L. V. Sakhno, E. G. Dubovaia, I. V. Koltuntceva, A. V. Emeljanova, E. Yu.. Makarova
The authors raise an issue of job responsibilities of a district paediatrician in case of a home visit, as well as of the standards for packing first-aid kits and emergency medical care kits. The provisions of the applicable legal acts are provided. The proceedings of international conventions on primary medical care for children, current federal clinical guidelines, paediatric medical care standards and procedures, orders of the Ministry of Health of the Russian Federation were analysed. We paid attention to the experience of foreign countries, as well as the regions of the Russian Federation in providing emergency medical care to the paediatric population. A survey among local paediatricians was conducted: 30 district paediatricians (10 persons from each of three children’s outpatient departments in different districts of St. Petersburg) answered questions on the algorithm for activities during home visit if emergency care was required. The results of the survey and analysis of the applicable legal acts showed that the district paediatrician is responsible for the life and health of his/her patients. However, there is no single standard regulating the responsibilities to provide emergency care to the child by the district pediatrician during home visit, and the volume of this care has not been established. Urgent conditions require immediate medical care right when they are detected by a paediatrician on call, until an ambulance team arrives. In conclusion, the authors determined that the creation of unified algorithms for emergency medical care to be provided by a paediatrician on call encompasses a number of medical, ethical and legal aspects. The development of this document is certainly a necessity and requires a balanced, judicious approach.
{"title":"Legal aspects, responsibilities and possibilities of providing emergency medical care by a district pediatrician at the patient’s home","authors":"L. V. Sakhno, E. G. Dubovaia, I. V. Koltuntceva, A. V. Emeljanova, E. Yu.. Makarova","doi":"10.21518/ms2023-274","DOIUrl":"https://doi.org/10.21518/ms2023-274","url":null,"abstract":"The authors raise an issue of job responsibilities of a district paediatrician in case of a home visit, as well as of the standards for packing first-aid kits and emergency medical care kits. The provisions of the applicable legal acts are provided. The proceedings of international conventions on primary medical care for children, current federal clinical guidelines, paediatric medical care standards and procedures, orders of the Ministry of Health of the Russian Federation were analysed. We paid attention to the experience of foreign countries, as well as the regions of the Russian Federation in providing emergency medical care to the paediatric population. A survey among local paediatricians was conducted: 30 district paediatricians (10 persons from each of three children’s outpatient departments in different districts of St. Petersburg) answered questions on the algorithm for activities during home visit if emergency care was required. The results of the survey and analysis of the applicable legal acts showed that the district paediatrician is responsible for the life and health of his/her patients. However, there is no single standard regulating the responsibilities to provide emergency care to the child by the district pediatrician during home visit, and the volume of this care has not been established. Urgent conditions require immediate medical care right when they are detected by a paediatrician on call, until an ambulance team arrives. In conclusion, the authors determined that the creation of unified algorithms for emergency medical care to be provided by a paediatrician on call encompasses a number of medical, ethical and legal aspects. The development of this document is certainly a necessity and requires a balanced, judicious approach.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"55 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135975014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Celiac disease is a chronic gluten-induced autoimmune enteropathy in genetically predisposed individuals with specific HLA genotypes carrying the DQ2 (DQA1*0501 and DQB1*0201) or DQ8 (DQA1*0301 and DQB1*0302) alleles. The overall global prevalence of celiac disease is 0.7–1.4%. The increase in the incidence rate is associated with significant consumption of gluten over the last century, which has a peculiar effect on the small intestine mucosa. Atrophic processes in the intestine mucosa contribute to malabsorption and development of gluten-dependent clinical symptoms, however, the manifestation of the disease can occur at any age. The small intestine disease with the development of hyper-regenerative atrophy of the small intestine mucosa is recognized as a systemic disease accompanied by various deficiency conditions both with and without atrophy of the small intestine mucosa. Long-term adherence to a gluten-free diet entails certain deficiency conditions, such as vitamins B, vitamin D, calcium, iron, and folic acid deficiencies, as well as a decrease in body mass index. To ensure adequate nutritional intake, patients with celiac disease require additional resources, namely specialized dietary nutrition products. The issues of understanding the need for enteral nutrition in the management of patients with celiac disease are stressed. The article presents a clinical observation of the nutritional support for a female patient with a typical course of celiac disease, grade 2 protein-energy malnutrition, which demonstrated that the use of specialized food products as additional nutrition can significantly improve the nutritional status and somatometric indicators in a patient with celiac disease on a gluten-free diet.
