Репозиторий Университета

© 2018, Pediatria Ltd.. All rights reserved. The article presents data of a systematic review of observational and interventional studies on possible associations between the level of macro-and micronutrients consumption by lactating mothers and their breast milk composition. Authors present the results of a 3-week prospective medical observation in assessing the tolerability of specialized products for lactating mothers, as well as the dynamics of the physical development of their children who are exclusively breastfed.

© 2018, Pediatria Ltd.. All rights reserved. Objective of the research: to dentify risk factors for growth retardation in patients with juvenile scleroderma (JSD). The presented data show that the most unfavorable factors for growth retardation in patients with JSD are the systemic form of the disease, debut age less than 4 years. Other unfavorable factors of growth retardation developing are father's height less than 175 cm and a mother's height less than 165 cm. Analysis of the effect of glucocorticoid saverage daily dose during the year on the growth rate in patients with JSD, normalization of growth rates was noted with its decrease to 0,2 mg/kg/day or less.

© 2018, Pediatria Ltd. All rights reserved. Modern literature data suggest that the active metabolite of vitamin D 1,25 (OH)2D is a steroid hormone with an extremely wide range of biological effects. Its role in the body is not limited to the regulation of calcium homeostasis. It has antiproliferative and differentiating effects, immunomodulatory and anti-inflammatory effects, promotes the synthesis and secretion of insulin, affects the functions of the cardiovascular, muscular and nervous system, the state of fat and connective tissue, etc. Vitamin D has many targets and is involved in a variety of physiological processes, which is why its potential role as a risk factor for development or, on the contrary, a protector in a variety of diseases incl. rheumatic (RD), is actively studied. Elimination of vitamin D insufficiency/deficiency should be considered an important aspect of treatment of patients with RD, as this can decrease not only the activity of autoimmune processes and inflammation, but also the risk of comorbid pathology, incl. fractures, obesity, cardiovascular pathology, disorders of carbohydrate metabolism, secondary infection, including tuberculosis, etc. Children with various RD often have vitamin D insufficiency/deficiency, and for this patient group its timely detection and elimination is particularly important. Further studies are needed to develop coordinated recommendations for monitoring vitamin D sufficiency and the use of its various metabolites in the complex treatment of children with rheumatic spectrum diseases.

© 2018, Pediatria Ltd.. All rights reserved. The article presents the case of IgG4-associated disease (IgG4-AD) with orbit lesion in a 5-year-old girl. IgG4-AD is a chronic immune-mediated disease of unknown etiology characterized by tumor-like infiltration of various organs tissues with plasma cells expressing IgG4 and eosinophilic infiltration followed by the development of fibrous fibrosis and obliterating phlebitis, and with increase of IgG4 levels in serum in a number of patients. The majority of clinical observations are associated with mature and older patients. In children, especially young, IgG4-AD is rare, so the description of each case is interesting for pediatricians and various specialists working with pediatric patients.

© 2018 Elsevier B.V. Background: Very recently, a novel European hantavirus, Sochi virus, has been discovered which causes severe courses of hantavirus disease with a case fatality rate of about 15 percent. Objectives: We aimed to study to which extent and with which clinical severity children were affected by Sochi virus infection. Study design: Sochi virus infection of patients was confirmed by molecular, serological, and epizoonotic studies. Clinical and laboratory parameters were analyzed for the age group of up to 15 years (n = 6) in comparison to all older patients (n = 56). Results: 9.7 percent of patients with hantavirus disease studied (6/62) were up to 15 years old. The children showed moderate to severe clinical courses similarly to the situation in adults. Conclusions: While children are in general considered to be less affected by hantavirus infections than adults, in case of highly pathogenic hantaviruses, such as Sochi virus, frequency of clinical cases as well as their clinical course are comparable between children and adults. Therefore, hantavirus disease, particularly in regions endemic to highly pathogenic hantaviruses, should be considered in cases of unclear fever and kidney/pulmonary failure in children.

