Vol 8, No 2 (2017)

Articles
Lipolysis In Lacto Trophy Of Newborn And 1-Year Infant
Model’ G.Y., Korot’ko G.F.
Abstract

Lipolysis is accomplished sequentially and simultaneously by lipase in saliva and gastric juice in the infant’s stomach as inductors in autolytic digestion by bile-dependent lipase in breast milk and colipase-dependent pancreatic lipase in the ileum. Lipase was determined in blood serum of women in labor, in umbilical cord blood, in water, and in infant gastric content. According to the data obtained, the initial lipolysis potential of newborns is significantly lower than that of the mothers. It is developed during the first half of pregnancy so gestation period does not have a significant effect on it. Over a year of lactation period, the breast milk steatolytic activity decreases, with a lower rate compared with other breast hydrolytic activities. If the steatolytic activity is low during the first month of lactation, it increases during the succeeding 4–5 months. In cases when steatolytic activity is high initially, it decreased during the following months. This indicates that the lipase content level has an effect on lipolysis at lactotrophy. Additional food and specifically bottle feeding strongly increased the steatolytic activity of duodenal content because of lipase exosecretion stimulation in the pancreas. In contrast, the steatolytic activity is decreased when mixed feeding is introduced. Assessment of lipolysis potential is important in choosing the feeding type for newborns and infants.

Pediatrician (St. Petersburg). 2017;8(2):4-9
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Blood lipids in athletes depending on the orientation of the training process
Vasilenko V.S., Semenova E.S., Semenova Y.B.
Abstract
Sports form the metabolic response caused by the body’s adaptation to increased physical stress, which leads to the restructuring of metabolism for energy and plastic maintenance of sport activities. The restructuring of carbohydrate and lipid metabolism is caused primarily by the increasing energy request body, depending on type and intensity of sports activity. In this research blood serum lipids were studied depending on the orientation of the training process. A total of 108 athletes (men and women) aged 15 to 20 years of different sports qualification (I sports category, Candidate Master of Sports and Master of Sports) were examined, and a control group of 28 persons of the same age and gender. Depending of the direction of the training process there were isolated 3 groups: cyclical sport that develops mainly endurance (academic rowing); sports of complex nature (football, volleyball, handball and Nordic combined); and complex coordinated sports (artistic gymnastics). Were studied: total cholesterol, high density lipoproteins, low-density lipoproteins, atherogenic coefficient and triglycerides. The study was conducted in the preparatory period of the training cycle. The research had shown that the level of blood lipids depends on the orientation of training process and sports training. The most marked reduction of total cholesterol and high-density lipoproteins has been observed both in men and women in cyclic kinds of sports, developing mainly stamina that indicates that intense exercise in athletes who train primarily for endurance, cause the connection of lipids to the processes of energy supply of muscle activity.
Pediatrician (St. Petersburg). 2017;8(2):10-14
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The status of autonomic nervous system and adaptation in infants with the different types of intrauterine growth restriction
Ivanov D.O., Kozlova L.V., Derevtsov V.V.
Abstract
The article presents the characteristics of the status of autonomic nervous system and adaptation in babies with the different types of intrauterine growth restriction (IUGR). In infants the presence of symmetrical IUGR in comparison to asymmetrical IUGR is related to higher frequency of first- and second-degree cerebral ishaemia at birth and autonomic dysfunction starting from the second six months of life. Thus, babies with symmetrical IUGR display: lower sympathetic nervous system activity and depletion of adaptation reserves at the age of two-three days; higher sympathetic activity and strain on adaptation, high frequency of asympathicotonic responsiveness of the autonomic nervous system at the age of one month; higher sympathetic activity and higher frequency of adaptation strain with the prevalence of adaptation failure at the age of three months; lower sympathetic activity and higher frequency of asympathicotonic autonomic responsiveness at the age of six months; higher sympathetic activity and strain on compensatory reserves, higher frequency of asympathicotonic autonomic responsiveness and adaptation dysfunction with the prevalence of unsatisfactory adaptation at the age of 12 months. The proven facts should lead neonatologists and pediatricians to specifically monitor infants having had intrauterine growth restriction in their past medical history, especially those who have suffered from symmetrical intrauterine growth restriction, and to take preventive measures against autonomic dysfunction in the first six months of life of such infants and curative measures starting with non-pharmacologic ones or with a sparing use of drugs in the second six months of life. At the same time, infants having had asymmetrical intrauterine growth restriction demand special attention during the neonatal period and at the age of twelve months.
