RESUMEN
Speech disorders still remains one of the cornerstones of pediatric neurology. Against the backdrop of gene diagnostic development, there are a huge amount of information about the role of genetic and chromosomal abnormalities in pathogenesis of speech disorders. In present article authors presenting an actual data on genetic basis of different types of speech disorders. Moreover, authors describing a clinical case of a patient with genetically determined developmental disorder, caused by KMT5B mutation validated by Sanger method.
Asunto(s)
Trastornos del Desarrollo del Lenguaje , Trastornos del Habla , Humanos , Niño , Trastornos del Habla/diagnóstico , Trastornos del Habla/genética , Trastornos del Habla/complicaciones , Mutación , Aberraciones Cromosómicas , Trastornos del Desarrollo del Lenguaje/diagnóstico , HablaRESUMEN
The article presents the work of a multidisciplinary team of experts from various fields of medicine to optimize the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology¼ for use in clinical practice. The survey of respondents was conducted from June 28 to September 28, 2021. As a result of this survey, by repeatedly making edits and clarifications during communication with respondents, the final version was obtained, which allows assessing the patient's subjective sensations by the nature and localization of pelvic pain, sensitivity disorders and pelvic organ function. The main objective of this Questionnaire is to differentiate patients with neurogenic pain from a huge number of patients with chronic pelvic pain. This aspect will allow a more targeted approach to the diagnosis and pathogenetically justified treatment of patients, including after appropriate instrumental examinations. The work of a multidisciplinary team implies a higher degree of objectification and terminological accuracy of the Questionnaire under discussion. The presented version of the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology¼ will be primarily used in coloproctological patients with pelvic pain problems and anal incontinence and obstructive defecation. Further studies will be directed to the clinical evaluation of the results of the work carried out.
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Incontinencia Fecal , Insuficiencia Multiorgánica , Humanos , Dolor Pélvico/diagnóstico , Dolor Pélvico/etiología , Estreñimiento , Encuestas y CuestionariosRESUMEN
This paper describes two cases of congenital bilateral perisylvian syndrome (CBPS), a rare disorder of late neuronal migration, which is characterized by language delay, intellectual disorders, epilepsy and bilateral perisylvian polymicrogyria. Pseudobulbar paralysis and orofacial muscles dyspraxia causing drooling and feeding difficulties are common for patients with CBPS. Communicational problems lead to low self-esteem and social maladaptation. Literature data regarding correlation between polymicrogyria topography and speech disorders and articulation impairment severity are presented. The results demonstrate the association of diffuse spreading of bilateral polymicrogyria and more severe speech disorders comparing to mild speech disorders in patients with more local polymicrogyria. Known etiology factors of this syndrome are bilateral cerebral hypoperfusion, brain damage while neuronal migration period, postmigrational vascular insults and gene mutations. Syndrome can be inherited in autosome dominant and X-linked manner. Speech apraxia with normal impressive speech, refractory epileptic seizures and status dysraphicus must be red flags for a physician regarding this syndrome. Overnight video-EEG monitoring and brain MRI confirm a thesis that this syndrome is underdiagnosed in everyday clinical practice.
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Discapacidad Intelectual , Malformaciones del Desarrollo Cortical , Polimicrogiria , Anomalías Múltiples , Corteza Cerebral , Niño , Humanos , Discapacidad Intelectual/diagnóstico , Imagen por Resonancia Magnética , Trastornos del Habla/diagnóstico , Trastornos del Habla/etiología , SíndromeRESUMEN
The article presents a description of a patient with chronic HCV infection and multiple extrahepatic manifestations, which manifested in dynamics and were recorded with a different sequence during 15 years of follow-up. In the patient we observed, the most frequently recorded extrahepatic manifestations were verified: porphyria cutanea tarda, mixed cryoglobulenemia, and utoimmune thyroiditis. Chronic HCV infection is often diagnosed in the presence of psoriasis was assessed as a paraneoplastic disease.
