Vol 7, No 3 (2016)

Acute respiratory infections are one of the most frequent diseases among children and teenagers around the World. Pneumonia which caused by infectious agents is dangerous disease of the lower respiratory tract that can lead to the death. The continuing high level of morbidity and mortality causes the issue. The article describes the WHO criteria for the diagnosis of community-acquired pneumonia (CAP) and CAP severity indicators, also radiographic signs of CAP and modern epidemiological data. The etiological structure of CAP has age-specific peculiarities. Streptococcus pneumoniae (S. pneumoniae) is leading causative agent of CAP, it causes invasive and non-invasive forms of pneumonia. The role of atypical pathogens (Mycoplasma pneumoniae, Chlamydophila pneumoniae) and viruses was mentioned. The etiology of CAP may vary depending on geographic area, vaccination coverage, using antibiotics. The modern methods for identification of S. pneumoniae were itemized in the article. The own identification from blood lytA gene and cpsA gene S. pneumoniae by polymerase chain reaction (PCR) frequency data was presented. Among examined patients who were hospitalized in clinic SPbGPMU in 2011-2015 years attending preschool children less than 5 years of age prevailed (which accounted for 48%). The invasive form is revealed at 34% of the patients with CAP. In this group of patients course of the disease was severity, there was complications such as pneumothorax, pulmonary edema, and pleural exudation.

One of the main causes of violations of women’s fertility is the pathology of the endometrium. Structural and functional inferiority of endometrium due to pathological inflammation, naturally leads to disruption of the implantation process and clinically infertility and prenatal losses. Finding solutions treatment of endometrial pathology exclusively relevant for the prevention of reproductive health of society. The main causes of diseases of the endometrium is inadequate hormonal regulation, acute and chronic inflammation (endometritis). Consistently high frequency CE denies membership issues to the category of banal, more kontraversii recent years postulate avoiding one-sided perception of the disease solely as a classic suppurative inflammation. For chronic endometritis is often characterized by a long asymptomatic and complexity of initial diagnosis. Important role in the development of chronic endometritis today belongs to obligate anaerobes - Bacteroides and peptostreptokokki, combined with microaerophiles and facultative anaerobic microorganisms. A special place in the development of chronic endometritis takes herpes infection. Its prevalence in all, including reproductive age is quite high. Special attention is paid to the verification of chronic endometritis immunohisto-chemical (IHC) study of the endometrium. The method can not only identify the type of infectious agent, but also to establish phase process, which has an important role to determine the treatment strategy. A special role is played by immunohistochemistry in the identification of viral etiology of chronic endometritis, as this method can reliably detect the presence of antigens to a variety of viral agents.

Aim. To evaluate the efficacy of a comprehensive survey of children with bad posture by using routine method combined with the non-standard functional test.

Materials and methods. We examined 91 children with bad posture aged from 7 to 10 years undergoing treatment in a rehabilitation center. Before treatment, all children were examined using the methods of visual diagnostics and functional tests. We then conducted a nonstandard test to determine the mobility of the sacroiliac joint using computed optical topography (COMET), developed in Novosibirsk research Institute of traumatology and orthopedics. A comparative assessment of the clinical results and hardware examination methods before and after treatment was done.

Results. Using computer topographic survey revealed abnormalities in 19 children (21 %), not detected during visual diagnosis on the primary admission. Using non-standard functional test in 34 children (37 %) was first identified functional block of the sacroiliac joint. During re-examination, the positive dynamics was revealed in 68 (75 %) children.

Conclusion. The conducted comprehensive survey in children has allowed to put a correct diagnosis at admission to treatment and to monitor the dynamics during the treatment course. Use of computer optical topography in combination with a number of standard and non-standard functional tests enhanced the accuracy and objectivity of the assessment of the musculoskeletal system of the patients, including allows to detecting functional blocks of the sacroiliac joint.

