Репозиторий Университета

© 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, Dynasty Publishing House. All rights reserved. The objective. To specify the duration of persistence of antigens and DNA of Mycoplasma pneumoniae (M. pneumoniae) and Mycoplasma hominis (M. hominis) cells in the free state and as part of circulating immune complexes in blood of children suffering from bronchial asthma. Patients and methods. In the University Children’s Clinical Hospital of the Sechenov University, 161 children aged 1 to 14 years were observed. Group 1 (treatment group) included 126 children with bronchial asthma. 55 children (43.7%) had a mild course of disease, 52 children – moderate (42.1%) and 19 children (15.1%) – severe. All children were in the exacerbation period. Group 2 (control) consisted of 35 children with ARVI. The mean age of children in group 1 – 5.4 ± 1.8 years (79 boys (62.7%) and 47 girls (37.3%)); in group 2 – 5.7 ± 1.9 years (20 boys (57.1%) and 15 girls (42.9%). Diagnostic methods used: cultivation of mycoplasmas, preparation of immune serums, aggregate-haemagglutination assays (AHAA), polymerase chain reaction (PCR), direct immunofluorescence (DIF), methods of detection of circulating immune complexes (CIC). Results. AHAA examination of 126 serum samples of children from group 1 with BA, M. pneumoniae and M. hominis antigens in the free state were found in 73 and 50% of cases, respectively. In children of group 2 AHAA detected M. pneumoniae and M. hominis significantly more rarely: M. pneumoniae was found in 3 (8.6%) children (p = 95.3), M. hominis – in 2 (5.7%) children (p = 97.1). Further examination of serum samples of children with BA found M. pneumoniae and M. hominis cell DNA in 7.14 and 16.6% of cases, respectively. The work has shown that M. pneumoniae antigens are found in the composition of CIC in 55.5% of cases, M. hominis antigens – in 46.8% of cases, DNA – in 26.98 and 46.8%, respectively. For treatment of mycoplasma infection, children with BA received three azitromicin courses in the dose 10 mg/kg for 3 days with a 4-day interval. Conclusion. These data are indicative of long-term persistence of mycoplasma cell antigens and DNA in the free state and in CIC in blood of children with BA. Mycoplasmas can be regarded as one of the factors of inducing BA exacerbations in children. Tests for mycoplasma infection are indicated in patients with BA. Addition of macrolides to standard BA therapy in children with mycoplasma infection, as a rule, yields positive results.

© 2018 Dynasty Publishing House. All rights reserved. The objective. To offer a characteristic of phenotypes of atopic bronchial asthma (BA) in children according to the level physical health (LPH). Patients and methods. Our observation included 359 children aged 4 - 14 years with atopic BA. We performed a questionnaire survey among parents, studied medical histories and took anthropometric parameters. The parameters of respiratory, muscular and cardiovascular systems, and LPH according to the method by G.L.Apanasenko (1992) were determined. Results. Using multiple factor analysis with the principal component method we selected parameters that characterize the level of physical health in BA: values of external respiratory function - ERF (VC, FEV1), hand muscle strength (HMS), body mass index (BMI), vital index (VI), Robinson index (IRob), muscular endurance (ME). In BA with low LPH no patient has full control over disease. Overweight is recorded in 37.9% of them, lower ERF parameters in 33.3%, lower HMS in 87.9%, deviations on the part of the cardiovascular system in 80.3%. In BA with higher LPH, full control over diseases is observed in almost half of children (48.7%), harmonious physical development - in 87.1% of cases. Parameters of ERF, muscular and cardiovascular system corresponded to the norm in 92.3; 61.5 and 100% of patients, respectively. Children with BA with average LPH take the intermediate position between these two groups. Conclusion. Physical health should be regarded as a factor of retaining control over BA. Phenotype determination according to the level of physical health and degree of disease control permits to personify rehabilitation programmes for children with atopic bronchial asthma.

© 2018 Dynasty Publishing House. All rights reserved. The objective: To give a characteristic of body composition in adolescents with atopic bronchial asthma combined with overweight, and to determine the impact of its disorders on the degree of disease control. Patients and methods: Bioimpedance analysis of the body composition was performed in 168 adolescents aged 12-17 years, including 68 patients with mild bronchial asthma in the remission stage and in combination with overweight, 50 overweight adolescents without asthma and 50 healthy same-age peers. Bioimpedance characteristics were compared with the degree of controlling the symptoms of disease. Results: As has been found, adolescents with atopic bronchial asthma combined with overweight are characterised by significant changes in the body composition, which is manifest by higher fat tissue (on average 156.8 ± 21.3% with respect to the norm), total body water and extracellular fluid (127.0 ± 8.1% and 112.3 ± 5.9%, respectively), lower active cell (to 92.8 ± 10.2%) and skeletal muscle mass (to 96.9 ± 6.2%). The degree of the above disorders of body composition was higher in patients with incomplete asthma control. Conclusion: Disorders of body composition in adolescents with bronchial asthma reflect a decreased physical activity, shifts in water-electrolyte balance and protein deficiency. Worsening of body composition is associated with loss of asthma control.

© 2018 Medical Education. All rights reserved. The aim of this study was to assess long-term effects of pneumococcal vaccination with 23-valent polysaccharide vaccine (PPV23) and 13-valent conjugate vaccine (PCV13) in patients with bronchial asthma. Methods. One hundred and three patients with mild to severe asthma were involved. They were randomly assigned to vaccination with PCV13, or PPV23, or PPV23 followed by PCV13, or vice versa. Clinical efficacy of vaccination was evaluated using number of asthma exacerbation a year before and 1 and 4 years after the vaccination; need in antibiotics a year before and 1 and 4 years after the vaccination; and number of hospitalizations due to asthma exacerbation a year before and 1 and 4 years after the vaccination. Results. In a year after vaccination, number of patients who had not experienced asthma exacerbation increased significantly in PPV23, PPV23/PCV13, and PCV13/PPV23 groups (p < 0.01 to p < 0.001). In 4 years after vaccination, number of patients without exacerbations increased significantly in PCV13/PPV23 group only (48.1%; p < 0.01). Number of patients who did not require hospitalization due to asthma exacerbation increased significantly in PCV13 group only (81.8%; p < 0.05). Conclusion. The authors proposed a hypothesis of impact of pneumococcal vaccines on immunopathogenesis of bronchial asthma. The authors consider vaccination against pneumococcus using PCV13 followed by PPV23 should be a part of the basic therapy of asthma.

© 2018, Pleiades Publishing, Ltd. Interleukin-33 (IL-33) belongs to the IL-1 cytokine family and plays an important role in modulating immune system by inducing Th2 immune response via the ST2 membrane receptor. Epithelial cells are the major producers of IL-33. However, IL-33 is also secreted by other cells, e.g., bone marrow cells, dendritic cells, macrophages, and mast cells. IL-33 targets a broad range of cell types bearing the ST2 surface receptor. Many ST2-positive cells, such as Th2 cells, mast cells, basophils, and eosinophils, are involved in the development of allergic bronchial asthma (BA). This suggests that IL-33 directly participates in BA pathogenesis. Currently, the role of IL-33 in pathogenesis of inflammatory disorders, including BA, has been extensively investigated using clinical samples collected from patients, as well as asthma animal models. In particular, numerous studies on blocking IL-33 and its receptor by monoclonal antibodies in asthma mouse model have been performed over the last several years; IL-33-and ST2-deficient transgenic mice have also been generated. In this review, we summarized and analyzed the data on the role of IL-33 in BA pathogenesis and the prospects for creating new treatments for BA.