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Vol 13, No 1 (2022)

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History and prospects of perinatal mortality rate in Russia

Ivanov D.O., Vetrov V.V., Kurdynko L.V.


Population reproduction is a priority task of social policy and a factor of Russia’s national security. The review presents the stages of recording the perinatal mortality indicator, which is closely related to the frequency of preterm birth. In the first stage, the criteria for registering preterm birth were 28 weeks of pregnancy, and in the second, since 2012, — 22 weeks. At both stages, due to underreporting of low birth weight babies (their transfer to the “miscarriage” group), stillbirths, including full-term babies, prevailed in the preterm birth indicator structure. The authors of the article stressed that the main cause of preterm birth (including iatrogenic) is the formation of endotoxemia syndrome, or “systemic effects of aggressive metabolites” in the mother – placenta – fetus system. In this etiopathogenetic therapeutic means are methods of efferent therapy in the form of plasmapheresis, etc. These technologies in many obstetric pathologies (thrombophilia, preeclampsia, Rh-conflict, isthmic-cesmic and chronic placental insufficiency, etc.) sanitize the mother – placenta – fetus system and allow to prolong pregnancy with a reduction of perinatal mortality index. The authors cite their own data on the use of efferent therapy methods in 102 women presenting at 22–28 weeks of pregnancy to the Perinatal Center of Saint Petersburg State Medical University from other institutions after unsuccessful treatment according to the Protocols for various obstetric complications. Pregnancies were prolonged by 2–15 weeks; all 123 children (20 twins, 1 triplet) were born alive, did not require long-term intensive care, survived and were not disabled. Six newborns died and the perinatal mortality rate was 48 : 1000, which is an order of magnitude lower than that quoted in the literature for similar pathologies and gestational ages. In conclusion of the article, it is suggested that in order to reduce perinatal mortality in Russia, all large institutions should arrange efferent therapy rooms to treat sick pregnant women using the safe, low-cost technologies developed by the authors, using domestic equipment.

Pediatrician (St. Petersburg). 2022;13(1):5-18
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Original studies

Remodeling of the bioelectric activity of the brain in the outcome of cortical resection

Astakhova E.A., Marchenko E.V., Chukhlovin A.A., Aleksandrov M.V.


Background: The total scalp electrorencephalography shows the activity of groups of cortical neurons. But each of these groups does not exist in isolation, but they are influenced by other areas, both cortical and subcortical systems of the brain. In the course of neurosurgical treatment, patients underwent resection of cortical areas in which the epileptiform focus was located. In patients with resection of the temporal lobe with structural drug-resistant epilepsy, EEG patterns of “loss of activity” are not recorded above the remote areas.

Aim: to study the mechanisms underlying the formation of electrorencephalography patterns recorded in the projection of the resected temporal lobe of the brain in patients operated on for focal drug-resistant epilepsy.

Materials and methods: There were examined 22 patients with structural pharmacoresistant epilepsy. Coherent analysis of the electrorencephalography was performed for an epoch of 30 seconds in transverse and longitudinal intrahemispheric pairs of leads.

Results: Correlation interactions between the temporal leads and their surrounding areas are enhanced after removal of the temporal lobe involved in the epileptic system.

Conclusion: The activity recorded in the postoperative period in the projection area on the scalp of the resected area is formed as a result of signal transmission from other departments.

Pediatrician (St. Petersburg). 2022;13(1):19-24
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Anxiolytic and antidepressant effects of melanin-concentrating hormone 1 receptor antagonist SNAP 94847

Vetlugin E.A., Bychkov E.R., Abrosimov M.E., Moskalyev A.R., Pshenichnaya A.G., Pyurveev S.S., Lebedev V.A., Lebedev A.A., Shabanov P.D.


Background: Melatonin Concentrating Hormone (MCH) is a neuropeptide involved in the regulation of eating behavior, energy balance, mood, and the sleep/wake cycle.

Aim: To study the effect of SNAP 94847, a selective melanin-concentrating hormone receptor type 1 (MCHR1) antagonist, on exploratory and emotional behavior in rats.