As it is known, colon carcinogenesis is associated with the inflammatory bowel disease (IBD). Colorectal cancer (CRC) being observed in 5.5-13.5 % of patients with ulcerative colitis (UC) and in 0.4-0.8 % of patients with Crohn disease (CD). The gut mucosa of patients with CD, but not with UC, as well as the stroma of CRC have elevated numbers of CD68(+) macrophages. It is known also that the expression of Fas Ligand (FasL), representing another branch of immunoreactivity, in the lesions of CRC and UC but not of CD is upregulated. The fact that enterocyte apoptosis is increased in lesions of CD and lymphocytes in UC are resistant to Fas-mediated apoptosis can be the keypoint for understanding the hypothesis [17], suggesting that cells express FasL and are able to kill Fas-expressing activated lymphocytes and escape rejection by the immune system, which can be the basis for differences in association of UC and CD with CRC. The aim of this study was to evaluate the number of CD68(+) macrophages and to analyze FasL expression in colon mucosa of patients with UC, CD and CRC in order to assess its value for prognosis of CRC. Expression of CD68 and FasL was analyzed immunohistochemically in the samples of colon mucosa taken from the affected areas of 4 patients with UC, 6 patients with CD and 10 patients with CRC. In addition in 7 CRC patients the samples taken from unaffected areas were analyzed. We find average expression of FasL in both unaffected and affected areas of CRC patients was higher than in CD patients (p = 0.04, p = 0.00). Average expression of FasL in affected areas of CRC patients was higher (p = 0.02) than in UC patients and the same (p = 0.23) as in unaffected areas of CRC patients. The revealed associations support the possibility to use expression of CD68 and FasL as prognostic markers for transformation of IBD to CRC.

The increase of sympathetic activity can serve as a starting point for increase blood pressure for both humans and experimental animals. Activation of the sympathetic nervous system is important not only in the early stages of the disease but also contributes to the formation of the cardiovascular risk in life later. Comparative information about the vegetative status of indigenous people and migrants with hypertension in the Far North in a systematic scientific literature not presented. The purpose of this research was aimed for study of the dynamics of the vegetative status in patients with arterial hypertension in the Far North indigenous people and migrants. Condition of the autonomic nervous system by the residents of the Russian Far North with arterial hypertension was evaluated. The data using cardiointervalography and active orthostatic test in the indigenous population and migrants from Nadym district of the Tyumen region in the age of 18-60 years were obtained. The study involved 220 people working-age population (86 migrants and 134 indigenous peoples of the Far North). Among them are 41 patients with hypertension (26 migrants and 15 indigenous people). The average age of the surveyed migrants amounted to 40,1 ± 13,4 years for indigenous 37,8 ± 12,4 years. The duration of stay in the Far North for migrants was 14,9 ± 10,7 years. 5 options for autonomic tone, as well as differences in the autonomic nervous system disorders among migrants and indigenous peoples of the Far North with hypertension patients were installed. Violations of the autonomic nervous system for migrant are mild sympathicotonia coupled with significant impairment of vegetative support activities. It is typical for an unfavorable course of adaptation processes. For indigenous people the change reduces to a shift towards sympathicotonia without significant changes in vegetative support activities.

Purpose. To estimate the prevalence and type of disturbance of the vegetative regulation in young adults and to compare the frequency of autonomic dysfunction with the severity of the phenotypic manifestations of inherited connective tissue disorders (ICTD).

Methods. 350 young adults were examined in a clinical study (collection of complaints), and with help the special “questionnaire for detection of signs of autonomic dysfunction”. At 61 young men was performed Holter ECG monitoring and cardiovascular tests D. Ewing. Results. The average number of complaints in the group of 317 healthy students was 6.5 ± 1.7. Almost all of the complaints have found significantly more frequent in girls. Examination with help special questioning for detection of autonomic dysfunction (AD) revealed AD a bit more often in girls than in boys (79 % and 64 %, respectively). Due to gender differences, further study carried out in a group of 61 young men. Нeart rate variability and autonomic test results in the groups of young men with and without AD according to the questionnaire did not reveal significant differences. At the same time in 30 % of young men without AD according to questionnaire have found an abnormal result in the active orthostatic test (AOT). Estimation of anthropometric indices and clinical features of inherited connective tissue disorders revealed that young men with AD based on the results of the questionnaire have more of skeletal and skin symptoms than that of young men without AD. The involvement of the skeletal system was present significantly frequently in young men with abnormal result AOP than that of young men with a normal result of AOP (90% and 55% respectively, p < 0,001).