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Hepatitis C , Porfiria Cutánea Tardía , Psoriasis , Humanos , AutoanticuerposRESUMEN
The second part of this review is devoted to the issues of modern and promising diagnosis of RN in children. The advantages and limits of the available methods for recording the structural and functional state of the kidneys in childhood are considered. Particular attention is paid to possibilities non-invasive methods for diagnosis and prediction of the disease course. Data on promising biomarkers of the early stages of RN formation and progression are presented. For the purpose of a comprehensive and adequate assessment of morphological changes in the kidneys, the necessity of studying various combinations of cytokines in biological media with the subsequent determination of the optimal spectrum is shown. The sensitivity and specificity of molecular indicators of renal damage reviewed as potential targets for renoprotective therapy in the nearest future.
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Enfermedades Renales , Pielonefritis , Reflujo Vesicoureteral , Niño , Humanos , Riñón , Enfermedades Renales/diagnóstico , Enfermedades Renales/etiología , Pronóstico , Reflujo Vesicoureteral/diagnósticoRESUMEN
The purpose of this review is to analyze the modern literature about renal damage caused by vesicoureteral reflux (VUR). VUR is the most common urodynamic pathology in children and reflux nephropathy (RN), as its main complication, ranks first among the causes of chronic kidney disease (CKD). The risk factors for the appearance and progression of RN are presented in the first part of the review. In the framework of this issue, the main methods of treatment of VUR and associated urinary tract infection are described. The possibilities of conservative and surgical methods for the elimination of reflux for prevention of RN and prognosis of its course are considered. The main morphological aspects of RN formation are described.
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Enfermedades Renales , Pielonefritis , Infecciones Urinarias , Reflujo Vesicoureteral , Niño , Humanos , Lactante , Pronóstico , Reflujo Vesicoureteral/complicaciones , Reflujo Vesicoureteral/diagnósticoRESUMEN
The mammalian kidney is a complex organ, requiring the concerted function of up to millions of nephrons. The number of nephrons is constant after nephrogenesis during development, and nephron loss over a life span can lead to susceptibility to acute or chronic kidney disease. New technologies are under development to count individual nephrons in the kidney in vivo. This review outlines these technologies and highlights their relevance to studies of human renal development and disease.
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Investigación Biomédica/tendencias , Diagnóstico por Imagen/métodos , Enfermedades Renales/patología , Nefronas/citología , Organogénesis , Animales , Humanos , Enfermedades Renales/diagnóstico por imagen , Nefronas/diagnóstico por imagenRESUMEN
For the first time, the functioning of the oxygen reductase Na+-pump (Na+-pumping cytochrome c oxidase of the cbb3-type) was demonstrated by examining the respiratory chain of the extremely alkaliphilic bacterium Thioalkalivibrio versutus [Muntyan, M. S., et al. (2015) Cytochrome cbb3 of Thioalkalivibrio is a Na+-pumping cytochrome oxidase, Proc. Natl. Acad. Sci. USA, 112, 7695-7700], a product of the ccoNOQP operon. In this study, we detected and identified this enzyme using rabbit polyclonal antibody against the predicted C-terminal amino acid sequence of its catalytic subunit. We found that this cbb3-type oxidase is synthesized in bacterial cells, where it is located in the membranes. The 48-kDa oxidase subunit (CcoN) is catalytic, while subunits CcoO and CcoP with molecular masses of 29 and 34 kDa, respectively, are cytochromes c. The theoretical pI values of the CcoN, CcoO, and CcoP subunits were determined. It was shown that parts of the CcoO and CcoP subunits exposed to the aqueous phase on the cytoplasmic membrane P-side are enriched with negatively charged amino acid residues, in contrast to the parts of the integral subunit CcoN adjacent to the aqueous phase. Thus, the Na+-pumping cytochrome c oxidase of T. versutus, both in function and in structure, demonstrates adaptation to extremely alkaline conditions.
