No 4 (2017)

Objective. To establish the clinical significance of the indicators of the blood cytokine status in determining the degree of immune disorders and the course of viral meningitis (VM) and the prediction of its outcome in children. Subjects and methods. ELISA was used to estimate the serum levels of interleukins (IL-lß, IL-2, IL-4, IL-6, IL-8, IL-10), TNF-а, and interferons (INF-а and INF-y) in 450 children aged less than 14 years with VM of different etiologies (enterovirus, arbovirus, mumps, adenovirus, and herpes virus) and in 50 healthy children of the same age. Results. It is established that an imbalance of cytokine regulation in children with VM depends on the period, severity, and course of the disease, is characterized by the activation of pro- and anti-inflammatory cytokines (IL-1ß, IL-4, IL-6, IL-8, IL-10, TNF-а) and the suppression of IL-2, IFN-а, and IFN-y, and reflects the severity of immune disorders. Conclusion. The findings may be used to predict the course of the disease, to determine the degree of immune disorders, to diagnose secondary immunodeficiencies, and to use appropriate immunomodulatory therapy.

Objective. To evaluate the efficacy, tolerability, and safety of using a combination metabolite drug containing L-glutamic acid, glycine and L-cystine in comparison with basic therapy in the correction of neurovegetative disorders in children with acute respiratory infections. Subjects and methods. The investigation enrolled 53 patients aged 12 to 18 years with acute respiratory infections who had clinical manifestations of neurovegetative disorders. The patients were randomized into 2 groups: a study group (n = 27) and a control group (n = 26). The study group received the metabolite drug as part of combination therapy; the control group had the basic therapy. The duration of treatment was 30 days. All the patients underwent comprehensive assessment of the neurovegetative status at admission and at 1-month follow-up. Results. There were no patients with obvious asthenia in the study group at the follow-up, while the proportion of such patients was 3.8% in the comparison group. After the end of treatment, 70% of the patients in the study group were diagnosed with a predominance of sympathetic tone of the autonomic nervous system; these were only 42.3% in the comparison group (p < 0.05). At the same time, there was no obvious abnormal sympathetic regulation when the drug was used (unlike the comparison group where this was noted in 34.6% of cases; p < 0.01), suggesting that the functioning processes of the neuroregulatory system were restored. After treatment completion, the children in the study group had diminished central nervous break-down, enhanced working efficiency, improved performance, and lower-level anxiety. No adverse events or abnormal hemogram readings were recorded after completing the therapy cycle. Conclusion. The investigation showed the efficacy and safety of using the metabolite drug containing L-glutamic acid, glycine, and L-cystine in children with neurovegetative disorders in the presence of acute respiratory infections. The therapy contributed to the reduced severity of post-infection asthenia.

Myocarditis is one of the nosological entities that are difficult to diagnose in daily clinical practice, which can result in fatal outcomes if timely adequate therapeutic actions are not undertaken. Clinicians rarely diagnose this pathology, despite the fact that it is accompanied by myocardial inflammatory changes in 1 to 10% of cases of infectious diseases, according to investigators. The paper presents basic information on myocarditis in children: classification, risk factors, etiology, pathogenesis, clinical picture, diagnosis, therapy and an algorithm for the management of patients in accordance with the current guidelines and the results of the authors’ investigations. Attention is drawn to the polymorphism of symptoms and the nonspecificity of detectable changes. Emphasis is laid on the high significance of electrocardiographic (ECG), ultrasound, and laboratory techniques that are available in a pediatrician’s daily practice. Probable myocarditis can be diagnosed based on the increased laboratory markers of myocardial damage, such as troponin, creatine kinase MB, and a-hydroxybutyrate dehydrogenase, as well as impairments detected by echocardiography. Etiotropic, metabolic, and symptomatic therapies are prescribed to patients.

Objective. To assess the intestinal cytokine profile in patients with acute enteric infections (AEI) in the dynamics of the disease during standard pathogenetic therapy and treatment according to the regimen added by aminodihydrophthalazinedione sodium (ADPNa). Subjects and methods. The patients were divided into 2 groups of 30 people each according to a therapy regimen. Group 1 received standard pathogenetic therapy. In Group 2, the regimen was added by ADPNa. The coprofiltrates taken at 1-2 days of the disease and 5 days later were used to determine the level of cytokines (interferon-y (IFN-y), IL-4, IL-6, and IL-10). Results. In both groups, the levels of IL-6 and IFN-y substantially increased, but those of IL-4 and IL-10 kept normal in the height of the disease. In Group 2, the level of IL-6 significantly decreased and that of IL-10 increased at hospital discharge. Only the similar insignificant trend was observed in Group 1. Changes in the cytokine profile also affected the duration of the symptoms of the disease. In Groups 1 and 2, the duration of diarrhea was 5.5 ± 0.2 and 4.0 ± 0.2 days, respectively (p < 0.01). Conclusion. The findings make it possible to recommend that the local cytokine profile should be corrected with ADPNa in the combination treatment of AEI.

Objective - to determine the efficacy and inhalation toxicity of the chlorine dioxide (CD) generator Barrier Reef used as a personal air disinfectant to inactivate the pathogens of airborne infections. The investigations conducted at the Research Institute of Influenza, Ministry of Health of Russia (Saint Petersburg), showed that the CD generator had high virucidal activity against influenza virus; when CD was used at low, low-toxic concentrations, the virus titer in the air samples was reduced by 90% at 1-3 min, by 97% at 3-5 min, and by 99% at 10-12 min. The agent was effective at least 30 days. The inhalation toxicity of CD was investigated in the experiments using the rats that were kept in an atmosphere of CD for a certain time. Then the structure of the trachea and lungs was histologically determined; the degree of oxidative stress was estimated from the tissue level of malonic aldehyde and the changes in the gene expression of all classes of antioxidant enzymes (a total of 15 different enzymes). The structure of the tracheal and lung epithelium was ascertained to be completely preserved; in this case, there were no increases in apoptotic cell death in both tissues or in lipid peroxidation in lung tissue. The enhanced protection of tracheal and lung epithelial cells against the highly toxic reactive oxygen species generated in the tissues is associated with the activation of gene expression of antioxidant enzymes in the epithelium, which is observed within the f irst hours after action of CD. The results of the investigations allow the air disinfectant Barrier Reef to be recommended for the prevention of airborne infections.