{"title":"Is a gluten-free diet enough to treat celiac disease?","authors":"L. S. Oreshko, Z. M. Tskhovrebova","doi":"10.21518/ms2023-383","DOIUrl":"https://doi.org/10.21518/ms2023-383","url":null,"abstract":"Celiac disease is a chronic gluten-induced autoimmune enteropathy in genetically predisposed individuals with specific HLA genotypes carrying the DQ2 (DQA1*0501 and DQB1*0201) or DQ8 (DQA1*0301 and DQB1*0302) alleles. The overall global prevalence of celiac disease is 0.7–1.4%. The increase in the incidence rate is associated with significant consumption of gluten over the last century, which has a peculiar effect on the small intestine mucosa. Atrophic processes in the intestine mucosa contribute to malabsorption and development of gluten-dependent clinical symptoms, however, the manifestation of the disease can occur at any age. The small intestine disease with the development of hyper-regenerative atrophy of the small intestine mucosa is recognized as a systemic disease accompanied by various deficiency conditions both with and without atrophy of the small intestine mucosa. Long-term adherence to a gluten-free diet entails certain deficiency conditions, such as vitamins B, vitamin D, calcium, iron, and folic acid deficiencies, as well as a decrease in body mass index. To ensure adequate nutritional intake, patients with celiac disease require additional resources, namely specialized dietary nutrition products. The issues of understanding the need for enteral nutrition in the management of patients with celiac disease are stressed. The article presents a clinical observation of the nutritional support for a female patient with a typical course of celiac disease, grade 2 protein-energy malnutrition, which demonstrated that the use of specialized food products as additional nutrition can significantly improve the nutritional status and somatometric indicators in a patient with celiac disease on a gluten-free diet.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"54 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135976137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Irritable bowel syndrome (IBS) is an important social problem, since it is often diagnosed in people of young working age, significantly affects the quality of life of patients and causes economic damage to society. IBS is a chronic functional bowel disease, the main manifestation of which is pain combined with changes in bowel movements, frequency and character of stool. The mechanism of formation of abdominal pain syndrome is due to a disruption in the interaction along the brain-gut axis, which leads to changes in the regulation of intestinal motor function and the development of visceral hypersensitivity (VH). Abdominal pain as a manifestation of IBS is primarily associated with spasm of intestinal smooth muscles. The first-line drugs for pain relief are antispasmodics, which reduce the tone and contractility of intestinal smooth muscles, effectively coping with abdominal pain. The domestic pharmaceutical market is represented by different groups of muscle relaxants, among which calcium channel blockers are of particular relevance for patients with IBS. Representative of the latter is the drug Otilonium bromide, which is widely used throughout the world, is effective and safe, well tolerated and superior to placebo in reducing symptoms and preventing relapse of pain in patients with IBS. The effectiveness of otilonium bromide is due to a triple mechanism of action: blockade of calcium channels (relief of spasm), antagonism of tachykinone NK2 receptors (effect on HHV) and inhibition of acetylcholine muscarinic receptors (M3-ChR) (reduction of intestinal secretion). This article presents a short review of the literature on the causes and mechanism of development of pain in IBS, as well as the possibilities of its relief, primarily with the use of smooth muscle relaxants, namely otilonium bromide.
