Vol 8, No 3 (2017)

Articles
Infant mortality in Russian Federation and influence on its dynamic factors
Ivanov D.O., Oryol V.I., Alexandrovich Y.S., Prometnoy D.V.
Abstract

Minimizing infant mortality (IM) is the primary national objective of the Russian Federation.

Aim: This study aimed to analyze IM indicators in the Russian Federation and identify factors that influence the dynamics of IM. The level of leading regional indicators of socioeconomic development and provision by doctors and hospital beds in the Russian Federation was studied and compared with the similar factors in foreign countries.

Materials: Official and operative reports of Rosstat for 2011-2016 were assessed.

Results. The coefficient of IM was 6.0 per 1000 live births in the Russian Federation, and varied from 4.8-9.2 in federal districts. The indicator increased in 2012 in connection with the transition to a new system of newborn registration. The indicator witnessed a permanent decline in 2016 and revealed a negative correlation between the regional bulk products and the coefficient of IM and a positive correlation with the overall IM. However, the relationship among the indicators of IM and the size of the region, the number of highways, the number of patients per one hospital bed or assigned to one doctor could not be established.

Conclusion. In the Russian Federation, IM is higher than that indeveloped countries; has permanent tendency to decline; correlates with regional bulk products; does not depend on transport availability, provision with doctors, and hospital beds; and is determined by the organization and the quality of medical care.

Pediatrician (St. Petersburg). 2017;8(3):5-14
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Intellectual characteristics of adolescents with chronic gastroduodenitis
Gurova M.M., Uspenskiy Y.P.
Abstract

Intellect is one of the indicators of children’s health, characterizing the optimality of the age development and the success of adaptation processes. In the case-control study, were included 60 adolescents with chronic gastroduodenitis (CGD) in the period of remission (main group), average age – 13 years old. The comparison group consisted of 22 children with the I group of health. A comparative evaluation of the features of the course of the antenatal period, childbirth, and features of early development of the child was carried out. Were estimated the indicators of stress level, social adaptation (M. Gavlinova’s questionnaire), intellectual functions (D. Veksler’s test). It was shown that the total index reflecting the level of stress in children of the main group was 173.03 ± 82.69 points compared to the index of children of the comparison group – 96.34 ± 38.5 points (p < 0.01). In the main group, compared with the control, children with low level of adaptability were more likely to meet, less often children with an average level of adaptation (34.8% / 21, CI 27.4-41.4% vs 55.3% / 12, CI 42, 32-63,28, р < 0,05) and there were no children with a high level of adaptation. In children with CGD, Veksler’s WISC method (for children 5-16 years of age) showed a slight decrease level of verbal, non-verbal and total IQ in comparison with healthy peers. Among the risk factors that affect intellectual status, the most important were the burdened perinatal history, the nature of feeding in the first year of life and the unbalanced diet in subsequent periods of life.

Pediatrician (St. Petersburg). 2017;8(3):15-22
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Comparative assesment of efficiency application cold atmospheric plasma and biopolymerous coats evaluation of the effectiveness for the treatment of skin burns of iii degree in experiment
Zinovyev E.V., Asadulaev M.S., Komissarov I.A., Shemet M.V., Yudin V.E., Shabunin A.S., Smirnova N.V., Kryukov A.E., Lukyanov S.A., Stoyanovskiy R.G., Shalonia T.A., Artsimovich I.V., Kostyakov D.V.
Abstract

The results of the application of cold atmospheric plasma are discussed in the experimental study. The effectiveness of an experimental wound dressing based on chitosan nanofibers and copolyamide and a commercial wound dressing material based on hyaluronic acid hydrogel in the treatment of third-degree skin burns (ICD-10) is also evaluated. During the first phase of the study, an original method of inflicting thermal burn on the skin of small laboratory animals (rodents) was developed. The temperature of dehaired skin and the temperature of skin heated by resistive electrical element metal plate were obtained through a digital thermometer sensor. The source for the generation of cold atmospheric plasma was made by specialists of St. Petersburg Polytechnic University of Peter the Great. Biopsy material for histological assay was taken 3, 7, 12, 15, 21, and 28 days after treatment. Paraffinic microscopic sectioning was performed with hematoxylin and eosin; after this, microscopic assay was done. The use of cold atmospheric plasma decreases the frequency of purulent complications and also helps reduce the recovery time of the skin by 20% (p < 0.05) but is not sufficient to achieve the result that has been proclaimed after an early escharectomy and replacement of surgical defects by wound dressing materials based on natural polymers. It was demonstrated that the wound dressing based on aliphatic copolyamide and chitosan and hyaluronic acid hydrogel can help significantly accelerate the process of reparative regeneration and histogenesis in the heat-affected zone after escharectomy for up to 14.6%-46% (p < 0.05).

