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Vol 7, No 1 (2016)

Articles
Modern principles of cardiopulmonary resuscitation in pediatric practice
Alexandrovich Y.S., Pshenisnov K.V.
Abstract
Quality improvement of cardiopulmonary resuscitation (CPR) is one of the most urgent problems in pediatric anesthesiology, resuscitation and intensive care. Despite the fact that in recent years the number of surviving children after cardiopulmonary resuscitation is constantly increasing, the number of young children among them, still small, which requires further improvement of provision of intensive care, especially in the pre-hospital stage. In the last two decades the protocols of cardiopulmonary resuscitation are regularly changed and supplemented every five years, which helps to improve outcomes of resuscitative measures. In October/November 2015 came the next recommendations of American Heart Association and European Resuscitation Council for basic and advanced cardiopulmonary resuscitation in children, which is reflected in this article. Using these recommendations will significantly improve the quality of the provision of intensive care to children and contribute to a more favorable neurological outcome even after a sudden circulatory arrest. This publication reflects the epidemiological evidence on the effectiveness and outcomes of cardiopulmonary resuscitation in pediatric practice, the modern principles of basic and advanced cardiopulmonary resuscitation in children are considered in detail, special attention is given to the use of drugs and defibrillation during resuscitation. Excerpts from the regulating documents governing the termination of resuscitation and ascertaining biological death are presented in this article.
Pediatrician (St. Petersburg). 2016;7(1):5-15
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Assessment of quality of life of adolescents with endocrine diseases
Akhmedova R.M., Sofronova L.V., Vladimirova K.N.
Abstract
Appreciation of life′s quality supplements complex medical investigation and make it possible to value child′s state of health and develop rational approach for therapy and rehabilitation. The life quality of 127 patients with obesity and 67 patients with diabetes of the 1st type were investigated. 120 teenagers of the same age and sex who were practically healthy compile the group of control. Questionnaire in life′s quality for children from 13 to 18 years old was used Ped′s QL 4.0 Pediatric Quality of life Questionnaire. It was established that teenagers with diabetes have all the indicators of life′s quality more lower than their contemporaries, specially in physical and social functioning. Children with diabetes of the 1st type, who are on insulin pump therapy have the life′s quality more higher than children receives insulin with the help of autoinjector. The indicators of life′s quality is registered at children who are ill the first year or more than five years. During the investigation of teenagers life′s quality with obesity was get registered that total indices of their life′s quality are significantly lower than at their mates from control group. More significant differences are discovered by indicator panel “Social functioning”. The indices of physical functioning of teenagers with obesity are significantly lower than at healthy mates. Girls comparatively with boys appreciate practically all indicators of life′s quality lower besides school if we compare indicators of life′s quality of teenagers with obesity and diabetes of the 1st type their general indicator is higher than at teenagers with excess weight.
Pediatrician (St. Petersburg). 2016;7(1):16-21
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Minitabletted pancreatin pangrol 10 000 iu and 25 000 iu efficacy and safety in patients with cystic fibrosis
Orlov A.V., Nikitina M.I., Pashkevich A.A., Kovalev V.N.
Abstract
The substitutive enzymatic therapy is vital in cystic fibrosis patients with pancreatic insufficiency. Usually patients are given enzymes at every meal. If it is necessary to replace one enzymatic remedy to another, the replacement should be done gradually (for 12-14 days). A comparative study of encapsulated enzyme preparations Creon 10 000 IU/25 000 IU and Pangrol 10 000 IU/25 000 IU safety, efficacy and tolerability was done in 20 patients with cystic fibrosis at the age of 11 months - 16 years. 13 people have got the doses in the calculation of the lipase up to 100 TU; and more than 100 TU - 7 people. Different drug doses effectiveness was determined according to faeces parameters and coprogram indicators. Numerical evaluation of the clinical efficacy and tolerability of both drugs was conducted through a questionnaire survey of patients and specialists. All patients completed the study. The effectiveness of the treatment according to coprogram was the same in both groups. In most cases, the process of transferring patients from Creon on Pangrol passed without the appearance of negative symptoms. It has been shown that encapsulated, mini-tablet pancreatin Pangrol well tolerated by patients. This allowed to 60 % of patients with cystic fibrosis change the treatment from Creon on Pangrol. Adverse events (10 %), detected in the process of transferring patients from one drug to another, were rare and short-term. The majority of physicians and patients prefer to continue therapy with Creon, according to their previous successful experience. Step-by-step scheme of replacing one enzymatic remedy on another is shown in this paper.