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Ectothiorhodospiraceae/enzimología , Complejo IV de Transporte de Electrones/metabolismo , Sodio/metabolismo , Proteínas Bacterianas/metabolismo , Dominio Catalítico , Cationes Monovalentes/metabolismo , Membrana Celular/enzimología , Membrana Celular/metabolismo , Ectothiorhodospiraceae/metabolismo , Concentración de Iones de Hidrógeno , Conformación ProteicaRESUMEN
This manuscript summarizes consensus reached by the International Anorectal Physiology Working Group (IAPWG) for the performance, terminology used, and interpretation of anorectal function testing including anorectal manometry (focused on high-resolution manometry), the rectal sensory test, and the balloon expulsion test. Based on these measurements, a classification system for disorders of anorectal function is proposed. Aim to provide information about methods of diagnosis and new classification of functional anorectal disorders to a wide range of specialists general practitioners, therapists, gastroenterologists, coloproctologists all who face the manifestations of these diseases in everyday practice and determine the diagnostic and therapeutic algorithm. Current paper provides agreed statements of IAPWG Consensus and comments (in italics) of Russian experts on real-world practice, mainly on methodology of examination. These comments in no way intended to detract from the provisions agreed by the international group of experts. We hope that these comments will help to improve the quality of examination based on the systematization of local experience with the use of the methods discussed and the results obtained. Key recommendations: the International Anorectal Physiology Working Group protocol for the performance of anorectal function testing recommends a standardized sequence of maneuvers to test rectoanal reflexes, anal tone and contractility, rectoanal coordination, and rectal sensation. Major findings not seen in healthy controls defined by the classification are as follows: rectoanal areflexia, anal hypotension and hypocontractility, rectal hyposensitivity, and hypersensitivity. Minor and inconclusive findings that can be present in health and require additional information prior to diagnosis include anal hypertension and dyssynergia.
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Canal Anal , Recto , Consenso , Humanos , Manometría , Federación de RusiaRESUMEN
AIM: To identify predictors of perioperative complications in children with obstructive uropathy. MATERIALS AND METHODS: A total of 178 patients with obstructive uropathy were divided into 3 groups. In Group 1 there were 108 children with hydronephrosis, while Group 2 included 47 children with ureterohydronephrosis and Group 3 consisted of 23 children with bladder outlet obstruction according to the results of clinical, laboratory, microbiological, X-ray and pathologic study. The evaluation of the urine level of pro- (IL-8) and anti-inflammatory (IL-10) cytokines was performed at two timepoints, prior to treatment (1 point) and on the 3-5th day after the surgery (2 point) using "Vector - Best" (Russia, Novosibirsk) (IL-8), "Bender Medsystems" (Austria) (IL-10) on the enzyme immunoassay analyzer Stat Fax 2010 (USA). RESULTS: The active phase of chronic pyelonephritis was shown in Groups 1, 2 and 3 in 38%, 36% and 100% of cases, respectively. Microbiological examination of urine allowed to identify a causative agent in 85% and 89% of biopsy specimens from the ureteropelvic and ureterovesical junction, respectively. In all groups, Escherichia coli was a main pathogen (40%). In 25% of patients of Groups 1 and 2, isolated pathogens in biopsy specimen and urine were different. According to the evaluation of cytokines in the urine, during the active phase of chronic pyelonephritis there was an increase in the level of IL8 (p<0.0001) at points 1 and 2 in all patients. In the latent phase of inflammation, there was an increase in the concentration of IL-8 (p<0.04) and IL-10 (p<0.002) at point 2 in Groups 1 and 2. Using the ratio of IL-8 and IL-10, an index of inflammation activity (IIA) was suggested, whose values were increased in all Groups at point 1 and 2. Based on the regression analysis of the changes in IIA level, a model for predicting perioperative complications and an algorithm for personalized patient management were developed. CONCLUSION: Cytokines are indicators of latent inflammation in children with OU and may be predictors of perioperative complications.
