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Vol 5, No 3 (2014)

Articles
Infections in mother, fetus and newborn infant
Savicheva A.M.
Abstract
The article reviews some major problems of diagnosis, prophylaxis and treatment of infections in mother, fetus and newborn infant and discusses possible ways of solving them. It is emphasized that there is a need in standardized approaches to management of pregnant women with infections imposing a risk of adverse effects on fetus or newborn infant, which can be achieved by development and implementation of national guidelines on management of perinatal infections.
Pediatrician (St. Petersburg). 2014;5(3):3-8
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Verification etiology of chronic infectious-inflammatory pulmonary diseases exacerbations in children
Boronina L.G., Samatova E.V.
Abstract
During the examination of 45 children with exacerbation of chronic infectious-inflammatory pulmonary diseases complex of laboratory methods (culture, polymerase chain reaction, indirect immunofluorescence, gas-liquid chromatography, immune-enzyme analysis) established that the exacerbation associated with monoculture (62.2 %): aerobic - 40 %, including facultative anaerobic bacteria, nonspore-forming anaerobic bacteria - 17.8 %, viruses - 4.4 %, and with associations of microorganisms (26.4 %): bacterial-bacterial - 15.4 %, bacterial-viral - 8.8 %, bacterial-fungal - 2.2 %.
Pediatrician (St. Petersburg). 2014;5(3):9-15
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Pulmonary Catamnesis in Children on Artificial Lung Ventilation in the Neonatal Period
Klyukhina Y.B., Zhelenina L.A., Ivanov D.O.
Abstract
Bronchopulmonary pathology is the most frequent cause of morbidity and mortality among newborn infants. Emergency aid and inten-sive care to newborn infants decrease death rate among children; at the same time, they cause an increase in pulmonary morbidity. The article deals with data concerning generation of bronchopulmonary diseases in children who underwent resuscitation in neonatal period, tracks pulmonary catamnesis, and analyzes hereditary load. The article confirms the adverse effect of artificial lung ventilation on lungs of both mature and premature babies. Neonatal pneumonia, together with iatrogenic factors of emergency care, is a dominating factor in formation of chronic non-specific pulmonary diseases in catamnesis.
Pediatrician (St. Petersburg). 2014;5(3):16-21
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Development of microbiota in the large intestine of newborns depending on various delivery methods
Naboka Y.L., Rymashevskiy A.N., Svirava E.G., Vasilyeva L.I., Bragina L.Y., Chernitskaya M.L., Dzhalagoniya K.T.
Abstract
We have examined 96 conditionally healthy primigravidae and 96 newborns. Group 1 (n = 51): gravidae with normal course of preg-nancy and delivery, group 2 (n = 45): gravidae with normal course of pregnancy and deliveries by caesarian section (indications for the operation - severe myopia), group 3 (n = 51): newborns from gravidae of group 1, group 4 (n = 45): newborns from gravidae of group 2. Purpose: study of the development of microbiota in the large intestine of newborns depending on various delivery methods. Enterococcus sp. (58,2 %), S. epidermidis (55,7 %), Corynebacterium sp. (53,1 %), E. coli (41,7 %) dominated in meconium microbiota. By the day 5 in group 3 we registered more frequently (p < 0,05) Bifidobacterium sp., Corynebacterium sp., E. coli, in group 4 - Klebsiella sp. Independently from the delivery method, by day 5 we observed in the feces of newborns increased (р < 0,5) content of Bifidobacterium sp., Lactobacillus sp., E. coli, Enterococcus sp., and S. aureus.
Pediatrician (St. Petersburg). 2014;5(3):22-29
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Gastrointestinal microflora of full-term newborn infants with different modes of delivery
Rybina Y.V., Kenbayeva K.G., Savicheva A.M.
Abstract
The study aimed to investigate the microflora of the gastrointestinal tract in infants born via vaginal delivery or Cesarean section. In the first hours postpartum, microbial colonization of the gastrointestinal tract occurred in 78 % of the infants born via vaginal delivery, and in 27 % of the infants born via Cesarean section. The effects of antibiotics and probiotics, which were administered to the women during pregnancy and labor, on the composition of gastrointestinal micro-flora in infants were studied. In the infants born to mothers receiving antimicrobials lactobacilli in gastric aspirate and meconium were not detected. Using probiotics during pregnancy did not have any effect on lactobacilli detection in the infants.
