Vol 9, No 6 (2018)

Vitamin D deficiency in children with cystic fibrosis:is there a link with the microflora of the lower respiratory tract, the frequency of hospitalizations and the volumeof antibiotic therapy?
Pashkevich A.A., Nachinkina T.A., Ushatskaia O.A., Dorofeikov V.V., Orlov A.V., Kostik M.M., Jelenina L.A.

Background. Cystic fibrosis (CF) – a hereditary disease which is characterized by a chronic infection and inflammation in airways and leads to the progressing of the lung damage and an early disability.

The aim of our study to evaluate the relationship between vitamin D deficiency and degree of the contamination of the lower airways (LA) by the main pathogens and requirement in intravenous (IV) antibacterial therapy and hospital admission duration.

Materials and methods. The study included 92 children with CF aged from 0 to 17 years. During the research (18 months) the serum 25(OH)D levels were evaluated trice. Vitamin D3 titration dosage was made according the 25(OH)D level and data about treatment compliance collected. According to the register of patients the number of flares and days of antibacterial therapy for 3 periods was counted: during 1 year before inclusion in the study (2016), for 2017 (during treatment) and in 2018. Statistical analysis was carried out with Statistica 10.0 software.

Results. From 92 people, only 66 were compliant and in 38/66 the normal level of 25(OH)D was reached. At children with initially normal level of vitamin D the requirement in IV antibacterial therapy within the first year of observation decreased. In patients who had normal 25(OH)D serum level (>30 ng/ml) we observed decreased number of in-patient department admission and decreased frequency of gram-negative bacteria of LA detection.

Conclusions. The maintenance of normal blood vitamin D level was a perspective therapeutic strategy in CF patients which may reduce the frequency of a chronic infection and as a result, the requirements in hospital admission and IV antibacterial therapy.

Pediatrician (St. Petersburg). 2018;9(6):5-12
Influence on the connective tissue dysplasia, hormones and cytokines in children with kidney disease acquired in the form of glomerulonephritis, haemolytic uraemic syndrome and secondary pyelonephritis
Mambetova A.M., Shabalova N.N., Inarokova A.M., Bizheva D.V., Cagova B.R., Zhamborova F.A.

Previously we found an adverse effect of undifferentiated connective tissue dysplasia (UCTD) on the development of nephrosclerosis in children with congenital malformations of urinary system organs. This article is devoted to the analysis of the influence of the State on the UCTD clinical course of acquired diseases of the kidneys in the form of glomerulonephritis, haemolytic uraemic syndrome and secondary pyelonephritis, as well as the production of hormones of Renin-angiotensin-aldosterone system and proinflammatory cytokines (TNF-α and Il-1β). 99 patients with acquired renal diseases were examined. 25 of them – children with tubulo-interstitial nephritis after haemolytic uraemic syndrome; 38 patients with chronic glomerulonephritis with nephrotic syndrome; 36 children with secondary not obstructive pyelonephritis. A control group consisted of 30 clinically healthy children of the appropriate age. NDST diagnosis has been carried out in accordance with the Russian recommendations on the diagnostics algorithms of violation of the structure and function of connective tissue. UCTD status was diagnosed in 36% of children with tubulointerstitial nephritis, 40% of children with chronic glomerulonephritis and 27.8% of children with pyelonephritis. All children underwent a complete nephro-urological examination using clinical, laboratory and instrumental methods: ultrasound of the urinary system, electrocardiography, echo-cardiography, daily blood pressure monitoring. Concentration of Renin, aldosterone plasma, as well as TNF-α and Il-1β was determined by immunoenzyme method. The results of the work have shown a significant adverse impact on the UCTD partial violation of the kidneys, the frequency of relapses secondary pyelonephritis, arterial hypertension and formation of steroid resistance steroid resistance in glomerulonephritis. In most patients the overproduction of Renin, aldosterone and both cytokines is accompanied with UCTD, which contributes to the progression of chronic renal disease. According to modern views, undifferentiated connective tissue dysplasia is the result of polygenic inherited predispositions to violate morphogenesis components of the extracellular matrix and is considered as the basis the formation of many chronic diseases. UCTD frequency in patients with acquired renal diseases is not investigated. This condition influence on the clinical course of the underlying disease, the production of hormones renin-angiotensin-aldosterone system and proinflammatory cytokines has not been studied.

