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Vol 12, No 2 (2021)

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Original studies

Cytokine status in middle-aged men with acute coronary syndrome after coronary artery stenting

Gostimskiy V.A., Vasilenko V.S., Kurnikova E.A., Shenderov S.V., Gurina O.P.

Abstract

Background. Inflammatory cytokines and growth factors are involved in various mechanisms of coronary artery disease. Clinical studies have shown the correlation between the increase in the level of proinflammatory cytokines and the severity of coronary artery disease, while the data on the role of proinflammatory interleukin IL-8 and anti-inflammatory interleukin IL-4 are contradictory.

The aim of the study is to assess the levels of proinflammatory cytokines (IL-8, TNF-α) and anti-inflammatory interleukin (IL-4) in patients with various forms of coronary artery disease who underwent coronary artery stenting.

Materials and methods. By the method of enzyme-linked immunosorbent assay, the levels of cytokines were determined in 30 patients with acute coronary syndrome who underwent primary stenting of the coronary arteries and in 24 patients with chronic coronary syndrome who had previously had myocardial infarction with stenting of an infarction-associated artery, who were admitted to the clinic for staged stenting of the coronary arteries.

Results. In patients with chronic coronary syndrome the levels of IL-4 a do not exceed the reference values, in patients with acute coronary syndrome the levels of IL-4 there was an increase 3,70 ± 0,24 and 240,85 ± 49,25 pg/ml, р ≤ 0,001. In patients with chronic coronary syndrome the levels of IL-8 a do not exceed the reference values, in patients with acute coronary syndrome the levels of IL-8 there was an increase 7,34 ± 1,29 and 110,33 ± 27,67 pg/ml, р ≤ 0,001.

Conclusion. Most likely the increase in the level of IL-4 has a compensatory character and, along with a slight increase in TNF-α, can be considered as a positive factor stabilizing the course of the disease. There may be some relationship between of the increase in the level of interleukins in patients with acute coronary syndrome on the degree of stenosis of the coronary arteries (90–95%) and impaired myocardial contractility was established.

Pediatrician (St. Petersburg). 2021;12(2):5-12
pages 5-12 views

Initial vegetative tone in mild atopic asthma in children

Buryak V.N., Antonova T.I., Dudko M.V., Malysheva I.V., Shepelenko K.K.

Abstract

Background. In most industrialized countries, allergic diseases affect up to 20% of the population. This pathology belongs to the most common in children: according to the World Health Organization, more than 15% of the world's child population suffers from it. In recent years, there has been a significant increase in the frequency and more severe course of these diseases, in connection with which they are considered in modern society as a major medical and social problem. Thus, the prevalence of bronchial asthma, according to domestic and foreign authors, ranges from 0.2 to 8.1%.

Purpose. In order to clarify the role of the autonomic nervous system in the genesis of the mild course of atopic bronchial asthma in childhood, the features of the interaction of the sympathetic and parasympathetic divisions of the autonomic nervous system in the examined children were clarified.

Materials and methods. 126 children aged 10 to 14 years were examined. Atopic bronchial asthma was diagnosed in 91 children. At the same time, 61 of them were diagnosed with an intermittent course, 30 – a mild persistent course of the disease. The control group consisted of 35 healthy children also aged 10 to 14 years. Complaints, anamnesis data were studied in all children, an objective and generally accepted laboratory and instrumental examination was carried out. All examined children underwent daily monitoring of the electrocardiogram, according to the results of which, based on the analysis of time and frequency indicators of heart rate variability, a variant of the initial autonomic tone was established.

Results. In children with atopic bronchial asthma, both with intermittent and mild persistent course, an absolute or relative dominance of sympathetic influences was revealed against the background of varying degrees of decrease in parasympathetic activity, which was interpreted as a compensatory reaction of the body in response to chronic allergic inflammation.

Pediatrician (St. Petersburg). 2021;12(2):13-18
pages 13-18 views

A comparative analysis of the relationship between stature and ultrasound dimensions of internal organs in adolescents

Yerkudov V.O., Pugovkin A.P., Volkov A.J., Musaeva O.I., Volkov D.J., Rogozin S.S., Chistjakova M.V., Kochubeev A.V., Pakhomova M.A., Brus T.V., Zabezhinsky M.M.

Abstract

The aim of the study was a comparative characteristic of the size of internal organs according to ultrasonography data in subjects with various deviations in stature, determined using international standardized norms.

Materials and methods. The stature was measured in 93 adolescents, aged 13 to 17 years. Based on the measurements, the Z-score of body length was calculated according to the WHO Growth Reference, 2007 and three groups were formed for comparing the sizes of internal organs: “average”, “above average”, “below average”. Ultrasonography data of the internal organs dimensions and thyroid gland was performed using a Toshiba Aplio 500 ultrasound scanner.

