Vol 9, No 5 (2018)

Clinical and epidemiological features of tuberculosis in young children in Saint Petersburg
Lozovskaja M.E., Nikiforenko N.A., Klochkova L.V., Vasilyeva E.B., Mosina A.V.

The problem of young children tuberculosis in Russian Federation (RF) still remains actual because of high-level spread of disease between adults and anatomical and physiological features of this period of childhood. The young children morbidity in Saint Petersburg, 2015-2017 became 7.1-5.3 of 100,000 population. It is typical for the age group from 0 to 3 years that tuberculosis development often becomes into the state of active disease and does not stop as latent infection. Our research includes children of early age whose tuberculosis has been diagnosed in 2012-2017 – totally 101 children. One third of the patients were not vaccinated with the BCG vaccine, moreover 41.9% were not vaccinated because of perinatal contact with HIV and 22.5% because of perinatal contact with HIV + hepatitis C. Each second child related to social risk group. Contact with MBT expectorator has been found for 64% of children: drug resistance for at least one drug has been met in 70% cases, including 19% MDR-TB and 11% XDR-TB. Immunology diagnosis analysis showed up that at the moment of the disease detection the tuberculin skin test in 93% cases was positive, but often moderately expressed, meanwhile the Diaskintest was positive in 92% cases, mainly hyperergic or expressed. Objective diagnosis for 79% patients showed symptoms of intoxication of different degrees, for 50% – micropolyadenia, local symptoms – only for 13%. Structure of diagnosis contained mainly intrathoracic lymph nodes tuberculosis (67%), gene ralized forms – 9%, extrapulmonary – 1%. Complicated tuberculosis has been observed in 38% cases. After treatment recovery has been achieved for 98 children, but also 3 lethal cases occurred – all for non-vaccinated infants in case of severe concomitant disease. Conclusion: nowadays development of active tuberculosis in young children is caused by increasing quantity of BCG-unvaccinated newborns – mostly because of perinatal HIV-contact, and poor social conditions.

Pediatrician (St. Petersburg). 2018;9(5):5-12
Neonatal seizures in term infants: clinical and electrophysiological features
Fomina M.Y., Melashenko T.V., Pavlova O.I.

This article presents the results of clinical, neuroimaging and electrophysiological examination of newborns with cerebral ischemia, accompanied by neonatal seizures. Neonatal seizures are an early clinical manifestation of cerebral disorders in term infants. The main method for diagnosing these conditions is to record the electrobiological activity of the brain during the interictal period and to identification of patterns of epileptic seizures. The purpose of this work was to study the clinical and electrophysiological features of neonatal seizures. In the Department of Intensive care unit and the Department of Pathology of the newborn of perinatal center of the Saint Petersburg State Pediatric Medical University, we examined 21 newborns with cerebral ischemia and neonatal seizures. All children underwent a clinical and laboratory examination, neuroimaging (neurosonography and magnetic resonance imaging of the brain), electrophysiological stu dies (EEG). It was shown that in newborn infants with convulsive syndrome in the early and neonatal period of the ictal and interictal electroencephalogram, such patterns as basal rhythm depression, discontinuity of the main electrobiological activity, acute focal or multifocal activity are recorded. The author gives his own observations of the EEG recordings in children during the fetal period, represented by focal monorhythmic patterns and focal rhythmic activity in the form of acute-slow wave complexes with subsequent suppression of the main rhythm.

Pediatrician (St. Petersburg). 2018;9(5):13-20
Experience using internet-ECG to optimize the patients hospitalization duration with acute myocardial infarction
Timofev E.V., Abdalieva C.A., Zemtsovsky E.V.

The aim of this study was to examine the efficiency of on-line Internet-electrocardiography (ECG) in the practice of GP (therapist) to clarify the factors causing chest pain and make a decision about the necessity of emergency hospitalization.

Materials and methods. 2022 ECG recording made by the patients at home by means of “Cardiometr” device (“Micard Lana”, St. Petersburg) were registered by GP (therapist) with concern to identify heart rhythm disorders and make a differential diagnosis of chest pain. The decision to hospitalize was taken in view of automatic detention.

