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Vol 12, No 3 (2021)

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About the absence of the need to prescribe antibacterial therapy to newborns from mothers with clinical chorioamnionitis

Shevareva E.A., Fedorova L.A., Nevmerzhitskaia O.V.


Background. The diagnosis of a woman in labor “chorioamnionitis” (CA) implies a high risk of infectious complications for the mother and fetus, which determines the need for additional examination of infants and the decision on the appointment of antibacterial therapy. The purpouse of this study was determine the need to administration antibiotic therapy to full-term newborns from mothers diagnosed with chorioamnionitis.

Materials and methods. 113 full-term newborns were examined, of which the main group consisted of children whose mothers were diagnosed with “chorioamnionitis” (n = 77), the comparison group – children born to healthy mothers (n = 36). All children performed clinical and laboratory monitoring, including a clinical analysis of capillary blood in the first 24 hours of life; determination of the level of C-reactive protein (CRP) in venous blood on the 3rd day of life. Bacteriological examination of newborns included sampling of material from the ear fold, buccal mucosa, umbilical cord blood, as well as the contents of the tracheobronchial tree (TBD) – during respiratory therapy with mechanical ventilation. Special research methods included studies of the proinflammatory cytokines (IL-1β, IL-6) in umbilical cord blood. Histological CA was diagnosed in the presence of morphological and functional signs of inflammation in the placenta.

Results. Newborns of the main group more often developed respiratory disorders requiring respiratory and oxygen therapy (p = 0,045). The production of IL-1β, IL-6 in umbilical cord blood in the examined newborns of the main group was higher than in the comparison group [Odds Ratio (OR) 8.4; 95% Confidence Interval (CI): 1.0–67.9; OR 7.4; 95% CI: 2.5–21.7 respectively]. The study of blood samples revealed leukocytosis (>34·109) 6.5% vs 0%, p > 0.05) and a shift in the leukocyte count to young forms of neutrophils (45.4% vs 16.7%, p < 0.05) in the peripheral blood of infants of the main group. Infants exposed to maternal clinical chorioamnionitis had increased level of CRP 10.3 times more frequent (95% CI: 2.8–37.1) than in newborns in the comparison group. With dynamic clinical and laboratory monitoring, 72 children of the main group (93.5%) had no data for the course of the infection, as a result of which they did not receive antibiotic therapy.

Conclusion: Administration antibiotic therapy to clinically healthy full-term newborns from mothers diagnosed with chorioamnionitis is unjustified. Infants of this group require clinical laboratory, dynamic observation with laboratory control, including a clinical blood test and determination of the CRP level, which is a preferred alternative to the appointment of antibiotic therapy.

Pediatrician (St. Petersburg). 2021;12(3):5-14
pages 5-14 views

Original studies

Clinical and electromyography characteristics of chemotherapy-induced polyneuropathy in children with acute lymphoblastic leukemia

Koryakina O.V., Kovtun O.P., Sabitov A.U., Pediatric L.G., Mikhailovskya S.I., Repakova A.V.


Background. The Hemoblastoses are one of the urgent problems of oncohematology. Modern methods for the treatment of hemoblastoses have improved the prognosis significantly. However, the use of chemotherapy is accompanied by a high frequency of drug complications, including those associated with neurotoxicity. The addition of neurological symptoms to the main clinical picture of the disease significantly aggravates the patient’s condition, affects the prognosis and quality to life.

Aim. Compare clinical picture and neurophysiological signs of chemo-induced polyneuropathy in children with acute lymphoblastic leukemia.

Materials and methods. Neurological examination and electromyography (EMG), were conducted in 21 children aged 3 to 17 years in Regional Children Clinical Hospital of Yekaterinburg from 2019 to 2020.

Results. In the study group, the signs of peripheral polyneuropathy, were revealed in almost all patients receiving induction chemotherapy (95.2%) while clinical neurological symptoms were found in 25% patients. During a 4-month follow-up, all children with subclinical signs of peripheral nerve damage developed corresponding neurological symptoms. According to EMG, the number of patients with mixed polyneuropathy increased by 1.7 times. In every third child, the amplitude of the M-response and nerve conduction velocity, were decreased.

Conclusions. Therefore, neurophysiological examination should be performed at an early stage to identify high-risk groups for neurotoxic complications in children with acute lymphoblastic leukemia receiving chemotherapy as timely administration of therapeutic treatment is required.

