Vol 10, No 3 (2019)

Assessment of adaptation of infants born with different types mild intrauterine growth and development retardation
Ivanov D.O., Derevtsov V.V., Serova N.P.

Objective. To estimate adaptation of an organism of the babies born with different types of light severity of a delay of pre-natal growth and development.

Material and methods. 609 children are examined. Since the birth under observation 141 children, from them are born in the result of the complicated pregnancy and childbirth, including with asymmetric type of light severity of a growth inhibition and development of a fruit – 57 (Group 1a) and with symmetric – 15 (Group 1b) and without that – 69 (Group 2) from mothers with the burdened somatic and obstetric and gynecologic anamnesis. Children are full-term, mature, looked round in 1 (131), 3 (118), 6 (109), 12 (110 children) months. Outcome recording methods were a comprehensive case history analysis, physical examination, assessment of cardiointervalography and body adaptation to the environment. Distribution-free statistical analysis methods.

Results. At children in Groups 1a and 1b satisfactory adaptation of an organism to conditions of the environment took place at the birth of 28. 07 and 26. 67%, in 1 month of 32. 69 and 35. 71%, in 3 months of 31. 11 and 25%, in 6 months of 51. 16 and 46. 15%, in 12 months of 48. 78 and 36. 36%. Tension and an overstrain of adaptation is recorded at 22. 81 and 40%, 36. 54 and 28. 57%, 33. 33 and 41. 67%, 30. 23 and 23. 04%, 19. 51 and 18. 18%. Unsatisfactory adaptation is defined at 42. 11 and 13. 33%, 21. 15 and 21. 43%, 24. 44 and 16. 67%, 11. 63 and 23. 04%, 21. 95 and 18. 18%. Failure of adaptation is revealed at 7. 02 and 20%, 9. 62 and 14. 29%, 11. 11 and 16. 67%, 6. 98 and 7. 69%, 9. 76 and 9. 09% of children respectively.

Conclusion. Study of characteristics of body adaptation to the environment in the scientific community is a perspective area, and any practical application (starting with perinatal centres) of assessment of body adaptation to the environment with follow-up groups identification and further determination during critical periods of growth and development (outpatient monitoring) justify patient-specific approach to outpatient follow-up of infants born with different types of mild intrauterine growth and development retardation.

Pediatrician (St. Petersburg). 2019;10(3):5-16
Original studies
Vitamin D and neurospecific proteins in children with inflammatory demyelinating diseases of central nervous system
Bukhalko M.A., Skripchenko E.Y., Alekseeva L.A., Skripchenko N.V., Monakhova N.E., Grigoriev S.G.

The relevance of studying the provision of vitamin D in children with inflammatory diseases of the central nervous system (CNS) is due to a high prevalence of vitamin D deficiency conditions in children population, which, according to current literature data, leads to the imbalance of the immune system and a predisposition to a severe disease course, chronization of the process, development of autoimmune pathology. The study of the concentration of neurospecific proteins (NSP) in blood serum and cerebrospinal fluid (CSF) has been recently used to analyze the degree and nature of nervous tissue damage in case of various CNS diseases. The study included investigation of blood serum and CSF samples obtained from 107 children (34 – with encephalitis, 28 – with disseminated encephalomyelitis (DEM), 20 – with multiple sclerosis (MS), 25 – control group). Determination of vitamin D levels (25(OH)D) was performed by the method of electrochemiluminescence immunoassay, concentrations of myelin basic protein, neuron-specific enolase, S100 protein and glial fibrillary acidic protein – by ELISA method. A decrease in the concentration of vitamin D under 30 ng/ml was found in 95% of children with inflammatory diseases of the central nervous system, while the severity of the deficiency of 25(OH)D was associated with the severity of the disease course. In the early stages of the disease in all groups, a significant increase in the level of the main myelin protein was found, while an increase in the concentration of other NSP was observed less frequently and was associated with a severe and complicated course of the disease. Correlations of different intensity and direction between NSP and 25(OH)D were found, which indicates their importance in the pathogenesis of inflammatory diseases of CNS.