Results. A high percentage of coincidence between automatic and medical conclusion on violation of heart rhythm and ischemic ECG changes was revealed. It also showed total match of automatic and expert opinions about the myocardial infarction stage and its localization. Use of on-line Internet ECG helps to substantially increase the amount of patients hospitalized in first 6 hours after the onset of chest pain (37,7% vs 19,4%, χ2 = 3,65, p = 0,05) and reduce the number of patients hospitalized in the late timeline (more 24 hours) (10,1% vs 27,8%, χ2 = 5,42, p = 0,01).

Conclusion. ECG automatic analysis provides high accuracy of diagnosis of cardiac arrhythmias and acute focal changes and will promptly resolve the necessity of emergency hospitalization of patients with myocardial infarction. It is advisable to equip the similar devices GP (therapist) carrying out visiting patients at home.

Pediatrician (St. Petersburg). 2018;9(5):21-26
Food sensitization in patients with diseases of the digestive system
Kryukova O.A., Matysheva N.N., Drygin A.N.

Allergic reactions to foods can occur in any one of four major types of reactions (P. Gell, R. Coombs). The most typical combination of several types of reactions, one patient. Food antigens can modify cellular and humoral immune response by influencing the emergence of new and for chronic diseases.

Objective: to study the spectrum of food sensitization in patients with diseases of the digestive system (DDS) to adjust their dietary therapy. The laboratory examination and treatment of 210 patient: 185 patients with DDS (gastroesophageal reflux disease, chronic gastroduodenitis, biliary dyskinesia, irritable bowel syndrome, IBD (ulcerative colitis (UC) and Crohn’s disease) and 25 healthy adults. To identify the reactions I, III and IV type food allergens used a range of methods – ELISA (IgE-specific) and the reaction of inhibition of migration of leukocytes (RIML), modification N.N. Matyshevoy and L.S. Kositsky (2000). Products that implement positive reactions, patients were excluded from the diet. 100% of patients identified specific reactions I, III and IV type food allergy, the number of responses increased in proportion to the severity of the disease, most patients with IBD, the smallest – in healthy individuals. Exclusion from the diet of the identified potential allergens contributed to a significant clinical improvement, and in patients with UC onset of persistent clinical and endoscopic remission.

Conclusion. To determine the most complete range of food sensitization in patients with DDS is necessary to use methods for assessing cellular and humoral sensitization types together. Diet exclusion of food allergens from the diet of patients with DDS leads to persistent clinical improvement and long-term maintenance of remission, especially in patients with UC.

Pediatrician (St. Petersburg). 2018;9(5):27-35
Effect of lipoic acid on the exchange of sialo-containing compounds in rats blood plasma with alloxan diabet
Volkhina I.V., Butolin E.G., Skvorsova E.A.

Oxidative stress is one of the markers of chronic diseases, including diabetes. Lipoic (tioctic) acid refers to natural non-enzyme antioxidants which is also necessary for the operation of multienzyme complexes catalyzing oxidative decarboxylation of pyruvate, α-ketoglutarate and other α-keto acids, and a poet omu plays an important role in the process of obtaining energy under aerobic conditions. Sialic acids are related to polyfunctional compounds that are part of various carbohydrate-containing compounds (glycoproteins, proteoglycans, gangliosides), including acute blood proteins.

The purpose of the study was a comparative study of the influence of lipoic acid lots on the exchange rates of compounds containing sialic acids in the blood plasma of rats with alloxan diabetes. Studies were conducted on white mongrel rats – males weighing 180-220 grams in the autumn-winter period. The animals were divided into three groups: the first – intact rats, in animals of the second and third groups, insulin-dependent diabetes mellitus (DM) was caused by a single subcutaneous injection of alloxan tetrahydrate. Rodents of the third group received lipoic acid intramuscularly. The degree of development of oxidative stress was assessed by the content of TBA-active products in the blood. Their indicators were compared with the concentrations of glucose, free, oligo- and protein-bound sialic acids in the blood on days 5, 10, 20, 30 and 40 of the experiments. It was found that on the background of the introduction of lipoic (thioctic) acid to experimental animals, there is a decrease in the level of glycemia, a decrease in the processes of oxidative stress and indicators of free and oligo-related sialic acids in blood plasma.