Pediatrician (St. Petersburg). 2021;12(3):15-23
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The results of therapy of congenital adrenal hyperplasia in children in perm region

Tomilina Y.M., Chistousova G.V., Sofronova L.V.


Background. Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders. About 90% of all children with CAH have 21-hydroxylase deficiency which is required for the synthesis of glucocorticoids and mineralocorticodes. The salt-wasting form of CAH develops with a deficiency of both types of hormones. This form of CAH results in infant death if not treated, therefore early disease detection and start of treatment are very important.

Aim of research is to study the clinical features of the course of the disease and evaluate the treatment efficacy of children with salt-wasting form of CAH in the Perm region.

Materials and methods. We conducted an analysis of the clinical features of the salt-wasting form of CAH in 40 children of the Perm region. To evaluate the treatment efficacy following symptoms were analyzed: salty food craving, hyperpigmentation of skin, hirsutism, delayed or accelerated growth, etc. and parameters of water-electrolytic balance, the level of 17-hydroxyprogesterone, adrenocorticotropic hormone, renin.

Results and discussion. Despite the modern possibilities of diagnosing and treating CAH, the complete control of the disease can’t be achieved in all children. Almost all the children examined had either symptoms of replacement therapy failure or overdose symptoms. Hormonal imbalance disorders were performed by a few children without any symptoms of the disease.

Conclusion. During our research we concluded that young children often have issues with an overdose of hormonal drugs and frequent occurrence of salt-wasting crises against the background of associated diseases, while for teenagers, problems associated with an insufficient dose of glucocorticoid drugs are relevant. Also, significant difficulties in the treatment of children with CAH are associated with the short action of hydrocortisone. One way to solve these problems is to organize a school for parents of children with CAH. Creating motivation, explaining the principles of treatment and importance of regular taking of drugs, as well as algorithm in medical emergency is an important step in achieving control for the disease.

Pediatrician (St. Petersburg). 2021;12(3):25-30
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Experimental modeling of behavioral disorders accompanying hashimoto’s thyroiditis by means of specific immunoglobulins

Sobolevskaia P.A., Gvozdeckii A.N., Utekhin V.J., Efimova E.V., Kuvarzin S.R., Fedotkina T.V., Churilov L.P.


Among the manifestations of Hashimoto’s autoimmune thyroiditis, there are various psychoneurological disorders. For more than a century, it has been known about psycho-neurological disorders associated with hypothyroidism, but along with that, there are also mental disorders in patients with thyropathies in euthyroid state. In 1966, Hashimoto’s encephalopathy was described, the pathogenesis and clear differential diagnostic criteria of which have not yet been determined. This article describes an experimental study in laboratory mice with intracisternal stereotaxic injection of IgG isolated from patients with autoimmune thyroiditis and comorbid depression or schizophrenia. A control group included animals receiving polyclonal IgG from healthy donors. Then behavioral tests were carried out, which revealed the characteristics and changes in behavior in the operated animals. Thus, animals that received immunoglobulins from patients with autoimmune thyroiditis and depression were less active in relation to the development of risk behavior. Porsolt’s tests on the 4th and 15th days after surgery showed that, regardless of the kind of the injected solutions, there was a change in the temporal relationships between the behavior patterns. In mice received IgG from patients with autoimmune thyroiditis and schizophrenia during the delayed Porsolt test, the ratio of the forms of motor activity shifted towards passive swimming. The mice received IgG from healthy donors did not demonstrate this change.

Pediatrician (St. Petersburg). 2021;12(3):31-41
pages 31-41 views

Levels IL-4, IL-8, TNF-α in middle-aged men with stented coronary arteries after repeated myocardial revascularization

Vasilenko V.S., Kurnikova E.A., Gostimskiy V.A., Shenderov S.V., Blinov A.E., Varlamova O.N., Dement’eva E.A.


Background. It has now been established that inflammatory cytokines are involved in all the stages of the development of coronary heart disease. It has been scientifically proved that the severity of coronary heart disease directly correlates with the increase in the level of proinflammatory cytokines, while data on the role of proinflammatory interleukin IL-8 and anti-inflammatory interleukin IL-4 are contradictory.

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

Materials and methods. By the method of enzyme-linked immunosorbent assay, the levels of cytokines were determined in 28 patients who had previously undergone myocardial infarction with stenting of an infarct-related artery, re-admitted due to the development of acute coronary syndrome, who underwent repeated stenting of coronary arteries. The same method was performed on 24 patients who also had previously undergone myocardial infarction with stenting of the 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 359,80±66,94 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 69,75±18,25 pg/ml, р ≤ 0,001.

