Vol 10, No 1 (2019)

Currently, pediatricians, neonatologists of maternity hospitals often take part in perinatal consultations. One of the indications for early delivery may be chronic placental insufficiency diagnosed during an ultrasound examination.

Objective: to evaluate the effectiveness of the main method of diagnosis of placental insufficiency at the present time – ultrasound evaluation of the placenta.

Materials and methods. An analysis was made of 357 birth histories, exchange cards, protocols for screening ultrasound in the third trimester of pregnancy and conclusions of pathoanatomical investigation.

Results. To substantiate the need for prenatal diagnosis of chronic kidney disease, a comparison was made of the evaluation of newborn babies on the Apgar scale and the state of the placenta according to histological data. With compensated chronic placental insufficiency, there was no difference in Apgar scores at the first and fifth minutes, whereas in the subcompensated stage, Apgar score on the Apgar scale was significantly lower in the first and fifth minutes than in the control group. To identify possible in practical use of the objective parameters of diagnosis of chronic kidney disease, the thickness of the placenta was measured during the screening ultrasound in the third trimester of pregnancy, as well as the thickness of the placenta after its separation. Significant differences in the thickness of the placenta or in the screening ultrasound, or when measuring the placenta after separation in patients with and without chronic placental insufficiency was not detected. When assessing a violation of the rate of maturation of the placenta in the third trimester of pregnancy, no significant differences were found in the presence and absence of placental insufficiency. An analysis of the amniotic index was carried out to determine the amount of amniotic fluid in patients of the main and control groups, which revealed no significant differences between the groups.

Conclusions. The authors believe that the main indicators currently used for diagnosis of chronic placental insufficiency (thickness of the placenta, degree of maturity of the placenta, appearance of structural changes in the placenta, change in the amount of amniotic fluid) are uninformative and modern placenography does more harm than benefit. The only parameter determined during the screening study in the third trimester of pregnancy and having significant differences in the main and control groups is fetal hypotrophy.

Relevance of the research. Intrauterine growth restriction in children is associated with an increased risk of insulin resistance and non-insulin-dependent diabetes mellitus later in life. The influence of type of intrauterine growth restriction and the mechanisms of insulin resistance are still unknown; the role of catch-up growth in this process is controversial.

The aim of the study was to identify insulin resistance in children with different types of intrauterine growth restriction and to analyze the role of catch-up growth in this process.

Materials and methods. The research involved 95 newborns, which were divided into groups based on birth weight and length: 60 newborns with intrauterine growth restriction (group I – 31 with asymmetrical intrauterine growth restriction; group II – 29 with symmetrical intrauterine growth restriction) and control group (group III) – 35 newborns without intrauterine growth restriction. Children also were divided into groups according to the presence of catch-up growth to 3 months old. The levels of insulin, insulin-like growth factor-1, growth hormone were measured in cord blood at birth and in blood serum at 3 months old. Glucose levels were measured in serum and insulin resistance index “the homeostasis model assessment of insulin resistance” (HOMA-IR) was calculated in children at 3 months.

Results. The children with intrauterine growth restrictioncompared to control group had significantly lower levels of insulin-like growth factor-1 in cord blood. The differences between types of intrauterine growth restrictionhave been observed: children with symmetrical intrauterine growth restriction had higher levels of growth hormone, insulin and HOMA-IR then in asymmetrical one. Correlations between insulin and glucose in children with symmetrical intrauterine growth restriction were absent unlike to asymmetrical intrauterine growth restriction (+0.61). The negative role of catch-up growth in insulin resistance development has been defined: it was related to hyperinsulinemia and increased the frequency of insulin resistance in children either in asymmetrical or in symmetrical intrauterine growth restriction, but more in symmetrical one.

Conclusion. Children with symmetrical intrauterine growth restriction especially with catch-up growth are at the highest risk of metabolic syndrome development in later life and require increased monitoring by pediatricians and endocrinologists.

