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Aortic Isthmus Retrograde Blood Flow in Intrauterine Child as a Sign of the Terminal Stage of Placental Dysfunction: Clinical Observation 宫内胎儿主动脉峡部逆行血流作为胎盘功能障碍终末期的标志:临床观察
Pub Date : 2023-05-07 DOI: 10.15690/vsp.v22i2.2537
N. M. Normuradova
Background. Aortic isthmus retrograde blood flow in intrauterine children with growth delay and centralization of blood circulation in the late stages of placental dysfunction is associated with a high risk of perinatal death. Timely diagnosis of such condition is crucial to select further obstetric tactics and delivery time. Clinical case description. Growth delay and absent end-diastolic flow in umbilical artery and no A-wave in the venous duct were diagnosed in intrauterine child (gestational age — 36 weeks) at ultrasound study. Peripheral resistance indices in middle cerebral artery in the intrauterine child were lower than peripheral resistance indices in umbilical artery. Color Doppler imaging has revealed aortic isthmus retrograde blood flow. The woman was recommended delivery due to critical circulatory disorder in the intrauterine child. Female child was delivered via Caesarean section, child’s weight — 890 g, APGAR score — 3/4. The newborn girl died due to multi-organ failure within the first day.Conclusion. Revealing the retrograde blood flow in intrauterine child in the aortic isthmus throughout the entire ventricular diastole is an unfavorable prognostic sign of the terminal stage of cerebral blood flow disturbance associated with placental dysfunction.
背景。胎盘功能障碍晚期生长迟缓和血液循环集中的宫内儿童的主动脉峡逆行血流与围产期死亡的高风险相关。及时诊断这种情况对于选择进一步的产科策略和分娩时间至关重要。临床病例描述。超声检查发现宫内儿(胎龄- 36周)发育迟缓,脐动脉舒张末无血流,静脉导管无a波。宫内患儿大脑中动脉外周阻力指数低于脐动脉外周阻力指数。彩色多普勒显像显示主动脉峡部逆行血流。该妇女被建议分娩,因为在宫内的孩子严重循环障碍。女婴经剖宫产,患儿体重- 890 g, APGAR评分- 3/4。新生女婴在出生第一天内因多器官衰竭死亡。揭示胎儿在整个心室舒张期的主动脉峡逆行血流是脑血流障碍伴胎盘功能障碍终末期的不利预后标志。
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引用次数: 0
Changes in the Preventive Vaccination Procedures in Children’s City Outpatient’s Clinic and its Efficacy 城市儿童门诊预防接种程序的变化及其效果
Pub Date : 2023-05-07 DOI: 10.15690/vsp.v22i2.2563
Snezhana D. Timoshkova, D. Rusinova, Tatyana N. Elagina, G. Glazkova, M. Fedoseenko, L. Namazova-Baranova
This article describes the implementation stages of the changes in preventive vaccination procedures in Children’s City Outpatient’s Clinic №133 of the Moscow Department of Health since December 2019. Comprehensive work has been performed on increasing the adherence to vaccination among doctors of various specialties, vaccination and immunization coverage of the registered pediatric population. As a result of this project medical prevention department was reorganized, data on vaccinations, medical exemption and refusals were added to the electronic medical records, monthly monitoring of vaccination coverage rate was initiated, as well as doctors training in preventive immunization via three forms of education. Center for Medical Prevention of the Moscow Department of Health, pediatric department of the Pediatric Faculty of Pirogov Russian National Research Medical University, the Union of Pediatricians of Russia have participated in this work. Intermediate results on efficacy of implemented measures have been presented.
本文介绍了自2019年12月以来莫斯科卫生部儿童城市门诊№133预防接种程序变化的实施阶段。在提高各专科医生的疫苗接种依从性、提高注册儿科人口的疫苗接种和免疫覆盖率方面开展了全面的工作。该项目重组了医疗预防部门,在电子病历中增加了疫苗接种、医疗豁免和拒绝接种的数据,开始每月监测疫苗接种覆盖率,并通过三种教育形式对医生进行预防性免疫培训。莫斯科卫生部医学预防中心、皮罗戈夫俄罗斯国立研究型医科大学儿科学院儿科系、俄罗斯儿科医生联盟参加了这项工作。对实施措施的有效性给出了中间结果。
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引用次数: 0
Analgesia and Sedation in Newborns with Long-Term Mechanical Ventilation 新生儿长期机械通气的镇痛和镇静作用
Pub Date : 2023-05-07 DOI: 10.15690/vsp.v22i2.2536
E. V. Shestak, O. Kovtun
Relevant data on drugs used for analgesia and sedation in newborns in the intensive care units during mechanical ventilation is presented. The overview of studies on the most common sedatives and analgesics (opioids, acetaminophen, ketamine, midazolam, dexmedetomidine, propofol) is provided. Analysis of their efficacy and risk of short-term and long-term adverse effects is presented, including those associated with the child’s nervous system development. The use of drugs both as monotherapy and in combination with other medications for analgesia and sedation is being discussed.