Pediatrician (St. Petersburg). 2019;10(3):17-24
Psychometric assessment of chronic pain syndrome in juvenile idiopathic arthritis
Santimov A.V., Chasnyk V.G., Grechanyi S.V.

Background. Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease of childhood. Chronic pain is one of the most frequent and difficult to objectively assess symptom of JIA. The influence of psychosocial factors on the severity of pain complicates the objective assessment of pain syndrome in JIA, necessary to assess the control of the disease and raises the question of the possible use of psychological questionnaires to objectify pain in patients with JIA.

Aim: to assess the intensity of pain syndrome, the level of social disadaptations, description of sensory and affective components of pain in patients with JIA, depending on the activity of the disease and the presence or absence of chronic pain syndrome.

Materials and methods. 147 school-age patients with verified diagnosis of JIA were examined. All patients included in the study underwent a traditional rheumatological examination with the assessment of disease activity according to the criteria of the American College of rheumatologists for pediatric patients. The severity of pain syndrome on a visual analog scale (VAS) from 0 to 10 was determined separately by patients and their parents, patients independently filled in the Von Korff Questionnaire and the McGill pain questionnaire.

Results. There were no differences in the severity of pain syndrome between patients with signs of arthritis activity and without signs of arthritis activity according to VAS, Van Korff and McGill questionnaires.

Conclusion. On the example of the studied patients, it is not possible to link chronic pain syndrome in JIA with the activity of arthritis. It is necessary to further study the possible causes of chronic pain syndrome in children with JIA, including anxiety and depressive disorders for a better understanding of the nature of chronic pain and search for additional methods of its treatment.

Pediatrician (St. Petersburg). 2019;10(3):25-30
Causes of violation of vaccination schedule in young children
Chernova T.M., Timchenko V.N., Myskina N.A., Lapina M.A., Orekhova A.E., Kanina A.D.

The high frequency of severe and complicated forms of infectious diseases in young children, with the possibility of death, confirms the importance of timely specific protection of this age group. In order to identify the causes of violation of the terms of vaccination of young children, 469 histories of children from 0 to 12 months of life were studied. The analysis showed that only 77% of the observed children in the first year of life were vaccinated according to the immunization schedule, whereas in 23% of cases, violations of the vaccination status were found. In 45% of children, the time of immunization was violated already at the stage of the maternity hospital: only every fifth child was not vaccinated because of health reasons, while 79% of children did not receive prophylactic vaccinations due to the mother’s refusal. Medical abductions prevailed in the structure of violations of vaccination terms in the сhildren’s оutpatient: 39% of children were vaccinated with deviations from the schedule due to temporary contraindications, 22% were vaccinated later than terms due to unreasonable medical leads. In 39% of cases of violation of vaccine status is associated with a misunderstanding of the parents of the risk of infectious diseases and the effectiveness of the child’s protection through immunization. Of these, 22% of children were denied, 10% of children were vaccinated with a significant delay, 7% of children did not reach the сhildren’s оutpatient during the year without an explanation of the reasons. Thus, the analysis showed that the majority of the observed children (57%) did not receive timely protection against infectious diseases due to attitudes towards vaccinations of parents, 43% of children were not vaccinated due to medical abductions.

Pediatrician (St. Petersburg). 2019;10(3):31-36
Tuberculosis infection in children with negative reactions to the diaskintest
Yarovaya Y.A., Lozovskaya M.E., Klochkova L.V., Vasilieva E.B., Stepanov G.A., Mosina A.V.

Variants of the course of tuberculosis infection in 54 children from two to 14 years old, negatively reacting to a sample with an allergen tuberculosis recombinant (Diaskintest) were analyzed. There were 3 groups: 1st – 27 children infected with Mycobacterium tuberculosis (MBT), 50. 0% of cases; 2nd – 16 children with newly diagnosed residual post-tuberculosis changes (OPTI), 29. 6% of cases; 3rd group – 11 patients with active tuberculosis, 20. 4% of cases.

