Vol 11, No 1 (2020)

The importance of antiangiogenic substances endoglin and sFLT-1, as well as endogenous digitalis-like factor marinobufagenin in the pathogenesis of preeclampsia
Reznik V.A., Ivanov D.O., Ruhlyada N.N., Tapilskaya N.I., Ershov I.A.

Objective. Establish the relationship between the action of antiangiogenic factors sFLT-1 and endoglin, as well as marinobufagenin in the formation of symptoms of preeclampsia in the clinic and experiment.

Materials and methods. In the first experimental phase, preeclampsia-like state was simulated in pregnant rats, the changes in the content of substances reflected in the target tissues were studied, as well as the effect on their concentrations of anti-marinobufagenin antibodies. In the second (clinical) phase, changes in the content of sFlt-1 and endoglin-1 in placental tissues, as well as marinobufagenin in blood plasma and activity of Na+/K+-ATPase of erythrocytes in pregnant women with preeclampsia were studied.

Results. In rats, an increase in systolic blood pressure, and marinobufagenin plasma levels was observed during the formation of a preeclampsia-like condition. Administration of antibodies to marinobufagenin caused a decrease in blood pressure. Found that during the formation of a preeclampsia-like condition, there is an increase in the content of sFlt-1 in the placenta and thoracic aorta and endoglin in the placenta. In patients with preeclampsia, it was found that the increase in blood pressure occurs against the background of an increase in the content of marinobufagenin in blood plasma, as well as a decrease in the activity of Na+/K+-ATPase of erythrocytes. The formation of preeclampsia is accompanied by a significant increase in the level of antiangiogenic factors endoglin and sFlt-1 in the placenta.

Summary. In patients with preeclampsia, the development of clinical symptoms is accompanied by an increase in the placental tissues of the content of antiangiogenic factors endoglin and sFlt-1 and the content of marinobufagenin in blood plasma. The obtained data are confirmed by the results of an experiment performed on pregnant rats with modeling of preeclampsia-like condition.

Pediatrician (St. Petersburg). 2020;11(1):5-12
Original studies
The role of secretary-motor stomach disorders in the genesis of atopic dermatitis in children
Buryak V.N., Antonova T.I., Malysheva I.V., Shepelenko K.K., Dudko M.V., Peshekhonova Y.V., Buryak N.V.

Objective: to study the relationship of the main mediators of atopy and clinical and morphological characteristics lesions of the stomach with its secretory-motor disorders in children with atopic dermatitis. We study 134 patients aged 7 to 14 years with atopic dermatitis and 30 healthy children as control group. All children passed general clinical and laboratory instrumental investigations. In addition, children with manifestations of atopic dermatitis and secretory-motor disorders of the stomach Fibroesophagogastroduodenoscopy, topographic intragastric pH-metry with aspiration biopsy of the gastric mucosa were performed, followed by morphological investigations. In sick children, an increase in the levels of total IgE, histamine and serotonin was detected in the blood, combined with a tendency to decrease acid-forming function, endoscopic and morphological changes in the gastric mucosa. It is assumed that concomitant atopic dermatitis secretory-motor disorders of the stomach are manifestations of gastrointestinal syndrome, which can be both secondary and primary in relation to skin manifestations and in both situations contribute the formation of endoallergens and maintain a vicious cycle of the pathological process.

Pediatrician (St. Petersburg). 2020;11(1):13-18
Clinical-laboratory characteristic and arterial blood pressure in children of under school and early school age with obesity
Nastausheva T.L., Boeva E.E., Volosovets G.G., Minakova O.V.

For the last 20 years obesity and overweight in childhood have become one of the most important healthcare problems for the vast majority of countries, including Russia. There is a data that obesity in early age correlates with the risk factors of chronic diseases in adultness, including diabetes, cardio-vascular diseases, arterial hypertension and many others. That is why the main goal of our survey was to compare clinical-laboratory parameters and lab based indicators and to explore the details of arterial blood pressure indicators of pre-school and younger school children with and without obesity in one region of Russia (Lipetsk Region). We have analyzed those parameters in 2 groups of children: first group consisted of 50 children with obesity, and second – 50 children with normal body mass. For checking the differences between two groups we have used Student’s t-test or its counterpart for independent samples Mann–Whitney U-test in cases when the variances of the values were high. The results of survey have shown the high index of hereditary burden among children with obesity, more birth weight of those ones, higher levels of glucose, cholesterol, and low density triglicerids andindex atherogenicity. The measurements of arterial blood pressure (systolic and diastolic) three times per day every day during a week showed significant increasing from mornings to evenings and from the beginning to the end of the week. The highest number of significant coefficients of correlation has been revealed between body mass of the children with obesity and arterial blood pressure (systolic and diastolic) during the day.