介绍了重症监护病房新生儿在机械通气期间使用镇痛镇静药物的相关数据。提供了最常见的镇静和镇痛药(阿片类药物、对乙酰氨基酚、氯胺酮、咪达唑仑、右美托咪定、异丙酚)的研究概况。分析了它们的疗效和短期和长期不良反应的风险,包括与儿童神经系统发育有关的不良反应。正在讨论使用药物作为单一疗法和与其他药物联合用于镇痛和镇静。
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引用次数: 0
Chronic Diarrhea as a Debut Manifestation of Crohn’s Disease in Infant: Clinical Case 慢性腹泻是婴儿克罗恩病的首次表现:临床病例
Pub Date : 2023-02-25 DOI: 10.15690/vsp.v22i1.2518
Anna M. Konovalova, D. V. Pechkurov, A. Tyazheva
Background. Chronic diarrhea can be a symptom of a wide variety of diseases, either of which requires special therapy approaches. The diagnosis of rare causes of chronic diarrhea is especially difficulty as it may be associated with inflammatory bowel disease (IBD) with very early (under 1 year of age) debut.Clinical case description. Boy E. had chronic diarrhea manifested on the first year of life. Ulcerative colitis was diagnosed at the age of 1.5 years, then the diagnosis was changed to Crohn’s disease at the age of 2.5 years. The results of 6-years-follow-up of the patient were presented, as well as analysis of diagnosis and treatment difficulties was carried out.Conclusion. The clinical case of Crohn’s disease with diarrhea as the leading clinical manifestation at the disease onset is described. Sequential diagnostic search allowed us to establish the diagnosis of IBD and to exclude other causes of chronic diarrhea that determined the correct therapeutic strategy. 
背景。慢性腹泻可能是多种疾病的症状,其中任何一种都需要特殊的治疗方法。罕见原因的慢性腹泻的诊断是特别困难的,因为它可能与炎症性肠病(IBD)非常早期(1岁以下)首次出现。临床病例描述。男孩e在出生第一年就表现出慢性腹泻。1.5岁时诊断为溃疡性结肠炎,2.5岁时诊断为克罗恩病。对患者进行了6年的随访,并对诊断和治疗难点进行了分析。本文描述了克罗恩病发病时以腹泻为主要临床表现的临床病例。顺序诊断搜索使我们能够确定IBD的诊断,并排除确定正确治疗策略的慢性腹泻的其他原因。
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引用次数: 0
Assessing the Diagnostic Significance of Herpes Virus Infections’ Serological Markers in Children: Overdiagnosis or Clinically Relevant Studies? Retrospective Study 评估儿童疱疹病毒感染血清学标志物的诊断意义:过度诊断还是临床相关研究?回顾性研究
Pub Date : 2023-02-25 DOI: 10.15690/vsp.v22i1.2519
A. Ivanov, T. Kulichenko
Background. Nowadays, population generally has high contamination with herpes virus infections. Infection commonly is asymptomatic, and the virus persists in the human body over a lifetime. Excessive diagnosis of herpes virus infections as well as overestimation of their role in the genesis of various diseases in immunocompetent people are common in Russian pediatrics.Objective. The aim of the study is to assess the frequency and efficacy of serological testing in the suspected correlation of herpes virus infections and infectious and somatic diseases in a multidisciplinary hospital.Methods. The study included patients hospitalized in the multidisciplinary hospital in Moscow, who were assigned serological examination for herpes viruses. The laboratory study was carried out by enzyme-linked immunosorbent assay with the revealing the markers of herpes simplex virus type 1 and 2, Epstein-Barr virus, and cytomegalovirus. The results of the examination were analyzed according to the nosology and their role in diagnosis and management.Results. The identification of herpes virus infections’ markers was performed for 996 patients undergoing medical treatment in 17 different hospital departments within 2 months. Most commonly the examination was prescribed in infectious disease, pediatric, and hematological departments and covered more than 140 different nosologies. Acute respiratory infection, reactive arthritis, thrombocytopenia, infectious mononucleosis, acute tonsillitis, gastrointestinal pathology, acute bronchitis, and pneumonia were the most common nosologies. Positive markers of acute infection were revealed in 1.71% of cases for HSV-1/HSV-2, in 4.89% — for EBV, in 3.81% — for CMV. Moreover, positive results of serological examination were mostly noted in the cases of infectious diseases: infectious mononucleosis, tonsillitis, or acute respiratory infections. Tests were assigned for all three infections at the same time in most cases.Conclusion. Widespread examination for herpes virus infections is the typical variant of overdiagnosis and it is usually less informative. Generally positive markers are observed in typical course of herpes virus infections when clinical picture is enough for diagnosis verification. 
