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Vol 12, No 5 (2021)

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Clinical features, treatment and rehabilitation of new coronavirus infection in patients with metabolic syndrome

Ivanov D.O., Uspenskiy Y.P., Sarana A.M., Fominykh Y.A., Sousova I.V., Zakharov D.V.


This review examines the main aspects of the course of a new coronavirus infection in patients with metabolic syndrome, provides up-to-date statistics on morbidity and mortality. Abdominal obesity, insulin resistance, arterial hypertension and dyslipidemia, which form the metabolic syndrome, are independent factors of a severe course of infection with a high risk of developing SARS, various complications, mainly the development of acute respiratory distress syndrome, extrapulmonary systemic inflammation and, finally, death. During the period of anti-epidemic measures, children turn out to be the most vulnerable in terms of losing the rational, healthy stereotypes of nutrition, regulation of “screen time”, responsible planning of study time and leisure, regular and intense physical activity. It requires increased attention of doctors, teachers and rehabilitation specialists to the problem maintaining the commitment of children and parents to a healthy lifestyle. Based on the formed concept of the presence of common links in the pathogenesis of the development of metabolic disorders and the infectious process, the authors identified the most significant issues of therapy and rehabilitation of this category of patients. Taking into account the need of patients for psychological adaptation of the past illness and increasing their resistance to stressful situations, within the framework of providing a personalized approach to the management of patients, may require timely diagnosis of anxiety-depressive disorders with the appointment of appropriate therapeutic measures.

Pediatrician (St. Petersburg). 2021;12(5):5-25
pages 5-25 views

Original studies

Features of the lesion of the vascular bed in purulent meningitis in children

Skripchenko N.V., Egorova E.S., Vilnits A.A., Gorelik E.Y.


Background. Purulent meningitis occupies one of the important places in the structure of neuroinfectious diseases in children and is the top ten places among the causes of death. The relevance of their study is due to the severity of the course, high rates of disability and deaths (8–39%). Damage to the vascular bed during neuroinfections, including purulent meningitis, is a mandatory component due to the predominantly hematogenous pathway of pathogens. The penetration of microorganisms through the blood-brain barrier into the cranial cavity and their hematogenous intrathecal circulation cause damage to the cerebral veins and arteries, leading to the development of vasculopathies and vasculitis.

Aim: To determine the features of vascular disorders in purulent meningitis in children.

Materials and methods. 100 children with purulent meningitis were examined, aged from 1 to 17 years 11 months, for the period since 2007 to 2020. All patients underwent neurological monitoring, etiological verification of diagnoses, determination of markers of endothelial dysfunction in the blood (D-dimer and desquamated endothelial cells), as well as MRI of the brain and MRI angiography.

Results. A complex lesion of the vascular system in purulent meningitis in children was proved, associated with both structural and functional properties of the vascular wall, as well as damage to the vasomotor function of the endothelium.

Conclusions. With purulent meningitis, there is damage to the vascular bed in the form of systemic vasculitis, including cerebral vessels, as evidenced by the presence of both markers of endothelial damage (desquamated endothelial cells and D-dimer) and changes in MRI and MRI angiography.

Pediatrician (St. Petersburg). 2021;12(5):27-35
pages 27-35 views

The use of tablet form of Polyoxidonium® for immunocorrection in children with secondary pyelonephritis

Kulygina E.S., Razin M.P., Petrov S.B., Dunaeva E.B., Makhneva V.A.


Background. Some aspects of diagnostics and treatment of secondary pyelonephritis in children continue to be urgent tasks of pediatrics, especially with regard to immunological changes in this disease and the search for ways to optimally correct them. The purpose of the study: to study immunological disorders in children with VP and to determine the features of the use of the tablet preparation Polyoxidonium® for their correction.