{"title":"Abdominal pain syndrome in patients with irritable bowel syndrome: features of selection of therapy","authors":"I. G. Pakhomova","doi":"10.21518/ms2023-360","DOIUrl":"https://doi.org/10.21518/ms2023-360","url":null,"abstract":"Irritable bowel syndrome (IBS) is an important social problem, since it is often diagnosed in people of young working age, significantly affects the quality of life of patients and causes economic damage to society. IBS is a chronic functional bowel disease, the main manifestation of which is pain combined with changes in bowel movements, frequency and character of stool. The mechanism of formation of abdominal pain syndrome is due to a disruption in the interaction along the brain-gut axis, which leads to changes in the regulation of intestinal motor function and the development of visceral hypersensitivity (VH). Abdominal pain as a manifestation of IBS is primarily associated with spasm of intestinal smooth muscles. The first-line drugs for pain relief are antispasmodics, which reduce the tone and contractility of intestinal smooth muscles, effectively coping with abdominal pain. The domestic pharmaceutical market is represented by different groups of muscle relaxants, among which calcium channel blockers are of particular relevance for patients with IBS. Representative of the latter is the drug Otilonium bromide, which is widely used throughout the world, is effective and safe, well tolerated and superior to placebo in reducing symptoms and preventing relapse of pain in patients with IBS. The effectiveness of otilonium bromide is due to a triple mechanism of action: blockade of calcium channels (relief of spasm), antagonism of tachykinone NK2 receptors (effect on HHV) and inhibition of acetylcholine muscarinic receptors (M3-ChR) (reduction of intestinal secretion). This article presents a short review of the literature on the causes and mechanism of development of pain in IBS, as well as the possibilities of its relief, primarily with the use of smooth muscle relaxants, namely otilonium bromide.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"54 7","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135976140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. V. Shubina, S. Yu. Tereshchenko, N. N. Gorbacheva, E. N. Anisimova
Introduction. It is known that the presence of the CagA gene in Helicobacter pylori is associated with its increased pathogenicity. However, in children, studies on the effects of this strain on the gastric mucosa are insufficient. Aim. To compare effects of different Helicobacter pylori (HP) strains on the gastric and duodenum mucosa in children to optimize indications for eradication. Materials and methods. 397 adolescents (169 boys and 227 girls) aged 11–18 were examined on the basis of the hospital gastroenterological department: the content of antibodies to the CagA strain of HP was determined by ELISA, esophagogastroduodenoscopy (EFGDS) was performedwith a biopsy of the gastric mucosa and determination of the HP contamination degree, and also HP gene was detected in the feces.According to the results obtained, all children were divided into 3 groups: 131 children (57 boys and 74 girls) infected with CagA by negative HP strains (CagA “-”); 119 children (52 boys and 67 girls) infected with CagA positive HP strains (CagA “+”); 94 children (36 boys and 57 girls) who are not infected with HP (HP “-”). Results. When we analyzed the endoscopic-histological picture of the gastric mucosa in the CagA “+” group, in contrast to the CagA “-” group, it was found that the chances of developing highbacteria contamination of the mucosa increased 4.7 times, II and III degree of gastritis activity – 6.6 times, chronic inflammation – 2.6 times, hyperplastic gastritis – 2.8 times, erosive gastritis or duodenitis – 2.7 times, peptic ulcer – 3.6 times, andalso signs of concomitant candidiasis (the presence of structural elements of the Candida fungus) – 4.1 times. Conclusion. Thus, it is advisable for all children with gastroduodenal pathology to recommend an examination for the detection of the CagA HP antigen with subsequent eradication.
{"title":"Еndoscopic and histological features of the gastroduodenal zone in children with the CagA Helicobacter pylori infection","authors":"M. V. Shubina, S. Yu. Tereshchenko, N. N. Gorbacheva, E. N. Anisimova","doi":"10.21518/ms2023-275","DOIUrl":"https://doi.org/10.21518/ms2023-275","url":null,"abstract":"Introduction. It is known that the presence of the CagA gene in Helicobacter pylori is associated with its increased pathogenicity. However, in children, studies on the effects of this strain on the gastric mucosa are insufficient. Aim. To compare effects of different Helicobacter pylori (HP) strains on the gastric and duodenum mucosa in children to optimize indications for eradication. Materials and methods. 397 adolescents (169 boys and 227 girls) aged 11–18 were examined on the basis of the hospital gastroenterological department: the content of antibodies to the CagA strain of HP was determined by ELISA, esophagogastroduodenoscopy (EFGDS) was performedwith a biopsy of the gastric mucosa and determination of the HP contamination degree, and also HP gene was detected in the feces.According to the results obtained, all children were divided into 3 groups: 131 children (57 boys and 74 girls) infected with CagA by negative HP strains (CagA “-”); 119 children (52 boys and 67 girls) infected with CagA positive HP strains (CagA “+”); 94 children (36 boys and 57 girls) who are not infected with HP (HP “-”). Results. When we analyzed the endoscopic-histological picture of the gastric mucosa in the CagA “+” group, in contrast to the CagA “-” group, it was found that the chances of developing highbacteria contamination of the mucosa increased 4.7 times, II and III degree of gastritis activity – 6.6 times, chronic inflammation – 2.6 times, hyperplastic gastritis – 2.8 times, erosive gastritis or duodenitis – 2.7 times, peptic ulcer – 3.6 times, andalso signs of concomitant candidiasis (the presence of structural elements of the Candida fungus) – 4.1 times. Conclusion. Thus, it is advisable for all children with gastroduodenal pathology to recommend an examination for the detection of the CagA HP antigen with subsequent eradication.