Nowadays, the breast-feeding, despite the approved advantages, is not a standard in many communities. The multi-factorial determinants determining its prevalence need to be supported at various levels - from legal and legislative one to views and values of society, conditions of women's labor and also health care system that can develop a favorable environment for breast-feeding. The breast-feeding effects positively on health, economic development and ecology and therefor it is a benefit for children, women and whole society in short-term and long-term perspective. The defense, propaganda and support of breast-feeding need a political will, and financial investments to implement its advantages.

© 2018, Pediatria Ltd. All rights reserved. Clinical guidelines for the selection and use of antibiotics (AB) for common and most important community-acquired infections are aimed at increasing the treatment efficacy and overcoming growth of bacterial pathogens resistance to AB. They are based on the principle of positive ratio of «benefit/risk» of AB and selection of primary and alternative drugs. The article presents Russian and foreign data on pediatricians preferences in the choice of AB for ARI in children, on the level of Streptococcus pneumoniae resistance to penicillins and macrolides and other respiratory bacterial pathogens to macrolides in Russia (including the pediatric population) and abroad, which led to similar changes in grouping of AB in the Eurasian clinical recommendations and WHO recommendations. It demonstrates a significant coincidence of the AB choice for community-acquired pneumonia and acute bacterial rhinosinusitis in children in comparable recommendations with the recognition of amoxicillin as the first choice drug and the general tendency to restrict the use of macrolides. It also points on the need to control the AB use.

© 2018, Pediatria Ltd.. All rights reserved. In 2011, a cohort for prospective follow-up was chose from the general population of newborns in Moscow. In 3 years of life, information on atopic dermatitis (AtD) symptoms was collected. Skin tests with allergens were performed in mothers and in children aged 1 year. Objective of the research – to correlate the sensitization of a child at the age of 1 year and sensitization of his mother with subsequent possible development of AtD in his early childhood. Study materials and methods: mother's sensitization and sensitization of a child at 1 year of age were examined separately for the possible appearance of AtD diagnostic signs at the age of 1, 2, 3 years of a child and in general in early childhood. The results of each study are presented by several methods of statistical processing: 1) analysis of conjugation tables, incl. hierarchical log-linear; 2) logistic regression models in which: a) the sensitization degree was considered, b) the sensitization was analyzed as a qualitative sign, in the presence of a papule. Results and discussion: рrospective monitoring of the cohort shows the dynamics of AtD frequency in early childhood, the number of sensitized mothers and their children. Mother's sensitization was not significant for AtD signs appearance in a child in early childhood. The sensitization of a child at the age of 1 year showed the importance of chicken egg allergen in relation to AtD signs appearance in early childhood. Study result: conclusions about the possible relationship of sensitization with AtD development in a child in early childhood.

© 2018, Pediatria Ltd. All rights reserved. The article presents results of conjugated pneumococcal vaccine use in combination with basic therapy in 64 children with chronic compensated tonsillitis. The study showed that vaccination assists activation of T-lymphocytes subpopulation, increases sensitization to bacterial antigens, normalization of proinflammatory cytokines content, which is clinically manifested in a significant decrease in acute respiratory infections incidences and antibacterial therapy courses for 2 years after vaccination compared to patients receiving a traditional therapy course.