Pediatrician (St. Petersburg). 2017;8(3):23-31
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Interstitial Syndrome And Alveolar Consolidation: Sonographic Markers of Hemodynamic Pulmonary Edema In Infants
Mohammad A.A., Akinshin I.I., Sinelnikova E.V., Rotar A.J., Chasnyk V.G., Solodkova I.V., Baryshek E.V.
Abstract

With the purpose of evaluating the possibility of describing hemodynamic pulmonary edema in infants with congenital heart disease using the previously suggested sonographic phenomena “alveolar consolidation” and “interstitial syndrome” in adults, 131 children of both genders were examined at the age of 1-246 days. Of these infants, 47 had congenital heart anomalies, 51 had chronic somatic pathology and patent foramen ovale, and 33 had a somatic pathology associated with either congenital heart disease or small heart abnormalities. The duration of observation and the number of sessions of ultrasound scanning were determined by the health status dynamics of the infants. All infants were described in terms of 179 characteristics of physical examination and laboratory and instrumental findings obtained through standard procedures. Echocardiography and ultrasound lung scans were performed with LOGIQ E (General Electric) and HD11 (Philips) using linear, convex, and sector transducers (7-12, 3-5, and 1.7-4.0 МHz respectively). In addition to standard protocols of heart and lung description, we also registered the square of consolidated parcels summarized for all lung segments, the number of B-lines summarized for all lung segments, and the swing of diaphragm and lung movement and calculated the diaphragm and lung swing ratio. An attempt to describe the differences between pulmonary circulation in terms of ultrasound sonography for heart defects associated and not associated with blood filling in the lungs was successful. The total area of air-free/consolidated subpleural parcels of lungs and the extent of interstitial lung syndrome were the most informative sonographic characteristics. It was concluded that interstitial edema and alveolar consolidation, described in terms of transthoracic ultrasound sonography, are recommended for use as markers of the disorders of pulmonary circulation associated with congenital heart malformations in infants.

Pediatrician (St. Petersburg). 2017;8(3):32-40
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Hemodynamic Patterns Determined By Non-Invasive Cw-Doppler Ultrasound Cardiac Monitoring (USCOM) in Preterm Neonates with Respiratory Distress Syndrome During Non-Invasive Respiratory Support
Sergeeva V.A., Alexandrovich Y.S., Strelkov D.M., Siniuk K.A.
Abstract

Aim: To determine the hemodynamic patterns in preterm neonates with respiratory distress syndrome (RDS) using the USCOM-1A technology.

Materials and Methods: The USCOM device is a bedside method of evaluating cardiac output (CO) based on continuous-wave Doppler ultrasound. Hemodynamic parameters were measured daily for 7 days in 32 preterm neonates 32 ± 1 weeks of gestation (1688 ± 111 g) with RDS requiring noninvasive respiratory support (NCPAP, NIPPV, HFNC) and no catecholamine support in comparison with 28 healthy term neonates (3100 ± 690 g).

Results: At day 1, preterm neonates had lower SVI (18 ± 5 vs 28 ± 8 ml m−2, p = 0.043) and higher SVRI (1585 ± 245 vs 1035 ± 358 dyn s cm−5 m2, p = 0.013) with a tendency for lower cardiac index (2.6 ± 0.8 vs 4.0 ± 1.3 l min−1 m−2, p = 0.089). Together with no difference in SMII, it indicates the presence of diastolic dysfunction with low preload. It is noted that all parameters had not changed by day 7 in preterm neonates, whereas term neonates demonstrated significantly increased SMII reflecting postnatal cardiovascular adaptation. Compared with preterm neonates with RDS requiring NCPAP/NIPPV, preterm neonates requiring HFNC had higher levels of FTc (330 ± 59 vs 388 ± 41 ms, р = 0.045), SVI (13 ± 3 vs 18 ± 4, ml/m2, р = 0.007), SMII (0.41 ± 0.09 vs 0.57 ± 0.21, р = 0.02), and CI (2.2 ± 0.6 vs 4.5 ± 0.9 l/min/m2, р = 0.006).