Pediatrician (St. Petersburg). 2020;11(1):19-26
Phenotypic characteristics of young men and women depending on the type of constitution and low body weight
Timofeev E.V., Zaripov B.I., Belousova T.I., Vutrih E.V., Reeva S.V., Parfenova N.N., Zemtsovsky E.V.

Asthenic type of constitution and low body weight are traditionally associated with hereditary disorders (dysplasia) of connective tissue (HDCT). Another specific signs of HDCT is dolichostenomelia (skeletal imbalances). The prevalence of signs of dysembryogenesis and skeletal imbalances in young people depending on sex, type of constitution and body mass deficiency have not been previously assessed.

Materials and methods. We examined 967 practically healthy people aged 18 to 25 years (330 boys and 637 girls) and 119 boys with a diagnosis of “body weight deficiency” by help general examination, phenotypic and anthropometric examinations.

Results. Most bone signs of dysembryogenesis significantly often detected in young men: keel-shaped chest deformity (4% vs 1%, p < 0.01) and funnel chest deformity (19% vs 9%, p < 0.01) deformations of thorax, high palate (39% vs 28%, p < 0.01), the growth of teeth (36% vs 19%, p < 0.01) and dolichostenomelia. Girls are characterized by a high frequency of joint hypermobility (50% vs 24%) and atrophic striae (30% vs 14%, p < 0.01). The bone signs (symptoms of arachnodactyly and chest deformities) detected more often in people with body weight deficiency, and the skin signs and joint hypermobility revealed more often in young people with normotrophy. Comparison of the frequency of signs of dysembryogenesis and skeletal imbalances in groups with asthenic and normal constitution did not reveal differences. All of external signs were found with equal frequency in individuals with different types of physique.

Conclusions. Body weight deficiency in young men is closely related to bone signs of dysembryogenesis, while the asthenic type of constitution is not a reliable marker of connective tissue defect.

Pediatrician (St. Petersburg). 2020;11(1):27-35
Influence of lipoic acid on the exchange of sialic acids in small intestine of rats with alloxan diabetes
Volkhina I.V., Butolin E.G.

Despite comprehensive study of features of the reasons and a pathogeny of a diabetes mellitus, its timely diagnostics, prevention and treatment remain among the most current problems of medicine. The patients suffering from the diabetes mellitus a long time have various forms of pathology of a digestive tract forming a picture of a gastroenterological form of autonomous neuropathy. At a diabetic polyneuropathy widely use drugs of α-lipoic acid of acid which is the universal antioxidant functioning as a cofactor in the multifermental complexes catalyzing oxidizing decarboxylation of α-keto acids, and therefore playing an important role in the course of obtaining energy in aerobic conditions taking part in regeneration of other antioxidants. Sialic acids which belong to multifunctional connections, being components various the glycoproteins and glycolipids of connections are a part of mucins of a blanket of a wall of a small bowel. The composition of mucins of the protective layer of the wall of the small intestine includes sialic acids, which are multifunctional compounds that are components of glycoproteins and glycolipids. The purpose of this study was a comparative study of the effect of lipoic acid on the indicators of sialic acid metabolism of rat small intestine wall compounds in alloxan diabetes. An increase in the rate of sialic acid metabolism in the wall of the small intestine of rats with alloxan diabetes was found, which may indicate a restructuring of the metabolism of enterocytes to adapt to conditions of insulin deficiency and hyperglycemia. The introduction of lipoic acid to experimental animals did not reduce sialidase activity and the content of all fractions of sialic acids in the wall of the small intestine, although, according to the literature, it reduced the degree of development of oxidative stress in the body, including in the studied section of the gastrointestinal tract.

Pediatrician (St. Petersburg). 2020;11(1):37-42
The relationship between endothelial dysfunction and intrahepatic blood flow disorders in patients with cardiovascular pathology
Manasyan S.G., Ermolov S.Y., Apresyan A.G., Serdyukov S.V.

A study of intrahepatic blood flow by polyhepatography and evaluation of endothelial function by peripheral arterial tonometry in patients with essential hypertension and coronary heart disease was conducted. The study included 105 people. The subjects were divided into three groups: patients with hypertension, coronary heart disease in combination with hypertension, and a group of healthy people. In all observed cases, except for the healthy group, hemodynamic changes were detected. The features of impaired intrahepatic blood flow in patients with cardiovascular pathology were revealed. The nature of blood flow disorders largely depended on the etiologic factor. The endothelial dysfunction revealed in patients with cardiovascular disease. In patients with arterial hypertension in combination with or without coronary heart disease, a relationship was found between endothelial dysfunction and intrahepatic hemodynamic disorders. The relationship of endothelial dysfunction and intrahepatic hemodynamic disorders was established, in patients with hypertension in combination with coronary heart disease or without it. Therefore, the liver is involved in the pathological process, regardless of the form of myocardial damage in cardiovascular pathology. It is accompanied by varying degrees of severity of intrahepatic microcirculation disorders and endothelial dysfunction of the peripheral vascular bed. This may be a consequence of the universal reaction of the endothelium due to realized effect of risk factors for the development of cardiovascular diseases. In this regard, the liver can be considered as one of the target organs in patients with cardiovascular pathology.