Pediatrician (St. Petersburg). 2018;9(5):36-40
Surgical treatment combination of gastroesophageal reflux disease and celiac trunk compression syndrome
Vasilevsky D.I., Balandov S.G., Ignashov A.M., Anisimova K.A., Davletbaeva L.I.

The combination of gastroesophageal reflux disease and the celiac trunk compression syndrome is well known and reflected in the literature comorbidity. In some articles a possible pathogenetic relationship of these diseases was assumed. A common factor in the development of gastroesophageal reflux and the s celiac trunk compression syndrome can be disorganization of the motor function of the digestive tract on the background of their chronic ischemia. However there is no the confirmation or the refutation of this hypothesis. The various clinical aspects of the combination of both diseases insufficiently developed. The modern concept of treating gastroesophageal reflux disease involves conservative therapy. Surgical treatment of this illness is justified only in the not-effective pharmacological cases. Unfortunately, refractory gastroesophageal reflux symptoms noted in 15-40% of cases during the drug medication. The only effective option to eliminate the celiac trunk compression syndrome is the surgical restoration of the full-value blood flow along this vessel. The need to complement the celiac trunk decompression with antireflux reconstruction in comorbidity cases remains a controversial issue and requires further studies. In the article presents an analysis of the results of examination and treatment of 84 patients with a combination of the celiac trunk compression syndrome and gastro-esophageal reflux disease. The factors predetermined or determined the ineffectiveness of drug therapy for gastroesophageal reflux in that comorbidity were identified. The tactics of treatment the gastroesophageal reflux disease the patients with the background of the celiac trunk compression syndrome, was developed and justified.

Pediatrician (St. Petersburg). 2018;9(5):41-46
Features of growth processes in boys and youths of various proportions and constitution types living in the south part of Kyrgyzstan
Sattarov A.E., Karelina N.R.

The purpose of our work was to assess proportionality of body and type of a constitution of boys and young men of mountain and mid-mountain zones of Kyrgyzstan.

Materials and methods. 555 boys and youths of 12-17 years living in different regions of Kyrgyzstan, namely in highlands (3100-3325 m above sea level) and middle mountains (1050 m above sea level) − the Alay valley − 238 persons and anthropogenically technogenic zone Osh − 317 persons were examined. The method of anthropometrical measurements was applied, the structure of body weight was counted on J. Mateigka. The computer somatotyping was carried out by means of Dorokhov's technique. For the examined group coefficient of a heterochronicity and the index of “harmony of morphological development” (IGMR) were determined by S.A. Pushkarev’s technique.

Results. The greatest number of students (40-60%) of both groups possess normostenoid proportions. Disharmony of proportions of body is expressed in doliсhomorphization (astenoid proportions) in each group coincides with completion of the pubertal period (16 years), and remains at youthful age (17 years), especially inhabitants of highlands. In students of MIMES from highlands maximum increase in length of body is the share of the beginning of pubertal period (13-14 years), body weights in the middle of this period (14-15 years). On the contrary, in teena gers of MAMES and MONTH the beginning of puberty is marked by increase in body weight, and length at 16-17 years. In teenagers of MIMES from anthropogenically technogenic zone maximum increase in body weight is noted at 13-14 years, and body lengths at the end of puberty (16-17 years). In representatives of MAMES- and MONTH in this zone of accommodation the maximum increases of body weight were established at the middle of a puberty (14-15 years), and body length in students of MONTH type at 15-16 years, teenagers of MAMES of type – at 16-17 years. On the basis of a somatotyping the heterochronicity of processes of growth in boys and youths having various somatotype living in various ecological zones of Kyrgyzstan is revealed.