Conclusions:Noninvasive respiratory support in preterm neonates with RDS may lead to diastolic dysfunction that is less prominent in neonates with HFNC.

Pediatrician (St. Petersburg). 2017;8(3):41-46
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The usage of combination of tricalcium phosphate and polylactic acid as materials for 3D printing of alloplastic blocks
Filatova O.O., Klimov A.G., Seleznev B.V.
Abstract

This study describes the manufacturing method of alloplastic blocks for treatment of bone defects through tissue replacement with combination of tricalcium phosphate and polylactic acid. The method is unique because for its implementation we used 3d-printing and materials that we had not combined before. Such approach to manufacturing of synthetic blocks allows us to decide several tasks: planning of surgical operation’s strategy by means of modelling in specialized software of certain operating region and to print block with suitable shape and size which would accurately fit the edges of bone defects and fill it. Thus, we can achieve all objectives in the shortest possible time, while saving time and resources. Using this methods, we created experimental model of lower jaw and alloplastic block that can be used with a real patient and be widely applied not only in surgical dentistry and maxillofacial surgery, but also in any other branch of medicine.Combination of tricalcium phosphate and polylactic acid has several advantages because first component acts as a frame and due to its chemical structure makes block’s shape more stable. The second component acts as a filler by means of irregular shape of granules and creates spongiform structure for further blood vessels growth. In addition, materials have properties such as: bioinertness, biocompatibility, biodegradable and don’t have negative impact on the organism. Using this method, we can get the fragment that meets all requirements, and surgical operation becomes economically profitable both for patient and for hospital.

Pediatrician (St. Petersburg). 2017;8(3):47-50
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Lesion of the mucous membrane of the stomach, caused by chlamydia in children with chronic glomerulonephritis
Chikulaeva E.V., Melnikova V.F., Nasyrov R.A.
Abstract

We studied biopsies of gastric mucosa and the gastric antrum bodies obtained from 60 children with chronic gastritis and chronic gastritis in combination with chronic glomerulonephritis. Clinical data of patients (age, gender, duration of the underlying disease, conducted therapy, the results of laboratory and instrumental studies) were studied. It conducts research using histological and immunohistochemical methods. A morphological study of the sections found gastrobiopsies characteristic manifestations of chronic gastritis c signs of chlamydial lesions. The immunohistochemical method determined Chlamidia trachomatis antigens in the antrum and corpus. The positive expression in the epithelial cells of glands and endothelial microvascular gastric mucosa with concomitant lesions of the stomach and kidneys. The possibility of the development of chronic gastritis chlamydial infection in chronic glomerulonephritis. Based on the obtained results was made comprehensive assessment of the gastric mucosa based on morphological, immunohistochemical and clinical data. The features of stromal-vascular responses in the development of chronic gastritis occurring in isolation and combined with chronic glomerulonephritis. The effect of steroid therapy, as a cause of decrease in protective mechanisms of gastric mucosa in children. The data supporting the need for immunohistochemical studies for the etiologic diagnosis of chronic gastritis and the subsequent selection of appropriate therapy.

Pediatrician (St. Petersburg). 2017;8(3):51-56
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The parents’ assessment of the procedure for providing paid medical services in a children’s hospital
Yuryev V.K., Sokolova V.V.
Abstract

Insufficient funding of the health system increased demand for medical services lead to a limited access to free medical care and growth of paid medical services. Currently, the specifics of the procedure for providing of paid medical services in children’s hospitals are a problem in the field of rendering of medical care for children. An anonymous survey of 1479 parents of children aged 0 to 18 years who were treated at four multidisciplinary hospitals of St Petersburg were conducted, in order to study the prevalence, structure and procedure of providing of paid medical services. Despite having medical insurance, the provision of paid medical services is widespread in the children’s hospital. According to the results of the survey, 29.6% of parents are forced to use personal funds to pay for medical services in a children’s hospital. Most often, respondents pay for medicines, laboratory tests, instrumental research, medical consultations of the specialists, surgeries and medical devices. The order of their provision is often violated. Parents who used the paid services in a children’s hospital, in most cases, had higher education, low material prosperity of the family, and previous experience of being with a child in the hospital. The highest percentage of paid medical services was recorded during hospitalization of pediatric patients in the emergency order and undergo treated on the surgical departments. Low awareness and lack of legal activity of parents in the acquisition on compulsory health insurance are revealed.