Pediatrician (St. Petersburg). 2018;9(6):13-20
Radiologic diagnostics in complex estimation of the features of neuroplasticity in preterm newborns with extremely low birth weight
Melashenko T.V., Tashilkin A.I., Narkevich T.A., Pozdnyakov A.V., Krasnogorskaya O.L., Nasyrov R.A., Ivanov D.O., Lvov V.S.

Patterns of neuroplasticity and cerebral maturation in preterm neonate can be assessed by MRI and cranial ultrasound. The score system of brain maturation includes the account of germinal matrix (GM) regression by MRI. The GM regression can be considered as pattern of neuroplasticity. There have been investigated the changes of neuroplasticity pattern or GM regression in preterm neonates with extremely low birth weight (ELBW) without intragerminal/intraventricular hemorrhages (n = 21). It is believe that the main causes of impair of GM are the intragerminal hemorrhages and hypoxia. The methods of study were cranial ultrasound (CU) and MRI. The measurement of GM was carried out by CU in anterior horn of the lateral ventricles of neonates in the study group (25-29 weeks). It was detected the GM regression in preterm neonates with increasing age, and complete GM regression to 30 week. MRI has been performed in 15 neonates from the study group on 27-38 weeks age with using the common pulse sequences – T1 WI, T2 WI and Flair. GM was detected by MRI up to 34 weeks inclusive by using the additional pulse sequence – DWI. By using common pulse sequences the GM was visualized up to 32 weeks age. Furthermore there has been pathological examination of GM in anterior horn of lateral ventricle in dead neonates from the study group (n = 3). We revealed the thickness reduction of GM in the lateral ventricles with increasing age of the dead neonates. Also we identified the delay of the GM reduction in two dead neonates 36-38 weeks age (post conceptual age) what may indicate the disorder of neuroplasticity in those preterm neonates. The performed study showed the capability of CU and MRI in examination of neuroplasticity in preterm neonates.

Pediatrician (St. Petersburg). 2018;9(6):21-28
Importance of activity of autophagy, apoptosis and intracellular protein degradation for early detection of malnutrition in patients with chronic kidney disease of 5th stage, receiving of hemodialysis: the results of case-control study
Prometnaya G.A., Batushin M.M., Bondarenko N.B.

Malnutrition significant affects the flowing and prognosis of chronic kidney disease (CKD) of 5th stage. It’s early detection with assistance is actual problem.

Purpose. Detect of more sensitive markers for diagnostic assessment of malnutrition and elucidate of availability of autophagy, apoptosis and intracellular protein degradation’ markers for the purpose.

Methods. It was made prospective case-control study. CKD of 5th stage’ patients with hemodialysis were included. Objective, laboratory study (n = 106) and detection of Beclin-1, 20S-proteasoma and Bcl-2’ levels (n = 80) prepared. Last three of them indicated of autophagy, intracellular protein degradation and apoptosis activity appropriately. We had two groups: with malnutrition (n = 93/71) and without it (n = 93/71).

Results. Variability of malnutrition’ quantity, depending on index for verification of it was detected: for index “lymphocytes < 1 800” – 71,1% (59 of 83 investigated patients), “transferrin saturation < 20” – 34% (36 of 106), “serum albumin < 35 g/l” – 1,9% (2), “body mass index < 18,5” – 0,9% (1), “body mass deficit” – 5,7% (6). High level of 20S-proteasome (46,2-72,5 ng/ml) increased of malnutrition chance (OR = 4,88 [95% CI = 1,09–21,84]). Somatic protein pool insufficiency was more frequently, than visceral pool is in malnutrition group: 25,8% (24 of 93) и 2,2% (2 of 93; р < 0,05).