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Citocinas/orina , Hidronefrosis , Inflamación/orina , Interleucina-10/orina , Interleucina-8/orina , Pielonefritis , Obstrucción del Cuello de la Vejiga Urinaria , Niño , Humanos , Atención Perioperativa , Federación de RusiaRESUMEN
OBJECTIVE: To evaluate the influence of clinical and morphological factors and HER2 copy numbers on pathologic complete response (pCR) rates in patients with HER2-positive stage II-III breast cancer (BC). MATERIAL AND METHODS: Treatment results were studied in 73 patients with HER2-positive Stage II-III BC, who received treatment at the N.N. Blokhin National Medical Research Center of Oncology in 2015 to 2018. Treatment included neoadjuvant chemotherapy (NACT) with HER2-blockade and radical surgery followed by the evaluation of a pathologic response in the primary tumor and regional lymph nodes. The patients` age varied from 29 to 71; its median was 51.5; 45.2% of patients had primary operable stages (T1-3N0-1) and 54.8% had locally advanced tumors. All the patients had grade 2-3 anaplasia; luminal HER2-positive BC was diagnosed in 41.4% of patients; hormone-negative tumors were seen in 58.9%; 91.5% of patients had Ki-67 ≥20% in 75.3% of patients, preoperative systemic therapy included anthracycline-containing regimens (4AC + 4 x paclitaxel 175 mg/m2/12 × weekly administrations of paclitaxel 80 mg/m2; trastuzumab therapy was simultaneously performed with the administration of taxanes in the standard regimen) and anthracycline-free regimen TCH ± Pertuzumab regimen in 24.7% of cases. After NACT patients underwent surgery (radical mastectomy in 78.1%, breast-sparing treatment in 21.9%) with the assessment of morphological findings. Biopsy specimens obtained before the treatment was restudied; HER2 amplification was detected using a Dako HER2 IQFISH pharmDx kit according to its instruction and the 2018 ASCO/CAP guidelines. In 87.1% of cases, the HER2-positive status corresponded to the first category of the 2018 ASCO/CAP criteria for HER2-positive BC; clustered HER2 amplification was found in 30.1% of cases. The authors analyzed the frequency of bpCR and tpCR attainment by various clinical and morphological factors, as well as the impact of a HER2 amplification level on pCR rates. RESULTS: A breast pCR (bpCR) was achieved in 57.4% patients; bpCR and lymph node CR (lnCR) were noted in 48.9% patients. The rates of bpCR significantly depended on female age, chemotherapy regimen, addition of Pertuzumab, and HER2 copy number. That of bpCR in women less than 35 years of age, in those aged 36-50 years, and in those aged older than 50 years was 22.2, 57.7 and 71.9%, respectively (p=0.026). The maximum bpCR rate observed with the TCH±P regimen was 80.0%, that with anthracycline-containing regimes was 52.8% (p=0.045), and the addition of Pertuzumab increased complete response rates up to 88.9% (that with Trastuzumab was 54.2% (p=0.049). The relationship of bpCR rates to the detection of cluster amplification turned out to be highly significant (81% in its detection and 48.9% in its absence (p=0.013). In addition, clustered HER2 amplification was the only significant predictive factor for complete regression in the primary tumor and lymph nodes: in its presence, the tpCR rate reached 68.8% versus 38.7%. CONCLUSION: Clustered amplification of the HER2 gene is the most significant factor of sensitivity to anti-HER2 therapy for Stage II-III BC, and is associated with the maximum rate of both bpCR and total pCR. Further study of this factor may assist in optimizing the treatment algorithm for HER2 + BC.
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Neoplasias de la Mama , Terapia Neoadyuvante , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica , Biomarcadores de Tumor , Neoplasias de la Mama/terapia , Femenino , Amplificación de Genes , Humanos , Mastectomía , Persona de Mediana Edad , Estadificación de Neoplasias , Receptor ErbB-2 , TrastuzumabRESUMEN
AIM: To substantiate the expediency of immunomodulators and probiotics application pathogenetically in the comprehensive preoperative preparation in children with congenital uropathies (U). MATERIALS AND METHODS: The study includes 60 patients with various types of congenital uropathy (CU) (vesicoureteral reflux, hydronephrosis, obstructive ureterohydronephrosis), which were divided into 3 groups in accordance with the preoperative preparation complex. 1 group - 20 patients with VU, immunomodulating drug Kipferon was added to the therapy at the preoperative stage, group 2 - 20 patients with VU - with the addition of the biologically active additive (BAA) "Bifidum No791 BAG", 3 control group - 20 children with VU standard complex of preoperative preparation. The diagnosis of VU was established using a standard urological examination. The examination of the content of pro-(IL-8) and anti-inflammatory (IL-10) cytokines in the urine was performed before the start of treatment (1 point) and on the 3-5th day after surgery (2 point) for all patients using the method of enzyme-linked immunosorbent assay. RESULTS: Based on signs of systemic inflammation and urinary syndrome, initially patients of all groups (n=60) were in the latent phase of chronic obstructive pyelonephritis. After surgical correction pyelonephritis was diagnosed in all children at point 2, the most pronounced was in the control group. Manifestation of dysbiosis in the control group was more often by 20% than in group 2. The examination of the cytokine profile of urine showed an increasing the level of IL-8 (p<0.0001) at 2 points in all groups, the most significant was in the control group (p<0.002). An increasing the level of IL-10 (p<0.0001) was noted at point 2 in all groups, the most significant was in groups 1 and 2 (p<0.003). High values of the inflammation activity index were observed only at point 2 in the children of the control group (p<0.001). CONCLUSION: The using of immunomodulators and probiotics in the comprehensive preoperative preparation of children with obstructive uropathies reduces the risk, severity and duration of postoperative complications.