Pediatrician (St. Petersburg). 2014;5(3):30-32
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Diagnostics and prevention of infections caused by Streptococcus agalactiae in pregnant women and newborn infants
Zatsiorskaya S.L., Krysanova A.A., Khvan V.O., Martikainen Z.M., Savicheva A.M.
Abstract
The study investigates colonization of the genitourinary tract and rectum in pregnant women by Streptococcus agalactiae in early pregnancy, as well as pregnancy outcomes for mother and infant depending on the use of antibiotic prophylaxis. The frequency of GBS colonization was 15.9 %, with the detection rate in urine being 8.6 %, in the vagina - 3.5 %, in the rectum - 10 %. The efficiency of amoxicillin/clavulanic acid administered in the II trimester was 66.7 %. Pregnancy outcomes in women receiving and those not receiving antibiotic prophylaxis were studied. In all women receiving amoxicillin/clavulanic acid term labor occurred, with healthy full-term infants born. In one woman not receiving antibiotic prophylaxis there was preterm labor at 34 weeks of gestation.
Pediatrician (St. Petersburg). 2014;5(3):33-36
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Application of quantitative multiplex real-time polymerase chain reaction for identification of causative agents of urinary tract infections in pregnancy
Khusnutdinova T.A., Savochkina Y.A., Gushchin A.Y., Shipitsyna Y.V., Savicheva A.M.
Abstract
Urinary tract infections (UTIs) represent the most common bacterial infections and often complicate pregnancy. UTIs in pregnancy are classified by site of bacterial proliferation as follows: asymptomatic bacteriuria, cystitis, pyelonephritis. Screening for asymptomatic bacteriuria is a standard of obstetrical care and is included in most international guidelines. The urine microbiologic culture is considered the gold standard for laboratory diagnosis of UTIs. Molecular methods enable to rapidly detect, identify and quantitate causative agents of UTIs in urine and are effective alternative to traditional bacteriological methods.
Pediatrician (St. Petersburg). 2014;5(3):37-41
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Intimate hygiene of an adolescent girl: principles, modern opportunities and problem of introduction
Kokhreidze N.A., Anufriyenko E.G., Bobrova I.V., Mironova A.V.
Abstract
30 girls aged from 11 to 17 years were surveyed in order to research the use of gels for the intimate hygiene containing xylitol, alginates and allantoin combined with chamomile extract or quince that have a neutral pH and do not contain perfumes. The average age of pa-tients was 15.2 ± 2.8 years (11; 17). Surveyed patients used to have the following clinical diagnosis: ovarian cysts - 8 patients , ovarian apoplexy - 8, acute salpingo-oophoritis - 1, abnormal uterine bleeding - 13. Patients were asked to evaluate the following quality criteria according to the scale from 1 to 5 scores: simplicity of use, comfort after hygienic procedures, the feeling of freshness, the perfume. Mean score for simplicity was 4.5 ± 0.7 (2; 5), comfort after the procedure - 4.5 ± 0.7 (3; 5), feeling of freshness - 4.6 ± 0.5 (3; 5) and perfume - 4.1 ± 0.9 (2; 5). 7 of 30 patients (23.3 %) estimated the perfume as scores 2 and 3. Lowest score 3.7 ± 1.2 was given by youngest girls aged 11-13 years (n = 6). Girls aged 14-15 years (n = 9) gave the higher score that equaled 4.1 ± 0.8 and girls aged 16-17 years (n = 15) gave the highest mean score of 4.3 ± 0,7. 22 (73.3 %) of 30 girls almost over 15 years old said they intend to use this hygienic agent in the future. 8 (26.7 %) younger girls found this difficult to assess. Thus, attractiveness of this agent for personal hygiene was lower in girls from younger age group (11-13 years) due to the absence of perfume and in spite of numerous assets.