Objective. Biomarkers can find malnutrition earlier than anthropometric indexes, and high level of 20S-proteasome can be early independent predictor of malnutrition.

Pediatrician (St. Petersburg). 2018;9(6):29-36
General anesthesia in infants during surgical laser treatment of retinopathy of prematurity in ophthalmological clinic
Utkin S.I., Stoliarov M.V., Ignatenko D.Y., Bachinin E.A., Khalfin R.N.

Retinopathy of prematurity (ROP) is the main cause of blindness in extremely premature infants. The frequency of ROP in different countries varies from 9 to 46.9% cases among children born prematurely, and from 69 to 90% cases among children born with extremely low birth weight. Laser coagulation (LC) of retina is the most effective way to treatment of active stage of ROP with high operational and anesthetic risk for the child.

Purpose. Comparative analysis of safety of general anesthesia (GA) with halothane and sevoflurane with using face mask and Mapleson breathing circuit in children with ROP at LC of retina.

Material and methods. In the period from 2008 to 2017 LC of retina at ROP with GA was performed in 284 children born prematurely at 24-34 weeks of gestation. 2 groups were formed of these, depending on the used anesthetic: the 1st group (n = 167) halothane was used at concentration of 0.3 vol%, in the 2nd group (n = 117) – sevoflurane at concentration of 1-1.5 vol%. Criteria of adequacy of GA: sleep, lacking of motor reactions of child, eye movements at introduction of blepharostat, at optical lens installation on cornea and at applying first coagulates.

Results. In 68 children of the 1st group (40.7%) negative reactions appeared in the form of respiratory depression, bradycardia, prolongation of awakening, delayed apnea, since halothane can cause depression of respiratory center and inhibit functions of respiratory musculature. In the 2ndgroup, negative reactions were observed in 14 children (11.9%), since sevoflurane is more manageable, promotes rapid awakening and low risk of depressive influence on functions of the child's body.

Conclusion. The optimal anesthetic for LC of retina in premature infants is sevoflurane in low concentrations when using face mask and Mapleson breathing circuit.

Pediatrician (St. Petersburg). 2018;9(6):37-44
Features of the organization of a day regimen and the level of ophthalmologic pathology at pupils of elementary grades of St. Petersburg
Zemlyanoy D.A., Lvov S.N., Brzhesky V.V., Efimova E.L., Puzyrev V.G., Alexandrovich I.V., Sorokina M.A.

Maintaining the health of school pupils is an important medical and social problem. The increase of the educational load and the use of computer technology and reduced motor activity of schoolchildren leads to a “school pathology” such as diseases of the eyes.

The aim is to study of the impact of computer technology and lifestyle on the development of visual pathology in primary school pupils.

Materials and methods. The questionnaire survey of school pupilsʼ parents in grades 1-5 of St. Petersburg was performed. School medical records of the child (form No. 026/y) were analyzed. The examination of visual acuity and refractometry was performed for 81 school pupils in fourth grade.

Results and discussion. First grade pupils parents estimated health of their child as “excellent” only in 20,8-25% of cases. None of the parents of pupils fifth grade did not consider their child absolutely healthy. Every third parent noted the childʼs complaints of headache, red eyes and dizziness. The duration of the night's rest corresponded to the recommended only in 16% of children. Only every second child (48.7%) takes a walk, and only 20.8% of them take long walks. Motor activity of children outside the school does not meet the recommended. The average daily duration of the total visual load (computer, gadgets, reading) for pupils first grade was 1 h 56 min, second grade – 2 h 10 min, fifth grade – 2 h 28 min. Refractive errors were absent in 84.0% of children who started educate in the first grade; 4.0% suffered from myopia; 12.0% – hyperopia. Healthy children accounted for 44.0% in the third grade. Myopia of varying degrees was found in 20.9% of pupils in the fourth grade, and accommodation disorders had 19.8% of pupils. 48.0% of fifth grade pupils suffer from myopia.

Conclusion. It is necessary to develop and implement a comprehensive rehabilitation program for the prevention of vision disorders in primary schoolchildren.

