Vol 8, No 6 (2017)

Patients with secondary pyelonephritis have a high risk of developing chronic renal failure and a decline in the quality of life already in childhood. This pathology is prone to chronization, recurrence and progression with the formation of nephrosclerosis and the development of CRF, leading to disability of the body and requiring extraordinary interventions. Annually in the world among children it is fixed about 50 million cases of infection of urinary ways. In an open, prospective comparative study, the results of the analysis of the outcomes of the therapeutic and prophylactic efficacy of various therapies are presented in 85 children aged 4-15 years with chronic dysmetabolic pyelonephritis. Objective: to develop the principles of secondary prevention of chronic dysmetabolic pyelonephritis in children. Patients were divided into 2 groups depending on the method of treatment. 1 group consisted of 48 patients who used conventional methods of treatment. Group 2 consisted of 37 patients with children who received complex therapy: regional lymphotropic antibiotic therapy + electrophoresis with 0.5% euphillin. The results of our studies showed that after the conventional treatment there was no positive dynamics of the studied indicators of the functional state of the kidneys. A comparative assessment of the results of the study of the functional state of the kidneys and indices of endogenous intoxication showed a high efficiency of the combined use of regional lymphotropic antibiotic therapy + electrophoresis with euphyllin. Complex treatment, recommended by the authors, promotes renoprophylaxis: prevention of frequent recurrence of the disease and development of renal failure.

One of the main tasks of the national healthcare is to increase the accessibility and quality of medical care to the population. One way of assessing the quality of care is to study patient satisfaction with medical care through sociological research. The degree of patient satisfaction reflects not only the social effectiveness of medical organizations, but also the work of all health systems. The bulk of medical care a child receives in the conditions of the polyclinic. Parents, being legal representatives of the child, can objectively assess the quality of medical care provided to them in the children's polyclinic, and, if necessary, protect his legitimate interests. With a view to identifying the main causes of the dissatisfaction of the child population of Saint Petersburg by the accessibility and quality of ambulatory-polyclinic care, the anonymous questionnaire of 1488 parents of children receiving the medical care in outpatient polyclinics was conducted. It found that in children's polyclinics parents often face difficulties when calling the doctor home, visiting a pediatrician and subspecialties doctor, passing medical examinations and procedures. Parents were not always satisfied with the preventive activities and sanitary and hygienic condition of the polyclinic. There are cases of inattentive and mistreatment by medical personnel. In General, over half (53.2%) parents have remained completely unsatisfied or not fully satisfied by the quality of provided ambulatory-polyclinic care.

Chronic obstructive pulmonary disease (COPD) is a common disease involving the pathological process, of bronchopulmonary and cardiovascular systems. This is a complex disease in which inflammation plays a leading role in the formation of the whole complex of pathological changes. COPD accompanies local deficit of antiproteases, excessive formation of active forms of oxygen, inducing uncontrolled lipid peroxidation and oxidative stress. An increase in the level of proinflammatory cytokines, such as IL-6, IL-8, TNF-α, is particularly significant in the combination of chronic obstructive disease with metabolic syndrome. Determination of a specific phenotype of COPD, and the degree of disruption of protective and adaptive systems in these forms of the disease course allows optimizing the treatment regimens for patients. The purpose of this work was to identify additional biochemical and biophysical markers of phenotyping and monitoring of therapy in patients with COPD of different phenotype and severity level in the acute stage on the basis of studying the main indicators of the system of antioxidant protection of blood and some cytokines. Significant differences in antioxidant system (AOS) indices in patients with COPD of different phenotype and severity were determined. The established differences in the activity of erythrocyte enzymes and the overall antioxidant activity of blood plasma can serve as an important additional link for the phenotyping of COPD. Complex treatment with the use of anticoagulants, normalizing the rheological properties of blood and mucolytics with pronounced antioxidant properties, reduces the level of prooxidant load on the body due to correction of metabolic processes and has the most pronounced effect on AOS blood parameters and cytokine profile.

Research objective: to prove the potential use of Trans spinal direct current stimulation for treatment of brain systems functioning disturbance attached with regulation of vasal tonus. Identify the most effective localizations and exposure regimens, so that in the future they can be used purposefully, for the treatment of cerebral blood flow disorders.