Pediatrician (St. Petersburg). 2017;8(3):57-61
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Anomalies of the Constitution and Tuberculosis Infection in Children
Yarovaya I.A., Lozovskaya M.E., Vasilieva E.B., Klochkova L.V., Noskova O.M., Bikova I.A.
Abstract

Phenotypical implications of genetic features are anomalies of the constitution or diathesis. A research objective children had an identification with a tuberculosis infection of occurrence of diathesis. 222 children aged from 1 year up to 14 years are examined: 106 children with active forms of tuberculosis; 54 children with residual post-tubercular changes; 62 children infected with MBT. Limfatiko-hypoplastic, allergic, neuroarthritic, exudative and catarral diathesis was taped. Children with limfatiko-hypoplastic (17.0 ± 3.7%) and neuroarthritic diathesis most often occur among patients with active tuberculosis (17.0 ± 3.7%), children with allergic diathesis are more rare (10.4 ± 3.0% of cases. The least favorable current of active forms of tuberculosis became perceptible at children with limfatiko-hypoplastic diathesis: the complicated forms of tuberculosis became perceptible at them in 27.8 ± 10.6% of cases. At patients with neuroarthritic diathesis the complicated forms developed less often - in 11.1 ± 7.4% of cases. Children with allergic diathesis transferred only uncomplicated forms of primary period of tuberculosis. At children without anomalies of the constitution the complicated current was observed often - in 27.6 ± 5.9% of cases. Frequency of occurrence of children with allergic diathesis is higher at patients with residual post-tubercular changes (29.6 ± 6.2%) and the infected MBT (33.8 ± 6.1%), than at patients with active tuberculosis (10.4 ± 3.0%). Existence of a certain anomaly of the constitution in many respects predetermines the course of a tuberculosis infection.

Pediatrician (St. Petersburg). 2017;8(3):62-68
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Risk factors of progression of chronic kidney disease in children with congenital malformations of the urinary tract in the postoperative period
Ahmetshin R.Z., Ildar I.L., Petr I.M.
Abstract

The aim of the study is the identification of independent predictors of progression of chronic kidney disease (CKD) in children operated on for congenital malformations of the urinary tract (CMUT).

Methods. Study design – retrospective, observational, cohort. Inclusion criteria were CMUT, glomerular filtration rate (GFR) <90 ml/min/1.73 m2. Age younger than 18 years of age. The study included 297 patients. Statistical processing of research results was carried out using the software package Statistica 6.0. and MedCalc (MedCalc Software, Belgium).

Results. We identified that only glomerular filtration rate during the initial hospitalization (ОR = 9.40) and arterial hypertension (OR = 4.40) were independent predictors of CKD progression. The combination of these two variant showed the area under the ROC curve (0.756), significantly (p < 0.005) higher than the isolated value of these symptoms.

Pediatrician (St. Petersburg). 2017;8(3):69-74
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Evaluation Of The Lactate significance In The Neonatal Intensive Care
Budarova K.V., Shmakov A.N., Sirota S.I.
Abstract

Background. Blood lactate level is often considered as a marker of complex metabolic disorders. Reducing the lactate’s level is a good indicator of therapy adequacy. The purpose: to show the significance of the determination of lactate for predicting the course of the postoperative period in newborns.

Materials and methods. 77 infants with abdominal surgical pathology were included in an observational study. Lactate level was measured on admission to the intensive care unit and three times in the first seven days of the postoperative period.

Results. ROC-analysis model showed a high predictive value of the indicator at the end of the first postoperative day and on the seventh day. Favorable outсome was connected with lactate ratio below 2.5 mmmol/L on admission, lower than 2.0 mmol/l in the third and seventh days. Point elevation to 3 mmol/l was marked at the end of the first postoperative day.

Conclusion. It is advisable to manage a dynamic assessment of lactatemia at the end of the first day and to the end of the third day of the postoperative period.