Pediatrician (St. Petersburg). 2018;9(6):45-50
Features of cardiovascular system functioning under emotional stress in dependence of maskuline-feminine personality traits
Nikolaev V.I., Denisenko N.P., Belogurova E.A., Denisenko M.D., Gorzy T.S.

The peculiarities of the adaptive reaction formation among people in dependence of masculine-feminine personality traits in condition of the emotional stress were explored. 87 healthy volunteers (male and female) were examined in the situation of the psychoemotional tension. It was detected that emotional stress triggered the adequate adaptive response among women with prevailing feminine and androgynous personal traits, accompanied by the activation of the sympathetic department of the regulation of the cardio-vascular system, mild increase of the index of functional changes. Tension of the mechanisms of cardio-vascular activity was found among men and women with pronounced masculine personal features. The excessive activation of sympathetic regulation of cardiovascular system which was accompanied by increase in the index of regulatory system activity by 2.5 times was noted among men with prevalence of androgynous properties of the personality. It has been proved that psychoemotional stress contributes to excessive tension and/or overstrain of cardiovascular activation mechanisms, accompanied by the retain or increase of the index of the functional changes, the index of regulatory system activity after termination of stressor action among men with pronounced masculine and, especially, androgynous personal traits. The functional change index, the strain index, the indicator of the activity of regulatory systems remained the same or increased among volunteers with these personality traits.

Pediatrician (St. Petersburg). 2018;9(6):51-56
Role of endothelium damage factors in the pathogenesis of cardiomyopathy surge in athletes sports
Lopatin Z.V., Vasilenko V.S., Karpovskaya E.B.

The cardiovascular system experiences the greatest stress when exercising. This leads to exhaustion and dysfunction of compensatory-adaptive mechanisms, forms a state of acute physical overstrain, increases the risk of cardiovascular disease. Endothelial dysfunction in athletes due to oxidative stress under high training loads. Risk factors include endothelial da­mage hypercholesterolemia, hyperhomocysteinemia, elevated levels of cytokines. To clarify the Ethio-features overvoltage held definition of cardiomyopathy endothelium damage factors of sports athletes. Surveyed 112 people aged 17-25 years, boys 1 level and candidates for master of sports. ECG signs of cardiomyopathy overvoltage on change trailing portion of ventricular complex alone and disrupt heart rhythm found in 36 (32%) athletes who entered the primary group. Group of comparison comprised 38 athletes without electrocardiographic signs of cardiomyopathy. Conducted definition damaging endothelium factors: homocysteine, cytokines IL-8, IL-4, TNF-α, lipid spectrum, including modified (oxidized) lipoproteins. Revealed in athletes with electrocardiographic signs of cardiomyopathy overexertion, an increase in low-density lipoprotein along with an increase in the level of homocysteon and anti-inflammatory cytokines, causing endothelial dysfunction, can play a significant role in the pathogenesis of cardiomyopathy overexertion. Accordingly, prevention and drug therapy of cardiomyopathy overexertion in athletes should be aimed at reducing the factors that cause endothelial dysfunction, namely, hyperhomocysteinemia, increase in the level of cytokines (TNF-α and IL-8) and modified oxidized lipoproteins.

Pediatrician (St. Petersburg). 2018;9(6):57-62
The foci of aberrant crypts and changes of microbiota of gut upon chemical mutagenesis and experimental hyperand hypothyroid status
Proshin S.N., Kurbanov R.A., Loskutov S.I., Barsukov N.N., Alibekov H.O., Kachanov D.A., Glushakov R.I., Bagaturiya G.O.

