卷 11, 编号 3 (2020)

The coronavirus pandemic (COVID-19) has become a challenge to higher education worldwide, affecting roughly over 90% of the student community. Due to the pandemic issues, it was essential to adjust the educational process to changing circumstances. Efforts to curb the spread of the disease, including social distancing and self-isolation, have led to the need of initiating a new approach of education and developing effective communications in medical education with the organization of online education from 23.04.2020. The Saint Petersburg state pediatric medical University of the Ministry of health of Russia has adopted the Discord platform for distance learning. Training courses have been organized for physicians working in hospitals that have been sorted out to operate with patients with coronavirus infection using the Moodle platform with access to register and monitor trainees as well. Instructing teachers to work in these Internet scopes required fewest time, which allowed them to switch to distance learning in due time. In order to attest the timeliness and adequacy of the response of the higher medical education system in the context of the COVID-19 pandemic, in this article, the experience of the transfer of the Department of infectious diseases of adults and epidemiology to running educational activities in remote mode. The possibility of conducting online classes not only theoretical, but also practical in the specialties of infectious diseases and epidemiology with students, residents, postgraduates and physicians was demonstrated.

Due to the high epidemiological risk of the spread of a new coronavirus infection in March 2020 in the Russian Federation and in particular in the city of Saint Petersburg all educational institutions in the city, including medical ones, have switched to distance learning. Our article summarizes the experience of conducting practical classes in such a specific discipline as Anatomy in the conditions of distance learning for first-year students of medical higher educational institutions. The goal that should be achieved at the end of our anatomy course is to form students’ stable anatomical knowledge, and most importantly, a holistic view of the structure and function of the human body. Based on this, the main tasks that determine the direction of the pedagogical process are given, and the methods of pedagogical work used to increase the level of students’ assimilation of knowledge on human anatomy in distance learning are described. The Department of human anatomy of the Saint Petersburg state pediatric medical University uses the Discord platform, adapted by an initiative group of employees and students of the University for distance learning. At the same time, the staff of the Department believes that no matter how good the distance learning platform is, no matter how hard teachers and students try, it can not be a full-fledged substitute for normal full-time training.

According to the current prevailing narrative, the virus responsible for the COVID epidemic is exceptionally deadly and contagious – possibly as deadly, contagious and dangerous as the 1918 “Spanish flu” – and, in the absence of prolonged lockdown measures, has had the potential to kill a million or more people in the USA alone. At the other end of the explanatory spectrum a counter narrative has greatly minimized the threat posed by COVID and sees little need for major public health intervention or social change. A disciplined scientific analysis suggests an additional narrative that navigates a reasonable path between fear driven prescriptions and dismissive reassurance. This middle ground narrative suggests that the intrinsic deadliness of the COVID virus is above average when compared to many of the seasonal flu viruses of the past decade, but similar to that of the 2017–2018 flu virus, which killed an estimated 61,000 people in the USA. It also emphasizes that the intrinsic deadliness of many current social arrangements has contributed to “COVID deaths” and that there is need for major social change. This article suggests that neither the narrative of fear that prescribes excessive social control, or a narrative of dismissive reassurance that disregards need for fundamental social change, are based on good science. The article raises concerns that the prolonged lockdown/re-lockdown approach is misguided and likely to cause an enormous number of unnecessary deaths – both a greater number of cumulative COVID deaths, as well as “deaths of despair,” deaths from worsening poverty and hunger, and deaths from inadequate attention for non-COVID health issues, particularly in disadvantaged communities and countries. An alternative response to the COVID epidemic is presented.

绪论这项研究的目的是建立由Z指数确定的青春期男孩的身高和体重偏差与其外周血细胞组成之间的关系。材料与方法。在常规的预防检查中测量了83名年轻男性的身体长度。根据测量结果，根据世界卫生组织2007年身高的参考值的标准计算Z指数。血液的细胞成分是用现代血液学分析仪测定的。计算Spearman相关系数，对所得结果进行统计分析。结果。通过分析血液学指标的值与Z指数所确定的体重和身体长度的偏差之间的关系，可以看出如下关系。血红蛋白浓度与身体质量指数的Z指数呈中度正相关，红细胞压积与身体质量指数的Z指数和体长呈中度正相关。血红蛋白浓度与体长Z指数呈弱正相关；红细胞数量与身体质量指数的Z指数和体长值的关系；MCV与身体质量指数的Z指数和体长。MCH、MCHC、白细胞、血小板计数与身体质量指数、体长Z指数无相关性。结论。在血色正常条件下，红细胞数量、血红蛋白含量和体长偏差的相关性得到了显示。所得的规律可以通过假设红细胞生成特征与身体尺寸之间的关系来解释。可以认为，身体质量指数较低的儿童红细胞和血红蛋白的数量较低是由于他们的身体普遍缺乏可塑性造成的。所得结果可用于鉴别和分析身体发育与内环境形态功能特征之间关系的标记物。