Materials and methods. The study is an open controlled prospective comparative single-center study, including two groups: observation and control. The observation group consisted of 40 children aged 5–15 years (Me = 10; Q1 = 6; Q3 = 14) with secondary pyelonephritis, realized against the background of congenital urological pathology. The control group consisted of 100 practically healthy children (health groups 1 and 2) aged 5 to 17 years (Me = 10; Q1 = 7; Q3 = 14). The patients underwent a standard examination, including in-depth immunological examination. The revealed violations of immunological resistance justified the inclusion of the domestic drug Polyoxidonium in the complex therapy of patients.

Results. 3 months after the treatment with the Polyoxidonium immunomodulator, an increase in the level of immunoglobulin A, the total number of lymphocytes, B cells, normalization of the number of CD19 lymphocytes, a decrease in the number of T lymphocytes and CD4 cells, an increase in phagocytosis and natural killers was noted.

Conclusion. Thus, complex therapeutic tactics for children with secondary pyelonephritis should be determined taking into account individual immunological shifts, namely: a reduced number of CD19 lymphocytes and the level of immunoglobulin A, an excessively high content of helper cells, to increase phagocytosis and the number of NK lymphocytes.

Pediatrician (St. Petersburg). 2021;12(5):37-45
pages 37-45 views

Comparison of different gastrostomy tubes materials resistance to the effects of damaging factors in vitro model experiment

Gavshchuk M.V., Zorin I.M., Vlasov P.S., Lisovskii O.V., Gostimsky A.V., Sarkisyan Z.M., Zavyalova A.N., Kabanov A.V., Kuznetsova Y.V., Karpatsky I.V., Lisitsa I.A.


Background. A variety of products made from different materials (natural latex, silicone, silicone-coated latex, polyvinyl chloride, polyurethane and other) are used as gastrostomy tubes. They have different resistance to damaging factors, different microbial landscape and timing of infection. The aim of investigation is to compare the resistance of various gastrostomy tubes materials to the effects of damaging factors in an in vitro model experiment.

Materials and methods. The experiment was performed with 2 latex urinary N 34 Pezzer catheters, 2 latex silicone-coated urinary 26 Fr Foley catheters, 2 polyurethane 18 Fr nasogastric tubes, 2 silicone 24 Fr branded gastrostomy tubes for percutaneous endoscopic bumper-type installation. All the tubes were cut on to 5 sections 50 mm long, weighed, marked at the ends and placed in a sealed vessels with 40 ml of water for 14 days at a temperature of 36°C. After that, the tube fragments were wiped with filter paper, re-weighed and measured. Similar pieces of tubes 50 mm long were weighed and placed in a 0.1 M hydrochloric acid solution for 14 days at a temperature of 36°C, followed by repeated measurements. After the experiment, the samples were washed with distilled water and dried at 70°C for a day, followed by measurement.

Results. The change in the mass and linear dimensions of the polyurethane and silicone tubes were negligible (0.1–0.5%) after the influence of water and a solution of hydrochloric acid. Changes in latex and latex with silicone coating tubes were significant, the mass changed by 2–12% due to water absorption, the length – by 1–3.5%. For latex materials, a decrease of 1% in mass was noted after drying. Decrease in linear dimensions of polyurethane materials was a result of exposure to elevated temperatures.

Conclusions. According to the results of the model experiment, silicone and polyurethane tubes showed the least absorption of liquids, changes in weight and length, which indicates their resistance to damaging factors in the experiment and allows us to recommend products made from these materials for gastrostomy. Latex catheters have demonstrated maximum fluid accumulation, weight and length changes, which makes their use in clinical practice impractical.

Pediatrician (St. Petersburg). 2021;12(5):47-52
pages 47-52 views

Experience of using a neuromonitor during thyroid surgery in children

Gostimsky A.V., Romanchishen A.F., Peredereev S.S., Vabalayte K.V.


Background. Thyroid surgery is associated with the risk of complications that worsen the course of the postoperative period and lead to disability of patients. One of these complications is damage to the recurrent laryngeal nerve, causing impaired phonation, and in the case of bilateral lesions, respiratory impairment.