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"55 7","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135975011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Functional dyspepsia, affecting up to 20% of individuals worldwide, remains both a cause of decreased activity of patients’ daily life and an obvious economic burden due to healthcare costs. Despite extensive research, the etiology of dyspepsia is unknown in most patients. Intestinal motility dysfunction has long been considered the major culprit, but recent studies suggest that immune pathophysiological and molecular effects in the duodenum are far more likely predisposing factors. Eosinophilia and an increase in mast cells in both the duodenum and gastric mucosa are identified in most patients with this disease. More and more data on the significant role of impaired paracellular permeability of the intestinal mucosa are now available. It is associated with subclinical inflammation in the submucosal layer in patients with functional dyspepsia. This explains the poor effectiveness of the treatments taken. The evidence from practice suggests that symptoms persist or return after eradication therapy in most patients. Proton pump inhibitors and antidepressants do not ease postprandial distress syndrome. Montelukast and cromolyn therapy has been proposed, but this approach is not yet widely popular. Therefore, there is an obvious need in finding other therapeutic approaches. One of them is the increased use of prokinetics, the most recent of which is acotiamide. Its mechanism of action is similar to that of prior generation prokinetics (inhibition of acetylcholinesterase activity), but is distinguished by the absence of impact on dopaminergy, due to which the drug has far fewer side effects. In addition, its effect on the production of ghrelin, which physiological role is being actively studied, is discussed.
{"title":"Functional dyspepsia: modern pathogenetic aspects and therapeutic approaches","authors":"I. V. Egorov","doi":"10.21518/ms2023-300","DOIUrl":"https://doi.org/10.21518/ms2023-300","url":null,"abstract":"Functional dyspepsia, affecting up to 20% of individuals worldwide, remains both a cause of decreased activity of patients’ daily life and an obvious economic burden due to healthcare costs. Despite extensive research, the etiology of dyspepsia is unknown in most patients. Intestinal motility dysfunction has long been considered the major culprit, but recent studies suggest that immune pathophysiological and molecular effects in the duodenum are far more likely predisposing factors. Eosinophilia and an increase in mast cells in both the duodenum and gastric mucosa are identified in most patients with this disease. More and more data on the significant role of impaired paracellular permeability of the intestinal mucosa are now available. It is associated with subclinical inflammation in the submucosal layer in patients with functional dyspepsia. This explains the poor effectiveness of the treatments taken. The evidence from practice suggests that symptoms persist or return after eradication therapy in most patients. Proton pump inhibitors and antidepressants do not ease postprandial distress syndrome. Montelukast and cromolyn therapy has been proposed, but this approach is not yet widely popular. Therefore, there is an obvious need in finding other therapeutic approaches. One of them is the increased use of prokinetics, the most recent of which is acotiamide. Its mechanism of action is similar to that of prior generation prokinetics (inhibition of acetylcholinesterase activity), but is distinguished by the absence of impact on dopaminergy, due to which the drug has far fewer side effects. In addition, its effect on the production of ghrelin, which physiological role is being actively studied, is discussed.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"55 5‐6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135975012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. E. Zhiltsova, E. A. Egorova, A. R. Surova, D. S. Tarakanova, A. E. Filchkova
The article presents the pathogenetic features of dermatitis in children of the first year of life, features of the clinical picture and approaches to therapy. Contact dermatitis is a fairly common pathology in young children. Previously, it was believed that the clinical manifestations in this group of children were mainly associated with simple contact dermatitis (SCD), but in recent years, studies have shown that contact sensibilization is quite common, and currently the diagnosis of allergic contact dermatitis (ACD) is not uncommon, but timely anti-inflammatory therapy prevents the formation of a focus of chronic inflammation. The prevalence of SCD and ACD in children of the first year of life, as well as the severity of skin inflammation, is associated with the existing structural features of the skin. Changes in the structures of the epidermis and dermis, characteristic of this age period, lead to easier skin damage when exposed to various irritants, both mechanical and chemical in nature, and the penetration of allergens into the skin. The peculiarity of the structure of blood vessels and increased vascular permeability is an important factor in the development and longer existence of local inflammation. The main condition for the effectiveness of treatment of dermatitis is the cessation of exposure to the substances that caused their development, and the main means of treating these conditions are topical glucocorticosteroids (TGCS). The article discusses cases of SCD and ACD in children of the first year of life, in which methylprednisolone aceponate in the form of 0.1% cream was used for external therapy. The choice in favor of this TGCS was made due to the absence of halogens in the methylprednisolone aceponate formula, the possibility of use from 4 months of age and in sensitive areas. During treatment, all patients had a good clinical effect and no side effects. The use of methylprednisolone aceponate in the form of 0.1% cream for SCD and ACD in children of the first year of life is a highly effective and safe remedy.