Pediatrician (St. Petersburg). 2018;9(5):47-52
The incidence and structure of congenital heart diseases in newborns in the Republic of Sakha (Yakutia)
Nelunova T.I., Burtseva T.E., Gogolev N.M., Chasnyk V.G., Orel V.I., Gureva N.A.

Congenital heart disease (CHD) is one of the major problems of practical health care and especially in neonatology and Pediatrics. Currently, congenital heart defects remain the leading position from the point of view of prevalence compared to other congenital malformations in children, accounting for, according to various estimates, from 18% to one-third of all cases in the structure of the CDF [1, 3, 8]. Currently, the introduction of early and timely methods of diagnosis and treatment have significantly reduced disability and mortality from this disease. The article presents an analysis of the prevalence and structure of congenital heart defects in newborns according to the data of the only multidisciplinary Pediatric center in the Republic of Sakha (Yakutia). In the course of the study were analyzed 1950 medical records, filled in for two time intervals: 2001-2003 and 2013-2015 Newborns included in the study were divided into three groups. The criteria for division into groups were the results of echocardiography, the size of blood discharge through the shunt on the atrial septum and the size of blood bypass through the functioning arterial duct. For comparison, the prevalence of CHD among newborns depending on geographical, climatic, social, medical and other conditions, the entire territory of the Republic of Sakha (Yakutia) was divided into 5 socio-territorial zones.

Pediatrician (St. Petersburg). 2018;9(5):53-58
Evaluation of the effectiveness of vitamin D deficiency correction in children with cystic fibrosis in St. Petersburg: results of a 12-month prospective study
Pashkevich A.A., Kovalev V.N., Nikitina M.I., Kajstrry I.V., Dorofeikov V.V., Jelenina L.A., Kostik M.M.

Background. Vitamin D deficiency is a frequent problem in the patients with cystic fibrosis (CF). Adequate vitamin D supplementation need for normal bone mineralization and different systems functioning.

The aim of our study was to evaluate the efficacy of vitamin D deficiency correction in CF pediatric patients in Saint Petersburg.

Materials and methods. In the study were included 92 CF children aged from 0 to 17 years (49 boys and 43 girls) who had not previous vitamin D3 treatment. 25(OH)D levels were measured 3 times during the study (0-6-12 months). Vitamin D3supplementation was made according to contemporary consensuses. During the study the vitamin D3 doses correction was made. The patient’s adherence to treatment was evaluated on the basis of the personal communications. For assessment of bone metabolism we checked levels of total and ionized calcium, phosphorus, parathormone, alkaline phosphatase. In all patients anthropometry, ultrasound distal radius densitometry was performed. Statistical analysis was made with Statistica 10.0 software. Mann-Whitny, Kruskall-Wallis, Wilcoxon matched paired test, chi2 and Fisher’s exact tests, Mac-Nemar and Fridman’s test and Spearman’s correlation analysis were utilized.

Results. Vitamin D deficiency (25OHD < 30 ng/ml) was detected in the 80% of the patients. Only 66 (71.7%) patients were complaint. The majority of the complaint patients increased 25OHD level during 12 months trial on the 33.7%. The best 25OHD increment indicators had young patients with initially higher levels of the 25OHD. Patients who were less 25(ОН)D deficient required proportionally lower vitamin D3 doses for correction.

Conclusions: founded differences in the possibility to 25(OH)D normalization related with age and initial 25(OH)D level.

Pediatrician (St. Petersburg). 2018;9(5):59-65
To the question about premature adrenarche at girls (the literature review)
Lagno O.V., Plotnikova E.V., Shabalov N.P.