Pediatrician (St. Petersburg). 2017;8(2):15-23
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A Marfanoid Habitus Dyagnostics’ Algorithm And Morfo-Functional Heart Singularities Relevent To This Dysplastic Phenotype
Timofeev E.V., Zaripov B.I., Malev E.G., Zemtsovsky E.V.
Abstract
Official Russian guidelines for inherited connective tissue diseases distinguish a range of dysplastic phenotypes, with the marfanoid habitus being one of them. The prevalence of the marfanoid habitus and morfometrical heart singularities among the young practically healthy persons were not studied before. Materials and methods of the study: 560 practically healthy young persons aged from 18 to 25 years (average value 19.2 ± 1.4) were examined within the framework of the study. All the persons were subjected to phenotypical and anthropometrical examinations, with a group of 320 persons studied with the Echo-cardiographic procedure specifically aimed at small heart anomalies’ discovery. The study resulted in assessment of the marfanoid habitus among the young persons depending on sex and selected threshold of Dolichostenomelia and arachnodactylia coefficients. It shows that the use of the diagnostic algorithms offered by official Russian recommendations leads to the identification of this state of nearly half practically healthy young male persons. This could cause a hyper-diagnostics among this contingent group. The girls with marfanoid habitus demonstrate alternated morfometrical parameters - greater myocardia mass index, bigger thickness of myocardia, the trend to left cardiac ventricle hypertrophy. The persons with marfanoid habitus also tend to have some cardiac anomalies more frequently (mitral and tricuspidal valve prolapsed, left ventricular false tendons, foramen ovale).
Pediatrician (St. Petersburg). 2017;8(2):24-31
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The results of an evaluation of quality of care and life in children with epilepsy
Guzeva O.V., Guzeva V.I., Guzeva V.V., Ochrim I.V., Maksimova N.E., Chokmosov M.S., Shin S.V.
Abstract
Epilepsy is characterized by a chronic course, repeated seizures and psychopathological disorders. The debut of epilepsy occurs mainly in childhood, and the frequency of the disease in the child and adolescent population is 0.5-0.75%. The interrelation of the forms of the disease with the perception of the child’s environment, the quality of his life, according to the literature, are not well studied. The establishment of this interrelation will help better understand of the psychology of sick child, improve quality of life, and its characteristics have to be considered in the prescribing the therapy. The aim of this study is to identify the impact of the form of epilepsy on the perception of the child or the parents of the treatment process, the conditions of stay in the medical institution, the assessment of quality of life. At the department of neurology, neurosurgery and medical genetics SPbSPMU examined 50 children with epilepsy, and conducted a survey of the children and their relatives. To children diagnosed symptomatic or cryptogenic epilepsy (the first group), to 14 children - idiopathic epilepsy (the second group). All patients were also tested, during which children and/or their parents were asked to answer 15 questions related to the finding on the treatment in the clinic. The studying of the significant differences in positive responses to each question in children groups I and II using the exact method of Fisher revealed significant differences in the answers to questions related to the conditions in hospitals, silence during examinations, and satisfaction with the continuance of waiting a doctor visit. Close relatives and children were given 10 questions regarding satisfaction with various aspects of life. A comparison of the number of positive ratings from relatives children’s group I and II using the exact method of Fisher showed that relatives of children of group II received for responding significantly greater number of good marks.
Pediatrician (St. Petersburg). 2017;8(2):32-43
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Peculiarities of sensory development in children in terms of military conflict depending on the type of feeding
Ershova I.B., Shirina T.V., Goncharova T.A.
Abstract
The aim of the research is to study the state of sensory functions in infants who were born and living in the Lugansk and Donetsk during the military conflict. Materials and methods. A dynamic clinical examination was made. Also it was made the assessment of the rate sensory development in 65 children in the area of military conflict. Among them 32 children were breast-fed, the main group of children (MGCh), and 33 children who were bottle-fed, formed the comparison group (CGCh). The control groups of our study consist of 73 children: 36 children (CGCh) who were breast-fed, and 37 children who were bottle-fed. There was a control group of comparison children (CGCCh) outside the zone of military conflict. The assessment of the level of sensory development of children was carried out using a standardized clinical-psychological techniques “Gnome”. Conclusions: the military conflict adversely affects the sensory development of children who were precisely in the area of conflict. The weakest spot was auditory function of children. It indicates the auditory hypersensitivity. The second place in terms of violations takes the reflex tactile sensitivity, the level of which depends on the age of the child and type of feeding. Breastfeeding is a powerful shock absorber of distressful influences of the military acts, that taking place in the environment of children. Children who have experienced the stress of war need the necessary rehabilitation measures.