Results. There were statistically significantly lower values of the liver span and the longitudinal size of the gallbladder in the examined subjects from the “below average” group compared to the rest of the subjects. The length of the spleen and the total volume of the thyroid gland were statistically significantly different in subjects from all three groups, with the highest values in volunteers from the “above average” group. A weak direct correlation was shown between the Z-score of body length and liver span, the length of the cauda of the pancreas, and the width of the spleen. An average direct statistical relationship was found between the Z-score of stature and the length of the spleen, as well as the total volume of the thyroid gland.

Conclusion. To a greater extent, body length is associated with the size of the parenchymal organs with a pronounced connective tissue frame - the liver and spleen, as well as the thyroid gland due to the relationship of its volume with hormones that regulate growth and development. Clinical substantiation of the relationship between the structure of the body and internal organs opens up the possibility of creating anatomical standards that allow ultrasound morphometric assessment of internal organs, taking into account the individual characteristics of the patient’s body size.

Pediatrician (St. Petersburg). 2021;12(2):19-27
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The effectiveness of osteopathic treatment 2,5–4,5 year-old children with dysarthria

Egorova I.A., Buchnov A.D., Zinkevich E.R.

Abstract

Background. In recent decades, diagnostic and therapeutic procedures related to classical orthopedics, manual medicine and osteopathy have become widespread in Russian clinical medicine. Osteopathy expands the possibilities of diagnosis and treatment of various diseases due to the fact that its methods are not addressed to individual symptoms of the disease, but to violations of the system organization of physiological functions of the body and to establishing cause-and-effect relationships between mechanical damage of human tissues and the development of subsequent pathologies. Currently, the problem of studying the relationship of indicators of the osteopathic status of preschool children having perinatal signs of dysarthria is relevant for osteopathic doctors.

Materials and methods. On the basis of the department of osteopathy of the Yaroslav-the-Wise Novgorod State University and the V.L. Andrianov Institute of the osteopathic medicine, a study was conducted aimed at assessing the clinical and physiological parameters of children aged 2.5 to 4.5 years with dysarthria and further substantiating the effectiveness of oteopathic treatment of adverse functional disorders of the brain that affect oral speech. The work used a computer electroencephalograph Mizar. Ultrasound dopplerography of the brain vessels of the subjects using the transcranial dopplerography device EME/Nicolet as well as ultrasound examination of the cervical spine was performed. The materials obtained in the course of the study were subjected to mathematical and statistical processing using the Statistica 6.0 software package, nonparametric (Wilcoxon test) and parametric methods were used with applying the Student’s t-test to assess the reliability of differences, and correlation analysis was performed to establish the relationship between clinical, physiological and osteopathic indicators in children before and after treatment.

Conclusions. The results of the assessment of the clinical and physiological parameters of the subjects allowed us to infer that the osteopathic treatment was effective.

Pediatrician (St. Petersburg). 2021;12(2):29-34
pages 29-34 views

Morphofunctional features of platelets in premature newborns with very low and extremely low body weight

Budalova A.V., Kharlamova N.V., Kuzmenko G.N.

Abstract

Background. Currently, the development of medicine in the field of perinatology is aimed at improving the quality of medical care for newborns, especially those born prematurely. Premature newborns are most likely to develop hemorrhagic disorders, which often aggravates their condition and determines high morbidity and mortality. On modern hematological analyzers, it has become possible to evaluate a larger number of blood parameters, including platelet parameters, however, there are a small number of studies devoted to the study of platelet parameters in premature newborns.

The aim was to study the morphofunctional features of platelets in premature newborns with very low and extremely low body weight.

Materials and methods. The study included 78 newborns born at 25–34 weeks of gestation, with a body weight of less than 1500 grams. On the 3rd–5th day of life, a clinical blood test was performed on the Advia 2120i hematological analyzer (Siemens), with the determination of platelet parameters: PLT, ×103 cells/µl, PCT, %, PDW, %, Large Plt, ×103 cells/µl, MPC, g/dl, MRM, pg.

Results. In newborns with ELBW, a decrease in the number and granularity of platelets in the blood, an increase in the average dry mass of platelets was found. Newborns with intrauterine growth retardation have a reduced platelet count and reduced thrombocrit. In premature newborns with a gestational age of 25–27 weeks, blood circulation of platelets with a reduced volume was established, and in newborns who were born at a gestational age of 32–34 weeks with increased granularity. In the absence of antenatal prevention of respiratory distress syndrome in newborns, there is a decrease in thrombocrit, the number of platelets, including large forms in the blood. In premature newborns born in a state of severe asphyxia, a decrease in platelet granularity was noted. The use of high concentrations of O2 in the oxygen-air mixture during respiratory therapy leads to a decrease in the number of platelets in the blood.

