Vol 9, No 6 (2018)

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.

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.

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 1^st group (n = 167) halothane was used at concentration of 0.3 vol%, in the 2^nd 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 2^ndgroup, 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.

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.

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.

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.

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.

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.