The article contains the up to date information about pathogenesis and diagnostics of premature adrenarche. The first clinical feature of adrenarche is the development of pubic hair. Girls aged 5-7 year old start adrenarche when the adrenal glands increase production of androgens. The article describes mechanism of development adrenarche and premature adrenarche according to different specialists who had been researching this complex problem. International terminology has a term of precocious pubarche, which relates to premature or/and excessive adrenarche, the latter correlated with Russian diagnosis of premature adrenarche, when organic and genetic causes of precocious pubarche and precocious puberty had been excluded. The article shows an approach of Russian and international endocrinologists towards the differential diagnosis between premature adrenarche and other pathologies which were described above. Special attention has been given to a diagnosis of an atypical form of congenital adrenal hyperplasia, which presents with symptoms similar to premature adrenarche. The article has collected information from the literature published by international and Russian researchers regarding the structure of premature adrenarche. The article also highlights the problem of hyperandrogenic dysfunctions in childhood, their possible outcomes and management methods. Girls with premature adrenarche carry risks of developing puberty with clinical manifestation of hyperandrogenic syndrome and, consequently, developing polycystic ovary syndrome and insulin resistance. The article also presents an opinion of Russian and international specialists regarding non clinical and clinical markers of premature adrenarche. The question which remains under discussion: How physiological process of premature adrenarche is, and also to whom, how and at what age the prophylaxis of possible hyperandrogenic and metabolic dysfunctions should be given. The problem of premature adrenarche should be considered as multidisciplinary, as many various specialties such as paediatric endocrinologists, paediatricians, paediatric gynaecologists, geneticists, oncologists and clinical pharmacologists have been involved in finding solution to this problem.

Pediatrician (St. Petersburg). 2018;9(5):66-74
Health and social care of minors in pregnancy, childbirth and the postpartum period
Ippolitova M.F., Mikhailin E.S., Ivanova L.A.

The analysis of the reproductive potential allows obstetric-gynecological and pediatric services to predict the demographic situation, the state of health of future pregnant women, parturient women, puerperas and born children. The medico-social aspects of pregnancy, childbirth and the post-natal period in adolescents remain subject to debate. The article presents a comprehensive analysis of the factors influencing the reproductive potential. The features of the course of pregnancy, childbirth and the postnatal period in minors have been revealed. The need to observe certain principles and interdisciplinary approach in the management of pregnancy, childbirth in juveniles is established. Questions of preventive maintenance of unplanned pregnancies, including repeated, sexual infections (from abstinence to reliable and accessible methods of contraception) are considered. Demonstrated the need for an integrated approach and joint work of the obstetrician-gynecologist, psychologist, social worker and lawyer in the conduct of pregnancy in minors. An integrated approach should include: reproductive education with the formation of a responsible attitude towards health in order to prevent unplanned pregnancies, including repeated (from abstinence to reliable and affordable methods of contraception); the management of pregnancy, childbirth and the post-natal period, taking into account age characteristics, observance of certain principles and interdisciplinary approach; a set of social measures to support minors from the moment of reproductive choice to the upbringing of a child by a minor.

Pediatrician (St. Petersburg). 2018;9(5):75-93
The systems of prevention of complications at patients of high risk
Alexandrovich Y.S., Prometnoy D.V., Pshenisnov K.V., Kupatadze D.D., Ulrikh G.E., Nezabudkin S.N., Podkamenev A.V.

Preventing complications in patients with a high risk of critical condition developing and fatal outcome is one of the most poignant problems of modern health care. The main cause of death in the world is the diseases like infection, trauma and various nutritional disorders. The article presents a survey of literature offering various solutions that prevent the development of life-threatening conditions. It was proved that signs of clinical deterioration of patient’s condition appear more than eight hours before the development of a critical condition, which allows the necessary correction of therapy to be provided on time. According to the data provided, the most effective preventive measures are the system of checklists and early recognition of patients’ clinical deterioration. When using a checklist system, it is worth using mnemonic rules that reflect sequences of diagnostic search or therapy. When introducing early prevention systems into clinical practice, thorough attention should be paid to vital signs and behavioral disorders assessment. The most specific and sensitive signs that might indicate a high risk of developing a critical condition are heart rate and respiratory rate. The key element for effective use of early prevention systems is not only timely identification of clinical deterioration signs, but also a standardization of actions of healthcare personnel in case of complications, which was represented by the SBAR system (Situation – Background – Assessment – Recommendation).