Pediatrician (St. Petersburg). 2016;7(1):22-26
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Differential evaluation of iron metabolism in children with hypochromic anemia
Pshenichnaya K.I., Zhilenkova Y.I.
Abstract
In the article are presented the indicators of iron metabolism in the two groups of children with hypochromic anemia in age from 7 months to 16 years who were examined in the Consultative and Diagnostic Center for Children of St. Petersburg: 28 patients with iron deficiency anemia and 21 patients with thalassemia minor. Characteristic changes are marked at children with IDA: reduced average iron and ferritin of serum and increasing the total iron binding capacity (TIBC) and soluble transferrin receptor (RTR). Children with thalassemia minor are characterized normal average serum iron, TIBC and ferritin, and a slight increase in RTR. But when we’ve analyzed the vibrations of each of these parameters in different groups of children, we founded a more diverse spectrum of disorders that may be associated with a combination thalassemia minor and iron deficiency, as well as the presence of comorbidities and conducted recently therapy by ferrum. Conclusion: it is necessary to evaluate the maximum number of biochemical parameters of iron metabolism, taking into account premorbid background and comorbidity.
Pediatrician (St. Petersburg). 2016;7(1):27-31
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Comparison of conducted antiepileptic therapy with indicators of hormones level in blood serum of girls with epilepsy
Guzeva V.I., Guzeva V.V., Guzeva O.V.
Abstract
Introduction. Multiple changes in the organism, which are observed in prepubertal and pubertal age, creates the need of clear diagnosis and treatment of the disease based on drugs interactions and their influence on hormonal status. In girls with epilepsy, such studies were not conducted. The aim of the study was to investigate the influence of modern antiepileptic drugs on hormonal status in adolescent girls with epilepsy. Materials and methods. In blood of 50 girls aged 8 to 17 years with epilepsy studied levels of thyroid-stimulating hormone (TSH), thyrogiobulin antibodies (a/b TG), triiodothyronine (T3), thyroxine (T4), parathyroid hormone (P) and cortisol (C). Treatment in most cases included valproic acid, carbamazepine, and topiramate. The main results of the study. In treatment with use of various drugs detected 2 (9.52 %) significant differences in hormone levels and 7 (33.33 %), significant differences in the width of distribution of hormones values. The highest content of thyroid-stimulating hormone found in girls 8-17 years treated by valproic acid, antibodies to thyroglobulin - treatment without AED, triiodothyronine - use of phenobarbital or benzobarbital, thyroxine - treatment on topiramate, PTH - in girls treated by valproic acid, cortisol in girls 8-13 years - on phenobarbital or benzobarbital, girls 14-17 years old - on oxcarbazepine. In 19 girls with epilepsy within 2-12 months after the first study hormone levels of TSH, a/b TG, T3, T4, C were re-determined. Indicators of hormones in different drug treatment changed according to the initial average content of hormones in all girls in 64.86 % of cases same way as in the first study. Conclusions. Significant difference of all hormones, in the content or width of distributions of their values, was found in girls with epilepsy taking different antiepileptic drugs. Choice of drug, dosage and its correction should be made taking into account its impact on children's hormonal status.
Pediatrician (St. Petersburg). 2016;7(1):32-42
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Clinical efficiency of midget doses of the affine cleared antibodies to S-100 protein at the children with dysfunction of autonomic nervous system and acute obstructive bronchitis in anamnesis
Melnikova I.M., Mizernitskiy Y.L., Pavlenko V.A.
Abstract
The importance in a pathogenesis of the wheezing and a development of a nonspecific bronchial hyperreactivity belongs to neurogenic mechanisms. It is known that perinatal damage of the central nervous system are an adverse background for a forwardness of acute wheezing and bronchial asthma at children. The available data on a role of a functional condition of autonomic nervous system at the wheezing aren't numerous and rather contradictory that demands further researches, including in respect of a choice of methods of the rehabilitation. The aim of our study was to determine of the clinical and functional efficiency of including of midget doses of the affine cleared antibodies to S-100 protein in complex rehabilitation of the children of early age with wheezing, depending on the presence of mild severity of perinatal damage to the CNS hypoxic genesis. Our data showed that additional including of midget doses of the affine cleared antibodies to S-100 protein in a complex of rehabilitation of these patients a positive effect on the autonomic imbalance, vegetative component of the wheezing. At the same time, prescription by a short course (less 5 weeks) of midget doses of the affine cleared antibodies to S-100 protein didn't prevent emergence of episodes of the wheezing. Perhaps, patients with recurrent wheezing with the expressed functional disturbances of the autonomic nervous system, need longer courses of the this medicine that can be useful in a complex of rehabilitation.