{"title":"Issues of pathogenesis and treatment of contact dermatitis in children of the first year of life","authors":"E. E. Zhiltsova, E. A. Egorova, A. R. Surova, D. S. Tarakanova, A. E. Filchkova","doi":"10.21518/ms2023-353","DOIUrl":"https://doi.org/10.21518/ms2023-353","url":null,"abstract":"The article presents the pathogenetic features of dermatitis in children of the first year of life, features of the clinical picture and approaches to therapy. Contact dermatitis is a fairly common pathology in young children. Previously, it was believed that the clinical manifestations in this group of children were mainly associated with simple contact dermatitis (SCD), but in recent years, studies have shown that contact sensibilization is quite common, and currently the diagnosis of allergic contact dermatitis (ACD) is not uncommon, but timely anti-inflammatory therapy prevents the formation of a focus of chronic inflammation. The prevalence of SCD and ACD in children of the first year of life, as well as the severity of skin inflammation, is associated with the existing structural features of the skin. Changes in the structures of the epidermis and dermis, characteristic of this age period, lead to easier skin damage when exposed to various irritants, both mechanical and chemical in nature, and the penetration of allergens into the skin. The peculiarity of the structure of blood vessels and increased vascular permeability is an important factor in the development and longer existence of local inflammation. The main condition for the effectiveness of treatment of dermatitis is the cessation of exposure to the substances that caused their development, and the main means of treating these conditions are topical glucocorticosteroids (TGCS). The article discusses cases of SCD and ACD in children of the first year of life, in which methylprednisolone aceponate in the form of 0.1% cream was used for external therapy. The choice in favor of this TGCS was made due to the absence of halogens in the methylprednisolone aceponate formula, the possibility of use from 4 months of age and in sensitive areas. During treatment, all patients had a good clinical effect and no side effects. The use of methylprednisolone aceponate in the form of 0.1% cream for SCD and ACD in children of the first year of life is a highly effective and safe remedy.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"2 3-4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135509588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. I. Nechaeva, A. N. Dakuko, E. N. Loginova, I. V. Bogatyrev
Introduction. Connective tissue is highly organized system, its disorders are characterized by a pronounced polymorphism of morphological and clinical manifestations. The cardiovascular pathology in patients with nonspecific connective tissue disorder attracts attention due to the high risk of complications: rhythm and conduction disorders, infective endocarditis, vascular thromboembolism and sudden cardiac death. Therefore, it’s very important to use up-to-date equipment and methods of early diagnosis of a high risk of fatal events in young. Aim. To investigate the structural features of the heart and their relationship with the process of myocardial remodeling in children with arrhythmic syndrome and nonspecific connective tissue disorder. Materials and methods. Sixty-five children were examined, 40 of them had arrhythmic syndrome in combination with nonspecific connective tissue disorder, and 25 had only minimal manifestations of nonspecific connective tissue disorder without arrhythmic syndrome. Such up-to-date methods as assessment of myocardial remodeling and longitudinal strain, natriuretic peptide assessment were included in the diagnostic algorithm. Results and discussion. The study showed a variety of phenotypic and visceral markers of nonspecific connective tissue disorder in children with arrhythmic syndrome. Arrhythmic syndrome was manifested by monotopic and heterotopic heart rhythm disorders, and structural changes of the heart: mitral valve prolapse and myocardial wall thinning were correlated with a more frequent increase in natriuretic peptide. Speckle-tracking echocardiography showed a significant decrease in longitudinal myocardial strain with predominance of myocardial strain in the anterior basal segment in children with arrhythmic syndrome. Conclusion. Our study showed a variety of phenotypic and visceral markers of undifferentiated connective tissue dysplasia in children with arrhythmic syndrome. The data obtained require further mathematical analysis and the establishment of a possible relationship between the external manifestations of the disease and cardiac rhythm and conduction disturbances.
