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Vol 11, No 3 (2020)

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The COVID-19 pandemic: higher medical education challenges and responses
Ivanov D.O., Alexandrovich Y.S., Orel V.I., Esaulenko E.V., Novak K.E., Ditkovskaya L.V., Basina V.V.

The coronavirus pandemic (COVID-19) has become a challenge to higher education worldwide, affecting roughly over 90% of the student community. Due to the pandemic issues, it was essential to adjust the educational process to changing circumstances. Efforts to curb the spread of the disease, including social distancing and self-isolation, have led to the need of initiating a new approach of education and developing effective communications in medical education with the organization of online education from 23.04.2020. The Saint Petersburg state pediatric medical University of the Ministry of health of Russia has adopted the Discord platform for distance learning. Training courses have been organized for physicians working in hospitals that have been sorted out to operate with patients with coronavirus infection using the Moodle platform with access to register and monitor trainees as well. Instructing teachers to work in these Internet scopes required fewest time, which allowed them to switch to distance learning in due time. In order to attest the timeliness and adequacy of the response of the higher medical education system in the context of the COVID-19 pandemic, in this article, the experience of the transfer of the Department of infectious diseases of adults and epidemiology to running educational activities in remote mode. The possibility of conducting online classes not only theoretical, but also practical in the specialties of infectious diseases and epidemiology with students, residents, postgraduates and physicians was demonstrated.

Pediatrician (St. Petersburg). 2020;11(3):5-12
Online teaching
The discipline anatomy in the new teaching environment during the epidemic COVID-2019
Karelina N.R., Khisamutdinova A.R., Artyukh L.Y., Denisova G.N.

Due to the high epidemiological risk of the spread of a new coronavirus infection in March 2020 in the Russian Federation and in particular in the city of Saint Petersburg all educational institutions in the city, including medical ones, have switched to distance learning. Our article summarizes the experience of conducting practical classes in such a specific discipline as Anatomy in the conditions of distance learning for first-year students of medical higher educational institutions. The goal that should be achieved at the end of our anatomy course is to form students’ stable anatomical knowledge, and most importantly, a holistic view of the structure and function of the human body. Based on this, the main tasks that determine the direction of the pedagogical process are given, and the methods of pedagogical work used to increase the level of students’ assimilation of knowledge on human anatomy in distance learning are described. The Department of human anatomy of the Saint Petersburg state pediatric medical University uses the Discord platform, adapted by an initiative group of employees and students of the University for distance learning. At the same time, the staff of the Department believes that no matter how good the distance learning platform is, no matter how hard teachers and students try, it can not be a full-fledged substitute for normal full-time training.

Pediatrician (St. Petersburg). 2020;11(3):13-22
Analysis of the COVID-19 epidemic: an additional narrative; an alternative response
Rennebohm R.

According to the current prevailing narrative, the virus responsible for the COVID epidemic is exceptionally deadly and contagious – possibly as deadly, contagious and dangerous as the 1918 “Spanish flu” – and, in the absence of prolonged lockdown measures, has had the potential to kill a million or more people in the USA alone. At the other end of the explanatory spectrum a counter narrative has greatly minimized the threat posed by COVID and sees little need for major public health intervention or social change. A disciplined scientific analysis suggests an additional narrative that navigates a reasonable path between fear driven prescriptions and dismissive reassurance. This middle ground narrative suggests that the intrinsic deadliness of the COVID virus is above average when compared to many of the seasonal flu viruses of the past decade, but similar to that of the 2017–2018 flu virus, which killed an estimated 61,000 people in the USA. It also emphasizes that the intrinsic deadliness of many current social arrangements has contributed to “COVID deaths” and that there is need for major social change. This article suggests that neither the narrative of fear that prescribes excessive social control, or a narrative of dismissive reassurance that disregards need for fundamental social change, are based on good science. The article raises concerns that the prolonged lockdown/re-lockdown approach is misguided and likely to cause an enormous number of unnecessary deaths – both a greater number of cumulative COVID deaths, as well as “deaths of despair,” deaths from worsening poverty and hunger, and deaths from inadequate attention for non-COVID health issues, particularly in disadvantaged communities and countries. An alternative response to the COVID epidemic is presented.

Pediatrician (St. Petersburg). 2020;11(3):23-40
Original studies
Physical development and blood composition correlation in adolescents
Erkudov V.O., Volkov A.J., Pugovkin A.P., Musaeva O.I., Chistjakova M.V., Rogozin S.S., Pakhomova M.A., Balashov L.D.

The goal of the study was to assess the correlation between height and body mass deviations measured with the aid of Z-index in teens and cell component of their peripheral blood.