Pediatrician (St. Petersburg). 2017;8(3):75-80
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The auditory function of infants with congenital heart diseases
Nnomzo’o A., Pavlov P.V., Garbaruk E.S., Gorkina O.C., Olina O.S.
Abstract

Congenital heart disease (CHD) is 1/3 of all congenital malformations and one of the main causes of infant mortality. Hearing loss may be part of syndromes associated with CHD, or the hearing pathology can be a consequence of the various stages of rehabilitation of underlying pathology. Currently, there isn’t any data on the systematic study of hearing impairment in children with congenital cardiac pathologies. Three hundred and six patients aged 2 days to 8.5 months were examined: 96 patients were included in the main group with CHD, and 300 children without CHD made up a comparison group. All children underwent newborn hearing screening. Infants with suspected hearing pathology were tested with a comprehensive audiological examination. In the CHD group hearing impairment was detected in 29% of children, including sensorineural hearing loss (SNHL) in 12%. And in the comparison group, 3.6% of infants had a hearing loss, SNHL was defined in 1%. Analysis of the data revealed the most significant risk factors for hearing impairments in children with CHD and it had showed the difference in the structure of the risk factors between the both groups. In the study group was registered a case of auditory neuropathy spectrum disorders. This case illustrated the importance of conducting hearing screening by means of click-evoked auditory brainstem responses and not only of registration of otoacoustic emissions. One child with CHD was found to have delayed SNHL, which requires long-term monitoring of hearing in children with cardiopathology.

Pediatrician (St. Petersburg). 2017;8(3):81-87
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Possibilities of topical treatment of inflammatory diseases of vulva and vagina in girls
Mironova A.V., Chernichenko I.I.
Abstract

Vulvitis and vaginitis in girls are the most frequent reason for contacting a pediatric gynecologist. The article considers options for local treatment with various forms of inflammation of the vulva and vagina. In recent years, there has been an increase in this pathology. The maximum number of appeals is observed at 1 year of age and at the age of 3-7 years. The formation of the inflammatory process in the vagina is caused by the state of the endocrine and immune systems, as well as a number of anatomical and physiological features of the structure of the external sexual organs. An important role in the development of vulvovaginitis and vulvitis is played by extragenital pathology. The development of the secondary inflammatory process in the vagina provokes such diseases as urinary tract infection, dysbacteriosis, atopic dermatitis, noopharyngeal diseases, frequent colds, transient immunodeficiency states, childhood infections. The clinical manifestations of vulva-guinitis and vulvitis are similar and depend on the severity of the process, the type of exciter. In acute nonspecific vulvovaginitis, a vivid clinical picture is typical. This discharge from the genital tract, hyperemia and swelling of the vulva, discomfort, burning with urination. The diagnosis of the disease is based on the details of complaints, clinical picture, laboratory and instrumental diagnostic methods. In the treatment of non-specific vulvovaginitis, girls rarely resort to the use of systemic antibacterial drugs. Preference is given to topical preparations. The advantage of local treatment is a minimal risk of adverse reactions, simplicity and ease of use, in the absence of contraindications (except for individual intolerance of the drug), as well as in the possibility of use in extragenital pathology.

Pediatrician (St. Petersburg). 2017;8(3):88-93
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Evaluation of efficiency of different methods of radiation diagnosis in the detection of tuberculosis in children
Sinitsyna A.V., Gavrilov P.V., Sinitsyn A.V., Michailova S.V., Pribitok K.V., Sinelnikova E.V.
Abstract

An evaluation of the effectiveness of the method of computer tomography in 77 children with suspicion of tuberculosis of the intrathoracic lymph nodes and positive test with recombinant tuberculosis allergen (Diaskintest). Ultrasound diagnosis is conducted with 60 children with a negative test with recombinant tuberculosis allergen (Diaskintest), with indirect signs of increase of intrathoracic lymph nodes, left tracheobronchial region according to traditional radiographic studies (plain radiography, linear tomography). In the first group of the frequency change detection by computed tomography in a group of patients, where it was revealed the changes on the survey radiograph, was almost 2 times more than in the group of patients with normal radiograph. There is a high rate of detection of changes at computed tomography in children with normal x-ray picture according to the classical methods. These changes were regarded as possibly associated with an active tuberculous process and required additional evaluation of clinical and laboratory data physician TB. In 32% of cases, the changes revealed by traditional x-ray, computed tomography has not been confirmed. When conducting sonography in the second group in the left tracheobronchial region was visualized left lobe of the thymus in 100%. Specific changes in the lymph nodes and the pleura was not determined by ultrasound. Thus the thymus simulated increase in intrathoracic lymph nodes. In the evaluation of clinical and laboratory data physician TB specialist, diagnosis of tuberculosis in this group, was not confirmed.