Methods of examination: intradermal Mantoux test with 2TE and Diaskintest, according to the testimony of a number of patients in vitro tests: QuantiFERON test (QFT), – SPOT test.TV, multispiral computed tomography, bacteriological, molecular genetic methods of investigation on MBT. The method of mass tuberculin diagnostics revealed 70. 4 ± 8. 8% of children of the 1st group, 93. 8 ± 4. 7% of the 2nd group and 54. 6 ± 15. 0% of children of the 3rd group. The duration of infection with MBT in children was different and was less than 1 year in children of the 1st and 2nd groups – 51. 9 ± 9. 6% and 43. 8 ± 12. 4% of cases, respectively, which was significantly more frequent than in patients of the 3rd group (18. 2 ± 11. 6% of cases). Tuberculosis disease occurred in the form of complicated forms of the primary period-in 45. 5 ± 15. 0 % of cases, uncomplicated forms – in 27. 3 ± 3. 4% of cases, generalized lesions – in 27. 3 ± 13. 4% of cases. Diagnosis of a specific lesion occurred equally in the manifest phases of inflammation: infiltration, infiltration and decay (45. 5 ± 15. 0% of cases), and in the phase of ongoing reverse development (incomplete calcination – in 45. 5 ± 15. 0% of cases), one child had a combination of infiltration and calcination phases (9. 1 ± 8. 7% of cases). Residual posttuberculosis changes in children of group 2 were more often formed in the form of calcifications in the organs of the thoracic cavity – in 87. 5% of cases, in 12. 5 ± 8. 3% of patients OPTI was formed by the formation of seals.

Conclusion: in children with negative reactions to the Diaskintest requires individual comprehensive diagnosis of tuberculosis infection.

Pediatrician (St. Petersburg). 2019;10(3):37-44
Navigation template for vertebral pedicle passage in transpedicular screw fixation
Kosulin A.V., Elyakin D.V., Lebedeva K.D., Sukhomlinova A.E., Kozlova E.A., Orekhova A.E.

Transpedicular screw fixation is the most established means to stabilize the spine. Present study evaluates personalized navigation templates application for vertebral pedicle passage. Navigation templates were used for inserting 35 transpedicular screws in 5 patients with spinal deformity (age 2–16). Each patient underwent computed tomography preoperatively. Acquired data was processed into a virtual 3d-model of target zone. Life size virtual pedicular probes were placed onto transpedicular trajectories determined on multiplanar cross-sections of the model. Navigation template was created by modification and union of geometric primitives. Target zone model and navigation template were made with PLA by 3D-printer. In surgery the template was placed on skeletonized posterior surface of appropriate vertebrae. After confirmation of template stability trajectories were passed to a depth of 20 mm through guiding tubes by pedicular probe. Resulting channels were controlled with ball tip feeler, and the full depth trajectories were made by free hand technique. Postoperatively screws placement accuracy was assessed by plain X-rays in each patient. Two patients (16 screws) also underwent computed tomography. In these patients screw placement accuracy was assessed by system based on 2 mm breach increments. 15 screws (93. 7%) were fully contained within the pedicle (grade 0), 1 screw breached external cortex of the pedicle by 0. 8 mm (grade 1). Efficacy and safety of navigation template for transpedicular screws insertion was demonstrated.

Pediatrician (St. Petersburg). 2019;10(3):45-50
Computer diagnostic features combining different types of radiographs of the maxillofacial area
Subbotin R.S., Puzdyreva M.N., Fomin I.V., Fishchev S.B., Kondratyuk A.A.

The introduction of new digital technologies into clinical practice and the improvement of X-ray equipment made it possible to widely use the method of cone-beam computed tomography and other X-ray methods of research. However, it is necessary to improve diagnostic methods by combining different research methods.