In our paper we present data on the induction of nitrosomethylurea focuses of aberrant crypts on experimentally altered thyroid status in mice and concomitant changes in the intestinal microbiota. Since the foci of aberrant crypts are an obvious prerequisite for long-range malignancy in colorectal cancer, the induction of colorectal cancer induced by nitrosomethylurea is the most appropriate model for investigating mechanisms of carcinogenesis. Male BALB / c male mice which were treated with nitrosomethylurea (NMU) for 24 weeks when also combined with L-thyroxin or propylthiouracil were used in the study. The results indicate that the incidence of aberrant crypt foci (FAC) was significantly higher for a group of animals which were treated with both NMU and L-thyroxin 38.9 ± 3.6%. At the same time the incidence of FAC with hyperthyroid status only without exposure to NMU was also high at 12.9 ± 4.2%. It was shown that the hypothyroid status had a significant protective effect on the intestinal epithelium when exposed to HMN – 16.1 ± 2.5%. A significant quantitative decrease in Lactobacillus spp. of microbiome was detected in groups of mice exposed not only to NMU, but also in animals with experimentally induced hyperthyroid status only. Mechanisms that contribute to the occurrence of an increased frequency of FAC in the context of hyper- and hypothyroid status are discussed. It was concluded that an increased incidence of foci of aberrant crypts and a decrease in the quantity of the normal microbiota are associated with hyperthyroid status which modulated upon administration of methylnitrosourea.

Pediatrician (St. Petersburg). 2018;9(6):63-72
Indicator of reticulocyte hemoglobin in diagnostics of fe-deficiency in children
Pshenichnaya K.I., Jelenina L.A., Kasatkina T.N., Ivashikina T.M., Zaidina M.V.

Iron deficiency is one of the most widely spread types of microelementosis, especially in a growing organism. It is essential to diagnose iron deficiency at an early stage in order to start treatment timely. Diagnostics of iron deficiency can be complicated by concomitant diseases that distort biochemical parameters of iron metabolism, thus making them not informative enough. In this connection, hemoglobin count in reticulocytes (Ret-Hb) may be a useful indicator because it helps to diagnose true iron deficiency at earliest stages and does not depend on concomitant conditions, which is described in reference sources. During the research, Ret-Hb was detected in the structure of blood hematology test performed on the hematology analyzer XT-4000 (Japan) in 17 children aged 1-18 with absolute iron deficiency; three of these children had absolute iron deficiency manifested as latent deficiency, and 14 children had hypochromic microcytic anemia of mild or medium severity. The parameter was below the normal limit (the average count was 21.4 ± 4.5 pg), while the normal limit is 28 pg, according to the reference sources. After two weeks of treatment, Ret-Hb increased up to 24.7 pg; at the same time, other parameters of the blood hematology test also showed an upward trend. The results of our research have demonstrated that Ret-Hb may be regarded as an informative, economical and affordable diagnostic parameter that does not require collection of additional blood samples. Its dynamics during treatment should be investigated further.

Pediatrician (St. Petersburg). 2018;9(6):73-76
VEB-mononucleosis in children at the hospital stage in modern conditions
Timchenko V.N., Bannova S.L., Pavlova N.V., Pavlova E.B., Kaplina T.A., Fedorova A.V., Bulina O.V., Balashov A.L., Hakizimana J.

VEB-mononucleosis is an actual infection of childhood. We analyzed 764 medical records of inpatients with VEB mononucleosis. Two groups of patients were formed: group I (young age) was 411 people (from 1 to 7 years), group II (school age) 353 people (from 7 to 17 years). In the I group, boys predominated, the peak of the disease occurred in the spring period, in group II – girls, the incidence of the incidence was noted in the winter. In both groups, moderate forms of the disease predominated, 684 people (89.5%). Severe forms of the disease prevailed in the children of group II. In group I the di­sease began acutely, and in the second group – subacute. In both groups, the whole syndrome of VEB mononucleosis was observed: fever, intoxication, acute tonsillitis, lymphadenopathy. The defeat of the nasopharynx and hepatosplenomegaly was more common in the I group. In this case, the increase in the size of the liver and spleen was up to 2 cm from the age norm. In the biochemical analysis of blood, an increase in ALT activity was detected with the same frequency in both age groups. Moreover, in the I group there was a moderate activity of ALT, in the II group – more significant. In clinical blood analysis, most patients in both age groups had leukocytosis. Lymphocytosis was more common in children of group I. Monocytosis was more common in children of group II. Increased ESR was observed in both groups with the same frequency. Atypical mononucleary in children of the I group appeared on the first, and in the older group – on the second week of the disease. A set of laboratory methods was used to diagnose VEB mononucleosis. In 100% of the observed children receiving viferon, there was a significant decrease in the duration of fever, intoxication, acute tonsillitis, lymphadenopathy, adenoiditis, hepatomegaly, splenomegaly and reduction in hospital stay.