{"title":"Structural features of the heart in children with arrhythmic syndrome due to nonspecific connective tissue disorder","authors":"G. I. Nechaeva, A. N. Dakuko, E. N. Loginova, I. V. Bogatyrev","doi":"10.21518/ms2023-359","DOIUrl":"https://doi.org/10.21518/ms2023-359","url":null,"abstract":"Introduction. Connective tissue is highly organized system, its disorders are characterized by a pronounced polymorphism of morphological and clinical manifestations. The cardiovascular pathology in patients with nonspecific connective tissue disorder attracts attention due to the high risk of complications: rhythm and conduction disorders, infective endocarditis, vascular thromboembolism and sudden cardiac death. Therefore, it’s very important to use up-to-date equipment and methods of early diagnosis of a high risk of fatal events in young. Aim. To investigate the structural features of the heart and their relationship with the process of myocardial remodeling in children with arrhythmic syndrome and nonspecific connective tissue disorder. Materials and methods. Sixty-five children were examined, 40 of them had arrhythmic syndrome in combination with nonspecific connective tissue disorder, and 25 had only minimal manifestations of nonspecific connective tissue disorder without arrhythmic syndrome. Such up-to-date methods as assessment of myocardial remodeling and longitudinal strain, natriuretic peptide assessment were included in the diagnostic algorithm. Results and discussion. The study showed a variety of phenotypic and visceral markers of nonspecific connective tissue disorder in children with arrhythmic syndrome. Arrhythmic syndrome was manifested by monotopic and heterotopic heart rhythm disorders, and structural changes of the heart: mitral valve prolapse and myocardial wall thinning were correlated with a more frequent increase in natriuretic peptide. Speckle-tracking echocardiography showed a significant decrease in longitudinal myocardial strain with predominance of myocardial strain in the anterior basal segment in children with arrhythmic syndrome. Conclusion. Our study showed a variety of phenotypic and visceral markers of undifferentiated connective tissue dysplasia in children with arrhythmic syndrome. The data obtained require further mathematical analysis and the establishment of a possible relationship between the external manifestations of the disease and cardiac rhythm and conduction disturbances.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"3 1-2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135509586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Irritable bowel syndrome (IBS) is one of the most common functional conditions among children and adults. At the basis of IBS, as well as other functional disorders of the digestive system, is the disorder of brain-gut-microbiota axis. In recent years, the latter has been given particular importance not only in post-infectious IBS, but also in classic stress-induced IBS. The intestinal microflora determines the state of the enteric nervous system, visceral sensitivity, intestinal motility. In addition, the intestinal microbiota interacts through the transmitters it produces with the central nervous system, which also affects intestinal motility and the state of the microflora. Updated guidelines for the diagnosis and treatment of IBS in children of the Russian Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists in the treatment section include psychotherapeutic correction, diet therapy and drug therapy. Correctors of intestinal motility (trimebutine), probiotics and antispasmodics have proven effectiveness. The efficacy and safety of use in IBS in children Lactobacillus rhamnosus GG , L. acidophilus LA5 , B. infantis , B. animalis , L. plantarum , L. casei , L. bulgaricus , Bifidobacterium lactis B В 12 , B. breve , B. longum , S. thermophilus , Saccharomyces boulardii CNCM I745. In this case, it is advisable to use multi-strain probiotics. Thus, the intestinal microbiota is directly involved in the pathogenesis of IBS, and the need for the use of probiotics as part of complex therapy is beyond doubt. Their effectiveness has been proven in many serious studies, which was the reason for their inclusion in practical recommendations for the treatment of IBS in children and adults.