Aim. Improvement of the method of investigation of the spatial arrangement of elements of the temporomandibular joint and medial incisors of the upper and lower jaw.

Materials and methods. The study analyzed teleroentgenogram in the lateral projection and computed tomography of 292 people with no signs of organic pathology of the maxillofacial region. Generally accepted in orthodontics morphological points and anatomical landmarks were used.

Results. The proposed method of combining computer tomography mandibular joint and medial cuts antagonists with teleroentgenograms of the head in lateral projection. The main reference points were the C points at the top of the articular process and the auditory passage of tomograms, which were combined with respect to the craniocerebral horizontal. When applying tomograms cutters guidance was conditional median vertical cutters, which were combined with lines forming mezhrassovyy angle teleroentgenogram, as well as the front vertical face (NPg), and the period Pg.

Conclusion. The study proposed matching algorithm telerentgenogram and some portions of the tomograms of the temporomandibular joints and the medial incisors in the occlusal relationship.

Pediatrician (St. Petersburg). 2019;10(3):51-56
Disturbance of food behavior as a predictor of obesity and metabolic syndrome: is possible prevention?
Bulatova E.M., But’ko P.V., Shabalov A.M.

Relevance of the study. Eating disorders in children in early childhood are among the leading causes of obesity and the metabolic syndrome. The aim of the study. For the prevention of noncommunicable diseases (obesity, metabolic syndrome) in the future, to carry out the analysis of actual nutrition of children of early age and to identify unfavorable factors influencing the formation of eating behavior.

Materials and methods. A survey of 297 parents with children aged 1 to 3 years. The survey is based on the Google Form on-line platform. The platform for the survey was the social network VKontakte, in particular, thematic groups for mothers with children from 1 to 3 years old. The questions were developed taking into account the recommendations set out in the modern normative documents on children’s nutrition.

Results. According to the data, only 28% of children had 5 organized meals per day, 51% had 4 feedings per day, 21% had 3 feedings. More than half of the children (52%) had 2 snacks per day. The most common snacks were flour products (30%), as well as vegetables and fruits (27%). Most parents (78%) did not pay attention to the design of dishes, 16% did not provide adequate replacement of dishes that the child refused. It should be noted that 12% of children do not like vegetables. A joint meal was not organized in 7% of families. During the meal, 40% of parents and 23% of children used a TV/tablet/smartphone. There are a large number of families (37%) who visit fast food restaurants (fast food) with young children, while 26% of them offered menu items to children.

Conclusion. Identified adverse factors in the formation of eating behavior require changes in the approaches to monitoring a young child on nutritional issues both by a pediatrician and by the implementation of a number of recommendations by parents.

Pediatrician (St. Petersburg). 2019;10(3):57-61
Peculiarities of the heart rate variability at patients with acute disorder of cerebral circulation depending on localisation of ischemic damage
Nikolaev V.I., Denisenko N.P., Brega A.V., Denisenko M.D.

Features of the heart rate variability at patients with acute disorder of cerebral circulation depending on localisation of ischemic damage and type of hemodynamics were studied in acute period of disease and in a condition of relative functional rest. Surveyed men and women (30–55 years old) were divided into 3 groups: patients with ischemic damage to the area of the left average brain artery, right average brain artery and with ischemia in vertebro-basilar department. According to indicators of the integral rheography of the body which was carried out in the acute period of a disease, patients of each group were divided into subgroups depending on hemodynamics type – with hyper dynamic, hypo dynamic and normo dynamic type of blood circulation. It was revealed that the highest activity of sympathetic link of regulation and also higher values of the index of tension and the index of vegetative balance characterized patients with ischemia in the area of right average brain artery and hyper dynamic type of blood circulation. The indicator of activity of regulatory systems characterized “overstrain of regulatory mechanisms” and also “exhaustion of mechanisms of regulation” at patients of this group in the acute period. However upon repeated examination 7 days later revealed the significant reduction of the values of the indicator of activity of regulatory systems. Similar indicators of the heart rate variability were found at patients with ischemic damage in the area of right average brain artery and normo dynamic type of blood circulation. Thus, it was detected that the greatest disorders of regulation of the cardiovascular system were characteristic of patients with ischemia in the area of right average brain artery both hyper dynamic and normo dynamic blood circulation types. Activation of parasympathetic and suppression of sympathetic link of regulation were noted in all patients on the seventh day of hospital stay regardless of localisation of ischemic damage and type of hemodynamics.