Pediatrician (St. Petersburg). 2018;9(6):77-82
Prevention of cardiovascular system adaptation failure in athletes with the method of cryotherapy
Vasilenko V.S., Mamiev N.D., Semenova Y.B.

The increase in the intensity and volume of training loads in modern sports to get her with strict antidoping policy draw increased attention to physiotherapeutic recovery methods. Thepaperpresentsthefindingsofthestudyofcryotherapytoenhanceadaptationtosportloads. The study group included 24 athletes (specialization “sci race”), age 16 to 18, proficiency level — the first class and Master of Sports candidates, sport experience over 5 years). The control group included 24 athletes of the same specialization, age and skill. The sessions of the cryotherapy (cryosauna) were held once a day for 10 days in the special preparatory period of the training cycle prior to the period of maximum loads. The training year included 3 courses of cryotherapy. The course of the cryotherapy improved microcirculation, total and effective albumin concentration, resulting in increased albumin binding reserve and metabolite excretion, and reduced CPK MV level. The study group demonstrated the decrease in the number of cardiovascular disorders compared to the controls. Cryotherapy can be considered an innovative efficient physiotherapeutic method to enhance the adaptive capacity.

Pediatrician (St. Petersburg). 2018;9(6):83-92
The role of autoimmune reactivity in pathogenesis of complicated forms of peptic ulcer disease in adults and children
Asaturov A.V., Varzin S.A., Stroev Y.I., Churilov L.P., Utekhin V.J.

The incidence of peptic ulcer disease does not tend to decrease, and the number of its complicated forms in recent years remains at a high level in Russia. The literature review discusses current views on the pathogenesis of gastric ulcer and duodenal ulcer, including the importance of Helicobacter pylori infection, data on the comorbidity of helicobacteriosis with other autoimmune conditions, as well as from the position of autoimmunity in general, taking into account the prevalence of the paradigm of the infectious origin of peptic ulcer pathogenesis to date. The paper analyzes pathogenetic features and clinical/pathomorphological manifestations of peptic ulcer disease associated with the use of aluminum-containing drugs (in view of adjuvant properties of aluminum) as well as the influence of calcium metabolism disorders in peptic ulcer disease. Pediatric and adolescent aspects of the problem are particularly considered. Ideas about the role of autoimmunity in peptic ulcer disease have been developing since the mid 60s of the last century. There is evidence of provocation by infectious factors and drugs that production of autoantibodies against some antigens of gastric mucosal cells, including immunoglobulins, which have a histamine-like effect. There are data on the ability of Helicobacter pylori to provoke autoimmunity to extragastric autoantigens, including platelet receptors, which may be associated with impaired hemostasis. A number of in vitro studies did not confirm the stimulating effect of autoantibodies on the gastric cells. The meager and contradictory data regarding the role of autoimmunity and its regulation/disregulation in peptic ulcer disease suggest the need for further scientific research and the development of laboratory diagnostic methods. It is necessary to clarify the nature and extent of autoimmune processes occurring in complicated peptic ulcer disease as well as the relations to other autoimmunopathies.

Pediatrician (St. Petersburg). 2018;9(6):93-100
Diagnostic evaluation of small-fiber neuropathies in various diseases (review)
Basantsova N.Y., Zinchenko J.S., Starshinova A.A., Yablonskiy P.K.

