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Vol 11, No 6 (2020)

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Editorial
Modern medical and organizational features of coronavirus infection
Orel V.I., Gureva N.A., Nosireva O.M., Smirnovа V.I., Buldakova T.I., Libova E.B., Razgulyaeva D.N., Sharafutdinova L.L., Kulev A.G.
Abstract

So far in the history of mankind, the pandemic has been declared only twice. The first was the H1N1 influenza pandemic of 1918-1920, known as the “Spanish flu” or “Spanish”. The second is the 2009-2010 H1N1 flu pandemic, referred to in the media as “swine flu”. At the end of 2019, there was an outbreak of a new coronavirus infection COVID-19 with an epicenter in the people’s Republic of China (PRC) in the city of Wuhan (Hubei province), and since the beginning of 2020, cases of a new coronavirus infection have been recorded in other countries whose citizens visited the PRC. In some territories, such as South Korea, Iran and Italy, the epidemiological situation for COVID-19 has sharply worsened, which subsequently led to a significant increase in the number of cases in the world associated with travel to these countries. In connection with the current epidemiological situation, on March 11, 2020, the Director-General of the world health organization (who), Tedros Adhanom Ghebreyesus, said at a briefing in Geneva that the spread of the new coronavirus in the world has become a pandemic. According to experts, the new coronavirus infection has a number of features, both epidemiological and clinical. Currently, information about this is quite limited, which makes it difficult to prevent and treat this disease. In our article, we tried to present some aspects of the new coronavirus infection COVID-19, referring to data published in open scientific literature sources, and reporting data from two administrative districts of the city of St. Petersburg.

Pediatrician (St. Petersburg). 2020;11(6):5-12
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Original studies
Features of electrophysiological activity in a neonate with severe post-hypoxic brain damage (post-hypoxic cerebral depression)
Melashenko T.V., Fomina M.Y., Palchik A.B., Pavlova O.I.
Abstract

The article briefly presents the literature data and a description of the clinical dynamic observation of a patient with severe hypoxic brain damage (from the neonatal period to 4 months of life), in the conditions of the neonatal intensive care unit. The article describes the clinical picture, features of paroxysmal states and antiepileptic therapy, dynamics of neuroimaging data, electroencephalographic phenomena recorded in a patient with cerebral depression and structural cerebral injuries. The significance of electroencephalographic examination in the intensive care unit as an informative method for assessing cerebral activity in young children with central nervous system depression syndrome is shown. Disorganization of background activity, indicating structural cerebral damage, long-term persistence of slow-wave activity, detection of epileptic changes in the form of generalized flashes of pointed waves in the theta range, alpha-coma pattern, subsequently replaced by suppression of the background pattern in the patient, are typical electrophysiological disorders recorded in severe hypoxic encephalopathy. In conditions of limited opportunities for visual diagnosis of a patient with impaired consciousness, EEG remains the only method of obtaining information about the functional state of the brain, the data obtained during the study are an important prognostic criterion.

Pediatrician (St. Petersburg). 2020;11(6):13-20
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An analysis of deviations from international standards of physique development in male youngsters from the former aral sea region
Yerkudov V.O., Pugovkin A.P., Matchanov A.T., Rozumbetov K.U., Dauletov R.K., Rogozin S.S., Pakhomova M.A.
Abstract

Introduction. According to the commonly accepted classification, geographical division of the Southern Near-Aral region (Karakalpakstan, Republic of Uzbekistan) is determined by the distance from the epicenter of the formal Aral Sea ecological disaster. The physique development was compared in male youngsters living in “Zone No. 1” (critical), “Zone No. 2” (stable) and “Zone No. 3” (normal). The aim was a comparison of body length and mass in male youngsters up to 17 years old living in all three zones.

Material and methods. Total body length and mass were studied in 320 male volunteers, age 17–19. Z-index of body length and body mass index (BMI) were estimated according to the standards of WHO Growth Reference, 2007. Batch-to-batch variations were studied with Kruskal–Wallis test, and Mann–Whitney criterion including Bonferroni correction for multiple comparison. Categorical features were compared using Fisher’s exact test for 3×3 contingency tables with calculating the proportion of children with one or another deviation in body weight. The results were considered statistically significant at p < 0.05.

Results. Subjects from Zone 1 possessed significantly lower valued of BMI and Z-index. The incidence of Z-index values lower than mean (less –1 SD) were significantly higher in Zone 1 (critical).