Pediatrician (St. Petersburg). 2019;10(3):63-69
Expression of bovine leukemia virus antigen in breast cancer tissue
Nasyrov R.A., Shramko A.D.

Breast cancer is a serious medical and social problem for most developed countries of the world. The search for new prognostic factors and targets for targeted therapy currently continues to be a pressing issue, as there are forms of breast cancer with uncertain targets for any type of therapy. The purpose of this work is to conduct an immunohistochemical study to detect and evaluate the expression of the antigen of the cow leukemia virus in the tissue of various types of breast cancer.

Method. 100 cases of breast cancer were investigated, divided into subgroups, the studied parameters: steroid hormone receptors, HER2 / neu, VEGF, BLV expression, molecular genetic research on BRCA1/BRCA2 mutations.

Results. In the group of triple negative breast cancer, 4 cases were detected expressing a cow leukosis virus antigen. Expression was represented by grains and clumps in the cytoplasm and on the surface of the tumor cell membrane, the wall of microvessels. Also in these cases, increased expression of VEGF was detected.

Conclusion. The results indicate that expression of the BLV antigen was observed only in cases of poorly differentiated triple negative breast cancer. It is also noteworthy that the same type of BRCA1 gene mutation (5382insC) and increased expression of vascular endothelial growth factor were detected in these tumors. The authors first used the immunohistochemical method for detecting the antigen of the BLV virus, which made it possible to reliably confirm its presence in breast tumors with similar molecular genetic and immunohistochemical profiles.

Pediatrician (St. Petersburg). 2019;10(3):71-74
Efficacy evaluation of closed reduction of fifth metacarpal neck fractures in children
Zhila N.G., Semenov S.J., Komarov K.M., Komarov P.B., Dumitrash V.G., But’ko P.V., Shabalov A.M.

This article covers the retrospective analysis of the results of treatment of 47 children aged 9 to 17 years with V metacarpal neck fractures, based on the data of radiation studies. The treatment of fifth metacarpal neck fractures, without reduction, does not have a reliable positive result. At large angles of deformity of the V neck of the metacarpal (>45°), the use of closed reduction leads to a significant positive therapeutic effect in the immediate observation period. However, from our point of view, the persistence of the displacement V metacarpal bone with sufficiently large degree in certain cases and the presence of posttraumatic changes in the structure of the heads, subcapital and growth zones in the observed patients cannot satisfy specialists from the standpoint of modern children’s traumatology. Thus, changes in the structure of the heads and subcapital zones in the long-term radiological control of the group were found in 11. 1% of patients who were treated without reduction with a stabilizing plaster cast and in 55% of patients who underwent closed reduction of the metacarpal fractures. The predominance of the narrowing of the growth zone of the injured V metacarpal bone occurs in patients who undergo a closed manual reduction, which may be due to the traumatic effect on the physical zone of the primary force or reduction manipulations. All this indicates the feasibility of further scientific research of this problem with the prospect of developing therapeutic technologies that allow to achieve a complete anatomical reposition of the metacarpal bones in pediatric patients.

Pediatrician (St. Petersburg). 2019;10(3):75-79
Revision procedures in bariatric surgery
Yashkov Y.I., Sedletskiy Y.I., Vasilevskiy D.I., Tsvetkov B.Y., Krichmar A.M.