Materials and methods. Apical height was measured in 83 adolescent boys in the course of regular prophylactic medical examination. Z-index was calculated according to WHO Growth Reference, 2007. Cell blood composition was studied with the help of automatic hematologic analyzer. The empiric data was processed statistically using Spearman’s correlation coefficient.

Results. The analysis of hematologic parameters correlation with deviations of height and bodymass by Z-index has yielded relationship as follows: moderate positive correlation of Hb concentration with bodymass index Z-index, hematocrite – with bodymass and height Z-index. Besides there is a mild positive correlation of Hb concentration with bodymass Z-index; RBC number with bodymass and height Z-index, MCV – with bodymass and height Z-index. There is no correlation of MCH, MCHC, WBC and Plt number with bodymass and height Z-index.

Conclusion. The study has demonstrated there is a correlation between RBC number, Hb concentration and height deviations in case of normochromicity. The relationship ascertained may be explained by an assumption that peculiarities of erythropoiezis correlate with body size. Lower RBC number and Hb concentration in children with smaller bodymass index may be due to general plastic deficiency in their organism. The results obtained in the present study may be used to reveal and analyze physical development and the organism morpho-functional peculiarities correlation markers.

Pediatrician (St. Petersburg). 2020;11(3):41-47
Features of the quality of life of achievers with different levels of cognitive development
Lebedenko A.A., Levchin A.M., Ershova I.B., Glusko Y.V.

One of the urgent problems of medicine is the relationship between the main aspects of the quality of life and the cognitive abilities of primary school children. This problem also covers issues of pedagogy, psychology and social aspects of the life of the child population. The results of the study led to the conclusion about the main aspects of the quality of life (PedsQL 4.0 questionnaire), interrelated with the level of intellectual development (D. Wexler’s method modified by A.Yu. Panasyuk (1973)) and academic performance (questionnaire) of first-graders at the beginning and at the end school year. The material was processed using the Mann – Whitney U-test and the Wilcoxon W-test, for dependent and independent variables. A significant tendency towards a decrease in social and school functioning, psychosocial health, as well as emotional functioning at the end of the school year is shown, which indicates a decrease in adaptive mechanisms in younger students. The discrepancy between the level of IQ indicators and school performance of children was revealed. It was determined that children “doing well” at school had higher quality of life indicators. The most vulnerable for all the children studied was the psychosocial aspect of health. It was shown that in children with a high level of cognitive development, the emotional aspect of health decreased during the year, in primary school children with a low level of cognitive development, school functioning, and with an average, an increase in indicators of physical functioning. Given the identified features of the quality of life, which depend on the level of cognitive development, it is important to observe an individual approach to training, with the involvement of specialists from the psychological level.

Pediatrician (St. Petersburg). 2020;11(3):49-56
Surgical complications of peritoneal dialysis in children with acute kidney failure
Dobroserdov D.A., Shchebenkov M.V., Shavkin A.L.

The dialysis department of the Children’s City Multidisciplinary Clinical Specialized Center for High Medical Technologies has been operating since 1977 and is the only specialized department in the North-West Region of the Russian Federation that provides assistance to children with both acute and chronic renal failure. Peritoneal dialysis is the treatment of choice for children with acute renal failure, the most common cause of which is hemolytic-uremic syndrome. Despite widely used measures to improve the results of peritoneal dialysis, complications are extremely common. The article analyzes the complications of peritoneal dialysis in children with acute renal failure who were treated in a hospital from 2008 to 2018. The emphasis in the study is on the analysis of complications of peritoneal dialysis, in the treatment of which the surgeon actively participated or should have taken part in. If the problem of acute renal failure is multidisciplinary in the sense that it requires the participation of nephrologists, resuscitators, infectious disease specialists, then if necessary, renal replacement therapy requires the surgeon to become not only a specialist providing “access”, but also a full-fledged participant in the treatment process. As follows from the foregoing, the surgeon’s actions depend not only on the quality of dialysis, but also the timeliness and adequacy of treatment of complications, which ultimately improves or worsens the quality of medical care in general.

Pediatrician (St. Petersburg). 2020;11(3):57-63
Acoustic assessment of pulmonary ventilation in children with bronchial asthma on the background of a single exposure to microwave radiation
Potapova N.L., Gaymolenko I.N.

Summary. Diseases of the respiratory organs of children, occurring with obstructive syndrome, represent one of the most serious problems in terms of transition to chronic forms. The chronic process is accompanied by a decrease in pulmonary ventilation, which leads to the search for effective methods of complex therapy of diseases.

The purpose of this study was to evaluate the dynamics of acoustic indicators of pulmonary ventilation in children with bronchial asthma, against the background of non-invasive non-thermal microwave radiation.