Conclusion. The results may be explained by via chemical pollution of the environment by the endocrine-disrupting chemicals in the critical zone of the Aral See region ecological disaster and can be implied for the health monitoring of the local population.

Pediatrician (St. Petersburg). 2020;11(6):21-28
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Features of sexual development, immune status and biochemical parameters in boys suffering from acne
Pilnik E.N., Zaslavsky D.V., Pyatibrat A.O.
Abstract

Among skin diseases in children and adolescents, the most common pathology is acne. The main pathogenetic link of acne in adolescents is hormonal imbalance. The effect on the sebaceous glands of high concentrations of dihydrotestosterone causes a change not only in the quantitative but also in the qualitative composition of the sebaceous secretion. The study is devoted to assessing the characteristics of sexual development, immune status and biochemical parameters in boys suffering from acne. Materials and methods.

Materials and methods. A comparative analysis of the state of immunity, sexual development, biochemical parameters of 147 boys suffering from acne, and 142 healthy boys who do not suffer from acne.

It was found that the immune status of boys suffering from acne was characterized by a decrease in cytotoxic lymphocytes. In the peripheral blood of these boys, serum interferon γ, tumor necrosis factor α, interleukins 1, 2, 8 and 10, as well as small circulating immune complexes were significantly higher than in the boys of the control group. In boys suffering from acne, in the puberty period, the concentration of prolactin in 13–14 years is significantly lower, and testosterone levels are significantly higher than in boys of the control group of the same age. At 15–17 years of age, the concentration of luteinizing hormone in boys with acne is significantly lower, and testosterone is higher than in boys in the control group. Evaluation of the degree of formation of secondary sexual characteristics indicates that boys suffering from acne differed from their peers from the control group by a small advance in sexual development. Thus, boys suffering from acne, characterized by advanced and disharmonious puberty.

Pediatrician (St. Petersburg). 2020;11(6):29-36
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Fetoplacental complex parameters’ changes during repeated increase of the blood volume in female rabbits
Pavlova N.G., Yakovleva A.A.
Abstract

One of the mandatory stages of introducing new drugs into obstetric practice is preclinical trials, the purpose of which is to study the effect of drugs on the development of fetuses and placentas. When conducting experimental studies, the main group of animals receiving the drug is compared with the control group of animals that do not receive drugs. At the same time, the volume of the test drug itself can significantly change the blood volume (BV) of an experimental animal, especially a small one, and such administration repeated repeatedly over several days can accumulate this effect, having an adverse effect on the functional state of the fetus. A model of chronic placental insufficiency created on the 18th day of pregnancy in female rabbits by ligating 1/3 of the preplacental vessels in one uterine horn was used to study the effect on the development of the brain and placenta of normally developed and retarded fetuses of multiple daily (19–28 days of pregnancy) infusions of saline solution to females in a volume of 6% of the animal’s BV and comparable to the volume of medications used in the treatment of placental insufficiency in clinical practice (main group of rabbits). It was found that repeated daily administration of saline solution to a female rabbit in the second half of pregnancy, which is about 6% of the BV, causes a violation of the functional state of her normally developed and, to an even greater extent, retarded fetuses. This is manifested by a 1.4-fold reduced survival rate of fetuses in the intact horn of the uterus and a more pronounced violation of brain metabolism in fetuses of the intact and experimental horns compared to those of the control group of females.

Pediatrician (St. Petersburg). 2020;11(6):37-44
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Сomparative analysis of acridineacetate-containing compounds’ radio-sensitizing effect during malignant tumor experimental radiotherapy in a metastatic colorectal cancer model in balb/c mice
Trashkov A.P., Muzhikyan A.A., Tsygan N.V., Ryabtsev A.V., Rybakova A.V., Kvanchiani V.V., Kravtsova A.A., Vasiliev A.G.
Abstract