Conclusion. Our study showed that AD present in the majority of young people. However, most often both subjective and objective signs of autonomic disorders common in young people with signs ICTD.

Goal: to develop mobile application for patients with kidney stone for compliance maintenance and possible reduction of recurrence rate. Material and methods. Existing mobile applications for urolithiasis were meticulously reviewed by three groups of doctors each from different urological facilities from Saint Petersburg, Russia. Information used in our mobile application was from main urolithiasis guidelines of different urological associations. Direct application development was done by professional programmers. After application release urologist from all over the Russia were questioned about the usefulness of this product. Results. As a result of combined work application “Urolithiasis: patient assistant” was produced. Among 102 respondents 96 % evaluated this application as very useful, 3 % as useful and only 1 % considered it as a weak tool. Conclusion. Application “Urolithiasis: patient assistant” being first and single in Russian language consists of tools for compliance maintenance and plenty of other useful information regarding recurrence risk reduction and thus may be used in patients with kidney stones.

The article presents the opportunity to identify the phenomenon of microchimerism in the genes of HLA loci A, B, C, DRB1, DQB1 by PCR-SSP. The sample group consists of the mothers and newborns with intrauterine growth retardation (IUGR) (20 pairs), hemolytic disease of the newborn (HDN) (21 pairs), after external rotation of the fetus (11 pairs), from women with malignancy (1 pair), autoimmune thrombocytopenia (1 pair), tuberous sclerosis (1 pair), bradyarrhythmias (1 pair). The control group consists of 13 pairs. Of the 138 studied blood samples microchimerism was detected in 33.9 % of patients and in 19.2 % of control group. Maternal microchimerism was found only in patients with perinatal pathology and was not met in the control group. Fetal microchimerism was distributed in all studied groups, but among patients with perinatal pathology, it was met three times more frequent than in the control group (23.9 % and 7.7 %, respectively). Significantly more frequent microchimerism was found in the group of patients with HDN than in the control (p = 0.04). In the other groups the occurrence of the chimeric gene from the control group was not statistically significant

Anatomical and functional characteristics of the pancreas and its close relationship to adjacent organs, primarily duodenum and biliary tract, cause its frequent involvement in pathological process. Difficulties in differentiation of functional and organic pathology of the pancreas are associated not only with the difficulties of diagnostic of functional diseases, but also with the problems of classification and definitions. As to realities of today optimal version is one proposed by the authors of ICD 10 and found further development in the materials of the Rome III consensus - namely the Oddi sphincter dysfunction in pancreatic type. Under this diagnosis there is the possibility for logical explanation of involvement of pancreas in pathological process. The article also describes the diagnostic criteria for the Oddi sphincter dysfunction in pancreatic type, which includes clinical, laboratory and instrumental signs. It is noted that the recommended set of instrumental examination in modern pediatric practice is not only unimplementable, but just is not necessary. The usefulness of the recommended methods (including procedures that are potentially dangerous in terms of developing pancreatitis) for functional disorders is discussing. In the article the issues of nutrition of children with diseases of the pancreas, as well as the program of medical correction of dysfunction of the sphincter of Oddi in pancreatic type, are described.