Materials and methods: 38 male Wistar rats were used in the work. The selective MCHR1 antagonist SNAP 94847 was administered intranasally. The behavior of the animals was assessed in the tests: open field, elevated plus maze, Porsolt forced swimming, resident-intruder.

Results: After intranasal administration SNAP 94847 there were an increase in the number of sniffs, the time of locomotion, and the number of squares crossed in open field test. In elevated plus maze test, after the administration of SNAP 94847, a decrease in the time spent by the animals in the closed arms of the maze was observed. In Porsolt forced swim test, the immobilization time decreased and the passive swimming time increased in experimental group.

Conclusion: In animal tests, the antidepressant and anxiolytic effects of the selective MCHR1 antagonist SNAP 94847 have been shown.

Pediatrician (St. Petersburg). 2022;13(1):25-34
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Clinical observation

Efferent therapy for dichorionic diamniotic twin pregnancy resulting from IVF, complicated by isthmic-cervical insufficiency

Vetrov V.V., Ivanov D.O., Reznik V.A., Romanova L.A., Melashenko T.V., Kurdynko L.V., Vyugov M.A.


Background: Dichorionic diamniotic twin pregnancy resulting from IVF can lead to isthmic-cervical insufficiency with concomitant complications. Against the background of the initial genital chronic infection in a woman there is a threat of septic complications for the mother-fetal couple. The complex pathology is accompanied by an accumulation of toxic substances in the mother-placenta-fetus system that requires pathogenetic treatment measures.

Clinical Cases: This paper presents data on the results of efferent therapy in two pregnant women with dichorionic diamniotic twin pregnancy complicated by fetal bladder prolapsing into the cervical canal up to the external pharynx (1 case) and with premature amniotic fluid outflow of the first fetus (2 cases). The patients received preserving therapy at the hospital and then were transferred to the perinatal center with the clinical signs of threatening abortion, endotoxemia, and moderate inflammatory response, which were treated with efferent therapy in the form of medium-volume membrane plasmapheresis combined with photodilution with ultraviolet and laser beams. There were no complications during efferent therapy. In 1 and 2 observations the pregnancies of women in the perinatal center were prolonged by 45 and 34 days with operative delivery at 27 and 31 weeks, respectively. There were no septic complications in women and children. The newborn premature infants after therapeutic and rehabilitative measures had good prospects for a full life.

Conclusion: The efferent therapy methods are safe and, in cases of IVF-infant foetuses with complicated isthmic-cervical insufficiency, are a pathogenetic measure; they help to prolong pregnancy and prevent infectious complications in the mother and fetus.

Pediatrician (St. Petersburg). 2022;13(1):35-42
pages 35-42 views

Combined surgical treatment of a giant peripheral nerve tumors of the “hourglass type” of the right cost-vertebral cornar

Gorodnina A.V., Kudziev A.V., Nazarov A.S., Malyshok D.E., Оrlov А.Y.


Paravertebral tumors of mediastinal localization — an extensive group of pathological processes, the surgical treatment of which is carried out by doctors of various specialties, such as neurosurgeons and surgical oncologists. Currently, thoracoscopic removal is considered to be the most preferred method of surgical treatment of these mass formations, in view of the least trauma, fewer complications, and a reduction in the time of postoperative recovery of patients. A clinical case of surgical treatment of a patient with a giant paravertebral tumor originating from the 4th thoracic root is presented. The tumor was an incidental finding during routine fluorography. There were no focal neurological symptoms. Taking into account the topographic and anatomical features of the volumetric formation, the patient underwent a combined two-stage surgical intervention, where the first stage was laminectomy and removal of the foraminal component of the tumor from the posterior approach, the second stage was single-port video-assisted thoracoscopic removal of the mediastinally located tumor fragment. The operation was performed under conditions of a collapsed lung on the side of the intervention. In the postoperative period, no neurological deficit was noted; according to the control introscopy, the tumor was removed completely. According to the results of histological examination – neurofibroma (Grade I).

Pediatrician (St. Petersburg). 2022;13(1):43-50
pages 43-50 views

Cushing’s syndrome as a result of nasal drops for the eyes with dexamethasone (clinical observations)

Olenev A.S., Tyrtova L.V., Parshina N.V., Turkunova M.E., Gorkina O.K.