The aim of the study was to study the frequency of postpartum hemorrhage in women with different somatotypes and to develop a method for predicting the risk of this pathology.

Materials and methods. 390 women were examined, 110 were mаcrosomatotype, 173 – mesosomatotype, and 107 – microsomatotype. Somatometry was performed according to R.N. Dorokhov for women in early pregnancy (before 9-10 weeks of gestation).

Results. It was found that postpartum hemorrhage was significantly more prevalent among the women of macro-and microsomatic body type compared with women with mesosomatotypes (p < 0.05). In the course of multiple regression analysis, we obtained a regression equation (formula) for predictive models, which predicts the development of postpartum hemorrhage in women of different somatotypes. The calculations according to the presented formula, allows to predict with high accuracy the prognosis of postpartum bleeding, and also allows to form among patients a high-risk group for the development of this disease in the first trimester of pregnancy when the pregnant woman is registered in the women’s consultation, long before delivery, which will contribute to more effective implementation of therapeutic and preventive measures to prevent the development of postpartum bleeding.

According to contemporary views, hereditary connective tissue disorders divided classified Marfan syndrome, Loeys-Dietz’s, Ehlers-Danlos syndrome, the primary mitral valve prolapse. It is known that the fibrillinopaty, which include the Marfan syndrome and Loeys-Dietz’s is characterized by activation of TGF-β signaling pathway. With high le vels of TGF-β attributed most of these clinical manifestations these diseases – aneurysm of the aorta, arahnodaktylya, duralectasy. Assessment of the activity of TGF-β in persons with marfanoid habitus has not previously been studied.

Materials and methods. As part of this work, surveyed 70 people: 61 patients young age (median age of 20.1 ± 2.1 years), among which 36 boys and 25 girls and 9 men with verified diagnosis Marfan syndrome (median age 27.9 ± 9.3 years). All survey performed Echocardiography with a targeted search of small anomalies of heart.

Results. Correlation analysis showed a direct and reliable connection between arahnodaktylya and concentration of TGF-β1 in serum (r = 0.4, p = 0.05). For young people with signs of marfanoid habitus are characterized by reliably a higher concentration in the serum of both isoforms of TGF-β. Excess of threshold levels of TGF-β1 revealed at 20% of the core group and not found at all in the control (p < 0.05). Among persons with exceedances of threshold values for at least one faction of the TGF-β patients with signs of marfanoid habitus met almost three times more often than in the group with normal values of TGF-β (p = 0.01, χ2 = 5.58). In the group of persons with marfanoid habitus and increases TGF-β are detected more frequently such as atrial septal aneurysm, false chord left ventricle papillary muscles, incremental, deflection of shutters of the mitral valve in 1-2 mm, asymmetry tricuspid aortic valve.

Pupils have a high level of chronic disease, the indicators of their physical development are reduced with increasing educational load. In this regard, of particular interest is the state of health of schoolchildren, additionally engaged in active sports in special clubs.

Purpose of research. To study the state of health of schoolchildren of St. Petersburg attending the clubs of active sport, depending on age. Materials and methods. Data of medical examinations of 1122 schoolchildren 8-16 years old, engaged in sports schools in St. Petersburg. The Mann-Whitney U-test and the comparison of relative frequencies in two populations were used. Results of the research and discussion. Among children, the most popular sports are football (36.7%) and athletics (29.4%), the prevailing majority of children attend clubs from 1 year to 6.5 years. The proportion of pupils from the second health group was 84.9%, healthy children from the first health group – 13.1%, respectively. The most frequent deviations of musculoskeletal system were posture disorders (69.7% of children) and scoliosis (10.0%), at the same time, by the age of 16, the incidence of posture disorders significantly decreased (p < 0.05), and the proportion of scoliosis increased (p < 0.01). Myopia of weak and moderate degree was revealed in 13.3% of surveyed schoolchildren, the proportion of children with myopia by the age of 16 increased significantly (to 20.7%, p < 0.05). Among children attending sports clubs, fewer have myopia than among pupils enrolled in regular schools. The revealed dynamics of morbidity of the musculoskeletal system among children engaged in sports sections, indicates the need for continuous medical monitoring of the level of physical activity and the need to correct the training regimen in identifying children’s health abnormalities.