Pediatrician (St. Petersburg). 2020;11(1):43-49
Pathogenetic role of changes in the type of blood circulation in the dynamics of brain vascular disorders
Nikolaev V.I., Denisenko N.P., Brega A.V., Denisenko M.D.

Features of the heart rate variability at patients with acute disorder of cerebral circulation depending on the type of hemodynamics were studied in acute period of disease and in a condition of relative functional rest. Surveyed men and women (121 patients, 30–55 years old) were divided into 3 groups according to the type of hemodynamics that was defined at the first day of their disease: the groups of patients with hyper-, hypo- and normodynamic types of hemodynamics were selected. The integral rheography of the body was carried out again on the 7th day of hospitalization of the patients. And according to the received data all examined individuals were divided into subgroups. The evaluation of indicators of the heart rate variability at patients during acute period of disease showed the significant increase of activity of the sympathetic link of regulation among people with hyperdynamic type of hemodynamics: the indices of tension and vegetative balance also as the standard deviation of NN intervals (SDNN) were rather law. The sam e patients examined on the 7th day of their disease demonstrated the reduction of the indices of tension and vegetative balance and the increase of the mean square difference between the duration of adjacent R-R intervals (RMSSD). These changes were regarded as gradual weakening of the sympathetic influences on cardio-vascular system in stabilization period. At examination of patients in a week from the moment of their hospitalization transformation of the type of hemodynamics was revealed among many of the surveyed. The indices of tension and vegetative balance were the lowest among patients with acute disorder of cerebral circulation and initially hyperdynamic type of hemodynamics and newly formed hypodynamic type of blood circulation. While patients with acute disorder of cerebral circulation and constantly hyperdynamic type of blood circulation showed the maximal tension in operation of the regulatory systems.

Pediatrician (St. Petersburg). 2020;11(1):51-57
The influence of parental compliance to treatment of chronic gastroduodenal pathology in children on patient’s quality of life
Barinova A.S., Nalyotov A.V.

The effectiveness of the treatment of chronic gastroduodenal pathology associated with Helicobacter pylori infection consists not only in the successful eradication of the pathogenic microorganism, but also in eliminating dyspeptic and abdominal pain syndrome, as the main clinical criteria for this pathology. Among the main reasons that affect the successful outcome of therapy, it can be distinguished strict adherence to the prescribed drug regimens. The aim of the work was to assess the effect of parental adherence to their child suffering from chronic gastroduodenal pathology, treatment on the patient's quality of life. 80 children of high school age suffering from chronic gastroduodenal pathology associated with Helicobacter pylori were examined. Anti-Helicobacter therapy using clarithromycin, amoxicillin, omeprazole for 14 days was held in all patients. The training of parental compliance in relation to ongoing therapy for their child was conducted before therapy in patients of the comparison group. The special questionnaire developed by us was used to assess the level of parental compliance. In addition, in all patients, the quality of life indices were studied using the SF-36 questionnaire at baseline and one month after the start of therapy. It was revealed that in children with chronic gastroduodenal pathology the initial indicators on all scales of quality of life were significantly lower compared to the children of the control group. It was found that the greater compliance of parents to their child's prescribed therapy leads not only to the successful eradication of Helicobacter pylori infection, but also to positive dynamics, both physical and psychological aspects of health.

Pediatrician (St. Petersburg). 2020;11(1):59-64
Acute myocarditis in children: problems of diagnosis and treatment
Pshenichnaya E.V., Dudchak A.P., Usenko N.A., Sosna V.V.

Acute myocarditis by the World Health Organization is an inflammatory disease of the heart muscle, confirmed by histologically, immunologically and immunohistochemically. The diagnosis of acute myocarditis in children remains open due to the presence of a number of reasons. First of all, it is difficult to diagnose myocarditis in children due to the variety of clinical manifestations and the presence of nonspecific symptoms of the disease. What matters is the lack of accessibility in the routine practice of a doctor of certain research methods and a sharp limitation in the use of endomyocardial biopsy. The search for differential diagnostic algorithms of the disease continues. According to modern literature, much attention is paid to non-invasive methods for the diagnosis of acute myocarditis in children. The course of acute myocarditis can be complicated by life-threatening cardiac arrhythmias: ventricular extrasystole, lengthening of the corrected QT interval, atrioventricular block. The appearance of cardiac arrhythmias increases the risk of sudden cardiac death. Recommendations for the treatment of myocardium in children often undergo changes due to the small number of multicenter and controlled studies in the pediatric population. The article provides an overview of modern approaches to the treatment of acute myocarditis in children: the use of antiviral drugs, intravenous immunoglobulin, immunosuppressive therapy, especially the treatment of heart failure in acute myocarditis in children.