肠易激综合征(IBS)是儿童和成人中最常见的功能疾病之一。肠易激综合征以及其他消化系统功能紊乱的基础是脑-肠-微生物群轴紊乱。近年来，后者不仅在感染后肠易激综合征中，而且在经典应激性肠易激综合征中也得到了特别的重视。肠道菌群决定了肠道神经系统的状态、内脏的敏感性、肠道的运动。此外，肠道微生物群通过其产生的递质与中枢神经系统相互作用，也影响肠道运动和微生物群的状态。俄罗斯儿科胃肠病学家、肝病学家和营养学家协会在治疗部分更新了儿童肠易激综合征的诊断和治疗指南，包括心理治疗矫正、饮食治疗和药物治疗。肠蠕动矫正剂(曲美布汀)、益生菌和抗痉挛药物已被证明有效。鼠李糖乳杆菌GG、嗜酸乳杆菌LA-5、婴儿乳杆菌、动物乳杆菌、植物乳杆菌、干酪乳杆菌、保加利亚乳杆菌、乳酸双歧杆菌B В -12、短芽孢杆菌、长芽孢杆菌、嗜热乳杆菌、博氏酵母菌CNCM I-745的疗效和安全性在这种情况下，建议使用多菌种益生菌。因此，肠道菌群直接参与IBS的发病机制，益生菌作为复杂治疗的一部分的必要性是毋庸置疑的。它们的有效性已在许多严肃的研究中得到证实，这就是它们被纳入儿童和成人肠易激综合征治疗实用建议的原因。
{"title":"Irritable bowel syndrome in children and intestinal microbiota: pathogenetic aspects and clinical guidelines","authors":"S. V. Belmer","doi":"10.21518/ms2023-299","DOIUrl":"https://doi.org/10.21518/ms2023-299","url":null,"abstract":"Irritable bowel syndrome (IBS) is one of the most common functional conditions among children and adults. At the basis of IBS, as well as other functional disorders of the digestive system, is the disorder of brain-gut-microbiota axis. In recent years, the latter has been given particular importance not only in post-infectious IBS, but also in classic stress-induced IBS. The intestinal microflora determines the state of the enteric nervous system, visceral sensitivity, intestinal motility. In addition, the intestinal microbiota interacts through the transmitters it produces with the central nervous system, which also affects intestinal motility and the state of the microflora. Updated guidelines for the diagnosis and treatment of IBS in children of the Russian Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists in the treatment section include psychotherapeutic correction, diet therapy and drug therapy. Correctors of intestinal motility (trimebutine), probiotics and antispasmodics have proven effectiveness. The efficacy and safety of use in IBS in children Lactobacillus rhamnosus GG , L. acidophilus LA5 , B. infantis , B. animalis , L. plantarum , L. casei , L. bulgaricus , Bifidobacterium lactis B В 12 , B. breve , B. longum , S. thermophilus , Saccharomyces boulardii CNCM I745. In this case, it is advisable to use multi-strain probiotics. Thus, the intestinal microbiota is directly involved in the pathogenesis of IBS, and the need for the use of probiotics as part of complex therapy is beyond doubt. Their effectiveness has been proven in many serious studies, which was the reason for their inclusion in practical recommendations for the treatment of IBS in children and adults.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"2 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135509589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The article discusses the problems of using products containing whole grains in the nutrition of young children. Among the most controversial are the issues of the optimal quantity and timing of inclusion of the whole grain component in baby food. The results of studies are presented confirming the effectiveness of including whole grains in children’s diets, as well as the level of their consumption in the world, demonstrating significant national differences (from 2 to 58 g per day). In general, despite the obvious benefits of whole grains, actual consumption of whole grains by children is not enough to realize their health potential. As one of the ways to solve the problem, the early inclusion of whole grains in the diet, starting from the first year of life, is considered. Aspects that limit the use of whole grains in nutrition are noted inconsistency in the identification of whole grain products and their sanitary and hygienic safety. Currently, both 30 and 50% have been proposed as the level of whole grain content in a product that allows it to be classified as whole grain. The issue of safety is especially relevant for baby food, since the outer layers of grains can concentrate contaminants (heavy metals, mycotoxins, arsenic, pesticides). It has been established that the arsenic content in whole rice products is higher than in refined analogues. In this regard, specialized baby food products have advantages for organizing nutrition for young children, the production of which involves special approaches to the selection of whole grain raw materials and technological processing modes to ensure the requirements for its quality and safety. Domestic and foreign documents regulating the requirements for safety indicators for specialized grain-based products for baby food are presented.