Pediatrician (St. Petersburg). 2017;8(3):94-100
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Clinic, diagnosis and treatment of children with dysplasia of the main veins
Kupatadze D.D., Azarov M.V., Nabokov V.V.
Abstract

Dysplasia of the main veins is one of the little-studied problems of childhood, which often leads to the erroneous diagnosis and the wrong treatment tactics of this defect. In the angiomyrosurgical department of the Federal State Sanitary and Epidemiological Service, there were 270 children with dysplasia of the main veins in the SPbGPMU of the Russian Ministry of Health. The appearance of children with dysplasia of the main veins, in the "classical" version, is very characteristic. The extremity is disproportionately increased in volume and elongated. Smooth or bulging vascular spots are observed on the skin (often outside) as a geographical map, cyanotic (purple, "port wine") color. The pathognomonic sign is the presence of an embryonic vein, the trunk of which is of different length and caliber (from 3 to 25 mm) passes along the outer or anterior-external surface of the limb. Sometimes there is gigantism of feet, macrodactyly, syndactyly. However, the above classic clinical picture, which allows confidently diagnose dysplasia of the main veins, is not always revealed. In this regard, we examined the general, characteristic for the majority of patients factors, and those that are most important in determining the severity of the lesion in the preoperative period are identified. We propose a scheme of rational approach to the examination and treatment of sick children (270 patients), which should help optimize the treatment of patients with this malformation. It is established that the volume and type of surgical interventions depend on the type of defect and severity of the lesion.

Pediatrician (St. Petersburg). 2017;8(3):101-106
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Electronmicroscopic examination of myometrium scar after use of monoand bipolar cauters
Kupatadze D.D., Safronova M.M., Il'inskaya Y.V.
Abstract

Uterine fibroids, which, according to various estimates, are found in 50% of cases, is the most common benign disease of the female genital area. A radical method of treating this disease is surgical removal. In radical operations are actively used bi- and monopolar cauters, both for cutting and for coagulation. After such an exposure necrotic scars are often formed, leading to gross deformations of the tissue and, as a consequence, to the impossibility of a normal onset and course of pregnancy. The question of studying postoperative myometrium scars at the ultrastructural level, with the aim of possible optimization of physical parameters for the most gentle operation, is highly important, since allows to estimate changes in tissues at the level of cellular and subcellular structures. At the moment, this experience is absent in our country. The electron microscopic investigation of a myometrium subjected to an electric current is considered in the article.

Pediatrician (St. Petersburg). 2017;8(3):107-110
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Role of TaqI-Genetic Polymorphism of Vitamin D Receptor Gene in Bone Metabolism in Children with Inflammatory Bowel Disease
Gabrusskaia T.V., Kostik M.M., Nasyhova Y.A., Revnova M.O., Kuzmina D.A.
Abstract

Evaluation of bone mineralization and bone metabolism in children with inflammatory bowel disease (IBD) in accordance with TaqI-polymorphic genotypes of vitamin D receptor (VDR) has been performed in this study. 83 children (38 girls and 54 boys) with IBD (60 with Crohn’s disease, 23 with ulcerative colitis) have been included in the study. Mean age was 13.0 years (11.0; 15.5). All patients have active phase of the disease. Bone mineral density (BMD) of lumbar spine (DEXA) have been assessed in all children. Level of serum osteocalcin (OC) as a marker of osteosynthesis, C-terminal telopeptides (CTT) as a marker of osteoresorbtion, parathyroid hormone (PTH), serum calcium, phosphorus, alkaline phosphatase and 25(OH) vitamin D was measured to evaluate bone metabolism. Molecular-genetic tests: analysis of TaqI (rs731236) polymorphism of vitamin D receptor gene (VDR) was perfomed by polymerase chain reaction with following restriction analysis. Association between molecular markers of VDR gene and bone metabolism and mineralization disturbances have been found. TT genotype of VDR gene was associated with tendency to decrease of linear growth velocity, low linear growth, decrease in osteosynthesis and increase of osteoresorbtion in this group of children. TT-genotype of TaqI-polymorphism of VDR gene can be assessed as a risk factor of bone metabolism disturbances in children with both Crohn’s disease and ulcerative colitis. C allele seems to have protective role in this group.