Pediatrician (St. Petersburg). 2020;11(1):65-72
Clinical observation
Malignant migratory partial seizures of infancy: description of clinical observations
Fomina M.Y., Rakova M.A., Efet H.A., Pavlova O.I., Liazina L.V.

Epileptic encephalopathies of infancy are difficult-to-treat destructive cases of epilepsy in infants and young children, which include the two clinical observations of Coppola – Dulac syndrome (malignant migrating partial attacks of infancy) given in this article. Epileptic encephalopathies are a genetically heterogeneous group of disorders that are characterized by the presence of a convulsive syndrome and are accompanied by cognitive and behavioral disorders. As a result of intensive development of methods of molecular genetic research, ideas about the causes of epilepsy in children began to change, this fact led to the fact that the international League against epilepsy replaced the term “idiopathic epilepsy” with “genetic epilepsy”. To date, about 60 phenotypic variants of early epileptic encephalopathies have been registered in children, including those associated with mutations of genes that regulate the functions of voltage-dependent calcium and sodium channels. In our work, we consider clinical observations of genetic epileptic encephalopathies caused by mutations in the CACNA1A and SCN8A genes, respectively, which are channelopathy. Malignant migrating partial attacks of infancy (infant epilepsy with migrating focal attacks, Coppola – Dulac syndrome) are manifested at an early age, from the first days to 6 months of life, and are characterized by typical multifocal attacks with a tendency to change hemispheres and involve opposite limbs. G. Coppola based on the analysis of their own observations, described in 1995 a new age – dependent epileptic syndrome, introducing a definition for it – “migrating partial attacks of infancy”. Currently, it is recommended to use the term “infant epilepsy with migrating focal seizures”. We present our own clinical and neurophysiological observations of this rare syndrome.

Pediatrician (St. Petersburg). 2020;11(1):73-81
Diagnostic problems of hirschsprung’s disease in neonates: clinical examples
Kagan A.V., Kotin A.N., Karavaeva S.A., Kesaeva T.V.

Hirschsprung’s disease usually manifests from the first days of life and is diagnosed in the newborn period. In some patients Hirschsprung’s disease can’t be diagnosed in the newborn period because of different forms of disease and clinical features. From 2008 to 2019 75 patients with Hirschsprung’s disease were operated in the City Children’s Hospital No. 1. 21 patients had delayed diagnosis. 11 newborns didn’t have very clear clinical symptoms, intestinal obstruction disappeared after decompression. 2 patients with associated chromosomal disorders were diagnosed with Hirschsprung’s disease later because of. In some of older patients disease manifested with severe constipations. Also, we presented some clinical cases of major diagnostic errors in patients with Hirschsprung’s disease. Conclusion. Diagnostic errors in patients with Hirschsprung’s disease are associated with the lack of alertness of neonatologists and inadequate interpretation of clinical manifestations and X-ray study. For many years these children can be treated by different specialists before having surgical consult.

Pediatrician (St. Petersburg). 2020;11(1):83-90
Clinical psychology
Psychological sexuality features in people living with HIV with the presence and the lack of substance use
Antonova D.V., Bocharov V.V., Chrustaleva N.S.

Psychological sexuality features in people living with HIV with and without substance use as a determinant of the HIV epidemic growth were explored. The study involved 136 respondents (2 groups of 50 people with different infection routes: blood-borne infection route and heterosexual transmission; 36 individuals without HIV). The following research methods were used: a specially developed clinical map, an original author’s questionnaire « Infection risk and the disease situation» (allows to register the main characteristics of the life situation of the disease), the incomplete sentences test of Sachs – Levy, Freiburgh Personality Inventory, I-structure Ammon test. Data processing included the Fisher criterion (Fisher angular transformation), ANOVA, content analysis. Significant negative effects in sexual sphere related to gender and the presence of HIV were revealed in the study. It has been established that people living with HIV with and without substance use differ in the frequency of concealment of HIV status and the presence of destructive type of sexuality. It has been established that people living with HIV and healthy respondents differ in the frequency of unrealistic way of thinking regarding opposite sex. A frequent occurrence of negatively colored attitude towards opposite sex and positively colored attitude towards sexual relations was noted in all groups. The results of the study determine the need for timely preventive measures in all population groups and psychocorrectional measures among people living with HIV, which will allow to prevent an increase in the number of children and adolescents with HIV. Psychological sexuality features in people living with HIV in the Russian sample were studied for the first time. The results are partially confirmed in foreign literature.

Pediatrician (St. Petersburg). 2020;11(1):91-101

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