Conclusions. Factors determining the morphofunctional state of platelets in premature newborns were established: the presence of a full course of antenatal prevention of respiratory distress syndrome of newborns, gestational age, the severity of asphyxia at birth, as well as the concentration of O2 in the oxygen-air mixture used in respiratory therapy. Newborns with ELBW have a reduced platelet count, low-granulated platelets, and an increased average dry platelet mass. Newborns with intrauterine growth retardation have a reduced number of platelets and thrombocrit in the blood. The revealed morphofunctional features of platelets allow us to clarify the nature of changes in the platelet link of hemostasis in premature newborns for the timely prevention of complications during the underlying disease.

Pediatrician (St. Petersburg). 2021;12(2):35-41
pages 35-41 views

The use of whole-body cryotherapy for increasing the stress resistance of female athletes in group types of gymnastics

Vasilenko V.S., Mamiev N.D., Semenova Y.B., Karpovskaya E.B.

Abstract

Background. Representatives of complex coordination sports are most susceptible to psychoemotional stress, since they demonstrate high sports results already at a young age. The tightening of anti-doping control has significantly reduced the possibility of using pharmacological and biologically active drugs to speed up the recovery of athletes. Against this background, in sports medicine, more attention is paid to the use of non-drug methods to improve performance and recovery in athletes.

Aim – to study the efficiency of the introduction of whole-body cryotherapy in the training process of female athletes of complex coordination sports (for example, group gymnastics) to increase stress resistance and reduce violations of adaptation processes as a result of neuropsychiatric overstrain.

Materials and methods. During the academic-training year, 22 gymnasts received six ten-day courses of whole-body cryotherapy in the ICEQUEEN cryosauna. 19 athletes were included in the control group. The studies were conducted 3 times: before the start of the procedures, after the first course of procedures, at the end of the training year. The diagnosis of nocturnal bruxism and the definition of the “psychological component of health” were carried out. Total and effective albumin concentrations were determined in the blood serum with the calculation of the albumin binding reserve, helper T-lymphocytes and killer T-lymphocytes with the calculation of the immunoregulatory index.

Results. After one course, there was an increase in the functional activity of serum albumins, a decrease in the number of episodes of involuntary contractions of the masticatory muscles at night, and an increase in the “psychological component of health” according to SF-36. After six courses of cryotherapy, the functional activity of serum albumins and the initial values of the immunoregulatory index were preserved by the end of the season, and the “psychological component of health” according to SF-36 was increased, while these indicators decreased in the control group. There was also a decrease in the number of episodes of involuntary contractions of the masticatory muscles at night with an increase in their number in the control group of female athletes.

Conclusions. Considering the obtained results, it is possible to recommend the use of whole-body cryotherapy in gymnasts during the preparatory and recovery periods of the annual training cycle in order to increase stress tolerance and prevent psychoemotional overstrain.

Pediatrician (St. Petersburg). 2021;12(2):43-52
pages 43-52 views

Reviews

Cutaneous manifestations of endocrine diseases in children

Gorlanov I.A., Leina L.M., Skorodok Y.L., Milyavskaya I.R.

Abstract

Endocrine diseases such as obesity, diabetes mellitus, Cushing’s syndrome, hypothyroidism and hyperthyroidism, acromegaly and hyperandrogenism in children and adolescents are often manifested by changes in the skin. Moreover, skin symptoms can be a marker of systemic, in this case, endocrine and metabolic diseases. Obesity and diabetes are chronic diseases that affect people all over the world, and their incidence is increasing in both children and adults. Clinically, they affect a number of organs, including the skin. The cutaneous manifestations caused or aggravated by obesity and diabetes are varied and usually bear some relation to the time that has elapsed since the onset of the disease. They include acrochordons, acanthosis nigricans, striae, xerosis, keratosis pilaris, plantar hyperkeratosis, fungal and bacterial skin infections, granuloma annulare, necrobiosis lipoidica. In obese patients, psoriasis and atopic dermatitis are more common than in the control group. With the pathology of the thyroid gland, diseases such as alopecia, pretibial myxedema, urticaria, and some others develop. Hyperandrogenism (polycystic ovary syndrome) is accompanied by skin lesions such as acne vulgaris, hirsutism, androgenic alopecia, acanthosis nigricans. This literature review focuses on the main skin syndromes accompanying endocrine pathology in children and adolescents. Information about such clinical associations can make it easier for pediatricians and endocrinologists to diagnose and treat endocrine diseases in a timely manner and, thereby, prevent long-term adverse consequences.

Pediatrician (St. Petersburg). 2021;12(2):53-64
pages 53-64 views

Obstructive sleep apnea syndrome in children: prerequisites for formation and possibilities of ultrasound diagnostics of structural and functional changes in the vascular system

Bolshakova S.E., Madaeva I.M., Berdina O.N., Bugun O.V., Rychkova L.V.