The dialysis department of the Children’s City Multidisciplinary Clinical Specialized Center for High Medical Technologies has been operating since 1977 and is the only specialized department in the North-West Region of the Russian Federation that provides assistance to children with both acute and chronic renal failure. Peritoneal dialysis is the treatment of choice for children with acute renal failure, the most common cause of which is hemolytic-uremic syndrome. Despite widely used measures to improve the results of peritoneal dialysis, complications are extremely common. The article analyzes the complications of peritoneal dialysis in children with acute renal failure who were treated in a hospital from 2008 to 2018. The emphasis in the study is on the analysis of complications of peritoneal dialysis, in the treatment of which the surgeon actively participated or should have taken part in. If the problem of acute renal failure is multidisciplinary in the sense that it requires the participation of nephrologists, resuscitators, infectious disease specialists, then if necessary, renal replacement therapy requires the surgeon to become not only a specialist providing “access”, but also a full-fledged participant in the treatment process. As follows from the foregoing, the surgeon’s actions depend not only on the quality of dialysis, but also the timeliness and adequacy of treatment of complications, which ultimately improves or worsens the quality of medical care in general.

The objective of the study: evaluation of the effectiveness of clinico-epidemiological and laboratory diagnostics of HIV infection in pediatric practice.

Materials and methods. Under the supervision of pediatricians of the Department of motherhood and childhood of the St. Petersburg AIDS Center, there were 388 HIV-infected children aged from one month to 17 years inclusive. Due to the reasons of late detection and HIV dissidence of parents, 18 children (4%) died cumulatively among the children observed in St. Petersburg center for AIDS. The object of the immunohistochemical study was randomly selected HIV-infected children who applied to the center for prevention and control of AIDS for return visits. Material for testing for the presence of HIV-1 P24 antigen was taken from the back wall of the nasopharynx.

Results. When analyzing the ways of HIV infection in children registered at the maternity and childhood Department of the Saint Petersburg AIDS Center, it turned out that 363 children were infected perinatally (93,6%), 23 (5,9%) sexually infected and 2 children through injecting drugs (0.5%). The proposed method of immunocytochemistry for the diagnosis of HIV infection in children can find its application, especially for primary diagnostics, which may simplify and reduce the cost of laboratory diagnostics.

The problem of meningococcal infection remains relevant due to the high epidemiological and social significance throughout the world, the unpredictability of the course, a wide range of clinical manifestations (from asymptomatic carriage to extremely severe generalized forms) with a high risk of life-threatening conditions and deaths, and a significant incidence of disability after past illness (loss of limbs, deafness, mental inferiority, and more). The changing serogroup landscape of meningococcal infection with an increase in the incidence of diseases caused by Neisseria meningitidis serogroup W, Y and others is noteworthy. The article presents an analytical review of literature and reflects current clinical, epidemiological, diagnostic and preventive trends in the Russian Federation and abroad. The review focuses on the epidemiological features of meningococcal infection, depending on the serogroup affiliation of meningococcus, the variety of clinical manifestations of the generalized form of meningococcal infection, including atypical manifestations, age-related features, depending on the serogroup of the pathogen. New diagnostic approaches and the possibilities of specific prophylaxis are highlighted. Attention is focused on the importance of monitoring the clinical and epidemiological characteristics of meningococcal infection depending on the genetic characteristics of the pathogen, and the need for further in-depth studies of this problem.

The high prevalence of hearing loss in children determines the need for reliable methods for the timely detection and diagnosis of hearing impairment at any age, starting from a birth. Otoacoustic emissions are widely used in hearing screening and audiological assessment as an objective tool for cochlear status evaluation. Over the past 30 years, their use in routine audiological assessments has increased significantly. Understanding the subtle processes that occur in the cochlea during the transmission of acoustic stimuli which generate otoacoustic emissions as well as knowledge about the registration parameters, otoacoustic emissions characteristics, otoacoustic emissions advantages and constraints are important for results analysis. Contemporary understanding of the occurrence of auditory sensations as well as the description of various types of otoacoustic emissions used in routine clinical practice (transient otoacoustic emissions and distorting product otoacoustic emissions) are presented in the review. The features of otoacoustic emissions using in pediatric practice are described: in newborns hearing screening, including the peculiarities of applying of this test for infants having had got their treatment in the intensive care units. Otoacoustic emissions significance for hearing diagnosis and as well as for ototoxicity monitoring is shown. Reliability, non-invasiveness, objectivity, simplicity of the otoacoustic emissions testing has done it one of the main methods both in hearing screening and diagnostics for children on any age.