Pediatrician (St. Petersburg). 2017;8(3):111-119
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Actual problems of measles
Timchenko V.N., Kaplina T.A., Leonicheva O.A., Bulina O.V., Hakizimana J., Timofeeva E.V.
Abstract

Measles is still an major public health problem in many countries. According to the World Health Organization, up to 3 million measles cases were recorded annually. Measles was one of the main causes of death among young children in the pre-vaccine period. More than 10 million children died of measles every year throughout the world. In 2014, on a global scale, there were 114 900 deaths from measles almost 314 deaths per day or 13 deaths per hour. The main cause of death from measles are complications from the respiratory tract (pneumonia), the central nervous system (meningitis, encephalitis, meningoencephalitis, encephalomyelitis), gastrointestinal tract (diarrhea). Between 2000 and 2014, mass measles vaccination reduced global measles mortality rate by 79%, and about 17.1 million children's lives were saved. However, measles still remains endemic and, one of the leading causes of childhood mortality in developing countries as a result of lack of immunization policies. Up to 98% of measles mortality are registered in developing countries, such India, Bangladesh, Nigeria, RDC, etc. If in the pre-vaccine period, measles affected predominantly children aged less than five years, the global immunization era led to a change in the measles-age-category pattern. The increase measles occurency in adults is due to the loss of protective antibodies, that last generally for 10 to 15 years after vaccination in only 36% of the vaccinees. Complications due to measles in adolescents and adults are most likely than in children. However, immunocompetent individuals may have repeated measles infections. The possibility of transplacental transmission of the disease: measles in pregnant women leads to a higher risk of premature birth, spontaneous abortion, congenital malformations, and with a woman at the end of pregnancy intrauterine infection and the birth of a child with signs of measles. In the absence of specific anti-measles antibodies in the mother, the child may become ill in theantenatal period. Differential diagnosis of measles is carried out with infections that occur with exanthema syndrome (parvovirus B19, sudden exanthema, etc.). Etiotropic therapy is carried out with preparations of recombinant interferon (viferon, etc.). Doses of drugs and the duration of treatment are determined by the severity of the disease. Pathogenetic and symptomatic therapy is strongly recommended.

Pediatrician (St. Petersburg). 2017;8(3):120-129
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Cardiovascular complications of antineoplastic therapy in children
Kulyova S.A., Semiglazova T.Y., Zvyagintseva D.A., Belogurova M.B., Ivanova S.V., Okisheva I.V.
Abstract

The improvement of long-term survival in children with malignant tumors is noted in the last five decades. Serious late consequences of the applied therapy including early death, the second tumors, different organ dysfunctions (heart, gonads, liver, lungs) began to come to light with increase in number of cured and follow-up. The article discusses the emergence of cardiotoxicity in children treated with cytostatic and radiation therapy for malignant tumors. Particular attention is paid to the influence of anthracycline antibiotics on the state of the heart muscle. Anthracycline and similar medicines - doxorubicin, rubomycin, idarubicin, mitoxantrone - are an important component of most regimen of chemotherapy in children. Briefly describes the history of the application of this group of drugs in oncology and the study of their effects on heart function. The attention to the pathogenesis of anthracycline cardiotoxicity risk factors for its development, display options, how to identify and mitigate. We describe the clinical manifestations of early and late cardiotoxicity arising after the application of antitumor antibiotics anthracyclines. The article defines the role of chemotherapeutic agents other groups in the development and worsening cardiotoxicity. No less important role in the development of long-term effects of the heart and blood vessels plays radiotherapy. The paper paid attention to cardiovascular dysfunctions that arise in different periods of observation after irradiation of the mediastinum. Finally, recommendations for practitioners on screening, monitoring and treatment of identified diseases of the cardiovascular system in patients cured of childhood malignancies are presented.