Materials and methods. 122 children with bronchial asthma aged from 3 to 17 years were examined. 113 patients underwent a single session of non-invasive microwave therapy with the Aster device. Comparison of acoustic characteristics of pulmonary ventilation was carried out taking into account the severity of the disease and the age of children with bronchial asthma. Acoustic assessment of ventilation function was performed using the computer bronchophonography complex Pattern-01 before the Aster procedure, after 5 and 15 minutes. In 20 (16.4%) patients with bronchial asthma, the dynamics of cough was evaluated against the background of Aster therapy for 7 days.

Results. Improvement of bronchial patency was registered in all age groups with mild bronchial asthma. In the group of moderate asthma, exposure to electromagnetic radiation led to a significant reduction in ventilation disorders in children aged 7–11 years. As patients grow older, as well as with severe bronchial asthma, the smallest dynamics of the parameters of pulmonary ventilation was observed against the background of Aster therapy. The use of electromagnetic radiation in addition to traditional basic therapy for 7 days leads to a faster regression of cough in patients with bronchial asthma.

Conclusion. The combination of traditional basic therapy with electromagnetic non-thermal radiation in patients with bronchial asthma reduces obstructive pulmonary ventilation disorders and promotes faster cough regression.

Pediatrician (St. Petersburg). 2020;11(3):65-72
Contemporary diagnosis of HIV infection in pediatrician’s practice
Hakizimana J., Ivanov D.O., Yastrebova E.B., Nasyrov R.A., Gusev D.A., Timchenko V.N., Bulina O.V.

The objective of the study: evaluation of the effectiveness of clinico-epidemiological and laboratory diagnostics of HIV infection in pediatric practice.

Materials and methods. Under the supervision of pediatricians of the Department of motherhood and childhood of the St. Petersburg AIDS Center, there were 388 HIV-infected children aged from one month to 17 years inclusive. Due to the reasons of late detection and HIV dissidence of parents, 18 children (4%) died cumulatively among the children observed in St. Petersburg center for AIDS. The object of the immunohistochemical study was randomly selected HIV-infected children who applied to the center for prevention and control of AIDS for return visits. Material for testing for the presence of HIV-1 P24 antigen was taken from the back wall of the nasopharynx.

Results. When analyzing the ways of HIV infection in children registered at the maternity and childhood Department of the Saint Petersburg AIDS Center, it turned out that 363 children were infected perinatally (93,6%), 23 (5,9%) sexually infected and 2 children through injecting drugs (0.5%). The proposed method of immunocytochemistry for the diagnosis of HIV infection in children can find its application, especially for primary diagnostics, which may simplify and reduce the cost of laboratory diagnostics.

Pediatrician (St. Petersburg). 2020;11(3):73-80
Meningococcal infection in modern conditions: clinical, microbiological and preventive aspects
Markova К.V., Skripchenko N.V., Lobzin Y.V., Karev V.E., Vilnits A.A., Gorelik E.Y., Martens E.A., Sidorenko S.V.

The problem of meningococcal infection remains relevant due to the high epidemiological and social significance throughout the world, the unpredictability of the course, a wide range of clinical manifestations (from asymptomatic carriage to extremely severe generalized forms) with a high risk of life-threatening conditions and deaths, and a significant incidence of disability after past illness (loss of limbs, deafness, mental inferiority, and more). The changing serogroup landscape of meningococcal infection with an increase in the incidence of diseases caused by Neisseria meningitidis serogroup W, Y and others is noteworthy. The article presents an analytical review of literature and reflects current clinical, epidemiological, diagnostic and preventive trends in the Russian Federation and abroad. The review focuses on the epidemiological features of meningococcal infection, depending on the serogroup affiliation of meningococcus, the variety of clinical manifestations of the generalized form of meningococcal infection, including atypical manifestations, age-related features, depending on the serogroup of the pathogen. New diagnostic approaches and the possibilities of specific prophylaxis are highlighted. Attention is focused on the importance of monitoring the clinical and epidemiological characteristics of meningococcal infection depending on the genetic characteristics of the pathogen, and the need for further in-depth studies of this problem.

Pediatrician (St. Petersburg). 2020;11(3):81-92
Central nervous system damage markers in children: current state of the problem
Panova M.S., Panchenko A.S.