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Atención Perioperativa , Enfermedades Urológicas , Niño , Humanos , Hidronefrosis , Pielonefritis , Reflujo VesicoureteralRESUMEN
The review focuses on the feminizing genitoplasty of the external genitalia in patients with disorders of sex development. The opinions of various surgeons and surgical schools on the timing, stages and methods of performing feminizing genitoplasty in girls with the virilization of the genitalia are presented. The development and improvement of surgical techniques for performing clitoroloplasty in patients with virilization of genitalia are described, as well as different types of labioplasty. The main methods of reconstruction of the urogenital sinus are given.
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Trastornos del Desarrollo Sexual/cirugía , Anomalías Urogenitales/cirugía , Virilismo/cirugía , Vulva/anomalías , Vulva/cirugía , Femenino , Humanos , Virilismo/etiologíaRESUMEN
AIM: To study clinical and genetic characteristics that impact on the efficacy of pharmacotherapy of depressive disorders. MATERIAL AND METHODS: The study included 188 patients with unipolar depressive disorders of different genesis (psychogenic, endogenous and organic). A clinical-psychopathological method and depression psychometric scales were used. Serotonin transporter 5-HTTLPR and STin2 and dopamine transporter 3',-VNTR polymorphisms were determined. RESULTS AND CONCLUSION: The S-allele of the 5-HTTLPR polymorphism is associated with the low efficacy of treatment with selective serotonin reuptake inhibitors. Tricyclic antidepressants are more effective in treatment of psychogenic depression. The authors determined clinical factors that can predict response to treatment of psychogenic and endogenous depression. No predictors were found for organic depression.
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Antidepresivos Tricíclicos/uso terapéutico , Trastorno Depresivo/tratamiento farmacológico , Trastorno Depresivo/genética , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Adulto , Alelos , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastorno Depresivo Mayor/genética , Proteínas de Transporte de Dopamina a través de la Membrana Plasmática/genética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polimorfismo Genético , Escalas de Valoración Psiquiátrica , Psicometría , Proteínas de Transporte de Serotonina en la Membrana Plasmática/genética , Resultado del TratamientoRESUMEN
Vesicoureteral reflux (VUR) is the most common type of obstructive uropathy in children. Reflux nephropathy (RN) is one of the most common complications of VUR that inevitably leads to chronic kidney disease. Patients with end-stage kidney disease require costly treatment, and the only way to cure them is kidney transplantation. A timely institution of renoprotective therapy is a key factor helping to preserve the function of the native kidneys. Hence, it is necessary to devise new highly sensitive and minimally invasive methods for early diagnosis of RN. The purpose of this article is to review the molecular mechanisms of initiation and progression of kidney fibrosis and the opportunities of instrumental and non-instrumental methods for its diagnosis. Special attention is paid to highly specific and highly sensitive non-invasive methods for the detection of minimal changes in the renal parenchyma. The authors discuss the promising biomarkers for the diagnosis and prediction of RN.
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Reflujo Vesicoureteral/diagnóstico , Reflujo Vesicoureteral/fisiopatología , Niño , Diagnóstico Precoz , Humanos , Reflujo Vesicoureteral/etiologíaRESUMEN
The histological and immunohistochemical type of chemically induced (injection of N-methyl-N-nitrosourea into the mammary gland) breast tumor was studied in Wistar females. The tumor induced by N-methyl-N-nitrosourea was moderately differentiated adenocarcinoma with infiltrative growth lacking estrogen-α and human epidermal growth factor receptors, and expressing progesterone receptors; tumor cells were characterized by high proliferative activity. This variant of chemically induced breast tumor corresponds to human breast cancer luminal type B.