Pediatrician (St. Petersburg). 2017;8(2):44-49
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Parental opinion regarding the pediatric outpatient organizations’ functioning as an important criterion of pediatric medical care quality
Dyachenko T.S., Gribina L.N., Devlyashova O.F.
Abstract
A survey was carried out to identify the factors influencing parent satisfaction with care provided in a pediatric clinical setting for children younger than 15 years. We distributed questionnaires to 300 parents to measure the quality of medical care provided in pediatric outpatient settings in Volgograd. The questionnaires included 26 closed questions, most of which were subjective and straightforward. The questions concerned availability of information about pediatric clinical settings, scheduling an appointment with a pediatrician or a pediatric specialist, patient waiting time for medical care, meeting the requirement to obtain voluntary informed consent from patients and availability and suitability for pediatric patients of most laboratory and diagnostic facilities. Parents reported that they obtained information from different sources, including registration staff in a clinical setting, the website of a clinical setting as well as from posters and patient brochures in the clinical setting. 68% of the respondents stated that the information provided was sufficient and comprehensible. Most respondents regarded registration staff working in pediatric clinical settings as the most authoritative source of information available. Registration stations in clinical settings were reported as the easiest and most affordable system for scheduling medical visits. 80% of the respondents stated that they always gave their informed consent to therapy or related issues, while 16% - rarely, and 4% of the respondents never provided informed consent. The majority of the respondents in the survey indicated that the information about their children’s health provided by the pediatrician was sufficient and accurate. The respondents reported being satisfied with the work hours of a pediatrician and waiting time for medical care. Out of 300 respondents, 79% said that their children received consultations with pediatric specialists as indicated.
Pediatrician (St. Petersburg). 2017;8(2):50-55
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The method of evaluation and prediction of formation of menstrual function of adolescent girls
Mironova A.V., Balasanyan V.G.
Abstract

Timely detection of risk groups at the onset of puberty and menstrual function is key to good physical, sexual, and mental health. Nowadays, many authors work at the problem of identifying risk factors that lead to the disruption of the formation of the reproductive system as well as creat predictive software and maps for the assessment of possible risks of the formation of this system in girls. The paper presents the possibility of predicting the formation of menstrual function in adolescent girls based on prognostic charts. The prognostic chart includes the following criteria: age, health, mother’s social position at the time of pregnancy and childbirth, place of birth and residence, and the transferred diseases of a girl with a group definition of health. Medical examination was performed in 432 girls aged 9-13 years and 11 months. It was revealed that more than half of the girls belong to a group with medium risk of all forms of menstrual dysfunction, requiring the attention of a gynecologist for adolescents. The main components of preventive observation and treatment consisted of gynecological examination, normalization of work and rest, nutrition, sanitation of foci of infection, sedative therapy, vitamin therapy, adaptogens, psychological training, physical therapy, and acupuncture. The chart can be used not only by gynecologists for children and adolescents but also by pediatricians, endocrinologists, and health workers in the school setting.

Pediatrician (St. Petersburg). 2017;8(2):56-61
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Correction of hepatic dysfunction in an extensive deep burn model
Brus T.V., Pahomova M.A., Vasiliev A.G.
Abstract
The ongoing increase of burn trauma rates urges elaboration of valid and effective methods of medical aid with actualization of pathogenetically-based intensive therapy. Burn disease is a peculiar nosologic form characteristic of local manifestations as well as critical systemic state with involvement of internal organs and systems with subsequent development of polyorganic insufficiency. Liver lesions in case of burn disease are multiform and often combine with disturbances of other organs yielding polyorganic insufficiency. Desintoxicating, hepatoprotector and organoprotector effects of succine acid - containing medicines used for prevention of hepatic failure were assessed in the present study in a model of extensive deep burn in comparison with standard therapy. The experiments involved 60 mature albino rats (180-200 g). Deep burns involving 20% of body surface caused hepatic dysfunction. Remaxol and Reamberin infusions’ effects were comparatively assessed. To evaluate desintoxicating and hepatoprotector effects of these medicines biochemical analysis of these rats’ blood serum was carried out on the 7th day after infliction of extensive deep burns. Alanine-aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase activity and bilirubin concentration were assessed. Analyzing desintoxicating and hepatoprotector effects of Remaxol and Reamberin upon the morphologic structure of the liver in case of extensive deep burn one must admit these medicines are capable of moderate desintoxicating and hepatoprotector effects.