Urolithiasis is one of the most wide-spread kidney lesions in males and females all over the world. It is particularly important for males with hypogonadism and metabolic syndrome.

The goal of the study is to assess the effectiveness and safety of Testosterone replacement therapy in males with hypogonadism and metabolic syndrome. Patients and methods. 465 male urolithiasis patients were studied. Mean age was 46 (38-54 years). All patients involved in the study had excessive body mass and obesity of various extent. Mean body mass was 92 (85-97 kg) and body mass index 40.5. More than 50% of the patients had Ischaemic Heart Disease, Cholelithiasis and Goiter. Essential Hypertension was present in 76.3% of cases. In more than 50% of the cases there was a combination of two or three nosological forms present. Depending on the replacement therapy used all patients were distributed into two groups: the main (300 patients) and the control one (165 patients).

Results of the study. Testosterone replacement therapy proved to contribute to normalization of mineral and lipid metabolism as well as improvement of kidney function and restoration of normal bone tissue density. Analysis of 5-year relapse frequency demonstrated it to be considerably lower in the main group (10%) than in the control one (30%) which is astatistically valid difference (p < 0.05).

Conclusion. Testosterone replacement therapy is a highly effective and safe method for urolithiasis therapy in males with hypogonadism.

The report presents two clinical observations of pregnancy outcome in patients with isthmic-cervical insufficiency of functional (first observation) and functional-organic (second observation) origin. In both cases, previously treated cervical erosion by laser (in the second observation – carried out excision of the cervix). In secundiparous women in the present pregnancy were noted recurrent urogenital (first observation) and genital (second observation) infection with a threatened miscarriage and the need for re-hospitalizations. Complex therapy with the introduction of obstetric discharge pessarium was not effective enough, there were manifestations of the inflammatory response of the body, isthmic-cervical insufficiency progressed, up to prolapse of the fetal bladder into the cervical canal (first observation). When entering the perinatal center, the treatment of pregnant women included methods of low-volume membrane plasmapheresis and photomodification of blood with ultraviolet and laser rays (alternated). In both cases, it was possible to stop the manifestations of inflammatory response, to improve the condition of the cervical canal, to prolong pregnancy to the term of normal childbirth. In the first observation, the birth occurred naturally, in the second case cesarean section was performed due to organic changes in the cervix. Childbirth, the postpartum period in women proceeded normally. Children were born healthy, full-term, develop normally, receive breastfeeding.

Based on Russian and foreign sources in the field of medicine, psychology and speech therapy, an overview of the main approaches to the systematization of speech disorders in childhood is conducted. It is shown that despite the long and winding path of research, there are numerous descriptions of phenomenology, but there is no consensus about the nature and mechanisms of speech disorders in children. Currently, there are two main directions in the study of speech pathology in children: clinical and psycholinguistic. In a clinical approach, impaired speech is considered as a pathological condition with certain symptoms, etiology and pathogenesis. Psycholinguistic approach to speech pathology involves the correlation of the observed violation with the normal functioning of the processes of generation and perception of speech, as well as an assessment of the degree of formation of language ability. As a result, the analysis of clinical, psychological and psycholinguistic studies shows a lot of contradictions, pushing for an active search for more accurate nominations and differential diagnostic criteria for distinguishing between different states of a child’s speech deficiency. Thus, a tendency is shown to move to a new level of professional reflection from a narrowly focused (clinical, speech therapy, psychological) to a systemic one, in which the focus of scientists will be not only the problem of determining the disadaptive development, but also the prospects for the mental and speech development of the child.