Pathology of the central nervous system (CNS) occupies one of the leading places in the structure of childhood morbidity and mortality. In the modern world the diagnosis of central nervous system diseases is based not only on the a thorough history, identification of certain neurological symptoms during an objective medical examination of the child and data from various neuroimaging methods, but also on the use of laboratory research methods with the identification of specific markers which indicate a pathological process occurring in the tissues of the brain and spinal cord. The article presents modern data on the biochemical parameters indicating damage to the nervous tissue, as well as their role in conditions of homeostasis and the prospects for further research. We analyzed the latest domestic and foreign literature on the properties and role of such indicators as neurotrophic growth factor, vascular endothelial growth factor, monocytic chemotactic protein, trigger receptor expressed on myeloid cells-1, trigger receptor expressed on myeloid cells-2, transforming growth factor, fractalkin, a nerve growth factor, which is a promising direction in the study of damage to nerve tissue. We can conclude that а study of the level of these markers will help diagnose the presence of damage to the nerve tissue, its severity, and therefore, select the right individual therapy for each specific child, thereby preventing the development of severe neurological consequences.

Pediatrician (St. Petersburg). 2020;11(3):93-99
Otoacoustic emissions: major trends in pediatric practice
Garbaruk E.S., Pavlov P.V., Gorkina O.K., Subora N.V., Belogurova M.B.

The high prevalence of hearing loss in children determines the need for reliable methods for the timely detection and diagnosis of hearing impairment at any age, starting from a birth. Otoacoustic emissions are widely used in hearing screening and audiological assessment as an objective tool for cochlear status evaluation. Over the past 30 years, their use in routine audiological assessments has increased significantly. Understanding the subtle processes that occur in the cochlea during the transmission of acoustic stimuli which generate otoacoustic emissions as well as knowledge about the registration parameters, otoacoustic emissions characteristics, otoacoustic emissions advantages and constraints are important for results analysis. Contemporary understanding of the occurrence of auditory sensations as well as the description of various types of otoacoustic emissions used in routine clinical practice (transient otoacoustic emissions and distorting product otoacoustic emissions) are presented in the review. The features of otoacoustic emissions using in pediatric practice are described: in newborns hearing screening, including the peculiarities of applying of this test for infants having had got their treatment in the intensive care units. Otoacoustic emissions significance for hearing diagnosis and as well as for ototoxicity monitoring is shown. Reliability, non-invasiveness, objectivity, simplicity of the otoacoustic emissions testing has done it one of the main methods both in hearing screening and diagnostics for children on any age.

Pediatrician (St. Petersburg). 2020;11(3):101-108
Coronaviral infection
Ivanov D.O., Chernova T.M., Pavlova E.B., Timchenko V.N., Barakina E.V.

Coronavirus infection (CVI) is a group of acute ubiquitous infectious diseases known since the 60s 19 century. The clinical picture of CVI is characterized by damage to the respiratory system from mild forms of acute respiratory viral infection to the development of a severe acute respiratory syndrome, as well as involvement of other organs in the pathological process of the gastrointestinal tract. For a long time, coronaviruses were not given attention, since it was believed that they were able to cause only mild respiratory diseases. It is known that children and adolescents are less susceptible to infection than adults. In the etiological structure of acute respiratory viral infections among hospitalized children, coronaviruses account for 6–9%. The introduction of multiplex polymerase chain reaction (PCR) with the inclusion of coronaviruses in practice has shown their role in the occurrence of severe diseases of the lower respiratory tract. Since 2002, outbreaks of coronavirus infection caused by previously unknown pathogens (SARS-CoV, MERS-CoV, SARS-CoV-2) have been observed in the world. New coronaviruses have genetic features and are relatively highly resistant in the environment. The diseases they cause are distinguished by the predominance of severe forms with high mortality due to the development of acute respiratory distress syndrome and sepsis. In December 2019, an outbreak of pneumonia caused by the SARS-CoV-2 virus began in China; in February 2020, the disease was called COVID-2019. In connection with the trend towards the global spread of new infections March 11, 2020, the World Health Organization announced a pandemic. The lecture covers the issues of epidemiology, pathogenesis, clinic, diagnosis and treatment of coronavirus infection, taking into account the emergence of new pathogens.

Pediatrician (St. Petersburg). 2020;11(3):109-117
Clinical observation
Early surgical correction of mitral valve infection endocarditis in 16-year old female patient
Badurov R.B., Shikhverdiev N.N., Kornishina T.L., Ivanilova A.A., Novak M.Y.