Pediatrician (St. Petersburg). 2016;7(1):43-49
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Clinical current and structural changes of pulmonary tissue at children with a bronchopulmonary dysplasia in the anamnesis
Zapevalova E.Y., Klyukhina J.B., Boitsova E.V., Kirbyatieva M.A.
Abstract
Bronchopulmonary dysplasia is currently the most common chronic lung disease in preterm infants. Since the initial description of the disease, more than forty years ago, new treatments and technologies have improved the outcome for preterm infants with very - low and extremely - low - birth - weight. As a result, the survival of extremely premature infants has increased but, despite of the improvement in neonatal care, the incidence of bronchopulmonary dysplasia continues to grow. At the same time the consequences of this disease for life has not yet been determined. The aim of the study to determine the clinical course, structural and functional changes in the lungs. In this study we surveyed 44 primary school children and adolescents who have had bronchopulmonary dysplasia in infancy. The children was carried out computed tomography of the lungs, research of function of external breath by methods of impulse oscillometry, spirometry, a body plethysmography, and also research of diffusion lung capacity. The features of the clinical course at different ages, the functional state of the respiratory system, as well as structural changes in the lung tissue. In school children and adolescents with a history of bronchopulmonary dysplasia found long - term structural changes in the lungs as inhomogeneity of ventilation and fibrotic changes on computed tomography of the thorax and also had evidence of airflow obstruction in the result of pulmonary function tests, in the absence of significant clinical signs of respiratory disease.
Pediatrician (St. Petersburg). 2016;7(1):50-57
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Extracorporeal photopheresis and anticytokine therapy in the treatment of steroid-refractory acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation in children
Kozlov A.V., Fedukova J.G., Bykova T.A., Moiseev I.S., Estrina M.A., Kulagina I.I., Bondarenko S.N., Morozova E.V., Osipova A.A., Borovkova A.S., Razumova S.V., Zubarovskaya L.S., Afanasyev B.V.
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-SCT) is used widely in the management of children with hematological, oncological and inherited diseases. Study to compare efficiency of steroid-refractory acute graft versus host disease treatment (extracorporeal photopheresis (ECP) vs anticytokine therapy) was conducted in Raisa Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of Saint Petersburg. Sixty four children were included in the analysis. Patients were divided into two groups: first “group with ECP” (n = 31; 50,5 %) ("ECP group") and second - "group without ECP" (n = 33; 49,5 %). Treatment in the second group consisted of anticytokine therapy (etanercept (n = 12), infliximab (n = 9), daclizumab (n = 8)) and alemtuzumab (n = 4). Ten-year overall survival (OS) of children with steroid-refractory acute graft versus host disease was 39 % without difference in OS between ECP and anticytokine therapy (5-year OS 40 % vs 35 %, p = 0,34). Response rate to the therapy was also the same in both groups (68 % after ECP and 70 % after anticytokine therapy, p = 0,77). Difference in cumulative incidence of relapse in "ECP group" and "group without ECP" was not statistically significant (18 % and 7 %, respectively, p = 0,2). In conclusion, ECP and anticytokine therapy are equally effective in the treatment of children with steroid-refractory acute graft versus host disease and are associated with the same cumulative incidence of relapse.
Pediatrician (St. Petersburg). 2016;7(1):58-64
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Improving the availability and quality of medical care and rehabilitation in children with cerebral palsy
Batysheva T.T., Guzeva V.I., Guzeva O.V., Guzeva V.V.
Abstract
Nowdays, cerebral palsy is a leader in the structure of chronic diseases of childhood. The earliest start of the rehabilitation of children with cerebral palsy, continuity and phasing their implementation, systematic and comprehensive, individual approach provide children with cerebral palsy to attain optimal physical, intellectual, psychological and/or social functional levels and to support it, thereby giving them tools designed to change their lives and expand their independence According to the latest scientific data in Russia today more than 40 % of newborns have various health disorders. Disease of the newborn, threatening the formation of cerebral palsy in almost half of cases partially or completely curable, but it requires time to diagnose them and begin proper rehabilitation treatment. It was in early childhood may successfully correct the existing neurological and orthopedic disorders, minimizing the effects of damage to the central nervous system. Introduction to the complex rehabilitation of patients with cerebral palsy high-tech methods of rehabilitation treatment will provide for pathogenetic treatment and significantly increase the speed of recovery of disturbed functions that will significantly reduce the degree of disability of such patients. Existing conditions of medical care and rehabilitation can not fully ensure a continuous process of complex rehabilitation of children with cerebral palsy. It is necessary to further improve the quality of treatment and rehabilitation, and their accessibility to children with cerebral palsy.