Pediatrician (St. Petersburg). 2014;5(3):42-45
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Comparative evaluation of innovative diagnostic tests for latent and active TВ infection in children
Lozovskaya M.E., Belushkov V.V., Gurina O.P., Vasilyeva Y.B., Klochkova L.V.
Abstract
The results of three new tests based on antigens CFP-10 аnd ESAT-6 were studied in 50 children: intradermal Diaskintest and tests in vitro QUANTIFERON and Tubinferon. Diaskintest and Tubinferon are developed and produced in the Russian Federation. QUANTIFERON test is performed by Cellestis (Australia). 20 children had active TB, 22 children had latent TB infection, and 8 were not infected by M. tuberculosis. It has been established that while the frequency of coincidence of the results is high (66 %), in some situations, tests may react differently and give additional information when used together in difficult diagnostic cases. In vitro tests were more sensitive compared with Diaskinintest in immunopathological conditions. Tubinferon test had higher sensitivity in latent TB infection (40.9 %) compared to Diaskintest (22.7 %) and QUANTIFERON test (31,8 %), but lower sensitivity in developed tuberculosis - 60, 80 and 85 % respectively. All three tests are more informative in TB disease than in latent TB infection. An important advantage of the Tubinferon test is the ability to evaluate in vitro postvaccinal allergy, due to presence of the sample with the tuberculin. This can be used in the differential diagnostic between tuberculosis and generalized BCG infection, including children with HIV. Mantoux test may be more effective then Diaskintest in children who was not vaccinated with BCG. Tubinferon test system deserves wide clinical application, further study and development.
Pediatrician (St. Petersburg). 2014;5(3):46-50
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Effect of interferon on the direction of polarization of the immune response to influenza in children
Golovacheva Y.G., Afanasyeva O.I., Osidak L.V., Obraztsova Y.V., Voloshchuk L.V.
Abstract
In 1900 children of different ages and 690 adults with laboratory confirmed influenza in different epidemic seasons studied levels of interferons and interleukins 4 and 10 in the serum calculating the ratio of interleukin 4, 10 to interferon gamma. There are three type of immune response to influenza depending on the clinical course. It was shown that in flu with moderate intoxication in 66.3 % of cases in children and 72.0 % of adults marked polarization on Th1 type with increase level in serum and spontaneous interferon gamma in all age groups, in which the ratio of IL-4/IFN-g from 0.8 to 2, while in severe intoxication only 33.5 and 43.9 %, respectively. In children with bronchitis immune response Th2 type and mixed Th1/Th2 type were observed in 54.6 and 33.3 % of cases respectively, and only 12.1 % of Th1 type. With influenza, pneumonia is a complication, in 76 % of cases were determined humoral immune response by Th2 type when the ratio of IL-4/IFN-g and IL-10/ IFN-g is greater than 3, due to the increase of the content of interleukin 4 and 10, while significantly reducing levels of interferon gamma. In 23.7 % of cases observed Th1/Th2 mixed type of immune response with a ratio of 2 to 3. The obtained data allow us to determine the type of immune response to influenza infection and to predict the severity of the disease and the development of complications in children and adults, and also to determine the necessity of including in the therapy drugs of immunocorrection.
Pediatrician (St. Petersburg). 2014;5(3):51-57
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Structural circumstances in the main types of fatal concomitant injury in children
Karavayev V.M.
Abstract
On the material of forensic research 284 corpses of children (108 own observations, 176 archive acts), died as a result of falling from height, hitting a moving car, drive to the wheels and the injury in a car, a study of the structure damage. Investigated the frequency and distribution of damage to the skin, skeletal and organ separate areas of the body, carried out the combined assessment of the extent of the damage when the considered variants of the circumstances of the injury. It is established that the children injured in the car to head injury in various manifestations, found in 100 % of cases. Damage to other areas of the body are less frequent than when hit by a car, moving its wheels and when falling from a height. In this regard, the aggregate amount of damages in case of injury in a car in children was less than for other types of trauma. The distribution of damage between the areas marked in cases of moving the wheels of the car; on trauma to the head, chest and limbs accounted for the same proportion of the damage. Under the circumstances spine-spinal cord injury, damage, neck, abdomen and pelvis met more frequently than other considered variants of injury. In cases of moving the wheels of the car and marked the largest amount of damage that significantly exceeds (рφ < 0,001) indicators when falling from a height, the shock of your vehicle and injury in his cabin.