Pediatrician (St. Petersburg). 2017;8(3):130-141
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Risk factors, predictors and contemporary diagnostics of bronchopulmonary dysplasia
Prometnoy D.V., Alexandrovich Y.S., Voronenko I.I.
Abstract

Improving of resuscitation and intensive care of premature babies allowed their survival. Bronchopulmonary dysplasia (BPD) is the significant complication of low-birth newborns. Identification of early predictors of disease can optimize of treatment and decrease of quantity of appearance and severity of BPD. Quantity of BPD is 5-97%. The significant predictors from hereditary and genetic factors are family bronchopulmonary pathology, dysplasia of connective tissue, gene polymorphism of VEGF, EPNX-113 Hiss, Nos3-786C, GCLC, 58 Т/С sod2, minore allele - 460 of T-gene (VEGF); from clinical and immunological factors - lung immaturity, alveolarization and vascularization disorders, hemodynamically significant ductus arteriosus; from biochemical factors - hyperoxy, lipid peroxidation and decreasing of antiperoxidation, disorder of angiotensin-1/endostatin; from therapeutic factors - overexertion of lungs during ventilation, avoiding of antiperoxid protection, insufficiency of nutrition. Contemporary methods of BPD diagnostic are clinical data (oxygen dependence at 28 days after birth), X-ray sings, identified by X-ray examination and tomography and bronchophonography. More of identified factors and predictors of BPD are difficult for examinations, haven’t 100% result or low predictive power, that is why further study is needed.

Pediatrician (St. Petersburg). 2017;8(3):142-150
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Operation on Billroth-I in gastric cancer surgery: the evolution of views
Morgoshiia T.S.
Abstract

In recent years almost all over the world, there is a decrease in the incidence of gastric cancer. Despite that carcinoma of the stomach annually affects on our planet about 1 million people. The prevalence of distal gastric cancer has a tendency to decrease, while the frequency of proximal cancer increases slightly. Early gastric cancer is only 10% of all new cases, and in 64,2% of patients are diagnosed at stages III-IV disease. Over the last 35 years, there has been substantial progress in the diagnosis and treatment of gastric cancer. Surgery that involves complete removal of the tumor remains the only method which gives hope for cure of the patient, despite the significant number of combined and complex treatment methods of this disease. However, many provisions of this concept have changed drastically. After surgery Billroth-I much less frequently and with less severity (than after resection Billroth-II) develops duodenogastric reflux in the absence of duodenostasis and adequate patency of the digestive tract. It is the reflux of bile and pancreatic juice plays an important role in the occurrence of cancer of the stomach stump. The basic cause of cancer is the development of atrophic gastritis as a consequence of denervation of the authority and the reflux of bile into the resected stomach. The choice of the method of restoring the integrity of digestive tract after distal gastrectomy is a topical problem, given the continuous increase in the number of patients undergoing this operation. In the review of literature shows that intervention in the modification of the Billroth-I does not increase the number of postoperative complications, no differences in long-term results of surgical treatment of gastric cancer for two methods of restoring the continuity of the digestive tract after distal resection.

Pediatrician (St. Petersburg). 2017;8(3):151-157
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Characteristics of acute period of traumatic brain injury in children with hemophilia
Guzeva V.I., Ochrim I.V., Maksimova N.E., Guzeva O.V., Guzeva V.V., Abramova N.N., Rodionov J.V.
Abstract

The clinical picture of traumatic brain injury (TBI) in children is characterized by pronounced polymorphism. To clarify the severity of TBI and the localization of the pathological process, use computed tomography (CT) or magnetic resonance imaging (MRI) of the brain.

The aim of the work was to justify the need for neuroimaging to all children with hemophilia with TBI and to determine the correlation between the severity of clinical manifestations and neuroimaging data. The article describes the clinical case of a favorable outcome of an TBI in a toddler child with hemophilia A. The case is of interest to physicians of various specialties and demonstrates the features of the clinical course of acute TBI with hemophilia. The diagnostic process for TBI was based on complaints, clinical and neuroimaging data. Complaints and the circumstances of the injury are known from the mother's words in connection with the early age of the child and the absence of a formed speech. Methods of investigation: collection of complaints and anamnesis of the disease, neurological examinations, laboratory and instrumental data, including neuroimaging data. It is known that the boy fell off the couch, hit the back of the head, did not lose consciousness, there was no vomiting. A day after receiving the injury, there was an increase in cerebral neurological symptoms. Clinically, hematoma is suspected. On the CT of the brain, epidural hematoma was determined. Thus, the presented clinical case illustrates that even a minor head injury in patients with hemophilia can lead to severe consequences. Neuroimaging of the brain with TBI is indicated for all children with hemophilia, regardless of the severity of clinical manifestations.

Pediatrician (St. Petersburg). 2017;8(3):158-163
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