Pediatrician (St. Petersburg). 2016;7(1):65-72
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Estimation of work of the specialized psychiatric help to child's population
Orel V.I., Sereda V.M., Gureva N.A., Krasnov B.Y.
Abstract
In the article data of analysis of quality of the specialized psychiatric help to the children and teenagers are presented in Saint Petersburg. Research came true on the base of Center of restoration treatment "Child's psychiatry" the name of S.S. Mnuchina, where work of service of quality to medicare, organization of examination of quality of medicare, was studied, sociological research of opinion of patients and their parents was conducted about organization of psychiatric help in this medical establishment and their satisfaction from the got medicare. Problems are educed in organization and quality of the specialized medicare to the children and teenagers with psychonosemas and disorders of behavior. The necessity of further perfection of work on the continuous upgrading of work of psychiatric service is set.
Pediatrician (St. Petersburg). 2016;7(1):73-79
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Consensus “Cystic Fibrosis: definition, diagnostic criteria, treatment” Section “Microbiology and Epidemiology of chronic respiratory infections in cystic fibrosis”
Shaginyan I.A., Chernukha M.Y., Kapranov N.I., Kondratyeva E.I., Kashirskaya N.Y., Amelina E.L., Asherova I.K., Volkov I.K., Gembitskaya T.E., Ginter E.K., Ilyenkova N.A., Karimova I.P., Krasovsky S.A., Merzlova N.B., Nazarenko L.P., Namazova-Baranova L.S., Neretina A.F., Nikonova V.S., Orlov A.V., Postnikov S.S., Protasova T.A., Semykin S.Y., Sergienko D.F., Simonova O.I., Uspenskaya I.D., Shabalova L.A., Sherman V.D.
Abstract
The main causative agents of lung infection in patients with cystic fibrosis (CF) are P. aeruginosa, S. aureus and H. influenzae. In the last decade, gram-negative nonfermentative microorganisms (NFMO) - Вurkholderia cepacia complex (Bcc), Stenotrophomonas maltophilia, Achromobacter xylosoxidans and non-tuberculous mycobacteria, fungi of the genus Aspergillus have acquired the clinical significance. It is found that the chronic lung infection in 2/3 of the cases caused by association of microorganisms. Among hospitalized patients, in contrast to outpatients, these associations are represented by two, three or more species of microorganisms. The associations of P. aeruginosa + S. aureus (18,2 %) and P. aeruginosa + Bcc (9,1 %) are the most common. Other representatives - A. xylosoxidans, S. maltophilia and A. baumanii - is often identified in the associations of microorganisms. The focuses of chronic lung infections are formed in patients with increasing age. The dominant pathogens are P. aeruginosa and S. aureus. The methicillinresistant staphylococci and P. aeruginosa strains with a mucoid phenotype are of particular importance for cystic fibrosis patients. Bcc isolates from cystic fibrosis patients in Russia often belong to genomovar III A-B. cenocepacia. The Bcc strains colonize the lower airways of patients with CF and are able for long-term persistence and transmission from patient to patient. The resistance to many antibiotics is the main feature of the P. aeruginosa, S. aureus and Bcc strains. The strains of microorganisms with atypical phenotype (small colony variants) are formed under the action of the antibiotic. Infections caused by Bcc and other NFMO are difficult to identify and we need to use a wide range of bacteriological, biochemical, molecular biological techniques and mass spectrometry.
Pediatrician (St. Petersburg). 2016;7(1):80-96
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Contrast-induced nephropathy (Pharmacology of X-ray contrast agents)
Raptanova V.A., Speranskaya A.A., Proshin S.N.
Abstract
In the last 30 years the use of X-ray contrast media (RCM) has increased significantly during urography, angiography, computed tomography, and operating procedures. Every year the world uses about 60 million doses of PKM, but, despite the use of newer and less nephrotoxic drugs, the risk of contrast-induced nephropathy (CIN) is still significant, especially among patients with prior renal impairment. Contrast induced nephropathy is a major cause of acute renal injury and is a huge problema in clinical practice. So far, con-tradictions remain in the understanding of many aspects of CIN. Contrast-induced nephropathy is acute renal failure (ARF) occurs within 48-72 hours after intravenous administration of contrast sub-stances. Toxicity PKC determined their molecular structure and its ability to dissociate in aqueous solution into ions which consist of salts which dissociate into cations and anions. The contrast-induced nephropathy is manifested in the increase of serum creatinine of 44 mmol/L (0.5 mg / dl) or more and the same rise in serum creatinine of more than 25 % compared to baseline in the absence of other possible causes. ARF is a sudden and sustained reduction in glomerular filtration rate and urine volume, or both together. Thus renal dysfunction existing even more than 1 month can be regarded as acute renal dysfunction. Usually the development of acute renal failure occurs within 1-7 days. The criteria of sustainability is a dysfunction of its registration within 24 hours or more. The aim: to consider different approaches to the pathogenesis, risk factors and achievements in the prevention of contrast-induced nephropathy.