Pediatrician (St. Petersburg). 2018;9(5):94-102
Clinical case of a Erythroderma induced by fibrogastroduodenoscopy
Sidikov A.A., Zaslavsky D.V., Egorova Y.S., Chuprov I.N., Gurkovskaya Y.Y., Fomenko M.N., Zubatov M.A., Nasyrov R.A., Grekova E.V.

Erythroderma – the term used for the description intensive and usually widespread reddening of the skin which has arisen owing to activation of the previous inflammatory dermatosis. Among the causes of erythroderma are the progression of chronic dermatoses, refractory to therapy, medication or inadequate local treatment of dermatoses. In addition, it can be a symptom and/or a sign of systemic diseases (lymphoma, leukemia, tumors of the lungs, intestines and ovaries). Most of the cases of erythroderma described in the literature were induced by taking different types of drugs and dietary supplements. High lethality of this category of patients is associated with both the main disease that caused the development of erythroderma and the nature of emerging metabolic disorders. Erythroderma is one of the most severe conditions that threaten the life of the patient, requiring special approaches in the diagnosis and early treatment. When diagnosing and determining the forms of erythroderma, one of the determining factors is clinical examination and clinical and pathological correlation. Patients with diseases of a digestive tract have high risk of development of side effects from intake of drugs and carrying out tool methods of a research. One of the screening methods of a research is the fibrogastroduodenoskopy (EGD). We provide the description of the first case in our practice of the patient with the erythroderma which has arisen after the EGD-research. Questions of pathogenesis, differential diagnostics of an erythroderma on the basis of a clinical picture and histological signs with illustrations are also discussed.

Pediatrician (St. Petersburg). 2018;9(5):103-108
Psychotic disorders of postpartum period as states of potential threat to newborn’s life and health (Clinical Case analysis)
Kozhadey E.V., Grechanyi S.V.

This article describes clinical picture of postnatal psychoses. In literature devoted to women’s postpartum mental disorders there are three variants: postpartum syndrome of “parturient sadness” (postpartum “blues”), postpartum depression and postpartum psychosis. Also, such diseases as postpartum panic disorders, obsessive-compulsive disorders, posttraumatic stress and others may occur. Ethiology of postpartum mental disorders may differ. In psychiatric literature the beginning of endogenic processual disease (with further chronical lifetime course) is often connected with development of postpartum psychosis. However, there are a lot of mentions about a possible beginning of psychosis due to exogenous hazards – after tough and long delivery followed convulsions and fever (40 Celcius and above). Interrelation with hidden infanticide is carried out. Infanticide includes cases of unpurposed and purposed abandoning an infant in situations dangerous for its health and life. Risk of postpartum psychoses followed by infanticide significantly increases in case of first-line relatives’ suicides. Case of severe delirious psychotic disorder during patient’s postpartum period in SPbSPMU is given. Psychopathologic symptoms of disorder are discussed. Lack of interrelation between pathological feelings and patient's belonging to concrete religious denomination is emphasized. Nosology of the given clinical case is discussed. Well-timed diagnostics of postpartum psychotic states is practically relevant. Postpartum psychoses are states that need evaluation from different perspectives.

Pediatrician (St. Petersburg). 2018;9(5):109-114
Layell syndrome: difficulties of diagnostics
Davydova Z.V., Sokolova O.V., Sobolev A.V.