Materials and methods. 38 children aged 4-12 years were examined who were treated with TSDCS and who had EEG at the beginning of the course of treatment – signs of hemolytic dysfunction with ICD-10 diagnoses as mental retardation (F70-F79), disorders of psychological development (F80-F89) or as behavioural and emotional disorders with onset usually occurring in childhood and adolescence (F90-F98). The following examinations were performed: an electroencephalogram, a neurological examination. The trans spinal direct current stimulation was carried out by a constant current of 100-200 μA, during 30-40 min. At the same time, the cathode was located lateral from the spinous process of the seventh cervical vertebra C7, and the anode counterlaterally to the cathode in the lumbosacral region at the level of the spinous processes L5-S1. A total of 3 to 5 sessions of TSDCS were conducted. A repeat EEG examination with the determination of Hemolucleodynamics Coefficient (HC) was performed 7-10 days after the last TSMP session.

Result. After the course of TSDCS, all patients significantly decreased the HC score. In 27 patients (71%) patients, HC decreased to the norm value (≤1,2). In 23 patients (29%), HC values corresponded to the first degree of hemolytic dysfunction.

A complex study of clinical and laboratory pathogenic features of cerebrovascular disease has been performed in rats using two experimental models: local ischemia with cerebral infarction and global ischemia caused by acute or chronic impairment of cerebral circulation without verified site of brain damage. A pronounced difference has been demonstrated between the two studied models of cerebral impairment. The development of brain damage site constituting 20-30% of the total cortex of the impaired hemisphere was demonstrated to be accompanied by a considerable increase of basic nervous tissue damage markers (neuron-specific enolase, S100β-protein), development of endothelial dysfunction and hemostasiological disturbances. Irreparable cerebral circulation impairment by ligation of carotid arteries was followed by considerably lower lethality in the experimental animals, neurospecific markers’ moderate dynamics but however side by side with pronounced and inadequately compensated manifestations in the hemostasis system and vascular endothelium caused by brain hypoxia.

Cognitive impairment (CI) is a major health problem in the modern world in connection with the trend of increasing life expectancy and noticeable increase in the number of elderly people with CI and dementia. Therefore research aimed at finding and studying potential biomarkers predicting higher risk of developing CI and vascular dementia is a high priority. The study includes 207 patients (106 men and 101 women at the age of approximately 60 years. The main group includes 162 patients and there are 45 healthy individuals in the control group without clinical signs of atherosclerotic lesions, but with risk factors of their development. Patients with CPR level exceeding 10 mg/L were not included in the study. Patients with isolated and multifocal atherosclerosis of the coronary and cerebral pools have been compared by indicator of subclinical inflammation – CRP and assessment of neuropsychological test MMSE. The obtained results testified to the presence of inflammatory component in the pathogenesis of CI: the concentrations of CRP were significantly higher in patients with a low MMSE score (multifocal) than patients with higher scores of neuropsychological testing (isolated). Thus inflammation, potentially contributing to the atherosclerotic process is the basis of the relationship between high levels of CRP and cognitive impairment. At the early stages of the disease, with isolated forms of atherosclerotic vascular lesions of the heart and the head rise of CRP level can be considered the indicator of CI. With severing of the disease and the involvement of coronary and cerebral pools an increase the concentration of CRP follows. After that we have revealed a negative correlation of CRP with a marking score of cognitive function on a MMSE scale in these pathologies, i.e., the level of CRP can serve as a biochemical predictor of cognitive impairment. The obtained results indicate a significant role of CRP, its identification and monitoring can be the basis for the prevention and early diagnostics, it will also reduce the risk of severe CI, thereby maintaining higher quality of life of patients.

Diet therapy, in most cases, is the first stage of treatment of diseases of the gastrointestinal tract. Especially, this question remains relevant in patients suffering from functional gastrointestinal disorders. The irritable bowel syndrome is one of the most common of functional gastrointestinal tract disorders in the population. The Rome criteria IV are basic recommendations for the diagnosis and treatment of functional gastrointestinal disorders in patients of different ages. The diet with a reduced content of fermentable oligosaccharides (fructans and galactans), di- (lactose), monosaccharides (fructose) and polyols (FODMAP) is recommended by current international consensus for patients of different ages with irritable bowel syndrome. The article presents current findings on the low-FODMAP diet effect on the clinical manifestations of irritable bowel syndrome. The elimination of various foods in the diet of patients with different clinical variants of irritable bowel syndrome according to the low-FODMAP diet scheme leads to a decrease in gassing and normalization of contractile activity of the intestine. It significantly reduces the frequency of exacerbations of the disease and improves the quality of life of such patients. A number of clinical studies using the low-FODMAP diet in adult patients and children with irritable bowel syndrome are presented. It is concluded that further clinical studies to study the effectiveness of the low-FODMAP diet in patients with irritable bowel syndrome are needed. Especially this issue remains relevant in pediatric practice.

