amplitude - 1,79±1,09 mV; there are no significant gender differences, but significant age differences. TMS of the tongue according to this protocol is relatively simple, not time-and efforts-consuming & may be widely implemented in clinical neurophysiology. There are significant differences on MEPs latencies and amplitudes in healthy persons, which may reflect age-related changes - lengthening of the cortico-lingual pathways and tongue muscle maturing in the childhood and then fibrous tissue development and other changes in nervous tissue and tongue muscle, developing with age.

[The efficacy of anti-viral therapy and serotherapy of tick-borne encephalitis in children]. / Effektivnost' protivovirusnoi terapii i seroterapii kleshchevogo entsefalita u detei.

OBJECTIVE: To evaluate the efficacy of different methods of antivirus therapy of tick-borne encephalitis (TBE) in children in the acute period and during chronic infections. MATERIAL AND METHODS: During 1 year, 130 children, aged 7-17 years, with TBEV received therapy in the acute period (an average in 3.5±1.3 days) in groups 1 (n=84) and 2 (n=20), and in the chronic infection in groups 3 (n=15) and 4 (n=11). Ribavirin orally, recombinant interferon-α2 (IFN-α2) i/m or in suppositories and anaferon orally were prescribed to children of groups 1 and 3. Children of groups 2 and 4 received tick-borne immunoglobulin (IgG)i/m and ribonuclease i/m. At admission, all patients received infusions of cytoflavin in the drip at the rate of 0.6 ml/kg per day. Etiological diagnosis included ELISA (IgM, G, viral antigen), and virus RNA by PCR in the blood and CSF. MRI of the brain and cervical spinal cord using standard programs was performed. All studies were performed prior to and in the course of treatment. RESULTS AND CONCLUSION: In patients of group 1, the period of increase in symptoms was reduced by ~ 4 days, and the duration of impairment of consciousness and pleocytosis in CSF ~ by 5 days, which was accompanied by a faster clearance of the virus in CSF, compared with group 2. In group 1, recovery without neurological deficit was observed in 83.3% (n=70), all patients had no progression of infection. In group 2, 30% of children (n=6) acquired TBEV chronic infection, and in 55% (n=11) there was a neurological deficit without progression. In patients of group 3 with chronic TBEV, the improvement was observed in 86.7% of cases, and complete regression of symptoms occurred in 1 patient, and replication of the virus was arrested in all of them. In group 4, symptoms increased in 72.7%, while virus replication was preserved and atrophic changes in the CNS increased on MRI. Antiviral therapy (ribavirin, IFN-α2 and release of active antibodies to gamma interferon -anaferon children) has the highest efficacy when prescribed for the first 5 days, while IgG and ribonuclease have insufficient efficacy in TBEV.

[Panencephalitis in children in modern conditions: clinical, etiological and mri-aspects]. / Panéntsefality u detei v sovremennykh usloviiakh: kliniko-étiologicheskie i MRT-aspekty.

AIM: To characterize the clinical picture, infectious etiology and MRI results of panencephalitis (PANE) in children, depending on the duration of the disease. MATERIAL AND METHODS: Children (n=32) with PANE at the age from 3 months up to 17 years were examined for a group of actual viral and bacterial infections. The inclusion criterion was a diffuse lesion of white matter hemispheres on MRI. MRI of the brain and spinal cord, CSF study (pleocytosis, oligoclonal IgG, the main myelin protein (MBP) were performed. The follow-up was 5-10 years. The complex therapy included etiotropic (antiviral) and pathogenetic agents, with priority given to cytoflavin as a drug with a multimodal effect. RESULTS: In 84.4% of cases, PANE in children are recorded under the age of 3 years and in 71.9% of cases, are associated with congenital infections with the prevalence of herpes viruses, especially cytomegalovirus (37,8%) and herpes type 6 (21.9%). In 78.3% of cases, PANE have chronic gradual development more often with a delay in the formation of motor and speech/prespeech skills, and manifested with pyramidal, cerebellar and other symptoms in the future. PANE is accompanied by a lesion of the white matter of the hemispheres in 1/2 cases with periventricular localization, less often in infratentorial structures (46.9%) and spinal cord (21.9%). With the duration of symptoms up to 3 months (n=22) PANE are characterized by inflammatory-demyelinating changes, signs of mass effect, contrast+, pleocytosis in CSF and the increase in MBP (average 4.2±0.8 ng/ml), and, with the duration of more than 3 months, by degenerative-sclerosing changes (n=10) and CSF oligoclonal IgG in 90% of cases. CONCLUSION: In almost 2/3 of cases, PANE are associated with congenital infections, accompanied by extensive symmetrical foci of demyelination in the CNS, and their clinical and laboratory parameters and outcomes depend on the start of treatment, with the positive dynamics in 75% of cases.