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Neoplasias Mamarias Animales/inducido químicamente , Neoplasias Mamarias Animales/patología , Metilnitrosourea/farmacología , Animales , Neoplasias de la Mama/inducido químicamente , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/patología , Proliferación Celular/genética , Proliferación Celular/fisiología , Receptores ErbB/metabolismo , Femenino , Inmunohistoquímica , Neoplasias Mamarias Animales/metabolismo , Ratas , Ratas Wistar , Receptores de Progesterona/metabolismoRESUMEN
The cytokine-producing potential of blood cells has been studied in the atrophic gastritis-adenoma-adenocarcinoma progression of pathological states of the stomach. It has been revealed that, at the initial stage of carcinogenesis, namely adenoma, immunocompetent cells have the highest cytokine-producing proto-oncogenic potential as compared to both atrophic gastritis, which presents a precancerous condition, and completely formed malignant tumor (gastric adenocarcinoma).
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Adenocarcinoma/sangre , Adenoma/sangre , Citocinas/sangre , Gastritis Atrófica/sangre , Leucocitos/metabolismo , Proteínas de Neoplasias/sangre , Neoplasias Gástricas/sangre , Femenino , Humanos , MasculinoRESUMEN
Modem approaches to diagnosis and treatment of tachyarrhythmia at military-medical organizations.. The article describes the principles of differential diagnosis and treatment of tachyarrhythmia. Developed algorithms of diagnostics and treatment of cardiac arrhythmias in the military-medical institutions. The algorithm relief hemodynamically stable rhythmic tachycardia. The results of interventional -treatment in 462 patients with tachyarrhythmia heart. The high efficacy and safety of radiofrequency ablation technique in patients with tachyarrhythmia heart.
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Algoritmos , Medicina Militar/métodos , Ablación por Radiofrecuencia , Taquicardia , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Taquicardia/diagnóstico , Taquicardia/fisiopatología , Taquicardia/terapiaRESUMEN
Splenectomy is a serious operation, which includes the removal of the largest peripheral immune organ. Vast array of different pools of immunocompetent cells and immune-factors eliminate from the body as a result of this operation. Occurrence of hyposplenism in our country pediatric service is not determined--there are neither clear criteria for its diagnosis, nor approved algorithms for prevention. Data of postsplenectomy sepsis incidence in Russia are unknown. In this review article authors give contemporary literature data relating to the issue of developing hyposplenism and changes in the body after removal of spleen. Systemic effect of organ-resecting operation and the basic directions of overwhelming postsplenectomy infection and sepsis prevention are discussed.
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Complicaciones Posoperatorias , Esplenectomía/efectos adversos , Enfermedades del Bazo , Salud Global , Humanos , Incidencia , Enfermedades del Bazo/epidemiología , Enfermedades del Bazo/etiología , Enfermedades del Bazo/prevención & controlRESUMEN
The rare combination of intestinal lymphangiectasia with malrotation of the duodenum in a child of three months of life is described. Basing on the literature review only 3 similar cases were described in the world practice. The boy with protein-losing enteropathy was examined at Moscow Scientific Centre of Children's Health. The child had vomiting, diarrhea, loss in body weight, hypoproteinemia, lymphopenia. The infectious nature of the disease was excluded. It had been suggested the Waldman desease (primary intestinal lymphangiectasia). The prognosis for such disease is unfavorable. An examination of the child was continued against the backdrop of ongoing symptomatic therapy. Complete physical examination included monitoring laboratory blood tests, X-ray examination with contrast, CT-scan, gastroduodenoscopy with biopsy of the mucosa of the small intestine. Malrotation duodenum with the recurrent mid-gut volvulus with the development of secondary intestinal lymphangiectasia was diagnosed. Modern methods of examination and multidisciplinary approach made it possible to diagnose the case. Operation to eliminate fixation duodenum resulted in the recovery of the patient. At the present time the child grows and develops according to age and does not require treatment. The prognosis for this disease is regarded as favorable.