Complete care of a patient is important in palliative medicine. The necessity of nutrition support is determined by the severity of nutritive, trophic deficit, features of diseases which can cause (or which have already caused) protein-energy deficiency. Nutritive support is a multidisciplinary problem: it concerns not only a dietitian and an intensive care specialist but also a surgeon, a gastroenterologist, an oncologist, a dentist and other specialists who face patients unabled to satisfy their needs by physiological way. The feeding using gastral tube or gastrostomy should be special because oral cavity is switched off the nutrition. Efficiency of treatment rises while adapting enteral nutrition to specialties of digestion and metabolism in various types of pathology. Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake, chronic neurological or mechanical dysphagia or gut dysfunction and in patients who are critically ill. Enteral nutrition is often used for children as well as for adults. Children may require enteral feeding for a wide range of underlying conditions, such as for malnutrition, for increased energy requirement, for metabolic disorders and also for children with neuromuscular disorders. Two main steps help to solve the problem of malnutrition: choosing the composition of formula and choosing the way to deliver the formula. This article gives a specification in using various feeding formulas according to different diseases and describes different ways to deliver the formula (from gastral tube to gastrostomy). If swallowing reflex is absent the formula should be delivered directly to stomach. The best way for a long-term or permanent nutrition support is feeding using gastrostomy. This article describes some surgical aspects of different types of gastrostomy from classical one to modern percutaneous endoscopic gastrostomy.

The article analyzes the role of rational and rational conscious components in difficult life situations assessment (DLS). Such indicators as meaningful goals, satisfaction of life process and its result, as well as the concept regarding life controllability are referred to the rational conscious aspects. As irrational conscious aspects there are studied indicators of irrational attitudes and religious commitment. The authors have verified the hypothesis about various roles of these indicators in cognitive assessment of difficult life situation of adults who are close relatives of a child who suffers from a serious life threatening disease. Based on the study works there have been a conclusion that a more satisfactory situation assessment more often correlates with higher indicators of life meaningfulness in case of refusing from irrational attitudes. However, in certain cases actualization of irrational attitudes in combination with the emerged religious commitment can be connected with the feeling of encouraging situation clearness (particularly, in cases of elder subjects who are relatives of elder children). The feeling of insolubility of the situation can be accompanied with the disappointment in religion and actualization of obligation towards oneself. In general, religious commitment of a person does not correlate with the felling of controllability of life, but it can reduce the severity of situation experience. The significant factor in perception of the situation severity, connected with the meaningfulness indicators and irrationality, is the age of a child.

The research activity of M. Wilms is characterized by diversity of its objects and breadth of breadth of its scope. A surgeon-oncologist, he is known to have devoted a number of his studies, to purely theoretical issues of Oncology. On the other hand, M. Wilms contributed to the development of clinical surgery and Oncology, offering a number of new methods of diagnostics and treatment of major forms of malignant tumors of the genital organs and kidney, making a significant contribution to the practice of world medicine. Classical studies of teratogenic tumors of the ovaries and testicles, mixed tumors, tumors of kidney belong to M. Wilms. The tumor described by M. Wilms in 1899 which is named after him is one of the most frequent malignancies in children usually occurring at the age of 2-5 years but which can also occur at any age, even in very old patients. In the same year his famous monograph “Mixed tissue tumor of the kidney” was published. In 1904 M. Wilms was awarded the title of Professor, and two years later he published his fundamental work “Intestinal obstruction – pathology and clinic” (1906), which brought M. Wilms fame and recognition among surgeons, oncologists and pathologists all over the world. M. Wilms also made contribution into pediatric surgery. In 1906 he proposed to classify the intussusception types, depending on the name of the colon which forms the intussusception head (the iliac colon, caecum, etc.). Analyzing the etiology of Hirschsprung's disease Max Wilms is known to have adhered to the theory of prolonged spasm of the anal canal and, consequently, to inception of secondary megacolon (1904). His assumptions he confirmed by performing manometric studies at the level of the anal canal of the rectum, and in the treatment he applied the method of anal bougienage. A talented scientist and teacher, demanding and fastidious towards himself and his disciples, Max Wilms published more than 130 research papers, of most of which he was the sole author.