Pediatrician (St. Petersburg). 2016;7(1):97-105
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Role of modified ultrafiltration in reduce of the systemic inflammatory response syndrome in cardiac surgery
Khubulava G.G., Marchenko S.P., Dubova E.V., Suvorov V.V.
Abstract
During open-heart surgery it is possible to disturbance of the barrier function and the appearance of inflammation in the systemic circulation of inflammatory mediators and pro-inflammatory cytokines, which is realized in the systemic inflammatory response syndrome (SIRS). To prevent the development of the condition, or to reduce the severity of its complications method of mechanical removal of inflammatory mediators and cytokines from the blood of the patient is the most efficient. At the moment, the problem of implementation of the systemic inflammatory response syndrome after surgery using cardiopulmonary bypass quite relevant because of the high frequency of its manifestations and adverse effects [18]. This explains the large number of studies aimed at both the study of the pathogenesis of systemic inflammatory response syndrome and the development of new methods to combat this phenomenon and the improvement of already applied methods and techniques [1, 4]. There are various ways to the reduction of the degree of systemic inflammatory response syndrome, but special attention is given to the study of methods of modified ultrafiltration and continuous veno-venous hemofiltration. Further study of the application of ultrafiltration on patients undergoing cardiac surgery heart surgery with the use of bypass is necessary for understanding of the physiology and pathophysiology of systemic inflammatory response syndrome induced by the conduct of bypass, as well as for the subsequent formulation of clinical guidelines for use in cardiac surgery practice. In this article we have tried to consider the most significant results of such studies.
Pediatrician (St. Petersburg). 2016;7(1):106-110
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The use of contrast media in radiology in children
Krylova A.I., Sotnikova E.A., Golbits A.B.
Abstract
Using of contrast media (CM) during traditional x-ray examination, CT, MRI plays an important role in obtain information. This information can be crucial for the final diagnosis or making choice of treatment in different areas of medicine, like surgery, pediatrics, oncology, etc. Principles regarding contrast media utilization and associated adverse events are generally similar between children and adults, but of course have some important differences. The main peculiarities of introducing contrast in children are: using small volume of contrast media (1,5-2 ml/kg); small gauge angiocatheters (for example, 24-gauge) located in tiny peripheral vessels. It makes performing this method more hard in newborns and small children. Dose of CM is calculated according body weight and concentration of the stuff. It is important not to forget about optimal temperature mode during introducing CM. As any invasive method introducing of CM can be associated with some complications. The most frequent complications in pediatric patients are contract-induced allergy and contract-induced nephrotoxicity. The assessment of renal function in children is determined by the special formula (Schwartz Equation). General guidelines for the prevention of allergic-like reactions in children are similar to those used for adult patients and include premedication regimen, using a combination of corticosteroid and antihistamine. It is necessary to apply modern multi-layer spiral CT and special programs for reducing radiation exposure.
Pediatrician (St. Petersburg). 2016;7(1):111-119
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The endocrinologic complications in children after anticancer treatment
Radulesku G.G., Matchenkova N.V., Belogurova M.B.
Abstract
During last three decades, there is a dramatic improvement in the survival of children and adolescents with cancer. This progress has been possible because of the recent programs of improved therapy (radiotherapy, chemotherapy). There are different toxic effects in patients who have received chemotherapy and radiotherapy. One of the most common late effects of anticancer treatment in children and adolescents is endocrine disorders. Radiotherapy, alkylating agents, high-dose chemotherapy with stem-cell transplantation are the main risk factors of endocrine impairment. All parts of endocrine system are involved in the pathologic process during and after the end of treatment of children and adolescents. Abnormalities in hypothalamo-pituitary function, thyroid function, adrenal function, gonadal function are variably associated with anticancer therapy. Different metabolic disturbances, abnormal sexual development and infertility are caused by the dysfunction of endocrine system. There are immediate (during therapy) and delayed (after the end of treatment) onset late effects of antineoplastic therapy. Early diagnosis and early treatment of complications - as the main factors to improve the results of treatment and quality of life of patients surviving cancer. The aim of this article to analyze the possible range of endocrine disturbance in children and adolescents after anticancer treatment, the necessary intensive follow-up for survivors after the diagnosis of cancer and the treatment of possible endocrine disorders.