Searching the optimal options for reoperations in overweight patients has the same lengthy and difficult history as all bariatric surgery. The key issues of this aspect of obesity surgery are inefficiency (inadequate weight reduction or it regain) and the unavoidable complications of conservative methods and the negative effects of primary surgery. Weight regain after bariatric surgery is a multicomponent problem. The main reason for the unsatisfactory results of surgical (and conservative) treatment of obesity in some patients is the nature of obesity – the lifelong chronic recurrent disease. A certain role in the return of excess weight is played by the imperfection of the currently existing surgical procedures for the correction of overweight, as well as the wrong choice of options for surgical interventions and technical errors in their implementation. Increase the number of worldwide operations for obesity and its associated diseases translates the problem of revision bariatric surgery from the category of narrow questions in this field of medicine into a serious problem. The article describes modern approaches to the surgical treatment of re-gaining weight after bariatric operations. It considered options for audit procedures, depending on the previously performed surgery. Original techniques of repeated operations for effective correction of the relapse of overweight are described in article.

Pediatrician (St. Petersburg). 2019;10(3):81-91
Pathogenesis of acute hemorrhage syndrome
Vasiliev A.G., Haitsev N.V., Balashov A.L., Balashov L.D., Kravtsova A.A., Trashkov A.P., Pakhomova M.A.

Circulation blood volume reduction, vascular tone change and decreased cardiac output are the three major factors constituting the acute hemorrhage syndrome pathogenesis that has originally been referred to as “hemorrhagic shock”. Vascular trend with secondary redistribution of the blood volume and following microcirculatory changes as well as the cellular one with principal metabolic modifications are considered to be the leading ones in the development of shock. After the establishment of the leading role of acute hypovolemia and anemia this phenomenon has been labeled “acute posthemorrhagic anemia syndrome”. The development of polyorganic insufficiency syndrome after acute hemorrhage is to a great extent associated with oxygen transport disturbance due to circulatory hypoxia and to a lesser one — with haemic hypoxia due to circulating red blood cells and hemoglobin deficit. Profound tissue metabolism disorders persist even after central hemodynamics and microcirculatory perfusion restoration thus considerably decreasing the nonspecific immune defense and the ability of tissues to reparation and enhancisng proinflammatory and destructive tendencies.

Pediatrician (St. Petersburg). 2019;10(3):93-100
History of medicine
V.P. Zhukovsky’s role in the development of domestic pediatrics and neonatology
Mikirtichan G.L.

Vasily Pavlovich Zhukovsky (1861–1938) belongs to Russian pediatricians who pioneered the field of pediatrics in 19th – beginning of 20th centuries and established it as an independent branch of medicine, however, his representation in modern history of medicine literature is lamentably scarce. He contributed a lot in institutionalization of pediatrics, worked out new actual problems of pediatrics. His doctoral dissertation subject was problem of rickets, a vaguely known disease in those days. V.P. Zhukovsky was one of the first to study special features in physiology and pathology in newborns, he wrote one of the first Russian manuals in neonatology “Diseases of newborn children” published in 1897. He is also the author of a special monograph “Congenital heart defects in children at birth” (St. Petersburg, 1913). He paid a lot of attention to the problems of infant mortality, especially newborn mortality; clearly raised the question of necessity of antenatal care of the fetus and of the obstetricians and pediatricians’ team working. He contributed a lot in organization of teaching of pediatrics, to amelioration of work of the children ambulatories and the department for the newborns at St. Petersburg obstetrical institution (nowadays Maternity clinic number 6 named after Professor V.F. Snegiryov), where he worked from 1897 to 1910 as one of the first Russian neonatologists. He can be by right considered one of the pioneers of Russian neonatology as he stand at the origins of new branches of Russian pediatrics such as neonatology, pediatric neurology and cardiology.

Pediatrician (St. Petersburg). 2019;10(3):101-111

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