Pediatrician (St. Petersburg). 2014;5(3):58-63
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Sonographic examination of peripheral nerve injuries at the hands of children
Romanova M.N., Zhila N.G., Sinelnikova Y.V.
Abstract
Ultrasound imaging of peripheral nerves can accurately determine the level of damage, and also to assess the extent of damage to the structure of the nerve fiber. Early detection of the type of damage can significantly improve patient outcomes.
Pediatrician (St. Petersburg). 2014;5(3):64-66
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Morphological facial features of people with the reduced height of the gnathic part of the face
Fishchev S.B., Sevastyanov A.V., Orlova I.V.
Abstract
The work contains the characteristics of the morphological facial features of people with reduced height of the gnathic part of the face. The work shows the morphological features of the gnathic part of the face depending on the form of its lowering - dentoalveolar, gnathic, or complex. The obtained data can be used to define the approach for both the orthodontic and prosthetic care of patients who suffer from the tooth alignment defects combining with occlusion anomalies.
Pediatrician (St. Petersburg). 2014;5(3):67-70
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Protection of the neurological dysfunctions of newborn by omega-3 acids
Abdaladze N.S., Avaliani T.V., Tsikunov S.G.
Abstract
Including of the concentrate of eicosapentaenoic and docosahexaenoic acids in traditional treatment of obstetric pathology (gestosis, uterine-placental insufficiency, delay of the development of the fetal) gives the positive results. The concentrate of omega-3-polyunsaturated fatty acids is a natural product, elaborated from fat sea hydrobionts, possesses antiaggregatory, antyoxcidative activity, expressed adoptive and reconstructive actions. The substance does not cause teratogenic or mutagenic effects as well as acute or chronic toxicity. The treatment proposal promotes reduction of delay of the fetal development, premature delivery, preventive maintenance of pre- and eclampsia. The clinical observations in early postnatal period have shown rise of frequency of children delivery with more high estimations according to Apgar scale as well as decrease of asphyxia and CNS impairments cases.
Pediatrician (St. Petersburg). 2014;5(3):71-77
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Does the age of first drug abuse influence on further development and course of the disease
Vostrikov V.V., Proshin S.N.
Abstract
Drug abuse has become urgent in the last 10- 15 years. In 2005 it was reported about 241.3 people per 100 000 population which suffered from drug addictions. The study was performed among the patients with opiate addiction syndrome of second stage that corresponds to F 11.242 due to International System. Patients underwent treatment in hospital. Assessment of social adaptation and stress test were carried out according to Dr. Holmes and Dr. Rage. The study involved 129 patients suffered from addiction to opiates. Medical history was evaluated bearing in mind the age of first drug abuse. Randomization of patients was carried out on the basis of the age of first use of narkogen. Connection it the two groups of abusers were elucidated as follows: the first group is if the age of first use of narkogen accounts for up to 18 years old. The second group is if the age of first use of narkogen accounts for the age 18 years old. The study showed that early initiation of drug abuse in adolescents was provoked by family history burdened by alcoholism. This group has more frequent accidents of head injury, contaminations by hepatitis, psychotic episodes and seizures. They are more frequently subjected to criminal prosecution. In this group the start preferential drug abuse is given to cannabis. They have more quickly developed detailed clinical picture and have more frequent episodes of overdose by drugs. Meanwhile the patients of this group are more socially adapted.
Pediatrician (St. Petersburg). 2014;5(3):78-81
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Analyze and prediction of expenses for public health in G7 countries
Peel E.A., Bulavko Y.E.
Abstract
This article represents an analysis were made using data of expenses for public health in G7 countries. We can see the expenses for public health in G7 countries spent during 10 years in 2000-2010. These expenses rise every year. We built a trend line in MS Excel to analyze correlation rates. Our analysis showed rather high correlation coefficients R2. For example, these coefficients R2 for three countries: USA, Germany and France have the following bounds: 0,9606 ≤ R2 ≤ 0,9997. Six diagrams which are presented in the article allow us to understand how the expenses of USA for public health change. These diagrams show us the following mathematical dependences: linear, logarithmic, exponential and polynomial approximations. These diagrams also present mathematical functions and correlation coefficients R2. We have got high correlation coefficients R2 so we can predict future meanings of expenses for public health in G7 countries with high reliability up to 2015.