[Transcranial magnetic stimulation in the diagnostic and treatment of pain syndromes in children and adults]. / Transkranial'naia magnitnaia stimuliatsiia v diagnostike i terapii bolevykh sindromov u detei i vzroslykh.

The authors review the literature and own data concerning therapeutic use of transcranial magnetic stimulation (TMS) in children and adult patients with pain syndromes of different origins. TMS may act as a tool to excite or inhibit neuroplasticity in the central nervous system, which depends of the therapeutic regime used. TMS induces neurogenesis and synaptogenesis, rhythmic TMS may cause long-lasting after-effects, including pain inhibitory effect. A decrease in the threshold and an increase in the amplitude of motor evoked potentials in TMS are the most frequent changes in pain syndromes in the diagnostic modality. The efficacy of different regimes in the treatment of pain syndromes remains understudied. Despite vast knowledge on clinical use of TMS in pain syndromes in adults, in pediatrics its use is limited to migraine treatment. TMS is a valuable diagnostic and therapeutic tool that should be more often implemented in neurorehabilitation and treatment of neurological diseases in adults and children with pain syndromes.

[Possibilities for optimizing the pathogenetic therapy of purulent meningitis in children]. / Vozmozhnosti optimizatsii patogeneticheskoi terapii gnoinykh meningitov u detei.

AIM: To assess an effect of the combined use of Cytoflavin and Sulodexide on the course and outcomes of purulent meningitis in children. MATERIAL AND METHODS: Fifty children with purulent meningitis, aged from 5 to 17 years 11 month, were studied. Thirty patients of the treatment group (n=30; mean age 6,8 ± 2,2 years) received Cytoflavin (0,6 mcg/kg once a day) during 5 days with the following treatment with Sulodexide (250 LSU/day in children 5-12 years, 500 LSU/day in children above 12 years). Patients of the comparison group (n=20), aged 5,9±1,8 years, received standard antibacterial treatment. Duration and persistent of fever, cerebral, meningeal symptoms, the recovery period of CSF, the normalization of the number of desquamated epithelial cells (DEC), D-dimer were estimated. Outcomes of purulent meningitis were assessed using a working scale representing a modification of Rankin's, Fisher's, and Glasgow scales. RESULTS AND CONCLUSION: The combination of drugs reduces the duration of cerebral and meningeal symptoms, leads to the normalization of hematological parameters (the level of leukocytes, desquamous epithelial cells, D-dimer) and improves outcomes.

[Difficulties of differential diagnosis of organic injury of the nervous system in children]. / Trudnosti differentsial'noi diagnostiki organicheskogo porazheniia nervnoi sistemy u detei.

The growth of organic lesions of the central nervous system (CNS) in children, clinical polymorphism, the similarity of clinical and laboratory parameters in inflammatory, demyelinating and oncological diseases necessitate careful differential diagnosis. The clinical case presented in the article confirms the difficulties of differential diagnosis of organic CNS lesion in children, and therefore it is urgent to expand the indications for a brain biopsy, which will allow to timely diagnose correctly, avoid an erroneous diagnostic search and develop adequate tactics.

[Age-related changes of peripheral nerve system and muscles of the limbs in healthy persons].

Our aim was to present and analyze age-related changes of peripheral nerves and muscles of limbs on a huge population of healthy persons of different ages. Persons aged from 2 months to 87 years were studied by conduction studies (EMG) during the period 2009-2016 years in Scientific Research Institute of Children's Infection. Data of those 1 121confirmed healthy was included in our study. Conduction along n. Medianus, n. Ulnaris, n. Musculocutaneus, n. Axillaris, n. Facialis, n. Tibialis, n. Peroneus et n. Femoralis was registered, with latency and amplitude of compound muscle action potential (CMAP) being analyzed. There were significant differences on latencies and amplitudes of CMAPs between different age groups. Significant lengthening of CMAP latency was registered in older age groups. We marked CMAP amplitude increase from the early childhood until adolescence and later it dropped in persons aged 55 years old and older. These changes may reflect, concerning latency, the lengthening of the peripheral nerves in the age 0-25 years, and later on age-related slowing of conduction starting from 55 years. Amplitude of CMAP may rise with the growing of muscles and drop in later life with age-related muscle atrophy and fibrous changes.