背景。目前,人群普遍存在疱疹病毒感染的高污染。感染通常是无症状的,病毒在人体内持续一生。在俄罗斯儿科,对疱疹病毒感染的过度诊断以及对其在免疫功能正常人群中各种疾病发生中的作用的过高估计是常见的。本研究的目的是评估在多学科医院进行疱疹病毒感染与感染性和躯体疾病疑似相关的血清学检测的频率和效果。该研究包括在莫斯科多学科医院住院的患者,他们被指定进行疱疹病毒血清学检查。采用酶联免疫吸附法检测单纯性疱疹病毒1型和2型、eb病毒和巨细胞病毒标志物。根据疾病分类学及其在诊断和治疗中的作用,对检查结果进行分析。在2个月内对17个不同医院科室接受治疗的996例患者进行疱疹病毒感染标志物鉴定。最常见的检查是在传染病、儿科和血液科,涵盖140多个不同的分科。急性呼吸道感染、反应性关节炎、血小板减少症、传染性单核细胞增多症、急性扁桃体炎、胃肠道病理、急性支气管炎和肺炎是最常见的病种。1型/ 2型单纯疱疹病毒急性感染标志物阳性率为1.71%,EBV阳性率为4.89%,CMV阳性率为3.81%。此外,血清学检查阳性结果多见于感染性单核细胞增多症、扁桃体炎或急性呼吸道感染等传染病。在大多数情况下,对这三种感染同时进行检测。疱疹病毒感染的广泛检查是过度诊断的典型变体,通常信息较少。在典型的疱疹病毒感染过程中,当临床表现足以诊断时,通常观察到阳性标记物。
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引用次数: 0
Langerhans Cell Histiocytosis in Children: Literature Review 儿童朗格汉斯细胞组织细胞增多症:文献综述
Pub Date : 2023-02-25 DOI: 10.15690/vsp.v22i1.2520
Evgeniy A. Burtsev, G. Bronin
Relevant information on Langerhans cell histiocytosis development and course in children is presented. The current concepts of disease pathogenesis, principles of its severity evaluation, patients stratification into risk groups, as well as of clinical course features are described. Modern approaches to the disease treatment via targeted therapy are summarized and analyzed. 
有关儿童朗格汉斯细胞组织细胞增多症的发展和病程的相关信息。目前的概念,疾病的发病机制,其严重程度的评估原则,患者分层到危险组,以及临床病程特征进行了描述。总结和分析了靶向治疗的现代方法。
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引用次数: 0
Assessment of Anthropometric Data of Children Died at Perinatal Period 围产期死亡儿童人体测量资料的评估
Pub Date : 2023-02-25 DOI: 10.15690/vsp.v22i1.2516
K. Moiseeva, D. Ivanov, V. K. Yur'ev, E. Berezkina, Kseniya G. Shevtsova, A. V. Alekseeva, Sh. Kharbedia
Background. Despite the decrease in fetoinfantile losses, the levels of perinatal mortality and stillbirth remain quite high. One of the medical criteria for viability is the anthropometric indicators of the child, therefore, their relevant medical and statistical assessment may allow us to establish potential opportunities for reducing the loss of viable children at perinatal period.Objective. The aim of the study is to assess anthropometric data of children died at perinatal period.Methods. We have analyzed 277 cases of children deaths at ante- and intranatal periods and 197 cases of newborns deaths during first 7 days of life. Assessment of anthropometric data of children died at perinatal period was presented via the method of sigmal deviations and the centile method.Results. Anthropometric data of premature infants died at perinatal period in 90–94% of cases corresponded to the physical development for children of this gestational age. Anthropometric data of full-term children died during the first 168 hours of life, in 70.0% of cases, corresponded to 3–6 corridors of physical development (P10–P90), in 20.0% of cases — 7–8 corridors. 58.3% of full-term children died at perinatal period have harmonious development which significantly exceeds the proportion of children with sharply disharmonious development (19.5%) and with disharmonious development (22.2%). 79.0% of all neonatal deaths occur in the first 72 hours of life (for the early neonatal period), while losses on the first day account for 54.0% of all deaths in children during the first week.Conclusion. This study has shown that the anthropometric data of children died at perinatal period significantly corresponded to the standard indicators established for children of this gestation age. 