The aim of this work was to study the features of the technique and the effectiveness of the use of neuromonitoring during operations on the thyroid gland.

Materials and methods. The study was conducted on a series of 55 clinical observations of thyroid diseases in children. Intraoperative monitoring was performed using the Inomed C2 Nerve Monitor, which records the action potential on the vocal folds caused by electrical stimulation of the recurrent laryngeal nerve.

Results. In 52 cases, no decrease in the amplitude of the neuromonitor signal was observed during surgical interventions. In two cases, intraoperatively, a decrease in the signal amplitude associated with excessive traction of the nerve was revealed. Another observation noted the absence of a signal at the end of the operation and the preservation of the mobility of the vocal cords in the postoperative period, probably due to technical errors in performing intraoperative monitoring. In one patient, during the operation, changes in the neuromonitor signal did not occur, but after surgery, a violation of the vocal function was noted, which fully recovered within 3 months. In all likelihood, these changes are due to the technique of tracheal intubation.

Conclusions. Neuromonitoring is an additional method for finding the recurrent laryngeal nerve, but in no way replaces the need for delicate anatomical identification of the latter.

Pediatrician (St. Petersburg). 2021;12(5):53-58
pages 53-58 views


Diagnostic value of cortisol identification in biological body fluid in case of infectious diseases (literature review)

Alekseeva L.A., Makarenkova E.V., Skripchenko N.V., Bessonova T.V., Zhirkov A.A., Monakhova N.E.


Disorders of control mechanisms caused by glucocorticoid hormones of adrenal cortex have a significant role in the pathogenesis of infectious diseases, first of all, due to cortisol, one of the key hormones with anti-inflammatory activity. Currently the conception about the mechanisms of cortisol influence, its functional abilities, connection with immune and nerve cells, involvement in cytokine regulation, features of free-radical oxidation has been extended. There has been identified the dependence of cortisol influence upon the isoform, amount and affinity of its receptors on target cells. The present review describes the study results concerning cortisol level in case of the most often occurring infectious diseases in children – acute respiratory and intestinal infections, infectious diseases of the central nervous system. There has been noticed a considerable data variability about cortisol level in normal state and in pathological one, however, the majority of articles have detected its connection with clinical manifestations and outcomes of the diseases. The study of cortisol level in cerebrospinal fluid is of a special interest in case of neuroinfections, specifying its direct connection with the disease severity and aetiology that gives new possibilities to develop effective diagnostic criteria. In general, the literature data specifies the advanced study of disorders of hypothalamus-hypophysial-adrenal gland functioning, receptor apparatus of target cells, as well as interrelations of cortisol with immune system in case of infectious diseases to reveal new criteria for diagnostics, course prediction and disease outcome, therapy correction.

Pediatrician (St. Petersburg). 2021;12(5):59-69
pages 59-69 views

Clinical observation

How to suspect tularemia in a child outside the endemic focus

Timchenko V.N., Barakina E.V., Chernova T.M., Bulina O.V., Fedyuchek O.O., Pochinyaeva L.M., Koshchavtseva M.Y., Shvedovchenko N.V.


Tularemia is an acute zoonotic natural focal disease caused by Francisella tularensis, with a variety of pathogen transmission mechanisms. A person becomes infected in various ways, mainly through insect bites (mosquitoes, ticks), through direct contact with infected animals, and also by inhalation. The disease is characterized by high fever, intoxication, inflammatory changes in the area of the entrance gate, regional lymphadenitis. It is often difficult to suspect tularemia in the early stages due to the lack of specificity of clinical manifestations (fever, intoxication, regional lymphadenitis). Even in endemic regions, in most cases, acute respiratory viral infection, lymphadenitis, fever of unknown origin are diagnosed, which leads to a late start of etiotropic treatment. There is a clinical case of tularemia in a 13-year-old child who was misdiagnosed in the early stages of the disease. And only a careful collection of an epidemiological history (stay in an endemic area, a mosquito bite), as well as a competent assessment of clinical and laboratory data, allowed tularemia to be included in the differential diagnosis on the 18th day of the disease and confirmed by the detection of the highest titers of anti-tularemia antibodies in blood serum. Thus, against the background of low morbidity, especially in childhood, there is no alertness among doctors of all specialties, which leads to late diagnosis and, as a consequence, late started specific treatment. All children with prolonged fever in the presence of lymphadenitis of unknown genesis, who have been in a territory unfavorable for tularemia, need to undergo a specific examination to identify mild and erased forms of the disease.