Pediatrician (St. Petersburg). 2017;8(2):62-67
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Measures in assessment of pediatric systemic lupus erythematosus
Kuchinskaya E.M., Kostik M.M., Chasnyk V.G.
Abstract
Systemic lupus erythematosus in children is aggressive disease with an unpredictable course and a more severe phenotype compared to adults. An appropriate monitoring of disease activity, damage and effectiveness of therapy is reqired. The first part of this artcle is review of indices and scales validated by international community for assessment of disease activity, flares, damage and response to therapy in clinical research, trials and usual clinical care; their strengths, restrictions and ability to detect changes are evaluated. We characterized different versions and modifications of standard indices, their advantages and disadvantages. Conclusion: The set of indices including ECLAM, SELENA-SLEDAI, SFI and Ped-SDI can be recommended for retrospective pediatric clinical studies, as they are simple for use and validated by international community.
Pediatrician (St. Petersburg). 2017;8(2):68-80
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Nursing and rehabilitation of very preterm infants: current state of the problem
Khmilevskaya S.A., Zryachkin N.I., Shcherbatyuk E.S., Ermolaeva E.I., Rebrova A.A.
Abstract
The article deals with basic ethiopathogenetic factors of birth of extremely premature infants, their malconditions, disease incidence. The authors give live birth criteria adopted in Russia in 2011 according to WHO recommendations. The article presents basic ethiologic factors of prematurely born and the role of intrauterine infection (IUI) in the pathogenesis of this condition, also survival rate, mortality and adverse outcomes. These literatures devoted to the international experience of nursing of such children and forecasting of viability of newborns in the viability limit zone (VLZ) are provided. Reflects the basic malconditions typical of children with very low (VLBW) and extremely low birth weight (ELBW) and leading to disability (damage to the nervous, respiratory system, analysis unit, etc). It is shown significance of IUI in the formation of infectious and inflammatory diseases (IID), the place and especially the innate immune system in the implementation of anti-infectious protection and ways of its correction in severe forms of EWI. Need of development of the differentiated programs of the treatment-and-prophylactic actions directed to correction of critical conditions and simplification of a course of the developed diseases is proved.
Pediatrician (St. Petersburg). 2017;8(2):81-88
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Choise of local antibacterial medications for prevention of sternal infection
Shihverdiev N.N., Khubulava G.G., Marchenko S.P., Suvorov V.V., Zaitsev V.V., Averkin I.I., Badurov R.B.
Abstract
Infection of wounds in surgery is one of the most frequent complications in the postoperative period. The development of this complication increases the duration of hospitalization, resulting in higher treatment costs, as well as the impact to the level of hospital mortality. There are many methods are exist to avoid this complication, which are allow to decontamination of pathogenic and conditionally pathogenic microorganisms including applying antimicrobial agents prior to surgery. One such method is intravenous antibiotic shortly before surgery. But there is evidence in the literature of successful local antibiotics in neurosurgery, traumatology and orthopedics, operations on the thorax and abdominal organs, including for prevention of sternal infection. For this purpose most often used vancomycin and gentamicin. This is often a causative agent of wound infection, which is a gram-positive flora: Staphylococcus aureus and Staphylococcus epidermidis. To increase the effectiveness of preventive measures to reduce the incidence of sternal infection intraoperatively topically applied antibiotics in various forms when closing the wound. For parenteral administration of antibiotics effective therapeutic dose is often not achieved, because it depend on the time period since the introduction of the substance until the start of the operation [3]. Local application of antibiotics to a reduction of frequency wound infection, as concentration of a substance is directly dependent on the applied dose.
Pediatrician (St. Petersburg). 2017;8(2):89-93
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Russia’s first POEM in the treatment of achalasia in children
Korolev M.P., Fedotov L.E., Ogloblin A.L., Kopyakov A.L., Mamedov S.D., Fedotov B.L., Baranov D.G.