Pneumonia is one of significant problems among infections of low airways in children. Morbidity of common-acquired pneumonia (CAP) continues to go in last year’s. Data available in the literature show, that pneumonia with empyema possibly associated with high risk of chronic obstructive pulmonary diseases, asthma and recurrent case of pneumonia in last life. Fatal pneumonia or developing chronic obstruction lung diseases occur mainly in children after severe and complicated forms of pneumonia, this information is presented in native and foreign literature. Currently pneumonia with the heavy and complicated current is a major cause of infant mortality or promotes development of a chronic obstruction lung diseases. Mortality from pneumonia is 3-19% according to different authors. The risk of respiratory diseases in the 3-6 months after pneumonia increased in children who underwent pneumonia. After complicated CAP the complete resolution of the inflammatory happens on 6-9 month. After not complicated САР forms at 10-30% of children radiological changes within 2-6 weeks were noted. In one research it is reported that the full recovery from slow resolving pneumonia at 96% of children has come on 6-8 month of the dispensary period. Some authors in the scientific works use immunomodulators and vaccinations to reduce the residual variation in the lungs and improve recovery time dramatically of pneumonia. In follow up study the important task is a identifying and elimination of risk factors for improvement of treatment and dispensary period for slow resolving pneumonia, recurrent case of pneumonia, sever pneumonia.

Cardiac involvement in acute and chronic infectious diseases - an actual pediatric problem. Diagnosis of myocarditis in children for general practitioners is difficult due to the lack of pathognomonic, specific only to this disease complaints, clinical and laboratory features. Symptoms of infection and myocarditis (fever, severe weakness, fatigue, shortness of breath, palpitations, headache, systolic murmur at the apex of the heart) are often the same. Many cases of myocarditis in viral and bacterial diseases remain undiagnosed, resulting in the outcome of a chronic cardiac disease. In order to increase alertness of doctors in relation to cardiac pathology at infectious diseases we have described a clinical example of heart disease when mixed streptococcal and Epstein - Barr virus infection in a 11-year-old girl. The peculiarity of this case is that the main symptom, indicating inflammation of the myocardium, was the ECG negative dynamics - the emergence of AV block of 1 degree in sinus tachycardia, whereas the level of cardiac enzymes (CK-MB, LDH) remained normal. Communication with the previous infection, the presence of one large (the appearance of pathological changes on ECG as AV block 1st degree) and two small (laboratory confirmation of infection - Epstein - Barr virus and streptococcus, tachycardia) diagnostic criteria of myocarditis, lack of valve heart disease and other major diagnostic criteria of acute rheumatic fever has allowed diagnosis of acute infection (viral and bacterial) myocarditis, focal (with a primary lesion of the conduction system of the heart). Thus, the only comprehensive assessment of complaints, clinical, laboratory and instrumental data allows to establish the diagnosis of carditis in infectious disease.

Introduction. Hypoxic-ischemic encephalopathy (HIE) in full term newborn is the most frequent courses of neonatal mortality and development of neurology handicap. Magnetic resonance imaging (MRI) is common noninvasive method for detect of post hypoxic brain lesions in newborn. Method of research. We assessed MR-pattern of hypoxic brain injury using Philips Ingenia 1.5 Tl for examination newborn on 14-16 days after delivery. Protocol of MRI scans included axial and coronal plan T1, T2, Flair weighted imaging (WI) and diffusion tensor imaging (DTI) with program Fiber tracking and detected fractional anisotropy (FA). FA was measuring within cortico-spinal tract besides. 3D reconstruction allowed to visualized white matter along the axon direction of cortico-spinal tract. Studies. Four full term newborn (after 37 weeks gestation) have been examined and separated in two groups. First group included newborns with HIE (evidence of fetal distress, low Apgar Scores, low umbilical cord pH ˂ 7.1, necessity for resuscitation and neurological signs, second group consisted term newborn without any medical and problems of health. Results of research. We detected MR-patterns of basal ganglia and thalamus lesions in newborn with HIE (abnormal high signal intensity on T1 and Flair WI). We didn’t detect any abnormal MR scans in healthy newborns (control group). FA within cortico-spinal tracts besides (total and ROI-1) were lower in newborns with HI then in healthy ones. Conclusion. This investigation showed common MR patterns of brain lesions in full term newborns with HIE which included changes of signal intensity T1 and Flair from basal ganglia and thalamus as well as reduction of FA within cortico-spinal tract.