Radio-sensitizing compounds are used to increase radiotherapy effectivity and reduce negative pathologic systemic effects of radiation. These radio-sensitizers selectively pile-up in tumor tissue and enhance necrobiotic processes caused by irradiation. Unfortunately, broad introduction of radio-sensitizers into clinical practice is hampered by their low effectivity and substantial negative side effects. This what determines radio-sensitizers effectivity studies high actuality in a colorectal cancer mice model. The study involved 156 male BALB/c mice who had been transplanted with colorectal cancer. After the transplantation they were injected with acridineacetate – containing compounds Cyclopherone and Procitol. A comparative assessment was undertaken of tumor growth dynamics and metastatic rate. A combination of gamma-irradiation with radio-sensitizing compounds produces a more substantial therapeutic effect according to all parameters of the experimental colorectal cancer growth and development than the isolated effect of radiotherapy or antitumor drugs. A considerable slowing down of tumor growth on the 14th and 28th day of the study was revealed as well as a reliable inhibition of lymphogenous and hematogenous metastatic spread of neoplasma during the entire study and a statistically valid increase of lifespan of the experimental animals. The radiosensitizing effect of Procitol in combination with radiotherapy turned out to be more substantial than that of Cyclopherone.

Pediatrician (St. Petersburg). 2020;11(6):45-53
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Reviews
Dermatological manifestations of psychic ailments
Prutyan G.V., Zhukov A.S., Lavrov N.V., Khairutdinov V.R., Samtsov A.V.
Abstract

An increase in the number of patients with psychodermatological manifestations and the identification of a certain comorbidity during the course of diseases in patients with a dermatological profile makes us take a fresh look at this problem. Psychodermatology is one of the relevant and, at the same time, the least studied areas of modern medicine, which is at the junction of psychiatry and dermatovenereology. Psychiatry and psychotherapy studies the inner world of a person; Dermatovenerology deals with the diagnosis and treatment of diseases of the human skin and its appendages, and psychodermatology combines these two sections of medicine. In the modern world, as a result of increasing the amount of incoming sensory information, accelerating the rhythm of life, the action of harmful environmental factors, a person can be subjected to excessive psycho-emotional stress, leading to the development of mental disorders. Often it is skin rashes that are an objective manifestation of such disorders. Early diagnosis of psychodermatosis and signs of obsessive-compulsive pathology in sick people contributes to the timely identification of the category of people at risk of psychotic reactions and mental illness. This is especially true for young patients. Against the background of hormonal changes in the body, the crisis of adolescence, the increased educational load on them at school, the destroyed institute of family and marriage, an overabundance of sensory information and physical inactivity, the incidence of psychodermatosis throughout the world, including in our country, is increasing.

Pediatrician (St. Petersburg). 2020;11(6):55-62
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Morbid obesity in clinical practice: current treatment concepts
Anisimova K.A., Vasilevsky D.I., Balandov S.G., Khamid Z.M.
Abstract

The article discusses modern methods of treatment of morbid obesity and associated diseases. It is known that obesity leads to disability in people, including young people, due to the frequent development of severe comorbid diseases. According to current clinical guidelines, the main goals of treating obese patients are: weight loss, achieving good metabolic control, and improving the course of diseases associated with obesity. A small selection of drugs for the treatment of obesity, the need for strict adherence to indications and contraindications to their appointment, significantly limits the possibilities of drug therapy for morbid obesity. With morbid obesity, the effectiveness of conservative treatment is only 5–10%. Up to 60% of patients cannot maintain the result of weight loss within 5 years of observation. Long-term use of bariatric surgeries, the purpose of which was initially to reduce body weight in patients with morbid obesity, showed certain possibilities of surgery in compensating for a number of diseases associated with obesity. Therefore, at present, the concept of bariatric surgery is not only to reduce the patient’s weight, but also to achieve beneficial metabolic effects (normalization of glycemia, lipid metabolism). In this regard, modern bariatric interventions are united by the term “metabolic surgery”. It has been proven that compensation of non-insulin-dependent diabetes mellitus after bariatric interventions is observed in 42–95% of patients, depending on the type of surgery, duration of non-insulin-dependent diabetes mellitus and basal C-peptide level. As a result of many years of research, bariatric surgery has allowed for the first time to formulate the term “remission of non-insulin dependent diabetes mellitus”.