背景。尽管胎儿死亡率有所下降,但围产期死亡率和死产率仍然很高。生存能力的医学标准之一是儿童的人体测量指标,因此,对其进行相关的医学和统计评估可能使我们有机会减少围产期存活儿童的损失。本研究的目的是评估围产期死亡儿童的人体测量数据。我们分析了277例产前和产后死亡的儿童和197例出生后7天内死亡的新生儿。采用标准差法和百分位法对围产期死亡儿童的人体测量资料进行了评价。围产期死亡早产儿的人体测量数据在90-94%的病例中与该胎龄儿童的身体发育相对应。足月儿童在出生后168小时内死亡的人体测量数据,70.0%的病例对应于3-6个身体发育走廊(P10-P90), 20.0%的病例对应于7-8个走廊。围产期死亡的足月儿和谐发育的比例为58.3%,明显超过严重不和谐发育(19.5%)和不和谐发育(22.2%)的比例。79.0%的新生儿死亡发生在生命的头72小时(新生儿早期),而第一天的死亡占第一周儿童死亡总数的54.0%。本研究表明,围产期死亡儿童的人体测量数据与该胎龄儿童的标准指标显著相符。
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引用次数: 0
G.N. Speransky’s Contribution to the Development of Russian Pediatrics (to the 150th Anniversary of His Birth) G.N.斯佩兰斯基对俄罗斯儿科发展的贡献(纪念他诞辰150周年)
Pub Date : 2023-02-25 DOI: 10.15690/vsp.v22i1.2532
A. Baranov, S. A. Sher
.
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引用次数: 0
Organization of Medical Care for Children in Home Front and on Front-Line Territories during the Great Patriotic War 卫国战争时期大后方和前线地区儿童医疗服务的组织
Pub Date : 2023-02-24 DOI: 10.15690/vsp.v22i1.2528
O. Yaremchuk, R. S. Serebryaniy, D. V. Kamelskikh
The status of open and closed children’s institutions (nurseries, orphanages), existing personnel potential, results of communicablediseases control in Yamal (home front territory) and in Kuibyshev region (front-line territory) were analyzed. The differences in primary problems solving by Yamal and the Kuibyshev Region health authorities stood out. The key issues in Yamalo-Nenets national district were prevention of mass diseases and combating highly infectious diseases (typhus, etc.). Meanwhile, the key aspect of medical care in Kuibyshev region was to implement measures to combat the spread of gastrointestinal tract diseases and digestive disorders. Data is provided to compare the nutrition status of children in Arctic region and in Middle Volga region using these two regions’ examples. Difficulties in food supply are shown. They were quite the same despite the difference in habitat and the contingent of children (evacuated from Kuibyshev region and tundra residents). The claim that Yamal was supplied with food and industrial products with higher standards than southern regions has been questioned as archival documents have revealed the insufficient availability of products in children’s institutions 
分析了亚马尔(前线地区)和古比雪夫地区(前线地区)开放和封闭儿童机构(托儿所、孤儿院)的现状、现有人员潜力、传染病控制结果。亚马尔和古比雪夫地区卫生当局在解决主要问题方面的差异十分突出。亚马尔-涅涅茨民族地区的关键问题是预防大规模疾病和防治高度传染性疾病(斑疹伤寒等)。同时,古比雪夫地区医疗保健的关键方面是采取措施,防止胃肠道疾病和消化系统疾病的蔓延。以北极地区和中伏尔加地区为例,提供了比较这两个地区儿童营养状况的数据。粮食供应方面的困难是显而易见的。尽管栖息地和儿童队伍(从古比雪夫地区撤离和冻土带居民)不同,但它们是完全相同的。声称亚马尔提供的食品和工业产品比南部地区的标准更高的说法受到质疑,因为档案文件显示,儿童机构的产品供应不足
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引用次数: 1
Congenital Knee Dislocation: Help for Neonatologists and Pediatricians 先天性膝关节脱位:对新生儿和儿科医生的帮助
Pub Date : 2023-02-10 DOI: 10.15690/vsp.v22i1.2517
I. Y. Kruglov, N. Y. Rumyantsev, G. G. Omarov, N. N. Rumyantseva, I. Kagantsov
Congenital knee dislocation is relatively rare pathology of the musculoskeletal system. Timely diagnosis and treatment onset allow us to achieve full range of motion in the knee joint. However, low awareness of physicians in these topics and, as a result, diagnostic errors lead to pseudo-correction and motor deficit in the knee joint. This article describes correct examination of a child with congenital knee dislocation directly in the delivery room, management after discharge, and subsequent patient's routing with the assistance of orthopedic traumatologist.
先天性膝关节脱位是相对罕见的肌肉骨骼系统病理。及时的诊断和治疗使我们能够实现膝关节的全范围运动。然而,由于医生对这些问题的认识不足,因此,诊断错误导致假矫正和膝关节运动障碍。本文介绍先天性膝关节脱位患儿在产房的正确检查,出院后的处理,以及在骨科创伤科医生的协助下,后续患者的路线。
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引用次数: 0
期刊
Current pediatrics
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