Conclusions. 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.

Pediatrician (St. Petersburg). 2021;12(3):43-50
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Hyperlactatemia and lactate acidosis in the practice of pediatricians

Parshina N.V., Danilova L.A., Dekhtyareva N.S.


Assessment of blood lactate / lactic acid levels by a General pediatrician is sometimes difficult. Lactate is a product of cellular metabolism of glucose, fatty acids, and some interchangeable amino acids. The norm of lactate in the blood is not defined by international standards, so it depends on the methodology and reagents used in the laboratory. The level of lactate in the blood is the result of an equilibrium between the processes of its formation and utilization. The leading causes of increased blood lactate are anaerobic muscle activity (heavy exercise, seizures), impaired liver and kidney function, lung and heart diseases (respiratory failure, circulatory failure), diabetes, sepsis, regional tissue circulatory disorders (burns and injuries), shocks, some severe abnormalities in the condition of newborns, mitochondrial diseases, and medications. Lactatacidosis is a rare dangerous complication caused by certain pathological conditions (diseases or syndromes), which can end in death. Identification of the cause of lactic acidosis and differential diagnosis of its type is a crucial factor for choosing a treatment strategy. Lactatacidotic coma in diabetes mellitus is a rare, but possible complication, that requires intensive complex treatment in intensive care units. The pediatrician should be able to assess the level of lactate in the blood, analyze the possible causes of hyperlactatemia, and know the algorithm of actions in the development of lactate acidosis.

Pediatrician (St. Petersburg). 2021;12(3):51-61
pages 51-61 views

Application of digital technology in the work of a pathologist: guidelines for learning how to use speech recognition systems

Khramtsov A.I., Nasyrov R.A., Khramtsova G.F.


Natural language processing is one of the branches of computational linguistics. It is a branch of computer science that includes algorithmic processing of speech and natural language scripts. The algorithms facilitate the development of human-to-machine translation and automatic speech recognition systems (ASRS). ASRS use is twofold: accurately converting operator’s speech into a coherent and meaningful text and using natural language for interaction with a computer. Currently, these systems are widely used in medical practice, including anatomic pathology. Successful ASRS implementation pivots on creation of standardized templated descriptions for organic inclusion in the diagnosis dictation, likewise – on physician training for using such systems in practice. In the past decade, there have been several attempts to standardize surgical pathology reports and create templates undertaken by physicians worldwide. After studying domestic and foreign literature, we created a list of the essential elements that must be included in the template for macro-and microscopic descriptions comprising the final diagnosis. These templates will help in decision-making and accurate diagnosis as they contain all the imperative elements in order of importance. This approach will significantly reduce the need for re-examination of both fixed macroscopic material and the preparation of additional histological sections. The templates built into ASRS reduce the time spent on documentation and significantly reduce the workload for pathologists. For the successful use of ASRS, we have developed an educational course, “Digital Speech Recognition in an Anatomical Pathology Practice”, for postgraduate education of both domestic and foreign doctors. A brief description of the course is presented in this article, and the course itself is available on the Internet.

Pediatrician (St. Petersburg). 2021;12(3):63-68
pages 63-68 views

Lysosomal storage diseases: mucopolysaccharidosis type I and II

Gorbunova V.N., Buchinskaia N.V.


Mucopolysaccharidosis (MPS) are a genetically heterogeneous group of rare monogenic metabolic diseases associated with hereditary insufficiency of lysosomal enzymes involved in the catabolism of glycosaminoglycans, or mucopolysaccharides. The pathogenesis of MPS is due to the accumulation of non-cleaved glycosaminoglycans in lysosomes, which can destroy cells. All MPS are characterized by a polysystemic manifestation, the simultaneous involvement of many organs and tissues in the pathological process, first of all, connective tissues, bones and cartilaginous. This review presents the epidemiology, clinical, biochemical, and molecular genetic characteristics of MPS types I and II, caused by the recessive mutations in the alpha-L-iduronidase and iduronate-2-sulfatase genes, respectively, and by the accumulation of dermatan and heparan sulfate. Each of these diseases is characterized by clinical polymorphism, especially observed in MPS I, which often manifests in a severe form of Hurler syndrome, but can also occur in a milder form of Scheie syndrome. Currently, there is an increased interest in MPS in the world due to the identification of the spectrum and frequencies of mutations in the IDUA and IDS genes in various populations, including in Russia, and the practical availability of methods for individual molecular diagnostics. The description of the existing experimental models, their role in the study of the biochemical basis of the pathogenesis of these severe hereditary diseases and the development of various therapeutic approaches are given. Discusses the possibility of early diagnosis of MPS I and II types based on neonatal screening in order to increase the effectiveness of their prevention and treatment, as well as the advantages and disadvantages of the main approaches to the treatment of these serious diseases, such as hematopoietic stem cell transplantation, enzyme replacement and substrate-reducing therapy. A clinical example of a combination therapy for a severe form of mucopolysaccharidosis type I – Hurler syndrome is presented