{"title":"Whole grain products in children nutrition","authors":"E. A. Pyrieva, A. I. Safronova, О. V. Georgieva","doi":"10.21518/ms2023-365","DOIUrl":"https://doi.org/10.21518/ms2023-365","url":null,"abstract":"The article discusses the problems of using products containing whole grains in the nutrition of young children. Among the most controversial are the issues of the optimal quantity and timing of inclusion of the whole grain component in baby food. The results of studies are presented confirming the effectiveness of including whole grains in children’s diets, as well as the level of their consumption in the world, demonstrating significant national differences (from 2 to 58 g per day). In general, despite the obvious benefits of whole grains, actual consumption of whole grains by children is not enough to realize their health potential. As one of the ways to solve the problem, the early inclusion of whole grains in the diet, starting from the first year of life, is considered. Aspects that limit the use of whole grains in nutrition are noted inconsistency in the identification of whole grain products and their sanitary and hygienic safety. Currently, both 30 and 50% have been proposed as the level of whole grain content in a product that allows it to be classified as whole grain. The issue of safety is especially relevant for baby food, since the outer layers of grains can concentrate contaminants (heavy metals, mycotoxins, arsenic, pesticides). It has been established that the arsenic content in whole rice products is higher than in refined analogues. In this regard, specialized baby food products have advantages for organizing nutrition for young children, the production of which involves special approaches to the selection of whole grain raw materials and technological processing modes to ensure the requirements for its quality and safety. Domestic and foreign documents regulating the requirements for safety indicators for specialized grain-based products for baby food are presented.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135509590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. S. Fedenko, I. N. Zakharova, O. V. Zaytseva, A. N. Pampura, O. B. Tamrazova
In February 2023, a meeting of the Council of Experts was held, attended by leading specialists in the fields of allergology, pediatrics and dermatology. The Working Group discussed the problem of sensitization to pollen allergens in patients with atopic dermatitis and exacerbation of the disease during the pollination season of plants, as well as the formation of epicutaneous sensitization through a damaged epidermal barrier. The experts comprehensively considered the criteria that a modern emollient used for the care of atopic dermatitis patients’ skin should meet, discussed the role of moisturizers in preventing seasonal exacerbations of atopic dermatitis based on previously conducted research, and developed unified recommendations on the principles of managing this type of patients. Suggestions were made for further informational and organizational measures aimed at expanding the knowledge of patients and medical specialists about the problem of epicutaneous sensitization to aeroallergens in atopic dermatitis patients, their role in the development of seasonal exacerbations of atopic dermatitis, and the possibility of their prevention using modern emollients.
{"title":"Practical issues of using emollients for the prevention of exacerbations of atopic dermatitis during the flowering season: expert resolution","authors":"E. S. Fedenko, I. N. Zakharova, O. V. Zaytseva, A. N. Pampura, O. B. Tamrazova","doi":"10.21518/ms2023-364","DOIUrl":"https://doi.org/10.21518/ms2023-364","url":null,"abstract":"In February 2023, a meeting of the Council of Experts was held, attended by leading specialists in the fields of allergology, pediatrics and dermatology. The Working Group discussed the problem of sensitization to pollen allergens in patients with atopic dermatitis and exacerbation of the disease during the pollination season of plants, as well as the formation of epicutaneous sensitization through a damaged epidermal barrier. The experts comprehensively considered the criteria that a modern emollient used for the care of atopic dermatitis patients’ skin should meet, discussed the role of moisturizers in preventing seasonal exacerbations of atopic dermatitis based on previously conducted research, and developed unified recommendations on the principles of managing this type of patients. Suggestions were made for further informational and organizational measures aimed at expanding the knowledge of patients and medical specialists about the problem of epicutaneous sensitization to aeroallergens in atopic dermatitis patients, their role in the development of seasonal exacerbations of atopic dermatitis, and the possibility of their prevention using modern emollients.","PeriodicalId":36137,"journal":{"name":"Meditsinskiy Sovet","volume":"3 3-4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135509585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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