Pediatrician (St. Petersburg). 2016;7(1):120-128
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Global and pediatric aspects of Zika virus infection
Ivanov D.O., Malinovskaya V.V., Timchenko V.N., Kaplina T.A., Hakizimana J.
Abstract
This article presents the results of data analysis or references on etiology, epidemiology, pathogenesis, clinical features, therapy and prophylaxis of Zika virus infection. The article presents the results of the literature analysis of the data on the etiology, epidemiology, pathogenesis, clinical presentation, treatment and prevention of Zika virus infection. Currently Zika fever is common in tropical climates (Uganda, Brazil, Haiti, Colombia, Ecuador, El Salvador, Venezuela, Jamaica, Thailand, etc.). However, a large number of travelers and areolas mosquito habitat Αedes kind of make this a global problem. Acquired Zika virus infection usually occurs in mild and/or moderate forms. The development of severe forms occurs mainly in people with a weakened immune system or autoimmune diseases. Patients affected with Zika virus may develop neurological complications such as encephalitis, myelitis, optic neuritis, meningoencephalitis, Guillain-Barre syndrome. Transplacental and sexual transmissions contribute to an increase in the number of cases among children, including newborns. Zika congenital infection is characterized with brain damage, hearing and sight. Acquired Zika fever in children is accompanied by the presence of the following syndromes: subfebrile fever, mild intoxication, maculopapular rash with a landmark distribution, arthralgia, myalgia, photophobia and conjunctivitis, diarrhea rarely observed. In the laboratory diagnosis are used virological, molecular biological and serological methods. There are no specific prophylactic methods.To treat Zika virus infection, may be used recombinant human inteferona α2β and interferon inducers.
Pediatrician (St. Petersburg). 2016;7(1):129-134
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Extensiv scleroma at 11 years old girl
Bakradze M.D., Petrovskaiya M.I., Polyakov D.P., Polyakova A.S., Shavrov A.A., Tatochenko V.K.
Abstract
Rhinoscleroma is a rare chronic granulomatous disease caused by Klebsiella rhinoscleromatis, which is a Gram-negative bacilli. Scleroma primarily affects the upper respiratory airway, preferably the nasal cavity, but the pharynx and larynx may also be involved. The term scleroma is preferred over the term rhinoscleroma because this disease affects not only the nose. Scleroma is endemic in countries of East Europe, Africa, South-East Asia and in sporadic areas worldwide. Scleroma usually begins at the nose and may progress to involve the larynx, pharynx or other regions of the neck. Scleroma generally progresses in three stages: the catarrhal or exudative phase, the proliferative or granulomatous phase, the sclerotic stage. Diagnosis of Rhinoscleroma depends on identification of the pathognomonic Mickulicz cells which is most prominent during granulomatous phase but spares or absent during catarrhal or sclerotic phases of the disease. We report a case of 11-year-old girl with the sclerotic stage of scleroma. This diagnose was proved by Mikulich cells histological detecting. We review the history, epidemiology, pathology, diagnosis, and treatment of scleroma. We report the case of a 11-year-old girl, hospitalize in our institute, diagnosed with rhinoscleroma in the context of recurrent breathlessness, wheezes and cough. The diagnosis difficulty caused by changes of nasal laryngeal mucous membrane after septoplasty 3 months ago and bronchial asthma diagnosed 2 years ago. The patient was given a six-month regimen of ciprofloxacin, and a dramatic improvement was observed.
Pediatrician (St. Petersburg). 2016;7(1):135-141
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Linguistic Disfluency in Story-telling: Evidence from Lithuanianand Russian-speaking Preschoolers
Balčiūnienė I., Kornev A.N.