Pediatrician (St. Petersburg). 2014;5(3):82-84
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Experience Reduce TB in children with routine immunization in Republic of Belarus
Shmeleva N.D., Turpakova T.G.
Abstract
General characteristic of the epidemic process in Tuberculosis in the Republic of Belarus for the period 1997 to 2013. Relative incidence active Tuberculosis of the total population compared with similar mental data registered in children aged 0-17 years. The tendency of morbidity compared modified as common approaches to immunization against tuberculosis of those observed in the study period. The article also provides an analysis of mass tuberculin, conducted routinely in children during the study time frame.
Pediatrician (St. Petersburg). 2014;5(3):85-87
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Diagnosis and therapy of bacterial vaginosis in pregnancy
Shalepo K.V., Nazarova V.V., Menukhova Y.N., Shipitsyna Y.V., Savicheva A.M.
Abstract
Bacterial vaginosis (BV) is the most common vaginal disorder in women of reproductive age. This review presents literature data regarding a role of BV in adverse reproductive health outcomes, describes current methods used for BV diagnosis and issues of treatment of this disease in pregnant women.
Pediatrician (St. Petersburg). 2014;5(3):88-95
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Specific laboratory diagnosis of viral hepatitis
Sokurova A.M.
Abstract
During the last years, the incidence of chronic forms of viral hepatitis has increased. This necessitates the need for a reliable and timely means of diagnosis, which have been improved progressively. The list of markers of infection has been expanding, and the appropriate interpretation of this data would allow doctors to make the choice of treatment required for each particular case. The following methods are used for diagnosis of viral hepatitis: immunno-electron microscopy (IEM), enzyme-linked immunosorbent assay (ELISA), polymerase chain reaction (PCR). The markers of acute hepatitis A are: anti-HAV Ig M and the viral RNA. The presence of anti-HAV Ig G is indicative of a past history of disease. Diagnosis of viral hepatitis B is based on detection of virus antigens - HBsAg, HBeAg and antibodies (Ig M and G to the НВсAg, Ig G to the HВeAg and Ig G to the HBsAg). In addition, viral DNA detected by PCR is indicative for viral presence. Serological blood testing for markers of hepatitis D is informative only in patients with the presence of HBsAg in the blood. Important are the hepatitis D viral RNA and Ig M/G to the virus. Specific laboratory diagnosis of hepatitis C is based on the detection of antibodies to viral proteins, although detection of viral RNA is considered the «golden standard» in diagnosing of this disease. Laboratory diagnosis of hepatitis E is based on exclusion of specific markers of acute hepatitis A, B, C, as well as by the method of IEM, which relies on the detection of the virus in the feces.
Pediatrician (St. Petersburg). 2014;5(3):96-100
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Modern aspects of the etiology and pathogenesis of urolithiasis
Vasilyev A.G., Tahirov N.S., Nazarov T.H., Madjidov S.A., Akhmedov M.A.
Abstract
Urolithiasis is one of the most actual public health problems world-wide, its prevalence is growing annually. Study of the problem of urolithiasis appeared in recent years to a new level due to changes in the multidisciplinary approach and the principles of evidence-based medicine. Expanding the study of etiology and pathogenesis of the disease, development and application of high-tech diagnostic and treatment methods have enabled solve many problems and deliver new ones, identify prospects for future scientific and practical works. The article provides an overview of modern data concerning the etiology and pathogenesis of urolithiasis.
Pediatrician (St. Petersburg). 2014;5(3):101-109
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The night 6/7 January 1918: a tragic page in the history of Mariinsky hospital
Lisenkova L.N.
Abstract
The article describes in details the circumstances of the murder of constitutional democrats party leaders, former ministers of the Pro-visional Government F. F. Kokoshkin and A. I. Shingarev on the night 6/7 January 1918 at Mariinsky hospital by anarchist sailors and also the investigation course. The reasons why guilty of the crime were not punished are studied. Their tragic death ushered in the era of Russian terror.