Pediatrician (St. Petersburg). 2020;11(6):63-69
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Clinical observation
А clinical case of mumps incurred in orhiepididimita a teenager
Ivanov D.O., Timchenko V.N., Pochinyaeva L.M., Shakmaeva M.A., Kaplina T.A., Subbotina M.D., Chernova T.M., Bulina O.V.
Abstract

Mumps currently is a vaccine-preventable infections. However, mumps still remains an urgent problem all over the world, due to periodic increases in the incidence in older children (including the vaccinated ones against this infection), in adults (the disease often does not go smoothly with involving various organs in the pathological process and systems). The literature describes the various adverse effects of male mumps, including infertility, testicular atrophy, testicular tumors, impotence, gynecomastia, etc. The article provides information on the incidence of mumps in the Russian Federation and St. Petersburg, the clinical manifestation of the infection. It was noted that in adolescent boys and men, the presence of orchitis (orchoepididymitis) is a frequent symptom of the disease. It is shown in the article, that testicular inflammation rate increases with age of patients. A brief description of modern methods of laboratory diagnostics and therapy is given in accordance with clinical recommendations and treatment standards. A clinical case of mumps, combined severe form (mumps + orchoepididymitis), in a 17-year-old boy is presented in this article. The features of the course of the disease, the results of laboratory and instrumental examination and treatment have been analyzed in this item. Conservative therapy (antiviral and antibacterial) of mumps, as well as timely surgical treatment of orchoepididymitis, led to a complete clinical and laboratory recovery of the patient.

Pediatrician (St. Petersburg). 2020;11(6):71-78
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During’s herpetiform dermatitis in pediatric dermatology: issues of diagnostics and treatment
Novikov Y.A., Zaslavsky D.V., Pravdina O.V., Zykova E.A., Lipatnikova A.S., Bolshakova E.S., Manylova E.S., Drozdova L.N.
Abstract

This article presents a case of clinical observation of a 5-year-old child with herpetiformis dermatitis (Duhring’s). This rare dermatosis is characterized by a chronic relapsing course, the presence of itching polymorphic rashes, typical histological and immunomorphological signs. The diagnosis was made on the basis of the clinical picture, histological and immunohistochemical studies of skin biopsy, as well as the results of HLA typing by PCR. Clinical observation of this case is of interest to practicing physicians-dermatologists due to the rare occurrence of Duhring’s herpetiformis in children, the complexity of differential diagnostic search, which requires further generalization of experience using histological, immunohistochemical and molecular genetic research methods. The disease is clearly differentiated from other rashes with the formation of subepidermal blisters according to histological, immunological and gastrointestinal criteria. The prevalence of dermatosis in various populations of the Europian race ranges from 10 to 39 cases per 100,000 population. Duhring’s dermatitis herpetiformis can develop at any age (cases of the childhood form of Dühring’s dermatitis herpetiformis have been reported), but most often the disease occurs at the age of 40–50 years. Dermatitis herpetiformis persists indefinitely with variable severity. In patients with Duhring’s dermatitis, associated gluten-sensitive enteropathy is often noted, which in most cases is asymptomatic.

Pediatrician (St. Petersburg). 2020;11(6):79-86
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Medical aspects of preschool and school education organization
Problems and negative features of contemporary russian system of preschool institutions (kindergardens) for children of early preschool age
Kuznetsova T.G., Struzhkin M.L., Rodina E.A.
Abstract

The appearance of this work governs by the modern requirements of the Russian Federation legislation, including Federal Law of 29.12.2012 No. 273-FL “Education in the Russian Federation”, Federal State Educational Standard, SanPiN and other regulatory acts of the Russian Federation Government with necessity to expand the network of preschool educational organizations having groups for young children and creating groups for infants starting from 2 months. The authors of the article analyzed the existing conditions in preschool organizations in our country and abroad. It is shown that in order to maintain health, successfully adapt and develop an infant and young child to preschool organizations, create groups for children up to a year old, it is necessary not only to bring the existing legal framework into line, but also to conduct a significant reorganization of the structure of preschool organizations, with the aim of creating adequate conditions for infants without harming the health of the newborn child and the social well-being of the family. It emphasizes the need to provide parents with recommendations for protecting health and preparing the baby for kindergarten by providing targeted financial assistance to parents for a conscious choice between home education and training in the context of early childhood care. Serious financial support is also required for preschool organizations to equip buildings and territories for the care, upbringing and safe development of children of this age. The need for the return of pediatricians, nurses, speech therapists, educators, psychologists to the staff of preschool organizations is emphasized that is the need for review in the direction of increasing staffing levels. A comparison is made of the preschool educational organizations work organization abroad and in Russia. Some features of the young children and infants psychophysiological and physical condition are briefly reviewed, and necessary recommendations are given to parents. The article discusses the possibility of improving the adaptation period to preschool educational institutions in Russian Federation without harming the health of young children and infants.

Pediatrician (St. Petersburg). 2020;11(6):87-97
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