Abstract
Speech disfluency can be distinguished as being either stuttering or linguistic disfluency; the latter can be divided into categories such as hesitations, fillers, repetitions, revisions, and connectors. Significance of linguistic disfluencies in the flow of conversation has been particularly emphasized at the very beginning of studies in conversational analysis; however, linguistic disfluency in children speech still has not been widely investigated. The paper deals with the production of mazes in story-telling. Our analysis was based on experimental data of two (Lithuanian- and Russian-speaking) groups of typically-developing monolingual children from middle-class families, attending state kindergartens. During the experiment, the children were asked to tell a story according to the picture sequence. After transcription of video-/audio-recorded stories, production of mazes was measured automatically by using CLAN tools. The study highlighted the main tendencies of linguistic disfluency in the narratives of Lithuanian- and Russian-speaking TD preschoolers, such as dominance of hesitations (especially, silent (unfilled) pauses) among all the mazes and prevalence of lexical reformulations among all the revisions. Only a few but significant differences were obtained between the groups: first, only in the Russian-speaking group hesitations correlated with revisions; second, in the Russian-speaking group, repetitions correlated with fillers, while in the Lithuanian-speaking group a correlation between silent (unfilled) pauses and repetitions was identified. The differences observed between the groups might lead to raising a question about cross-linguistic and cross-cultural universalities and differences from the perspective of linguistic disfluency in narrative speech.
Pediatrician (St. Petersburg). 2016;7(1):142-146
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Infancy and the First Steps of Professional Midwifery Schools in Russia
Novikova T.O.
Abstract
This research is devoted to the analysis of the first schools for midwives in Russia and first of all we will review the principles, which were the basis for teaching obstetricians and understanding the socio-cultural reception childhood and motherhood, which arises in connection to this. Why the focus is on the professional organization of obstetric and midwifery practice development in Russia? Ideas about how childhood is interpreted, what status does a child have in the social structure, how the concern to protect the life of the newborn may be reflected - all these problems could be found in a variety of legal laws and regulations. Establishment of professional obstetrics is not only the important milestone in the history of medicine, it is also very important for the whole of human knowledge, as the emergence of professionally organized obstetrics may be a sign of changes of the attitude to women and children in the socio-cultural system. This is especially important when it comes to infants, since this stage of life is usually beyond the scope of social and cultural reflection, infancy is not asserting itself and attitude to infants shows itself in the history of culture indirectly through the represented visual images, creating a certain material culture and formation system of views on the care of mothers and children. Providing professional medical assistance to a woman during childbirth and to an infant means that their life and health are important for the state and they should not rely only on the grace of God.
Pediatrician (St. Petersburg). 2016;7(1):147-150
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The quality of interaction between mother and child as a factor of formation of health
Vasilenko T.D., Vorobeva M.E.
Abstract
The article is devoted research of factors and conditions quality of early interaction between mother and child. In our work it is important that consideration of motherhood from the point of view of social and role-playing component of social identity in connection with the style of readiness to motherhood. These data suggest that in women with adequate style readiness to motherhood to the fore the social role of wife and mother, as well as the role of a professional. Women style with alarming readiness to motherhood hierarchy of social roles are determined by the primary role of the mother. Ignoring the style, readiness to motherhood a woman defines herself as a professional, employee, indicating the rejection of the role of mother with this style. Found communication style, readiness to motherhood in women during pregnancy, quality of early interaction with the child and the health of children in the first 6 months of life. As a result, longitudinal studies of the dynamics of the interaction between mother and infant conclusions, allowing to prevent violations of the contact in the dyad "mother-child" on the stage of pregnancy and after the birth of a child within 6 months. Style the willingness to motherhood influence the formation of social role component of the identity of a woman. During pregnancy formed a stable hierarchy of social roles. It allows you to design individually oriented psychological intervention, but also confronts us with the task to prepare the woman during pregnancy to the adoption of social roles as mothers.
Pediatrician (St. Petersburg). 2016;7(1):151-155
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Assessment of life quality in disabled individuals
Malikova T.V., Pirogov D.G.
Abstract
This article presents the study of the features of the subjective evaluation the quality of life of disabled people. The article contains a comparative analysis of Paralympians and persons with locomotor disorders and a comparison of Paralympian and professional athletes. The study describes the features of perception of the life in a time perspective and considers some characteristics of the quality of life (self-attitude, coping strategies, values). Within the framework of the presented research which was revealed Paralympians' positive assessment of their quality of life, unlike the comparison group (athletes and persons with locomotor disorders). An orientation to the future and positive assessment of the present tense are typical for paralimpians. They demonstrate a high level of satisfaction with social relationships, positive view of their own health, and the harmonic type of relationship to the disease, which allows adequate distribute their own strength and to determine their capabilities. Paralympians confront to their physical defect by overcoming the difficulties that they face in everyday life, and through sports. The structure of the Paralympians' attitude to yourself indicates the importance of the self-development indicators and orientation to overcome the difficulties. Thus, Paralympians show less interest in the others assessment of their capabilities and achievements as opposed to professional athletes. Sport is a life that allows Paralympians feel full member of society. Sport helps Paralympians to exclude from their behavior destructive forms of responses in stressful situations, which are typical for people with disorders of the musculoskeletal system, who also not involved in sports and don't take active part in a social relations.
