[The analysis of visits for telemedicine consultations in the National Medical Research Center of Children Health during three-years period].

The purpose of the study was to analyze functioning of the Department of telemedicine department over three-year period with assessment of main trends and regional characteristics, as well as the most significant results of telemedicine consultations. The step-wise analysis of applications for telemedicine consultation in 2019-2021 was carried out. They were conventionally classified by "in-coming" and "out-coming" information. At the first stage, number of applications received in 2019-2021 (n=10,145) was analyzed. The regional features of applications were established. At the second stage, extended analysis of all applications received in 2021 (n=4518) was carried out considering type of request, profile of request, fact of video communication, structure of directional diagnoses according the ICD-10 classes with identification of regional characteristics. At the third stage, sampling analysis of applications in 2021 (n=1000) was carried out with in-depth assessment of "in-coming" and "out-coming" information. The study established trend of annual increase of number of requests for telemedicine care (2,380 in 2019; 3,237 in 2020; 4,518 in 2021). The Privolzhsky Federal Okrug is leading in number of applications. The neurologists, rheumatologists and gastroenterologists are the most called-for specialists of somatic profile. The thoracic, neonatal and abdominal surgeons are the most-called specialists of surgical profile. This structure corresponded in whole to the structure of the ICD-10 classes that the region requested. The analysis of consultations testified high need in hospitals to transfer children to the Federal Center for treatment (57.6% of applications), that was not always justified. Therefore, positive decision about hospitalization was made less often (35% of cases). The recommendations of specialists of the National Medical Research Center for Children Health concerning treatment tactics (46% of applications) and additional examinations (44% of applications) were provided more often than it was indicated in application. The conclusion was made about increasing demand for and importance of telemedicine consultations in format "physician-physician" in pediatric practice and necessity of further research study with purpose to improve and optimize this type of medical care.

[Pediatric Health Quality Assessment in Different Regions of Russian Federation].

Background: The quality of pediatric healthcare is a cornerstone for good maternal and infant health. Aims: To evaluate the quality of healthcare in secondary and tertiary regional pediatric hospitals in the Russian Federation. Methods: Healthcare quality assessment was performed in 21 pediatric hospitals (tertiary, n=5; secondary, n=16) of four regions. The WHO recommendations were used. Results: In all regions, similar traits of inpatient pediatric healthcare determining a poor quality were observed. These included low preparedness for emergent care at admission departments; a high rate of unjustified hospitalization due to lack of clear indications for inpatient care; a widespread polypharmacy and unnecessary painful procedures and treatment; inadequate unjustified antimicrobial and parenteral therapy. Conclusions: The revealed identity of problems in different regions of the country allows to consider a common strategy to overcome them, which, obviously, should primarily involve education of medical personnel, restructuring of hospital beds to increase day care beds, increasing the clinical expert work in hospitals.

[On quality of life of children of senior school age in the Republic of Udmurtia].

The article presents results of population study of quality of life of children aged 2-17 years. The study of quality of life of children of senior school age using questionnaire PedsQL was carried out. The comparative characteristic of indices of quality of life of children ofjunior and senior school age in the Republic of Udmurtia is presented. The regional indices of quality of life of children of senior school age are determined. Among all aspects of quality of life the highest values had «physical functioning¼ and «social functioning¼. The scales «emotional functioning¼ and «social functioning¼ differed by their lesser level. The quality of life of girls of senior school age was lower than in boys in all aspects but more concerned emotional sphere. The residence in urban or rural territory effects indices of quality of life of children of senior school age in Udmurtia. The urban children had higher indices of quality of life on aspects «physical functioning¼ and «emotional functioning¼. The level of aspects of «social functioning¼ and «school functioning¼ is characterized by absence of disagreements between urban and rural children. The geographical area of residing of children of senior school age in Udmurtia has no effect on indices of quality of life. The aspects of «social functioning¼, «emotional functioning¼ and «school functioning¼ have particular characteristics depending on age (8-12 years and 13-17 years). The age characteristics consist in increasing of level of social functioning; age trend of aspects «emotional functioning¼ and «school functioning¼ has negative dynamics.

[Assessment of the life quality in children with phenylketonuria].