Cushing’s syndrome often develops due to an excessive intake of glucocorticoids with oral, intravenous, intramuscular administration, but it is possible to get a similar complication with intranasal administration. In this article, we present two cases of children who received nasal eye drops with dexamethasone. The use of drugs for 5–6 months in one case, and 3 years in another led to the formation of a typical clinical picture of the syndrome. The patients showed progressive dysplastic obesity with a moon-shaped face, atrophic skin changes with the appearance of red-violet, crimson stretch marks, and a decrease in the growth rate. There were some peculiarities in the results of laboratory and instrumental examination, due to age-sex characteristics and the duration of taking dexamethasone. According to the totality of anamnestic, clinical and laboratory parameters, instrumental examination, a drug-induced cushingoid syndrome was diagnosed. Subsequent follow-up after discontinuation of the drug confirmed the diagnosis. The presented clinical cases emphasize that the eye drops contain high doses of steroids and can lead to the development of Cushing’s syndrome, especially in children with intranasal use. When using nasal drops, it should be borne in mind that glucocorticoids will enter the mouth and be absorbed through the gastrointestinal tract. One should take into account the possibility of psychological dependence on such drops and, as a result, uncontrolled consumption by adolescent children.

Pediatrician (St. Petersburg). 2022;13(1):51-59
pages 51-59 views

Orbital plexiform neurofibroma associated with congenital glaucoma in a child with neurofibromatosis type I: a case report

Bolotnikova I.V., Ivanov V.P., Shapovalov A.S., Khachatryan W.A., Brzheskiy V.V.


The article describes a clinical case of familial neurofibromatosis type I. This diagnosis was made in a nine-month-old patient according to the diagnostic criteria recommended by the International Expert Committee on Neurofibromatosis. Clinicaly, there were hyperpigmented café-au-lait spot on the skin, the presence of one plexiform neurofibroma, the father had a genetically confirmed diagnosis of neurofibromatosis type I. Also after birth, this patient was diagnosed with buphthalmos.

A mutation in the Neurofibromin gene NFI leads to increased cell proliferation, with a rapidly progressive course, characterized by combined damage to the skin, eyes, nervous system and some internal organs, leading to neuroectodermal and mesodermal dysplasia. Neurofibromin is an intracellular protein in the human genome that regulates several pathways of growth control and plays a key role in the pathogenesis of congenital glaucoma associated with neurofibromatosis type I and plexiform neurofibroma. Plexiform neurofibroma originates from the sheaths of the peripheral nerves, often affects multiple nerves, is abundantly perfused, and is a benign neoplasm, but there is a lifelong risk of malignancy. On the other hand, congenital glaucoma is a relatively rare disease, usually due to infiltration of the anterior chamber angle by neurofibromas, closure of the angle by neurofibromatous-thickened ciliary body and choroid, fibrovascularization. The clinical picture of neurofibromatosis type I can be very variable, even among members of the same family. Under the influence of a combination of pathogenetic factors, an asymptomatic course is determined in one individual, while in another, the disease proceeds in a severe form, up to disability.

Surgical treatment for isolated orbital plexiform neurofibroma is used to decompress the orbit and prevent malignancy of the tumor. It should be noted that due to the peculiarity of the structure of the tumor, its total removal is often not possible. In this case, mini-frontal access was used.

After the intervention, exophthalmos regressed, ophthalmotonus returned to normal. The child was discharged in a satisfactory condition.

Thus, the described clinical case is of particular interest, based on the combination of orbital plexiform neurofibroma and congenital glaucoma associated with neurofibromatosis type I.

Pediatrician (St. Petersburg). 2022;13(1):61-68
pages 61-68 views

Endoscopic endonasal surgery for intracranial rhinogenic complications. Analysis of two clinical cases

Verezgov V.A., Breusenko D.V., Pavlov P.V., Zakharova M.L., Snytkina A.S., Gorkina O.K., Dmitrenko V.V., Kuryanova Y.A., Kukushkina O.E.