Abstract

Obstructive sleep apnea (OSA) in children are relatively frequent sleep disorder, with a prevalence of 1–5 %, in pediatrics population, as reported by different studies. The clinical consequences of OSA are daytime sleepiness, cognitive and behavioral disorders, and poor school performance. OSA has serious social implications given their correlations with cardiovascular diseases and obesity. The article reflects the mechanisms involved in the development of the pathologic changes in cardiovascular system in OSA patients, which remain completely unclear, which determines the need for further study of the problem. The role of endothelial dysfunction in children with OSA as the main marker of vascular damage is considered. The description of ultrasound methods for studying the vascular system in OSA pediatric patients is given. The work on the study of cerebral hemodynamics using transcranial duplex scanning of the vessels of the base of the brain and its changes caused by vascular remodeling in OSA are presented. This review discusses the possibility of ultrasound assessment of endothelium-dependent dilatation of the brachial artery in a test with reactive hyperemia as a functional method for diagnosing endothelial dysfunction in OSA children. The use of these methods will make it possible to timely identify the structural and functional changes in blood vessels, which will allow determining the vector of early prevention and pathogenetically substantiate innovative approaches to the treatment of various cardiovascular diseases in OSA children from the standpoint of sleep medicine.

Pediatrician (St. Petersburg). 2021;12(2):65-72
pages 65-72 views

Наследственные болезни обмена

Congenital metabolic diseases. Lysosomal storage diseases

Gorbunova V.N.

Abstract

The classification and epidemiology of hereditary metabolic disorders are presented. That is a large group consisting from more them 800 monogenic diseases, each of which caused by inherited deficiency of certain metabolic fate. Many of these disorders are extremely rare, but their total incidence in the population is close to 1:1000–5000. Lysosomal storage diseases (LSD) resulting from inherited deficiency in lysosomal functions occupy a special place among hereditary metabolic disorders. The defects of catabolism cause the accumulation of undigested or partially digested macromolecules in lysosomes (that is, ‘storage’), which can result in cellular damage. About 60 diseases take part in this group with total incidence of about 1:7000–8000. LSDs typically present in infancy and childhood, although adult-onset forms also occur. Most of them have a progressive neurodegenerative clinical course, although symptoms in other organ systems are frequent. The etiology and pathogenetic aspects of their main clinical entities: mucopolysaccharidosis, glycolipidosis, mucolipidosis, glycoproteinosis, etc, are presented. Mucopolysaccharidoses caused by malfunctioning of lysosomal enzymes needed to break down glycosaminoglycans are more frequent among LSD. Sphingolipidoses caused by defects of lipid catabolism are second for frequency group of LSD. The state-of-art in field of newborn screening. clinical, biochemical and molecular diagnostics of these grave diseases are discussed. The main directions of modern lysosomal storage diseases therapy are characterized: transplantation of hematopoietic stem cells; enzyme replacement therapy; therapy with limitation of substrate synthesis (substrate-reducing therapy); pharmacological chaperone therapy. Perspective directions for LSD therapy are gene therapy and genome editing which are at advanced preclinical stages.

Pediatrician (St. Petersburg). 2021;12(2):73-83
pages 73-83 views

Clinical observation

A clinical case of extremely severe major venes displasia in a child

Azarov M.V., Kupatadze D.D., Nabokov V.V., Makhin Y.Y., Kolbaia L.М., Dyug I.V.

Abstract

Dysplasia of the great veins (DMV) is known by the names of the authors who described this pathology as Klippel–Trenone syndrome. The clinical picture of the Klippel–Trenone syndrome in the classic description of the authors is characterized by a triad of symptoms: vascular spots, atypical varicose veins, hypertrophy of soft tissues and bones with an increase in the volume and length of the affected limb. It should be emphasized that the severity of these symptoms depends, first of all, on the type of lesion (embryonic or fetal) and the severity of the lesion. Klippel–Trenone syndrome is almost always sporadic, meaning that it develops in people with no family history of the disorder. Research shows that this condition is due to gene mutations that are not inherited. These genetic changes, called somatic mutations, occur randomly in a single cell during the early stages of development before birth. Klippel–Trenone syndrome can be caused by mutations in the PIK3CA gene. This article presents a clinical observation – the course of the disease of a 1-year-old child, with an extremely severe form of dysplasia of the great veins. In the presented clinical observation, attention is drawn to the difficulties of treating this patient against the background of the underlying chronic disease. The treatment of these patients should be carried out on the basis of a multidisciplinary hospital, which includes specialists in vascular surgery, an orthopedist and an intensive care physician. On the example of the described case, diagnostic tactics and surgical treatment are demonstrated. It is obvious that timely surgical and conservative treatment of pathology in children with dysplasia of the great veins improves the quality of life and social adaptation of children.

Pediatrician (St. Petersburg). 2021;12(2):85-89
pages 85-89 views

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