The optimal time for surgery on the heart valves in patients with active infectious endocarditis (IE) is still controversial. It is a well known fact that cerebral, coronary or renal thromboembolism is the most common cause of death in patients with left-sided IE. Thromboembolism can develop before the appearance of clinical manifestations of the destruction of the valvular apparatus of the heart. Currently, early surgical intervention is considered as the most effective method of treatment of many forms of active left-sided IE. Early surgery involves performing surgical correction until the completion of a full antibiotics course. We present the clinical case of early surgical correction of the patient (A., 16 years) with mitral valve infectious endocarditis. The disease was acute, with recurrent embolisms to the right kidney with infarction and to the left clavicle with osteomyelitis. Surgical intervention was performed as a matter of urgency; surgical access – right-sided anterolateral thoracotomy. The girl was operated on the 4th day of the hospitalization to our hospital. However, time of treatment was lost at the prehospital stage and rapid mitral valve destruction did not allow to repair the valve. Therefore, the mitral valve replacement was performed. The postoperative period was favorable. On the 3rd day after the operation, the girl was transferred to the cardiology department. On control ECHO after 3 years: myocardial contractile function is good, EF 65%, the function of the MV prosthesis is not impaired.

Pediatrician (St. Petersburg). 2020;11(3):119-124
Professor V.A. Waldman and his family: a contribution to Russian medicine
Baram D.V., Dzeranova N.Y., Isakov V.A., Kovalev Y.R., Parfyonova N.S.

Outstanding representatives of the St. Petersburg medical dynasty from the Waldman family: V.A. Waldman, his son A.V. Waldman and sister A.A. Waldman made a huge contribution to the health care of our country. The founder and first head of the department of faculty therapy at the Leningrad State Pediatric Medical Institute, Viktor A. Waldman, is an outstanding therapist, cardiologist, rheumatologist, classic of domestic medicine, a successor to the best traditions of the Botkin school. Cardiovascular pathology was studied clinically and experimentally by him and his staff, the pathogenesis of various forms of rheumatism was studied, methods for its diagnosis and treatment were developed. He did a great job of creating the rheumatological service of the city, for the first time founded in Leningrad cardiac rheumatology rooms at large enterprises, and later on – a cardiac rheumatology clinic. Arthur V. Waldman – son of V.A. Waldman, a prominent pharmacologist, head of the department of pharmacology of the 1st Leningrad Medical Institute named after academician I.P. Pavlov, academician of the Academy of Medical Sciences of the USSR made a significant contribution to the study of the mechanism of action of various pharmacological substances on synaptic transmission of excitation in the central nervous system. A large series of works by A.V. Waldman is devoted to the pharmacology of emotional stress, the problem of the experimental study of emotions and means of controlling them. Alisa A. Valdman – sister of V.A. Waldman, a pathologist, an employee of the All-Union Institute of Experimental Medicine, studied the role of nervous and hormonal regulation in the development of the infectious process, which she studied on a paratyphoid model for enteric infection in laboratory animals.

Pediatrician (St. Petersburg). 2020;11(3):125-134
Doctor, scientist, leader. In memory of Ekaterina Tikhonovna Bokova
Kalinina E.Y., Davydova Z.V., Nasyrov R.A., Anichkov N.M., Nazarov Y.V., Samoilova N.E.

The article is dedicated to Ekaterina Tikhonovna Bokova, who left a bright trace in the memory and hearts of people who connected their lives with forensic medicine. After graduating from the 1st Leningrad Medical Institute and graduate studies at the Department of Forensic Medicine. Ekaterina Tikhonovna was appointed head of the Forensic Medical Examination of the LHE. When appointing, Bokova’s business qualities were taken into account: her high efficiency, directness, determination, modesty, as well as successful work in the Komsomol and the recommendations of Professor M.I. Raysky. Since 1940, she began to combine as an assistant of the Department of Forensic Medicine of the Leningrad Pediatric Medical Institute (LPMI). The whole period of the Great Patriotic E.T. The lateral war remained in Leningrad, led the forensic medical expert service of the city, and from March 1942 until June 1944 she also temporarily acted as head of the department of forensic medicine at the LPMI. Thanks to the courage and selfless work of the Leningrad forensic doctors, led by Ekaterina Tikhonovna, it was possible not only to maintain expert research in the besieged city at the required level, but also to return to the pre-war organization of work as soon as possible. Ekaterina Tikhonovna was awarded the medals “For the Defense of Leningrad” and “For Valiant Labor in the Great Patriotic War”. In the postwar years, E.T. Bokova continued to lead, actively engaged in research and teaching work. In 1952, E.T. Bokova defended her thesis “Morphological features of damage to the soft integument of the head and bones of the skull with chopping weapons.” In addition to scientific and teaching work, Ekaterina Tikhonovna was an active social activist, was elected as a deputy of the Vyborg District Council of Leningrad, a member of the Vyborg District CPSU Committee. February 24, 1965 Ekaterina Tikhonovna suddenly died.

Pediatrician (St. Petersburg). 2020;11(3):135-138

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