© 2018, Pediatria Ltd. All rights reserved. Materials and methods: the study assessed safety and clinical efficacy of combined use of vaccine preparations against S. pneumoniae and H. influenzae type b, leading pathogens in bronchopulmonary diseases exacerbations development, in previously unvaccinated 38 children aged 2–17 years with chronic bronchopulmonary diseases: 19 with malformations of the bronchi and lungs (MBL); 10 with malformations of bronchi and lungs in combination with bronchial asthma (MBL+BA); 9 with bronchial asthma (BA). The control group consisted of 19 unvaccinated children of the same age with a similar pathology. Combined vaccination against these infections, as well as their separate administration, did not cause adverse effects. Results: a year after the introduction of Pneumo-23 vaccine, the incidence of acute respiratory infections (ARI) and exacerbations of the main disease decreased by 2,3 times; Act-HIB by 2,3 and 2,1 times respectively; by 1,7 and 1,5 times respectively with simultaneous administration of these preparations. In children with BA the duration of one exacerbation decreased by 3,4 times, the average duration of temperature reaction by 1,9 times and the systemic antibiotic therapy of one exacerbation episode by 2,4 times. In the group of children with MBL+BA these indicators decreased by 2,1, 1,8 and 1,6 times, respectively, and in patients with MBL by 1,6, 1,5 and 1,4 times, respectively. Conclusion: vaccination against pneumococcal and hemophilic type b infections using one or both vaccines in patients with MBL and with MBL+BA is safe and positively affects the clinical course of the main disease.

© 2018 Paediatrician Publishers, LLC. All Rights Reserved. The article provides the characteristic of a tumor from cells of cartilaginous tissue - chondroblastoma. Current data on etiology, key links of pathogenesis, types of tumor, General clinical manifestations, approaches to diagnosis and treatment in children are analyzed.

© 2018, Dynasty Publishing House. All rights reserved. The article discusses a clinical case of necrotizing enterocolitis in a newborn girl with a high risk for intrauterine infection, respiratory distress syndrome, cerebral depression, prematurity grade 2, intrauterine growth restriction. Literature data of the possible risk factors for the development of this disease, causes and mechanisms of its appearance, and also modern treatment options are given.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To determine vitamin D status in children with rheumatic disease who live on the territory of Russia. Patients and methods. A pilot study was conducted that included 52 children (35 girls and 17 boys) aged 5 to 17 years (11.88 ± 0.48 years), among them 29 children with systemic connective tissue disorders (SCTD) and 23 children with juvenile idiopathic arthritis (JIA). All patients underwent complex clinical-laboratory and instrumental examination in order to confirm the diagnosis and assess the patients’ health. Vitamin D status was assessed by 25(ОН)D serum levels using the method of chemiluminescence immunoassay. Results. Sufficient levels of 25(ОН)D (>30 ng/l) were found only in 5 (9.5%) children, vitamin D insufficiency (25(ОН)D 21–30 ng/l) was observed in 6 (11.5%) children, deficiency (25(ОН) <20 ng/l) in 41 (79.0%) children, among them in 7 (13.4%) it was severe (25(OH)D <10 ng/l), in spite of a long-term intake of low-doses of cholecalciferol (100–400 U/day) by 40 (76.9%) patients. Average levels of 25(ОН)D in patients with SCTD were significantly higher than in patients with JIA (20.86 ± 2.15 ng/l vs. 14.98 ± 0.91 ng/l, p = 0.0151), deficiency was more rarely found in these patients (69.0% vs. 91.3%), which was to a certain degree conditioned by more intensive vitamin D therapy. Conclusion. Insufficiency/deficiency of vitamin D is noted in an overwhelming majority of children with RD. Standard therapy with low doses of cholecalciferon offered to patients with RD is not sufficient for obtaining optimal 25(ОН)D levels and needs correction.

© 2018 Voprosy Sovremennoi Pediatrii - Current Pediatrics. All rights reserved. The problem of dosing drugs at an early age is conditioned by specific metabolism of medicinal products (MP) in the child's body. Currently, there are a few clinical trials on the study of physiological characteristics in different periods of childhood and systematised data. It is still relevant to understand the characteristic differences that affect the bioavailability, distribution and excretion of MP, especially in children over one month of life. The results of such studies are necessary in order to formulate the recommendations for use of MP in children taking into account their age and compensate for the lack of data from direct clinical trials in pediatrics. The possibility of using a dose calculation method regarding the fat content of the body in different periods of childhood and the chemical properties of the substance has been discussed.