Pediatrician (St. Petersburg). 2016;7(1):156-162
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Features of assimilation of knowledge by students at the process of studying the discipline “Functional anatomy of the central nervous system”
Zavarzina N.Y., Kulbakh O.S., Zinkevich E.R.
Abstract
In the article the process of assimilation of knowledge when studying discipline "Functional anatomy of the central nervous system" at faculty of clinical psychology of GBOU VPO "St. Petersburg State Pediatric Medical University" of the Ministry of Health of Russia is analyzed. In the course of assimilation the preparatory stage of studying of a subject is of great importance. The teacher focuses attention of students that anatomy as the descriptive discipline is subjective in the basis. It causes need of development of the uniform principles and approaches to the description of a structure of various anatomical structures. At the first stage of assimilation of knowledge there is a perception of a certain anatomic object; allocation of its properties and qualities on the offered algorithm is carried out. At the second stage the judgment of the most essential communications and the relations of the object of studying is made. At the third stage there is a process of imprinting and storing of features of a structure of the studied object, and also its communications and functions allocated as a result of repeated visualization and repetition. At the fourth stage active reproduction by a student of acquired knowledge and understanding of its essential properties and the relations is carried out. Only at this stage the teacher can estimate quality of the acquired knowledge by students. The fifth stage assumes active use of the acquired knowledge, its creative transformation, application in studying of other subject matters.
Pediatrician (St. Petersburg). 2016;7(1):163-166
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The emotionally-valuable attitude to themselves in adolescents with chronic allergic diseases
Leushina E.A.
Abstract
In the following work are presented the results of experimental psychological research on suffering from chronic allergic respiratory and skin diseases adolescents’ emotionally-valuable attitude to themselves. As the results of study at 51 adolescents suffering from bronchial asthma concomitant with allergic rhinitis and atopic dermatitis have been found that chronically ill adolescents tend to identify themselves as sick people, both currently and in the suture, more than their conditionally healthy peers (p ≤ 0.05). However, both boys and girls suffering from the allergic diseases tend to expect to become less ill that now (p ≤ 0.01 for boys and p ≤ 0.05 for girls). After considering the features of their gender identity have been found suffering from allergic diseases adolescents do not expect an increase in their typically male features in the process of growing up, that is typical for their healthy peers (p ≤ 0.01). Moreover, the research has shown that boys with the chronic allergic disease do not expect a decrease of immature deeds in their behavior, which are typical for childhood, that occurs in the normal case of growth. Generally, both adolescents from the experimental and from control group tend to positively react to their personalities taking into account all the existing advantages and disadvantages, marking the lack of self-control in their behavior its dependence on external factors and also a low level of personal activity. After considering the temporal perspective of the personality has been shown that chronically ill and conditionally healthy adolescents see themselves more active, stronger and more respectable in the futures.
Pediatrician (St. Petersburg). 2016;7(1):167-172
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The adaptive capacity of conscripts of urgent service with the deficit of body weight
Kosina N.V., Sokolova N.G.
Abstract
A common problem during the conscription of young people into military service is the deficit of body weight of conscripts, which is associated with specific emotional, personal, adaptive characteristics and features of efficiency. The purpose of research to identify and study the features of adaptive capacity and specificity of efficiency of military men with the deficit of body weight. Experimental psychological diagnosis of conscripts of urgent service with an average body mass index of 18.3 + 1.3 was carried out on the basis of the analysis of case histories, biographical forms, complex personal and psychophysiological methods. Results and conclusions: The conscripts with the deficit of body weight are characterized by: The lack of full-fledged family in the process of education, at a sufficiently high material well-being; Low adaptive capacity and behavioral regulation that characterizes a lack of mental stability; High level of personal anxiety, at a relatively low situational anxiety; Hypochondriacal, hypomanic and hysterical accentuation of character that characterizes high anxiety and suspiciousness in combination with the desire to compensate asthenic occurrences due to the demonstration of activity, intense mental and physical effort; Anxious and egocentric types of attitude to the disease, reflecting the specific experiences associated with his condition; High level of discipline, with avoidance of conflict situations characterizes in General the passive nature of the behavior; Optimal efficiency in a short period of time, then drop of the qualitative characteristics of the activity, as evidenced by the low rate of endurance and reliability of the efficiency.
Pediatrician (St. Petersburg). 2016;7(1):173-177
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