In this article, we want to present a complex case from our practice when a diagnostically uncertain patient has been treated for a long time from a respiratory disease, then she developed toxic epidermal necrolysis (Lyell’s syndrome), which had an atypical beginning, whose complications were the immediate cause of the patient’s death. Toxic epidermal necrolysis is an acute, severe, life-threatening disease characterized by a widespread bullous lesion of the skin and mucous membranes, its peculiarity is the appearance of thin-walled, easily tearing bubbles, in the place of which extensive necrotic fields resemble severe burns of 2-3 degrees, in combination with severe intoxication and impaired functions of all organs. The development of the disease is most often associated with taking medications, possibly with epidermotropism. The information reflecting the modern view on the etiology, pathogenesis, diagnosis of Lyell’s syndrome, as well as the morphological picture of the disease are presented. On a concrete example, objective reasons are analyzed from practice, which led to a belated diagnosis of epidermal necrolysis, formation of sepsis and multiple organ failure. The data that are relevant for the practice of forensic medical examinations are presented, which allow us to formulate objective and scientifically substantiated conclusions about the existence of cause-effect relationships between the defects in the provision of medical care and the onset of death of the patient.

Pediatrician (St. Petersburg). 2018;9(5):115-119
Acute thymic hemorrhage, simulating an anterior mediastinal mass, as a complication of hemorrhagic disease of the newborn
Podkamenev A.V., Karavaeva S.A., Mysnikova I.V., Syrtsova A.R., Ti R.A., Pozdnyakova O.F., Kondratiev G.V., Kupatadze D.D., Lee A.G., Nazarova I.V.

Mediastinum is one of the most frequent localizations of pathological mass in childhood. In most cases, mediastinal masses require surgical treatment or biopsy. Spontaneous acute thymic hemorrhage, as a complication of hemorrhagic disease of newborn, is an extremely rare condition with life-threatening clinical manifestations. In patients with such disease radiological findings may be mistakenly regarded as tumor, and lead to aggressive surgical treatment. We report a case of a newborn with a late-onset form of hemorrhagic disease, complicated by thymic hemorrhage, simulating an anterior mediastinal mass.

Pediatrician (St. Petersburg). 2018;9(5):120-124
On the issue of differential diagnosis of childhood autism and childhood schizophrenia (clinical psychological evaluation of the case)
Sokolova N.N., Tarkhanov V.S., Denisova E.A., Petrakova A.V., Stus E.A.

The article discusses the current state of the problem of the multidisciplinary approach to the diagnosis of childhood autism and child schizophrenia, the differentiation of nosology data. The article is based on the analysis of a case of prolonged clinical observation of the formation of a specific defect in a patient with an early and severe onset of endogenous disease, which led to disruption in development. Differences between childhood autism and schizophrenia are presented in the dynamics of differential-diagnostic data. Detailed anamnestic and follow-up data collected over 8 years, data from pathopsychological markers of children's autism and childhood schizophrenia are highlighted. The issues of medical, psychological, pedagogical and social assistance to the child with communicative and cognitive disorders of the schizophrenic circle are touched upon. Variants of distorted dysontogenesis, which are different and specific for children’s autism and child schizophrenia, are shown. The specifics of the formation of a mental defect (cognitive, emotional-volitional) on different age stages with subsequent deficiency of personality, features of socialization and disadaptation, accruing with the course of the disease, are highlighted. The necessity of dynamic complex observation of patients on the background of medical and psychological-pedagogical correction is underlined. The importance of clinical and paraclinical methods of examination is indicated, which makes it possible to correctly diagnose and resolve the issues of timely assignment of adequate treatment, rehabilitation and social and labor expertise in the future.

Pediatrician (St. Petersburg). 2018;9(5):125-130
Eduard Kuzmich Tsybul'kin the founder of critical and emergency care for children in Leningrad - Saint Petersburg (The 80th anniversary of his birth)
Shabalov N.P., Alexandrovich Y.S.

Edward Kuzmich Tsybul'kin was an outstanding physician and scientist He was a wonderful person, who devoted his entire life to selfless service to sick children, who were on the verge of life and death. The article depicts the life and creative path of doctor Tsybul'kin, reflects his colossal role in establishing and developing pediatric anaesthesiology, resuscitation and intensive care of children in critical condition in Leningrad and thereafter in Saint Petersburg. The diversity of his medical, scientific and pedagogical activities is revealed in the article.

Pediatrician (St. Petersburg). 2018;9(5):131-138

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