BACKGROUND: Phenylketonuria (PKU) - the most common inherited disorder of amino acid metabolism, identified in Russia by neonatal screening. The results of dietary treatment demonstrate a positive effect. However, the quality of PKU patients life remains unknown. OBJECTIVE: The aim of the study was to assess the quality of PKU children life in comparison with their healthy peers, also depending on the treatment onset and the patient's age. METHODS: The study involved 64 pairs - PKU child and one of his parents. It was used the common questionnaire survey Pediatric Quality of Life Inventory (PedsQLtm4. 0, Varni et al., USA, 2001) and the program SPSS v. 14.0 (US) for statistical processing of the results. RESULTS: The statistically significant (p <0.001) differences between PKU patients and healthy children in the physical, emotional, social and role functioning were found. The most pronounced differences were observed in the social (70 points vs 90 respectively) and role (57.5 vs 80 respectively) functioning. Maximum significant correlation (p <0.001) was installed between the social functioning of PKU patients and timing of the dietary treatment. Also the statistically significant interaction (p <0.05) was found between the role functioning, patient's age and treatment onset. The assessment points of social and role functioning were higher (p <0.05) in the PKU patients subgroup with early treatment initiation. CONCLUSION: These results confirmed the need of early diagnostics of PKU and initiation of dietary treatment, as well as the organization of timely psychological support for parents of sick children.

[Changes of the spasticity patterns in children with cerebral palsy GMFCS III at the age of 2 to 12 years]. / Izmenenie patternov spastichnosti u detei s tserebral'nym paralichom s III urovnem dvigatel'nogo razvitiya po sisteme klassifikatsii bol'shikh motornykh funktsii (GMFCS III).

Spastic muscles in the pathological motor patterns may change at different ages that leads to the changes in anti-spastic treatment. OBJECTIVE: To study the specific patterns of spasticity in CP patients with level III according to the Gross Motor Function Classification System (GMFCS) in different age periods. MATERIAL AND METHODS: A retrospective analysis of injection protocols of Abobotulinum toxin A for 99 patients with bilateral spastic CP GMFCS III at the age of 2 to 12 years was performed. Spasticity patterns were evaluated according to the frequency of target muscle selection for the botulinum toxin A (Abobotulinum toxin A) injections. RESULTS: The equinus foot deformity (89.7%, 95%CI 72.8-97.2) and its combination with internal hip rotation (79.3%, 95% CI 61.3-90.5) and/or hip adduction (65.5%, 95% CI 47.3-80.2) were the main lower extremity spasticity pattern for the patients aged 2 to 4 years. Between 4 and 6 years, there was the decrease in injections to the gastrocnemius muscle (75%, 95% CI 52.8-89.2), and less to the m. gracilis (70%, 95% CI 47.9-85.7) and hip adductors (55% 95 CI 34.2-74.2). In the 6-12 year old patients, the predominant spasticity patterns were internal hip rotation (80%, 95% CI 66.8-88.9), adduction (54%, 95% CI 40.4-67.0) and knee flexion (66%, 95% CI 52.1-77.6). The leading upper extremity patterns at all observed ages were forearm pronation (70.7%, 95% CI 61.1-78.8) and elbow flexion (47.5%, 95% CI 37.9-57.2). The frequency of injections to these muscles slightly decreased in elder groups. CONCLUSIONS: CP GMFCS III patients demonstrate age-related changes of the spasticity patterns both in lower and upper extremities. These changes and typical spastic muscles should be taken into account during the rehabilitation and botulinum toxin treatment planning, as well as in the detection and prevention of the orthopaedic complications.

[Botulinum toxin type A (Incobotulinum toxin A) in spastic forms of cerebral palsy: a retrospective analysis of clinical experience]. / Botulinicheskii toksin tipa A (IncobotulinumtoxinA) pri spasticheskikh formakh detskogo tserebral'nogo paralicha: retrospektivnyi analiz klinicheskogo opyta.

OBJECTIVE: A retrospective analysis of the experience of using Incobotulinum toxin A injections for the treatment of spasticity in children with cerebral palsy (CP). MATERIAL AND METHODS: One hundred and eighty-five children with spastic forms of CP, including 114 boys (61,6%), were studied. The average age of the patients was 3,8±2,5 years; the average weight was 14,2±6,9. The patients received injections of Incobotulinum toxin A according to registered indications or recommendations of a consultation of specialists and voluntary informed consent of the patient's representative. At least 1 point decrease of muscle tone according to the modified Ashworth scale was used as a criterion of the antispastic effect of Incobotulinum toxin A. RESULTS: The total dose of Incobotulinum toxin A for the whole group of patients with CP was 154,5±67,7 U and 11,6±4,7 U per kg/body weight. The gracilis muscle (65,4% of cases, 95%CI 58,1-72,2) and the gastrocnemius muscle (49,4% of cases, 95%CI 41,8-56,6) were the most frequently injected targets in the lower extremities, and the pronator teres muscle (58,9% of cases, 95%CI 51,5-66,1) - in the upper extremities. Adverse events were observed in 13 patients (7,0%). They were mild in 9 patients and moderate in 4 patients. CONCLUSION: Our data confirmed the effectiveness and safety of Incobotulinum toxin A injections in spastic CP. The calculated average doses of Incobotulinum toxin A for target muscles and the frequency of different spasticity patterns could serve as a reference for the botulinum therapy planning.