Pediatrician (St. Petersburg). 2014;5(3):110-115
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Main stages of studying childhood infectious diseases
Likhtshangof A.Z.
Abstract
The article deals with the history of studying the most common childhood specific infectious diseases: measles, diphtheria, whooping cough, scarlet fever, mumps, chickenpox, and rubella. Similarities are clearly observed in the history of their study, so it was possible to distinguish four main phases according to reflection of the problem in medical literature, mainly scientists’ attention to one or another side of the pathological process, the discoveries made. 1) Since the first appearance of childhood infectious diseases in the medical literature until the mid XVI century: fragmentary references in the doctors’ writings and historical chronicles. 2) Mid XVI century - mid XIX century: due to a rise of the diseases incidence their empirical study started, many of them were described for the first time. While describing epidemics clinical and epidemiological features of diseases were specified. 3) Mid XIX century - mid XX century: the ethiopathogenesis of childhood infectious diseases was studied, their agents were found. These discoveries led to a break-through in the treatment (serums, antibacterials). 4) Period of mass vaccination against most childhood infectious diseases.
Pediatrician (St. Petersburg). 2014;5(3):116-122
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Clinic, diagnosis and prevention of latex allergy in patients and hospital medical staff
Mitin Y.A., Vologzhanin D.A.
Abstract
In this article present the data about occurance, immunopathogenesis and clinical features of latex allergy. It discussed in detail professional aspects of developing latex allergy in medical personal, hallmark features of allergologic anamnesis, latex allergy local and systemic manifestations, clinical and laboratory diagnostic methods and prophylaxis measures.
Pediatrician (St. Petersburg). 2014;5(3):123-127
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Fears among children and overcoming them
Gorkovaya I.A.
Abstract
The article examines the fears of children, which are divided into three following groups: the “instinctive” fears (fear of death, death of relatives, fear of doctors, injections, etc.), fears of “interpersonal relations” (fear of being late, did not catch, fear of inability to cope with feelings, fear of disapproval from peers, etc.) and “technological” fears (fear of fire, fly a plane, explosions, etc.). According to the research of 2008- 2011, almost all children revealed a fear of losing their parents. Change is observed in the content side: children 4-6 years were afraid of losing their parents because parents provide their lives. The perception of parents is changing at the age of 7-9 years and children realize love for them, in 10-11 years signs of the partnership and its value appear. Also the fear of school can be attributed like one of the most frequent fears in children and adolescents. The results of our study showed that almost every third child in the preschool group does not want to go to school and / or nega-tively assesses its educational opportunities. Number of school fears decreases with age and in early adolescence 11-12 years is about 20 %. The article contains a description of such ways to overcome fears as: creation of conditions to transfer interactions and feelings on the toy to defuse a tension; drawing as a way of expressing positive and negative emotions; a variety of fairy tales including in the form metaphors of the life path; parent’s ability to control the amount of crisis situations in children using the Diary of a gradual change of the child problematic behaviour and etc. The study examined the phenomenon of “no fear” in children, which has been found in almost every tenth child. Discusses its possible causes and negative sides.
Pediatrician (St. Petersburg). 2014;5(3):128-133
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Psychological characteristics preceding the development of homosexuality
Isayev D.D.
Abstract
490 gay men and 235 heterosexual men were surveyed to reveal frequency of distribution of childhood and adolescence gender non-conformity in gay men compare to similar features in straight men. Significant differences identified between two samples. The vast majority of gay men had history of various combinations of identity problems, crossgender behavior, communication problems, difficulties in adoption normative gender roles, the inability to find a common language with peers. In heterosexual sample basis were communicative problems related to particular personality features of some part of the control group. Gender-variance by itself cannot be regarded as an obvious sign indicating the development of homosexuality. In some cases it is a sign of congenital determinants that lead to the same sex sexual attraction, and in others this is only contributing personality characteristics facilitating under certain circumstances occurrence of erotic attachments to persons of the same gender.
Pediatrician (St. Petersburg). 2014;5(3):134-137
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