Abstract

The article describes various methods of treatment of achalasia, for example, endoscopic balloon pneumatic dilation that extends the lower esophageal sphincter, injection of botulinum toxin that decreases cardia tone, minimally invasive endoscopic methods in combination with medicinal therapy, and surgical treatment of patients at the fourth stage of the disease that promotes good or satisfactory clinical results in 98.2% of patients. The present study also introduces an optimal algorithm for the examination of patients with suspected achalasiocardia. X-ray diagnostics and endoscopic examination were used to verify the diagnosis. All these methods ensure timely and correct diagnosis, determining also the stage of the disease development. Stage-wise diagnostics in Russia are mostly based on the classification suggested by B.V. Petrovsky in 1962. This classification is founded upon X-ray examination of the esophagus due to its simplicity and availability. The article also presents a completely novel approach for the treatment of achalasiocardia in Russia, that is, peroral endoscopic myotomy (POEM).This method of endoscopic operation has been used in our clinic since 2014 for adult patients, and in 2016, it has been for the first time in Russia performed on a child. A clinical example of achalasiocardia in a child is presented as well as diagnostic methods, medicinal treatment, and the use of balloon pneumatic dilation resulting in a recurrence that subsequently demanded peroral endoscopic myotomy. This minimally invasive endoscopic operation nowadays is highly effective and prospective for the treatment of achalasiocardia in both adults and children.

Pediatrician (St. Petersburg). 2017;8(2):94-98
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Neonatal Diabetes Mellitus in the Structure of IPEX Syndrome
Turkunova M.E., Ditkovskaya L.V., Suspitsin E.N., Tyrtova L.V., Jelenina L.A., Guseva M.N.
Abstract
This disease is characterized by the onset of primary immunodeficiency, which expresses itself as autoimmune multisystem failure, often clinically manifests during the first year of life; there are only about 150 cases in the world described by now. IPEX syndrome is caused by FOXP3 gene defect, which is a transcription factor that affects the activity of regulatory T-cells responsible for the maintenance of aytotolerance. There are around 70 pathogenic mutations in this gene described so far. Most patients with IPEX-syndrome have a clinical manifestations of the disease in the early neonatal period or during the first 3-4 months of life. For this disease the following clinical triad of manifestations is typical: Autoimmune enteropathy (100%), diabetes mellitus (70%), skin lesions (65%), as in the syndrome structure includes severe developmental delay (50%), thyroid disease (30%), recurrent infections (20%), rarer autoimmune cytopenia (Coombs-positive hemolytic anemia), pneumonia, nephritis, hepatitis, artrit, myositis, alopecia. However, some cases of later manifestations were described (in patients of more than 1 year of age) when patients did not show all clinical and laboratory symptoms typical for severe forms of the disease. Due to the severity of the disease and the high mortality in this group of patients, it is very important to diagnose it early and start therapy timely. The article describes a clinical case of permanent neonatal diabetes mellitus in the structure of IPEX syndrome.
Pediatrician (St. Petersburg). 2017;8(2):99-104
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Features of the dynamics of self-assessment of people with autism spectrum disorders in the rehabilitation process
Kosina N.V., Vasilyeva M.A.
Abstract
This article is devoted to analysis of the dynamics of self-assessment of persons with autism spectrum disorders in the rehabilitation process. The findings suggest that in the process of rehabilitation in this group of satisfaction with life in general increases, self-assessment becomes more adequate and related primarily to the importance of social support, focusing on social interaction and the ability to properly understand their feelings. In the process of rehabilitation self-perception becomes more realistic, appears the striving for greater sensitivity, empathy and self-confidence. In the process of rehabilitation work activity, sociability and optimism, orientation to urgent incentives and external circumstances increases, the ability to describe and identify feelings improves, the feeling of loneliness reduces, stresses the importance of social activity and interaction with family and people around, awareness and understanding of life events. Also it should be noted that examinees begin to perceive themselves introversive, closed, selfish and hostile, however seek to become surer, independent, energetic, active and resolute. The rehabilitation process contributes to a realistic assessment of yourself, your future and interaction with the social environment. The results of the study confirm the high efficiency of psychological support and comprehensive rehabilitation measures for improving social adaptation in society of persons with autism spectrum disorders.
Pediatrician (St. Petersburg). 2017;8(2):105-110
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