Pediatrician (St. Petersburg). 2021;12(3):69-83
pages 69-83 views

Clinical psychology

Emotional and behavioral components of infertility-related stress experienced by infertile women

Kargol V.N., Zemlianykh M.V.


The article is devoted to the study of infertility-related stress experienced by infertile women. We studied such components of the stress of infertility as anxiety, depression, coping strategies, emotional schemes, as well as the psychological component of the quality of life. The aim of the study was to study the characteristics of individual components of the stress of infertility, such us anxiety, depression, emotional schemas and coping strategies. The following research methods were selected: A. Beck’s Anxiety Scale, A. Beck’s Depression Scale; questionnaire of the study of the quality of life in infertility FertiQoL J. Boivin; R. Leahy Scale of Emotional Schemes Questionnaire (LESS II); COPE coping strategies questionnaire in adaptation by T.O. Gordeeva, E.N. Osin, E.A. Rasskazova, O.A. Sychev, V.Yu. Shevyakhova. 33 women with infertility (main group) and 33 women without infertility and not planning pregnancy in the near future were studied. The results of the study revealed such characteristics of women with infertility as insufficient satisfaction with the quality of life, subjectively felt emotional discomfort, insufficient social support and some dissatisfaction with marital relations. At the same time, subclinical levels of anxiety-depressive symptoms are accompanied by a general tension of emotional schemes, the prevalence of such schemes, “Feelings of guilt for their own emotions”, “Lack of meaningfulness”, “Invalidation of emotions by others”, “Predicted duration of emotions”, “Tendency to ruminate”, “A simplified idea of emotions”. Behavioral strategies in a stressful situation in women with the stress of infertility are characterized by inflexibility, a tendency to avoidance and denial, and the rare use of positive reformulation and humor. The study revealed the presence of various supporting stress factors of infertility characteristic of women suffering from infertility: insufficient satisfaction with the quality of life, subjectively felt emotional discomfort, insufficient social support and dissatisfaction with marital relations. At the same time, subclinical levels of anxiety-depressive symptoms are accompanied by a general tension of emotional schemes and limited behavioral strategies in a stressful situation.

Pediatrician (St. Petersburg). 2021;12(3):85-91
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Albert vazgenovich papayan – outstanding scientist, pediatrician, teacher (towards 85th anniversary)

Ivanov D.O., Savenkova N.D.


The article presents the medical, scientific, and pedagogical activities of the Honored Scientist of the Russian Federation Albert Vazgenovich Papayan (1936–2002), Head of the Department of Faculty Pediatrics (1974–2002), Dean of Foreign Students (1969–1985), Vice-Rector for International Relations (1999–2002) of the Leningrad Pediatric Medical Institute, then the St. Petersburg State Pediatric Medical Academy. Professor A.V. Papayan is an outstanding scientist who formed the largest pediatric nephrology school within the walls of the SPbSMA, as the founder of the study of the hemostasis system in kidney diseases in children, as a teacher who brought up several generations of pediatricians and nephrologists, as a doctor who restored the health of thousands of sick children. Professor A.V. Papayan is the author of over 400 scientific papers, including 14 monographs and chapters in 14 manuals. Under the guidance of Professor A.V. Papayan completed and defended 62 dissertations of the Candidate of Medical Sciences, with scientific advice – 1 dissertation of the Doctor of Medical Sciences. Honored Scientist of the Russian Federation Albert Vazgenovich Papayan is the pride of the national pediatric science, education and health care. The editorial presents medical, scientific, pedagogical activity academician of the Russian Academy of Medical Sciences, Honored Scientist of the Russian Federation.

Pediatrician (St. Petersburg). 2021;12(3):93-100
pages 93-100 views

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