© 2018 Izdatel'stvo Meditsina. All rights reserved. The review discusses the issue of reflux nephropathy for specialists of the system of higher medical education: the article provides the definition, characterizes the epidemiology, risk factors for disease development in children with vesicoureteral reflux, causes and molecular mechanisms of renal fibrosis formation and progression in reflux nephropathy, markers for diagnosing and predicting the disease course.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. The lecture discusses the issue of reflux nephropathy for specialists of the system of higher medical education: the article provides the definition, characterizes the epidemiology, risk factors for disease development in children with vesicoureteral reflux, causes and molecular mechanisms of renal fibrosis formation and progression in reflux nephropathy, and markers for diagnosing and predicting the disease course. In order to control the retention of the lecture material, the text includes case problems and multiple-choice tests.

© Sergey D. Batoev. The government’s incorporation of the vast territory of the Transbaikal region did not initially involve broad socio-economic development of this region. Gradually, it became clearly understood that for the successful development of the economically advantageous territory it was necessary to solve a number of issues related to the organization of public health care, in particular for women and children. Military and economic measures alone would not ensure the social wellbeing of both the indigenous population and Transbaikal’s new arrivals. The indigenous population,s traditional way of life, the confessional differences between those living in the territory and the severe climatic and geographic conditions slowed the spread of public medicine in this region. The constant shortage of qualified medical personnel, the small number of medical institutions and serious financial difficulties exacerbated the difficult situation. The first measures taken in the social policy field concerned the foundation of the Irkutsk Order of Public Charity in March 1784, but they were not successful in any serious way. State medical care remained inaccessible, therefore the population continued to mainly use folk and Tibetan medicine methods. A definite turning point was observed in the middle of the 19th century. It was then that the first children’s shelters, and the first obstetric institutions for female prisoners appeared. However, it was only at the beginning of the 20th century that obstetric and gynecological hospital beds were introduced in the city hospital in the regional center in Chita. The author of the article notes that for two centuries, during which the territory of Transbaikal was part of the Russian Empire, there were some positive changes in the provision of medical care, including medical care for women and children. Significant financial investment and highly qualified personnel were required for the development of medicine in pre-revolutionary Transbaikal. Attempts by society, including medical organizations, to influence the existing system of medical care without a legislative base and corresponding government support were doomed to failure. There was a need for a radical transformation of health care, including in the field of women’s and children’s health.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. The article discusses issues related to the long-term administration of macrolide antibiotics for a bronchoectatic disorder of the pulmonary system in children. The relevant information about the results of long-term intake of macrolides in adults and children, the effective dose titration, possible toxic effects of therapy, including the development of cardiotoxic effect and ways to prevent it, has been enlightened in detail. It has been noted that a limited number of clinical studies involving children determine the need for studying the possibility to extrapolate adult treatment.

© 2018 Dynasty Publishing House. All rights reserved. The objective. To determine age-related specificities of microcirculation-tissue systems in children from varied age groups. Patients and methods. We analysed the results of examining healthy children aged 3 to 17 years and also young people under 25 years of age with the use of nail-fold capillaroscopy (n = 65) and laser Doppler flowmetry(n = 50). Results. According to capillaroscopy, no significant differences in microcirculation parameters in children of varied age have been obtained, but as has been found, diameters of all parts of capillaries and the width of perivascular spaces increased to some extent with children's age. Also, the density of first-line capillaries increased with age in the examined patients. The average microcirculation values obtained by LDF did not show any statistically significant difference between children from the age group 7 to 13 years and children aged 13 to 18 years. Microcirculation parameters are not dependent on a patient's age. The average values of PI may be used as reference parameters for diagnosing microcirculation impairments in children with varied pathologies. Conclusion. The capillaroscopy values and basal microcirculation values that we have obtained may be used in practically healthy children for comparison with such values in children with varied pathologies, which might be helpful in diagnosing various diseases and disorders at early stages and exercising control over treatment with selection of individual pharmacotherapy.