Pediatrician (St. Petersburg). 2021;12(5):71-78
pages 71-78 views

Successful outcome of ivf and gestation in a patient with infertility with retrograde ejaculation of a partner

Krivolesova T.A., Ivanov D.O., Reznik V.A., Romanova L.A., Guryanova G.V., Chernobrovkina A.K., Vetrov V.V., Kurdynko L.V.


The report presents the results of successful treatment of a married couple. A patient with multiple somatic pathology (varicose veins of the lower extremities, cholelithiasis, chronic cholecystitis) had 2 normal births in her first marriage. In the second marriage (the husband of 62 years revealed hypogonadism, cryptozoospermia, retrograde ejaculation) in 2018, ICSI was performed, which ended in an undeveloped pregnancy with curettage of the uterine cavity, in 2019, with the 4th pregnancy (CryoET), cesarean section (CS) at 28th week of pregnancy for chronic placental insufficiency with severe blood flow disorders in the placenta, nonimmune fetal dropsy. The child died on the 7th day of life. In 2020, due to the failure of the postoperative scar on the uterus after cesarean section, laparoscopy, hysteroscopy, and metroplasty were performed. The real, 5th pregnancy occurred after IVF with her husband’s sperm taken from post-ejaculatory urine. At 39th week of pregnancy, a planned Сaesarean section was performed, a boy was born at 3710 gr, 52 cm long with an Apgar score of 8/9 points. There was no bleeding during childbirth, the patient’s postoperative period was smooth. She was discharged home on the 5th day after delivery in a satisfactory condition with normal tests with a baby receiving breastfeeding.

Pediatrician (St. Petersburg). 2021;12(5):79-83
pages 79-83 views

Clinical psychology

Discourse acquisition along with the early and preschool age

Balčiūnienė I., Kornev A.N.


Numerous studies in language acquisition have been revealed that oral discourse plays a crucial role in cognitive development and communicative development and has an impact on the so-called narrative mind, social intelligence, autobiographic memory, and personal identity. The paper is devoted to the main patterns and mechanisms of the acquisition of oral personal discourse along with the early and preschool age. The paper includes the following sub-topics: conversation acquisition, personal narrative and fictional story acquisition, relations between different genres of personal discourse, and cognitive prerequisites for the acquisition of personal discourse. The paper is based on the meta-analysis of numerous studies covering various fields of science (psychology, psycholinguistics, sociolinguistics, and linguistics) and decades of scientific investigations in child development. The main issues discussed in the paper are acquisition and development of interaction structure (the skills necessary to initiate and to close a conversation); acquisition and development of conversation structure (the skills necessary for turn-taking and topic continuation); acquisition and development of some metadiscursive skills necessary for successful communication (e.g. to acknowledge communication breakdowns in a proper way); acquisition and development of some pragmatic skills necessary for successful communication (e.g. to modify speech characteristics according to the social role and status of the interlocutor and the context of the communication, to produce relevant speech acts); acquisition and development of narrative structure (story structure, episode completeness, internal state terms); and acquisition and development of narrative cohesion and coherence. The given issues are discussed from the perspective of the biological age and linguistic, communicative, and cognitive development.

Pediatrician (St. Petersburg). 2021;12(5):85-95
pages 85-95 views

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