Rhinogenic intracranial complications, such as brain abscess and thrombosis of the veins and sinuses of the brain, are still a formidable, life-threatening pathology, often resulting in death, despite the widespread development of antibiotic therapy and adherence of patients to the treatment. Often the cause of the development of intracranial complications is the exacerbation of a chronic inflammatory process in the paranasal sinuses, while acute ENT pathology of the sinuses leads to the development of rhinogenic complications only in a small percentage of cases. Unfortunately, the high development of radiation and laboratory diagnostics does not always allow diagnosing these conditions in time and providing adequate surgical care. In childhood and adolescence, it is important to perform a timely complete and at the same time minimally invasive, non-disabling, surgical intervention. An analysis of foreign literature in recent years shows that neurosurgical operations in various volumes (from trepanopuncture of the brain to craniotomy) occur in the vast majority of cases of treatment of rhinogenic intracranial complications. The article presents two clinical cases of patients with intracranial complications successfully treated in the Department of Otorhinolaryngology of St. Petersburg State Pediatric Medical University without a highly traumatic neurosurgical operation. The combination of endonasal endoscopic surgery and massive adequate conservative therapy (antibiotic therapy in combination with the use of anticoagulants for sinus thrombosis) allows the patient to recover without resorting to neurosurgical intervention.

Pediatrician (St. Petersburg). 2022;13(1):69-81
pages 69-81 views

Clinical psychology

Motivation and readiness of pediatric medical university graduates to select medical careers at primary healthcare institutions

Sakhno L.V., Koltunceva I.V., Dubovaia E.G., Zemlianykh M.V.


Background. The goal of the study is to assess the readiness of pediatric medical university graduates to work in primary health care institutions and the correlation relationships with their motivations.

Aim. There is a significant staff shortage in Russian healthcare sphere. Directions for solving the problem are indicated, one of them is to increase the attractiveness of the labor function for young specialists with higher and secondary medical education.

Materials and methods. In the 2019/2020 academic year, an anonymous survey of 104 6th year students was conducted at St. Petersburg State Pediatric Medical University, which resulted in a correlation analysis of motivation and willingness to work immediately after graduation from the university as a local pediatrician.

Results. All 104 graduates answered 18 questions on the questionnaire. It was revealed that 77% of students have confidence in their correct choice of the profession of a doctor; 82% of them say that they are attracted by the ability to provide medical care in the profession, 60% – are interested in attractive social status, the ability to earn enough is the attractive feature for 47%. There are several reasons that make the doctor’s profession unattractive. 17% of graduates think that it is working with unhealthy people. Disrespectful attitude of others is significant for 80% of respondents, high legal liability requirements – for 68%, difficulties earning enough – for 62%. Students have also proposed solutions to the problem of staff shortages in primary care. The study revealed that the majority of pediatric university graduates by the time they graduate are confident in the correctness of their chosen profession.

Conclusions. The results of this research can be useful to healthcare organizers to attract graduates of medical universities to work in primary health care, solve the problem of staff shortages and improve the quality of medical care.

Pediatrician (St. Petersburg). 2022;13(1):83-92
pages 83-92 views

Physical training for medical professionals

On the history of the sports festival “Physical culture — the second profession of a doctor”

Sklyarova I.V., Komissarchik K.M., Khalilova L.I., Kharitonova N.Y.


The profession of a doctor involves great physical activity and high working capacity. Of course, physical education and sports play an important role in the process of preparing student youth for social and professional activities, have significant potential in the formation of a system of knowledge and skills related to professional safety, health protection, and the prevention of certain diseases of doctors. It is impossible to overestimate the importance of physical culture in the formation of the professional qualities of the future medical work, the use of its means and methods for the rapid and complete restoration and working capacity of the doctor. The festival of students of medical and pharmaceutical universities of Russia “Physical culture and sports — the second profession of a doctor” is called upon to attract medical students to active sports life. In the article, the authors pay special attention to a retrospective review of the emergence and further holding of the departmental Sports Festival. The result of the presented analytical review was the determination of the results of student speeches in accordance with the affiliation to a particular medical university. During the study, the statistical data of the competition protocols were analyzed. Today, ten years later, you can summarize some of the results of the past eight festivals of medical universities in Russia, determine their role and place in improving the system of higher professional education, and evaluate the effectiveness.

Pediatrician (St. Petersburg). 2022;13(1):93-98
pages 93-98 views

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