Coronavirus infection (CVI) is a group of acute ubiquitous infectious diseases known since the 60^s 19 century. The clinical picture of CVI is characterized by damage to the respiratory system from mild forms of acute respiratory viral infection to the development of a severe acute respiratory syndrome, as well as involvement of other organs in the pathological process of the gastrointestinal tract. For a long time, coronaviruses were not given attention, since it was believed that they were able to cause only mild respiratory diseases. It is known that children and adolescents are less susceptible to infection than adults. In the etiological structure of acute respiratory viral infections among hospitalized children, coronaviruses account for 6–9%. The introduction of multiplex polymerase chain reaction (PCR) with the inclusion of coronaviruses in practice has shown their role in the occurrence of severe diseases of the lower respiratory tract. Since 2002, outbreaks of coronavirus infection caused by previously unknown pathogens (SARS-CoV, MERS-CoV, SARS-CoV-2) have been observed in the world. New coronaviruses have genetic features and are relatively highly resistant in the environment. The diseases they cause are distinguished by the predominance of severe forms with high mortality due to the development of acute respiratory distress syndrome and sepsis. In December 2019, an outbreak of pneumonia caused by the SARS-CoV-2 virus began in China; in February 2020, the disease was called COVID-2019. In connection with the trend towards the global spread of new infections March 11, 2020, the World Health Organization announced a pandemic. The lecture covers the issues of epidemiology, pathogenesis, clinic, diagnosis and treatment of coronavirus infection, taking into account the emergence of new pathogens.

The optimal time for surgery on the heart valves in patients with active infectious endocarditis (IE) is still controversial. It is a well known fact that cerebral, coronary or renal thromboembolism is the most common cause of death in patients with left-sided IE. Thromboembolism can develop before the appearance of clinical manifestations of the destruction of the valvular apparatus of the heart. Currently, early surgical intervention is considered as the most effective method of treatment of many forms of active left-sided IE. Early surgery involves performing surgical correction until the completion of a full antibiotics course. We present the clinical case of early surgical correction of the patient (A., 16 years) with mitral valve infectious endocarditis. The disease was acute, with recurrent embolisms to the right kidney with infarction and to the left clavicle with osteomyelitis. Surgical intervention was performed as a matter of urgency; surgical access – right-sided anterolateral thoracotomy. The girl was operated on the 4^th day of the hospitalization to our hospital. However, time of treatment was lost at the prehospital stage and rapid mitral valve destruction did not allow to repair the valve. Therefore, the mitral valve replacement was performed. The postoperative period was favorable. On the 3^rd day after the operation, the girl was transferred to the cardiology department. On control ECHO after 3 years: myocardial contractile function is good, EF 65%, the function of the MV prosthesis is not impaired.

圣彼得堡Valdman医学王朝的杰出代表—V.A.Valdman，他的儿子A.V.Valdman和妹妹A.A.Valdman都为俄罗斯的卫生保健做出了巨大的贡献。Viktor Aleksandrovich Valdman是Leningrad State Pediatric Medical Institute究所治疗系的创始人和第一任主任，他是一位杰出的治疗师、心脏病学家、风湿病学家，是俄罗斯医学的经典，也是波特金学院最佳传统的继承者。他和他的同事对心血管病理学进行了临床和实验研究，研究了各种风湿病的发病机理，并开发了诊断和治疗方法。V.A.Valdman在创建城市风湿病服务方面做得很大贡献，他首先在列宁格勒的大型企业建立了心脏医疗办公室，后来又成立了一家心脏风湿病学的防治所。Artur Viktorovich Valdman是V.A. Valdman的儿子，是著名药理学家，The Pavlov First Leningrad State Medical University药理学系主任。苏联医学科学院院士对研究各种药理学物质对中枢神经系统兴奋突触传递的作用机制做出了重要贡献。A. V. Valdman的一系列著作致力于情绪压力的药理学、情绪的实验研究问题及其管理方法。Alisa Aleksandrovna Valdman是V.A. Valdman的妹妹，是一名病理解剖学家，联合实验医学研究所的一名工作人员在实验动物肠道感染的副伤寒模型上研究了神经和激素调节在感染过程发展中的作用。