In the last three decades with the improvement of the diagnostic methods, it has become possible to evaluate the lesions of the small nerve fibers (types A-delta and C) in the skin. This condition is known as small-fiber neuropathy (SFN) and developing as a result of metabolic, genetic, toxic or immune-mediated factors, including sarcoidosis and several types of mycobacteriosis. Its main manifestations include sensory complaints, such as disorders of pain and temperature sensitivity and autonomic dysregulation of the cardiovascular, gastrointestinal, and urinary systems. The diagnosis of neuropathy of small fibers is established mainly on the patient’s clinical examination and anamnesis data, assessment of symptoms with validated neurological scales and performing a skin biopsy with measuring the density of intraepidermal nerve fibers. It is important to note that damage to fibers A delta and C types is not recorded during routine electroneuromyography, which makes diagnosis difficult. Treatment of this disease is a complex task, that including treatment of underlying disease, using painkillers, such as antidepressants and anticonvulsants of various groups, local anesthetics, such as lidocaine and capsaicin. Studies are being conducted on the effectiveness of intravenous immunoglobulins and antagonists of tumor necrosis factor alpha in the treatment of this patho­logy. This review presents information on the etiology, clinical and diagnostic aspects and the basics of therapy of SFN, which can improve the quality of medical care and quality of life of patients with sarcoidosis and tuberculosis.

Pediatrician (St. Petersburg). 2018;9(6):101-110
Grief and bereavement of preschool children
Malikova T.V., Novikova T.O., Pirogov D.G.

The article deals with questions connected with grief and bereavement in preschool age of childhood. The main monographs and articles on the problem of grief and bereavement in preschool childhood are reviewed in this text. The authors, analyzing the Russian and European tradition of research, mention that in Russian psychological literature there are almost no texts for parents and educators about child’s experience of grief. The authors point that existing articles do not clear the specific influence of children’s concept of death on the grief process. The accent in the article is put on the difference of loss acceptance depending on the age of a child and the specific of child’s death-concept. The peculiarities of different age periods among the preschool childhood age are viewed in the prism of death and loss. The authors pay attention on the dynamic of child’s grief depending on the expected and unexpected death of the beloved one. The variants of normal and pathological grief are described in the text of the article. The authors give recommendations concerning the normalization of child’s psycho-emotional condition in accordance with the peculiarities of the child’s grief. Special accent in the article is to the subject of psychological support of a child in the situation of announcement of death and possibility of child’s attendance to the funeral. Also there are recommendations to preschool educators about the psychological help to bereaved child and his/ her resocialization in the kindergarten.

Pediatrician (St. Petersburg). 2018;9(6):111-117
Soranus of Ephesus: the first Greco-Roman perinatologist and pediatrician
Jarman O.A., Mikirtichan G.L.

Soranus of Ephesus, a famous Greek physician and polymath, one of the most lucid authors of so called ‘Methodist Sect’, who lived in Rome in the 2nd century, composed a treatise that was unique for his time, ‘Gynekology’ (“Gynaikeia”), in four volumes; that treatise had been a bible of obstetrics, gynecology, and pediatrics in Europe till 17th century. One third of this treatise is dealing directly with a child. Especially important and distinctive are the achievements of Soranus not only as an obstetrician but also as a unique Greco-Roman pediatrician, neonatologist and, in certain degree, as a perinatologist. Soranus expremely thoroughly for his time described case management from the conception until weaning (severing the navel cord, baby’s clothes, baby care, swaddling etc.), the rules of breastfeeding and symptoms of some diseases of newborn children. The attention he paid to the little child is unique for both Greco-Roman culture and medicine. Soranus might well have used the midwives’ lore and transformed it from the point of view of rational medicine into the medicine practiced by males, keeping the best of it. He described conception, prevention of spontaneous abortion, severing the navel cord, the first baby’s hygienic procedures, bath, massage, breastfeeding, some children diseases; he also gave the characteristics of newborn’s vitality, which can be compared with modern Apgar score, i.e. he was considering the problems that are nowadays in the focus of perinatologists and neurologists. In this respect, his gigantic figure stands alone not only in the field of Greco-Roman medicine, but also medieval medicine with no rivals.

Pediatrician (St. Petersburg). 2018;9(6):119-128

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